Narcissism, Paranoia, and Depression in Borderline Patients: Transference and Counter-Transference.

The author advanced theoretical grounding on the process by which pathological narcissism, paranoia, and depression relate to core conflicts, defenses and deficiencies in borderline patients. He reviewed relevant developmental theory, counter-transference theory, and literature on counter-transference with borderline patients, and conceptualized predominant transference/counter-transference paradigms which emerge during psychotherapy with borderline patients. These theoretical considerations on borderline psychodynamics as related to the transference/counter-transference paradigms were explored in a series of structured, videotaped sessions with eleven therapists interviewed about experiences with eleven borderline patients. Content covered diagnostic criteria, patient's developmental history, and transference and counter-transference issues. The videotapes were then coded according to the following subjects: major manifest transference, defended-against transference, patient defenses, therapist defenses, conscious counter-transference, unconscious counter-transference, relationship of transference to patient's current life and developmental history, therapist's style with borderline patients compared with neurotic patients, the affective source of therapist's counter-transference, and the effect of counter-transference on therapeutic outcome. Inter-coder reliability for most of the coding categories was below acceptable st and ards of reliability (mean = .75); operationalizing abstract theoretical constructs reliably without direct clinical examples proved difficult. Consequently, results were limited to descriptive categories of individual case interviews. The eleven cases were assigned to one of the following transference/counter-transference paradigms: (a) liking/idealizing; (b) vigilant/distrustful; (c) limit-setting/distancing; (d) concernful/depressive; and (e) disliking/rageful. Two outst and ing transference paradigms were identified and labeled as paranoid/schizoid and symbiotic transferences. The author discussed therapist and patient characteristics prerequisite to successful resolutions of borderline transference and counter-transference issues, and the development of paranoid/schizoid and symbiotic transferences throughout the course of treatment. He suggested future studies, which would include methodological improvements on this study (with the five transference/counter-transference categories developed in this study serving as coding categories). A future study could utilize group supervision as an aid to management of counter-transference difficulties with borderline patients.PhDClinical psychologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/159253/1/8304566.pd