Understanding Transference-Focused Psychotherapy (TFP Therapy)

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Table of Contents

The world of clinical psychology utilizes many different modalities of mental disorders treatment which are dependent on the training of the therapist and the specific needs of the client. From traditional psychoanalysis to Behavioral Therapy, and everything in between, there is an effective treatment for most mental health issues and diagnoses.

Transfer-Focused Psychotherapy (TFP) is an evidence-based treatment modality, primarily intended to treat clients with Borderline Personality Disorder (BPD). Clients with BPD often experience difficulty with their interpersonal relationships with, their sense of self, suicide ideation, impulsivity, reckless behavior and more. TFP aims to improve the client’s view of self and others, in more realistic and healthy ways.

In this article we will discuss Borderline Personality Disorder in greater depth, general and treat borderline personality disorder, criteria, how TFP works, supportive data of TFP, and what treatment outcomes can be expected.

Borderline Personality Disorder

According to the Mayo Clinic, “BPD is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships.”

Common symptoms of BPD include:

  • Self-harm

  • Suicide Ideation

  • Impulsivity

  • Extreme or misdirected anger

  • Frequent mood swings

  • Risky behavior (unprotected sex, gambling, over-eating)

  • Intense fear of abandonment

  • Difficulty being alone

Personality disorders can be difficult to treat, but positive outcomes are possible. Unlike episodic depressive episodes, personality disorders are life-long and pervasive. People with personality disorders tend to have extreme and inflexible ways of perceiving themselves and others.

 

In order to meet criteria of a personality disorder, there are four areas of consideration for diagnosis.

  1. Emotions tend to be intense, extreme, and rapidly shifting

  2. Relationships tend to be difficult and filled with conflict

  3. There may be issues with impulsivity, self-destructiveness, or self-sabotaging behaviors

  4. There is a lack of a clear and coherent sense of identity

Transference-Focused Psychotherapy (TFP)

TFP places great emphasis on the client’s transference onto the therapist, the here-and-now of the therapeutic relationship is paramount to successful treatment. Transference occurs when a client expresses feelings towards their therapist that are based on the client’s past feelings about someone else. Witnessing the client’s thoughts and feelings during initial phase of the treatment process through transference, allows the therapist a window into how the client operates internally and externally in their world.

An example of transference might involve the client having experienced feelings of abandonment as a child when her father left the family. Now, the client’s therapist had to reschedule an appointment due to an emergency, and the client feels those similar feelings of abandonment towards her therapist that she felt towards her father. The definitive attribute of transference is, the feelings being “transferred” originate from past experiences.

To differentiate the terms transference and projection, let’s take a look at an example of projection. 

Let’s say a man goes on a first date and he really likes the woman. He interprets every smile and gracious attitude of hers as an indication she likes him too. He is in essence attributing his own fond feelings for her – onto her, as though they were her own. 

She may not be attracted to him, but is behaving politely because she does not want to offend him, or perhaps she only perceives a potential friendship. Or, she may in fact like him, regardless, unless she confirms these feelings, in reality, these feelings belong to him. 

The major difference between projection and transference is, transference is based on the client’s past feelings towards someone else that is currently playing out in the present. Whereas projection is the client’s own feelings being placed onto someone else.

 

How does TFP work

The initial meeting between the client and therapist begins with an intake session. Though intake sessions are standard practice, an intake during a TFP therapy session focus heavily on the client’s social relationships with friends, co-workers, family and romantic partners. It may also be applicable to invite the client’s significant others into sessions to gain insight, as well as help those people understand the diagnosis and treatment objectives.

Together, the therapist and client develop a treatment plan with agreed upon goals. Traditionally, the client and therapist meet twice per week, with successful treatment taking 1-3 years. Goals and treatment focuses are clearly defined. Due to the nature of clients with Borderline Personality Disorder, suicide ideation and how to manage those urges, are thoroughly outlined in the treatment plan.

A unique component to TFP is the “meaningful activity requirement.” The meaningful activity can include work, volunteering, or school for 20 hours per week. The purpose of this is so the therapist and client can discuss and analyze the emotions, thoughts, and behaviors associated with how the client relates to others and interprets others’ behaviors.

Therapists utilizing Transference Focused Psychotherapy assess the client’s issues in a non-judgmental manner. They begin by working with the least intimidating emotions and problematic behaviors, and as they build trust, they dive deeper into more demanding issues.

 

TFP Techniques

Therapists use clarification to reiterate the main point the client is relaying, to make sure they have a mutual understanding of the issue. This is important for two reasons. First, the therapist wants to make sure they are understanding the core issue. Secondly, the client gets to hear their issue stated out loud through an objective filter.

Therapists also use confrontation in TFP. The therapist will notify the client of contradictory experiences. 

For example, a client believes his boss thinks he’s inadequate at work, despite being recently promoted. This belief system seems incongruent with the patient’s integrated sense of life and reality and therefore, the therapist will point this out in an attempt to help recalibrate the client’s belief system.

Interpretation is a technique upon which a therapist offers his or her viewpoint about the client’s motivation for certain emotional states or behaviors. This offers the client a fresh and objective analyses they might not have otherwise considered.

 

Transference-Focused Psychotherapy Research Data

There have been numerous and very promising studies regarding the effectiveness of TFP. One such study by the American Journal of Psychiatry in 2007, regarding the treatment of clients with Borderline Personality Disorder, found TFP to reduce depression, anxiety, suicidality, irritability, and verbal assaults. 

This study also indicated a significant improvement in the client’s social relationships. Though most of these studies focused on the Borderline Personality Disorder population, data seems to indicate the effectiveness of TFP for other personality disorders, such as Narcissistic Personality Disorder.

        Outcomes

        As data has revealed, TFP is a successful modality for the specific treatment of Borderline Personality Disorders and for other severe personality disorders as well. The underlying core value of TFP is, transference is the vehicle to discovering the client’s beliefs, emotions, and behaviors

        “Observations of the patient’s moment-to-moment experience of the therapist provides the most direct access to understanding the make-up of the patient’s internal world.” – Barry Stern, Ph.D. Helping clients achieve an understanding towards their shifting experience of themselves and of others is a fundamental goal of treatment.

        Conclusion

        If you or someone you love is in need of support for Borderline Personality Disorder, make sure to select a therapist trained in Transference-Focused Psychotherapy, as it is the most highly regarded modality for treating BPD symptoms.

        Personality disorders can be challenging to live with and challenging to treat, but successful management and positive outcomes are achievable with the right support. Whether in-person or online, there are many qualified therapists to help get you the treatment you deserve.

        Lauren Reynolds - Licensed Marriage and Family Therapist
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