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TFP for Neurotic Personality Organization: Dynamic Psychotherapy for higher level personality pathology (DPHP)

Dynamic Psychotherapy for Higher Level Personality Pathology (DPHP) (Caligor, Kernberg and Clarkin, 2007) is derived from Transference-Focused Psychotherapy (TFP), with modifications introduced to optimize treatment of personality pathology at the healthier end of the spectrum of severity. DPHP is recommended for treatment of better-functioning dependent, histrionic, and narcissistic personality disorders, as well as for obsessive- compulsive, depressive, hysterical and avoidant personality disorders.

Higher level personality pathology is associated with relatively stable and well integrated experiences of self and others, and with a capacity for relationships characterized by mutual dependency and concern. As a result, individuals with higher level personality pathology are often able to function reasonably well, and sometimes very well, in some domains. Nevertheless, higher level personality pathology is associated with internal and external difficulties that bring these individuals to the attention of mental health professionals. In the clinical setting, patients commonly present with problems in their interpersonal and intimate relationships and/or with difficulty living up to their potential in their professional lives. Problems with self-esteem and/or self-criticism, emotional and sexual inhibitions, difficulty coping flexibly with internal and external stressors, as well as symptoms of anxiety and depression are common. DPHP was developed to best meet the clinical needs of these individuals, organized at a neurotic or high borderline level of personality organization using Kernberg’s criteria, and functioning at levels 1 and 2 on the DSM5 Levels of Personality Functioning Scale.

DPHP is an intensive form of psychotherapy in which therapist and patient meet one-on-one. Therapy is typically conducted at a frequency of two sessions per week, and usually lasts from one to three years. The therapist’s stance is active, helping the patient to identify specific treatment goals and then to focus on and explore the psychological conflicts underlying presenting difficulties. The goal of DPHP is personality change, as reflected in patients’ functioning and satisfaction in their interpersonal, intimate and work lives, and improvement in symptomatology. DPHP can be combined with medication management and other specific treatments for affective, anxiety, and eating disorders, which are often comorbid with personality pathology.

Like TFP, DPHP builds on psychodynamic object relations theory, in which internalized images of self and other are seen to organize interpersonal and subjective experience. In higher level personality pathology, views of self and other that are conflictual are largely outside of conscious awareness. In this setting, defensively held views of self and other are rigidly maintained, and come to organize subjective experience. Clinical intervention in DPHP targets personality rigidity. Psychotherapeutic technique focuses on helping patients develop fuller awareness of rigid, defensively held views of self and other, particularly in relation to presenting problems and complaints, to question these views, and to consider alternate perspectives. Focused inquiry on the part of the therapist, combined with a non-judgmental and accepting therapeutic stance, facilitates exploration and working through in the therapy of conflicts underlying defensive views of self and other. As conflictual aspects of experience become conscious the therapist helps the patient tolerate the painful emotions typically associated with such awareness, and to work through the thoughts and feelings that emerge. In this process, conflictual views of self and others come to be better integrated into subjective experience, leading to more flexible and adaptive psychological functioning and to resolution of presenting problems and symptoms.

The goals, strategies, tactics, and techniques of DPHP, along with the underlying theory of personality pathology are clearly described in our manual, Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology.

Reference

Caligor E, Kernberg OF, Clarkin JF (2007). Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology. Washington, DC: American Psychiatric Publishing.

Contact

Eve Caligor, MD, Director, Psychotherapy Division, Columbia University Center for Psychoanalytic Training and Research, Clinical Professor of Psychiatry, NYU School of Medicine, eve.caligor (at) gmail.com