Using Transference-Focused Psychotherapy (TFP) Principles in the Treatment of Medical and Personality Disorder Comorbidities

Patients with co-occurring medical and personality disorder (PD) symptomatology pose distinct challenges for treating clinicians. Providers of mental health services will routinely see patients with PD pathology who have co-occurring medical concerns, either directly or obliquely related to specific PD manifestations. Physicians, nurses, and other professionals will frequently see patients with PD pathology in most settings of medical care; these patients may carry PD diagnoses, or they are often described only as “difficult” patients. While these referenced clinical situations are predictably vexing, there has been relatively limited investigation of these phenomena, and few overarching approaches to patient management proposed. Transference-focused psychotherapy (TFP) offers clinicians general principles for use with these sub-populations. This chapter focuses on two approaches informed by TFP precepts: (1) using TFP principles in consultation-liaison psychiatry, and (2) a pilot program using TFP principles in general medicine training.