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Dear Editors
Lesley Murdin's article in the August issue (BJP 25(3): 331-42) and the responses to it in the same issue raise important points about the place of transference-based therapies today.
There are clearly well-grounded concerns amongst those of us practising psychoanalytic psychotherapy as there are two aspects of the current therapy climate in the UK that appear to be quite threatening. As Lesley Murdin's article points out, we have to think about NICE and the guidance it produces, which is drawn from evidence and RCTs which are seen as the gold standard. Then there is the whole Improving Access to Psychological Therapies (IAPT) project which is largely about providing CBT interventions.
There is one area in which there are grounds for optimism about the future of transference-based therapies. For many years now in the United States John Clarkin, Otto Kernberg, Frank Yeomans and colleagues from the Personality Disorders Institute, New York Presbyterian Hospital, have been working with and researching a form of psychodynamic psychotherapy they term Transference-Focused Psychotherapy (TFP). This is a treatment that has shown good results in treating borderline patients and others with severe personality disorders, in particular narcissistic patients.
What is important about Clarkin et al. is they have grasped the nettle of conducting clinical research without compromising their approach. They have produced a book (Clarkin et al., 2006) which outlines the approach. At the heart of the treatment is attention, always, to what is happening in the transference as well as the therapist's countertransference. There is an emphasis on the use of transference interpretations although there is a developmental aspect to this as therapy moves from emphasis on the treatment frame (especially necessary with patients who tend to act out) to clarification of the patient's affect states and confrontation-reflection on contradictory aspects of the material they bring to the sessi