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Narcissistic Personality Disorder (NPD) is complex and difficult to treat. Whilst there is no research based evidence for the specific treatment of NPD, there is an evidence base for psychotherapeutic approaches to Borderline Personality Disorder (BPD) which includes Transference Focused Psychotherapy (TFP). TFP is a contemporary object relations approach which has been developed to treat patients with a Borderline Personality Organization, which includes narcissistic personality structures. TFP therefore stands to contribute to the treatment of NPD. We introduce main tenets of TFP, and how TFP views narcissism. We then present a case illustration to illustrate aspects of TFP which are key clinical contributions in treating NPD. These include assessment of personality organization, the treatment contract, transference, countertransference, use of clarification and interpretation, technical neutrality, therapist centered interpretations, the treatment frame and consideration of the stage of treatment [ABSTRACT FROM AUTHOR]

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This meta-analysis synthesizes research on the relation between patient adult attachment style and patient-rated working alliance. A random-effects model was used to calculate the mean weighted product-moment correlation (r) for 24 studies (12 published in peer-reviewed journals and 12 unpublished doctoral dissertations) of individual outpatient therapy with adults. The mean weighted r for attachment avoidance and alliance was −.137, p<.001, and the mean weighted r for attachment anxiety and alliance was −.121, p<.001. These findings suggest that therapists should attend to attachment in order to foster alliance and have additional implications for theory and future research. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to analyze and compare attachment status and mentalization of the comorboid narcissistic personality disorder (NPD) and borderline personality disorder (BPD) patients with the BPD and non-NPD patients following their psychotherapy with transference work. It informs that two randomized clinical trials were used for the treatment of the patients with BPD. The results show significant difference between the patients in terms of attachment.

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy. [ABSTRACT FROM AUTHOR]

A commentary on Dr. Sidney J. Blatt's article, "A Fundamental Polarity in Psychoanalysis: Implications for Personality Development, Psychopathology, and the Therapeutic Process" is presented by articulating Dr. Blatt's significant contribution to psychoanalysis, developmental and attachment theory, and therapeutic process research. According to Blatt's theory, normal maturation involves a complex reciprocal transaction between two developmental lines throughout the life cycle: (a) the establishment of stable, enduring, mutually satisfying interpersonal relationships and (b) the achievement of a differentiated, stable, and cohesive identity. He has applied this theory to understand both normal and pathological psychological phenomena, the latter resulting from disruptions in these developmental lines, resulting in an overemphasis on relational (anaclitic) or self-definitional (introjective) issues. Further, Dr. Blatt has evaluated his theoretical model through empirical study and demonstrated that relationally oriented and self-definitionally oriented persons have differential responses to psychotherapy. Finally, areas of question and potential for future research are outlined. Specifically, it is argued that although anaclitic and introjective configurations are easy to discuss as distinct types, relevant evidence from attachment, theory raises the issue of whether these types may be better conceptualized as dimensions, with different configurations located within two-dimensional space. Further, findings of a group evidencing mixed anaclitic and introjective features raise additional questions about how these configurations relate to one another, and evidence from the attachment literature is used to shed light on this issue. [ABSTRACT FROM AUTHOR]

Describes a psychodynamic treatment modified for patients with severe personality disorders identified as borderline personality disorder. Efficacy of transference-focused psychotherapy (TFP); Utility of various methods to teach the treatment; Comparison of TFP with cognitive-behavioral and supportive treatment.

Discusses psychotherapeutic processes that relate meaningfully to psychotherapeutic outcome for patients with panic disorder undergoing panic-focused psychodynamic psychotherapy. Validity of interactive process assessment; Psychometric properties; Patients' use of ego defenses to avoid frightening affects.

Focuses on importance of attachment behavior of people in psychoanalysis. Types of disorganized attachment; Importance of polarity of attachment and separation in personality development; Developmental levels in avoidant and anxious preoccupied attachment.

AbstractObjective: Previous meta-analyses have shown that client-rated working alliance is negatively correlated with attachment anxiety and attachment avoidance. The purpose of this study is to provide an updated meta-analysis of the relation between alliance and the two dimensions of attachment insecurity. Method: Random effects models were used to examine the relation between the working alliance and attachment anxiety and the relation between the working alliance and attachment avoidance. Results: The overall relation between alliance and attachment anxiety was r = −.09 (p = .01, k = 33, I2 = 43.7%). The overall relation between alliance and attachment avoidance was r = −.13 (p < .001, k = 33, I2 = 44.7%). There was no evidence that these relations varied across study characteristics such as client race or the number of therapists in the study. Conclusion: The results support the negative relations between client-rated alliance and both dimensions of client-rated attachment insecurity. Further research is needed to identify the factors that moderate this relationship, using a more diverse sample of study characteristics and a wider range of measures. [ABSTRACT FROM AUTHOR]