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

[DynamicDidactic]

Oh thank goodness! What a shy of relief. I think TFT tends to refer to Thought Field Therapy but I guess the psychodynamic world is more foreign to me than the pseudoscientific treatments that seems to be becoming more and more commonplace.

I really thought someone on here actually didn’t find Thought Field Therapy to be quackery. I just didn’t put the two together. I actually never even heard of Transference Focused Psychodynamic Therapy until this thread.

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[DynamicDidactic]

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 think the goal posts always need to be moved. We started at trepanning and keep moving the goals posts until we get to a place where we can show strong efficacy. I do not think we are anywhere close with psychotherapy but better than the 1920's, for sure.

That paper is not meant to be an evaluation of each individual therapy but an evaluation of what studies D12 considers good enough. That paper should not be used as an indicator or any single treatment but the broad evaluation of trials used as evidence for inclusion on the list.

Finally, I am fairly confident what the authors meant by that statement is that their analysis did not look at treatment-by-disorder effects. I have a strong inkling the authors will continue that kind of work and look more specifically at treatments for specific diagnoses. Here is their follow-up:

Google Scholar

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[R. Matey]

Oh thank goodness! What a shy of relief. I think TFT tends to refer to Thought Field Therapy but I guess the psychodynamic world is more foreign to me than the pseudoscientific treatments that seems to be becoming more and more commonplace.

I really thought someone on here actually didn’t find Thought Field Therapy to be quackery. I just didn’t put the two together. I actually never even heard of Transference Focused Psychodynamic Therapy until this thread.

Well, I had never heard of thought field therapy until your last post so I guess that makes two of us. My thirty seconds spent reviewing it just now tells me it's crazy so you'll won't get an argument from me there. Re semantics: I just tried TFT therapy in google and thought field therapy came up. I guess TFP is what the transference people like to use. My mistake.

think the goal posts always need to be moved. We started at trepanning and keep moving the goals posts until we get to a place where we can show strong efficacy. I do not think we are anywhere close with psychotherapy but better than the 1920's, for sure.

You'll get no disagreement from me on this point, but then I think the door swings both ways. I read this review last year in protest of being forced to attend a Barry Duncan webinar. A key conclusion from that review is the overall quality of evidence across both common and specific factors is poor. So if we have to be tentative, can we be less tentative about some treatments compared to others?

That paper is not meant to be an evaluation of each individual therapy but an evaluation of what studies D12 considers good enough. That paper should not be used as an indicator or any single treatment but the broad evaluation of trials used as evidence for inclusion on the list.

Hmmm...not sure about that. The effects are combined by treatment, which suggest to me a rating of the quality of evidence across treatment rather than individual study. Table 2, I think it was, listed the overall effects by treatment across their indices, not by single study. I've never done a meta-analysis though so someone can correct me if I'm getting that wrong.

Finally, I am fairly confident what the authors meant by that statement is that their analysis did not look at treatment-by-disorder effects. I have a strong inkling the authors will continue that kind of work and look more specifically at treatments for specific diagnoses. Here is their follow-up:

Could be. I only skimmed the paper. I downloaded the follow up and I'll take a look at it.

 

[clausewitz2]

but from what I understand about TFT, the interventions on the relationship seem to be bulk of the protocol.

Aggressively so. Check out the mock session videos Frank Yeomans did to accompany the TFP manual (videos 3-8 at the link): APA - Yeomans, Transference-Focused Psychotherapy for Borderline Personality Disorder

One big difference at the view from 10,000 feet in terms of role of therapeutic relationship in TFP v. CBT is that TFP frequently and explicitly involves interventions commenting and drawing attention to what is happening in the room between therapist and client and directly and explicitly conveying elements of the therapists emotional reaction to the client to the client themselves.

This is what some people mean by "relational".


EDIT: As an aside I actually quite like some of these videos because they feature moments of the therapist kind of stumbling and being clumsy and things not quite landing more like actual reality and are not of the "and then I masterfully cured them of all their problems" genre.

 

[Seven_Costanza]

Aggressively so. Check out the mock session videos Frank Yeomans did to accompany the TFP manual (videos 3-8 at the link): APA - Yeomans, Transference-Focused Psychotherapy for Borderline Personality Disorder

One big difference at the view from 10,000 feet in terms of role of therapeutic relationship in TFP v. CBT is that TFP frequently and explicitly involves interventions commenting and drawing attention to what is happening in the room between therapist and client and directly and explicitly conveying elements of the therapists emotional reaction to the client to the client themselves.

This is what some people mean by "relational".


