A case report of the treatment of narcissistic personality disorder with transference focused psychotherapy.

The following case study provides a description of the transference-focused psychotherapy (TFP) treatment of a young man diagnosed with narcissistic personality disorder (NPD). TFP is an individual, psychodynamic therapy developed to treat a range of personality disorders. TFP is evidence-based for the treatment of borderline personality disorder and has been adapted for the treatment of NPD. This case illustrates the application of the strategies and techniques of TFP to treatment of NPD as well as challenges clinicians may face in arriving at timely diagnosis of the disorder. Although no specific treatment for NPD has been empirically validated, TFP utilizes the therapeutic techniques identified across modalities for successful treatment of pathological narcissism. This report describes how treatment interventions such as goal setting, developing a therapeutic alliance, using a treatment contract and addressing treatment interfering behaviors contributed to this patient's improvement in self-reflection, formation of healthier and more flexible ideas about self and other, increased self-agency, tolerance of normative disillusionments and increase in empathy.

[Love is all around? - On dealing with eroticism and infatuation in three different psychotherapeutic approaches]. / Love is all around? ­ Über den Umgang mit Erotik und Verliebtheit in drei verschiedenen Therapieschulen: Ein Scoping Review.

How do therapists react when their patients or they themselves develop erotic feelings in the therapeutic setting? Conceptual differences of different therapy approaches (psychoanalytic therapy, cognitive behavioral therapy and client-centered therapy), specific attitudes of therapists and possibilities of intervention will be shown. The literature search in several databases revealed that in comparison to the abundance of psychoanalytic literature on the topic, little (but relevant) information can be found in the two other approaches. These publications point to the regular occurrence of feelings of infatuation in behavioral therapy and client-centered psychotherapy and to a need to engage with the topic as therapists. The consensus of the publications presented here is that therapists want to accept and work with feelings of infatuation in patients and in themselves, while maintaining abstinence. It is considered especially important not to shame disclosing patients by rejecting them. Treatment discontinuation should be avoided whenever possible. More research on erotic feelings in behavioral and client-centered psychotherapy is encouraged, as well as ideas for education and training.

The Development of Transference-Focused Psychotherapy and Its Model of Supervision.

Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to meet the needs of patients with personality pathology. As it became more clearly defined through a series of treatment manuals and empirical research, TFP has also come to be considered a conceptual and technical model of therapy that can be used to introduce therapists in training to the principles of psychodynamic psychotherapy in a systematic way. Advanced levels of TFP training and practice involve an emphasis on supervision that is applied in a more structured way than traditional psychodynamic supervision, while respecting the depth and subtlety of psychoanalytic exploration. This article reviews the development of the treatment model and the supervisory process that guides the therapist to carry out TFP in accordance with its proposed mechanism of change.

Empirical Developments in Transference-Focused Psychotherapy.

OBJECTIVE: Transference-focused psychotherapy (TFP) is an empirically supported individualized psychotherapy for patients with borderline personality disorder. This review highlights its development and current status. METHODS: A review of the theoretical background underpinning TFP and empirical advances in the development of TFP provide perspective. RESULTS: Otto Kernberg's object relations model of personality and its implications for assessment and diagnosis of personality disorders are described. The authors review the programmatic research that has been developed and has demonstrated the efficacy of TFP. In view of the empirical studies that have demonstrated the successful outcomes and processes of TFP for patients with borderline personality disorder, compared with other approaches, TFP has been applied to a broader range of difficulties related to patients' self-functioning and interpersonal functioning across the range of severities in personality pathology, consistent with the Alternative DSM-5 Model for Personality Disorders. The authors discuss borderline personality organization in the context of interpersonal, neurocognitive, and self-regulatory dysfunction, including preliminary findings. CONCLUSIONS: The theoretical and empirical advances in TFP lead to future directions for research evaluating personality disorder and its treatment.

Between The Real And The Imaginary: Truth And Lies In The Psychoanalytic Encounter.

