Understanding the Therapeutic Process

Transference Focused Psychotherapy (TFP) is a specialized form of psychodynamic treatment specifically designed for individuals with borderline personality disorder and other difficulties characterized by unstable relationships, variable self-esteem, and intense emotional responses. Developed over decades of clinical research, TFP is an evidence-based treatment with strong empirical support.

The Concept of Transference

Transference refers to the ways we unconsciously transfer feelings, expectations, and patterns from past relationships onto present ones—including the relationship with the therapist. In TFP, we pay particularly close attention to these transference patterns as they emerge in our work together.

For someone with borderline personality organization, these patterns tend to be intense and to shift rapidly. You might experience your therapist as deeply caring one moment and cruel the next. These dramatic shifts are not random—they reflect fundamental difficulties in integrating contradictory feelings and maintaining a stable sense of yourself and others.

The Therapeutic Approach

TFP is active and engaged. The therapist doesn't just listen passively but points out patterns, contradictions, and shifts in how you're experiencing the relationship. This can feel confronting, but it's done with care and with the explicit goal of helping you develop a more balanced, integrated view of yourself and others.

We establish a clear treatment contract at the beginning, outlining what we can realistically accomplish and what's required of both of us. This structure creates safety and helps contain the intensity of the work.

What Changes Occur?

Over time, TFP helps you develop what we call "mentalization"—the capacity to understand your own mental states and those of others. You become better able to tolerate contradictory feelings without splitting them apart or acting impulsively to escape discomfort.

Relationships become more stable as you develop the capacity to hold complex, nuanced views of people—seeing them as whole individuals with both positive and negative qualities, rather than swinging between idealization and devaluation. Self-esteem becomes less dependent on external validation and more grounded in genuine self-understanding.

Is TFP Right for You?

TFP requires commitment—typically meeting twice weekly for at least a year, often longer. It's demanding work that asks you to tolerate discomfort and examine painful patterns. But for those willing to engage in this process, the changes can be meaningful and lasting: more fulfilling relationships, greater emotional stability, and a more integrated sense of self.

If you struggle with intense and unstable relationships, feelings of emptiness, or self-destructive patterns, TFP may offer a path toward meaningful change.

Empirical Support

TFP has been evaluated in several randomized controlled trials and comparative studies. Key research includes:

• Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164(6), 922–928.
• Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: Randomised controlled trial. British Journal of Psychiatry, 196(5), 389–395.
• Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., & Kernberg, O. F. (2006). Change in attachment and reflective function following a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74(6), 1027–1040.

Psychodynamic psychotherapy is a depth-oriented treatment grounded in psychoanalytic thinking. It is distinguished by a focus on unconscious processes, the meaning of symptoms, and the ways that past experiences—particularly early relationships—shape how we think, feel, and relate to others in the present.

Core Principles

At its heart, psychodynamic therapy rests on several key assumptions: that much of our mental life operates outside of awareness; that our early relationships create templates for how we relate to others throughout life; and that bringing unconscious material into conscious awareness allows us to make different choices.

Frequency and Depth

One of the defining features of psychodynamically oriented work is attention to the frequency of meeting. While once-weekly therapy can be meaningful, meeting multiple times a week creates a fundamentally different quality of treatment. More frequent sessions allow for deeper access to unconscious material, a more sustained focus on the therapeutic relationship, and the kind of sustained attention that deep change often requires.

At higher frequencies, patterns emerge more vividly. The relationship with the therapist becomes a central vehicle for understanding and change—what arises between patient and therapist, session to session, becomes as important as what is discussed. This intensity is not incidental; it is part of what makes the work effective.

The Therapeutic Relationship

In psychodynamic treatment, the relationship with the therapist is not merely a backdrop to the work—it is the work. The feelings, expectations, and patterns that arise in the therapy room reflect the same dynamics that show up elsewhere in your life. By examining them together, in the moment, we gain direct access to what might otherwise remain out of reach.

What to Expect

Psychodynamic psychotherapy is an open-ended process with a long-term orientation. It is suited for people who are interested not only in relieving symptoms but in understanding themselves more deeply—in living with greater freedom, authenticity, and capacity for connection. The work requires patience and commitment, but for those who engage with it seriously, the changes tend to be lasting.