Index

Abstract thinking, and identity diffusion,

42

Acting out

. See also Affect storms

beginning phase of treatment and,

201–202

interpretation of,

53

as priority for intervention,

179

psychopathic transference and,

186–187

therapeutic alliance and,

199

treatment contracts and,

126

treatment techniques and,

144

Active stance, of therapist,

138–141

Acute countertransference reaction,

163

Acute risk,

184–185. See also High-risk behaviors

Adherence, and rating of TFP-A/MACS,

218–219, 220, 221, 224, 228

Adolescence, and adolescents

. See also Borderline personality disorder; Personality disorders

cognitive changes during,

77–78, 145–147

developmental status of as distinct from adults and younger children,

136

different expectations for early and late,

77

legal consent for mental health care and,

117–118

major structural changes in personality of,

29–33

neurobiological changes in,

21–23

object relations theory and personality of,

34–37

separation-individuation process and,

37–44

structural changes in personality and development challenges of,

33–34

therapeutic alliance and,

197–200

treatment contracts and,

113–116, 123–125

use of language during interventions and,

187

Affect regulation, and assessment

of severity of personality pathology, 90. See also Peak affect activation

Affect storms, interventions for management of,

182–183

Age

. See alsoAdolescence; Children

different expectations for adolescents according to,

77

free association technique and,

175

at peak of BPD symptoms,

42

Aggression

assessment of severity of personality pathology and,

85–87

holding environment and,

137

psychopathic transference and,

186–187

therapeutic alliance and,

199–200

Amygdala,

22

Antisocial behavior

in case study,

58, 108

moral functioning and,

89

narcissistic personality disorder and,

54

Anxiety

active stance of therapist and,

144

borderline personality organization and,

81

holding environment and,

136–137

separation-individuation and,

166–171

sexuality and,

172

Arrogance, and psychopathic transference,

186–187

Assessment

. See alsoDiagnosis

case studies of,

58–59, 62–63, 64–65, 67, 101–102, 102–103, 104–110

clinical diagnostic interviewing and,

76–93

components of evaluation process,

68–70

end of treatment and,

211

feedback from,

100–103

main features of,

57–58, 89–93

presentation of evaluation process and,

61–67

procedural adherence and initiation of,

58–59

rationale for evaluation process and,

59–61

severity of personality pathology and,

71–75, 90

standard procedures in,

70–71

Structural Interview and,

93–100

Attachment styles, and attachment

theory holding environment and,

136

risk factors for BPD and,

15–16

sexuality and,

25

Attention-deficit/hyperactivity disorder (ADHD),

9

Australian National Health and Medical Research Council,

4

Authoritarian behavior, by parents,

166

Autonomy

ending of treatment and,

210–211

evaluation process and,

62

Behavior(s)

. See Acting out; Aggression; Antisocial behavior; Authoritarian behavior; Deceptiveness; High-risk behaviors; Self-harm

Behavioral activation, and treatment contract,

117

Blocking, and active work with transference and countertransference,

164

Body image, and assessment of severity of personality pathology,

90

Borderline personality disorder (BPD), in adolescents

. See also Assessment; Case studies; Externalizing symptoms; Internalizing symptoms

age at peak of symptoms,

42

categorical and dimensional approaches to diagnosis of in DSM-5,

5

comorbidity of,

4, 7

contraindications for family therapy and,

184

core features of,

9, 69

depression and,

60

diagnosis of in parents,

14, 91

external reality and,

179

heterogeneous symptoms of,

7–9

impact of diagnosis,

3–4

multiple pathways to,

17–20

prevalence of,

xiii, 5

therapeutic alliance and,

199

varied treatment histories and,

211–212

Borderline personality organization (BPO)