When reality is too much to bear, bodymind unity can fracture, creating self-deceptions, distortions, and disguises of emotional experience that amount to unconscious lies. Without clarity regarding what is real and what is imaginary, emotional truth is difficult to discern. Lies disrupt the development of a subjective sense of self, making it difficult to trust sensations, emotions, or thoughts. In the absence of this trust, a patient may form a delusion that they do not exist. Working psychoanalytically with patients traumatized in infancy and early childhood requires the analyst to experience a somatic link between herself and the patient, thereby enabling a process that was inhibited and, in some cases, nearly aborted to resume functioning. Clinical material is presented illustrating a negative hallucination of not existing following an emotional experience that could not be borne as well as bodymind dissociation that separated the patient's psychic pain from her childhood narrative. The author concludes that these methods of coping with trauma prevent the grieving necessary for truth to become bearable and the mind to grow.

Raw Object Identification.

This paper attempts to deal with a specific kind of pathological identification-"raw object identification"-which tends to appear as concrete physiological phenomena, trying to escape meaning and integration. These somatic manifestations stem from early traumatic experiences with a meaningful object and entrap-as revealed through analysis-specific significant qualities of that object. A massive splitting ensues between body and mind, self and object, relation and identification. Certain properties of the object are then experienced as a foreign body in the subject and are defensively identified with. Thus, raw object identification is often manifested in stubborn bodily symptoms.

Money Matters in Psychiatric Assessment, Case Formulation, Treatment Planning, and Ongoing Psychotherapy: Clinical Psychoeconomics.

ABSTRACT: Trainees often receive little guidance concerning money matters in patients' lives and treatment, that is, clinical psycho-economics. Accordingly, this article considers: a) practical approaches to inquiring about intrapsychic and interpersonal influences of money matters pertinent to psychiatric assessment; b) how money matters should impact case formulation; c) how money matters realistically impact treatment planning; and d) money matters in ongoing psychotherapy affecting transference, countertransference, and clinical supervision. To supplement their clinical experiences, the authors conducted a limited narrative review via PubMed, followed by snowballing for articles of interest. Evidence suggests that money matters influencing intrapsychic and interpersonal lives commonly cause emotional distress, generating a range of dysfunctional behaviors. These reactions manifest as explicit conflicts, implicit issues, and unequivocal money-related pathologies. Clinical vignettes illustrate specific issues. By explicitly addressing money matters in patient's intrapsychic and interpersonal lives, trainees can enrich their assessments, case formulations, treatment planning, and ongoing psychotherapy.

Self-constitution and "Infrastructural" Change: An Interdisciplinary Account of Psychoanalytic Action.

Beyond revealing unconscious pathological identifications and traits-including their past usefulness but current toxicity-what techniques in our psychoanalytic practice can lead to change? Radically different from mainstream philosophical views advocating that such undesirable self-aspects should not be endorsed as Self, psychoanalysts hold that these negative traits must instead be understood as part of one's Self. But then what? Investigating concepts from classical conditioning, neuroscience, the philosophy of mind and action, and psychoanalytic practice itself, this article will suggest a preliminary account of the mechanism of action of psychoanalytic work after insight.

[Medication in a transferential sense]. / Medicatie in overdrachtelijke zin.

Pharmacotherapeutic interventions are not always effective. It is argued that by paying attention to the handling of non-pharmacological aspects of the intervention, medication can be used more effectively. Some of those aspects are discussed: the influence of therapeutic relationship, expectations and meanings ascribed to the medication and constellations around medication prescriptions in the transference and countertransference..

Core conflictual relationship theme: the reliability of a simplified scoring procedure.

