Chapter 8.Early Treatment Phase

In this and the following two chapters, we explore the major issues that arise in the different phases of transference-focused psychotherapy (TFP) and the progressive changes that occur in patients. We can generalize about the major issues that arise in the early, middle, and late phases of treatment; however, individual differences are to be expected among patients across the borderline personality organization (BPO) range as they progress through treatment. To relate the principles of TFP to individual cases, we have chosen to illustrate the interaction of principles and individual patients by following two representative cases across the phases of TFP (Table 8–1). These are composite cases with details changed to protect confidentiality. Because two cases cannot capture all the possible major variations found in patients, we also present examples of other specific clinical situations in the three chapters. Both cases meet the criteria for borderline personality disorder (BPD). Amy is a prototypical patient with low-level BPO at the beginning of treatment. In contrast, Betty, who was introduced in Chapter 4 (“Assessment Phase”), is a prototypical example of high-level BPO, with prominent identity diffusion and isolation but less aggression than Amy. These differences in level of personality organization have an impact on the treatment process in the early phases of treatment, but the differences begin to fade as the goals of treatment are achieved.