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 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.     

Is Established Knowledge About Cross-Cultural Differences in Individualism–Collectivism Not Applicable to the Military? A Multi-Method Study of Cross-Cultural Differences in Behavior

Preparing for international military collaboration includes raising knowledge about cultural differences. The differences in individualism–collectivism between countries are among the most central aspects likely to impact collaboration. However, are the differences in individualism–collectivism between countries as documented in a significant amount of civilian research (e.g., Hofstede, 2001a Hofstede, G. (2001a). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations (2nd ed.). Thousand Oaks, CA: Sage. [Google Scholar]) generalizable to a military context? Or are the differences not the same in a military context, as suggested by Soeters (1997) Soeters, J. L. (1997). Value orientations in military academies: A thirteen country study. Armed Forces and Society, 24, 7–32. 10.1177/0095327X9702400101[Crossref], [Web of Science ®] , [Google Scholar] on the bases of a values survey? Quasi-experiments were conducted in a distributed collaborative computer game environment. The study is multimethod, employing self-reporting, observer ratings and direct behavioral measures, and it is the first study of cross-cultural differences in individualism–collectivism in behavior in a military context. By studying differences in collectivist-type behaviors in a sample of military officers (N = 154) in 4 different countries (the United States, the Netherlands, Sweden, and Norway), this study seeks to determine whether the cross-cultural differences in values found by Soeters from a military context are reflected in behavior. The study also includes a values survey using Hofstede’s (2007) Hofstede, G. (2007). Values survey module 1994 (VSM-94). Retrieved from www.geerthofstede.com [Google Scholar] measurement tool, the Values Survey Module (VSM), consistent with Soeters’ study. The study is considered exploratory because of a somewhat limited sample. The results from the 6 different measures of collectivist behaviors provide no support for the suggestion that cross-cultural differences in individualism–collectivism are not the same in military organizations as in civilian organizations. Although not conclusive, the results raise doubt concerning the appropriateness of using the VSM in military samples. The implications are discussed.     

The Role of Effort–Reward Imbalance for Reservists on a Military Deployment

The present study extended the effort–reward imbalance (ERI) model (Siegrist, 1996b Siegrist, J. 1996b. “Soziale Krisen und Gesundheit [Social crises and health]”. In Gesundheitspsychologie [Health psychology] Edited by: Krohne, H. W., Schmidt, L., Netter, P. and Schwarzer, R. Vol. 5, Göttingen, , Germany: Hogrefe.  [Google Scholar]), first by differentiating between separate reward components, second by including intrinsic reward, and third by additionally predicting a non-health outcome (i.e., turnover intention) in a military context. Regression analyses of 789 reservists found financial and esteem reward to moderate the impact of extrinsic effort on depressive symptoms, whereas only financial reward moderated the effort turnover intentions relationship. Results supported the usefulness of the extended ERI model in the military context. Relevant areas for future research on the military effort–reward perspective are discussed.     

A New Model for Acquiescence at the Interface of Psychometrics and Cognitive Psychology

ABSTRACT

When measuring psychological traits, one has to consider that respondents often show content-unrelated response behavior in answering questionnaires. To disentangle the target trait and two such response styles, extreme responding and midpoint responding, Böckenholt (2012a Böckenholt, U. (2012a). Modeling multiple response processes in judgment and choice. Psychological Methods, 17, 665–678. doi:10.1037/a0028111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed an item response model based on a latent processing tree structure. We propose a theoretically motivated extension of this model to also measure acquiescence, the tendency to agree with both regular and reversed items. Substantively, our approach builds on multinomial processing tree (MPT) models that are used in cognitive psychology to disentangle qualitatively distinct processes. Accordingly, the new model for response styles assumes a mixture distribution of affirmative responses, which are either determined by the underlying target trait or by acquiescence. In order to estimate the model parameters, we rely on Bayesian hierarchical estimation of MPT models. In simulations, we show that the model provides unbiased estimates of response styles and the target trait, and we compare the new model and Böckenholt’s model in a recovery study. An empirical example from personality psychology is used for illustrative purposes.     

A Unified Empirical Account of Responsibility Judgments*

Skeptical worries about moral responsibility seem to be widely appreciated and deeply felt. To address these worries—if nothing else to show that they are mistaken—theories of moral responsibility need to relate to whatever concept of responsibility underlies the worries. Unfortunately, the nature of that concept has proved hard to pin down. Not only do philosophers have conflicting intuitions; numerous recent empirical studies have suggested that both prosaic responsibility judgments and incompatibilist intuitions among the folk are influenced by a number of surprising factors, sometimes prompting apparently contradictory judgments. In this paper, we show how an independently motivated hypothesis about responsibility judgments provides a unified explanation of the more important results from these studies. According to this ‘Explanation Hypothesis’, to take an agent to be morally responsible for an event is to take a relevant motivational structure of the agent to be part of a significant explanation of the event. We argue that because of how explanatory interests and perspectives affect what we take as significant explanations, this analysis accounts for the puzzling variety of empirical results. If this is correct, the Explanation Hypothesis also provides a new way of understanding debates about moral responsibility.