BACKGROUND: Creating a case formulation is an important and basic skill in psychotherapy meant to guide treatment. A patient's interpersonal pattern is an essential part of a case formulation. Core Conflictual Relationship Theme (CCRT) is a well-known structured method to describe interpersonal patterns. The CCRT method is based on the assumption that humans display a central relationship theme, which is shown in most relationships as well as in the patient-therapist relation. The CCRT scoring is based on how the patient describes interactions with others, in therapy sessions or in a specific interview. These descriptions are transcribed. Raters then score the identified relational episodes by choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. The method has shown high validity and reliability. Inter rater reliability is generally good: Cohen's kappa ranging from 0.55 to 0.70. To decide CCRT pattern from transcribed material is time consuming and labour intensive This study investigates a labour- and timesaving version of the method. METHODS: This study aimed to investigate rater agreement in a simplified method of scoring the CCRT, based directly on live semi-structured dynamic interviews without transcribing the material. Fifty-two patients referred for psychotherapy in a clinical trial, were scored for CCRT pattern. Based on information that came forth during the two-hour interview, raters scored the patients choosing elements from the clustered categories of Wishes, Response from Others and Response from Self. More than one category in each component could be chosen without ranking. Five raters compared two by two were investigated. Inter rater reliability was measured by Cohen's kappa. RESULTS: Mean kappa for Wishes, Response from Others and Response from Self was .33, .41 and .45 respectively. Mean kappa for CCRT in total was .41 among 5 raters. CONCLUSION: In this simplified method to score the CCRT based on oral dynamic interviews, fair to moderate IRR was obtained. TRIAL REGISTRATION: First Experimental Study of Transference-interpretations (FEST307/95). Registration number: ClinicalTrials.gov Identifier: NCT00423462.

Exploring memory function in earthquake trauma survivors with resting-state fMRI and machine learning.

BACKGROUND: Traumatized earthquake survivors may develop poor memory function. Resting-state functional magnetic resonance imaging (rs-fMRI) and machine learning techniques may one day aid the clinical assessment of individual psychiatric patients. This study aims to use machine learning with Rs-fMRI from the perspectives of neurophysiology and neuroimaging to explore the association between it and the individual memory function of trauma survivors. METHODS: Rs-fMRI data was acquired for eighty-nine survivors (male (33%), average age (SD):45.18(6.31) years) of Wenchuan earthquakes in 2008 each of whom was screened by experienced psychiatrists based on the clinician-administered post-traumatic stress disorder (PTSD) scale (CAPS), and their memory function scores were determined by the Wechsler Memory Scale-IV (WMS-IV). We explored which memory function scores were significantly associated with CAPS scores. Using simple multiple kernel learning (MKL), Rs-fMRI was used to predict the memory function scores that were associated with CAPS scores. A support vector machine (SVM) was also used to make classifications in trauma survivors with or without PTSD. RESULTS: Spatial addition (SA), which is defined by spatial working memory function, was negatively correlated with the total CAPS score (r = - 0.22, P = 0.04). The use of simple MKL allowed quantitative association of SA scores with statistically significant accuracy (correlation = 0.28, P = 0.03; mean squared error = 8.36; P = 0.04). The left middle frontal gyrus and the left precuneus contributed the largest proportion to the simple MKL association frame. The SVM could not make a quantitative classification of diagnosis with statistically significant accuracy. LIMITATIONS: The use of the cross-sectional study design after exposure to an earthquake and the leave-one-out cross-validation (LOOCV) increases the risk of overfitting. CONCLUSION: Spontaneous brain activity of the left middle frontal gyrus and the left precuneus acquired by rs-fMRI may be a brain mechanism of visual working memory that is related to PTSD symptoms. Machine learning may be a useful tool in the identification of brain mechanisms of memory impairment in trauma survivors.

When the Assessor's Limits Are Tested: Enactments and the Assessment Frame in Psychological Testing.

