Transference-focused psychotherapy

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Transference-Focused Psychotherapy (TFP, German transmission focused psychotherapy ) is a special form of the psychodynamic (d. E. On the psycho-analysis -based) psychotherapy, mainly in patients with personality disorders is applied. It was described in 1998 in the form of a manual by John F. Clarkin, Frank E. Yeomans and Otto F. Kernberg . The focus of the therapeutic work in the TFP is on working through the transference relationship between patient and psychotherapist.

The therapy manual

The therapy manual is based on the standards for the development of therapy manuals (described by Moras (1993) and by Calhoun et al. (1998) ). It contains comprehensive information on the principles of therapy and describes the knowledge and skills that the therapist must acquire. The aim of the manual is reproducibility by other therapists:

The therapist should orient his treatment principles to a guiding theory, the individual elements (strategies, tactics and techniques) of which are precisely defined. His therapeutic work is supervised with the help of video recordings.

This process is called "empirically-supported treatment" and also includes the control of the therapists using an "Adherence and Competence Rating Scale" (scaled questionnaires).

Target group of the TFP

This psychotherapy was developed for the treatment of patients with personality disorders whose disorders are defined as cluster B personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ; American Psychiatric Association 1994) on axis II . This records personality disorders of the form borderline , histrionic , narcissistic and antisocial , as well as the "unspecified personality disorders" and the borderline personality organization.

A differentiation according to the severity of the disorder to be treated differentiates the categories: very severe disorder with narcissistic or antisocial characteristics or character pathologies, moderate disorder with histrionic or dependent character traits, slight impairment with hypomanic or depressive-masochistic traits.

Basics

The Transfer-Focused-Psychotherapy (TFP) is based on the theories of psychoanalysis, whereby it refers to the object relationship theory and the ego psychology . Based on Margaret Mahler's theories , disturbed object relationships from childhood can be transferred to the psychotherapist. According to the concept developed and empirically proven by Kernberg , an improvement in the area of ​​object relationships is possible if a form of therapy concentrates on working through the transference.

While the therapist engages in a transference relationship in classical psychoanalysis and thus supports the patient in regression , the TFP works with the analysis of the transference that occurs in the here-and-now .

Forms of therapy with similar aspects

Many elements have been incorporated into the psychodynamic therapy of the borderline personality with TFP which correspond to the clinical experience in the psychotherapy of patients with borderline pathology. z. B. the psychoanalytically oriented psychotherapy of patients with borderline personality disorder (modified from Waldinger, 1987) takes into account the same basic principles:

  • Establishing a stable treatment framework
  • Avoiding a passive therapeutic posture
  • Providing holding space ( "contain" )
  • Confrontational, active handling of self-destructive behavior
  • Establishing a connection between feelings and actions (“acting out”)
  • Setting and maintaining limits
  • Perceiving the countertransference
  • Interventions with a focus on the "here and now"

Luise Reddemann also developed the approach of giving the transfer great weight without promoting regression from her inpatient work with traumatized borderline patients and is incorporated in a free, non-manual form in the Psychodynamic developed by Reddemann (2004) Imaginative trauma therapy .

The handling of transference and countertransference is also used here in the sense of an “ interactive understanding ” of the therapeutic relationship. The transference neurosis in a trauma therapy to specifically support would even be contraindicated because subconsciously reinforces the self-blame tendencies of trauma patients by a neutral attitude of the therapist or the return burdensome memories can be conveyed to the facts of the case, which may be re-traumatising effect.

effectiveness

The effectiveness of TFP has been confirmed in various meta-analyzes. Perry (1999) and Leichsenring and Leibing (2003) found psychodynamic psychotherapies to be very effective.

