Is the “favorite person” concept in BPD an empirically-validated thing?

[futureapppsy2]

I’ve recently fallen down the rabbit hole of reading Reddit to see what correct/incorrect mental health stuff is out there, and one thing that seems to be accepted as true is the idea that people with BPD have a “favorite person” who is the focus of their BPD symptoms (splitting, fear of abandonment, etc). I did a quick lit search on this and couldn’t really find anything on it. Is this an empirically validated concept?

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[summerbabe]

I’ve received DBT training from UW people and I’m almost certain this isn’t a formal concept in Linehan’s work since DBT is all about developing the skills to more effectively manage everything that life throws at us.

So fundamentally, DBT wouldn’t differentiate between a one-off interaction with a stranger or somebody with a ‘permanent’ role (parent, child, sig other who doesn’t leave). Sure, it’s probably easier to regulate emotions, tolerate distress and be interpersonally effectively with a stranger than a ‘favorite’ but one would be using the same exact DBT skills to be more skillful in both interaction contexts.

However, if we think about ‘favorite’ relationships in the life of a BPD individual, I think it makes sense that a lot of symptomology might be directed towards a specific person since that person is likely to often elicit intense (unregulated) emotions which creates (ineffective) action urges that could then look like symptoms such as frantic fear of abandonment on repeat.

 

[R. Matey]

If memory serves, I think that observation comes from psychoanalysis. Something about BPD folks employing projective identification as a primary defense against anxiety that is dealt with via transference interpretation. Several rounds of telephone later and the internet calls it "favorite person." Not empirical, but TFT has some some support behind it.

 

[Mercury in Taurus]

I’ve recently fallen down the rabbit hole of reading Reddit to see what correct/incorrect mental health stuff is out there, and one thing that seems to be accepted as true is the idea that people with BPD have a “favorite person” who is the focus of their BPD symptoms (splitting, fear of abandonment, etc). I did a quick lit search on this and couldn’t really find anything on it. Is this an empirically validated concept?

Not familiar with the term “favorite person.” In object-relation, there is this concept of a "good object."

 

[clausewitz2]

I wish I hadn't heard of this concept. A patient of mine is currently living in an interpersonal warzone because two of their housemates and their arguments related to this. apparently, Person A used to be the Favorite Person of Person B but then B developed a new Favorite Person and A was very upset by this and B became their Favorite Person and as you can imagine drama ensues. At no time was Person A or Person B ever romantically interested in each other and the surface-level arguments were explicitly about this Favorite Person status rather than anything else either of them had said or done. All three of the people in this house claim BPD diagnoses as distinct badges of honor. They also all have frequent arguments about which ones of them count as mentally ill which are just as productive as you'd imagine.

I'm pleased that my patient at least is coming around to a viewpoint on their challenges much more in line with the DBT perspective of "you're doing the best you know how to do and you have to do better" rather than "if I declare a particular behavior is because of 'my' BPD then you have to offer unlimited support and validation."

 

[Mercury in Taurus]

I wish I hadn't heard of this concept. A patient of mine is currently living in an interpersonal warzone because two of their housemates and their arguments related to this. apparently, Person A used to be the Favorite Person of Person B but then B developed a new Favorite Person and A was very upset by this and B became their Favorite Person and as you can imagine drama ensues. At no time was Person A or Person B ever romantically interested in each other and the surface-level arguments were explicitly about this Favorite Person status rather than anything else either of them had said or done. All three of the people in this house claim BPD diagnoses as distinct badges of honor. They also all have frequent arguments about which ones of them count as mentally ill which are just as productive as you'd imagine.

I'm pleased that my patient at least is coming around to a viewpoint on their challenges much more in line with the DBT perspective of "you're doing the best you know how to do and you have to do better" rather than "if I declare a particular behavior is because of 'my' BPD then you have to offer unlimited support and validation."

Triangulation is a common strategic that both BPD and NPD use to make their importance more pronounced in interpersonal relationships. For BPD, there is this flavor of "I hate you but don't go away," verses NPD would be acting like they don't need anyone or make the target feel useless or powerless.
If person A used to be the Favorite Person of Person B, and now Person B took new interest in a new Object, there are many possibilities. For BPD traits, maybe Person B got bored and wanted more excitement in relationships by creating this triangle or maybe Person B wants to keep A at a distance where the intensity of the relationship can be tolerated. For NPD traits, it might be a way to express frustration, hurt or disappointment, re-establish the power position, or inflect what Person B is feeling inside. It is also possible that the new Object serves as a Transitional Object. Both BPD and NPD use a Transitional Object to preserve a relationship that serves/meets their needs. When BPD and NPD get bored or get burned with the Transitional Object, they may move on to someone newer and more exciting; however, if developing a relationship with the new Object seems too risky, they would likely go back to the previous Good Object.

I'm pleased that my patient at least is coming around to a viewpoint on their challenges much more in line with the DBT perspective of "you're doing the best you know how to do and you have to do better" rather than "if I declare a particular behavior is because of 'my' BPD then you have to offer unlimited support and validation."

Great insight and it shows willingness to take responsibilities instead of depending upon an Object to help regulate their fluctuating emotions and/or self-worth.

 

[summerbabe]

All three of the people in this house claim BPD diagnoses as distinct badges of honor.

If people aren't able to change maladaptive environments themselves, some in the DBT community believe that we need take an active role in facilitating that change for them. So buckle up and start figuring out how to get this person evicted asap (TOTALLY KIDDING!).

 

[futureapppsy2]

All three of the people in this house claim BPD diagnoses as distinct badges of honor. They also all have frequent arguments about which ones of them count as mentally ill which are just as productive as you'd imagine.

This household must be 24/7 drama.

 

[clausewitz2]

Triangulation is a common strategic that both BPD and NPD use to make their importance more pronounced in interpersonal relationships. For BPD, there is this flavor of "I hate you but don't go away," verses NPD would be acting like they don't need anyone or make the target feel useless or powerless.
If person A used to be the Favorite Person of Person B, and now Person B took new interest in a new Object, there are many possibilities. For BPD traits, maybe Person B got bored and wanted more excitement in relationships by creating this triangle or maybe Person B wants to keep A at a distance where the intensity of the relationship can be tolerated. For NPD traits, it might be a way to express frustration, hurt or disappointment, re-establish the power position, or inflect what Person B is feeling inside. It is also possible that the new Object serves as a Transitional Object. Both BPD and NPD use a Transitional Object to preserve a relationship that serves/meets their needs. When BPD and NPD get bored or get burned with the Transitional Object, they may move on to someone newer and more exciting; however, if developing a relationship with the new Object seems too risky, they would likely go back to the previous Good Object.

I appreciate that explanation in object relations terms and it makes sense. I was more commenting on the fact that who had the label was a point of contention between them.

 

[cara susanna]

I don't know about empirical evidence, but I do know that when my BPD patients are going through the idealization/devaluation process there is usually a specific person involved. I don't see any harm in using a more colloquial term to describe that, unless it reaches the point of ADHD rejection sensitivity dysphoria where people think it's an actual validated thing.

 

[futureapppsy2]

unless it reaches the point of ADHD rejection sensitivity dysphoria where people think it's an actual validated thing.

