Transference focused psychotherapy

Transference Focused Psychotherapy (TFP), is a highly structured, twice-weekly modified psychodynamic treatment based on Kernberg’s object relations model of borderline personality disorder. TFP consists of a couple of main concepts, including “internal representation” and “object relation dyads”.

Internal representation
Internal representation refers to a person’s conception of self, other or relationships and it cannot be directly observed. Internal representations are shaped based on one’s early relationships with caregivers. Experiences of neglect and abuse may lead to negative representations, and a caring individual may develop positive representations.

In borderline patients internal presentations of frustrating others in relation to a helpless deprived self are totally split off from internal representations of gratifying others in relation to a satisfied self. Because the patient has no conscious awareness of this split internal world, this leads to black and white thinking. The therapist tries to make the patient conscious about this way of thinking and tries to change it. It is expected that the unintegrated representations of self and other will be activated in the treatment setting as they are in every aspect of the patient’s life. These partial representations are constantly active in determing the patient’s experience of real life interactions and in motivating the patient’s behavior. The difference in therapy is that the therapist both experiences the patient’s representation of the interaction and nonjudgmentally observes and commands on it.

Object relation dyads
Object relation dyads are units that combine a specific representation of the self and a specific representation of another object. The tension and feelings that provoke this are called dyads. Different dyads represent different images of the self and of the other connected by different affects. These object relation dyads are the basic elements of psychic structure insofar as they serve as the organizers of motivation and behavior. These dyads are not exact, accurate representations of historical reality, but tend to represent extreme images and affects as they were experienced during development.

In the course of psychological development, these separate dyads become integrated into a unified whole with a more mature and flexible sense of self and others in the world. In borderline the lack of integration of the internal object relations dyads corresponds to a split psychological structure in which totally negative representations are split off from positive representations of self and other. The global mechanism of change in patient treated with TFP is the integration of the polarized affect states and representations of self and other into a more coherent whole. This integration leads to a more realistic sense of self and others. As the split-off representations become integrated, patients tend to experience increased coherence of identity.