active stance of therapist and,

139

clinical diagnostic interviewing and,

76–89

description of concept,

72

evaluation process and,

102

severity of personality pathology and,

73, 92–93

Structural Interview and,

95, 96, 98

Borderline personality-related characteristics (BPRC),

10–11

BPD

. See Borderline personality disorder

BPO

. See Borderline personality organization

BPRC scale,

17–18

Brain, development of in adolescents,

21–23

Bullying, in case study,

132

Case studies, of TFP-A for borderline personality disorder

of active stance of therapist,

140–141

of assessment,

58–59, 62–63, 64–65, 67, 101–102, 102–103, 104–110

of borderline personality organization,

73–75

of confrontation as treatment technique,

150–152

of free association,

175–177

of holding environment,

137–138

of identity crisis,

41–42, 44

illustrations of TFP-A techniques in,

141–145

of interpretation,

155–159, 160–162

of neurotic personality organization,

75

of parental involvement in treatment,

188–189

of separation-individuation,

38, 166–171

of Structural Interview,

98–100

of suicidality,

8–9

of transference,

16–17

of treatment contracts,

114–116, 118, 124–125, 127–132

of trivialization,

180–181

Categorical approach, to diagnosis of personality disorders in DSM-5,

5

Certified supervisor, and TFP-A/MACS,

218

Change, markers of and transition to middle phase of treatment,

204–205

Checklists, and standard evaluation procedures,

70–71

Child Behavior Checklist (CBCL),

70–71

Children, development status of as distinct from adolescents,

136. See also Development; Neglect; Physical abuse; Sexual abuse

Children in the Community (CIC) Study,

20–21

Chronic countertransference development,

163

Clarification

description of,

51

evaluation process and,

94, 109

interpretation and,

140, 143, 147–148, 150, 153

Cognitive changes

identity formation and,

77–78

interpretative process and,

145–147

Collaboration, with parents,

117–123, 124, 195–197

Collective audience, and egocentrism,

146

Collusion, of parents with adolescent,

196

Commitment, and identity formation,

43

Communication

. See alsoLanguage; Silence

active stance and,

140

beginning phase of treatment and,

200–201

free association and,

174

Comorbidity, of psychiatric disorders evaluation process and,

60, 101

BPD in adolescents and,

4, 7

Competence, and rating of TFP-A/MACS,

218, 220, 221, 224, 228

Conduct disorder (CD),

18

Confidentiality

evaluation process and,

62

interventions and management of,

189

treatment contracts and,

124, 125–126, 128, 129

Conflicts, between parents,

123

Confrontation

evaluation process and,

94, 109

interpretation and,

143, 144, 148–150, 152, 153

purpose of,

51

splitting defenses and,

84–85

Conscience, and severity of personality pathology,

87–88

Contracts, for TFP-A treatment

active participation of patient and,

114–116

agreement on common understanding of problems,

112–113

anticipating and preventing resistance,

116–117, 181

basic elements of,

111

beginning phase of treatment and breaches in,

194

behavioral activation and,

117

collaboration with parents and,

117–123, 124

confidentiality and,

125–126

definition of,

61

developmental tasks and,

117

education of patient about role in treatment,

113–114

establishing “safe” frame for treatment,

116

issues related to abuse or neglect,

130–132

responsibilities of adolescent and,

123–125

review of and recontracting,

132–133

technical neutrality and,

126

therapist errors and reestablishment of treatment frame,

126–130

Contradictions, and confrontation,

148–149, 150, 151, 152

Control, by parents in beginning phase of treatment,

194–195

“Cost consciousness,” of interpretation,

160

Countertransference

. See also Transference-countertransference analysis

active work on in middle phase of treatment,

208–209

defenses and,

84, 85

definition of,

51, 163

evaluation process and,

67

parents and management of,

190

sexuality and management of,

164, 171–172

treatment contracts and,

130

treatment techniques and,

139, 144, 148, 150

Couples therapy, for parents,

123

Culture, and stereotypes,

53

Deceptiveness, as priority for intervention,

179

Defenses

. See also Paranoid defenses;Regression; Splitting

end of treatment and,

211

free association and,

177–178

severity of personality pathology and,

83–85

treatment contracts and,

130

Depression, comorbidity with BPD and treatment for,

60

Detoxification, and substance abuse,

186

Devaluation, of therapist as split object representation,

206

Development

affect of personality disorders on,

31

of brain in adolescents,

21–23

evaluation process and history of,

68

identification and focus on priority theme and,

178–181

identity and,

40–42

moral functioning and,

87–88

precursors and etiological risk factors for BPD,

10–17

structural changes in personality during adolescence and,

33–34

treatment contract and,

117

treatment techniques and,

135–136, 166–171

Diagnosis

. See alsoAssessment

categorical and dimensional approaches to in DSM-5,

5, 6

core features of BPD and,

9

evaluation process and,

109–110

hesitancy of clinicians to diagnose BPD in adolescents,

4

Dimensional approach, to diagnosis of personality disorders in DSM-5,

5, 6

Dissociative reactions, and psychopathic transference,

186, 187

Divorce, impact of on TFP-A treatment,

197

DSM-5

criteria for personality disorders in,

5–6, 72–73

description of BPD in,

69

identity as basic substrate of personality disorders in,

38

Duration, and criteria for diagnosis of personality disorders in children and adolescents,

