What are the pros and cons of participating in Transference-Focused Psychotherapy?

In this article, I will briefly discuss the pros and cons of participating in transference-focused psychotherapy (TFP), a psychodynamic therapy that evolved from psychoanalytic and object relations theory. It was developed in the 1970's and 1980's by the psychoanalyst and psychiatrist Otto Kernberg. The focus is on addressing transference, a psychological phenomenon within counselling therapy, where a person's feelings (usually related to a primary relationship from childhood, such as with their parents) are unconsciously transferred to a relationship in the present, often with their counsellor.

Let's begin with the pros. First, TFP can help people gain awareness of conflicting views of themselves, others, and the events they experience. This is beneficial in cases where thoughts, feelings, or behaviors are outside a person’s awareness and in situations where they move back and forth between contradictory experiences, such as with feeling overwhelmed at one moment and then unsure at another moment. This inconsistency between conscious and unconscious thoughts and feelings provides a ripe opportunity for confronting defenses and avoidance, and encouraging integration by using TFP techniques.

Furthermore, TFP is an expressive psychodynamic approach with empirical support for treatment of Borderline Personality traits. It may be worth noting that Borderline Personality Disorder is a neighbor of Histrionic Personality Disorder. For these personality types and traits, it may be helpful to work with people on distinguishing and integrating perceptions of themselves and others. This can lead to developing a better understanding of self and others, along with emotional regulation, and the capacity for achieving goals.

The potential cons of using transference-focused psychotherapy are that its non-judgmental stance encourages exploration of all sides of a person’s experience, including those that may be difficult to tolerate. If the person is used to or prefers a different approach, such as a more supportive frame (like humanistic or person-centered therapy), there may be difficulties with resistance and irritation to these things which they may find intolerable. In addition, an exploratory approach with TFP may be challenging, although still beneficial, because some people may tend toward a dependent relationship and want specific structured advice and directives about what exactly they should do to solve their problems.

In summary, it is important to note that in using a TFP approach, the counselling therapist must consider setting the frame (discussion and agreement about structure of treatment), roles and responsibilities, sharing an understanding of the person’s difficulties and goals, and the rationale for the treatment approach. It is necessary to be explicit about this treatment frame, and to be consistent with maintaining the agreed-upon frame, as it is likely to be tested, especially while working with people with personality and trait issues that are familiar in Borderline and Histrionic types.