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Mental Disorders

Transference Focused Psychotherapy (TFP) for Personality Disorders

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

Transference Focused Psychotherapy (TFP) was developed by the psychiatrist and psychoanalyst Otto Kernberg, M.D. Dr. Kernberg is a well-recognized expert on the theory and treatment of personality disorders and is considered to be one of the pioneers on the subject. TFP is based on the object relations theory of personality disorders, and stems from the tradition of psychodynamic therapy.

TFP emerged in response to the failure of psychoanalysis to treat personality disorders. Psychoanalysis was an earlier form of psychodynamic therapy based on Sigmund Freud's theories. In the mid-1900s, American psychiatry was heavily influenced by Freudian theory.  Therefore, the primary method of treatment during that time was psychoanalysis.

Psychoanalysis consisted of encouraging a patient to free-associate. Free-association means to say aloud whatever comes to mind, without censorship, and then connections are made between important topics. The idea of free association was to assist the patient to become aware of unconscious processes in order to gain an understanding of the conflicts between the opposing forces in the patient's psyche called the Id, Ego, and Superego (according to Freudian theory). For a more thorough explanation of these concepts, please return to section on the history of the diagnostic system.

Psychoanalysis was open-ended.  This means therapists did not impose a specific agenda on the therapy session. While this approach seemed to benefit some people, clinicians practicing during this period of history found this approach was not helpful for people with severe personality disorders. In fact, many people with personality disorders appeared to get worse with psychoanalysis. Rather than considering something may be wrong with the treatment method itself, psychoanalytic practitioners of that era concluded these disorders were untreatable. Kernberg challenged the idea that personality disorders were untreatable. He modified the traditional psychoanalytic treatment techniques and tailored them to the treatment of people with severe personality disorders, thus developing Transference Focused Psychotherapy (TFP).

TFP is based on object relations theory. For a thorough explanation of the theory behind TFP please return to that section. By way of a brief review, object relations theory posits that during infancy, we develop internal representations of ourselves (referred to as "self") and other people (referred to as "objects"). These "objects" are typically early caregivers. These early self-object representations are connected to each other through a dominant affect (an emotion). An example would be a terrified and weak self (child) connected to a powerful, threatening object (caregiver/parent) through the affect of fear.

In early stages of infant development, it is thought that positively-toned, self-object representations get built up separately from negative- toned representations. This means representations of the same object, such as mommy, are represented twice. There is a "good mommy' object to store positively-toned affects and a "bad mommy" object to store negatively-toned affects.  According to Kernberg, healthy adult personality development requires these split-off, positively- and negatively-toned object representations to become integrated into a single, cohesive whole.  Conversely, when these good and bad representations remain split-off and separate, the result is a disintegrated personality organization, or personality disorder.

Once formed, these object relationship pairs (dyads) function as a template through which later relationships may be understood and enacted. In fact, these internalized object relations are thought to later play out in a person's life in every relationship of importance. It's almost as though they serve as a map or model of how relationships are supposed to work. To the extent one receives an accurate and nuanced map or model, a healthy and accurate understanding of future relationships is available. Conversely, when one is using an incorrect, "split-off" and polarized map or model, interpersonal problems emerge. This also includes the relationship with the therapist. It is precisely this fact that enables the therapist to identify the nature of the structural problem and to develop a strategy for repair.