Limit testing in psychological assessment is understood typically as a unidirectional technique in which the assessor intentionally introduces a parameter(s) in the service of data gathering by modifying standard procedures. Other parameters are introduced as conflict-based enactments tied to projective identification processes, and represent modifications in the assessment framework. Such modifications, abstracted from the psychotherapy literature, include atypical shifts in the assessor's usual practices concerning fees, scheduling, confidentiality, privacy, anonymity, administrative and technical procedure, and intervention style. In this article, I suggest that most framework modifications, if analyzed, hold the promise of an incremental data yield. These points are illustrated through discussion of (a) the assessment frame, enactments, and projective identification; (b) transference-countertransference interplay in response to frame issues; (c) 2 Rorschach responses that symbolically reflect enactments and projective identification; (d) interaction with coding consultants; (e) configurational analyses of the Rorschach responses; (f) patient-assessor and assessor-consultant parallel processes; and (g) test feedback.

A systematic review of psychodynamic theories in community psychology: Discovering the unconscious in community work.

The aim of this systematic review is to provide a narrative synthesis of the peer-reviewed literature regarding the role of psychodynamics in community psychology. The authors screened 301 records on the topic, found in major citation databases (Scopus and Web of Science) without time or language restrictions. Ten articles addressing the review question were identified, showing the contributions of interpersonal psychoanalysis, Adlerian psychology, the Tavistock psychodynamic model, and Lacanian psychoanalysis. Several points of synergy between community psychology and psychodynamics were outlined mainly concerning empowerment theory, preventative and ecological perspective, power, and social order. Besides, the view on the community life, the role of emotion, and the conceptualization of the unconscious domain are discussed. Implications for community interventions are highlighted, regarding clients' demands, the role of community practitioners, and the use of transference/countertransference in consultative work. Limitations and future directions are also considered.

ON BEING ABLE TO PAINT: THE REVIVAL OF AESTHETIC IMAGINATION THROUGH THE 'DYADIC PSYCHOANALYTIC ARTIST'.

Vera, a middle-aged, bright and skillful mental health professional, consistently maintained throughout the first years of her analysis that she had no imagination and, indeed, exhibited during the early years of work a limited, stunted capacity for truly abstract symbolic thinking, emotional expression and playfulness. I report developments within the fourth year of Vera's psychoanalysis, currently in its eighth year, during which Vera spontaneously began to draw objects, at first copying and eventually drawing from imagination. For a time, Vera was critical of her work, which was actually quite good, and experienced great difficulty acknowledging and appreciating the many internal dimensions and interests that her work revealed. This watershed development required an equally gradual "interpretive welcoming" on the analyst's part so as to contain Vera's transition from preoccupation with concrete, technical aspects of her drawings toward a more mature thirst for the aesthetic, symbolism and play. At some point, analysand and analyst began to play with cognate associations surrounding the Hebrew word for art-o'ma'nut-combined with the image of the nursing mother (o'me'net), and fidelity, trust and faith (e'mu'nah). This creative countertransference enactment eloquently reflected the spectrum of shared transformative aesthetic-imaginative processes within both analytic partners, or the emergence of the dyadic psychoanalytic artist. Discussion elucidates what has been achieved and what remains to be achieved.

Developmental trends in lineup performance: Adolescents are more prone to innocent bystander misidentifications than children and adults.

We tested developmental trends in eyewitness identification in biased and unbiased lineups. Our main interest was adolescent's lineup performance compared with children and adults. 7-10-year-olds, 11-13-year-olds, 14-16-year-olds, and adults (N = 431) watched a wallet-theft-video and subsequently identified the thief, victim, and witness from simultaneous target-present and target-absent six-person photo lineups. The thief-absent lineup included a bystander previously seen in thief proximity. Research on unconscious transference suggested a selection bias toward the bystander in adults and 11-13-year-olds, but not in younger children. Confirming our hypothesis, adolescents were more prone to bystander bias than all other age groups. This may be due to adolescents making more inferential errors than children, as predicted by fuzzy-trace theory and associative-activation theory, combined with lower inhibition control in adolescents compared with adults. We also replicated a clothing bias for all age groups and age-related performance differences in our unbiased lineups. Consistent with previous findings, participants were generally overconfident in their decisions, even though confidence was a better predictor of accuracy in older compared with younger participants. With this study, we show that adolescents have an increased tendency to misidentify an innocent bystander. Continued efforts are needed to disentangle how adolescents in comparison to other age groups perform in forensically relevant situations.

