While all patients become more concrete in their psychological functioning in areas of conflict, especially in the setting of transference regression, in the treatment of patients with severe personality pathology this process poses a particular clinical challenge. In the psychoanalytic psychotherapy of patients with severe personality pathology in general, and borderline personality disorder in particular, the interpretive process serves multiple functions. This process comprises a series of steps or phases that can be viewed as moving the patient further away from a single, poorly elaborated, and concrete experience in the transference, which dominates and floods subjectivity, and toward more fully elaborated, complex, stable, and integrated representations of the analyst and of what he or she evokes in the patient's internal world.
References
1.
Abend, S.M., Porder, M.S., & Willick, M.A. (1968). Borderline Patients: Psychoanalytic Perspectives . New York: International Universities Press.
2.
Appelbaum, A.H. (2006). Supportive psychoanalytic psychotherapy for borderline patients: An empirical approach. American Journal of Psychoanalysis66:317-332.
3.
Balint, M. (1979). The Basic Fault. London: Tavistock Publications.
4.
Bateman, A., & Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial . American Journal of Psychiatry156:1563-1569.
5.
--- --- (2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: An 18-month follow-up . American Journal of Psychiatry158:36-42.
6.
--- --- (2004). Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. New York: Oxford University Press.
7.
--- --- (2008). Eight-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual . American Journal of Psychiatry165:1-7.
8.
Bion, W.R. (1962a). A theory of thinking. International Journal of Psychoanalysis43:306-310.
9.
--- ( 1962b). Learning from Experience. London : Heinemann.
10.
--- ( 1967). Second Thoughts. London: Heinemann.
11.
Bender, D.S., Dolan, R.T., Skodol, A.E., Sanislow, C.A., Dyck, R.T., Mcglashan, T.H., Shea, M.T., Zanarni, M.C., Oldham, J.M., & Gunderson, J.G. (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry158:295-302.
12.
Bromberg, P. (1998). Standing in the Spaces. Hillsdale, NJ: Analytic Press.
13.
Caligor, E., Kernberg, O.F., & Clarkin, J.F. (2007). Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology. Washington, DC: American Psychiatric Publishing.
14.
Clarkin, J.P., Foelsch, P.A., Levy, K.N., Hull, J.W., Delaney, J.C., & Kernberg, O.F. (2001). The development of a psychoanalytic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders15:487-495.
15.
--- Levy, K.N., Lenzenweger, M.F., & Kernberg, O.F. (2004). The Personality Disorders Institute / Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: Rationale, methods, and patient characteristics. Journal of Personality Disorders18:52-72.
16.
--- --- --- --- (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry164:1-8.
17.
--- Yeomans, F.E., & Kernberg, O.F. (1999). Transference-Focused Psychodynamic Therapy for Borderline Personality Disorder Patients. New York: Wiley.
18.
--- --- --- (2006). Psychotherapy of Borderline Personality: Focusing on Object Relations. Washington, DC: American Psychiatric Publishing.
19.
Diamond, D., Yeomans, F., Clarkin, J.F., & Levy, K.N. (2008). The reciprocal impact of attachment and transference-focused psychotherapy with borderline patients. In The Adult Attachment Interview in Clinical Context, ed. H. Steele & M. Steele.New York: Guilford Press, pp. 339-385.
20.
Fonagy, P. (1991). Thinking about thinking: Some clinical and theoretical considerations. International Journal of Psychoanalysis72:639-656.
21.
--- Gergely, G., Jurist, E.L., & Target, M. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press .
22.
--- Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, K., Target, M., & Gerber, A. (1996). The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting & Clinical Psychology64:22-31.
23.
--- Steele, H., Moran, G., Steele, M., & Higgitt, A. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal13:200-17.
24.
--- --- & Steele, M. (1991). Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development62:891-905.
25.
--- --- --- & Target, M. (1998). Reflective Functioning Manual: Version 5. For application to Adult Attachment Interviews. Unpublished manual, University College London.
26.
George, C., Kaplan, N., & Main, M. (1998). The Berkeley Adult Attachment Interview. Unpublished manuscript, Department of Psychology, University of California , Berkeley
27.
Joseph, B. (1985). Transference: The total situation. International Journal of Psychoanalysis66:447-454.
