Transference-Focused Psychotherapy (TFP) is a psychodynamic treatment designed especially for patients with borderline personality disorder (BPD). A distinguishing feature of TFP in contrast to many other treatments for BPD is the belief in a psychological structure that underlies the specific symptoms a borderline individual suffers from. In other words, the focus of treatment is on a deep psychological make-up – a mind structured around a fundamental split that determines the patient’s way of experiencing self and others and the environment.
Since this internal split determines the nature of the patient’s perceptions, it leads to the chaotic interpersonal relations, impulsive self-destructive behaviors, and other symptoms of BPD. The internal split is based on a model of the mind in which early affectively-charged experiences are cumulatively internalized over time in the individual’s mind and become established in the individual’s psychological structure as “object relations dyads” – units which combine a specific representation of the self and a specific representation of the other linked by a specific affect.
Different dyads represent different images of the self and of the other connected by different affects. These dyads are not exact, accurate representations of historical reality, but tend to represent extreme images and affects. In the course of psychological development, these separate dyads become integrated into a unified whole with a more mature and flexible sense of self and others in the world. However, in borderline individuals, these separate dyads do not become integrated in this way. Instead, dyads associated with sharply different affects exist independently from one another and determine the lack of continuity of the borderline patient’s subjective experience in life.
An obvious question is why this integration does not take place in individuals with BPD. TFP posits a multifactorial explanation in which elements of biologically-determined temperament and of environment combine to maintain this split psychological structure. In over-simplified terms, internal representations of frustrating others in relation to a helpless deprived self are totally split off from internal representations of gratifying others in relation to a satisfied self.
These opposite images are imbued with intense affects, both hateful (in association with the first internal representation), and loving (in association with the second). While the patient has no conscious awareness of this split internal world (and his or her ability to identify with either side of it at different moments in time), this structure underlies and determines the symptoms mentioned above, such as chaos in interpersonal relations, emotional lability, black-and-white thinking, anger, and proneness to lapses in reality testing. In psychodynamic terms, this split internal structure corresponds to the syndrome of identity diffusion and use of primitive defense mechanisms. In more phenomenological terms, this psychological structure results in an individual going through life with a subjective experience that is fragmented, discontinuous, rigid and impoverished.