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Primer of Transference-Focused Psychotherapy for the Borderline Patient » (1st Edition)

Book cover image of Primer of Transference-Focused Psychotherapy for the Borderline Patient by Frank E. Yeomans

Authors: Frank E. Yeomans
ISBN-13: 9780765703552, ISBN-10: 0765703556
Format: Hardcover
Publisher: The Rowman & Littlefield Publishing Group Inc
Date Published: July 2002
Edition: 1st Edition

Author Biography: Frank E. Yeomans

Book Synopsis

Treating borderline patients is one of the most challenging areas in psychotherapy because of the patient's extreme emotional expressions, the strain it places on the therapist, and the danger of the patient acting out and harming himself or the therapeutic relationship. Many clinicians consider this patient population difficult, if not impossible, to treat. However, in recent years dedicated experts have focused their clinical and research efforts on the borderline patient and have produced treatments that increase our success in working with borderline patients. Transference-Focused Therapy (TFP) is psychodynamic treatment designed especially for borderline patients. This book provides a concise and comprehensive introduction to TFP that will be useful both to experienced clinicians and also to students of psychotherapy.

	Preface
Pt. I	Who Are the Patients? Diagnostic Issues
1	What is borderline personality disorder (BPD)?	3
2	What is the borderline personality organization (BPO) and how does it provide a broader understanding and conceptual framework than borderline personality disorder (BPD)?	5
3	What is identity diffusion?	8
4	What is reality testing?	9
5	What are primitive defense mechanisms?	10
6	What is object relations theory and how does it apply to borderline personality and transference-focused psychotherapy (TFP)?	12
7	How are defense mechanisms understood in terms of internalized object relations?	18
8	How does the development of internal psychological structure differ in normal individuals as compared to individuals with borderline personality?	23
9	What is psychic structure?	26
10	Are there circumstances in which adults who are not borderline function at a split level of psychic organization?	27
11	In the primitively organized split psyche, what interactions might be expected within and among the object relations dyads?	28
12	How does one assess for BPO and BPD?	31
13	What are the origins of borderline personality organization?	33
Pt. II	What is the Essence of the Treatment?
14	What is TFP?	39
15	What are the patient inclusion and exclusion criteria for TFP?	41
16	Aside from the strict exclusion criteria, are there other prognostic factors?	43
17	What kind of change can be expected from TFP?	45
18	How does TFP modify traditional psychodynamic psychotherapy to create a treatment specific to borderline patients?	47
19	What are the principle alternative treatments for BPD and BPO?	49
Pt. III	Treatment Strategies
20	What is the concept of treatment strategies?	55
21	What are the specific treatment strategies?	57
Pt. IV	Treatment Tactics
22	What are the treatment tactics?	67
Pt. IV-A	Tactic #1 - Contract Setting
23	Does therapy start with the first session?	71
24	What constitutes an adequate evaluation?	73
25	Is it possible to include others, beside the patient, in the evaluation process?	74
26	What does the therapist say to the patient after arriving at a diagnostic impression?	75
27	When is the treatment contract set with the patient?	79
28	What therapeutic concepts underlie the treatment contract?	80
29	What are the universal elements of the treatment contract?	86
30	What are the elements of the contract that are specific to the individual patient?	88
31	How do I keep anxiety about the possibility of patients' killing themselves from distracting me from my work?	91
32	What about patients who call very frequently?	95
33	What calls are appropriate?	96
34	What is done if the patient breaks the treatment contract?	97
35	When and how does a therapist shift from the contract-setting phase of therapy to the therapy itself?	100
36	What are the most common ways therapists have to intervene to protect the treatment frame?	101
37	What is the concept of secondary gain and why is it important to eliminate it?	103
Pt. IV-B	Choosing the Priority Theme to Address
38	Given the amount of data therapists are exposed to in a session, how to they decide what to address?	107
39	What are the economic, dynamic, and structural principles that guide the therapist's attention?	108
40	What are the three channels of communication?	111
41	What is the hierarchy of priorities with regard to material presented in a session?	114
42	How does the therapist use this hierarchy from moment to moment in the course of a session?	116
43	Which items on this list generally present a special challenge to the therapist?	118
44	Is there a strict separation between the addressing obstacles to therapy and the analytic work itself?	120
Pt. IV-C	The Remaining Tactics
45	How does the therapist maintain the balance between expanding incompatible views of reality between patient and therapist and establishing common elements of reality?	125
46	Why is it important to maintain an awareness of analyzing both the positive and negative aspects of the transference?	131
Pt. V	Treatment Techniques
47	What are the techniques used in TFP?	137
48	What is meant by clarification in TFP?	138
49	What is meant by confrontation in TFP?	140
50	What is meant by interpretation?	142
51	What are the different levels of interpretation?	143
52	How should interpretations be delivered?	148
53	How does the therapist go about the transference analysis of primitive defenses?	151
54	What is technical neutrality and how does the therapist manage it in TFP?	156
55	How do therapists monitor their countertransference and integrate what they learn from it into the treatment?	160
Pt. VI	Course of Treatment After the Contract
56	What are the phases of TFP?	163
57	Does treatment generally demonstrate a linear progression?	164
58	What are some of the early problems that may be encountered in carrying out the treatment? Early problems I - Testing the frame/contract	166
59	Early problems II - The meaningful communication is subtle and is in the patients' actions more than in his or her words	169
60	Early problems III - The therapist has difficulty with how important the therapist has become to the patient	172
61	How does the therapist manage affect storms?	174
62	What are the signs of progress in TFP?	178
63	What are the signs that the patient is nearing the termination of therapy and how does the therapist conceptualize and discuss termination?	179
Pt. VII	Some Typical Treatment Trajectories
64	Is it possible to delineate some typical treatment trajectories that illustrate TFP principles as the therapy evolves?	185
Pt. VIII	Common Complications of Treatment
65	How does the therapist deal with the threat of the patient dropping out of treatment?	213
66	Are patients with childhood sexual and/or physical abuse capable of engaging in TFP?	217
67	Is hospitalization ever indicated in the course of treatment?	220
68	If the patient is hospitalized, should the therapist meet with the patient in the hospital?	223
69	What is the role of medications in TFP?	224
70	Who should prescribe the medications?	229
71	What are the most typical transference meanings of medication?	231
72	How does one handle crises around interruptions in the treatment?	232
73	How does the therapist deal with intense eroticized transferences?	233
Pt. IX	Requirements for Doing TFP
74	What are the basic skills needed to do this treatment?	237
75	What forms and levels of supervision are necessary/advisable?	241
Pt. X	Practical Questions in Delivering the Treatment
76	How does one get consultation on the TFP treatment of BPO patients or organize a supervision group?	245
77	How does one cover these patients when the therapist is away?	246
78	What if I work in a clinic that does not support twice-a-week therapy?	247
79	Is there empirical data to show that TFP is effective?	248
	A Final Note	253
	Index	271