6

Dynamic principle, of interpretation,

154

Eating disorders

childhood history and symptom profiles of BPD,

19

as complication of TFP-A treatment,

186

severity of personality organization and,

72

Economic principle, and interpretation,

153–154

Education

. See alsoPsychoeducation

end of treatment and improvement in functioning,

211

treatment contract and,

111, 113–114

Egocentrism, as defense,

85, 146

“Ego ideal,” and “ideal ego,”

31

Environmental risk factors, for BPD,

10, 11–16

Equifinality, risk factors for BPD and concept of,

10

Evaluation

. SeeAssessment

Experiential risk factors, for BPD,

10, 11–16

Explanations, and evaluation process,

61–65

Exploration, and identity formation,

43

Extensiveness, and adherence rating of TFP-A/MACS,

219

Externalizing symptoms, of borderline personality disorder

checklists and,

71

mixing of with internalizing symptoms,

6

External reality, as priority for intervention,

179

Extratransferential material

interpretation of,

153

working from to transference in middle phase of treatment,

205–206

Facial expression, of therapist,

139

Family, assessment of functioning,

90, 116. See also Parent(s)

Family history, and evaluation process,

68

Family therapy, contraindications for,

184

Feedback

evaluation process and,

100–103, 109

treatment contract and,

112

Financial issues, and treatment contract,

119, 121, 123

Foreclosure status, and identity formation,

43

Free association

main strategies of TFP-A and,

49, 136

maintaining of as intervention,

173–178

Frequency

adherence rating of TFP-A/MACS and,

219

of meetings with parents,

121–122

Freud, Anna,

30

Freud, Sigmund,

34

Gender

. See also Sexual identity

countertransferences and sexual behavior,

172

identity diffusion versus identity crisis and,

42

pubertal changes and,

23, 24

Genetics, and risk factors for BPD,

10–11, 13

Goals

of evaluation process,

103

identity assessment and,

80–81

of Structural Interview,

97

of TFP-A,

xiv–xvi, 213

Grandiosity

. See also Arrogance evaluation process and,110

narcissism and,

14, 15, 54

Guilt, confronting parental,

189–190

High-risk behaviors

active engagement in management of,

184–185

treatment techniques and,

144

Holding environment, and treatment techniques,

136–138

Home visits, by “third party,”

