Frank E. Yeomans

Weill Cornell Medicine | Cornell · Department of Psychiatry

Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to meet the needs of patients with personality pathology. As it became more clearly defined through a series of treatment manuals and empirical research, TFP has also come to be consider...

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working wi...

Transference‐focused psychotherapy (TFP) is a manualized treatment for patients with a personality disorder based on 18 months of once‐weekly or twice‐weekly therapy. TFP is suitable for publicly funded psychotherapy and private practice. Devised by Kernberg and colleagues, its conceptual framework is based on Kleinian theory of primitive defences...

Purpose of review The authors describe the application of a twice-weekly, exploratory psychotherapy, Transference-Focused Psychotherapy (TFP), to patients with Narcissistic Personality Disorder (NPD). The paper describes the pathology of object relations within which narcissistic pathology can be understood, and how TFP establishes a treatment fram...

The authors describe the application of a twice-weekly exploratory psychotherapy, transference-focused psychotherapy (TFP), to patients with borderline personality disorder. The article describes the pathology of internal object relations that provides a framework for understanding borderline personality and how TFP establishes a treatment framewor...

The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The au...

Transference-focused psychotherapy (TFP) is a manualized evidence-based treatment for borderline and other severe personality disorders that is based on psychoanalytic object relations theory. Similar to other psychodynamic psychotherapies, TFP focuses on changing psychological structures, but also focuses on symptom and behavioral change, particul...

The authors outline the application of Transference-Focused Psychotherapy (TFP), a structured, twice-weekly psychoanalytic psychotherapy, to patients with narcissistic pathology. The operation of splitting-based defenses in the maintenance of the pathological grandiose self that is characteristic of individuals with narcissistic personality disorde...

Objective: Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD from the perspective of individuals seeking information or services related to BPD ("BPD care s...

Objective: This article discusses Transference-Focused Psychotherapy, a contemporary evidence-based and manualised form of psychoanalytic psychotherapy for borderline personality disorder. Transference focused psychotherapy has evolved from decades of research in the object-relations approach developed by Professor Otto Kernberg and his collaborat...

Both the diagnosis and treatment of NPD require a coherent conceptualization of the disorder that can unify a wide range of clinical presentations. The DSM system has in the past focused on a descriptive characterization that emphasizes grandiosity (in fantasy or behavior), the need for admiration, entitlement, and a lack of empathy. However, these...

Transference-focused psychotherapy (TFP) principles can aid clinicians in crisis management in a variety of settings. The TFP contract has multiple provisions related to expectable crises explored in advance of starting the treatment. The essential elements of severe personality disorder pathology, specifically the predominant use of splitting-base...

Transference-focused psychotherapy (TFP) has been introduced to psychiatry residency training in a number of pilot programs. The introduction of TFP to residency training has multiple goals: the instruction about an empirically validated treatment for patients with borderline personality disorder and, more broadly, the introduction of a set of tool...

Transference-focused psychotherapy (TFP) will include more family contact than would be expected in a traditional psychoanalytic treatment. The TFP assessment process will include family involvement if the patient is dependent on family support in any significant way. The TFP therapist’s meeting with the patient and family will include psychoeducat...

The pharmacotherapy of severe personality disorder pathology is a challenging subject. Patients with certain personality disorder diagnoses, particularly borderline personality disorder, take medications at high rates, despite limited dating supporting efficacy. Prescribers will often struggle when patients exhibit primitive defenses (idealization/...

Transference-focused psychotherapy (TFP) proceeds in a deliberate way following the assessment and contracting phase. The TFP therapist expects to encounter confusing and confounding material reflecting the patient’s underlying pathology. The therapist manages this confusion by “naming the actors” or putting into words the most prominent affects id...

Transference-focused psychotherapy (TFP) is an empirically validated psychotherapy for adults with borderline personality disorder (BPD). TFP is a psychoanalytically informed treatment with roots in object relations theory. TFP has been used more broadly for adults with narcissistic personality pathology, higher level personality pathology, and ado...

The interface between personality disorder pathology and issues related to medical conditions and medical care is complex. Patients with personality disorder diagnoses will often have co-occurring medical conditions (some directly related to the personality disorder symptoms, such as the results of self-injury), and personality disorder pathology c...

