Transference-Focused Psychotherapy

Transference-focused psychotherapy (TFP) is a treatment that was developed for individuals with borderline personality disorder (BPD) and other personality disorders. This modality aims to help clients understand how their emotional responses to relationships and present experiences impact their connection with their psychotherapist, the people in their lives, and themselves. This psychotherapeutic modality uses techniques like parts work, integration, and observations to change behaviors and beliefs. 

What is transference-focused psychotherapy?

Transference-focused psychotherapy and personality disorders

As transference-focused psychotherapy was developed to treat personality disorders—specifically, borderline personality disorder (BPD)—it explicitly explores "splitting behaviors." This is what makes the treatment transference-centered: It’s aimed at analyzing how emotions transfer from one part of the conscious experience to another or from situation to situation. For example, feeling connected to a person in one moment and hateful toward them several minutes after due to a disappointment or emotional change may be an example of splitting as a symptom of borderline personality disorder. 

In psychotherapy, splitting may occur toward the psychotherapist, as the client may reflect their experiences with others or themselves onto the psychotherapist. The psychotherapist may be able to observe the client's patterns in their outside relationships by noting how they act in sessions. The phenomenon of a client reflecting labels, roles, behaviors, or ideas onto their psychotherapist is called transference, which is why transference-based psychotherapy is named this way. 

The goal of TFP is to create a healthy effective relationship between the psychotherapist and the client while addressing boundaries, interpersonal concerns, and splitting behaviors. 

What are personality disorders? 

Personality disorders are mental illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These conditions impact an individual's personality and perception of personality. Transference-focused psychotherapy is often used in the treatment of those with personality disorders that fall under a category known as cluster B personality disorders, which includes:

• Antisocial personality disorder (ASPD)
• Borderline personality disorder (BPD)
• Narcissistic personality disorder (NPD)
• Histrionic personality disorder (HPD) 

Personality disorders are marked by a pervasive pattern of inner experiences and behaviors that deviate from a given culture's expectations of cognitive and emotional responses, interpersonal relationships, and impulse control. Transference-focused psychotherapy can be helpful in treating these symptoms.

The effectiveness of transference-focused therapy for personality disorder treatment

Transference-focused psychotherapy is an object relations model of psychological functioning. It has been suggested by research to be highly effective in reducing social challenges and symptoms of depression, and anxiety in those with borderline personality (BPD). It may also improve global functioning and social adjustment by reducing client anger, impulsivity, and splitting behaviors.

Research supporting transference-focused psychotherapy for BPD

A 2001 study examined the effects of TFP for treating individuals with BPD for one year. Twenty-three women diagnosed with borderline personality disorder attended sessions two times a week and were assessed before and after treatment. After the treatment ended, the number of clients who attempted self-harm or suicide in a specific period significantly decreased, which suggests that TFP may be used as a form of crisis intervention support.

Research supporting transference-focused psychotherapy for NPD

A controlled trial from 2021 also looked at adapting transference-focused psychotherapy (TFP) for the treatment of narcissistic personality disorder (NPD). Although further studies are required, this method shows promise for treating symptoms of several different personality disorders.

Can you see a transference-focused therapist for other reasons?

Anyone can see a transference-centered psychotherapist, including those with other mental health diagnoses besides personality disorders or no diagnoses at all. However, due to the nature of the sessions, this modality may not be as effective for those who do not experience transference, splitting, or reflective behaviors. Other forms of evidence-based psychotherapy that may be effective for those looking to address broader emotional or mental health challenges include:

• Cognitive-behavioral therapy (CBT) 
• Interpersonal psychotherapy (IPT) 
• Dialectical behavior techniques or dialectical behavior therapy (DBT) 
• Emotionally focused therapy (EFT) 
• Acceptance and commitment therapy (ACT) 
• Schema-focused techniques or schema-focused therapy
• Couples therapy
• Marriage and family therapy 
• Internal family systems therapy (IFS) 

TFP techniques

Keep in mind that TFP for borderline personality disorder and other conditions may look different for everyone. That said, here are some common components of this type of treatment.

Parts work

Parts work is a therapeutic technique inspired by internal family systems therapy (IFS). It involves identifying different parts of the self or various aspects of the personality that care for various responsibilities for the individual. Parts are aspects of the self that make up an individual's whole personality. Note that they are different from dissociative identity disorder (DID), a rare condition in the DSM-5 separate from BPD or any other mental illness.

With borderline personality disorder, the various parts of an individual's personality may be more pronounced or apparent to others. One part may be considered more angry and confrontational, whereas another may be passionate, kind, and empathetic. These parts are aspects of the same person, but each helps an individual cope with various situations. Parts are often said to have developed due to a past adverse event, traumatic experience, or challenging childhood. 

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Identifying and understanding these parts may help clients form a clearer picture of their identity, which can benefit those with a personality disorder who struggle with self-image. In this aspect of transference-focused psychotherapy, the focus is put on accepting, loving, and holding space for these parts to give each one a voice. 

Integration 

Integration is connected to parts work. In integration techniques, the psychotherapist helps the client take the identified parts and bring them together to see them as a whole and to solidify the client's understanding of who they are. This element of transference-focused psychotherapy for borderline personality disorder is about developing an embodied self, feeling compassion for the parts that may cause shame, and identifying how certain elements of the personality may reflect dynamics onto others. 

Therapist-client relationship work 

TFP providers work with clients on their therapeutic relationship and the client's outside concerns. For example, if a client frequently raises their voice at the psychotherapist when the psychotherapist suggests a particular topic, they can explore where the defensive mechanism comes from and how to change it. The client can learn to identify that their psychotherapist is not the source of their anger. 

Setting boundaries

For the therapist-client relationship to be healthy, the first couple of sessions may be dedicated to setting boundaries for therapy and clearly outlining what will occur and what can be accepted. For example, the psychotherapist may let the client know that they are using the treatment to address symptoms of borderline personality disorder and ask the client if they want any clarification on what that means for them. 

Next, the psychotherapist can let the client know if there are any behaviors they cannot accept as part of the professional alliance. For example, clients may be expected to attend psychotherapy sessions consistently. Frequently missed sessions might end the therapeutic relationship. Receiving these boundaries upfront may help those with personality disorders cope with a fear of abandonment, as they know their actions can have direct results.

Safety planning and TFP

As personality disorders often involve symptoms of self-harm and suicidal ideation, a transference-focused psychotherapist can also help the client develop a safety plan early in the intervention. The plan may include a list of crisis support hotlines, social support systems, local resources, and a plan for how to proceed if a crisis occurs. Some therapists may also offer their clients an on-call number for crises they can call at any time. 

Mental health treatment options

Transference-focused psychotherapy—along with cognitive behavior therapy, dialectical behavior therapy, and many other modalities—can be practiced in various environments, including in person at a therapist's office or online. Many clients may find online transference-focused therapy preferable due to its lower cost, availability, and flexibility in scheduling. On days when it may be difficult to leave home due to mental health symptoms, you can still attend therapy from your own space as long as you have an internet connection. 

Does online mental health treatment actually work?

A 2022 review of 11 clinical psychology studies on internet-delivered interventions for personality disorders indicates that online therapy is more widely available than in-person therapy. It also suggests that the effectiveness of online treatments is on par with in-person options and that client satisfaction with this method was high.

BetterHelp online counseling

If you're interested in trying an online therapy format, consider signing up with a platform like BetterHelp, which offers a wide network of therapists providing various types of support. With multiple specialties and modalities offered, you can request a therapist who meets your needs and preferences upon signing up and get matched with a provider in as little as 48 hours.