What Is Transference-Focused Psychotherapy?

H. Colledge

Transference-focused psychotherapy is a type of psychological talking therapy used to treat patients with borderline personality disorder. People with borderline personality disorder have unstable emotions and identities that affect their behavior and relationships, making normal life difficult. Transference involves projecting feelings about people and situations from the past on to individuals and events in the present. During transference-focused psychotherapy, the patient expresses inner feelings to the therapist inside safe boundaries. The therapist interprets the patient's inner world and draws attention to contradictions, helping the patient develop a more stable, integrated sense of self.

Transference-focuses psychotherapy takes place within safe boundaries.
Transference-focuses psychotherapy takes place within safe boundaries.

Object relations theory, which is concerned with relationships between people and images of the self and others, originally gave rise to transference-focused psychotherapy (TFP). Normally, people hold a mixture of positive and negative views of themselves and others, but in borderline personality disorder, these positive and negative views are kept separate. This is known as splitting, and it means that other people may be seen as totally good or absolutely bad, affecting how the patient conducts relationships with them. Splitting also causes feelings of emptiness and the lack of a meaningful, whole sense of self. Patients may feel disturbed, unable to understand either themselves or others.

A patient with alcoholism will need to address that issue before starting transference-focused psychotherapy.
A patient with alcoholism will need to address that issue before starting transference-focused psychotherapy.

Before transference-focused psychotherapy begins, a contract is created between the patient and therapist, ensuring that the psychotherapy takes place in a safe environment with defined boundaries. Dangerous individuals are not suited to the therapy, due to the risk to the therapist, and patients also need to address any serious problems with alcohol and drugs before beginning treatment. During treatment, patients are generally expected to take part in an activity which brings them into contact with other people. This helps provide material that can be used in the psychodynamic treatment sessions. Sessions may take place once or twice a week for a year or more.

During transference-focused psychotherapy, a process known as projective identification may occur. In projective identification, inner emotional conflicts lead to patients interpreting their own unacceptable thoughts and feelings as justifiable reactions to the therapist. Projective identification and splitting are both types of defense mechanisms.

Following transference-focused psychotherapy, patients may experience feelings of anxiety related to the difficulty of ending treatment. The ending of therapy is normally discussed throughout the treatment period, and the therapist helps the patient come to terms with ending the therapeutic relationship. Sometimes, further follow-up sessions may be offered, in which the therapist finds out how the patient is progressing.

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