Oh they definitely do.

 

[futureapppsy2]

I appreciate that explanation in object relations terms and it makes sense. I was more commenting on the fact that who had the label was a point of contention between them.

We just need to bring back MySpace “top friends” to quantify this. 😉

 

[Mindfulpsych22]

I work with pts with BPD and BPD traits of many ages from young teens to pts in their 60s. Just anecdotal, but all the pts I have had who used this term or described this phenomenon were under the age of 25, leading me to hypothesize there is a strong influence of the internet in pts conceptualizing their feelings toward someone this way and that it is correlated with age. I've also had several pts that I have seen on and off for a long time since they were adolescents and now are adults. When the were teens they would talk a lot about things like "favorite person" but don't mention this at all anymore as adults.

 

[matchedandconfused]

Oh they definitely do.

there’s actual research on rejection sensitivity dysphoria though lol

 

[futureapppsy2]

there’s actual research on rejection sensitivity dysphoria though lol

Specifically in the context of ADHD? I would legit be really interested in the references. Thanks!

 

[DynamicDidactic]

I’ve recently fallen down the rabbit hole of reading Reddit to see what correct/incorrect mental health stuff is out there, and one thing that seems to be accepted as true is the idea that people with BPD have a “favorite person” who is the focus of their BPD symptoms (splitting, fear of abandonment, etc). I did a quick lit search on this and couldn’t really find anything on it. Is this an empirically validated concept?

Who is accepting this concept? Clients or practitioners? What kind of practitioners?

As others have mentioned, this is likely an artifact of psychodynamic thinking.

FWIW, I have a very behavioral approach (DBT) and I can see where this comes from. If people were to use a non-empirical approach, they could often see this sort of individual in their life that leads to a lot of interpersonal difficulties yet often the client wavers between loving and hating that individul. It is sort of one of the criteria for the disorder. However, people can easily be diagnosed with BPD without this criteria and without this pattern of interpersonal relationships. Similarly, the entire category of personality disorders is overlapping and I can easily see something similar in potential other diagnoses (even paranoid personality). More importantly, I think the general catch all of interpersonal problems as being key to BPD (and all PDs) is more useful. I don't think it matters much if you are asocial, antisocial, or interpersonally stormy, either way you need help with interpersonal relationships.

I think these concepts and the fact that practitioners have these concepts of disorders is likely more harmful than helpful.

 

[cara susanna]

there’s actual research on rejection sensitivity dysphoria though lol

I haven't seen any research on rejection sensitivity dysphoria. I've only seen research on rejection sensitivity, and not within the context of ADHD.

There's actually an SDNer who apparently researches rejection sensitivity and wasn't familiar with the concept of rejection sensitivity dysphoria in ADHD, either. We had a thread about it.

 

[R. Matey]

I haven't seen any research on rejection sensitivity dysphoria. I've only seen research on rejection sensitivity, and not within the context of ADHD.

There's actually an SDNer who apparently researches rejection sensitivity and wasn't familiar with the concept of rejection sensitivity dysphoria in ADHD, either. We had a thread about it.

ADHD and BPD are commonly co-morbid though so I wonder if people are confusing some of those symptoms for rejection sensitivity dysphoria.

 

[WisNeuro]

ADHD and BPD are commonly co-morbid though so I wonder if people are confusing the fear of abandonment for rejection sensitivity dysphoria, which I'm not entirely convinced is categorically different.

Any more comorbid than other co-occurring disorders, though? Also, while I also think there is some diagnostic overlap and co-occurrence, I was curious about the data, and I'm not sure that cite is the best one to use .

"We searched four databases, referred to the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition, used other relevant literature, and referred to our own clinical experience."

Upon more review, seems it is an opinion review funded by Eli Lilly. I'm sure it has nothing to do with them trying to sell more of one of their several ADHD treatments 🙂

 

[futureapppsy2]

"We searched four databases, referred to the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition, used other relevant literature, and referred to our own clinical experience."

While clinical experience can be an important adjunct to empirical data, this really reads like "and when we couldn't find support for our argument, we said 'we've seen this in clinic, trust us'." 😉

I do think there's an interesting link between ADHD and apparent emotional dysregulation-like behaviors via impulsivity, but there's a considerable difference between that and full-blown BPD or even clinically notable BPD traits.

 

[R. Matey]

Any more comorbid than other co-occurring disorders, though? Also, while I also think there is some diagnostic overlap and co-occurrence, I was curious about the data, and I'm not sure that cite is the best one to use .

Maybe not the best written abstract in the world, but they did review 106 papers between 1974-2013 looking at co-morbidities between ADHD, BPD, and BD and present fairly concise statements about the degree of overlap between symptoms. Here's a quote for your consideration:

"In two studies, 16.1% and 38.1% of adults with BPD had comorbid ADHD19,20. Ferrer et al.20 found that adult patients with BPD could be categorized into two subgroups, based on ADHD comorbidity: patients with comorbid ADHD-BPD had a more homogeneous and impulsive profile, while patients with BPD without ADHD were more likely to have anxiety and depressive disorders. Avoidant personality disorder only affected patients with BPD without ADHD20. It may also be the case that adults with the combined type presentation of ADHD are more likely to have BPD than those with predominantly inattentive presentations of ADHD106, perhaps due to the overall severity of the disorder when the combined presentation of ADHD persists into adulthood. Thus this study suggests that BPD is most often seen in adults with the most severe and persistent forms of ADHD, when both symptom domains persist. Furthermore, emotional instability, a core component of BPD, is strongly linked to the hyperactive/impulsive symptoms of ADHD and therefore more likely to be prominent in patients where significant hyperactivity/impulsivity persists into adulthood107,108. For ADHD and BPD, neuroimaging studies suggest that there may be some shared neurobiological dysfunction, thus a degree of overlap may exist in underlying brain dysfunctions, as well as in symptomatology. For instance, there may be dysfunctions of the prefrontal cortex, a core region for attentional mechanisms and impulse control, and in the orbitofrontal cortex, a core region for impulsivity and emotional control109–113."

I don't know if it's more common than other disorders or not. I certainly wasn't making that claim, or at least not intending to. I don't think everyone with ADHD is claiming RSD either, but it would be interesting to see if this claim occurs more frequently in this crossover. To your point, this review doesn't include borderline in their list of psychiatric comorbidities, but it does include bipolar.

Also they go on to recommend psychotherapy, specifically DBT, for borderline so I'm not sure what being funded by Eli Lilly does to influence that recommendation.

 

[cara susanna]

That makes sense for emotion regulation and impulsivity, but not so much the rejection sensitivity piece. Also, I'm pretty sure rejection sensitivity as it has been studied is different from how the mainstream is defining rejection sensitivity dysphorioa.

 

[R. Matey]

That makes sense for emotion regulation and impulsivity, but not so much the rejection sensitivity piece. Also, I'm pretty sure rejection sensitivity as it has been studied is different from how the mainstream is defining rejection sensitivity dysphorioa.

Indeed. My initial point was the two were often confused.

