La psychothérapie de patients limites permet souvent d'observer comment les affects intenses, la rage et la destructivité peuvent bloquer l'élaboration de contenus psychiques qui restent confinés aux ...passages à l'acte. Or on observe aussi que dans bien des cas, l'interprétation de la destructivité du patient ne suffit pas ; l'interprétation semble même parfois provoquer un enlisement dans le transfert négatif. Nous croyons qu'il faut en pareille situation s'intéresser à la difficulté du patient limite de
mentaliser - au sens où l'entendent Fonagy et Target - les relations objectales dans le transfert et, en particulier, les relations aux bons objets. Cette difficulté est souvent mal reconnue, bien qu'elle laisse libre cours à la destructivité du patient limite et qu'elle mette en danger la continuation du traitement. Nous expliquons ici comment les interventions thérapeutiques doivent être modulées afin de favoriser le développement de la mentalisation du patient limite. Il nous semble enfin que la mentalisation d'une relation à un bon objet dans le transfert puisse constituer une indication de changements profonds dans la personnalité du patient limite.
Psychotherapy of borderline patients allows us to observe that often, the intense affects, the rage and the lack of good internal objects prevent the mentalization of object relations that are confined to acting-out. Moreover, mentalization deficiency inhibits the experience of relationships with a good object in the transference, which often jeopardizes the continuation of the treatment. It is argued that these dimensions of borderline pathology can be better worked out by closely adjusting therapeutic interventions to the patient's ability to mentalise psychological experiences, particularly with regards to positive transference. We explain our view that the capacity to mentalise in the transference a relationship with a good object is an indication of structural change.
Confronté aux troubles récurrents de la conduite des adolescents, le clinicien a besoin d'instruments fiables, permettant de faire un diagnostic différentiel entre une problématique identitaire et ...une organisation limite. Dans ce contexte, l'étude des dysfonctionnements cognitifs apparaissant dans les tests projectifs peut être particulièrement intéressante. Conjointement au Rorschach et au TAT, nous utilisons les histoires écrites sous induction musicale, qui se sont montrées un instrument fécond du point de vue du diagnostic, de la thérapie et de la recherche. Ces tests font apparaître des facettes complémentaires du dysfonctionnement cognitif lié aux états limites et ont leur place dans une psychothérapie intégrée. Les résultats de l'étude comparative nous font réfléchir sur l'action de la musique comme stimulus de l'imaginaire et ouvrent la voie à une attitude d'optimisme thérapeutique.
When he is confronted with recurrent conduct disorders in adolescents, the clinical psychologist needs reliable tools, allowing him to make a differential diagnostic between the troubles linked to the identity quest and a borderline personality organization. In this context, the study of the disordered thinking appearing in the projective tests may be especially interesting. Together with the Rorschach and the TAT, we use the stories written under musical induction, which have proved to be a prolific tool in diagnosis, therapy and research. These tests reveal complementary features in the disordered thinking of borderline patients and they can be used as a part of an integrated psychotherapy. The results of some comparative studies make think about the action of music as a stimulus of fantasy and invite us to adopt an attitude of therapeutic optimism.
This study examined whether different pathological personality traits (psychopathic, narcissistic, and borderline) moderated the relationship between time in treatment and empathy in a sample of ...incarcerated male sex offenders (N=58). Empathy was explored on a global level as well as on the level of specific victim groups. Principal components analysis with oblique rotation was conducted using three measures of empathy. A three factor solution for empathy was revealed: general empathy, empathy for children and hostility for women. Hierarchical linear regression analyses demonstrated that certain DSM-IV, Axis II personality traits were significant moderators of the effects of time in treatment on levels of general and victim empathy. There was a positive main effect found for length of time in treatment for victim empathy. This effect was much smaller for general empathy. This effect was moderated by pathological personality traits, such that offenders with higher levels of pathological traits did not exhibit greater empathy with more time in treatment. In contrast, offenders with lower levels of pathological traits exhibited increased empathy as treatment length increased. There are direct implications for clinical practice and treatment planning for sex offenders.
Forty-six inpatients were independently diagnosed according to the DSM-III concept of borderline personality disorder, the diagnostic interview for borderlines (DIB) and the concept of borderline ...personality organization, which is linked to Kernbergs structural interview. The interviews were videotaped. Satisfactory inter-rater reliability was demonstrated for the DIB, which furthermore showed high sensitivity and specificity in identifying patients with a clinical DSM-III diagnosis of borderline personality disorder from patients with a other personality disorders or schizophrenic disorders. Discriminant features, demographic profile and earlier treatment history for the patients with a borderline personality disorder are described and discussed. The structural interviews were scored according to a specified format. Inter-rater reliability was satisfactory but not too impressive. Borderline personality organization turned out to be a very broad concept and only half of the patients within this concept received a syndrome diagnosis of borderline personality disorder. A general conclusion was that borderline personality organization should not be considered as a diagnostic entity but rather as a different diagnostic dimension representing an intermediate level of personality structure.
The PCL-R is the primary means of assessing psychopathy in research and forensic practice. However, recent research suggests that supplemental measures of defensive process used in conjunction with ...the PCL-R may better capture the psychopath's internal core. Borderline personality organization and the relationship between defensive process and cognitive style are inextricably linked to psychopath's ability to feel. The use of primitive defenses guides the psychopath's interpersonal style and mediates emotional experience. The relationship between unconscious defensive process and conscious cognitive style is a distinguishing feature of psychopathy within which the unique emotional (and emotionless) experiences of the psychopath can be more fully explored and understood. This paper reviews the literature on the assessment of borderline personality organization in psychopaths offering illustration of expression of primitive defenses in the language of the psychopath. The ways in which psychopaths' verbal and interpersonal expressions of defensive process can be utilized in criminology, criminal justice, and forensic practice are discussed.
The following discussion is based on experience treating borderline patients with the psychoanalytic psychotherapy referred to as transference-focused therapy (TFP) that we have developed at the ...Personality Disorders Institute of the Cornell University Medical College (Clarkin, Yeomans, and Kernberg 1999) . The management of affect storms in the sessions of patients with borderline personality organization and severe regression in the transference presents us with two apparently opposite and yet complementary situations. The first is one in which an open, observable affect storm explodes in the psychotherapeutic setting, usually with an intensely aggressive and demanding quality but also, at times, with
The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to ...analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.
