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Fox-Fliesser, J. (2002). Supportive Psychotherapy for Borderline Patients: A Psychoanalytic Research Perspective Presenter: Ann Halsell Appelbaum, M.D. Discussant: Kenneth N. Levy, Ph.D. Date: February 15, 2001. Am. J. Psychoanal., 62(2):201-202.
   

(2002). American Journal of Psychoanalysis, 62(2):201-202

Scientific Meeting of The American Institute for Psychoanalysis

Supportive Psychotherapy for Borderline Patients: A Psychoanalytic Research Perspective Presenter: Ann Halsell Appelbaum, M.D. Discussant: Kenneth N. Levy, Ph.D. Date: February 15, 2001

Judith Fox-Fliesser, M.D.

Edited by:
Daniel Feld, Psy.D.

Dr. Appelbaum's aim in her presentation was to show that supportive psychotherapy deserves to be considered a treatment used by psychoanalysts and taught in psychoanalytic institutes. She noted that historically, psychoanalysts have considered supportive psychotherapy as a distinct form of treatment, inferior to psychoanalysis. However, she reported that there have been some investigators (she mentioned Robert Wallerstein and Fred Pine) who have felt that supportive psychoanalytic psychotherapy can lead to structural change. On the other hand, Otto Kernberg, following Strachey, holds to the belief that only transference interpretation is mutative. Only empirical research, Appelbaum states, can establish the efficacy of a form of treatment.

A major research project is currently underway to study the effectiveness of the treatment of borderline personality disorder. As one aspect of the research, The Weill Medical College of Cornell University, under the direction of Otto Kernberg and John Clarkin, is studying the psychotherapeutic treatment of borderline personality disorder. Patients are randomly assigned into one of three forms of psychotherapy: (a) Kernberg's Transference Focused Psychotherapy (TFP), (b) Linehan's Dialectical Behavior Therapy (DBT), or (c) Supportive Therapy (“treatment as usual”).

Appelbaum heads the Supportive Therapy component of the research project and with the collaboration of Monica Carsky, has written a treatment manual for it. The task in writing this manual was to operationalize the therapeutic treatment so that researchers watching videotapes of psychotherapy sessions would be able to distinguish it from the other forms of psychotherapy being studied. This meant avoiding transference interpretations and translating abstract concepts into clinically observable behaviors. Appelbaum questioned, if you eliminate transference interpretations, what remains that is mutative in supportive psychotherapy? She hypothesized that the mutative factor is the patient's capacity to form an identification with the therapist.

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