Transference-Focused Psychotherapy for Adolescents with Severe Personality Disorders

Offers clinicians a comprehensive, compassionate presentation of this specialized psychodynamic psychotherapy. Like the transference-focused psychotherapy model developed for borderline personality disorder in adults, the version for adolescents is based on contemporary psychoanalytic object relations theory as developed by Otto Kernberg.

Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders is a manual for clinicians who wish to learn an effective psychodynamic treatment for young people with personality disorders (PDs). Despite converging evidence that PDs emerge in childhood and are clearly evident in adolescence, research on effective treatments has been limited. The editors have therefore created a book that details treatment models with strong theoretical foundations and examines systematic interventions designed to explore and resolve the conflicts and behaviors, common to PDs, that impede normal adolescent development. The book begins with an overview of psychopathology and normal adolescent development from a psychodynamic perspective. The next section offers therapeutic approaches, including a discussion of the major goals and strategies of TFP-A, the clinical evaluation and assessment process, establishment of the treatment framework and collaboration with parents, and finally, the techniques and tactics of TFP-A. The last section of the book reviews the phases of treatment and discusses the strengths and competencies a therapist must have to successfully conduct transference-based therapy. Authored by experts in the field (including Dr. Kernberg, a pioneer in object relations), Transference-Focused Psychotherapy for Adolescents (TFP-A) with Severe Personality Disorders teaches clinicians how to conduct TFP-A, with the ultimate goal of resolving the intrapsychic restrictions that interfere with normal adolescent development.

Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders offers clinicians a comprehensive, compassionate presentation of this specialized psychodynamic psychotherapy. Like the transference-focused psychotherapy model developed for borderline personality disorder (BPD) in adults, the version for adolescents is based on contemporary psychoanalytic object relations theory as developed by the leading thinker in the field, Otto Kernberg, one of the authors of this insightful manual. This book fills an acute need: currently, there is relatively little research on promising treatments for adolescents with PDs, in part because clinicians hesitate to diagnose PD in patients so young (because of stigma and other factors), although it is evident that a constellation of symptoms can be observed in children and adolescents. However, these personality issues are unlikely to resolve without interventions developed explicitly to treat adolescents. In TFP-A, the psychotherapist provides patients with a safe space to examine emotions, relationships, and past trauma, with the focus on helping them gain better behavioral control; increase affect regulation; develop more intimate and gratifying relationships with family, peers, or close friends; and engage in a productive life aimed at realizing current and future goals.

Noteworthy themes and features of the text include:

• Emphasis on the therapist as "third voice," acting as interpreter and mediator between the adolescent, the parental couple, and conventional society and its values, with the ultimate goal of fostering ego integration sufficient to allow the adolescent to proceed under his own agency.
• Detailed coverage of the techniques of TFP-A, including creating a holding environment, assuming an active stance, engaging in the interpretive process, analyzing transference and countertransference, achieving technical neutrality, and ensuring interventions are developmentally informed.
• Practical and accessible review of TFP-A "tactics," including establishing the treatment frame, collaborating with parents, and other interventions that maintain the conditions necessary for working effectively with the adolescent and for protecting treatment integrity.
• Thoughtful review of the attributes that make a clinician a good "fit" for transference-focused psychotherapy. For example, therapists must have their own lives "together," because they will have to use countertransference reactions to identity and understand what is projected onto them.
• A rich and useful repository of assessment scales and forms in the Appendices, as well as extended and illustrative patient interviews.

Navigating adolescence is fraught under the best of circumstances, but patients with PDs are hampered in their quest for individuation. Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders fills a critical gap in the treatment literature and is an eminently useful guide for clinicians serving this vulnerable population.