Donald B. Colson

Transference interpretation in the psychotherapy of borderline patients : a high-risk, high-gain phenomenon

&NA; The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference 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 neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclltic rather than Introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapists difficulty in shifting to a more supportive approach when indicated.

The effect of therapist interventions on the therapeutic alliance with borderline patients.

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

A Reexamination of the Color-Shading Rorschach Test Response and Suicide Attempts

Summary This research adds support to a previous finding that the use of shading in colored areas of the Rorschach plates by hospitalized psychiatric patients is an indicator of suicidal tendencies. The color-shading response occurred significantly more often among patients who had attempted suicide than among those who had not attempted suicide. Speculations about psychological processes that may be involved in the color-shading determinant are offered.

Difficult Patients in Extended Psychiatric Hospitalization: A Research Perspective on the Patient, Staff and Team

A series of publications has emerged from a comprehensive research project on difficulties in extended psychiatric hospital treatment, each of which describes factors that may influence difficulty: staff perceptions, difficult patient profiles, countertransference, intrapsychic features, organic brain impairment, problematic areas of treatment. This paper is intended to provide an overview and clinical integration of those diverse findings and an application of the findings to clinical conceptualization. The research supplements existing knowledge about treatment difficulty and countertransference in dyads by providing information about how such phenomena are influenced by clinical teams, by professional roles or disciplines, and by the treatment delivery system. Finally, I will describe future issues, questions and research efforts that are generated by these findings.

A New Experimental Approach to the Relationship Between Color-Shading and Suicide Attempts

Summary A new experimental approach was devised to increase responses to color and shading, thereby facilitating study of the previously demonstrated relationship between Rorschach Test color-shading responses and suicide attempts. The present study demonstrates that of 17 matched pairs of hospitalized psychiatric patients, those who had attempted suicide give significantly more shading responses to chromatic cards than those who had no history of suicide attempts. These results suggest that the technique may be useful in further studies of affect.

Scales to assess the emphasis of psychiatric hospital treatment.

There are few studies of psychiatric hospital treatment that include measures of the treatment process. Perhaps the greatest neglect exists in the failure to collect from the clinicians their observations about the treatment interventions they most emphasize in each patients treatment. The purpose of this paper is to report the development of a set of rating scales that call on hospital clinical staff to assess the relative prominence of various forms of interventions, namely, degree of restriction, vocational and avocational activities, therapeutic and community groups, medication, degree of supportive versus expressive emphasis and individual psychotherapy. We present a study of interrater reliability in a variety of hospital settings and results of a factor analysis of a portion of the scales.

Child abuse and treatment difficulty in inpatient treatment of children and adolescents.

This study examined the associations between abuse and staff perceived treatment difficulty in sixty-nine hospitalized children and adolescents. Subjects were rated on a treatment difficulty scale, and clinical charts were reviewed for evidence of physical abuse, sexual abuse, abuse between parents, and parental history of abuse. Subjects with histories of abuse were not rated as more difficult or less responsive to treatment than other patients. Physically abused youngsters were rated as more self-destructive and more accessible to treatment than non-abused children, while sexually abused youngsters were self-destructive and demanding, and their families were seen as more distant and unavailable.