Psychodynamic psychotherapy of borderline personality disorder: a contemporary approach

All the Faces of Research on Borderline Personality Pathology: Drawing Future Trajectories through a Network and Cluster Analysis of the Literature

"Borderline Personality Disorder is a severe condition that affects self and interpersonal dimensions and emotional and behavioral regulation. Since the last decades of the 20th century, an impressive amount of research and clinical contributions on BPD came from specific fields such as psychiatry, clinical psychology, psychopharmacology, and, more recently, cognitive neuroscience. All contributions tackled the challenges of finding reliable diagnostic categories, highlighting detailed developmental trajectories, and fostering effective treatment protocols. However, as results come from different areas, it is often challenging to depict a coherent and yet multifaceted framework on this topic. In this study, we conducted a scientometric analysis of the available literature on BPD to provide a systematic and comprehensive overview of research on BPD and emphasize historical changes, intertwining between fields and new areas of investigation. Results clearly show the evolution of research on BPD starting from the initial development of the construct, passing through the studies on treatment efficacy, the results of longitudinal studies, the advances in cognitive neurosciences, and the recent dimensional conceptualization in DSM-5. Moreover, it emphasizes promising areas of investigation, such as the relations of BPD with NSSI, ADHD, and vulnerable features of narcissism."

A Dialectical Behavior Therapy Skills Group in a Psychoanalytic Community Service: A Pilot Study

This exploratory study reports on the implementation and effectiveness of a 20-week Dialectical Behavior Therapy (DBT) skills group provided to 8 outpatients (7 women, average age 33 years old) within a psychoanalytic community clinic. We report on the practical implementation of this DBT skills group, and describe how the theoretical/technical differences between DBT and psychoanalysis were negotiated by the two co-therapists. The effectiveness of the skills group was evaluated on standardized measures of borderline personality symptoms, depression, anxiety, interpersonal problems, quality of life, and mindfulness skills that patients completed before and after treatment. At post-treatment, patients evaluated the DBT skills group on a satisfaction questionnaire and therapists completed a countertransference measure. Pre-post outcome data indicated reduced symptom levels of anxiety, depression, and improved quality of life. Both therapists reported moderate therapist responses typically associated with borderline personality disorder psychopathology. Their therapist responses were not associated with symptom levels or change but were related to patient satisfaction. Accumulative pilot studies like these add to the practice-based evidence of DBT components offered within psychoanalytically-oriented community clinics. However, given the exploratory nature of this study, strong conclusions are precluded until further effectiveness research is conducted.

Services for personality disorder: organisation for inclusion

Mental health services are not yet organised to allow patients with personality disorders easy access, and practitioners lack the necessary skills to implement effective treatment. A number of service models have developed, albeit without a clear evidence-base. These include sole-practitioner, divided-functions and specialist-team models. In general, a divided-functions or specialist-team model is probably best for reducing risk and improving outcomes. Both models present difficulties with integrating treatment, but these can be overcome by good communication. Good management of patients requires careful assessment of need and risk, a consistent approach, constancy of staff, team coherence and adequate in-patient support. Not all practitioners can treat patients with personality disorders and the interpersonal skills of the mental health professional may be crucial in maintaining a patient in treatment.

'In good times and in bad': boundary relations of psychoanalysis in post-war USA

This paper suggests writing the history of psychoanalysis by focusing on the manifold ways in which its practitioners may relate to the boundaries dividing it from its neighbouring professions. This approach is illustrated by two loosely interrelated examples: the 1950s debate among leading US psychoanalysts on whether borderline patients can be analysed, and the 1990s responses of psychoanalysts to psychopharmacological treatments of schizophrenia. A close reading of psychoanalysts' journal publications reveals in each instance multiplicity (of voices), instability (of boundaries), duality (of defence and dialogue) and simultaneity (of internal and external addressees). At the same time, a common rhetorical stance emerged in each period, serving as a shared discursive frame while allowing a plurality of boundary relations.

[Psychoanalysis and University: the potential interface through psychoanalytic clinical research. Alice Glass-breaker]

The relationships between Psychoanalysis, Science and Universities have been discussed since Freud and gained relevance over the 21st century as an important subject for Psychoanalysis. Psychoanalysts who work in Universities are supposed to conduct research. This article comments on possible psychoanalytical research models and supports individual case clinical research through the psychoanalytical method itself, added on qualitative research elements. The authors study the psychoanalytical psychotherapy process and the mental functioning of a borderline patient treated for four years in a public university institution. Approximately 120 of 340 sessions were registered. They were read and re-read by the investigator-psychoanalyst as if they were narratives and revealed some meaningful developments from the psychoanalyst-patient.

The experience of borderline phenomena through cinema: Guentin Tarantino's Reservoir dogs, true romance, and pulp fiction

The experience of many patients with borderline personality is intense and kaleidoscopic. These qualities may be represented in film in ways that reflect and convey their essential features that are less readily captured in words. Quentin Tarantino has produced a trilogy of films that bring to light and to life the borderline experience. We use these movies to illustrate and discuss five key borderline themes: the fluid nature of drive derivatives, the discontinuous experience of time and space, the coniflicted search for an idealized parent, antisocial distortions of the superego, and the organizing and stabilizing function of a central romantic fantasy.