ABSTRACT
This chapter outlines an integration of cultural difference, race, class, and identity into transference-focused psychotherapy (TFP), a psychoanalytic evidence-based treatment for borderline personality disorder (BPD), using a systemic lens to understand those differences within a context of socioeconomic and political inequality. This inequality – between those psychically and socio-politically configured as “haves” and “have-nots,” the richest and the poorest, oppressor and oppressed – is integrated with the psychoanalytic literature on the impact of race, culture, and inequality on the psyche, with insights from liberation psychology. Liberation psychology, with its emphasis on the dynamics of internalized oppression, is used to outline a “cultural adaptation” of TFP and discuss how reflection on these dynamics can inform psychoanalytic treatment for Latinos and other people of color with BPD in inner-city settings. In delineating this outline, Gaztambide first discusses the question of multicultural competence in the treatment of BPD and what TFP can contribute to this dialogue, followed by a review of TFP’s object-relational formulation of BPD and its approach to treatment. Then he reviews the literature on cultural and racial differences in BPD and makes a link between this literature and emergent theorizing on the role of inequality in the prevalence of BPD. It is here that Gaztambide introduces liberation psychology and develops a psychodynamic formulation of BPD that integrates questions of race, identity, and culture, and further synthesizes this perspective with TFP’s theoretical apparatus and clinical interventions. This chapter ends with a clinical illustration of a culturally adapted form of TFP as it has emerged from the author’s practice in a diverse metropolitan clinical setting serving the Harlem and Upper Manhattan community in New York City.
