Conversion to Transference-Focused Psychotherapy from Other Treatments by the Same Therapist: Pitfalls and Benefits

Borderline personality disorder and broadly speaking, borderline personality organization, including narcissistic personality disorder, can be effectively treated by transference-focused psychotherapy (TFP), which is a modern object relations-based structured psychoanalytic psychotherapy. TFP can be taught successfully to therapists from a wide array of backgrounds, not only to psychoanalysts, provided they have a basic grasp of psychodynamic concepts, including object relations theory. We initially thought that starting with a new patient would always be easier than conversion to TFP from a different method. Our supervisory experience supported this only partially. To learn more, we distributed a survey among therapists who completed formal TFP training or participated in supervision for at least 1 year. Only four of the 36 respondents felt that starting with a new case was easier. Conversion was a lot more common than we had expected (in fact, it seemed to be an almost inevitable part of training), and it often took place without appropriate supervision of the process. Moving from supportive therapy to TFP was the most difficult for the therapist, and often for the patient. All respondents felt that they would treat all new patients with borderline personality organization with TFP from the outset or, if indicated or necessary, begin with a preliminary treatment using TFP elements. Our findings strongly suggest that conversion needs to be taught in training seminars, and should not be left to be dealt with entirely in supervision.