Transference-Focused Therapy for Borderline Personality

Key Takeaways

• Transference-focused therapy (TFP) uses your relationship with your therapist to help change how you relate to others.
• TFP may help reduce symptoms like anger, impulsivity, and irritability associated with borderline personality disorder (BPD).
• TFP is practiced with the therapist twice a week and helps build awareness of destructive behaviors and improve emotional states.

Transference-focused therapy (TFP) for borderline personality disorder (BPD) is a type of psychotherapy that focuses on using your relationship with your therapist to change how you relate to other people in the world. This may help you identify problematic thoughts, develop healthier behaviors, and improve social interactions. 

What Is Transference-Focused Therapy?

Transference is the theoretical process by which emotions are transferred from one person to another. Transference is a key concept in psychodynamic psychotherapies.

In these types of therapies, it is presumed that your feelings about important people in your life, such as your parents or siblings, are transferred to the therapist. You then come to feel about and react to the therapist as you would to these important figures in their lives.

It is believed that through transference, the therapist can see how you interact with people and then use this information to help you build healthier relationships.

Therapists who practice transference-focused therapy for BPD believe that the key cause of BPD is related to dysfunctional relationships in childhood that continue to impact adolescent and adult relationship functioning. The theory is that through interactions with our caregivers in early childhood, we develop a sense of self as well as mental representations of others. If something goes wrong during this development, we may have difficulty forming a solid sense of self or have problems in how we relate to other people.

Because there is evidence that childhood maltreatment or early loss of caregivers is associated with increased risk of BPD and because the ​symptoms of BPD include significant problems in relationships and instability in sense of self, some experts have proposed that BPD needs to be treated by building healthier relationships through the use of transference.

Techniques

During TFP, people meet with their therapist twice a week. During these sessions, the therapist uses techniques from object relations theory. Object relations theory stresses the importance of social interaction in order to help people change their maladaptive behaviors. These techniques may include:

• Creating trust between the therapist and the individual
• Establishing boundaries that relate to the individual’s specific symptoms
• Exploring behavior patterns, emotions, and sense of self and how those elements influence a persons ability to cope
• Building awareness of destructive or problematic behaviors
• Learning to shift emotional states and improve interactions to help relieve symptoms

TFP in Other Conditions

While transference-focused psychotherapy (TFP) was primarily developed for use with people who have borderline personality disorder, it may also be applicable in other issues and conditions. It may help with:

• Decreasing symptoms of anxiety and depression
• Improving emotional regulation
• Improving social interactions and relationships
• Reducing symptoms such as anger, impulsivity, and irritability
• Reducing self-harm and suicidal ideation

TFP may also be useful in the treatment of other personality disorders that share characteristics with BPD, including narcissistic personality disorder.

Benefits of TFP

While the support for this treatment is still considered debatable, there may be some benefits of this type of therapy for the treatment of BPD. More research is needed to better determine how this approach compares to other forms of treatment, but some possible benefits include:

• Helping people identify internalized thoughts that contribute to harmful behaviors
• Allowing people to better understand how these thoughts affect different areas of their life
• Helping people integrate different areas of their thoughts and beliefs in order to develop a more cohesive sense of self

Effectiveness

Preliminary research supports the use of transference-focused therapy for BPD. A 2007 randomized controlled study, one of the most rigorous forms of research, demonstrated that transference-focused therapy was equivalent to dialectical behavior therapy (DBT) in reducing some of the symptoms of BPD, such as thoughts of suicide, and was better than DBT in reducing other symptoms, like impulsive behaviors or anger.

A later randomized controlled trial compared TFP to treatment by experienced community psychotherapists and found that transference-focused psychotherapy was more effective in reducing BPD symptoms, improving psychosocial functioning, and improving personality organization. It also appeared to be more effective for reducing suicidality and reducing the need for in-patient treatment.

The Society of Clinical Psychology, Division 12 of the American Psychological Association, gives TFP the unusual designation of “strong/controversial research support” because findings have been mixed.

Questions about TFP

It is important to note that while the current research points to the potential efficacy of prolonged treatment with TFP, this type of therapy is still considered somewhat controversial. Further studies are needed to better understand how lasting the results of this treatment may be and whether it might be a better choice over some other treatment modalities. 

While this is promising preliminary support for the effectiveness of this treatment, it is important to note a major limitation of the 2007 randomized controlled trial: Patients in the transference-focused therapy group received more individual psychotherapy than those in the DBT condition.

While it is possible that transference-focused therapy is as good if not better than DBT at reducing symptoms of BPD, it is also possible that the improvements were due to the patients receiving more therapy. More research is needed to examine the success of this treatment.

How to Get Started

In transference-focused therapy for BPD, the focus is on the interaction between you and the therapist. The therapist rarely gives advice or instructs you on what to do. Instead, the therapist will likely ask you many questions and help you explore your reactions during sessions.

An emphasis is placed on the current moment rather than the past. Instead of talking about how you related to your caregivers, you will spend more time talking about how you are relating to your therapist. The therapist also tends to remain neutral in this type of therapy; they will avoid giving their opinion and remain unavailable outside the therapy session except during emergencies. 

Consider talking to your therapist about whether or not transference-focused therapy might work for you. They will talk you through the benefits and drawbacks of this kind of therapy and can give you a recommendation based on your unique situation. 

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1. Clarkin JF, Caligor E, Sowislo J. TFP extended: development and recent advances. Psychodyn Psychiatry. 2021 Summer;49(2):188-214. doi:10.1521/pdps.2021.49.2.188

2. American Psychological Association. Transference. APA Dictionary of Psychology.

3. Diamond D, Hersh RG. Transference-focused psychotherapy for narcissistic personality disorder: an object relations approach. J Pers Disord. 2020;34(Supplement):159-176. doi:10.1521/pedi.2020.34.supp.159

4. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164(6):922-8. doi:10.1176/ajp.2007.164.6.922

5. Doering S, Hörz S, Rentrop M, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiatry. 2010;196(5):389-395. doi:10.1192/bjp.bp.109.070177

6. Society of Clinical Psychology. Transference-focused therapy for borderline personality disorder. 2016.

7. Levy KN, Meehan B, Yeomans FE. An update and overview of the empirical evidence for transference-focused psychotherapy and other psychotherapies for borderline personality disorder. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds.), Psychodynamic Psychotherapy Research. Humana Press; 2012:139-167. doi:10.1007/978-1-60761-792-1_8

By Kristalyn Salters-Pedneault, PhD

 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.

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