Managing the clinical encounter with patients with borderline personality disorder in a general psychiatry setting: key contributions from transference-focused psychotherapy

This article describes how the core principles and techniques of transference-focused psychotherapy (TFP) can be used in general psychiatry to help in the management of patients with borderline personality disorder (or other moderate to severe personality disorders). It focuses on: knowledge appreciating how an understanding of object relations assists the clinician in assessment and treatment; attitude - developing a stance to manage the confusing and negative feelings that may arise in both clinician and patient; and skills - describing how use of TFP techniques (technical neutrality, analysing the transference and countertransference, and judicious use of interpretation) helps the clinician to continue thinking in the fraught clinical encounter. The structural (including contemporary object relations) and structured approach in TFP are exemplified in clinical vignettes. LEARNING OBJECTIVES After reading this article you will be able to: Apply an understanding of object relations theory to interactions with patients with Borderline Personality Disorder (BPD) Describe the use of the treatment contract and technical neutrality Understand and better manage the counter-transference in working with patients with BPD