Using Transference-Focused Psychotherapy (TFP) Principles in Adult and Adolescent Day Hospital Settings

Transference-focused psychotherapy (TFP) is an effective psychotherapy intervention for patients with borderline personality disorder (BPD), as well as other personality disorder presentations described as meeting the criteria for borderline personality organization (BPO). TFP has been used predominantly as an outpatient, individual modality. More recently, TFP principles have been integrated into the approach used in the day hospital (DH) setting; this use of TFP elements in a setting that involves interactions with multiple patients and clinicians has been described as “Institutional therapy,” which distinguishes it from the standard, familiar individual patient-therapist dyad. We present material from two DH treatment programs, one for adult patients in Barcelona, Spain, and the other for adolescents in Cologne, Germany. The specific theoretical and practical elements of TFP that are used in these programs are reviewed. We describe the aspects of applied TFP that are useful in the DH setting for both patient populations, and the modifications that are required based on the patient’s age, development, and severity of illness. The elements of TFP applied in this context are outlined, with special attention to the facilitation of reflective capacity, the resolution of splitting, and the promotion of identity integration. Overall, these interventions informed by TFP principles allow patients to be successfully discharged from the DH to less intensive outpatient treatment settings.