EDIT: As an aside I actually quite like some of these videos because they feature moments of the therapist kind of stumbling and being clumsy and things not quite landing more like actual reality and are not of the "and then I masterfully cured them of all their problems" genre.

Sounds very similar to CBASP which I have found helpful for working with folks with chronic depression.

 

[PsyDr]

Sounds very similar to CBASP which I have found helpful for working with folks with chronic depression.

Why haven't you posted this?!

 

[R. Matey]

EDIT: As an aside I actually quite like some of these videos because they feature moments of the therapist kind of stumbling and being clumsy and things not quite landing more like actual reality and are not of the "and then I masterfully cured them of all their problems" genre.

That makes me like it even more. I can't really stand the self-congratulating hubris found in most psychotherapy training content.

 

[DynamicDidactic]

Hmmm...not sure about that. The effects are combined by treatment, which suggest to me a rating of the quality of evidence across treatment rather than individual study. Table 2, I think it was, listed the overall effects by treatment across their indices, not by single study. I've never done a meta-analysis though so someone can correct me if I'm getting that wrong.

That's because its the way D12 lists them. It was a by-product of the D12 list rather than the goal of the paper. It would also be very limited to view it as a review of any single treatment for any single disorder since those are not anywhere close to exhaustive or representative trials. Which was the major goal of that paper.

I read this review last year in protest of being forced to attend a Barry Duncan webinar. A key conclusion from that review is the overall quality of evidence across both common and specific factors is poor. So if we have to be tentative, can we be less tentative about some treatments compared to others?

I have said this a few times on here but the big difference is that no one in the common factors school has ever (to my knowledge) attempted an RCT to test the effect of any single common factor. A major aspect of science is to try to disconfirm theories and take a risk. It is not outrageous to create a set up where you remove empathy or have no consistent relationship with a therapist compared to therapists that score high on empathy. The fact that the clout these common factors folks have and yet never took the chance, to me, is a thunderous signal.

 

[R. Matey]

That's because its the way D12 lists them. It was a by-product of the D12 list rather than the goal of the paper. It would also be very limited to view it as a review of any single treatment for any single disorder since those are not anywhere close to exhaustive or representative trials. Which was the major goal of that paper.

It's not like they conducted a real search of the literature either, major file drawer problem, IMO.

I have said this a few times on here but the big difference is that no one in the common factors school has ever (to my knowledge) attempted an RCT to test the effect of any single common factor. A major aspect of science is to try to disconfirm theories and take a risk. It is not outrageous to create a set up where you remove empathy or have no consistent relationship with a therapist compared to therapists that score high on empathy. The fact that the clout these common factors folks have and yet never took the chance, to me, is a thunderous signal.

Indeed, the review was a critical review where the authors make similar points to yours. The only difference is they extend their critiques to the statistical weaknesses in the specific factors literature.

Edit: My ask going forward in this discussion is that you at least skim the papers I'm linking prior to replying.

Another Edit: When applied to TFP (not TFT), your argument here is flawed as there are RCTs in the TFP literature (e.g.: RCTs count only for the treatments I have decided are effective a priori).

 

[DynamicDidactic]

Edit: My ask going forward in this discussion is that you at least skim the papers I'm linking prior to replying.

I am very familiar with the Cuijpers paper and have even posted it on this forum before. I'd like to find examples but the search feature isn't working for me.

The only difference is they extend their critiques to the statistical weaknesses in the specific factors literature.

That is why I said: "The big difference" and I could have said more clearly: the big difference between limitations of specific factors and common factors research.

Another Edit: When applied to TFP (not TFT), your argument here is flawed as there are RCTs in the TFP literature (e.g.: RCTs count only for the treatments I have decided are effective a priori).

I am not making any particular argument about the efficacy of TFP since we both just got on the same page about it. My relevant point to TFP is about the psychodynamic concept of transference, not the treatment.

It seems like we are having a real hard time understanding each other in this thread. It may be me since I am in the midst of a semester ending and a child that has been at quarantined at home for over a week. Or, more likely, the internet is not the best way to have these conversations.

 

[R. Matey]

It seems like we are having a real hard time understanding each other in this thread. It may be me since I am in the midst of a semester ending and a child that has been at quarantined at home for over a week. Or, more likely, the internet is not the best way to have these conversations.

My own kiddo was sick last week when I was under a deadline so I can empathize. Maybe it would be better for us both to assume best intentions since history suggests we agree more than we disagree when it comes to conceptualizations of mental health. When you have the time, I'd like to revisit the conversation about transference perhaps in a separate thread.