What is the concept of parental 'emotional transference' to children? A Walker and Avant concept analysis.

PROBLEM: Human emotions come from relationships with others, and emotional states can be transferred to others through emotional transfer, leading people to experience identical emotions unconsciously. Emotional transference is not a new concept; however, no concept analysis has been performed on emotional transference from parents to children. ELIGIBILITY CRITERIA: A literature search was conducted of terms related to 'emotional transference', (e.g. 'emotional transfer' and 'affective transference') in the following databases: PubMed, CINAHL, ProQuest, RISS and DBPIA published between 1987 and 2016; documents were published in English or Korean. SAMPLE: Forty-four studies met review criteria. RESULTS: This review highlighted analysis of the concept of emotional transference from parent to child, a unidirectional process. The apparent attributes which are of importance to the child during parental interaction consist of parental expression (facial, voice, postural), child's interpretation of parental emotional expression and child's emotional formation. CONCLUSIONS: Understanding parental emotional transference to children is very important in effecting positive outcomes in the nursing environment. IMPLICATIONS: Nurses need to be aware that parental emotional transference to children and its attributes essential to assessment and intervention. Further study and education are needed to develop nursing care for children.

Repetition Compulsion Revisited in Relational Family Therapy: The Discovery of Old in Order to Develop Something New.

Psychoanalysis has always been full of diversity and controversy, in the theoretical field and especially in the plasticity and variety of its modalities and approaches. Yet all these theories are based on the premise that individuals compulsively repeat their old psycho-organic content, both in their personal lives and in analysis; the premise of Relational Family Therapy is that old emotional, behavioral and bodily complications must first be repeated before being fully processed so that something new can be created.

Sándor Ferenczi, A Classical and Contemporary Psychoanalyst : (with particular reference to transference and countertransference).

The article intends to show how Ferenczi is a genuine precursor for many of the themes which lie at the center of the current psychoanalytic debate and, for this reason, how he is the classical and the contemporary psychoanalyst par excellence, especially by the way he has progressively understood and learnt to operate with the patients focusing on working-through the mutual feelings engendered by the therapeutic process.

WORKING WITH RELIGION: OFTEN NEGLECTED ASPECTS OF TRANSFERENCE AND COUNTERTRANSFERENCE.

The author contends that psychoanalytic theory has generally presented religious beliefs as developmentally immature or pathological. This viewpoint has resulted in a neglect of religion on the part of psychoanalysts and an avoidance of their religious life by patients. Even though there has been an evolution from the traditional Freudian foundational approach to religion as an "illusion" to the inclusion of psychoanalytical training within some Christian institutes and attributions that psychoanalysis, itself, is a religion, religious beliefs should be included in psychotherapy because they can become involved in transference and countertransference issues in ways that are ignored if religious issues are not discussed in therapy. The author presents clinical material to illustrate this problem.

Psychoanalytic psychotherapy and its supervision via videoconference: experience, questions and dilemmas.

The patient lives in Berlin, the therapist in Lisbon and the supervisor in Budapest. Not long ago, continuous psychotherapy and supervision would have been impossible in such a setting. Nowadays, modern communication technologies via the Internet create new possibilities for patients, therapists, and supervisors. However, when we engage in psychoanalytic practice via modern means of telecommunication, we need to examine if the fundamental tenets of the psychoanalytic process are preserved. We need to think about initial assessment, about how we arrange the setting, how we work with transference and countertransference, what kinds of new forms of resistance we are facing and, indeed, how we can recognize new phenomena and handle inevitable problems. In this clinical paper, we tackle these questions in the context of three-times-a-week psychoanalytic psychotherapy.