 

[WisNeuro]

Maybe not the best written abstract in the world, but they did review 106 papers between 1974-2013 looking at co-morbidities between ADHD, BPD, and BD and present fairly concise statements about the degree of overlap between symptoms. Here's a quote for your consideration:

"In two studies, 16.1% and 38.1% of adults with BPD had comorbid ADHD19,20. Ferrer et al.20 found that adult patients with BPD could be categorized into two subgroups, based on ADHD comorbidity: patients with comorbid ADHD-BPD had a more homogeneous and impulsive profile, while patients with BPD without ADHD were more likely to have anxiety and depressive disorders. Avoidant personality disorder only affected patients with BPD without ADHD20. It may also be the case that adults with the combined type presentation of ADHD are more likely to have BPD than those with predominantly inattentive presentations of ADHD106, perhaps due to the overall severity of the disorder when the combined presentation of ADHD persists into adulthood. Thus this study suggests that BPD is most often seen in adults with the most severe and persistent forms of ADHD, when both symptom domains persist. Furthermore, emotional instability, a core component of BPD, is strongly linked to the hyperactive/impulsive symptoms of ADHD and therefore more likely to be prominent in patients where significant hyperactivity/impulsivity persists into adulthood107,108. For ADHD and BPD, neuroimaging studies suggest that there may be some shared neurobiological dysfunction, thus a degree of overlap may exist in underlying brain dysfunctions, as well as in symptomatology. For instance, there may be dysfunctions of the prefrontal cortex, a core region for attentional mechanisms and impulse control, and in the orbitofrontal cortex, a core region for impulsivity and emotional control109–113."

I don't know if it's more common than other disorders or not. I certainly wasn't making that claim, or at least not intending to. I don't think everyone with ADHD is claiming RSD either, but it would be interesting to see if this claim occurs more frequently in this crossover. To your point, this review doesn't include borderline in their list of psychiatric comorbidities, but it does include bipolar.

Also they go on to recommend psychotherapy, specifically DBT, for borderline so I'm not sure what being funded by Eli Lilly does to influence that recommendation.

Fair, I'd want to see how the diagnoses were given in those studies, though. As, we all know the dangers in relying on things like problem lists in large scale data scraping. Just look at the mess that JAMA puts out regarding mTBI and dementia in VA samples.

As for the recommendation of therapy, I'd still contend that Eli Lilly benefits greatly with even implying a linkage in diagnoses through polypharm. I very rarely see psychotherapy recommended for ADHD or ADHD-like symptoms. And, when it is rarely offered, almost every patient chooses the pill vs. the couch.

 

[R. Matey]

Fair, I'd want to see how the diagnoses were given in those studies, though. As, we all know the dangers in relying on things like problem lists in large scale data scraping. Just look at the mess that JAMA puts out regarding mTBI and dementia in VA samples.

As for the recommendation of therapy, I'd still contend that Eli Lilly benefits greatly with even implying a linkage in diagnoses through polypharm. I very rarely see psychotherapy recommended for ADHD or ADHD-like symptoms. And, when it is rarely offered, almost every patient chooses the pill vs. the couch.

You'll get no argument from me on that final point nor your first one given this reviewed is over a period of nearly forty years. Honestly, I was surprised so little had been done.

 

[WisNeuro]

You'll get no argument from me on that final point nor your first one given this reviewed is over a period of nearly forty years. Honestly, I was surprised so little had been done.

Yeah, I am interested in comorbidity and overlap over time, particularly as there has been some significant tweaking of disorders in the DSM over iterations. Historically speaking, comorbidity has been the rule rather than the exception, so I also wonder if some comorbidities are distinct, or related in some way above and beyond the "noise."

 

[R. Matey]

Historically speaking, comorbidity has been the rule rather than the exception, so I also wonder if some comorbidities are distinct, or related in some way above and beyond the "noise."

I don't have much love for the categorical approach either especially considering correlations between some symptom presentations. I've been interested in some of David Barlow's later work, but I know it's a ways out.

 

[Ollie123]

For those not familiar with the HiTOP initiative, it seems relevant here.

About HiTOP | Renaissance School of Medicine at Stony Brook University

Objectives of the Hierarchical Taxonomy of Psychopathology (HiTOP) are to advance the classification of psychopathology to maximize its usefulness for research and clinical practice. The HiTOP aims to address limitations of traditional nosologies, such as the DSM-5 and ICD-10, including...

renaissance.stonybrookmedicine.edu

Noteworthy that both BPD and ADHD load on an "antagonistic externalizing" spectra. Certainly fits with much of what is described above. I haven't dug into the modeling that was done specifically to justify that component of their framework, but this certainly would suggest some overlap between those two above and beyond a "general psychopathology comorbidity" factor.

Full disclosure that I'm a part of this working group (mostly on paper, haven't had a chance to really engage with them yet beyond attending some meetings).

 

[PsyStudent24]

I’ve received DBT training from UW people and I’m almost certain this isn’t a formal concept in Linehan’s work since DBT is all about developing the skills to more effectively manage everything that life throws at us.

So fundamentally, DBT wouldn’t differentiate between a one-off interaction with a stranger or somebody with a ‘permanent’ role (parent, child, sig other who doesn’t leave). Sure, it’s probably easier to regulate emotions, tolerate distress and be interpersonally effectively with a stranger than a ‘favorite’ but one would be using the same exact DBT skills to be more skillful in both interaction contexts.

However, if we think about ‘favorite’ relationships in the life of a BPD individual, I think it makes sense that a lot of symptomology might be directed towards a specific person since that person is likely to often elicit intense (unregulated) emotions which creates (ineffective) action urges that could then look like symptoms such as frantic fear of abandonment on repeat.

The favorite person concept most likely stems from the psychodynamically-oriented theories of BPD. I don’t think it is an empirically validated construct and I’m not sure how this could be tested. However, I do believe that many people with BPD do indeed have a “favorite person” that they cling onto from what I have observed. Those with BPD are typically drawn towards the warm and nurturing individuals as they feel safe around them. As often the case, individuals with BPD will often see the FP as someone who can meet their emotional needs. They will give all of themselves to this individual but eventually feel rejected when the commitment is not reciprocated. Either the FP will eventually cut ties or be rejected when they fail to meet those standards.

The FP is very similar to the interpersonal relationships of those with NPD. Such individuals, especially those in authority will identify someone as a “golden child” who can do absolutely no wrong and a “black sheep” who they often ridicule and demean. These relationships represent extensions of the narcissist’s self representation. The golden child reminds a narcissistic individual of his or her positive or admirable attributes while the black sheep represents the aspects of the vulnerable self such as insecurities or characterological flaws. Those with NPD engage in projective identification with both individuals.

The FP in the context of BPD is someone that they turn to for safety and protection. An FP could be a co-worker, friend, family member, significant other, or even a therapist and will often change depending on the situation.

In other words, I do believe it is an actual phenomenon but most likely would not be considered an empirically validated construct in psychological research.

 

[futureapppsy2]

The favorite person concept most likely stems from the psychodynamically-oriented theories of BPD. I don’t think it is an empirically validated construct and I’m not sure how this could be tested.

Why couldn’t it be studied in some way? I’m always hesitant when people claim that a phenomenon is legitimate but that it just can’t be studied.

