Transference Focused Psychotherapy with Richard Hersh, MD-Slides

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Transference-Focused Psychotherapy (TFP) is a form of psychoanalytic psychotherapy that draws significantly from Object Relations theory. It has been tailored to treat more impaired patients, notably those with borderline personality disorder (BPD), and is recognized as an evidence-based treatment method. TFP is a manualized therapy, typically administered twice a week for one to three years, through which therapists engage in intensive transference analysis, interpret unconscious motivations, monitor countertransference, and maintain a balance of technical neutrality with patients.<br /><br />The therapy focuses on establishing a treatment contract personalized to each patient, emphasizing concrete, measurable goals such as work, studies, relationships, and hobbies, rather than abstract desires like happiness or improved self-esteem. Key to TFP is the initial structural interview and obtaining parallel information from past treaters to inform treatment specifics. A treatment contract covers various responsibilities including patient activities, session management, and stipulations on medication adherence and intersession contacts.<br /><br />Once therapy begins, therapists guide patients to speak freely regarding material tied to their goals, and they monitor communication across verbal expressions, behaviors, and their own counter-transference responses. A crucial aspect of TFP is tolerating confusion often evident in personality disorder patients, listening for emerging dominance in object relations, and identifying role reversals in aggressive behavior dynamics.<br /><br />TFP's principles have evolved into "Applied TFP" for use in broader psychiatric settings beyond traditional psychotherapy, offering a structured approach beneficial for risk management and treatment outcome improvements. This includes inpatient and emergency psychiatric care, and pharmacotherapy scenarios, facilitating the diagnosis and management of personality disorders, promoting a coherent therapeutic approach, and helping avoid polypharmacy and unnecessary hospitalizations.

Keywords

Transference-Focused Psychotherapy

Object Relations theory

borderline personality disorder

evidence-based treatment

transference analysis

treatment contract

countertransference

Applied TFP

personality disorders

psychiatric settings

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