More threads by Daniel E.

Daniel E.
Transference Focused Psychotherapy Explained in Human Terms
by Tami Green, Borderline Personality Support

I recently spoke with one of the nicest guy's ever, Dr. Frank Yeomans, Clinical Associate Professor of Psychiatry at the Weill Medical College of Cornell University. I wanted him to help me understand Transference Focused Psychotherapy (TFP) so I could put it in terms that lay folks could understand.

Dr. Yeomans developed a special interest in treating Borderline patients during his residency in the early 80's. Though the (misguided) consensus at the time was that BPD patients were generally difficult, he felt they could be particularly rewarding to work with. (Obviously a man after my own heart.)

I launched right in with asking how TFP differs from Dialectical Behavioral Therapy (DBT), the most well-known treatment option for BPD here in America, and he offered this example:

"When a patient has a hard time getting a job, and tends to get anxious and angry, tends to feel she is being challenged, she responds in a hostile way. DBT will teach her to master the reactions, while TFP questions her perceptions and helps her distinguish between the internal and external reality.

TFP helps sort out the internal perceptions that stem from childhood that may not match the external reality of today. It helps the patient question the way they think. In order to accomplish this, these therapists don't soothe their patients, so that a natural relationship is developed."

In this way, feelings that would normally arise in the course of a relationship are felt during therapy so they can be thought about and discussed.

I asked him how it is possible to assist someone in changing their internal views. He said, "by validating and then challenging. Get them to think. It may take months and years of
going back and forth. As a therapist, you can introduce data into someone's mind so they can begin to entertain it, but it only lasts a while because it usually feels safer to return to the previously held position."

When asked about actually changing the brain neurobiology, he offered some very exciting news: "There is more plasticity in the brain than once believed. The change happens through repetition, exposure and reflection." It would only make sense that to change our brain permanently would take a lot of time, then. However, life is not put on hold during therapy.

As a matter of fact, engaging in the world is a very important requirement of the therapy. Repetitive bad outcomes of the past--such as failed relationships or jobs--can be turned around successfully by bringing the real-time challenges to the therapy where they can be discussed and worked through. And though two therapy sessions are held each week, more than that is discouraged, as it fosters a dependence upon the therapist that is unnecessary.

He also discussed how TFP is a little controversial because of its' emphasis on the basic nature of the two sides of the human mind: the loving side (affinity and affection) as well as the competitive aggressive side.

Dr. Yeomans continued by saying:

"Our Mentalization (MBT) and DBT colleagues don't talk about innate aggressive drives, but even though these drives have been tamed in civilization, what do we do with them
now? Part of TFP is integrating the aggression and mastering it."

Speaking of this aggressive side and the need to integrate it, he added, "it was once thought that more women than men had BPD, but we now know that it is an equal percentage of each. It's just that more men with BPD show up in jail, not in the clinical community."

He said that everyone has this aggressive side, not just those with BPD. TFP helps the patient to learn to stop and analyze reactions. There is, for example, nothing wrong with
yelling and screaming if you chose to do it and control it and use the behavior effectively.

He also offered that not only are there angry, challenging types of BPD, but also the depressed type of BPD...

For more information, see Tami Green's articles, videos, and bookstore at Borderline Personality Support.

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