 

[PsyStudent24]

Why couldn’t it be studied in some way? I’m always hesitant when people claim that a phenomenon is legitimate but that it just can’t be studied.

Well, a main issue with psychoanalytic/psychodynamic theories is that they cannot be falsifiable through empirical research. Therefore, the concepts cannot be validated or debunked through empirical research. Hence why many psychologists dislike those frameworks. I personally think they can provide a deeper understanding of all individuals especially those with BPD.

 

[R. Matey]

Well, a main issue with psychoanalytic/psychodynamic theories is that they cannot be falsifiable through empirical research. Therefore, the concepts cannot be validated or debunked through empirical research. Hence why many psychologists dislike those frameworks. I personally think they can provide a deeper understanding of all individuals especially those with BPD.

Probably worth mentioning that a few psychoanalytic-lite treatments have enjoyed some success in empirical scrutiny--TLDP, TFT, and IPT come to mind. In fact, Judith Beck herself discusses a few useful strategies from psychoanalysis in her book, Cognitive Therapy for Challenging Problems. I also believe the main quibble from the psychoanalytic community is not the concepts cannot be reliably and validly identified by practitioners and therefore operationalized, but more so that the RCT framework is poorly suited to study the process of psychoanalytic treatment because the protocols aren't as easily standardized as they are in CBT.

 

[PsyStudent24]

Probably worth mentioning that a few psychoanalytic-lite treatments have enjoyed some success in empirical scrutiny--TLDP, TFT, and IPT come to mind. In fact, Judith Beck herself discusses a few useful strategies from psychoanalysis in her book, Cognitive Therapy for Challenging Problems. I also believe the main quibble from the psychoanalytic community is not the concepts cannot be reliably and validly identified by practitioners and therefore operationalized, but more so that the RCT framework is poorly suited to study the process of psychoanalytic treatment because the protocols aren't as easily standardized as they are in CBT.

That makes perfect sense! By IPT, are you referring to interpersonal psychotherapy? Many interpersonally oriented psychologists would say that it isn’t psychoanalytical and more present focused. Those who aren’t often say it’s psychodynamic or object relations without an emphasis on past experiences and relationships.

Regarding the FP concept in BPD, I think it’s more anecdotal but fairly common in this population given the tendency to quickly latch onto people.

 

[R. Matey]

That makes perfect sense! By IPT, are you referring to interpersonal psychotherapy? Many interpersonally oriented psychologists would say that it isn’t psychoanalytical and more present focused. Those who aren’t often say it’s psychodynamic or object relations without an emphasis on past experiences and relationships.

The concepts in IPT come from blending psychoanalytic and attachment theory.

Regarding the FP concept in BPD, I think it’s more anecdotal but fairly common in this population given the tendency to quickly latch onto people.

I've observed this in my own work with some borderline patients, but I personally think attribute it more to a fear of abandonment and poor emotional regulation than a transference reaction.

 

[futureapppsy2]

Well, a main issue with psychoanalytic/psychodynamic theories is that they cannot be falsifiable through empirical research. Therefore, the concepts cannot be validated or debunked through empirical research. Hence why many psychologists dislike those frameworks. I personally think they can provide a deeper understanding of all individuals especially those with BPD.

I mean, surely it could be studied through qualitative research, mixed methods research, correlational research, etc? RCTs aren't the only form of valid or rigorous psychology research or the only form of rigorous research, period.

 

[msc545]

I’ve recently fallen down the rabbit hole of reading Reddit to see what correct/incorrect mental health stuff is out there, and one thing that seems to be accepted as true is the idea that people with BPD have a “favorite person” who is the focus of their BPD symptoms (splitting, fear of abandonment, etc). I did a quick lit search on this and couldn’t really find anything on it. Is this an empirically validated concept?

As far as I can tell, it is not empirically validated, but in my clinical experience the "favorite person" often is actually the "favorite victim".

 

[DynamicDidactic]

Probably worth mentioning that a few psychoanalytic-lite treatments have enjoyed some success in empirical scrutiny--TLDP, TFT, and IPT come to mind. In fact, Judith Beck herself discusses a few useful strategies from psychoanalysis in her book, Cognitive Therapy for Challenging Problems. I also believe the main quibble from the psychoanalytic community is not the concepts cannot be reliably and validly identified by practitioners and therefore operationalized, but more so that the RCT framework is poorly suited to study the process of psychoanalytic treatment because the protocols aren't as easily standardized as they are in CBT.

I think we need to be careful. Studying the efficacy of a psychodynamic treatments is different than studying the concepts of psychodynamic theory.

I mean, surely it could be studied through qualitative research, mixed methods research, correlational research, etc? RCTs aren't the only form of valid or rigorous psychology research or the only form of rigorous research, period.

If asking about the concepts (e.g., the unconscious, this favorite person idea, defense mechanisms, transference) of psychodynamic theory, this can be studied and is studied by some. However, there are many barriers:
1. There are different schools (most prominently: Freudian, Ego Psychology, Object Relations, and Self Psychology) that influence psychodynamic concepts. I am not very knowledgeable about this but I think there is lack of agreement on the concepts from these different perspectives. Even terms like ego and the self are understood differently depending on which school one subscribes to.
Here is a video discussing some of the differences

Ego, Self & Object Relations Theory | Definition & Overview - Video & Lesson Transcript | Study.com

Learn about the self psychology theory. Understand what ego theory is and see its main assumptions. Comprehend key features of the objects...

study.com

A quote from wiki: Ego psychology - Wikipedia

By the 1970s, several challenges to the philosophical, theoretical, and clinical tenets of ego psychology emerged. The most prominent of which were: a "rebellion" led by Rapaport's protégés (George Klein, Robert Holt, Roy Schafer, and Merton Gill); object relations theory; and self psychology.

2. The entire psychodynamic field is built on a dualistic perspective. The Freudian idea of the unconscious mind (the Structural Theory of the Mind), which is adopted by all of psychodynamic theories (AFAIK), posits that there is a mind that influences much of human behavior. Let us avoid the libido portions that Freud discussed but more importantly, this mind is relatively inaccessible and thus cannot be measured well. There is seemingly nothing one can do to ever show that the concept of a relatively inaccessible and immeasurable mind (that is metaphorically the size of an iceberg that sunk the Titanic) is not real (falsification). How can I find evidence for or against the mind if I can never test those predictions. Now, this relies on a rather positivistic and Popperian view of science, which is an entirely different discussion and one that is more philosophical. More practically, the idea that there is a mind separate from the brain is very dated and goes against much of what we know from other fields about the natural world.

3. Let us even ignore the dualistic and pseudoscientific aspects of psychodynamic thought. While it is not the only way to study concepts, validated measures are needed (again, I understand there are other way but this is a very common method). These are sorely lacking for psychodynamic concepts.

3a. Often psychodynamic folks criticize CBT research by saying that they only measure symptoms while psychodynamic folks address more than symptoms. Well, what is that they address? In the rare situations when measures are available, they seem to show no difference in outcomes. Here is an example: Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus non-behavioral psychotherapy experts for borderline personality disorder

4. Who is going to pay for this research and who is going to publish this research? Most funding agencies are not interested in funding this type of research. I think most of the journals in this area are below 1 IF. Consequentially, most of academia is not interested in hiring academics in this area (poor funding, low-IF journals can't help). Obviously, there are still some strongholds of psychodynamic thinking but these are becoming less and less available.

