Psychotherapy for Borderline Personality

Psychotherapy for Borderline Personality (New York: Wiley, 1999) is the first full treatment manual of transference-focused psychotherapy (TFP), written by John F. Clarkin, Frank E. Yeomans and Otto F. Kernberg at the Personality Disorders Institute of Weill Cornell. It turns the expressive psychoanalytic psychotherapy that Kernberg had described for patients with borderline personality organization into a manualized, teachable treatment, held twice weekly within a firm frame. Its premise is object-relational: the borderline patient's inner world is split into polarized, affect-laden pairs of self and other representations, idealized and persecutory, victim and destroyer. In the relationship with the therapist these pairs are enacted, and the therapist is drawn into shifting roles. The book is in three parts. The first sets out the ingredients of the treatment: its theory, its overarching goals, the strategies that prevail over weeks and months, the tactics of each session, and the techniques by which they are carried out. The second follows the phases of treatment: assessment and the negotiation of a treatment contract, early tests of the frame and the containment of impulsive and self-destructive acting out, a middle phase of growing integration interrupted by regressions, and an advanced phase leading to termination. The third deals with special problems such as crises, suicidal and parasuicidal behaviour, hospitalization and medication. Throughout, the authors teach the therapist to identify and name the dominant object-relational dyad in the here-and-now, to clarify, confront and interpret it from a stance of technical neutrality, and to use the countertransference as information. The aim is not only to reduce symptoms but to integrate split-off parts of the self, so that the patient comes to experience self and others as whole, complex people. Verbatim clinical vignettes illustrate each step. The manual underlay the randomized trials of TFP that followed, was translated into German in 2001, and was revised in 2006 as Psychotherapy for Borderline Personality: Focusing on Object Relations.