Transference-Focused Psychotherapy: An Effective Treatment for Borderline Personality Disorder

According to the DSM-IV-TR, psychology's premier diagnostic manual, Borderline PD 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?

Transference Focused Psychotherapy 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.

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).

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 BPD; 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.

More Information on Borderline PD

This article is a description of one type of therapy used to treat Borderline Personality Disorder. The content is not meant to be a substitute for professional help and counseling.

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).

Jan 16, 2009 3:06 PM

Guest :

Are there really any successes in treating BPD? I'm a 45 year old woman that was diagnosed with BPD 15 years ago and have been in psychotherapy on and off for 30 years. When or will it never end?? I am still plagued with this crippling disease.
regards, Starr

Feb 2, 2009 11:19 AM

Guest :

Dear Guest!

There is hope! Your best bet is to find someone qualified in providing DBT. This is a challenge, as this requires much training. Try visiting this website as a starting point to find a therapist. You want someone who, at a minimum, has completed the "DBT Intensive" training by Behavioral Tech. This is becuase this is the authorized traing by the treatment's creator, Dr Marsha Linehan in Seattle.
http://behavioraltech.org/resources/crd.cfm

Beware therapists who ONLY teach DBT skills, or who only attended a weekend class. They are not prepared or qualified to say that they provide DBT - there is more to DBT than just DBT skills. Linehan has laid out a very specific and documented set of treatments that combined amount to DBT. As documented in several peer-reviewed medical journals, DBT is proven effective in treating BPD.

The other hard part is your part: you must commit yourself to finding a qualified therapist (which can be hard - some people have to move to where there is a good therapist), AND you have to commit yourself to doing what the therapists tells you to do! If your therapist is good, you may come to hate this person at times, and you have to hang in there with the QUALIFIED therapist.

Also, if you are seeing a therapist who is unqualified to treat BPD, this person may be asking you to talk about "all the bad things that have happened to you." Unless and until you have the skills to deal with the emotions this creates, this can cause grave harm. Spend your time looking for a qualified DBT therapist.

May 27, 2009 6:35 AM

Guest :

There is hope! I am a highly functioning person with the BPD label. Fortunately, I have a psychiatrist who is trained in DBT. It's been 5 years of hard work and struggle but I have recently been told that I'm almost at the point where the BPD diagnosis won't pertain to me!!!

G.V.

Oct 28, 2009 1:55 PM

Guest :

Dear Guest,
I have BPD too. I am not "cured", but I consider myself to be a success! 6 years ago I had my big crash - my entire world came down around me because of my BPD. (I had struggled with it and depression my entire life, but it took away my significant other, my career, I was accused of child abuse-I was a teacher-and I almost my son.) I spent 2 years either sleeping or hurting myself. Then I found DBT and the correct medications. The combination have worked WONDERS for me!
I now hold a part time job (25-30 hours a week), I have returned to school (8 credits), and I am very actively involved in my son's life. And I feel great!
BPD isn't a life sentence - it's just a major challenge!
~Al