New developments in transference focused psychotherapy

  • Kernberg O
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Abstract

Transference Focused Psychotherapy (TFP) was based upon the Menninger Foundation's psychotherapy research project (Kernberg et al., 1972), that indicated that the optimal treatment of patients with severe personality disorders or "low ego strength" was a psychoanalytic psychotherapy, with systematic interpretation of the transference in the hours, and the provision of as much external support as the patient required outside the hours to permit the treatment to develop successfully. In contrast, neither the treatment with standard psychoanalysis nor with a purely supportive modality based on psychoanalytic principles was as effective. On this basis, at the Personality Disorders Institute of the Weill Cornell Medical College and The New York Hospital, we developed a psychoanalytic psychotherapy centered upon the principle of systematic interpretation of the transference, and the setting up of a treatment structure—including limit setting when needed, in order to protect the patient and the treatment from the severe acting out that is practically unavoidable in the treatment of these patients. These efforts, over a period of approximately 15 years, culminated in the development of a manualized psychoanalytic psychotherapy. Transference Focused Psychotherapy, that fulfilled these general characteristics mentioned above. We tested the possibility of training psychotherapists in carrying out this manualized treatment, and, after sufficient adherence and competence in carrying out that treatment was confirmed carried out a set of psychotherapy research projects that, at first, confirmed the efficacy of this treatment in comparison to treatment as usual for borderline patients, and then a randomized, controlled trial comparing TFP to Dialectic Behavior Therapy and to a supportive psychotherapy based on a psychoanalytic model. All three treatments were manualized, carried out by therapists who were convinced about the helpfulness of this model and proficient in carrying it out. The findings revealed the efficacy of all three forms of therapy, and showed significant differences regarding the treatment of suicidal and parasuicidal symptoms, more effective with TFP and DBT than with Supportive Psychotherapy. TFP was effective in reducing various aspects of aggressive affects and behaviour of these patients in comparison to the other modalities (Kernberg et al., 2008). At various points of our developing work we studied the possibility of applying the principles of TFP to psychoanalytic group psychotherapy, and developed a tentative model that seemed clinically satisfactory. We have applied this mostly to a day-hospital setting, and in sporadic attempts to apply it to an in-patient setting as well. While clinicians involved in this effort have felt encouraged to pursue it further, we have not yet carried out empirical research on the efficacy of such a group psychotherapy, and the present paper is a first effort to spell out, the general model of this form of group psychotherapy and its relationship to other related models. I shall first present an outline of the basic principles of TFP as applied to individual patients, and then present an overview about how these principles apply to a corresponding TFP group psychotherapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Author-supplied keywords

  • Contract breaches
  • Countertransference
  • Personal responsibility
  • Selected fact
  • Suicide
  • Technical neutrality
  • Total transference situation

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Authors

  • Otto F. Kernberg

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