28.
--- ( 1992). Psychic change: Some perspectives. International Journal of Psychoanalysis73:237-243.
29.
Kernberg, O.F. (1984). Severe Personality Disorders: Psychotherapeutic Strategies. New Haven: Yale University Press.
30.
--- ( 2004). Transference and countertransference management with borderline patients: Preliminary, informal report on the main conclusions of the IPA Research Committee sponsored research group.
31.
--- Burstein, E.D., Coyne, L., Appelbaum, A., Horwitz, L., & Voth, H. (1972). Psychotherapy and psychoanalysis: Final report of the Menninger Foundation's Psychotherapy Research Project. Bulletin of the Menninger Clinic36:3-75.
32.
--- Diamond, D., Yeomans, F.E., Clarkin, J.F., & Levy, K.N. (2008). Mentalization and attachment in borderline patients in transference focused psychotherapy. In Mind to Mind: Infant Research, Neuroscience, and Psychoanalysis, ed. E. Jurist & A. Slade.New York: Other Press, pp. 167-201.
33.
--- Yeomans, F.E., Clarkin, J.F., & Levy, K.N. (2008). Transference focused psychotherapy: Overview and update. International Journal of Psychoanalysis89:601-620.
34.
--- --- Levy, K.N., Clarkin, J.F., Foelsch, P.A., & Kernberg, O.F. (2004). Transference focused psychotherapy for patients diagnosed with borderline personality disorder: A comparison with a treatment as usual cohort. Unpublished manuscript.
35.
Lenzenweger, M.F., Clarkin, J.K., Kernberg, O.F., & Foelsch, P. (2001). The Inventory of Personality Organization: Psychometric properties, factorial composition and criterion relations with affects, aggressive dyscontrol, psychosis-proneness, and self domains. Psychological Assessment4:577-591.
36.
Levy, K.N., Mehan, K.B., Kelly, K.M., Reysco, R.S., Clarkin, J.F., Lenzenweger, M.F., & Kernberg, O.F. (2006). Change in attachment and reflective function in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of Consulting & Clinical Psychology74:1027-1040.
37.
Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press .
38.
Main, M., & Goldwyn, R. (1998). Adult attachment scoring and classifications system. Unpublished manual, Department of Psychology, University of California, Berkeley.
39.
Ogden, T.H. (1988). On the dialectical structure of experience: Some clinical and theoretical implications. Contemporary Psychoanalysis24:17-54.
40.
Sandler, J., Dare, C., & Holder, H. (1992). The Patient and the Analyst. 2nd ed. Madison, CT: International Universities Press.
41.
Schafer, R. (1997). The Contemporary Kleinians of London. Madison, CT: International Universities Press.
42.
Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development7:283-298.
43.
Sroufe, L.A., Egeland, B., Carlson, E., & Collins, W.A. (2005). Placing early attachment experiences in developmental context: The Minnesota Longitudinal Study. In Attachment from Infancy to Adulthood: The Major Longitudinal Studies, ed. K.E. Grossmann, K. Grossmann , & E. Waters.New York: Guilford Press, pp. 48-70.
44.
Steele, H., & Steele, M. (2008). On the origins of reflective functioning. In Mentalization: Theoretical Considerations, Research Findings, and Clinical Implications, ed. F. Busch.New York: Analytic Press, pp. 133-158.
45.
--- --- & Fonagy, P. (1996). Associations among attachment classifications of mothers, fathers, and their infants: Evidence for a relationship-specific perspective. Child Development67:541-555.
46.
STEINER, J. (1993). Psychic Retreats. London: Routledge. --- (1996). The aim of psychoanalysis in theory and practice. International Journal of Psychoanalysis 77:1073-1083.
47.
Suess, G.J., Grossmann, K., & Sroufe, L.A. (1992). Effects of infant attachment to mother and father on quality of adaptation in preschool: From dyadic to individual organisation of self. International Journal of Behavioral Development15:43-65.
48.
Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2001). Attachment security in infancy and early adulthood: A 20-year longitudinal study. Child Development71:684-689.
49.
Young, J.E., Klosko J., & Weishaar, M.E. (2003). Schema Therapy: A Practitioner's Guide. New York: Guilford Press .
