Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence

The paper suggests a way of understanding borderline personality disorder in terms of the failure of a secure base. We begin with an account of optimal self-development in a secure attachment context, highlighting the importance of the caregiver's ability to help the small child think about his own and others' minds. This optimal self-development is crucial in developing the child's capacity for mentalization, which can enhance his resilience in the face of later trauma. We discuss the impact of attachment trauma in later development, arguing that the extent of this impact depends on how well early attachment relationships facilitated the capacity for mentalization. We identify some of the consequences for the representations of the internal world of a failure of mentalization that may follow trauma in individuals made vulnerable by genetic predisposition or disorganized early attachment. We link these features to the clinical presentation associated with borderline personality organization. Finally, some of the necessary characteristics of successful psychotherapeutic treatment of borderline personality disorder are briefly considered.     

The Evaluation of Psychoanalytical Practice in Stockholm

The authors discuss several surveys that cover the practices of psychoanalysts and psychotherapists in the Stockholm region. They compare these practices with other psychiatrists in both the private and the public sector. In addition, they discuss the results from an attempt towards continuous evaluation of psychoanalytical practices and their treatment standards including an evaluation of the development of individual psychoanalytical processes.     

Christer Sjödin interviews Jan Stensson

Abstract

The author examines different definitions and applications of the terms “psychic energy” and “libido.” With regard to the “psychic energy” terminology, he shows that its application and usage relate in particular to the perspective of Brenner and not to Freud's definition. He argues that Freud uses the term “psychic energy” as a synonym for “libido,” and not “libido” as a synonym for “psychic energy.” It is demonstrated that in Freud's view, up until 1914, “libido” relates to manifestations of bodily sexual tensions, and subsequently this term applies to the manifestations of sexual energy in the psychic field. The author rejects this change in terminology and also challenges Freud's attempt to use dynamic-economic considerations as an explanatory device for epistemological reasons. Freud's concept of energy is inconsistent with the meaning of energy as defined in the physical sciences, and whereas the metapsychological topographical, dynamic, and structural viewpoints have a solid foundation in the representational world to which the psychoanalytic process affords unique access, this is not true of the economic viewpoint. It is claimed that bodily tensions only exist in the representational world in the form of affects, so that, in the author's opinion, the economic viewpoint should be abandoned in favour of an affective one. In the context of the endeavour to obtain pleasure and avoid unpleasure adduced by Freud, this viewpoint focuses on the relationships between affects and the different elements of the representational world, thereby serving as the subject of metapsychological investigation.     

Of “sleep and dream: A psychoanalytic essay' by Joyce McDougall (discussion)

Abstract

The author describes experiences gathered during several years of teaching psychodynamic psychotherapy with psychologists and psychiatrists within a 2-year-training programme in Shanghai, China. Questions and problems of the reception of psychoanalysis – shame, sexuality, harmony, abstinence – as well as the possibilities and limitations of exporting psychoanalysis are discussed. The possible future development of psychoanalysis in China is also outlined.     

A response to Nordstrom and pilgrim's critique of Alan watts’ mysticism

Abstract

Experiencing the sacred is a paradigmatic spiritual phenomenon, revered across diverse eras and cultures. This empirical research is a human scientific inquiry into the sacred in everyday life. In‐depth interviews are interpreted via a rigorous phenomenological method. A dialogue involving transpersonal psychology, existential phenomenology, psychoanalysis, and the world's spiritual traditions is presented, including an appreciation and critique of Freud's interpretation of religion. Revelation and awareness of an essential, interpermeating communion between self and world constitutes the core of experiencing the sacred. This involves a metamorphosis from an egoic to transpersonal self‐sense and way of being.     

The Relationship Between Arousal and the Remembered Duration of Positive Events

The relation between affect and retrospective duration estimation has hardly been examined. In this paper, we contribute to filling this gap by studying the influence of arousal on the remembered duration of positive events. On the basis of the contextual change model, we expected that high‐arousal positive events would be remembered as longer compared with low‐arousal positive events. To test this hypothesis, we set up a naturalistic study in which participants were asked at the end of a pleasant amusement park ride at the local fair to rate how pleasant and aroused they felt during the ride as well as to estimate the ride's duration. Feeling more aroused during a ride was associated with longer estimates of the ride's duration. Results are discussed within the framework of retrospective time estimation models. Copyright © 2013 John Wiley & Sons, Ltd.     

Child Personality as Moderator of Outcome in a School‐based Intervention for Preventing Externalising Behaviour

Studying moderators of intervention effects is essential to elucidate what works for whom. The present study investigated whether child personality moderates short‐term and follow‐up effects of an individualised preventive school‐based intervention for children with externalising behaviour. The sample consisted of 48 schools, with 264 fourth‐grade children displaying externalising behaviour (M_age = 10.2 years), randomly assigned to the intervention (n = 191) or no intervention control (n = 73) condition. Teachers and children reported at pretest, posttest and follow‐up test about reactive and proactive aggression. Child personality was assessed by teachers at pretest. Child conscientiousness moderated short‐term intervention effects, indicating that more organised and planful children benefited more from the intervention. Child extraversion moderated both short‐term and follow‐up intervention effects, with low extraverted children showing larger effects. These results affirm the importance of including personality as moderator of intervention effects in future studies, as interventions adapted to specific child traits might yield larger effects. Copyright © 2012 John Wiley & Sons, Ltd.     

Factors influencing two types of congruence in multirater judgments

In two studies of 360° judgments, it was shown that congruence measured in terms of intercorrelations between ratings by different people (congruence‐r) and in terms of the discrepancy between those ratings (congruence‐d) were empirically independent of each other. Congruence‐r was greatest, and congruence‐d was smallest, between judgments made by a target person and his or her supervisor, rather than by subordinates or peers; the differential observability of rated behaviors predicted congruence‐r but not congruence‐d. Variations in both forms of congruence were found to arise from the source of a judgment, and from a target person's age, gender, cognitive ability, and certain personality attributes. Over‐ and under‐rating associated with a personality or another third factor was shown to derive from substantially different correlations between such a factor and the two separate judgments under consideration.