5. Psychodynamic/analytical thinking is becoming less and less in the purview of doctoral psychology and more so in master's level practitioners and social work. I say this anecdotally since I am not in the area. I did my internship in Chicago, which is seemingly the stronghold of psychodymanic/analytical thinking in the Midwest. I had numerous supervisors in this area and they reported this movement. One of my supervisors was a faculty at the Chicago Psychoanalytic Institute and said how most of the students are social workers nowadays.

I am also not sure what is the point of this concept. How is this helpful? If a person has problems with interpersonal relationships, they may need help for that. If they do not have problems, then it is not a problem. Meaning, if you have a favorite person and it does not lead to any conflict then let it be. If we studied it more, how would it help us understand BPD or help people (I mean aside from showing that the construct is not reliable or valid).

 

[R. Matey]

I think we need to be careful. Studying the efficacy of a psychodynamic treatments is different than studying the concepts of psychodynamic theory.

Good point, but I think transference is pretty widely accepted.

5. Psychodynamic/analytical thinking is becoming less and less in the purview of doctoral psychology and more so in master's level practitioners and social work. I say this anecdotally since I am not in the area. I did my internship in Chicago, which is seemingly the stronghold of psychodymanic/analytical thinking in the Midwest. I had numerous supervisors in this area and they reported this movement. One of my supervisors was a faculty at the Chicago Psychoanalytic Institute and said how most of the students are social workers nowadays.

Ever been to Boston?

 

[DynamicDidactic]

Good point, but I think transference is pretty widely accepted.

Accepted by whom? As all the defense mechanism, this lacks any serious research into validity and reliability. As mentioned before, how can I even test this concept? How can I ever test whether the emotions a client has towards me are unconsciously misplaced on to me from the client's mother/father/partner? Or, more importantly, why is not more simple to say that they manner in which a person behaves across settings can be consistent. And that when a client gets angry/jealous/anxious at a therapist it really is just an emotion directed at that therapist. Moreover, they also have those emotions in relation to others.

When I was working consistently with individuals diagnosed with BPD, I always considered their anger or praise toward me, whether justified or not, as an example of how they tend to behave with others more globally. I think it would have been less helpful to think that this is just transference from another relationship.

 

[R. Matey]

Accepted by whom?

Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus on mechanism. Current opinion in psychology, 21, 80-85.

Clarkin, J. F., Levy, K. N., & Schiavi, J. M. (2005). Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders. Clinical Neuroscience Research, 4(5-6), 379-386.

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychiatry, 164, 922-928.

Doering, S., Horz, S., Rentrop, M., Fishcer-Kern, M. et al. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. British Journal of Psychiatry, 196, 389-395.

Fried, D., Crits-Christoph, P., & Luborsky, L. (1992). The first empirical demonstration of transference in psychotherapy. The Journal of Nervous and Mental Disease, 180(5), 326–331. The First Empirical Demonstration of Transference in... : The Journal of Nervous and Mental Disease

Gelso, C. J. & Bhatia, A. (2012). Crossing Theoretical Lines. Psychotherapy, 49 (3), 384-390. doi: 10.1037/a0028802.

Gelso, C. J., Kivlighan, D. M., Wine, B., Jones, A., & Friedman, S. C. (1997). Transference, insight, and the course of time-limited therapy. Journal of Counseling Psychology, 44(2), 209–217. APA PsycNet

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658.

Goodman, G. (2013). Is mentalization a common process factor in transference-focused psychotherapy and dialectical behavior therapy sessions? Journal of Psychotherapy Integration, 23(2), 179–192. APA PsycNet

Heim, A. K., & Westen, D. (2005). Transference patterns in the psychotherapy of personality disorders: Empirical investigation. The British Journal of Psychiatry, 186(4), 342-349.

Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. The International Journal of Psychoanalysis, 89(3), 601-620.

Leichsenring, F., & Leibing, E. (2007). Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence. Psychology and Psychotherapy: Theory, Research and Practice, 80(2), 217-228.

Levy, K. N. & Scala, J. W. (2012). Transference, Transference Interpretations, and Transference-Focused Psychotherapies. Psychotherapy, 49 (3), 391-403. doi: 10.1037/a0029371.

Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., & Kernberg, O. F. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of consulting and clinical psychology, 74(6), 1027-1040.

Marmarosh, C. L. (2012). Empirically Supported Perspectives on Transference. Psychotherapy, 49 (3), 364-369. doi: 10.1037/a0028801.

Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J. (2009). The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome. Journal of Counseling Psychology, 56(3), 337–350. APA PsycNet

Ogrodniczuk, J. S., Piper, W. E., Joyce, A. S., & McCallum, M. A. R. Y. (1999). Transference interpretations in short-term dynamic psychotherapy. The Journal of nervous and mental disease, 187(9), 571-578.

Robiner, W. N. (1987). An experimental inquiry into transference roles and age. Psychology and Aging, 2(3), 306–311. APA PsycNet

Suszek, H., Wegner, E., & Maliszewski, N. (2015). Transference and its usefulness in psychotherapy in the light of empirical evidence. Roczniki Psychologiczne, 18(3), 363-380.

Ulberg, R., Hummelen, B., Hersoug, A.G. et al. The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study. BMC Psychiatry 21, 106 (2021). The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study - BMC Psychiatry

Yeomans, F. E., Levy, K. N., & Caligor, E. (2013). Transference-focused psychotherapy. Psychotherapy, 50(3), 449.

Zilcha-Mano, S., McCarthy, K. S., Dinger, U., & Barber, J. P. (2014). To what extent is alliance affected by transference? An empirical exploration. Psychotherapy, 51(3), 424–433. https://doi.org/10.1037/a0036566

As all the defense mechanism, this lacks any serious research into validity and reliability. As mentioned before, how can I even test this concept? How can I ever test whether the emotions a client has towards me are unconsciously misplaced on to me from the client's mother/father/partner? Or, more importantly, why is not more simple to say that they manner in which a person behaves across settings can be consistent. And that when a client gets angry/jealous/anxious at a therapist it really is just an emotion directed at that therapist. Moreover, they also have those emotions in relation to others.

I don't think it's impossible to study, just probably not really a funding priority. As you can see, some evidence exists for transference, but, of course, the science isn't settled. Personally, I think a multitrait-multimethod design would be a great way to study transference if psychometric evidence could be established for observed rated transference scale to be compared with clinician ratings of transference reactions and contrasted with, perhaps, skill deficit ratings. Idk I'm spitballing, but I could probably come up with something if given enough time and money 🙂

AND...to quibble with an earlier point you made: While I do agree that it is important to separate what's efficacious about treatment vs. the underlying mechanisms, you do have content experts operationalizing the concepts in an evidenced based practice. I know we all think of Shapiro when I say that, but from what I understand about TFT, the interventions on the relationship seem to be bulk of the protocol. If we're to generalize beyond transference, than maybe there's something in the sauce about relational interventions as being efficacious. I just got Judith Beck's latest edition of Cognitive Behavior Therapy and even she makes that admission.

