What is Transference-Focused Psychotherapy (TFP)?

Transference-Focused Psychotherapy (TFP) is a psychodynamic psychotherapy that is an established evidence-based psychotherapy for severe personality disorders. People with these difficulties struggle with their identities, intense emotions (like anger, depression, shame, anxiety, etc.), impulsive behaviors (like self injury or substance abuse), and relationships. Consequently, they are unable to find fulfillment and/or achieve their full potentials in the domains of work, romantic relationships, social relationships, and creative endeavors.

"Psychodynamic" means that the mind consists of different parts that are constantly in motion. These parts are typically outside the awareness of the individual. Frequently this process results in "conflict" between different parts of the mind. For example, there may be conflict between acting on an urge that may result in momentary gratification versus causing problems in the long term.

The basic premise of TFP is that an individual has a core problem with the psychological structure of the mind. This results in the various difficulties that the person experiences. The psychological structure consists of images of self and others connected by emotions that were internalized during the course of development through interactions with important others. Generally these images are outside of a person's awareness. In people with severe personality disorders, these images result in significant distortions of the self and others because they are the lens through which the person experiences himself in relation to the world. Images that are extreme, unrealistic, contradictory , and/or distorted contribute towards the difficulties in the various domains: identity, emotions, behaviors, cognitions, and relationships.

Transference-Focused Psychotherapy is a treatment that can modify the problematic psychological structure. This process relies heavily on examination of the transference. The "transference" is the transfer of the patient's internal images, beliefs, and attitudes (the patient's internal world) onto the therapist. Through a repeated pattern of examining the transference, the therapist and patient can identify and work through the main distorted images that the patient automatically imposes on external reality. With TFP, the patient increases the capacity for self-reflection, which increases the person's choice over how to act and increases the person's ability to adapt to life. This process results in diminished psychiatric symptoms and improved capacity to find fulfillment in work, relationships, and creative endeavors.

Psychiatric medications can be helpful for some people with personality disorders because of associated symptoms like depression, anxiety, impulsivity, or cognitive distortions, amongst others. The use of psychotropic medications will be evaluated during the consultation process and throughout the course of psychotherapy. These medications could require the monitoring of weight, blood pressure, heart rate, EKG's, and/or blood work. The benefits and risks will be discussed in detail prior to initiation of any medication. There is also the possibility that the person may be on numerous psychiatric medications with unclear benefits so the tapering of medications, possibly to discontinuation, will be assessed.

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