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This book is a welcome addition to the library on working with borderline personality disorder (BPD). The emphasis is on what the authors call transference-focused psychotherapy (TFP). Rooted in psychoanalytic thinking, the ambition of the book is to provide ‘a rigorous research methodology and empirical evaluation’. That objective is the strength of the book; in my view it is also its weakness.
TFP is designed for the most difficult patients in the therapist's case-load: patients presenting with BPD. In contrast to say, cognitive behavioural therapy, psychodynamic approaches not only offer symptom relief but also address the underlying structures of the BPD. The authors assert that TFP is a more systematic procedure for psychodynamic work with borderline patients. With that in mind, TFP initially promises to enhance the social and vocational functioning of the patient with BPD, their love lives and their creativity. Once the reader starts to dig deeper into the text, however, such sweeping statements start to be qualified.
The therapeutic treatment and application of TFP is broken down into stages: case selection, the importance of the frame, the development and analysis of the transference; guidelines are given for managing crises, sexual enactments, suicidal presentations and so forth. Indeed, the blurb on the back cover describes the book very well: ‘a remarkable roadmap for clinicians - truly a GPS for TFP that maps the treatment terrain’. In a nutshell, that is this book: it is a manual. Like all manuals, this means it has some useful information but also a lot of limitations.
The main components of BPD are commonly thought of as identity problems, negative relationships, affective instability and self-harm. Where the book is strong is with the excellent description of the internal world of the borderline patient. Psychodynamic conceptualizations have long emphasized that with BPD more needs to be taken into consideration than just the more observable behaviours.