Transference-focused Psychotherapy

Abstract

Transference-focused psychotherapy (TFP) is an evidence-based treatment developed for the treatment of borderline personality disorder (BPD) that has been adapted to treat other personality disorders. This chapter summarizes the theory and practice of TFP and provides an illustrative clinical vignettes. From TFP’s perspective, the central feature of personality disorders is an individual’s lack of an integrated and coherent sense of self. TFP is based on object-relations theory, the branch of psychoanalysis that emphasizes internalized mental representations of the self and of others that are highly charged with affects and determine an individual’s experience and expression of emotional states and conflicts. Personality disorders with a borderline personality organization (BPO) are characterized by internal representations that are rigid, extreme, and split into groupings that have either a total positive, ideal affective charge or those that have a negative one involving aggression, anger, or hatred. BPO stems from a lack of successful psychological maturation, which leaves individuals suffering from affective instability, identity diffusion, splitting-based defenses, impulsive aggression, and difficulty sustaining personal and work relationships. TFP starts with an interview to establish and communicates a clear diagnosis, and an adequate treatment contract. The contract helps contain acting-out and facilitates the exploration of underlying conflicts at the core of the patient’s behavioral problems and sense of distress. TFP offers techniques that help patients gain awareness of unrecognized internal experiences. This empowers the patient to achieve symptom reduction, behavioral control, and psychological integration of a coherent sense of self.