Mechanisms of Change in Transference-Focused Psychotherapy
TFP uses mostly techniques of psychoanalysis, particularly interpretation. These focus specifically on the here-and-now of the therapeutic relationship. However, an interpretation can only be effective, if it is prepared by a process that implies implicit procedural experience and explicit, verbal interactions between patient and therapist, that create a joint narrative of what is going on in the relationship between the two.
Non-verbal communication is of highest relevance within this process of interpretation, which involves facial expression of emotion and other embodied channels of communication. The therapists ability to allow for and identify his or her own emotional and bodily reactions to the patient is crucial for an interpretation out of empathic understanding and affective permeation with the right timing and depth.
Empirical results, theoretical concepts, and a clinical illustration will be presented.
Introduction to Transference-Focused Psychotherapy
TFP was developed by Otto F. Kernberg and is based on psychoanalytic object relations theory. 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. In such a psychological organization, thoughts and feelings about self and others are split into dichotomous experiences of good or bad, black or white, all or nothing.
TFP is a twice-per-week outpatient individual psychotherapy that combines psychodynamic principles with a structured setting and a treatment contract. The treatment focuses on the transference [the patient's moment-to-moment experience of the therapist] because it is believed that the patient lives out his/her predominant object relations dyads in the transference. Once the treatment frame is in place, the core task in TFP is to identify these internal object relations dyads that act as the "lenses" which determine the patient's experience of the self and the world. It is believed that the information that unfolds within the patient's relation with the therapist provides the most direct access to understanding the make-up of the patient's internal world for two reasons. First, it has immediacy and is observable by both therapist and patient simultaneously so that differing perceptions of the shared reality can be discussed in the moment. Second, it includes the affect (feelings) that accompanies the perceptions, in contrast to discussion of historical material that can have an intellectualized quality.
Clinic for Psychoanalysis and Psychotherapy, Medical University Vienna
The aims of this workshop
This workshop gives an introduction to Transference-Focused Psychotherapy (TFP), which is a psychodynamic treatment for Borderline Personality Disorder. TFP has been manualized and has demonstrated its efficacy in the treatment of borderline patients in randomized-controlled trials. Thus, it can be regarded empirically validated.
Alexopoulos J, Steinberg C, Liebergesell-Kilian NE, Hoeffkes B, Doering S, Junghöfer M (2019). Biased emotional attention in patients with dental phobia. European Journal of Neuroscience 49(2):290-302.
Doering S, Blüml V, Parth K, Feichtinger K, Gruber M, Aigner M, Rössler-Schülein HZ, Freidl M, Wininger A. Personality functioning in anxiety disorders. BMC Psychiatry 18:294. Doi: 10.1186/s12888-018-1870-0
Ferrer M, Andión O, Calvo N, Hörz S, Fischer-Kern M, Kapusta ND, Schneider G, Clarkin JF, Doering S, and the European STIPO Research Group (2018). Clicical Components of borderline personality disorder and personality functioning. Psychopathology 51(1):57-64.
Tmej A, Fischer-Kern M, Doering S, Alexopoulos J, Buchheim A. Changes in Attachment Representation in Psychotherapy (2018): Is Reflective Functioning the Crucial Factor? Zeitschrift für Psychosomatische Medizin und Psychotherapie 64:222-236.
Hörz-Sagstetter S, Diamond D, Clarkin JF, Levy KN, Rentrop M, Fischer-Kern M, Cain NM, Doering S (2018): Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients with Borderline Personality Disorder. Journal of Personality Disorders 32(4):562-575.
Buchheim A, Hörz-Sagstetter S, Doering S, Rentrop M, Schuster P, Buchheim P, Pokorny D, Fischer-Kern M (2017): Change of Unresolved Attachment in Borderline Personality Disorder: RCT Study of Transference-Focused Psychotherapy.Psychotherapy and Psychosomatics 86:314-316.
König K, Dahlbender RW, Holzinger A, Topitz A, Doering S (2016): Kreuzvalidierung von drei Fragebögen zur Strukturdiagnostik: BPI, IPO und OPD-SF. Zeitschrift für Psychosomatische Medizin und Psychotherapie 62(2):177-189.
