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.     

Space Fortress game training and executive control in older adults: A pilot intervention

ABSTRACT

We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC) – elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC) – game play with standard instructions; Passive Control (PC) – evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter–number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.     

The hypercorrection effect in younger and older adults

ABSTRACT

The hypercorrection effect, which refers to the finding that errors committed with high confidence are more likely to be corrected than are low confidence errors, has been replicated many times, and with both young adults and children. In the present study, we contrasted older with younger adults. Participants answered general-information questions, made confidence ratings about their answers, were given corrective feedback, and then were retested on questions that they had gotten wrong. While younger adults showed the hypercorrection effect, older adults, despite higher overall accuracy on the general-information questions and excellent basic metacognitive ability, showed a diminished hypercorrection effect. Indeed, the correspondence between their confidence in their errors and the probability of correction was not significantly greater than zero, showing, for the first time, that a particular participant population is selectively impaired on this error correction task. These results potentially offer leverage both on the mechanisms underlying the hypercorrection effect and on reasons for older adults’ memory impairments, as well as on memory functions that are spared.     

美方专家观点:未来的挑战——信任是临床试验的核心

信任是医患关系的一个基本特征,是社会和医生之间的隐性合同的一部分。合同要求双方的期望值。病人会告诉医生他们内心深处的个人隐私,信任医生会为他们保守秘密,允许医生在他们生病和悲伤时进入家里和医院。但是,要做到这些,医生必须维持包括关爱、保密和承诺的伦理标准。因为信任就像个很小但却很珍贵的宝石－很难得到,又很容易失去,失去之后想要在找回来极为困难。     

EMU Leadership: An egalitarian magnanimous undemocratic way for schools

This paper suggests that the nature of leadership as a significant human characteristic, derived from both philosophical and psychological theorizing, can appropriately be seen as egalitarian (in Macmurray's sense) and magnanimous (in Aristotle's sense), whilst remaining undemocratic. Empirical research carried out in schools supports the idea that, in particular circumstances, this model of leadership may indeed already be recognized in schools. In addition, there are brief references to the psychology of leadership, to the ways in which learning in schools might be theorized, and to the nature of schools as communities. Finally, implications for 'followers' as well as leaders, and for spiritual development in schools, are explored.     

Obsessive ruminations : a controlled trial of thought-stopping technique

Thought-stopping treatment for obsessive ruminations was described by Wolpe and Lazarus (1966) and more recently there have been several case-reports in some of which components of the method were unsystematically varied (Stern, 1970; Kumar et al., 1971; Yamagami, 1971). The present study examined one of these variables while holding constant the other components. When thought-stopping is given, the subject is usually relaxed (using a standard set of instructions to relax his muscles) and then asked to ruminate about the obsessive thought. The therapist then shouts ‘Stop’ while making a sudden noise at the same time. At this point the patient is told that he must stop thinking his obsessive idea ; after a pause, this interruption is repeated several times until the obsessional rumination ceases. This procedure was compared to a similar technique in which the patient imagined a neutral (‘control’) thought instead of an obsessive one prior to the onset of the ‘stop’ instruction. In every other way the two procedures were identical.