Academic journal article International Journal of Psychoanalysis

New Developments in Transference Focused Psychotherapy

Academic journal article International Journal of Psychoanalysis

New Developments in Transference Focused Psychotherapy

Article excerpt

Introduction

What follows is a capsule description of the basic aspects of Transference Focused Psychotherapy (TFP) and new developments of this therapeutic approach derived from both our research findings and the clinical experience gathered in various centers where it is being studied. Please keep in mind that this treatment is indicated for patients whose severity of illness, urgency of related life situations, and lack of capacity to participate in the therapeutic frame required by standard psychoanalysis would induce most experienced clinicians to carry out a supportive treatment. TFP, derived from psychoanalytic theory and technique, expands the realm of psychoanalytic therapeutic approaches with severely disturbed patients.

While abundant clinical evidence of positive developments in fundamental personality change with TFP is now available, and justifies, we believe, focused research efforts to empirically study these effects in long-term follow up studies, the present paper is an effort to update aspects of the basic techniques of TFP as described in the third edition of our manual (Yeomans et al., 2015). In essence, these developments represent an expansion of the exploration of the transference by focusing on sharply dissociated expressions of severely self-destructive tendencies in the patient's external life. This focus is reflected in various technical approaches to be outlined in this paper. These are new developments that stem from our clinical observations of patients treated in our various research projects, as well as from the consistent study of the most difficult cases in weekly group meetings of the Personality Disorders Institute and the related Personality Studies Institute in New York.

Transference Focused Psychotherapy (TFP) is a manualized, empirically validated psychoanalytic psychotherapy, derived from a synthesis of contemporary object relations theory and modifications of psychoanalytic technique to treat patients whose severity of pathology contraindicates standard psychoanalysis (Clarkin et al., 2007; Doering et al., 2010; Kernberg et al., 2008; Yeomans et al., 2015). The specific objective of TFP is the modification of the personality structure of patients with severe personality disorders, particularly borderline personality disorder, but also narcissistic, paranoid, schizoid and schizotypal personality disorders. We have also had success in treating personality disordered patients with significant antisocial traits and behavior, but not antisocial personality disorder proper; patients with milder borderline features - the infantile or histrionic personalities, and, finally, patients with a specific hypochondriacal syndrome.

TFP is focused not only on reducing the symptoms typically seen in severe personality disorders, such as chronic suicidal behavior, antisocial behavior, substance abuse, and eating disorders (Zanarini et al., 2010a, b), but, as mentioned above, also has the ambitious goal of modifying the personality structure of the patient sufficiently to meaningfully improve functioning in the arenas of work, studies and profession, and intimate relations, such that the individual develops a fuller capacity to integrate emotional commitment, sexual freedom, and tenderness. Such integration leads to improvements in the capacity for genuine friendships as well as investment in creative and cultural pursuits (Yeomans et al., 2015).

Brief overview of TFP

The treatment is conceptualized as applying basic strategies, techniques, and tactics (Kernberg et al., 2008) as outlined below.

Strategies

Our assumption was that patients with severe personality disorders or borderline personality organization (BPO) have the syndrome of identity diffusion - that is, a chronic, fixed internal split reflecting the lack of integration of the concept of self and of the concept of significant others - and that the ultimate cause of that syndrome is the failure of psychological integration resulting from the predominance of aggressive internalized object relations over idealized ones. …

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