Psychotherapy For Borderline Personality: Focusing On Object Relations

PSYCHOTHERAPY F OR B OR DE R L I NE PERSONALITY Focusing on Object Relations This page intentionally left blank PSYCHOTHERAPY F OR B OR DE R L I NE PERSONALITY Focusing on Object Relations John F. Clarkin, Ph.D. Frank E. Yeomans, M.D., Ph.D. Otto F. Kernberg, M.D. Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2006 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 09 08 07 06 05 5 4 3 2 1 First Edition Typeset in Adobe’s Janson Text, Univers, and VAG Rounded. American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data Clarkin, John F. Psychotherapy for borderline personality : focusing on object relations / John F. Clarkin, Frank E. Yeomans, Otto F. Kernberg.— 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 1-58562-210-9 (pbk. : alk. paper) 1. Borderline personality disorder—Treatment. 2. Psychotherapy. 3. Transference (Psychology). [DNLM: 1. Borderline Personality Disorder—therapy. 2. Psychotherapy— methods. 3. Transference (Psychology) WM 190 C612p 2005] I. Yeomans, Frank E., 1949– II. Kernberg, Otto F., 1928– III. Title. RC569.5.B67C582 2005 616.85’852—dc22 British Library Cataloguing in Publication Data A CIP record is available from the British Library. 2005028834 Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix 1 2 3 4 5 6 7 8 The Nature of Borderline Personality Organization . . . . . . 1 Treatment of Borderline Pathology: The Strategies of Transference-Focused Psychotherapy . . . . . . . . . . . . . 33 Techniques of Treatment: The Moment-to-Moment Interventions. . . . . . . . . . . . . . . . 71 Tactics of Treatment: Laying the Foundation for the Techniques . . . . . . . . . . . . 121 Assessment Phase, I: Clinical Evaluation and Treatment Selection . . . . . . . . . . 155 Assessment Phase, II: Treatment Contracting . . . . . . . . 179 Early Treatment Phase: Tests of the Frame and Impulse Containment . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Midphase of Treatment: Movement Toward Integration With Episodes of Regression . . . . . . . . . . . . . 241 9 Advanced Phase of Treatment and Termination. . . . . . . 279 10 Common Treatment Complications . . . . . . . . . . . . . . . . . . 307 11 Change Processes in Transference-Focused Psychotherapy: Theoretical and Empirical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 A B O U T T H E A