Book
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.
Main ideas
- The book is the first manual of transference-focused psychotherapy, a manualized form of the expressive psychoanalytic psychotherapy Kernberg developed for borderline personality organization.
- Borderline pathology is understood through object relations: split, polarized dyads of self and other representations, each tied to an intense affect, that alternate and are enacted in the relationship with the therapist.
- Treatment begins with assessment and a carefully negotiated treatment contract that sets the frame, the responsibilities of patient and therapist, and how threats to the treatment will be handled; the therapist does not commit until the contract is agreed.
- The treatment is organized at three levels: long-range strategies, session-by-session tactics, and moment-to-moment techniques.
- The core techniques are clarification, confrontation and interpretation of the dominant object-relational dyad in the here-and-now of the transference, from a stance of technical neutrality, with the countertransference used as information.
- Interventions follow a hierarchy of priorities: threats to life and to the continuation of treatment come first, then acting out that undermines the work, and only then the transference themes.
- The treatment moves through phases: early tests of the frame and containment of impulsivity, a middle phase of growing integration interrupted by regressions, and an advanced phase leading to termination.
- Special problems are addressed directly: suicidal and parasuicidal behaviour, secondary gain, crises, hospitalization, medication, and antisocial or malignant narcissistic features.
- The goal is structural change, integrating split representations so that the patient can see self and others as whole and complex, rather than symptom relief alone.
What it shows
- 1999
Otto F. Kernberg introduced Transference-focused psychotherapy
With John Clarkin and Frank Yeomans at Cornell, Kernberg turned his psychoanalytic treatment of borderline patients into a manualised method, first published as Psychotherapy for Borderline Personality (1999).
- 1999
Otto F. Kernberg collaborated with John F. Clarkin
Kernberg and Clarkin worked together for decades at the Cornell Personality Disorders Institute, where they developed, manualised and tested transference-focused psychotherapy.
- 1999
Otto F. Kernberg collaborated with Frank E. Yeomans
Kernberg and Yeomans co-wrote the manuals of transference-focused psychotherapy and worked together on training clinicians in the method at the Cornell Personality Disorders Institute.
Transference-focused psychotherapy derives from Borderline personality organization
Transference-focused psychotherapy was built as the treatment for borderline personality organization: its aim of integrating split images of self and others follows directly from the structural account of the disorder.