Development and Evolution of Transference-Focused Psychotherapy (TFP): A Foundation for Expanding Treatment Applications

Transference-focused psychotherapy (TFP) is an empirically validated treatment for a patient with borderline personality disorder (BPD) derived from psychoanalytic object relations theory. TFP was developed by clinicians steeped in traditional psychoanalytic theory and practice, but TFP deviates significantly from orthodox psychoanalytic practice. TFP is a highly structured treatment that rests on the foundation of Kernberg’s structural interview as an assessment tool, and the development and maintenance of a detailed treatment contract that anchors the extended exploratory process. While TFP is an exploratory treatment, the identification and pursuit of concrete goals beyond symptom reduction are central to the approach. TFP’s strategies, tactics, and techniques were influenced by specific aspects of BPD psychopathology, including the predictable emergence of powerful negative or paranoid transferences, which historically had adversely impacted the effectiveness of psychoanalytic interventions with this patient population. Despite its deviations from the traditional psychoanalytic treatment approach, TFP nevertheless includes the pillars of technical neutrality, utilization of countertransference, transference analysis, and interpretation of unconscious processes. Since its development, the TFP model has been used for individual treatment with patients with narcissistic disorders and with other higher level personality disorder presentations. The goal of this chapter is to provide foundational information about the theory and practice of TFP; the expanded applications that are the subject to this volume are informed by this original treatment template.