Specialized Treatments for Borderline Personality Disorder: What is Transference Focused Psychotherapy?
The research group around Otto Kernberg and John Clarkin at Weill Cornell Medical Center has for years been working on developing and researching a specialized form of psychotherapy for Borderline Personality Disorder. You can find interviews with Otto Kernberg and John Clarkin on this site under David van Nuys’ blog.
Transference Focused Psychotherapy (TFP) comes out of the psychoanalytical tradition of Object Relations Theory. To put it simply, the basic theoretical idea is that we develop internal representations of ourselves (referred to as “self”) and other people, mostly early caregivers (referred to as “objects”), and of the affect between the self and the object. In other words, the theory says that we hold in our minds representations of self-object dyads that are connected through a dominant affect.
The idea is that we relate to other people in our lives based on these patterns of self-object-affect units which we have internalized, and that these patterns also play out in the relationship between the therapist and the patient. It is important though to keep in mind that these representations are not assumed to be accurate representations of the entirety of self and other, but they are seen representations of self and others from moments when affect was very intense. This means the representations are not just cognitive depictions of memories and reality, but are actually connected to very raw affective states. TFP assumes that in Borderline patients, the representations stay almost “frozen” in often extreme representations of “all good” or “all bad” self and objects, instead of becoming more mixed pictures over time. The relationship with the therapist in the here-and-now is used in TFP to identify, understand, and work on these internal representations and how they play out in a person’s life.
TFP was developed not only for people with Borderline Personality Disorder in a stricter sense, but also for people with other types of personality disorders. At the beginning of treatment in TFP, there is usually an extensive evaluation phase. Important for the treatment is a contract between patient and therapist, in which roles, boundaries, treatment frame and emergency procedures are defined. The therapist takes on a very active role, asking clarifying questions and pointing out patters of behaviors or feelings. The focus is on the patients’ present situation and on building a life by encouraging the patient to be productive in some kind of work or volunteer arrangement. Sometimes, when there are difficulties such as substance use or eating issues, referrals may be made to adjunctive treatments for those issues. Sessions are usually twice a week, sometimes with adjunctive group treatment where indicated. For more information, look at the interviews with Drs. Kernberg and Clarkin, or refer to the book “A Primer of Transference Focused Psychotherapy” by Frank Yeomans, John Clarkin, and Otto Kernberg (London: Aronson, 2002).