How Does Transference-Focused Psychotherapy Work?
Borderline personality disorder is a complex condition that affects how someone feels about themself and others.
Some people living with BPD experience what is called splitting, or “all or nothing” thinking. For example, they commonly alternate between seeing themselves and other people as all good or all bad. They may struggle to have a nuanced experience of themselves and others.
The primary goal of TFP is to bring the patient’s split-off parts together through a process called integration. TFP’s goals include not just changing a person’s behavior, but changing their emotions and sense of self as well.
To do this, the patient and therapist explore how their relationship develops and evolves. The therapist observes the patient’s feelings and examines any splitting that occurs in the patient’s outside world.
TFP alters the personality structures that underlie the patient’s behaviors. By doing so, it allows patients to function more fully in important areas of their lives, such as work, romance, and friendship.
TFP Is Effective
TFP has been shown to be effective in treating several BPD symptoms.
A 2001 study in the Journal of Personality Disorders found that after 12 months of TFP treatment, suicide rates and hospitalizations in patients with BPD decreased, as did the severity of self-harming behaviors.
TFP is a proven & effective Therapy
A 2007 study in the American Journal of Psychiatry compared TFP to two other evidence-based treatments for BPD: dialectical behavior therapy and dynamic supportive treatment.
The study found that all three treatments showed positive changes in patients’ depression, anxiety, and social adjustment. TFP and dialectical behavior therapy also showed reductions in suicidality. Only TFP showed reductions of irritability and verbal assault.
TFP is also shown to increase reflective functioning (ability to understand emotions of oneself and others) in people with BPD, as shown in a 2018 study in the British Journal of Psychiatry.
TFP Assessment and the Structural Interview
When making a diagnosis and developing a treatment plan, clinicians who practice transference-focused psychotherapy use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as a tool called the structural interview.
In the structural interview, a therapist pays more attention to a patient’s social history than they would during a standard assessment. They focus on learning about the patient’s friendships, romantic life, work history, and finances.
They also assess a patient’s case with a focus on several areas outlined in critical books on the topic including Fundamentals of Transference-Focused Psychotherapy and Transference-Focused Psychotherapy for Borderline Personality Disorder.
The following aspects of the structural interview allow the therapist to understand more about the patient.
This is an objective evaluation of an emotion or thought against an actual situation. The more inaccurate a patient’s reality testing is, the more severe their difficulties are likely to be.
The therapist seeks to understand any hostile behaviors and attitudes. The therapist takes note of a patient’s aggression toward self and others, and how this could affect the treatment process.
Many BPD patients show unconscious ways of managing conflicting impulses and the realities of everyday life. Some defenses are less adaptive than others. The therapist looks for which types of defenses the patient uses.
Identity Diffusion vs. Consolidation
This references the level of stability and consistency the patient shows in life choices, including interests, values, and friends. This is tied to a patient’s self-concept (“Who am I?”) and sense of internal stability.
The therapist seeks to understand the quality of the important relationships in a patient’s life. The therapist gets a sense of the patient’s experiences with self and others.
Moral values are tied to a person’s self-acceptance and role in society. The patient’s moral values are evaluated by asking questions like “Has the patient stolen or lied?” or, on the other end of the spectrum, “Does the patient have an excessively strict moral code?”
Together, the therapist and patient discuss the BPD diagnosis. They talk about the patient’s personal goals, such as finding a job or a healthy romantic relationship. They cover treatment goals, such as how the patient can learn to recognize self-destructive behavior.