184

“Hyperbolic” temperament,

11

Hypersensitivity, and parental separation as risk factor for BPD,

20

Ideal ego, and ego ideal,

31

Idealization/devaluation, as defense,

84

Identity

. See also Identity crisis; Identity diffusion; Identity integration;Self

borderline personality organization and,

76, 78–81

developmental aspects of,

40–42

separation-individuation process and,

39–40

Structural Interview and status of,

95

Identity crisis

case study of,

41–42

childhood psychological problems and,

19

core diagnostic features of BPD and,

9

identity diffusion versus,

42–44

Identity diffusion

borderline personality organization and,

78, 81

identity crisis versus,

42–44

object relations theory and,

34

Structural Interview and,

95

Identity integration, and main goals of TFP-A,

49

Identity Status Interview,

43

Illegal activities, and moral functioning,

89

“Imbalance model,” of adolescent brain development,

21

Incompatible realities, and transference-countertransference analysis,

163

Initial crisis, and assessment,

58

Intelligence, and assessment of identity status,

80

Interference, and collaboration with parents,

195–197

Internalizing symptoms, of borderline personality disorder

checklists and,

71

mixing of with externalizing symptoms,

6

International Society of Transference-Focused Psychotherapy (ISTFP),

218

Interpersonal relationships

. See also Social networks

end of treatment and improvement in,

211

evaluation process and,

69

severity of personality pathology and,

82–83, 90, 92–93

Interpretation

evaluation process and,

109

treatment contracts and,

113–114, 133

treatment techniques and,

145–162

Interventions

. See also Treatment techniques

free association and,

173–178

identification of and focus on priority theme and developmental challenges,

178–181

management of resistances and negative therapeutic reactions,

181–187

specific tactics for parents,

187–190

Inventory of Personality Organization— Adolescent Version (IPO-A),

33

Kernberg, Paulina,

xiii, xiv, 3, 32, 71, 83, 138, 160, 213

“Kindling” event, and temperamental risk factors for BPD,

11

Language, use of adolescent’s own,

187. See also Communication

Language disorders, and borderline personality organization,

80

Legal consent, for mental health care of adolescents,

117–118

Life circumstances, changes in and modification of contracts,

133

Limit setting

evaluation process and,

109, 110

technical neutrality and,

165–166

“Looping” technique, and interpretation,

153, 174

Malignant narcissism, and countertransference,

164

Maltreatment, and risk factors for BPD,

11, 12–13, 14–15. See also Neglect; Physical abuse

Mentalization

beginnning phase of treatment and,

200–201

end of treatment and,

211

free association and,

174

interpretation and,

153

use of metaphors and,

32, 160

Metaphors

main strategies of TFP-A and use of,

53

mentalization and,

32, 160–162

Mood disorders, comorbidity of with BPD in adolescents,

4. See also Depression

Moral defense, and issues related to abuse or neglect,

131

Moral functioning, and severity of personality pathology,

87–89

Moratorium status, and identity formation,

43

Mothers, diagnosis of BPD in,

14, 91. See also Parent(s)

Mourning process, comparison of adolescence to,

30

Narcissism

. See also Grandiosity; Malignant narcissism; Narcissistic personality disorder; Narcissistic

transferences

assessment of severity of personality pathology and,

90

case study of in assessment interview,

104–110

maltreatment and,

14–15

sexual behavior and,

172

transference-countertransference analysis and,

162–163

Narcissistic personality disorder,

54

antisocial behavior and,

54

in case studies,

58, 73–75

transference-countertransference analysis and,

163

Narcissistic transferences, and middle phase of treatment,

206

National Institute for Health and Care Excellence (NICE),

4

Negative therapeutic reactions, interventions for management of,

181–187

Neglect

. See also Maltreatment; Physical abuse

as risk factor for BPD,

12

treatment contracts and issues related to,

130–132

treatment techniques and,

144–145

Neurobiology, changes in during adolescence,

21–23

Neurotic personality organization (NPO)

in case study,

75

description of concept,

72

expression of aggression and,

86

interpersonal relationships and,

83

moral functioning and,

88

repression-based defenses and,

85

Structural Interview and,

95, 96

therapeutic alliance and,

198–199

NPO

. See Neurotic personality disorder

Object relations, and object relations theory

main strategies of TFP-A and,

49–50

mothers diagnosed with BPD and,

14

resistance and paranoid transference,

202–203

severity of personality pathology and,

81–83

structural changes in personality during adolescence and,

34–37

Object relations dyads,

34, 35

Omnipotent control, as defense,

84

Oppositional defiant disorder (ODD),

9, 18

PAI

. See Personality Assessment Interview

Paranoid defenses

end of treatment and,

211

regression and,

163

Paranoid transference, and beginning phase of treatment,

202–203

Parent(s)

. See alsoFamily; Mothers authoritarian behavior by, 166

beginning phase of treatment and,

194

collaboration of,

117–123, 124, 195–197

evaluation process and,

61–67, 90–92, 100–103

goals of TFP-A and,

xv

legal consent for mental health care of adolescents,

118

mental illness in as risk factor for adolescent BPD,

20

separation of as risk factor for adolescent BPD,

20

specific tactics concerning,

187–190

split-off object relations and main strategy of TFP-A,

49–50

treatment contracts and,

112–113, 117–123

withdrawal of as risk factor for BPD,

14

Parentification

. See Role reversal

Participation, of adolescent patient in treatment,

114–116

Peak affect activation,

35–36

Personal fable, and egocentrism,

146

Personality

. See also Borderline personality organization; Neurotic personality organization

