Article

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy

Cornell University, Итак, New York, United States
Journal of Clinical Psychology (Impact Factor: 2.12). 04/2006; 62(4):481-501. DOI: 10.1002/jclp.20239
Source: PubMed

ABSTRACT

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.

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    • "Downloaded from destabilized. Research has shown this treatment to benefit clients with BPD more in terms of reflective functioning and narrative coherence (Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Levy et al., 2006;). "
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    ABSTRACT: This qualitative case study explored one client's recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and "moving into the world" was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts.
    Full-text · Article · Dec 2015 · Qualitative Health Research
    • "These effects were maintained at 1-year follow-up (Vermote et al., 2009, 2010). In line with other studies concerning the effect of psychodynamic treatment of patients with severe PD (e.g., Chiesa & Fonagy, 2003; Fonagy & Bateman, 2006; Levy et al., 2006), elsewhere we have demonstrated a positive association between change in self and object representations, felt safety, and mentalization, and change in symptomatic distress, personality functioning, and interpersonal functioning (Vermote, 2005; Vermote et al., 2010). "
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    ABSTRACT: This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self-object relations. Based upon this model a hospitalization-based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation-Relatedness Scale. A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre-treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5-year follow-up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning. Copyright © 2015 Institute of Psychoanalysis.
    No preview · Article · Jun 2015 · The International Journal of Psychoanalysis
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    • "Again, this is not an exhaustive list of possible therapeutic actions for dynamic therapy, but is an enumeration of those with operationalized measures and empirical tests. We should also note that changes in attachment style (a construct arising out of analytic theory, but adopted by clinical psychology more broadly) have also been found to result from psychodynamic treatment (Levy et al., 2006). "
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    ABSTRACT: Objective and method: Two psychodynamic therapists and researchers from different generations reflected upon the past and present state of psychodynamic therapy research as well as possibilities for the future. Results and conclusions: Several issues (e.g., decreased research funding, increased medicalization of mental health problems, and declining psychodynamic representation among research faculty) were identified as potential impediments for future high-quality research. In addition to encouraging the field to face these challenges directly, a number of specific recommendations were provided. These included not only suggestions for traditional process and outcome research, but also recommendations to modify our current assessment practices, improve our field's cohesiveness, increase our public visibility, and improve relationships with our non-psychodynamic colleagues. In is argued that, if the field confronts these many challenges in a creative and flexible manner, psychodynamic therapy research will not only continue to be relevant, but will also thrive.
    Full-text · Article · Jan 2015 · Psychotherapy Research
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Questions & Answers about this publication

  • Marta Andralojc added an answer in Borderline Personality Disorder:
    Does anyone have experience with Borderline Personality Disorder treatment options?

    Most therapists, mental health agencies, consider BPD untreatable.  I choose to believe that all things are possible.  Can anyone lead me to research in this area?

    Marta Andralojc

    Actually, the psychodynamic therapy for severe personality disorders is called the Transference-Focused Psychotherapy (TFP). It is manualized and evidence-based. If interested, you can read more here at RG:

    http://www.researchgate.net/profile/Kenneth_Levy/publication/51373386_The_mechanisms_of_change_in_the_treatment_of_borderline_personality_disorder_with_transference_focused_psychotherapy/links/09e4150815baa2183b000000.pdf

    Or here:

    http://drfrankyeomans.com/assets/ijp_046.pdf 

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      [Show abstract] [Hide abstract]
      ABSTRACT: We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.
      Full-text · Article · Apr 2006 · Journal of Clinical Psychology