scholarly journals Managing the clinical encounter with patients with borderline personality disorder in a general psychiatry setting: key contributions from transference-focused psychotherapy

2018 ◽  
Vol 25 (4) ◽  
pp. 229-236 ◽  
Author(s):  
Tennyson Lee ◽  
Richard G. Hersh
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Object Relations ◽  
Clinical Encounter ◽  
Borderline Personality ◽  
List Type ◽  
Object Relations Theory ◽  
General Psychiatry ◽  
Treatment Contract ◽  
Transference Focused Psychotherapy

SUMMARYThis article describes how the core principles and techniques of transference-focused psychotherapy (TFP) can be used in general psychiatry to help in the management of patients with borderline personality disorder (or other moderate to severe personality disorders). It focuses on: knowledge – appreciating how an understanding of object relations assists the clinician in assessment and treatment; attitude – developing a stance to manage the confusing and negative feelings that may arise in both clinician and patient; and skills – describing how use of TFP techniques (technical neutrality, analysing the transference and countertransference, and judicious use of interpretation) helps the clinician to continue thinking in the fraught clinical encounter. The structural (including contemporary object relations) and structured approach in TFP are exemplified in clinical vignettes.LEARNING OBJECTIVESAfter reading this article you will be able to: •Apply an understanding of object relations theory to interactions with patients with Borderline Personality Disorder (BPD)•Describe the use of the treatment contract and technical neutrality•Understand and better manage the countertransference in working with patients with BPDDECLARATION OF INTERESTNone.

An object relations perspective on borderline personality

2002 ◽  
Vol 14 (2) ◽  
pp. 76-80 ◽  
Author(s):  
F. E. Yeomans ◽  
K. N. Levy
Keyword(s):  
Clinical Practice ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Cognitive Science ◽  
Object Relations ◽  
Empirical Research ◽  
Developmental Psychology ◽  
Empirical Studies ◽  
Borderline Personality ◽  
Object Relations Theory

One of the principal formulations of borderline personality disorder is based on object relations theory, a component of psychoanalytic theory. To remain relevant, psychoanalytic formulations must find support from empirical research. After summarizing the object relations understanding of borderline personality, the authors review studies in biological neuroscience, developmental psychology and cognitive science related to the fundamental concepts of object relations theory as it aplies to borderline pathology. This review suggests that these empirical studies support psychoanalytic formulations originally derived from clinical practice and observation.

Psychotherapy for Borderline Personality Disorder

2018 ◽  
Author(s):  
David Grunwald ◽  
Erica Robinson ◽  
Sarah Fineberg
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavioral Therapy ◽  
Supportive Therapy ◽  
Borderline Personality ◽  
Funding Sources ◽  
Study Intervention ◽  
Transference Focused Psychotherapy ◽  
Landmark Study

This chapter provides a summary of a landmark study on borderline personality disorder. How does transference-focused psychotherapy, supportive therapy, and dialectical behavioral therapy compare in the treatment of borderline personality disorder? Starting with that question, the chapter describes the basics of this study, including funding sources, study location, who was studied, and how many patients participated in the study. The study design is described, as well as the study intervention, follow-up, endpoints, results, and finally a discussion of criticisms and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Staff attitudes towards patients with borderline personality disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1010-1010
Author(s):  
E. Bodner ◽  
S. Cohen-Fridel ◽  
I. Ianco
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Professionals ◽  
Negative Emotions ◽  
Borderline Personality ◽  
List Type ◽  
Staff Attitudes ◽  
Community Settings ◽  
Common Diagnosis ◽  
Level Of Agreement

IntroductionBDP is a common diagnosis in hospitals and community settings, estimated at 20% and 11%, respectively. Nevertheless, the attitudes and skills of all mental health professionals regarding the treatment of these patients had hardly been studied.ObjectivesDevelop tools and use them to understand staff attitudes towards BDP patients.Aims(1)To develop two inventories for the measurement of cognitive and emotional attitudes towards borderline personality disorder (BPD) patients and their treatment;(2)To use these tools to understand and compare attitudes of psychiatrists, psychologists and nurses toward BPD patients.MethodTwo lists of items referring to cognitive and emotional attitudes towards BPD patients were formulated. Nurses, psychologists and psychiatrist (n = 57), working in public psychiatric institutions rated their level of agreement with each item. Both lists of attitudes yielded three factors (cognitive: required treatment, suicidal tendencies, and antagonistic judgment, and emotional: negative emotions, experienced difficulties in treatment, and empathy, respectively).ResultsPsychologists scored lower than psychiatrists and nurses on antagonistic judgments. Nurses scored lower than psychiatrists and psychologists on empathy. Regression stepwise analyses on the three emotional attitudes separately showed that suicidal tendencies of BPD patients mainly explained negative emotions and difficulties in treating these patients. All groups were interested in learning more about the treatment of these patients.ConclusionsSuicidal tendencies of BPD patients provoke antagonistic judgments among the three professions. Psychiatrists, psychologists and nurses hold distinctive cognitive and emotional attitudes towards these patients. Staff training programs regarding BDP patients should consider these differences and concerns.

scholarly journals Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial

2010 ◽  
Vol 196 (5) ◽  
pp. 389-395 ◽  
Author(s):  
Stephan Doering ◽  
Susanne Hörz ◽  
Michael Rentrop ◽  
Melitta Fischer-Kern ◽  
Peter Schuster ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Randomised Controlled Trial ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Controlled Trial ◽  
Borderline Personality ◽  
Patient Treatment ◽  
Significant Group ◽  
Randomised Controlled ◽  
Transference Focused Psychotherapy

BackgroundTransference-focused psychotherapy is a manualised treatment for borderline personality disorder.AimsTo compare transference-focused psychotherapy with treatment by experienced community psychotherapists.MethodIn a randomised controlled trial (NCT00714311) 104 female out-patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist.ResultsSignificantly fewer participants dropped out of the transference-focused psychotherapy group (38.5% v. 67.3%) and also significantly fewer attempted suicide (d = 0.8, P = 0.009). Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology (d = 1.6, P = 0.001), psychosocial functioning (d = 1.0, P = 0.002), personality organisation (d = 1.0, P = 0.001) and psychiatric in-patient admissions (d = 0.5, P = 0.001). Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology, all without significant group differences (d = 0.3–0.5). Self-harming behaviour did not change in either group.ConclusionsTransference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology, psychosocial functioning, and personality organisation. Moreover, there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment.

The unified protocol for anxiety and depression with comorbid borderline personality disorder: a single case design clinical series

2019 ◽  
Vol 12 ◽  
Author(s):  
Michelle E. Lopez ◽  
Steven R. Thorp ◽  
Matthew Dekker ◽  
Andrew Noorollah ◽  
Giovanna Zerbi ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotional Disorders ◽  
Single Case ◽  
Borderline Personality ◽  
Anxiety And Depression ◽  
Individual Treatment ◽  
List Type ◽  
Unified Protocol ◽  
Clinical Series

AbstractThis study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.Key learning aims (1)To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.(2)To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.(3)To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.

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