advanced phase of treatment and consolidation of structure,

210

evaluation process and organization of,

69–70

major structural changes in during adolescence,

29–33

object relations theory and,

34–37

separation-individuation process and,

37–44

structural changes and developmental challenges during adolescence,

33–34

trauma integrated in,

203–204

Personality Assessment Interview (PAI),

93, 94–95, 100, 106

Personality disorders (PD), in adolescence

. See also Assessment; Borderline

personality disorder; Narcissistic personality disorder; Severity

adolescence as critical period for development of,

20–26

affect of on development of adolescent,

31

dissociative reactions and differentiation of from PTSD,

186

DSM-5 criteria for,

5–6

hesitancy of clinicians to diagnose in adolescents,

xiv

identity and,

39

mentalization and,

174

phenomenology of,

3–4

prevalence of in adolescents,

xiii

severity of and assessment,

71–75

Physical abuse

. See also Maltreatment; Neglect

etiology of PDs and,

186

as risk factor for BPD,

12

treatment contracts and issues related to,

130–132

Piaget, Jean,

146

Play, and free association,

175

Posttraumatic stress disorder (PTSD)

dissociative reactions and differentiation of from PDs,

186

sexual abuse and,

20

treatment of,

203

Predictive symptoms, of adolescent BPD,

7

Prefrontal cortex (PFC),

21, 22, 23

Prevalence, of BPD and PDs in adolescents,

xiii, 5

Principal investigator (PI), and research trials on TFP-A,

218

Priority theme, identification of and focus on,

178–181

Projective identification

erotic countertransferences and,

172

interpretation of and main strategies of TFP-A,

53

severity of personality pathology and,

84

Psychoeducation, and treatment of personality disorders in adolescents,

32. See also Evaluation

Psychological structure, and object relations theory,

34

Psychopathic transference, interventions for management of,

183–184

Puberty, and psychopathology in adolescents,

23–24

Rater qualifications, for TFP-A/MACS,

218

Reality testing, and Structural Interview,

96. See also External reality

Reconsideration process, and identity formation,

43

Recontracting, of treatment contracts,

132–133

Reexperiencing, and PTSD,

186

Reflective functioning

advanced phase of treatment and,

209–210

assessment of severity of personality

pathology and,

90

formal operational reasoning and,

32

Structural Interview and,

95

Reflective loop, and free association,

174

Rehabilitation, and substance abuse,

186

Repression, and defenses,

85

Research assistant, and TFP-A/MACS,

216

Resilience, and core diagnostic features of BPD,

9

Resistance

beginnning phase of treatment and,

202–203

concepts of “ideal ego” and “ego ideal,”

