Transference-Focused Psychotherapy (TFP) is an evidence-based, twice-weekly psychodynamic therapy for people with problems in self and interpersonal functioning, including those with Borderline Personality Disorder (BPD), Narcissistic Personality Disorder (NPD; "narcissistic vulnerability"), and other personality disorders.
Like psychodynamic therapy more generally, TFP can help you better understand the self-defeating patterns that play out in your life, how your mind works, the internal conflicts you wrestle with, the defense mechanisms you use, and other things that might be outside of your awareness.
TFP therapists pay special attention to the ways people bring their problems with them to therapy. That is, you and your therapist work together to analyze how your interpersonal problems play out in the room, with the therapist. This process helps a person to recognize the different parts of themself that are especially hard to tolerate and integrate, e.g., angry, critical, hateful parts, feelings of inferiority and superiority. The objective is to integrate the good and the bad you see in yourself and others, to see yourself and others in a more nuanced, sympathetic, and realistic manner.
This type of treatment is ambitious, demanding, frustrating at times, but also empowering and life-changing. The desired outcome is a stronger sense of self, improved self-control, greater emotional stability and nuance, less self- and other-criticism, less fear of others, and a greater sense of agency and inner strength.
When we think of personality, the first thing we think about are character traits. Is someone organized and conscientious? Are they extraverted? But a lot more goes into personality than that.
Personality also includes:
our sense of self or identity
knowing our values, our interests, our goals
what motivates us
what we like and don’t like
knowing our story and how we came to be who we are
self-esteem
our coping and defense strategies
self-image
attachment style
how we perceive others
Sometimes certain parts of our personality can function in ways that cause us problems.
Our sense of self could be unstable, shifting around day-to-day and hour-to-hour, leading us to be emotionally volatile and unpredictable. Though I feel one way at this moment, I might feel completely different a few hours from now.
Our sense of self could be poorly integrated, meaning that there might be aspects of ourselves that are hard for us to accept, that we unconsciously try to keep out of awareness. It might be hard for me to accept that there is a part of me that can be domineering. Instead of being aware of it in myself, I might instead be sensitive to seeing it in others, sometimes even misperceiving others as domineering. Difficulties integrating different aspects of yourself can lead to chronic feelings of emptiness and feeling like you don’t know who you are.
Our self-esteem could be too rigid, inflexibly low, where we are never able to live up to expectations. In contrast, self-esteem could also be inflexibly high, where we’re not able to recognize and tolerate our limitations, accept ourselves for who we are, and see ourselves realistically.
In general, problems arise when parts of the personality are too rigid and inflexible, or too unstable and unintegrated.
Problems related to personality range from very mild and not very noticeable, to severe, where it’s hard for us to feel good about ourselves, maintain gratifying relationships, and feel satisfied at work.
BPD is a common disorder characterized by interpersonal hypersensitivity, or sensitivity to rejection or abandonment.
This doesn’t mean you have a bad personality or that you’re a bad person.
People with BPD have strong emotional reactions to signs of rejection which can lead to self-destructive behavior.
They tend to idealize relationships when things are going well and devalue them when things are going poorly.
There is a tendency to experience things in a black and white, all or nothing way.
Estimates indicate about 2-3% of the population has BPD.
Why do people develop BPD? We don’t completely know. There is a strong genetic factor. About 40 to 50% of BPD comes from genetics. The environment also plays a role. In particular, sometimes the fit between children and their parents was not the best. In addition, many people with BPD have histories of trauma which contributes to their struggles.
Narcissism has extremely negative connotations in contemporary culture. The word is often used in a pejorative manner, even by therapists. There is a wealth of misinformation about personality disorder on TikTok and other social media platforms. Disturbingly, a lot of this misinformation comes from people who appear to be therapists and counselors.
Firstly, there is a distinction between "healthy narcissism" and "pathological narcissism."
A healthy narcissism is something we all hope to have.
This means we have a generally positive view of ourself, feel accomplished enough, good enough, despite also being aware of the ways we fall short of our ideals.
With a healthy narcissism, we are able to weather the inevitable setbacks and disappointments of life, without our self esteem completely collapsing (even though setbacks and disappointments hurt and will naturally make us question ourselves).
Pathological narcissism, or narcissistic vulnerability, refers to rigidity or instability in self esteem.
People with narcissistic vulnerability have a difficult time regulating their self-esteem.
They rely on validation, admiration, and impressing others to maintain their self-esteem.
Their self-esteem is extremely sensitive to any sign of falling short, being criticized, judged, looked down upon, disrespected, or slighted. They can feel shame, humiliation, or rage as a result.
They have difficulties with vulnerability and depending on others. They want to be in control and self-sufficient.
They have tendency to hold unrealistic expectations or standards. This can lead them to be overly harsh with themself (and others), to be chronically disappointed, or to be avoidant of engaging with the world.
Issues related to self-esteem can lead them to be critical and envious of others.
They can view the world as a hierarchy in which people are either strong or weak, superior or inferior, accomplished or a failure. This is a black and white, all or nothing appraisal of self-worth.
Narcissistic vulnerability is common and ranges from mild to severe. Having the above struggles does not mean that you are unpleasant or disliked. Many kind, generous, high-functioning people have some degree of narcissistic vulnerability.