Zerbe Aug09
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1) Golden oldies techniques for psychotherapy of borderline personality disorder include addressing failures in separation-individuation and confronting self-defeating behaviors. Interpreting abandonment depression and carefully preparing for breaks in treatment are also important. 2) New mentalization-based treatment approaches employ patient education, groups, and a team approach. The goal is to develop the ability to understand one's own mind and the minds of others to regulate affect and attachment. 3) Therapists using mentalization techniques label thoughts with "I wonder if" statements, use transference tracers to keep patients in the present, and co-create safety plans to anticipate difficulties with control.
Zerbe Aug09
- 1. Psychotherapy of Borderline Personality:Golden Oldies and Some New HitsKathryn J. Zerbe M.D.Training & Supervising AnalystOregon Psychoanalytic CenterFormerly Jack Aron Chair in Womens Mental Health and Psychiatric EducationProfessor of Psychiatry, OHSU
- 2. Golden OldiesFailure of Separation-Individuation in Rapprochement Subphase (Mahler, Pine, Bergman, 1975) Clinical application by Kernberg; Masterson; Rinsley; Aktar
- 3. Confront Self-defeating/self destructive behavior within and outside therapeutic dyadGolden OldiesInterpret 'Abandonment Depression;' Prepare scrupulously for weekend, vacation, between session interruptions.
- 4. Consider Use of Transitional Objects
- 5. Ask the patient what would be helpful and make the choice specific to that patient; Avoid 'e pluribus unum' effect.Golden OldiesGoal of treatment is to identify split object units, perceive others as whole objects. Translates into fewer rapid shifts and eventually moving beyond idealization and devaluation
- 6. Projection, Projective identification, and Psychological
- 7. Protection of Self and Other
- 8. Reduce and eliminate all good/ all bad splitting defense Some New HitsMentalization-Based Treatment(Fonagy, Target, Bateman)Mentalization Therapy employs patient education, groups, team approach.
- 9. Mentalization: An imaginative state of mind that recognizes mind of self and other; Subjectivity and continuity of selfSome New HitsMentalization-Based Treatment(Fonagy, Target, Bateman)Disorganized Attachment (trauma, maltreatment) leads to failure to mentalize and severe problems with affect regulation
- 10. Therapist uses 'stop, listen, look,' and 'stop, rewind, explore' techniques in sessionSome New HitsMentalization-Based Treatment(Fonagy, Target, Bateman)Label with "I wonder if... "statements
- 11. Make Use of Transference Tracers, always in the Here and Now ExamplesI can see that you were upset because I missed our Friday session
- 12. It's understandable to me that you might be anxious, worried, angry... when I wasn't available on Friday because when you were little you were often left alone.....Some New HitsMentalization-Based Treatment(Fonagy, Target, Bateman)The goal is to create consistent narrative.
- 13. Anticipate difficulties in effortful control.
- 14. Co-create a safety plan.
- 15. Explore understanding of others, including therapist Some New HitsMentalization-Based Treatment(Fonagy, Target, Bateman)Examples You are quick to think that I was out of the office on Friday because I was bored with you. Could there be another explanation?
- 16. Can you see that you have made strides over the past year?
- 17. Today you can consider that I am going away for the weekend to l earn at a conference and are not so worried that I am angry with you.AlisvolatpropriisShe flies with her own wings-Motto of the State of Oregon