 

[DynamicDidactic]

@R. Matey I don't know all the names on there but a lot are familiar. Seemingly, you made my point that mostly the psychodynamic folk accept this concept.

A lot of those citations seem to about treatments that target transference (PS, seemingly no difference based on the Ulberg study).

Looks like Fried, D., Crits-Christoph, P., & Luborsky, L. (1992) provide the first empirical examination of transference. A quick scan of the article seems to indicate nothing more than that people interact with therapists in many of the same ways they interact with others people. Nothing seems to indicate this is a defense mechanism or it is related to the unconscious mind. A much more parsimonious understanding would be that this is learned and is behaviorally consistent across settings/relationships. We can all observe the same behavior but give it different theoretical causes. This seems to be simple behaviorism and not the concept of transference.

To keep us on track, I disagree that the concept of transference is accepted by the majority of the field. That would be simple enough to test (I could be wrong but I imagine it much less accepted in CBT).

AND...to quibble with an earlier point you made: While I do agree that it is important to separate what's efficacious about treatment vs. the underlying mechanisms, you do have content experts operationalizing the concepts in an evidenced based practice. I know we all think of Shapiro when I say that, but from what I understand about TFT, the interventions on the relationship seem to be bulk of the protocol. If we're to generalize beyond transference, than maybe there's something in the sauce about relational interventions as being efficacious. I just got Judith Beck's latest edition of Cognitive Behavior Therapy and even she makes that admission.

You seem to be repeating the same fallacy often used on this forum and in the field. Nothing in CBT ignores the therapeutic relationship. However, the therapeutic relationship is not the lone putative therapeutic mechanism. Here are two of my favorites RCTs indicating that severe problems/disorders require much more than the relationship:

A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa - PubMed

Despite the marked disparity in the number of treatment sessions and the duration of treatment, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology. The findings...

pubmed.ncbi.nlm.nih.gov

Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder

Context Dialectical behavior therapy (DBT) is a treatment for suicidal behavior and borderline personality disorder with well-documented efficacy.Objective To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non–behavioral...

jamanetwork.com

(for this RCT, there is a previously mentioned analyses addressing many of the critiques from the psychodynamic perspective)

Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus non-behavioral psychotherapy experts for borderline personality disorder - PMC

The purpose of the present study was to explore the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Women meeting DSM-IV ...

www.ncbi.nlm.nih.gov

a quote:

The current study provided us with the opportunity to respond to two criticisms of dialectical behavior therapy (DBT) stating that 1) DBT is symptom focused with little to no impact on intrapsychic or personality related factors and 2) behavioral therapies underemphasize the therapeutic relationship.

I am still waiting for the relationship folks to complete a single RCT testing the efficacy of the relationship alone (e.g., no skills, no psychoed) in contrast to say skills that lack any real relationship with a therapist (e.g., an app).

Also, let us not keep going down the pseudoscience wormhole by bring TFT into this discussion.

 

[R. Matey]

Nice straw man. Next time read my posts before you reply to them.

 

[R. Matey]

You seem to be repeating the same fallacy often used on this forum and in the field. Nothing in CBT ignores the therapeutic relationship. However, the therapeutic relationship is not the lone putative therapeutic mechanism. Here are two of my favorites RCTs indicating that severe problems/disorders require much more than the relationship:

Nothing I wrote implies so. Again, please read and ask questions instead of making reactionary assumptions.

To keep us on track, I disagree that the concept of transference is accepted by the majority of the field. That would be simple enough to test (I could be wrong but I imagine it much less accepted in CBT).

Right, so maybe downgrade the level of certainty?

Also, let us not keep going down the pseudoscience wormhole by bring TFT into this discussion.

Calling something pseudoscience doesn't make it so. That's the naming fallacy. Forgive me if I don't just magically believe you. While I am not a TFT practitioner or psychodynamic in the least bit, I do strive to keep an open mind. Division 12 lists TFT as having strong, yet controversial evidence, which means to me there is an ingredient that may be relational given the protocol.

Looks like Fried, D., Crits-Christoph, P., & Luborsky, L. (1992) provide the first empirical examination of transference. A quick scan of the article seems to indicate nothing more than that people interact with therapists in many of the same ways they interact with others people. Nothing seems to indicate this is a defense mechanism or it is related to the unconscious mind. A much more parsimonious understanding would be that this is learned and is behaviorally consistent across settings/relationships. We can all observe the same behavior but give it different theoretical causes. This seems to be simple behaviorism and not the concept of transference.

Ok, but what about the rest of them?

Edit: my basic point is here that it's an area of ongoing research, which means there is acceptance within the community that it's a thing. We can debate all day long the quality of evidence, but the point is that the research is ongoing. Please look at the other papers, which offer empirical conceptualizations of transference before pronouncing judgement based on one article. I imagine you'd encourage your students to do something similar.

 

[WisNeuro]

Ok, but what about the rest of them?

To maybe help narrow down and focus the discussion, which of the articles best examines the concept in a way that best isolates and validates the concept of transference? In essence, is there a sort of dismantling study?

 

[R. Matey]

To maybe help narrow down and focus the discussion, which of the articles best examines the concept in a way that best isolates and validates the concept of transference? In essence, is there a sort of dismantling study?

Searching quickly on google scholar yielded the following paper for dismantling study, but unlike the other ones, I haven't at least skimmed it:

Høglend, P., Dahl, H. S., Hersoug, A. G., Lorentzen, S., & Perry, J. C. (2011). Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders. European Psychiatry, 26(7), 419-424.

Searching quickly, it looks like first author does some research in dismantling in this area.

Høglend, P., Bøgwald, K. P., Amlo, S., Marble, A., Ulberg, R., Sjaastad, M. C., ... & Johansson, P. (2008). Transference interpretations in dynamic psychotherapy: do they really yield sustained effects?. American Journal of Psychiatry, 165(6), 763-771.

Bøgwald, K. P., Høglend, P., & Sørbye, Ø. (1999). Measurement of transference interpretations. The Journal of psychotherapy practice and research, 8(4), 264.

Of the papers I listed in my other post, I'd say the review articles are useful. You'll notice that Psychotherapy did a special section on it in 2012.

Edit: I was just looking for a critical review and couldn't find one, but I'd be open to reading one if someone could post.

 

[PsyStudent24]

Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus on mechanism. Current opinion in psychology, 21, 80-85.

Clarkin, J. F., Levy, K. N., & Schiavi, J. M. (2005). Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders. Clinical Neuroscience Research, 4(5-6), 379-386.

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychiatry, 164, 922-928.

Doering, S., Horz, S., Rentrop, M., Fishcer-Kern, M. et al. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. British Journal of Psychiatry, 196, 389-395.

Fried, D., Crits-Christoph, P., & Luborsky, L. (1992). The first empirical demonstration of transference in psychotherapy. The Journal of Nervous and Mental Disease, 180(5), 326–331. The First Empirical Demonstration of Transference in... : The Journal of Nervous and Mental Disease

Gelso, C. J. & Bhatia, A. (2012). Crossing Theoretical Lines. Psychotherapy, 49 (3), 384-390. doi: 10.1037/a0028802.

