An Interview with John Clarkin, Ph.D. on Transference-Focused Therapy For Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a badly named personality disorder that describes a group of individuals with severe interpersonal difficulties, pronounced fears of abandonment, polarized 'black and white' thinking, and a tendancy towards impulsive and self-destructive actions which can include self-mutilation and suicide. BPD is difficult to treat, but by no means impossible. Various therapies have emerged, including Dialectical Behavior Therapy (DBT), and Transference-Focused Therapy (TFT), and judicious use of symptom-focused medication treatments can help as well.
John Clarkin, Ph.D., a clinicial psychologist, is a proponant of TFT, a form of therapy that updates older transference based psychodynamic psychotherapy ideas . TFT is a semi-manualized therapy, meaning that its principles are written down in a book, but session-by-session therapist directions are not provided. TFT is highly 'here-and-now' focused, using the relationship that forms between patient and therapist as a laboratory environment in which the patient's interpersonal problems will play out. TFT therapists help patients to understand and become aware of their maladaptive interpersonal patterns so that they can start to alter them. TFT therapists encourage patients, many of whom are disabled, to get out and work, even if that work is only on a volunteer basis. Conflicts that occur in the work environment are discussed in therapy.
Dr. Clarkin is in the news recently as author of a study comparing TFT, DBT and Supportive Psychotherapy (ST) as therapies for the treatment of BPD. Ninty patients with BPD were randomly assigned to one of the three therapy conditions, and then followed across one year of therapy. Study results showed that all forms of therapy were helpful in improving symptoms of depression and anxiety, and in increasing overall global functioning and social adjustment. DBT and TFT treatments, but not supportive therapy, were found to have reduced rates of suicide attempts. Of the three therapies studied, TFT produced the 'widest' effect (meaning that TFT patients showed improvements on more measures included in the study than those who received other forms of therapy).
For the future, Dr. Clarkin hopes to study how TFT and other useful therapies like DBT can be integrated. An integrated therapy would offer the concrete DBT style interventions that reduce self-harm, but also work on altering patient's maladptive interpersonal patterns.
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About John Clarkin, Ph.D.
John F. Clarkin, Ph.D. is Co-Director of the Personality Disorder Institute at New York Presbyterian Hospital, Westchester Division, and Clinical Professor of Psychology in Psychiatry at the Weill Medical College and Graduate School of Medical Sciences of Cornell University in New York City. He is Past President of the International Society for Psychotherapy Research. He is an expert on the treatment of Borderline Personality and, among his many publications, he is co-author of Psychotherapy for Borderline Personality: Focusing on Object Relations.