31

evaluation process and,

65–67

free association and,

177–178

interventions for management of,

181–187

parents and,

91

treatment contract and anticipation or prevention of,

116–117

Responsibility

evaluation process and,

62

treatment contract and parental,

121

Rigidity/inhibition, and assessment of severity of personality pathology,

90

Risk factors, for development of BPD,

10–17. See also High-risk behaviors

Role reversals

diagnosis of BPD in mother and,

14

holding environment and,

138

narcissism and,

15

self representation and,

50–51

“Safe frame” for treatment,

116

Safety, and expectations about confidentiality,

128. See also Self-harm; Suicide

Scaffolding

clinical diagnostic interviewing and,

82

holding environment and,

137

Schedule for Affective Disorders and

Schizophrenia for School-Age

Children (K-SADS),

70

Secondary gain

anxiety and,

172

confrontation as treatment technique and,

149

treatment contract and,

54–55

Secrets, and psychopathic transference,

183–184

Self

. See also Identity

developmentally informed interventions

for integration of sexuality in,

171–172

integrated concept of,

35–36

separation-individuation process and core sense of,

37

Self-awareness, and advanced phase of treatment,

209

Self-esteem, as risk factor for adolescent BPD,

19

Self-harm

. See also Suicide

BPD as predictor of,

7

severity of personality organization and,

72

symptom profiles of BPD and,

19

treatment contracts and,

124, 125

Self representation, and split-off object relations,

50

Semi-structured interviews,

69, 70, 93

Separation-individuation

anxiety and,

166–171

development of personality during adolescence and,

37–44

Severity, of personality pathology

aggression and,

85–87

assessment of,

71–75, 90

defenses and,

83–85

identity status and,

78–81

moral functioning,

87–89

object relations and,

81–83

Sexual abuse

etiology of severe PDs and,

186

as risk factor for BPD,

12, 13, 19–20, 25

trauma integrated in personality and,

203–204

treatment contracts and issues related to,

130–132

Sexual identity

risk factors for BPD and,

20

as source of conflict in adolescence,

26

Sexuality

. See also Sexual abuse; Sexual identity; Sexual orientation

assessment of severity of personality

pathology and,

90

countertransference and,

164, 171–172

developmentally informed interventions and,

171–172

development of moral functioning and,

88

development of personality disorders in adolescents and,

24–26

interventions for high-risk behavior,

185–186

Sexual orientation, as source of conflict in adolescence,

26

Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A),

17

Silence, as form of resistance,

182, 202–203

Social networks, and attachment styles,

16. See also Interpersonal

relationships

Social workers, and home visits,

184

Splitting

acting out and,

183

integration of in middle phase of treatment,

206–207

severity of personality pathology and,

84–85

Stereotypes, and interpretation of transference developments,

53

Stern, Daniel,

15

Stigmatization, of adolescents with personality disorders,

xiii–xiv

Stimulation, and free association,

174

Structural Interview (SI),

69, 93, 94–96, 97–98, 100, 106. See also Semi-structured interviews

Structural principle, of interpretation,

154–155

Substance use

as complication of TFP-A treatment,

186

relationships with peers and,

92

Suicide, and suicidal behavior

BPD as predictor of,

7

interventions for,

185

treatment contracts and,

116, 124, 126

Support systems, and evaluation process,

68–69. See also Social networks

Symptoms

. See Externalizing symptoms; Internalizing symptoms; Predictive symptoms

Tactics

. SeeInterventions

Technical neutrality

definition of,

54

treatment contracts and,

120–121, 126

treatment techniques and,

164–166

Temperament, and risk factors for BPD,

10, 11

Termination, of TFP-A treatment,

210–212, 228

TFP-A

. See Transference-Focused Psychotherapy for Adolescents

TFP-A Manual Adherence and Competence Scale (TFP-A/MACS),

217–230

Therapeutic alliances

collaboration with parents and,

195

forging of with adolescent,

197–200

Therapists

ability of to tolerate uncertainty,

202

active stance of,

138–141

creation of holding environment by,

137

errors of and reestablishment of treatment frame,

126–130

rating of competence and skill level in TFP-A/MACS,

220

Timeliness, of interpretation,

159–160

Transference

. See also Narcissistic transference; Paranoid transference; Psychopathic transference; Transference-Focused Psychotherapy; Transference-Focused Psychotherapy for Adolescents

attachment styles and,

16–17

main strategies of TFP-A and,

50–55

working from extratransferential material to in middle phase of treatment,

205–206

Transference-countertransference analysis,

162–164

Transference-Focused Psychotherapy (TFP)

focus of on patients with chronic suicidal behavior,

185

technical differences between TFP-A and,

135

Transference-Focused Psychotherapy for Adolescents (TFP-A)

. See also Adolescence; Assessment; Borderline personality disorder; Case studies; Contracts; Interventions; TFP-A Manual Adherence and Competence Scale; Transference; Treatment techniques

advanced phase of,

209–210

beginning phase of,

193–205

description of,

xi, 213

end of,

210–212

features and goals of,

xiv–xvi, 213

impact of severity judgments on,

72

major goals and strategies of,

49–55

middle phase of,

205–209

organization of manual,

xvi–xviii

parental involvement in,

120–122

Trauma, dealing with integration of in personality,

203–204

Treatment frame

implementation of,

194–195

therapist errors and reestablishment of,

126–130

Treatment techniques, of TFP-A

. See also Interventions

active stance of therapist and,

138–141

developmental differences in,

135–136

developmentally informed,

166–171

holding environment and,

136–138

illustration of,

141–143

interpretation and,

145–162

technical neutrality and,

164–166

transference-countertransference analysis and,

162–164

use of term,

135

Trivialization, as priority for intervention,

179–181

Trust, and issues related to abuse or neglect,

132

Uncertainty, ability of therapist to tolerate,

202

Unidimensional model, of BPD,

7

Ventral striatum,

22, 23

Vulnerable narcissism, and countertransference,

14–15

Work, improvement in functioning and end of treatment,

211

World Health Organization (WHO) Guideline Development Group,

4