The School of Graduate and Professional Education of DEREE – The American College of Greece will host an engaging workshop for professionals in the field of psychology, featuring the renowned psychotherapist Dr Frank Yeomans. The three-day workshop by Dr Yeomans will focus on “Transference-Focused Psychotherapy: An Evidence-based Treatment for Borderline Personality Disorder,” and will take place on February 12-14 at DEREE.
In the following interview, Dr Yeomans discusses the merits of TFP, as well as what he will cover during the upcoming intensive three-day TFP workshop at DEREE, and his future goals.
Interview with Dr Frank E. Yeomans, MD, PhD
Can you briefly explain the goals and benefits of Transference – Focused Psychotherapy (TFP) and how it differs from other methods when dealing with borderline personalities?
There are a number of evidence-based models of psychotherapy that help bring about symptom change, especially behavioral symptoms such as self-harm. TFP is unique in that it also addresses the psychological structure that, in our opinion, underlies and leads to the symptoms. We see Borderline Personality Disorder (BPD) as a complex disorder that can be best understood as stemming from the lack of an integrated self.
This state, which we refer to as identity diffusion, comes from a combination of biological-temperamental and environmental factors. The individual with identity diffusion does not experience a sense of continuity in their sense of self or of others and is prone to a desperate sense of emptiness accompanied by anxiety and depressive states.
Many patients who have learned to control their symptoms in other treatments come to us saying that they have not been able to find a way to feel good about themselves or enter into deep and intimate relations with others. Our focus on the experience of self and other within the therapeutic settings helps patients become familiar with the dissociated and split off affect states and representations of themselves and of others that constitute their fragmented internal world. After becoming familiar with these internal states, the interpretive process helps patients integrate them into a coherent and whole sense of self and others.
Which types of disorders present the greatest challenge for psychotherapy and why?
0BPD has traditionally been considered very difficult to treat but, with the development of manualized, evidence-based treatments, such as TFP, DBT (Dialectical Behavior Therapy), and MBT (Mentalization-Based Treatment), we know better how to treat those disorders.
The “new frontier” in terms of challenges for therapists is Narcissistic Personality Disorder (NPD). We see NPD as a variant of BPD with a particular structural characteristic that leads to difficulty engaging the patient in successful treatment. We call that structural characteristic the Pathological Grandiose Self. It is a psychological structure that takes all the idealized elements from a fundamentally unintegrated self and combines them into a facsimile of unity that is both fragile and brittle. It is an idealized view of the self that does not correspond to reality.
Therefore, narcissistic patients in general are capable of only very superficial contact with others because any in-depth contact challenges their sense of self. Many of these patients retreat from contact with others into isolated lives. The gap between the self-image and reality can almost seem psychotic in some cases. I believe there is a quiet epidemic of hidden narcissistic cases in the USA.
Apart from borderline personality in which other forms of psychopathology is TFP effective? For instance, could it be applied to anxiety or psychosomatic disorders?
TFP can treat the whole range of personality disorders. We also find that, in contrast to a model of psychopathology that has been prominent in psychiatry for the past decades, many patients who experience anxiety and depressive symptoms suffer from underlying personality pathology. It is very important in assessing a patient to distinguish between biological depression and characterological depression. Dr. Kernberg has a simple phrase: “An affect may be the manifestation of an underlying object relation.” I will discuss that concept in the workshop.
Can we ever talk about long-term recovery from severe personality disorders?
Yes, and in the most successful cases, we can talk about cure from severe personality disorders. Again, this will be discussed in the workshop.
What are some of the common misconceptions about narcissistic personalities? When would a narcissist seek out therapy?
The most common misconception about NPD is that patients always demonstrate overt grandiosity, which is emphasized in the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for NPD. In fact, many patients with NPD have “covert narcissism” or “masochistic narcissism,” which have the same structure as overt narcissism but different presentations.
More overt narcissists seek therapy when there is a problem in their external life that is a mystery to them – for example, their wife saying she is leaving.
More covert narcissists seek therapy because of feelings of depression and anxiety.
More antisocial narcissists seek therapy when their social system (parents or legal system) sends them for treatment.
What personally attracted you to the TFP treatment approach?
What attracted me was the fact that it seeks a full understanding of the person. I find TFP and the object relations theory that it is based on a compelling model for understanding both individuals and also groups and societies.
What does the complete training for TFP entail?
It entails first the type of didactic training that I will be doing in this workshop. The didactic training generally consists of three 3-day workshops separated by at least six months in order to allow the student to assimilate the model. If the student would like to become a certified TFP therapist, they then enter a period of two years of supervision, often in a small group, during which time they need to treat at least two patients for at least a year. This is followed by an oral examination.
To what extent is the TFP method currently practiced in Europe? What can participants expect from the workshop, a first for Greece in TFP?
We have many colleagues in Europe who are practicing and teaching TFP. The countries in which TFP is most practiced are Germany, the Netherlands, Austria, Italy, and Spain. We also have active groups in the United Kingdom, Switzerland, Poland, Denmark, and Turkey. We are beginning to develop a group in Sweden.
Participants in the workshop can expect to be introduced to a model of therapy that can help them improve their treatment of patients with severe personality disorders. They will not be able to learn the model fully from one workshop, but they will learn concepts and techniques that can help them even if they do not practice the model in its full form.
You are such an accomplished professional. Is there something you still want to tackle?
Thank you for your kind words. I would like to find ways to apply what we know about group dynamics to the intense political/social/ethnic conflicts that have always plagued the world. It is very frustrating that our world is so full of conflict and that, while we have ways of understanding the psychological level of group conflicts, it is very hard to put them to any practical use.
Greece is currently in the middle of a major crisis. Does psychoanalysis have the potential to make us happier?
If the source of a person’s anxiety is reality-based concern about adequate food and shelter, it is very difficult to find help from psychoanalysis or any other treatment. That is also the case for young people who have no work and have difficulty imagining a future. Having said that, psychoanalytic principles can help people whose despair is a combination of real circumstances and negative ways of processing material. Certain personality types can worsen the impact of external stressors and individuals with these personalities may benefit from a focused therapy. Psychotherapy cannot make people in misery happy, but it can help the individual deal better with adverse circumstances.
Dr Yeoman’s open lecture “The Treatment Contract in Transference-Focused Psychotherapy: Establishing the Goals and Conditions of Therapy in Treating Patients with Personality Disorders” will be held Thursday, 12 February, 19:00-21:00 at the John S. Bailey Library, Upper Level, Ag. Paraskevi Campus – 6 Gravias Street.
Dr Frank Yeomans’s three-day workshop kicks off on February 12 and is open to all professionals in the fields of individual and group psychotherapy and mental health practice. A Certificate of Participation from the DEREE – School of Graduate & Professional Education & Weill Cornell Medial College will be awarded to participants. The workshop is organized in the framework of the MS Program in Counseling Psychology & Psychotherapy of the DEREE School of Graduate and Professional Education.
To find out more about the MS in Counseling Psychology & Psychotherapy and to register for the spring semester starting March 2, please click here