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What
is TFP?
TFP is a
modified psychodynamic psychotherapy, based in object relations theory,
to treat personality disorders. The theoretical basis is the assumption
that personality disorders are characterized by disruptions in the normal
organization of internalized object relations. Normal personality organization
is characterized by an integration of positive and negative objects.
Persons with personality disorders have internalized object representations
that are split into either "all good" (positive) or "all bad" (negative)
self and other representations. The emphasis in the treatment is to work
within the transference in the "here and now" of the moment with the patient
by identifying the split part internalized objects and the linking affect
(either idealized "all good" or devalued "all bad") that are enacted in
the transference during the session and work systematically to bring these
to the patient's awareness. In this process, the part objects become integrated
(the "good" and "bad" are no longer split) and the individual developes
the capacity to experience relationships and themselves in a more integrated,
balanced way. The person can now view themselves and others as containing
both "good" and "bad", not "all good" one minute and "all bad" in the next.
Is TFP
only for Borderline Personality Disorder (BPD)?
No. TFP is
used for the spectrum of personality disorders. Although it is most
widely associated with BPD and the majority of the supporting research
has been restricted to that patient population. However, even within the
research protocols, a large number of patients have a full range of co-morbid
AXIS II diagnosis. most frequently including Narcissistic, Paranoid, Schizoid
and Antisocial. Those diagnosis also show improvement after one year of
TFP treatment.
How do
I identify when someone may benefit from TFP?
The most
common signs that indicate a patient may benefit from TFP are:
(1)
Multiple
treatment failures. Patients have often been to many previous
therapists, tried multiple medications, all with little or no positive
benefit. Additionally, previous treator's may describe the experience of
feeling hopeless or frustrated in their attempts to help the patient.
(Aapel's
note: It seems "stange" to read that the first criteria to try this treatment
with a BPD people is the failure of all the previous ones. During this
time, what about the patient suffering ? )
(2) Relationship
difficulties. Patients frequently report either a series of chaotic
relationships or a complete void of relationships. The patients who are
involved in relationships often report that relationships tend to develop
a level of intimacy quickly, describe the other person in idealized terms,
become narrowly focused on the relationship (sometimes decreasing contact
with friends and family and/or not paying attention to work responsibilities).
This phase is then followed by a shift in affection, precipitated by some
"failing" in the other person. The relationship usually ends precipitously,
with full blame for the failure in the relationship assigned to the other
person. There may be repeated attempts to reunite with the other, but usually
these fail. In the most severe cases, threats of suicide may become
involved as a way of testing the relationship or communicating the level
of affection and/or distress. For other individuals, there may be a complete
lack of the development of love relationships.
(3). Work/Career
difficulties. Patients with personality disorders frequently
have difficulty maintaining jobs or following a career path. There
are often interpersonal difficulties that arise between the individual
and his/her supervisor,boss, or co-worker. They may also describe
themselves as "undecided" about what they want to do for a living, or describe
vague somewhat contradictory plans/goals. When pressed to describe how
they might accomplish their goals, the plan falls apart. Alternatively,
the individual may be able to work consistently, but changes jobs frequently
and describes themselves as dissatisfied in career or work. In the most
severe cases, a person has been unable to work productively and relies
on subsidies from the state or federal government.
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