For the patient with severe personality disorder pathology, an inpatient psychiatric hospitalization can be of benefit, but can also be associated with significant risk. The transference-focused psychotherapy (TFP) contracting process will explore in advance a number of contingencies related to psychiatric hospitalization. The TFP approach to hospi...

This book offers clear, practical, and simple recommendations for treating patients with personality disorders. The goals of the book are twofold: 1) to describe the essential elements of Transference-Focused Psychotherapy (TFP), an evidence-based treatment for Borderline Personality Disorder, and 2) to describe how core principles and techniques o...

The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the tre...

Abstract The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific...

Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in t...

This chapter presents the adaptation of transference-focused psychotherapy for personality disorders in adolescents (TFP-A). This treatment is based on contemporary psychoanalytic object relations theory as developed by Kernberg (1984, 1992) and supported by findings from current evidence-based and neurobiological research (Clarkin, Levy, Lenzenweg...

Several efficacious therapies for borderline personality disorder (BPD) now exist despite longstanding skepticism in the field regarding amenability to treatment. In this article, 4 master clinicians describe a brief interaction with an actress playing the part of a patient with BPD that occurred at the First Annual Meeting of the North American So...

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experie...

Transference-Focused Psychotherapy (TFP) is a manualized evidence-based treatment for borderline and other severe personality disorders that is based on psychoanalytic object relations theory. The treatment contracting/setting the frame, managing countertransference, and the interpretative process are three critical components of TFP. We provide vi...

The challenge of accurate diagnosis remains at the heart of good psychiatric treatment. In the current state of psychiatry, a confluence of forces has increased this challenge for the clinician. These include practical pressures-such as limited time for diagnostic evaluation, the question of what is reimbursed by insurance, and the issue of directi...

Though attachment research today is best conceptualized as integrationist and multidisciplinary, it is important to remember that attachment theory was born out of clinical process. Bowlby [1–3] was first and foremost a psychoanalyst, and he drew from clinical experiences with children and adults to conceptualize his theory. Many of his ideas devel...

It is generally believed that psychoanalytically or dynamically oriented clinicians are not interested in research for a host of reasons ranging from the challenges of designing a randomized controlled trial that would demonstrate the efficacy of a psychoanalytic approach to epistemological and philosophical disagreements about the nature of scienc...

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This article will address an aspect of many therapists’ practices that is often hidden from view. Therapists sometimes find themselves in impasses where they not only feel that progress is not being made but that they have had lapses in judgment. They report feeling both uncomfortable about their role and unable to extricate themselves from it. As...

What changes and how quickly these changes occur as a result of therapy in borderline personality disorder (BPD) is an important ongoing question. The features of BPD patients that are most predictive of rates of change in such patients remain largely unknown. Using the Cornell Personality Disorders Institute (CPDI) randomized controlled trial data...

We present an overview of psychoanalytic object relations perspectives on narcissistic pathology, with an emphasis on a form of psychodynamic psychotherapy, Transference Focused Psychotherapy (TFP) designed to treat personality disorders including NPD. We also review therapeutic modifications of TFP that help clinicians effectively treat patients w...

While all patients become more concrete in their psychological functioning in areas of conflict, especially in the setting of transference regression, in the treatment of patients with severe personality pathology this process poses a particular clinical challenge. In the psychoanalytic psychotherapy of patients with severe personality pathology in...

Writing about psychodynamic psychotherapy for borderline personality disorder (BPD) is difficult because it is not a unified approach. In fact, it is often said that psychoanalysis, although frequently used singularly, is in actuality a plural noun representing an array of theoretical ideas and technical applications. These schools broadly include...

Borderline personality disorder (BPD) is characterized by considerable heterogeneity. Prior approaches to resolving heterogeneity in BPD pathology have used factor and cluster analytic as well as latent class analysis strategies. These prior studies have been atheoretical in nature, but provide an initial empirical corpus for further sub-typing eff...

Dans cet article, les auteurs tentent d’illustrer comment les questions liees a l’attachement sont au coeur de la psychotherapie focalisee sur le transfert (PFT), une psychotherapie psychodynamique manualisee pour le traitement des personnes ayant un trouble de la personnalite limite (TPL). Les auteurs mettent en evidence que la facon dont le psych...

