TRANSFERENCE INTERPRETATION IN THE PSYCHOTHERAPY OF BORDERLINE PATIENTS - A HIGH-RISK, HIGH-GAIN PHENOMENON

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has bee n highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies tha t eschew transference work have been advocated in the literature. We r eview this literature and identify three emerging trends in thought: ( 1) Primarily interpretive approaches should be reserved for patients w ith greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expre ssive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transferenc e interpretation. Our psychotherapy process study revealed that transf erence interpretations tended to have greater impact-both positive and negative-than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologi cally based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic ten dencies, and anaclitic rather than introjective psychopathology are am ong the patient characteristics that influence the impact of transfere nce interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.