Managing Countertransference in the Treatment of Personality Disorders

2021 ◽  
Vol 49 (2) ◽  
pp. 339-360
Author(s):  
Monica Carsky
Keyword(s):  
Object Relations ◽  
Personality Disorders ◽  
Emotional Reactions ◽  
Personality Pathology ◽  
Clinical Process ◽  
Internal Object ◽  
Personality Disordered ◽  
Representational World ◽  
Transference Focused Psychotherapy

The clinical and technical difficulties presented by patients with personality disorders are well documented. This article focuses on the challenges faced by therapists when managing their emotional reactions, that is, their countertransferences, to patients with personality disorders. While leaving room for therapists' unique and idiosyncratic countertransferences to the patient with personality pathology, Kernberg emphasized the role of a more general form of countertransference, one reflective largely of the patient's conflicts and defenses, in the treatments of personality disordered individuals. Here, the nature of the patient's internal and external functioning can be seen to lead to similar reactions among different therapists, opening the possibility of utilizing countertransference to better understand the patient's difficulties. In transference-focused psychotherapy (TFP), countertransferences arising in the patient–therapist interaction are first identified and contained by the therapist and then utilized to clarify and explore how the patient's internal object relations are being enacted in the clinical process. This article describes this process and how TFP therapists work with their countertransference to help illuminate the patient's split representational world, paving the way for interpretation and integration.

Kernberg's Object-Relations Theory and the Group Psychotherapy of Psychosis

1994 ◽  
Vol 27 (4) ◽  
pp. 419-432 ◽  
Author(s):  
Charles F.A. Milders
Keyword(s):  
Object Relations ◽  
Personality Disorders ◽  
Group Process ◽  
Psychotic Disorders ◽  
Personality Pathology ◽  
Object Relations Theory ◽  
Individual Group ◽  
Psychotherapeutic Process ◽  
Psychic Process ◽  
The Individual

The application of object-relations theory to the psychotherapy of severe personality disorders owes much to the writings of Otto Kernberg. According to Kernberg, object-relations theory facilitates analysis of the psychotherapeutic process and the clarification of personality pathology. It is a concept that integrates theories of psychic process in the individual, group process and the organization of the clinical setting, and has found general support among Dutch (group) psychotherapists treating patients with borderline and psychotic disorders. However, the scope of object-relations theory is seldom addressed. When object-relations theory is separated from clinical psychiatry it can be overvalued as a universal explanatory model.

Does Childhood Trauma Cause Personality Disorders in Adults?

1998 ◽  
Vol 43 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Joel Paris
Keyword(s):  
Personality Disorders ◽  
Childhood Trauma ◽  
Personality Pathology ◽  
Traumatic Experiences ◽  
Review Of The Literature ◽  
Gene Environment ◽  
Research Findings ◽  
The Relationship

Objective: To examine the relationship between trauma in childhood and personality disorders in adulthood. Method: A review of the literature was conducted. Results: The reported associations between trauma and personality pathology are illuminated by the following research findings: 1) personality is heritable; 2) only a minority of patients with severe personality disorders report childhood trauma; and 3) children are generally resilient, and traumatic experiences do not consistently lead to psychopathology. Conclusions: The role of trauma in the personality disorders is best understood in the context of gene–environment interactions.

Ethical Processes in Psychoanalysis and Psychodynamic Psychotherapy

2020 ◽  
Author(s):  
Robert P. Drozek
Keyword(s):  
Object Relations ◽  
Psychodynamic Psychotherapy ◽  
Self Psychology ◽  
Treatment Intensity ◽  
Object Relations Theory ◽  
Clinical Process ◽  
Therapeutic Goals ◽  
Therapeutic Outcomes ◽  
Exploratory Technique

This chapter explores the foundational role of ethical experience in psychoanalysis and psychodynamic psychotherapy, from the perspective of theory as well as technique. The author reviews seminal ethical constructs across the range of analytic perspectives, including classical psychoanalysis, object relations theory, self-psychology, and contemporary relational/intersubjective thought. While all forms of psychotherapy recognize the importance of ethically grounded principles of care, psychoanalysis is unique in its theorizing about the relevance of ethics to fundamental aspects of the clinical process itself, including therapeutic goals, therapeutic outcomes, and “how change happens” in psychotherapy. These areas of theory are surveyed, along with some basic ethical tensions generated by defining aspects of psychodynamic praxis: the ethics of unconscious exploration, the ethics of “working in the transference,” the ethics of exploratory technique, and the ethics of treatment intensity.

scholarly journals Suicidality and Personality Pathology in Adolescence: A Systematic Review

2021 ◽  
Author(s):  
Marta Moselli ◽  
Maria Pia Casini ◽  
Camilla Frattini ◽  
Riccardo Williams
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Suicidal Risk ◽  
Research Papers ◽  
Mediating Role ◽  
Identity Diffusion ◽  
Predictive Role

AbstractThis work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

scholarly journals The role of migration processes and cultural factors in the classification of personality disorders

2021 ◽  
pp. 136346152110364
Author(s):  
Ardalan Najjarkakhaki ◽  
Samrad Ghane
Keyword(s):  
Personality Disorders ◽  
Ethnic Minorities ◽  
Historical Trauma ◽  
Cultural Factors ◽  
Cultural Dimensions ◽  
Economic Resources ◽  
Personality Pathology ◽  
Indigenous Populations

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term “culturally masked personality disorder” is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma.

The General Criteria for Personality Disorders Assessed by Interview: Do They Still Have a Role to Play?

