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Transference Focused Psychotherapy to Treat Borderline Personality Disorder

According to the DSM-IV-TR, psychology’s premier diagnostic manual, BPD is a personality disorder typified by problems regulating emotions. The characteristic emotional instability results in dramatic and sudden shifts in mood, impulsivity, poor self-image, turbulent relationships, and often threats of and attempts at suicide. Prevalence of Borderline Personality Disorder is estimated at between 1% and 2% of the general population.

In addition to appropriate drug therapy, psychotherapy has proven to be the most effective means of treating BPD, and in recent years, new therapies such as Dialectical Behavior Therapy (DBT) and Transference-Focused Psychotherapy (TFP) have been designed specifically to treat this disorder (Clarkin 2007).

* What Is Transference Focused Psychotherapy? *

TFP is an individual psychoanalytic treatment designed particularly for borderline patients. This therapy focuses on revealing the underlying causes of a patient’s borderline condition and working to build new, healthier ways for the patient to think and behave.

* The Theory Behind Transference Focused Psychotherapy *

A distinguishing feature of Transference-Focused Psychotherapy is the theory that a borderline patient’s perception of self, and of others, is split into unrealistic extremes of bad and good. These conflicting dyads are thought be expressed through the specific self-destructive symptoms of Borderline PD.

In the course of normal psychological development, dyads based on experience become integrated into a unified whole, resulting in a mature and flexible sense of self. However, in borderline individuals, these separate dyads do not become integrated. Instead, dyads associated with sharply different emotions exist independently from one another and contribute to the roller coaster of emotional experience that is typical in borderline patients.

As an example of this fragmented emotional experience, a borderline patient’s perception of negative interactions that result in feelings of helplessness and deprivation can be totally split off from perceptions of positive interactions resulting in feelings of happiness and well-being. This lack of continuity in psychological structure results in an individual going through life with a subjective experience that is emotionally fragmented, discontinuous, and rigid (Clarkin 1999, Yeomans 2002).

* What is Transference? *

The term “transference” refers to the patent’s experience of his or her moment-to-moment relationship with the therapist. The treatment focuses on transference, because it is believed that patients will display their unhealthy dyadic perceptions not only in day-to-day life, but also in the interactions they have with their therapist. TFP focuses on using patient-therapist communications to help the patient integrate these different representations of self and, in the process, develop better methods of self-control (Clarkin 1999, Yeomans 2002).

* Recent Research on Treatment of Borderline PD *

A study of treatments for Borderline PD by Clarkin et al. (2007) recently appeared in The American Journal of Psychiatry. The researchers examined the efficacy of Transference-Focused Psychotherapy in comparison with two other therapeutic options used to treat Borderline PD; Dialectical Behavior Therapy and Dynamic Supportive Treatment. The results indicated that although all three therapeutic approaches were effective in fostering global improvement in the symptoms of BPD, Transference-Focused Psychotherapy corresponded to progress in the most borderline characteristics examined.

* Sources *

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., and Kenberg, O.F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. The American Journal of Psychaiatry. Vol. 164, 6.

Clarkin, JF, Yeomans, FE, & Kernberg, OF (1999). Psychotherapy for Borderline Personality. New York: J. Wiley and Sons.

Yeomans, FE, Clarkin JF, & Kernberg, OF (2002). A Primer of Transference-Focused Psychotherapy for the Borderline Patient. Northvale, NJ: Jason Aronson.

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)

*This article was originally published in Suite101 online magazine.