Fischer-Kern M, Doering S, Taubner S, Hörz S, Zimmernmann J, Rentrop M, Schuster P, Buchheim P, Buchheim A (2015): Transference-focused psychotherapy for borderline personality disorder: change in reflective function. British Journal of Psychiatry 207(2):173-174.
Diamond D, Levy KN, Clarkin JF, Doering S, Cain N, Fischer-Kern M, Hörz S, Buchheim A (2014): Attachment and Mentalization in Female Patients with Co-morbid Narcissistic and Borderline Personality Disorder. Personality Disorders: Theory, Research, and Treatment 5(4):428-433.
Baus N, Fischer-Kern M, Naderer A, Klein J, Doering S, Pastner B, Leithner-Dziubas K, Plener Pl, Kapusta ND (2014): Personality organization in borderline patients with a history of suicide attempts. Psychiatry Research 218:129-133.
Doering S, Burgmer M, Heuft G, Menke D, Bäumer B, Lübking M, Feldmann M, Schneider G (2014): Assessment of Personality Functioning: Validity of the Operationalized Psychodynamic Diagnosis Axis IV (Structure). Psychopathology 47(3):185-93.
Blüml V, Kapusta ND, Doering S, Brähler E, Wagner B, Kersting A (2013): Personality Factors and Suicide Risk in a Representative Sample of the German General Population. PLoS ONE: 8(10): e76646. doi:10.1371/journal.pone.0076646.
Doering S, Burgmer M, Heuft G, Menke D, Bäumer B, Lübking M, Feldmann M, SCHNEIDER G (2013): Diagnosing Personality Functioning: Validity of the Operationalized Psychodynamic Diagnosis (OPD-2) Axis IV: Structure. Psychopathology 2013 Oct 26. [Epub ahead of print]
Doering S, Burgmer M, Heuft G, Menke D, Bäumer B, Lübking M, Feldmann M, Hörz S, Schneider G (2013): Reliability and Validity of the German Version Structured Interview of Personality Organization (STIPO). BMC Psychiatry 13:210.
Schmeck K, Schlüter-Müller S, Foelsch P, Doering S (2013): The role of identity in the DSM-5 classification of personality disorders. Child and Adolescent Psychiatry and Mental Health 7:27. doi:10.1186/1753-2000-7-27.
Enzi B, Doering S, Faber C, Hinrichs J, Bahmer J, Northoff G (2013): Reduced deactivation in reward circuitry and midline structures during emotion processing in borderline personality disorder. World Journal of Biological Psychiatry 14:45-56.
Doering S, Enzi B, Faber C, Hinrichs J, Bahmer J, Northoff G (2012): Personality Functioning and the Cortical Midline Structures – An Exploratory fMRI Study. PlosONE 7(11): e49956. doi:10.1371/journal.pone.0049956. *shared first authorship
Zimmermann J, Ehrenthal JC, Cierpka M, Schauenburg H, Doering S, Benecke C (2012): Assessing the Level of Structural Integration using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM-5. Journal of Personality Assessment 94(5):522-532.
Fan Y, Wonneberger C, Enzi B, de Greck M, Ulrich C, Doering S, Northoff G (2011): The narcissistic self and its psychological and neural correlates: An exploratory fMRI study. Psychological Medicine 41(8):1640-50.
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 experienced community psychotherapists for borderline personality disorder: randomized controlled trial. British Journal of Psychiatry 196(5):389-395.
Leibing E, Jamrozinski K, Vormfelde SV, Stahl J, Doering S (2008): Dimensions of Personality - Relationship between DSM-IV Personality Disorder Symptoms, the Five-Factor Model, and the Biosocial Model of Personality. Journal of Personality Disorders 22(1):101-108.
Dr. Stephan Doering is psychiatrist and psychoanalyst. He is chair and professor of Psychoanalysis and Psychotherapy and head of the Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna, Austria. His main research foci are psychotherapy research, diagnosis and treatment of personality disorders, and psychosomatic medicine. He is editor and co-editor of four scientific journals and member of numerous scientific associations. Moreover, he has received five scientific awards. He is ESSPD president, vice president of the German Society for Research and Treatment of Personality Disorders (GePs), and past president of the International Society fpr Transference-focused Psychotherapy (ISTFP).