2019 ◽  
Vol 33 (4) ◽  
pp. 515-S9
Author(s):  
Josep M. Peri ◽  
Ana Muñoz-Champel ◽  
Rafael Torrubia ◽  
Fernando Gutiérrez
Keyword(s):  
Personality Disorder ◽  
Personality Traits ◽  
Personality Disorders ◽  
Short Duration ◽  
Self Report ◽  
Personality Pathology ◽  
Practical Relevance ◽  
Diagnostic Aspects ◽  
Long Duration

On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire–4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.

Why, How, and When to Integrate Narrative Identity Within Dimensional Approaches to Personality Disorders

2022 ◽  
pp. 1-22
Author(s):  
Majse Lind ◽  
Carla Sharp ◽  
William L. Dunlop
Keyword(s):  
Personality Disorders ◽  
Narrative Identity ◽  
Life Stories ◽  
Identity Theory ◽  
The Self ◽  
Personality Pathology ◽  
Future Research ◽  
Dsm 5 ◽  
Considerable Benefit

Researchers and clinicians are beginning to adopt dimensional approaches in the study and treatment of personality disorders (PD). Although dimensional approaches in the DSM-5 and ICD-11 hold considerable benefit, they need to better incorporate an appreciation of individuals’ life stories, or narrative identities. Doing so will be necessary to flesh out the emphasis that both frameworks place on the role of identity in personality pathology. In this article, the authors review why, how, and when narrative identity theory and research can be integrated within dimensional approaches to PD. The authors describe established ways to assess narrative identity, review extant research on this construct in relation to PD, and signal areas crucial for future research. Stories lie at the heart of what it means to be human. The authors conclude that a greater consideration of the ways in which the self is storied can help further understanding and treatment of PD.

Personality disorder and the mental representation of early social experience

1994 ◽  
Vol 6 (2) ◽  
pp. 375-388 ◽  
Author(s):  
Matthew Patrick ◽  
R. Peter Hobson ◽  
David Castle ◽  
Robert Howard ◽  
Barbara Maughan
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Object Relations ◽  
Social Experience ◽  
Borderline Personality ◽  
Adult Attachment Interview ◽  
Internal Working ◽  
Internal Object ◽  
Early Social Experience

AbstractControversy surrounds the role of early social experience in the development of personality disorder. In particular, little is known of the means by which continuities from infancy through adulthood might be mediated. One suggestion is that a person's mental representations of relations between him- or herself and other people, either in the form of “internal working models” or “internal object relations,” provide the essential link. We report on an investigation of this issue in which we focused on the formal qualities of accounts of childhood offered by adults who were drawn from two contrasting clinical groups; borderline personality disorder and dysthymia. The results lend support to the claims made by attachment theory and the object relations school of psychoanalysis, that at least in certain groups of individuals, adults' modes of representing early experience are intimately related to styles of interpersonal functioning. More specifically, the form of interpersonal Psychopathology characteristic of borderline personality disorder may be associated with enmeshed and unresolved patterns of responding to the Adult Attachment Interview of George, Kaplan, and Main (1985) and with reports of low maternal care and high maternal overprotection on the Parental Bonding Instrument of Parker, Tupling, and Brown (1979).

Transference-Focused Psychotherapy for Adolescents With Personality Disorders

2021 ◽  
Vol 49 (2) ◽  
pp. 215-243
Author(s):  
Lina Normandin ◽  
Alan Weiner ◽  
Karin Ensink
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Current Evidence ◽  
Evidence Based ◽  
Object Relations Theory ◽  
Major Focus ◽  
Assessment And Treatment ◽  
Personality Disordered ◽  
Transference Focused Psychotherapy ◽  
Over Time

This article presents a conceptualization of personality disorders in adolescence and the adaptation of transference-focused psychotherapy (TFP) for personality disordered adolescents (TFP-A). The model of assessment and treatment presented is based on contemporary psychoanalytic object relations theory developed by Otto F. Kernberg and supported by findings from current evidence-based outcome research. We present a method of assessing personality disorders in adolescents that addresses the variability of personality disorder symptoms and traits among adolescents and their instability over time. We then present the goal of TFP-A and its major phases of implementation. A major focus is therapist interventions.

scholarly journals Personality Disorders in Time of Pandemic

2020 ◽  
Vol 22 (12) ◽  
Author(s):  
Emanuele Preti ◽  
Rossella Di Pierro ◽  
Erika Fanti ◽  
Fabio Madeddu ◽  
Raffaella Calati
Keyword(s):  
Personality Disorders ◽  
Health Impact ◽  
Therapeutic Strategies ◽  
Borderline Personality ◽  
Psychological Effects ◽  
Personality Pathology ◽  
Mitigation Measures ◽  
Main Diagnosis ◽  
Starting Point

Abstract Purpose of Review We report evidence on the negative psychological effects of pandemics in people with personality disorders (PDs) and on the role of personality pathology in compliance with mitigation-related behaviors. Considering the paucity of studies, after a description of the main features of PDs, on the basis of the current literature on pandemic and quarantine mental health impact, we trace some clinical hypotheses. Recent Findings Paranoid traits and detachment (cluster A) might lead to worse psychological outcomes. Cluster B patients may show more intense stress-related reactions and react strongly to social distancing, especially considering borderline personality disorder. Cluster C patients might be particularly prone to anxiety and stress due to fear of contagion and may be less flexible in adaptation to new routines. Evidence on compliance with mitigation measures is mixed, with lower compliance in cluster B patients and higher in cluster C ones. Summary We suggest that PD patients might be particularly affected by pandemics. Furthermore, they might react differently, according to their main diagnosis. Similarly, compliance with mitigation measures may differ according to specific PDs. Our results should be considered as a starting point to reflect on therapeutic strategies to be adopted in the post-COVID-19 situation.

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