Transference-focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg's object relations model of borderline personality disorder (BPD).
[1] It views the individual with borderline personality organization (BPO) as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged.
The treatment focuses on the integration of split-off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.
[8] The infant's experience, initially organized around moments of pain (e.g., "I am uncomfortable and in need of someone to care for me") and pleasure (e.g., "I am now being soothed by someone and feel loved"), become increasingly integrated and differentiated mental templates of oneself in relation to others.
In a normal personality organization the individual has an integrated model of self and others, allowing for stability and consistency within one's identity and in the perception of others, as well as a capacity for becoming intimate with others while maintaining one's sense of self.
Under conditions of high stress, individuals with BPD may fail to appreciate the "whole" of the situation and interpret events in catastrophic and intensely personal ways.
[11] As the split-off representations of self and other get played out in the course of the treatment, the therapist helps the patient to understand the reasons (the fears or the anxieties) that support the continued separation of these fragmented senses of self and other.
The integration of the split and polarized concepts of self and others leads to a more complex, differentiated, and realistic sense of self and others that allows for better modulation of affects and in turn clearer thinking.
Therefore, as split-off representations become integrated, patients tend to experience an increased coherence of identity, relationships that are balanced and constant over time and therefore not at risk of being overwhelmed by aggressive affect, a greater capacity for intimacy, a reduction in self-destructive behaviors, and general improvement in functioning.
In TFP, hypothesized mechanisms of change derive from Kernberg's[11] developmentally based theory of Borderline Personality Organization, conceptualized in terms of unintegrated and undifferentiated affects and representations of self and other.
The putative global mechanism of change in patients treated with TFP is the integration of these polarized affect states and representations of self and other into a more coherent whole.
The TFP group experienced significant improvement in personality organization, psychosocial functioning, and number of suicide attempts.
However, the TFP cell contained more suicidal patients and showed less adherence casting doubt on a direct comparison between treatments.
A follow-up of this study concluded that both clients and therapists rated therapeutic alliance higher in schema therapy than in TFP.