literature

  • Frank E. Yeomans, John F. Clarkin, Otto F. Kernberg: Transfer-Focused Psychotherapy for Borderline Patients: The TFP Practice Manual. Schattauer Verlag, 2016, ISBN 3-7945-3160-4 .
  • Peter Fonagy, Glen O. Gabbard, John F. Clarkin: Psychodynamic Psychotherapy of Personality Disorders: Manual for Clinical Practice. Schattauer Verlag, 2012, ISBN 3-7945-2835-2 .
  • Eve Caligor, Otto F. Kernberg, John F. Clarkin: Transfer-Focused Psychotherapy for Neurotic Personality Structure. Schattauer Verlag, 2009, ISBN 3-7945-2628-7 .
  • Stephan Doering, Inge Seiffge-Krenke, Franz Resch: Transfer -focused psychotherapy (TFP) (compact psychodynamics). Vandenhoeck & Ruprecht Verlag, 2016, ISBN 3-525-40569-3 .
  • Richard G. Hersh, Eve Caligor, Frank E. Yeomans: Fundamentals of Transfer-Focused Psychotherapy: Applications in Psychiatric and Medical Settings. Springer Verlag, 2016, ISBN 3-319-44089-6 .
  • Frank E. Yeomans, John F. Clarkin, Otto F. Kernberg: Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide. American Psychiatric Association Publishing, 2014, ISBN 1-58562-437-3 .

