Psychoanalytic Books: Reviews and Discussions. A Primer of Transference-Focused Psychotherapy for the Borderline Patient, by Frank E. Yeomans, John F. Clarkin, and Otto F. Kernberg. Northvale, NJ: Jason Aronson, 2002, 304 pages, $50.00

The clinical and technical difficulties presented by patients with personality disorders are well documented. This article focuses on the challenges faced by therapists when managing their emotional reactions, that is, their countertransferences, to patients with personality disorders. While leaving room for therapists' unique and idiosyncratic countertransferences to the patient with personality pathology, Kernberg emphasized the role of a more general form of countertransference, one reflective largely of the patient's conflicts and defenses, in the treatments of personality disordered individuals. Here, the nature of the patient's internal and external functioning can be seen to lead to similar reactions among different therapists, opening the possibility of utilizing countertransference to better understand the patient's difficulties. In transference-focused psychotherapy (TFP), countertransferences arising in the patient–therapist interaction are first identified and contained by the therapist and then utilized to clarify and explore how the patient's internal object relations are being enacted in the clinical process. This article describes this process and how TFP therapists work with their countertransference to help illuminate the patient's split representational world, paving the way for interpretation and integration.

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Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N)

Psychodynamic Psychiatry ◽

10.1521/pdps.2021.49.2.244 ◽

2021 ◽

Vol 49 (2) ◽

pp. 244-272

Author(s):

Diana Diamond ◽

Frank Yeomans ◽

John R. Keefe

Keyword(s):

Personality Disorder ◽

Sense Of Self ◽

Assessment Process ◽

Narcissistic Personality Disorder ◽

Object Relations Theory ◽

Pathological Narcissism ◽

Personality Functioning ◽

Therapeutic Interaction ◽

Narcissistic Personality ◽

Transference Focused Psychotherapy

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.

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