• Choose a category
• All
• Classic-Fiction

By Root 409 0

another’s feelings.8 The term overlaps with the concept of psychological mindedness (understanding the connection between feelings and behaviors) and mindfulness (a goal in DBT; see above). Fonagy theorizes that when the normal development of mentalization beginning in early childhood is disrupted, adult pathology develops, particularly BPD. This conceptualization is based on psychodynamic theories of a healthy attachment to a parenting figure (see chapter 3). When the child is unable to bond appropriately with a parent, he has difficulty understanding the parent’s or his own feelings. He has no healthy context on which to base emotions or behaviors. Object constancy cannot be sustained. The child develops abandonment fears or detaches from others. This developmental failure may arise either from the child’s temperament (biological or genetic limitations) or from the parent’s pathology, which may consist of physical or emotional abuse or abandonment, or inappropriate smothering of independence, or from both.

MBT is based on the supposition that beliefs, motives, emotions, desires, reasons, and needs must first be understood in order to function optimally with others. Confirming data on the effectiveness of this method has been documented by Bateman and Fonagy, primarily within a daily partial hospital setting in England.9,10 In this design, patients attend the hospital during the day, five days a week for eighteen months. Treatment includes psychoanalytically oriented group therapy three times a week, individual psychotherapy, expressive therapy consisting of art, music, and psychodrama programs, and medications as needed. Daily staff meetings are held and consultations are available. Therapists, employing a manual-based system, focus on the patient’s current state of mind, identify distortions in perception, and collaboratively attempt to generate alternative perspectives about himself and others. While much of the behavioral techniques recalls DBT, some of the psychodynamic structure of MBT overlaps with Transference-Focused Psychotherapy (TFP).

Transference-Focused Psychotherapy (TFP)

TFP is a manual-based program that Otto Kernberg, MD, and colleagues at Cornell have developed from more traditional psychoanalytic roots.11,12 The therapist focuses initially on developing a contract of understanding of the roles and limitations in the therapy. Like DBT, early concerns revolve around suicide danger, interruption of therapy, dishonesty, and so on. Like other treatment approaches, TFP acknowledges the role of biological and genetic vulnerability colliding with early psychological frustrations. A primary defense mechanism seen in borderline patients is identity diffusion, which refers to a distorted and unstable sense of self and, consequently, others. Identity diffusion suggests a perception of oneself and others as if they were fuzzy, ghostlike distortions in a fun-house mirror, barely perceptible and insubstantial to the touch. Another feature of BPD is persistent splitting, dividing perceptions into extreme and opposite dyads of black or white, right or wrong, resulting in the belief that oneself, another, or a situation is all-good or all-bad. Accepting that a good person could disappoint is difficult to comprehend; thus, the formerly good person mutates into an all-bad person. (The professional reader will note that distortions in MBT’s mentalization would include the concepts of identity diffusion and splitting; the difficulty with dyadic extremes recalls the dialectical paradoxes theorized in DBT.)

TFP theorizes that identity diffusion and splitting are early, primary elements in normal development. However, in BPD, normal, developing integration of opposite feelings and perceptions is disrupted by frustrating caregiving. The borderline is stuck at an immature level of functioning. Feelings of emptiness, severe emotional swings, anger, and chaotic relationships result from this black-and-white thinking. Therapy consists of twice-weekly individual sessions, in which the relationship with the therapist is examined.