Using Transference-Focused Psychotherapy Principles in the Pharmacotherapy of Patients with Severe Personality Disorders

Abstract

Transference-focused psychotherapy (TFP) is an evidence-based, manualized treatment for severe personality disorders. TFP provides clinicians with a comprehensive diagnostic approach, overarching theoretical orientation, and specific clinical techniques. While TFP was developed as a long-term psychodynamic psychotherapy for patients with personality disorders, the approach, orientation, and techniques used in psychotherapy treatment may be of use in pharmacotherapy with the same patients. Patients with borderline personality disorder, in particular, are high utilizers of all subtypes of psychotropic medication despite limited evidence for their effectiveness, creating multiple challenges for the prescribing clinician. The author suggests specific ways the TFP model can assist prescribers, including those who do not practice TFP psychotherapy.

Managing the clinical encounter with patients with borderline personality disorder in a general psychiatry setting: key contributions from transference-focused psychotherapy

“…Sessions are typically twice a week, although the National Health Service (NHS) in the UK offers sessions once a week. Applied TFP principles can be used in general psychiatry (Zerbo 2013; Hersh 2015, 2017) and this is what we address in this article.…”

Transference-focused psychotherapy.

“…TFP was originally conceptualized within a developmental psychopathology framework based in identify diffusion and polarized representations of others and the self that cut across PD categories, and authors have therefore noted that other styles and levels of severity of personality pathology may benefit from TFP principles (Caligor et al, 2007(Caligor et al, , 2018. The application of TFP principles have now been described for working with college students (Hersh, 2013), prescribing psychiatric medication (Hersh, 2015), treating patients in acute clinical care settings (Hersh et al, 2017;Zerbo et al, 2013), working with traumatized patients (Draijer & Van Zon, 2013), treating complex depression (Clarkin et al, 2019), and training psychiatric residents (Bernstein et al, 2015). Integrating TFP with other treatments has also been explored: Good psychiatric management (McCommon & Hersh, 2021), supportive psychotherapy (O. F. , behavioral activation (Levy & Scala, 2015;Yeomans et al, 2017), and modular treatments (Clarkin et al, 2015) have all been considered as potential modalities for integration.…”

Symbolic meaning of drugs in psychotherapy: A psychodynamic perspective.

“…In patients with borderline personality disorders (BPDs), the oral activity of ingesting PDs reveals the need for self–other fusion typical of the oral stage, as Kernberg (1985) explained. Interestingly, in the transference-focused psychotherapy model (Kernberg, Yeomans, Clarkin, & Levy, 2008; Yeomans, Clarkin, & Kernberg, 2015)—a treatment conceived to be effective for patients with BPD—the author proposes an “integrated” approach in which principles of psychotherapy are applied from a pharmacotherapeutic perspective (as discussed in Hersh, 2015) and considered as a relevant issue in the treatment of these patients.…”