What Is Transference-Focused Psychotherapy?

Transference-focused psychotherapy (TFP) uses the relationship dynamics between an individual and a psychotherapist to develop a clearer sense of self and better relationships with others. TFP is usually used to treat borderline personality disorder and other personality disorders.

Transference-focused psychotherapy might also help you understand the impact of early childhood relationships and integrate those lessons into everyday life. It can also help you better manage your emotions, understand others more realistically, and have a stronger sense of self.

This article covers TFP principles and techniques, what TFP is used for, TFP benefits and limitations, whether or not the method is effective, and what to expect when trying TFP.

Principles of Transference-Focused Psychotherapy

Transference is when a person applies feelings and attitudes about important people in their lives to their therapist. The goal of transference-focused psychotherapy is to use transference to help people with self-awareness and relationship skills as the relationship between the therapist and the individual evolves over time.

Principles of TFP include:

• A person's issues relating to others and themselves will emerge in the individual-therapist relationship.
• Borderline personality disorder includes extreme black-and-white thinking, where people are all "good" or bad," also called "splitting." TFP can create a more nuanced view of the world.
• A sense of self can be developed in therapy, even if it wasn't developed in childhood.
• People can change their personalities to better support their lives.
  

Techniques

Therapeutic techniques used in TFP include:

• A verbal contract that sets clear expectations and rules, such as being on time, showing up to sessions, and avoiding chaotic behaviors
• Requiring the person to have at least one positive activity or job in the outside world
• Focusing more on present relationships and behaviors than on the past
• Reality testing is the process of comparing a person's ideas to reality
• Behavior activation, the process of encouraging activities that bring rewards and create positive motivation, like exercising or having a hobby
• Discouraging impulsive behaviors that cause upheavals so that therapy is not interrupted
• A requirement that other issues that could get in the way of TFP, like addiction or disordered eating, are treated along with TFP or before TFP
• Making it clear that a person's disruptive behavior does not define them and that their underlying issues can be healed

What Is TFP Used for?

TFP is most commonly used for borderline personality disorder, and it has also been applied to narcissistic personality disorder.

Research has found TFP could be used for other personality disorders. Personality disorders are when a person's thoughts, emotions, and behaviors interfere with relating to the world and sense of self. TFP's structured, relationship-based approach could help a range of people with these qualities.

Other personality disorders that might benefit from TFP include:

• Histrionic personality disorder
• Obsessive-compulsive personality disorder
• Dependent personality disorder

Benefits

The benefits of TFP include:

• A therapist that is more actively engaged with the person in treatment
• A structured approach to psychotherapy with clear rules
• Encouragement to engage with the outside world instead of isolating from it
• A belief that the personality can be changed
• Learning how to integrate "good" and "bad" sides of things instead of operating in an all-or-nothing manner
• Can be used in a variety of therapeutic settings, including group therapy and emergency services
  
• Backed by research for borderline personality disorder and narcissistic personality disorder

Limitations

There are some limitations to TFP, including:

• Lack of focus on the past, which could be harmful for people managing the effects of childhood abuse
• The individual-therapist contract could limit a person's exploration of their identity
• A person might want more independence to make their own choices and mistakes
• Therapy could abruptly end if a person violates their contract or challenges their therapist too many times.
• Rules about treating other issues might require additional help, such as support groups for addiction or eating disorder treatment
• Not well researched for conditions other than borderline personality disorder and limited in research for narcissistic personality and other disorders

Effectiveness

TFP has been backed by several studies for borderline personality disorder. However, there are other benefits, including:

• TFP has been effective in treating suicidal tendencies.
• TFP was more effective against impulsive behavior and anger than other methods.
• TFP might also be more effective in improving attachment styles in relationships.
• Provides long-term results when it came to social functioning and maintaining mental health.
• Could be effective for narcissistic personality disorder.

What to Expect

A person seeking transference-focused psychotherapy should expect the following:

• Setting a verbal contract of expectations and roles with their therapist
• An expectation of having at least one positive activity in the outside world, such as a hobby or job
• A call to limit impulsive behavior that causes upheavals
• Requirement to treat other concerns that could get in the way of focusing on TFP, such as addiction or eating disorders
• A focus on the present
• One to three years of therapy

Finding a Qualified Therapist

To find a therapist, you'll first want to check what mental health services are available based on your insurance status.

If you have insurance:

• Check if your company has a searchable directory
• Confirm how many sessions your insurance will cover
• Ask your healthcare provider or local clinic for a referral

If you don't have insurance:

• Ask a local clinic or your healthcare provider for a referral.
• Search for sliding scale therapists online or locally.
• Ask therapists you are interested in if they take sliding scale clients.
• In the U.S., the Substance Abuse and Mental Health Services Administration (SAMHSA) has a mental health facilities locator. These facilities are usually federally-funded and free or low-cost.
• Search professional organizations like the American Psychological Association or the American Counseling Association.
  

When searching for a therapist specializing in TFP, it might help to search for someone specializing in borderline personality disorder or transference as a healing tool. Asking about evidence-based (scientifically researched) practices the therapist knows can also help.

For those who prefer intensive TFP experience, the International Society of Transference-Focused Psychotherapy has a certificate program. Searching for therapists who have the certification could be another way to find a TFP specialist.

Summary

Transference-focused psychotherapy (TFP) uses the person-therapist relationship as a vehicle for healing issues relating to others and the self. TFP can be applied in a group or individual setting and to a range of personality disorders. TFP is usually used to treat borderline personality disorder.

TFP techniques include setting clear expectations of therapy, requiring some interaction with the outside world via a positive activity, focusing on the present instead of history, and a requirement to limit chaotic behavior that could distract from therapy.

A Word From Verywell 

If you want to commit to healing relationships and understanding your role within them while also working on understanding your impulses, TFP might be worth exploring.

To find a TFP-focused therapist, consider looking for someone who has worked with borderline personality disorder before or asking a therapist you are interested in what they think of TFP. It never hurts to shop around for the mental healthcare you need. If cost is an issue, support groups could also help begin your healing journey.