Mental Health Therapy What Is Transference-Focused Psychotherapy? By Neha Kashyap Neha Kashyap Neha is a New York-based health and science news writer. Neha has written for WebMD, ADDitude, HuffPost Life, and dailyRx News. Learn about our editorial process Published on September 21, 2022 Medically reviewed by Michael MacIntyre, MD Medically reviewed by Michael MacIntyre, MD LinkedIn Michael MacIntyre, MD, is a board-certified general and forensic psychiatrist. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Principles Techniques What Is TFP Used for? Benefits Limitations Effectiveness What to Expect Finding a Qualified Therapist Frequently Asked Questions 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. Bymuratdeniz / Getty Images 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 behaviorsRequiring the person to have at least one positive activity or job in the outside worldFocusing more on present relationships and behaviors than on the pastReality testing is the process of comparing a person's ideas to realityBehavior 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 interruptedA requirement that other issues that could get in the way of TFP, like addiction or disordered eating, are treated along with TFP or before TFPMaking 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 treatmentA structured approach to psychotherapy with clear rulesEncouragement to engage with the outside world instead of isolating from itA belief that the personality can be changedLearning how to integrate "good" and "bad" sides of things instead of operating in an all-or-nothing mannerCan be used in a variety of therapeutic settings, including group therapy and emergency servicesBacked 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. Alternatives to TFP There are other therapy methods that can be effective for treating borderline personality disorder, including the following: Schema therapy: Schema therapy focuses on present-day behaviors and relationships, the dynamics of an individual-therapist relationship, and childhood trauma to help a person change how they view the world. Dialectical behavioral therapy (DBT): DBT focuses on changing behavior, but it also emphasizes the need to accept the self as is. Mentalization-based therapy: MBT is about developing an ability to understand the mental states, motivations, and personalities of others and the self. What to Expect A person seeking transference-focused psychotherapy should expect the following: Setting a verbal contract of expectations and roles with their therapistAn expectation of having at least one positive activity in the outside world, such as a hobby or jobA call to limit impulsive behavior that causes upheavalsRequirement to treat other concerns that could get in the way of focusing on TFP, such as addiction or eating disordersA focus on the presentOne 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 directoryConfirm how many sessions your insurance will coverAsk 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. Frequently Asked Questions What does transference-focused therapy treat? Transference-focused therapy (TFP) is most often used for borderline personality disorder and has also been used for narcissistic personality disorder. It can be helpful to anyone who wants to develop their personality to be more supportive of their connections and goals. Learn More: List of Personality Disorders Does transference-focused therapy work? TFP has been especially helpful with anger issues in borderline personality disorder. TFP might also help with developing healthy attachment styles. Another study comparing TFP to general psychotherapy found it was more effective in preventing future suicide attempts and hospitalizations and in improving social functioning. Learn More: Types of Therapy for Mental Health What is the overall goal of transference-focused psychotherapy? Transference-focused therapy (TFP) has several goals, including:Creating a structured environment where a person can focus on treatmentDeveloping an ability to see the nuance in people and situations instead of resorting to black-and-white thinkingChanging the personality to be more supportive of a person's lifeEngaging in life through fulfilling activities and relationships Learn More: What Is BPD Splitting? 16 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Division 12 of the American Psychological Association. Transference focused therapy for borderline personality disorder. McLean Hospital. Understanding transference-focused psychotherapy. American Psychological Association. Transference. The Center for Transference-Focused Psychotherapy. Transference-focused psychotherapy (TFP). Division 12 of the American Psychological Association. Behavioral activation for depression. Yeomans FE, Delaney JC, Levy KN. Behavioral activation in TFP: the role of the treatment contract in transference-focused psychotherapy. Psychotherapy. 2017;54(3):260-266. doi:10.1037/pst0000118 Clarkin JF, Caligor E, Sowislo J. TFP extended: development and recent advances. Psychodynamic Psychiatry. 2021;49(2):188-214. doi:10.1521/pdps.2021.49.2.188 Arntz A, Stupar-Rutenfrans S, Bloo J, van Dyck R, Spinhoven P. Prediction of treatment discontinuation and recovery from borderline personality disorder: results from an rct comparing schema therapy and transference focused psychotherapy. Behaviour Research and Therapy. 2015;74:60-71. doi:10.1016/j.brat.2015.09.002 The International Society of Transference-Focused Psychotherapy. Research on TFP. Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF. The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders. 2001;15(6):487-495. doi:10.1521/pedi.15.6.487.19190 Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. AJP. 2007;164(6):922-928. doi:10.1176/ajp.2007.164.6.922 Levy KN, Meehan KB, Kelly KM, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol. 2006;74:1027-1040. doi:10.1037/0022-006X.74.6.1027 Diamond D, Yeomans F, Keefe JR. Transference-focused psychotherapy for pathological narcissism and narcissistic personality disorder(TFP-N). Psychodynamic Psychiatry. 2021;49(2):244-272. doi:10.1521/pdps.2021.49.2.244 American Psychological Association. Schema therapy. American Psychological Association. Dialectical behavior therapy. American Psychological Association. Mentalization. By Neha Kashyap Neha is a New York-based health journalist who has written for WebMD, ADDitude, HuffPost Life, and dailyRx News. Neha enjoys writing about mental health, elder care, innovative health care technologies, paying for health care, and simple measures that we all can take to work toward better health. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit