Borderline Patients: Extending the Limits of Treatability

Borderline Patients: Extending the Limits of Treatability

Borderline Patients: Extending the Limits of Treatability

Borderline Patients: Extending the Limits of Treatability

Synopsis

Borderline conditions are a growing presence in the treatment room, yet they are uncommonly resistant to treatment. Dr. Kernberg and his colleagues have already articulated the modality they call Transference-Focused Psychotherapy. Now, in an unusually textured elaboration, they confront the complications that limit treatability -- co-existing psychopathologies, early trauma/dissociation, problems endemic to the therapeutic situation (attachment disturbances, erotic transferences) -- and bring new rounds of clinical ammunition to meet those challenges.

Excerpt

The goal of this book, which builds on our previous work on the treatment of borderline patients, is to delineate an approach for some of the more difficult situations encountered by therapists who work with these patients. It is an outgrowth of our systematic articulation of a psychodynamic psychotherapy for borderline patients, an approach that derives from an ego psychology and object relations model. We have identified the sources of a number of impediments that arise all too often: an inability to establish more than a tenuous treatment relationship in the first place; entrenched interpersonal patterns that surface once treatment is under way; the complicating effect of common comorbid conditions such as depression. It is our hope that some of the perspectives and tactics we present here can broaden the range of borderline patients who benefit from treatment.

We codified the principles and practice of transference-focused psychotherapy (TFP)--a form of psychodynamic psychotherapy tailored to the treatment of borderline patients--in our first work, Psychodynamic Psychotherapy of Borderline Patients (Kernberg, Selzer, Koenigsberg, Carr, and Appelbaum 1989), and developed them further in a work informed by the study of recorded research cases as part of a National Institute of Mental Health (NIMH) treatment development grant, Psychotherapy for Borderline Personality (Clarkin, Yeomans, and Kernberg 1999). We have also described in detail the contract-setting phase of TFP, in Treating the Borderline Patient (Yeomans, Selzer, and Clarkin 1992). We have always sought to strike a balance between an operationalized description of treatment that could be communicated in the most clinically accessible fashion (and the most uniform for research purposes) and an approach that does justice to the individual differences among patients, to their individual defensive and coping styles, and to the diversity of emotionally pressing concerns each patient brings to each hour.

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