Transference Focused Psychotherapy
Transference Focused Psychotherapy (TFP)
TFP is a treatment for borderline and other severe personality disorders. It was developed in the USA by Dr. Otto Kernberg and colleagues. The model is based on object relations theory. The idea is that people relate to one another and to themselves in terms of object relations dyads. An example of such a dyad might be a person views themselves as weak the other as powerful and the linking affect is one of fear.
A person’s internal world is made up of a number of these dyads and their linking affects. In most people we see a healthy mix of positive dyads alongside more negative ones.
The theory of borderline personality disorder is that patients with this condition are in a position where negative and positive dyads are kept apart and not integrated into the personality as a whole. There is a split in the patient’s internal world that is played out in relationships with others who are experienced as ‘all good’ or ‘all bad’. This split leads to ‘identity diffusion’, a sense of self that is lacking coherence and is often accompanied by chronic feelings of internal emptiness.
All of this can have a disturbing effect on the patient who may experience periods when it is difficult to make sense of their own feelings and those of others.
Dyads can be unconscious but also conscious. They are addressed as the therapy progresses rather than identified and named at the beginning.
Who can benefit?
Patients with a diagnosis of borderline personality disorder can benefit from TFP. It can also be a helpful treatment for patients who have a more Narcissistic Personality Disorder.
Patients need to have a willingness to engage in treatment and a wish to change.
General exclusions
It is not possible to work with patients who have a severe alcohol or substance misuse problem. This would need to be addressed first. The service will work with people over the age of sixteen years.
Patients who present a serious risk of harm to the therapist cannot be worked with as the therapist needs to feel safe.
It is useful for the patient to have had a previous experience of therapy. However this is not essential as it is recognized that short term interventions are not helpful for patients with a borderline personality disorder.
How does it work?
TFP involves a contract between the therapist and patient. This helps create a safe treatment frame in which the therapy can take place. The contract includes things like what to do in a crisis, how to get help, as well as specific aspects such as conditions around alcohol or treatment for self-harm.
In TFP patients are expected to do something that involves contact with others. This might be a training course, voluntary work, or a job. The key thing is the opportunity to mix with others means this can be discussed in the sessions.
TFP emphasizes the use of transference and transference interpretation. This is the idea that the patient’s internal world is expressed in the relationship with the therapist within the boundaries of the treatment contract. Interpretation draws attention to aspects of the patient’s experience that might not be accessible to current awareness. In TFP interpretation is a gradual process beginning with clarification and moving through confrontation which is the process of pointing out to the patient contradictory statements in a way that is meant to stimulate curiosity rather than catch the patient out.
The relationship with the therapist is the key aspect of TFP and the therapist tolerates often very powerfully experienced emotions in a wish to help the patient understand themselves better.