What is the difference between Transference Focused Psychotherapy and standard psychotherapy?
The other week, I received an email from a reader asking me to explain the difference between Transference Focused Psychotherapy (TFP) and standard psychotherapy. I was intrigued, and I thought this was a really interesting question. The term “standard psychotherapy” is tricky. There are many different types of psychotherapy that are based on different theoretical orientations and use different techniques. You can peruse this site for an overview of different schools of psychotherapy.
Many clinicians are eclectic in their approach. In research projects that examine specialized forms of psychotherapy (such as Dialectical Behavior Therapy, TFP, or others), the specialized treatment is often compared to what we call “Treatment As Usual” (TAU). This basically means that the people in the comparison group are treated by clinicians in the community, and that there is great variety in terms of theoretical orientation, frequency of treatment, length of treatment, and intensity of treatment, reflecting the great variety of ‘standard’ psychotherapy out there.
Transference focused psychotherapy is a form of psychodynamic psychotherapy. It is, however, a specialized form of psychodynamic psychotherapy with explicit tactics, strategies and techniques that were written up in a manual. It was developed for a specific and defined set of problems (severe personality disorders). In TFP, patient and therapist meet twice a week and agree on a treatment contract. The session is conducted with the patient sitting up, as opposed to lying on the couch (as in psychoanalysis). The focus of the treatment is in the here and now. This is different from some other approaches of psychotherapy that do not use a treatment contract, or that focus on exploring childhood experiences, or that focus on learning skills and changing behaviors.
Jill Delaney, an experienced TFP therapist and senior member of the Personality Studies Institute that trains clinicians in applying TFP, explains that TFP believes human behavior can be understood in terms of internal conflicts, beliefs, and experiences with early caregivers, some of which are operating outside of our conscious awareness. These unconscious patterns play out in people’s lives, as much as they play out in the relationship with the therapist. By working on understanding the relationship with the therapist in the here and now, these patterns can be made conscious and be brought into awareness.
“TFP places great emphasis on achieving a stable sense of self and others“, she explains, “A solid sense of self allows a person to navigate the disappointments, stresses and challenges of life without too much disruption to healthy functioning. Borderline patients generally have a very chaotic, unstable sense of self that greatly affects their experience of themselves and others. Many patients report that they never feel like the same person two days in a row, which makes it very difficult to maintain relationships or to function at work. This unstable internal experience leads to instability in people’s external lives and relationships. TFP therapy closely focuses on these quickly and drastically shifting experiences people with Borderline Disorders have. One way to approach this is by understanding of the interaction with the therapist (the "transference"), in the belief that awareness and understanding of these intense, contradictory, and discontinuous internal states ultimately leads to a more nuanced and at the same time more consistent sense of self, allowing the person to achieve new modes of relating to themselves, and, therefore others, in more productive, satisfying ways.”