Gelso, C. J., Kivlighan, D. M., Wine, B., Jones, A., & Friedman, S. C. (1997). Transference, insight, and the course of time-limited therapy. Journal of Counseling Psychology, 44(2), 209–217. APA PsycNet

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658.

Goodman, G. (2013). Is mentalization a common process factor in transference-focused psychotherapy and dialectical behavior therapy sessions? Journal of Psychotherapy Integration, 23(2), 179–192. APA PsycNet

Heim, A. K., & Westen, D. (2005). Transference patterns in the psychotherapy of personality disorders: Empirical investigation. The British Journal of Psychiatry, 186(4), 342-349.

Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. The International Journal of Psychoanalysis, 89(3), 601-620.

Leichsenring, F., & Leibing, E. (2007). Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence. Psychology and Psychotherapy: Theory, Research and Practice, 80(2), 217-228.

Levy, K. N. & Scala, J. W. (2012). Transference, Transference Interpretations, and Transference-Focused Psychotherapies. Psychotherapy, 49 (3), 391-403. doi: 10.1037/a0029371.

Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., & Kernberg, O. F. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of consulting and clinical psychology, 74(6), 1027-1040.

Marmarosh, C. L. (2012). Empirically Supported Perspectives on Transference. Psychotherapy, 49 (3), 364-369. doi: 10.1037/a0028801.

Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J. (2009). The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome. Journal of Counseling Psychology, 56(3), 337–350. APA PsycNet

Ogrodniczuk, J. S., Piper, W. E., Joyce, A. S., & McCallum, M. A. R. Y. (1999). Transference interpretations in short-term dynamic psychotherapy. The Journal of nervous and mental disease, 187(9), 571-578.

Robiner, W. N. (1987). An experimental inquiry into transference roles and age. Psychology and Aging, 2(3), 306–311. APA PsycNet

Suszek, H., Wegner, E., & Maliszewski, N. (2015). Transference and its usefulness in psychotherapy in the light of empirical evidence. Roczniki Psychologiczne, 18(3), 363-380.

Ulberg, R., Hummelen, B., Hersoug, A.G. et al. The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study. BMC Psychiatry 21, 106 (2021). The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study - BMC Psychiatry

Yeomans, F. E., Levy, K. N., & Caligor, E. (2013). Transference-focused psychotherapy. Psychotherapy, 50(3), 449.

Zilcha-Mano, S., McCarthy, K. S., Dinger, U., & Barber, J. P. (2014). To what extent is alliance affected by transference? An empirical exploration. Psychotherapy, 51(3), 424–433. https://doi.org/10.1037/a0036566



I don't think it's impossible to study, just probably not really a funding priority. As you can see, some evidence exists for transference, but, of course, the science isn't settled. Personally, I think a multitrait-multimethod design would be a great way to study transference if psychometric evidence could be established for observed rated transference scale to be compared with clinician ratings of transference reactions and contrasted with, perhaps, skill deficit ratings. Idk I'm spitballing, but I could probably come up with something if given enough time and money 🙂

AND...to quibble with an earlier point you made: While I do agree that it is important to separate what's efficacious about treatment vs. the underlying mechanisms, you do have content experts operationalizing the concepts in an evidenced based practice. I know we all think of Shapiro when I say that, but from what I understand about TFT, the interventions on the relationship seem to be bulk of the protocol. If we're to generalize beyond transference, than maybe there's something in the sauce about relational interventions as being efficacious. I just got Judith Beck's latest edition of Cognitive Behavior Therapy and even she makes that admission.

I’ve actually read some of those articles. One of the authors of some of the studies is a professor at the university where I completed my undergraduate education and the individual taught one of my courses. The professor has done a great deal of research on the assessment and treatment of borderline personality disorder. I remember the individual supporting the use of psychodynamically-informed treatments for BPD, as these approaches can provide a deeper understanding about the present reality of these patients.

 

[R. Matey]

as these approaches can provide a deeper understanding about the present reality of these patients.

I actually think DBT provides a sufficient case conceptualization of the patient. @DynamicDidactic and I are likely in agreement that CBT is often mischaracterized as being shallow when it's not. My main argument is more that there are other empirical approaches aside from DBT for the treatment of borderline personality disorder currently under study that have some evidence behind them.

 

[WisNeuro]

Searching quickly on google scholar yielded the following paper for dismantling study, but unlike the other ones, I haven't at least skimmed it:

Høglend, P., Dahl, H. S., Hersoug, A. G., Lorentzen, S., & Perry, J. C. (2011). Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders. European Psychiatry, 26(7), 419-424.

Searching quickly, it looks like first author does some research in dismantling in this area.

Høglend, P., Bøgwald, K. P., Amlo, S., Marble, A., Ulberg, R., Sjaastad, M. C., ... & Johansson, P. (2008). Transference interpretations in dynamic psychotherapy: do they really yield sustained effects?. American Journal of Psychiatry, 165(6), 763-771.

Bøgwald, K. P., Høglend, P., & Sørbye, Ø. (1999). Measurement of transference interpretations. The Journal of psychotherapy practice and research, 8(4), 264.

Of the papers I listed in my other post, I'd say the review articles are useful. You'll notice that Psychotherapy did a special section on it in 2012.

Edit: I was just looking for a critical review and couldn't find one, but I'd be open to reading one if someone could post.

Thank you for the narrowing down. Trying to mow through some reports and a few meetings over the next few days, but I'll read through some of those when I can put some directed attention their way.

 

[DynamicDidactic]

If my preceived tone was aggressive or assumptive, I apologize. I typically try to avoid arguing with people online since it rarely leads to any change. I think we generally agree on a lot of issues in mental health. Here are some comments in return.

Nice straw man. Next time read my posts before you reply to them.

I am unsure of what straw man argument you are referring to.

Nothing I wrote implies so. Again, please read and ask questions instead of making reactionary assumptions.

I apologize if I assumed to much and it came off as reactionary. You wrote the following:

maybe there's something in the sauce about relational interventions as being efficacious. I just got Judith Beck's latest edition of Cognitive Behavior Therapy and even she makes that admission.

Were you not referring to the therapeutic relationship? Meaning that those treatments primarily posit that the therapeutic mechanism is via the therapeutic relationship? Even J. Beck admits so... as if the therapeutic relationship is not inherent to most psychological interventions including CBT.

Calling something pseudoscience doesn't make it so. That's the naming fallacy. Forgive me if I don't just magically believe you. While I am not a TFT practitioner or psychodynamic in the least bit, I do strive to keep an open mind. Division 12 lists TFT as having strong, yet controversial evidence, which means to me there is an ingredient that may be relational given the protocol.

