Moderate EvidencePsychodynamicSpecialist

Transference-Focused Psychotherapy(TFP)

Last evidence review: January 20265 printable resources

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Overview

Transference-Focused Psychotherapy is a specialist, manualised psychodynamic therapy developed for severe personality pathology, particularly borderline personality disorder. It focuses on understanding and integrating split, unstable internal representations of self and others through the therapeutic relationship.

What this therapy focuses on

TFP targets identity diffusion, affect instability, impulsivity, and unstable relationships by working with the patient’s moment-to-moment experience in the therapy relationship to clarify patterns and integrate fragmented self–other representations.

What sessions are usually like

Session length: 45–50 minutes

Frequency: Usually twice weekly

Often longer-term with structured phases

Not worksheet-driven; focus is on reflection and relational patterns

Session profile

Duration: 45–50 minutes

Frequency: Twice weekly

Typical course: 1–3 years

Between sessions: Reflection on relational patterns; no formal worksheets

Common uses and suitability

What problems it is commonly used for

Borderline personality disorderSevere personality pathology with recurrent relational crisesChronic suicidality/self-harm requiring specialist containment

Who this therapy may suit best

Individuals with severe identity and relational difficulties
Those able to engage reliably in structured, high-intensity therapy

When it may need adapting or may not be suitable

Active substance dependence undermining attendance
Uncontained psychosis or mania
High immediate risk without adequate crisis systems

Where this therapy may not be enough

TFP is designed for severe personality pathology. It is not indicated for mild/moderate presentations or acute symptom management.

What happens in therapy

Contracting and Frame Management

Establishing clear agreements about how therapy works and what to expect.

Clarification

Your therapist asks questions to understand exactly what you’re experiencing.

Confrontation

Gently pointing out contradictions in what you say or do, to help you see patterns.

Transference Interpretation

Exploring how the patterns that show up in your therapy relationship connect to patterns elsewhere in your life.

Evidence Base

Guideline support

Present in some specialist pathways; varies by country and service.

Strength of evidence

Moderate for severe personality presentations. RCTs (Clarkin et al., Doering et al.) demonstrate improvements in personality functioning, affect regulation, and self-harm.

Limitations

Requires high training investment and robust governance. Not a brief therapy. Fewer RCTs than DBT for BPD.