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This article will address an aspect of many therapists' practices that is often hidden from view. Therapists sometimes find themselves in impasses where they not only feel that progress is not being made but that they have had lapses in judgment. They report feeling both uncomfortable about their role and unable to extricate themselves from it. As members of a group that specializes in treating patients with personality disorders that have not responded to other approaches, we periodically get calls from therapists with regard to these overwhelming cases.1 While this article will focus on the dynamics and management of these difficult situations rather than on an overall treatment approach, many of the concepts that we apply stem from the object relations-based model, called transference-focused psychotherapy or TFP (Clarkin, Yeomans, & Kernberg, 2006).
The main ingredients of TFP can be described as follows: TFP is based on the clinical view that the symptoms of serious character pathology are manifestations of an underlying psychological structure that suffers from the lack of a coherent and consistent sense of self and others. The internal sense of self and others is built up of different pairings