Web links

Individual evidence

  1. ^ A b Frank E. Yeomans, John F. Clarkin, Otto F. Kernberg : Transfer-Focused Psychotherapy for Borderline Patients: The TFP Practice Manual. Schattauer Verlag, 2016, ISBN 3-7945-3160-4 .
  2. ^ A b John F. Clarkin, Frank E. Yeomans, Otto F. Kernberg : Psychotherapy for borderline personality: Focusing on object relations. Wiley Publishers, New York 2006.
  3. ↑ Frank E. Yeomans, John F. Clarkin, Otto F. Kernberg : Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide. American Psychiatric Association Publishing, 2014, ISBN 1-58562-437-3 .
  4. ↑ Otto F. Kernberg , Frank E. Yeomans, John F. Clarkin, Kenneth, N. Levy: Transference focused psychotherapy: Overview and update. Int J Psychoanal (2008) 89: 601-620.
  5. ^ Richard G. Hersh, Eve Caligor, Frank E. Yeomans: Fundamentals of Transference-Focused Psychotherapy: Applications in Psychiatric and Medical Settings. Springer Verlag, 2016, ISBN 3-319-44089-6 .
  6. ↑ a b c d e Peter Fonagy , Glen O. Gabbard, John F. Clarkin: Psychodynamic Psychotherapy of Personality Disorders: Manual for Clinical Practice. Schattauer Verlag, 2012, ISBN 3-7945-2835-2 .
  7. ↑ a b J.F. Clarkin, KN Levy, MF Lenzenweger, OF Kernberg : A multiwave RCT evaluating three treatments for borderline personality disorder. American Journal of Psychiatry, (2007) 164: 922-928.
  8. ↑ S. Doering, S. Hörz, M. Rentrop, M. Fischer-Kern, P. Schuster, C. Benecke, A. Buchheim, P. Martius, P. Buchheim: Transference-Focused Psychotherapy vs. treatment by community psychotherapists for borderline personality disorder: A randomized controlled trial. British Journal of Psychiatry, (2010) 196: 389-395.
  9. ↑ a b Otto F. Kernberg : Borderline conditions and pathological narcissism. New Haven, CT: Yale University Press, 1995, ISBN 0-87668-177-1 .
  10. ^ A b Perry JC, Banon E, Ianni F. Effectiveness of psychotherapy for personality disorders. At J Psychiatry. 1999; 156: 1312-1321.
  11. ↑ a b J.F. Clarkin, PA Foelsch, KN Levy, JW Hull, JC Delany, OF Kernberg: The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, (2001) 15: 487-495.
  12. ↑ Eve Caligor, Otto F. Kernberg , John F. Clarkin: Transfer-Focused Psychotherapy for Neurotic Personality Structure. Schattauer Verlag, 2009, ISBN 3-7945-2628-7 .
  13. ↑ JF Clarkin, PA Foelsch, KN Levy, JW Hull, JC Delany, OF Kernberg: The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, (2001) 15: 487-495.
  14. ↑ Annelies Verheugt-Pleiter, Margit Deben-Mager: Transference Focused Psychotherapy and Mentalization-based Treatment: Brother and Sister? Psychoanalytic Psychotherapy, December 2006, Vol. 20, No. 4, 297-315.
  15. ^ John F. Clarkin, Frank E. Yeomans, Otto F. Kernberg : Psychotherapy for borderline personality: Focusing on object relations. Wiley Publishers, New York 2006, ISBN 1-58562-210-9 .
  16. ↑ KN Levy, KB Meehan, KM Kelly, JS Reynoso, M. Weber, JF Clarkin, OF Kernberg :. Change in attachment patterns and reflective function in a randomized control trial of Transfer Focused Psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, (2006) 74: 1027-1040.
  17. ^ Otto F. Kernberg : Severe personality disorders. New Haven, CT: Yale University Press, 1993, ISBN 978-0-300-05349-4 .
  18. ↑ KN Levy, JF Clarkin, FE Yeomans, LN Scott, RH Wasserman, OF Kernberg: The mechanisms of change in the treatment of transference focused psychotherapy. Journal of Clinical Psychology, (2006) 62: 481-501.
  19. ↑ JF Clarkin, LN Levy: Psychotherapy for patients with borderline personality disorder: Focusing on the mechanisms of change. Journal of Clinical Psychology, (2006) 62 (4): 405-410.
  20. ↑ Stephan Doering, Inge Seiffge-Krenke, Franz Resch: Transmission -focused psychotherapy (TFP) (compact psychodynamics). Vandenhoeck & Ruprecht Verlag ,, 2016, ISBN 3-525-40569-3 .
  21. ↑ PA Foelsch, OF Kernberg : transference focused psychotherapy for Borderline Personality Disorders. Psychotherapy in Practice, (1998) 4 (2): 67-90.
  22. ↑ OF Kernberg , E. Caligor: A psychoanalytic theory of personality disorders. In: Major Theories of Personality Disorder . MF Lenzenweger & JF Clarkin (eds). 2nd Guilford Press, New York 2005, pp. 114-156.
  23. ↑ a b P.A. Foelsch, OF Kernberg: Transference-Focused Psychotherapy for Borderline Personality Disorders. Psychotherapy in Practice, (1998) 4 (2): 67-90.
  24. ^ A b F. Leichsenring , E. Leibing: The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a metaanalysis. At J Psychiatry. 2003; 160: 1223-1232.
  25. ↑ a b S2 guidelines for personality disorders (S2 practice guidelines in psychiatry and psychotherapy, volume 1). German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology eV (DGPPN), Steinkopff Verlag, 2009, ISBN 978-3-7985-1853-7 .
  26. ^ A b Luise Reddemann : Psychodynamic Imaginative Traumatherapy. PITT the manual . Pfeiffer at Klett-Cotta, 2004, ISBN 3-608-89729-1 .
  27. ↑ Gottfried Fischer , Peter Riedesser : Textbook of Psychotraumatology. 4th edition. Reinhardt, Munich 2009, ISBN 978-3-8252-8165-6 .
  28. ↑ Gottfried Fischer : Multidimensional Psychodynamic Trauma Therapy MPTT: Manual for the Treatment of Psychotraumatic Disorders. Roland Asanger Verlag, 2000, ISBN 3-89334-347-4 .
  29. ↑ Peter Buchheim, Stephan Doering: The transference-focused psychotherapy (TFP) of borderline personality disorder. PiD - Psychotherapy in Dialogue, 2007: 8 (04), pp. 323-327, doi: 10.1055 / s-2007-986283.