Transference-Focused Psychotherapy for Borderline Patients: Its Possibilities and Limitations from a Psychoanalytic Perspective. Gerhard Dammann, pp.  71-116.

The author describes the rationale for the development of psychotherapy manuals for treating patients with severe pathology. Specifically, he discusses the manual for borderline patients developed by Kernberg and his study group.1 The aim of this group's manual-guided transference-focused psychotherapy is to transform the

borderline's primitive and rigid object relations into more flexible and mature ones. Since externalization and projection of intolerable and unwanted aspects of the self and internal objects onto the therapist occurs regularly and forcefully in this patient population, working in the transference of the here and now allows the therapist to interpret the transferred and distorted aspects of the patient's experience, and thus to gradually modify them.

Dammann describes the risks of such a manual-guided approach—for example, overfocusing on the negative transference to the exclusion of other difficulties (such as dealing with loss or self-object needs), not allowing patients enough room to be active and creative in their treatments, or losing the possibility to intervene psychoanalytically altogether because of too many parameters. He suggests that there is a spectrum of borderline pathology, and that for certain treatment-resistant patients, a more active and confronting approach, as is required by the manual, is likely to be indicated. Dammann notes that therapists seem to have already generally accepted the necessity for parameters in the treatment of this patient population (e.g., greater structure, verbal treatment contracts, and a more active engagement on the part of the therapist).

A manual-guided psychotherapy approach is not designed as a substitute for psychoanalysis, but can serve as a preliminary helpful instrument to get the patient ready to do analytic work in the narrower sense. A psychodynamic manual could,