Transference‐focused Psychotherapy for Patients with Personality Disorders: Overview and Case Example with a Focus on the Use of Contracting

Abstract

Transference-focused psychotherapy (TFP) is a manualized treatment for patients with a personality disorder based on 18 months of once-weekly or twice-weekly therapy. TFP is suitable for publicly funded psychotherapy and private practice. Devised by Kernberg and colleagues, its conceptual framework is based on Kleinian theory of primitive defences in the paranoid schizoid position. A TFP 'structural assessment' is carried out before negotiating a treatment contract, which must be agreed before therapy can begin. Contracting addresses destructive acting-out and isolative lifestyles, and requires a commitment to active engagement with therapy and its agreed aims. The therapist closely attends to relationships outside therapy and transference parallels. The goal is greater integration of the self and self-object relations. In addition to changes in symptoms, TFP can lead to changes in patients' defensive structures with concomitant shifts in personality structure, improved satisfaction in life, and fuller engagement in work and relationships. A case example is given of a patient with a withdrawn lifestyle. Her object relationships were interpreted as they unfolded in life outside therapy and in the transference, leading to personality structure changes which enabled her to be able to function successfully in work and in her personal relationships.

How treatment arrangements enhance transference analysis in transference-focused psychotherapy.

“…These guidelines may be referred to as a treatment “contract,” but what is really meant is clear arrangements about patient and therapist responsibilities, including payment and scheduling, providing a frame for therapy and an emotional container for each to do her work. To create these, patient and therapist discuss the potential threats to the treatment for the particular individual (e.g., Radcliffe & Yeomans, 2019; Yeomans, Delaney, & Levy, 2017; Yeomans, Selzer, & Clarkin, 1992). These will arise because this treatment is likely to challenge the patient’s defenses, and the patient’s tendency to act out in certain ways could end the therapy, as it may have ended others in the past.…”

Transference-focused psychotherapy as an aid to learning psychodynamic psychotherapy: qualitative analysis of UK psychiatry trainees’ views

“…Assessment, preliminary contract setting 29 and goal setting completed by the specialist service. Trainee-led contract finalisation takes place in a preliminary meeting after allocation.…”