You can call it a fallacy (there must be a fallacy of erroneously calling something a fallacy) but TFT is literally the poster child for pseudoscience. While there is no single set of agreed standards for what is science, and then what is pseudoscience, TFT literally addresses almost all of the major elements of pseudoscience. I cannot say it any less strongly than this: if you do not see TFT as pseudoscience than we are living in two very different worlds. The theory of TFT includes the belief in acupoints, which is already a bastardized version of acupuncture, which is itself steeped in pseudoscience. It makes exaggerated claims and does not align with anything else we know about biology or physics (e.g, tapping into bioenergy). I know it is difficult to take my perspective since we are arguing on the internet but read over some of the links below. TFT appears more like a MLM scheme than a science-based treatment.

http://skolenforoverskud.dk/Artikler%20-%20TFT/Artikel%20om%20TFT.pdf

SAGE Journals: Your gateway to world-class research journals

Subscription and open access journals from SAGE Publishing, the world's leading independent academic publisher.

journals.sagepub.com

Response to Disaster

Psychological service in the wake of cataclysmic life events has emerged as a prominent and visible component of social response. This has generated a bandwagon of potential service providers, service approaches, and service venues. Where once help was scarce, it has become plentiful enough to...

books.google.com

Account Suspended

Again, there are few treatments nowadays more pseudoscience-y than TFT. It makes EMDR seem like a golden beacon of science. Fortunately, it is not as harmful as primal scream therapy or attachment therapies like rebirthing but equally pseudoscientific.

I think it important to address the D12 list. Some of those articles are older and do not address the evidence base that TFT has built up since then. To put it simply, it is rather easy to hack an RCT and TFT is great at that. Similarly, while at once useful, the D12 list is really outdated and not a great indicator of science-based treatments, especially in the light of the replication movement.

Making Meaning of Mixed Evidential Value for Research on Empirically Supported Treatments (ESTs) | Society of Clinical Psychology

div12.org

The original article: https://www.apa.org/pubs/journals/features/abn-abn0000421.pdf

But it is important to understand that efficacy trials do not equate to science. Something could be pseudoscientific (e.g., bilateral stimulation of the eyes) and yet be effective (for other reasons). Similarly, TFT may be effective yet be a stain on the psychotherapy landscape for its intense level of pseudoscience (is that too much? 😬).

I again disagree about transference. Perhaps it is a semantic issue. I agree that that transference is a known putative phenomenon rather than an accepted valid phenomenon. At this point, I think we can all agree that Freud's ideas about the libido (e.g.,Oedipus and Electra Complex) are not accepted. Do we agree? Similarly, anything based in the unconscious mind is a dualistic perspective. Generally speaking, that makes it very difficult to accept as valid. If I had to put it in a hierarchy, personally, the favorite person would be more likely than transference (in the psychodynamic sense).

Finally, I too will look over your shorter list in the next few days. However, treatment outcome studies are of low-relevance to this discussion. I am looking for papers that discuss how to validly asses transference as a byproduct of a relatively inaccessible unconscious mind. I do not argue that biology and early environment influence how people behave interpersonally and that those behaviors are consistent across settings, including with a therapist. I argue that this has nothing to do with the unconscious.

 

[R. Matey]

Were you not referring to the therapeutic relationship? Meaning that those treatments primarily posit that the therapeutic mechanism is via the therapeutic relationship? Even J. Beck admits so... as if the therapeutic relationship is not inherent to most psychological interventions including CBT.

I didn't say the therapuetic relationship is the absolute lone mechanism of change to the exclusion of other interventions nor did I say that the therapuetic alliance doesn't exist within CBT. Stop putting me in this category. I said only that it's an ingredient and transference is interesting. Assuming best intentions, then we simply have a misunderstanding. Worst intentions would mean a straw man.

You can call it a fallacy (there must be a fallacy of erroneously calling something a fallacy) but TFT is literally the poster child for pseudoscience. While there is no single set of agreed standards for what is science, and then what is pseudoscience, TFT literally addresses almost all of the major elements of pseudoscience. I cannot say it any less strongly than this: if you do not see TFT as pseudoscience than we are living in two very different worlds. The theory of TFT includes the belief in acupoints, which is already a bastardized version of acupuncture, which is itself steeped in pseudoscience. It makes exaggerated claims and does not align with anything else we know about biology or physics (e.g, tapping into bioenergy). I know it is difficult to take my perspective since we are arguing on the internet but read over some of the links below. TFT appears more like a MLM scheme than a science-based treatment.

So first of all, I'm talking about Transference Focused Therapy, not Thought Field Therapy. If you have even skimmed the list of cites I included in my replies to you and Wis, you would've seen that all of them deal with transference. I especially don't know how you got there considering this tear we are on started with transference. Honestly I'm having serious doubts about people closely reading my posts. As an experiment, I've inserted the word bananas somewhere in this post. Let's see who finds it.

But it is important to understand that efficacy trials do not equate to science. Something could be pseudoscientific (e.g., bilateral stimulation of the eyes) and yet be effective (for other reasons). Similarly, TFT may be effective yet be a stain on the psychotherapy landscape for its intense level of pseudoscience (is that too much? 😬).

Not sure what the point is here. I linked varying degrees of evidence for the phenomena above, including RCTs. Take a look at the cites I posted and get back to me.

I think it important to address the D12 list. Some of those articles are older and do not address the evidence base that TFT has built up since then. To put it simply, it is rather easy to hack an RCT and TFT is great at that. Similarly, while at once useful, the D12 list is really outdated and not a great indicator of science-based treatments, especially in the light of the replication movement.

Don't you think this is moving the goal posts? The same could be said for virtually any psychological concept. Many treatments, including cognitive behavioral ones, are pending reevaluations in light of the replication crisis yet books are still sold and trainings continue to commence every year. In the article you linked, DBT performed poorly across their metrics of evidential value. To be fair, TFT also performed poorly, but it looks like it was due to lack of useable effects, which was the substantial flaw in this meta-analysis given it only retained studies cited by Division 12.

Also from your paper:

"Based on the available evidence, we do not know if there are differences in the level of empirical support for ESTs, and we do not know if ESTs offer benefit beyond that of other bona fide psychotherapies in treating patients with specific diagnoses (p. 507)." I assume you would disagree.

I again disagree about transference. Perhaps it is a semantic issue. I agree that that transference is a known putative phenomenon rather than an accepted valid phenomenon. At this point, I think we can all agree that Freud's ideas about the libido (e.g.,Oedipus and Electra Complex) are not accepted. Do we agree? Similarly, anything based in the unconscious mind is a dualistic perspective. Generally speaking, that makes it very difficult to accept as valid. If I had to put it in a hierarchy, personally, the favorite person would be more likely than transference (in the psychodynamic sense).

Yes, I'm not a Freudian, not even close. I'm primarily a cognitive therapist. But, from what I understand, few practitioners of psychodynamic psychotherapy are pure Freudians.

Finally, I too will look over your shorter list in the next few days. However, treatment outcome studies are of low-relevance to this discussion. I am looking for papers that discuss how to validly asses transference as a byproduct of a relatively inaccessible unconscious mind. I do not argue that biology and early environment influence how people behave interpersonally and that those behaviors are consistent across settings, including with a therapist. I argue that this has nothing to do with the unconscious.

The empirical understanding of transference, from what I've read when I went down this rabbit hole a few days ago, is more that a person can subtly remind a patient or therapist of another person in their lives, which can bias their behavior towards that person (i.e.: Maramarosh, 2012). Personally, I could rationalize it as just another attributional error without all of the psychodynamic mumbo jumbo. That said, it would also follow that addressing it in the relationship as it occurs could correct the distortion.