Les auteurs presentent un apercu de l’eventail des interpretations psychanalytiques de la pathologie narcissique, en mettant l’accent sur le modele et le systeme de classification decrits par Kernberg (1984). Ils abordent la maniere dont le clivage des dyades relationnelles objectales favorise une importante pathologie, tant du developpement que du...

Au Personality Disorders Institute, nous avons etudie l’efficacite de la psychotherapie focalisee sur le transfert (PFT), une psychotherapie psychodynamique manualisee qui se deroule deux fois par semaine a l’intention de personnes souffrant de troubles de personnalite limite (TPL). Nous avons compare la PFT a la therapie dialectique comportemental...

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contem...

At the Personality Disorders Institute we have been investigating the efficacy of Transference-Focused Psychotherapy (TFP), a twice weekly manualized psychodynamic psychotherapy for borderline personality disorder compared to Dialectical Behavior Therapy (DBT) and Supportive Psychotherapy (SP) in a randomized clinical trial of 90 borderline patient...

This paper illustrates the centrality of attachment issues in a manualized psychodynamic psychotherapy for BPD, Transference-focused psychotherapy (TFP). The focus is on how the psychotherapist's awareness of these issues may advance the understanding of psychopathological processes mediated by attachment disorganization, and in particular how the...

In this paper, the authors present an overview of a range of psychoanalytic understandings of narcissistic pathology with an emphasis on the model and system of classification described by Kernberg. They discuss how the concept of a fundamental split between object relations dyads can contribute to major pathology of superego development and functi...

Transference-Focused Psychotherapy (TFP) is a modified psychodynamic psychotherapy, based on object relations theory of personality and psychoanalytic principles of the dynamic unconscious, the importance of transference and counter-transference, and the reliance upon interpretation of the transference as the dominant therapeutic intervention. TFP...

The authors address psychodynamic therapies, particularly transference-focused psychotherapy (TFP), in the treatment of patients who present with non-suicidal self-injury. In doing so, they briefly discuss various psychodynamic approaches with empirical evidence for their effectiveness. They describe TFP, including its treatment rationale, putative...

Résumé La psychothérapie focalisée sur le transfert (PFT) est une version modifiée de la psychothérapie psychodynamique classique et spécialisée pour les troubles graves de la personnalité. Elle se fonde sur les principes de la psychanalyse et sur la théorie des relations objectales. L’organisation du monde psychique se structure à partir de l’expé...

I’m writing as a consultant to the study in the June 2006 issue of the ARCHIVES, “Outpatient Psychotherapy for Borderline Personality Disorder: Randomized Trial of Schema-Focused Therapy vs Transference-Focused Psychotherapy.”1 The topic is important, but I regretfully have to object to aspects of this study and question its conclusions. Besides th...

Transference focused psychotherapy is a version of psychodynamic psychotherapy that is modified and specialized for patients with borderline personality disorder. It is based on psychoanalytic principles with an emphasis on object relations theory. A fundamental concept in this model is that the organization of an individual's psyche is structured...

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the int...

Psychodynamic theoreticians and clinicians have given increasing attention to the nature and treatment of personality disorders. In this chapter, we explore the psychodynamic models most relevant to understanding these disorders and then describe the application of these models in treatment. The psychodynamic literature has tradtionally focused mor...

Presents partial findings on 5 patients, 2 of whom shifted to secure states of mind after 1 year of transference focused psychotherapy (TFP) on the Adult Attachment Interview (AAI) and 3 of whom did not. The authors also present findings on the use of the Patient-Therapist AAI to assess the impact of attachment organization on therapeutic process a...

One of the principal formulations of borderline personality disorder is based on object relations theory, a component of psychoanalytic theory. To remain relevant, psychoanalytic formulations must find support from empirical research. After summarizing the object relations understanding of borderline personality, the authors review studies in biolo...

Psychodynamic psychotherapy, a field that once lagged behind other areas in psychiatry with regard to empirical studies, has gone through a culture change. Methods of research that were once felt to be, at best, an awkward fit with psychodynamic therapy are being applied with positive results. Major efforts have been made in instrument development,...

Presents changes in attachment style and self and object representations of 2 of 20 patients over the course of a year in psychoanalytically oriented Transference-Focused Psychotherapy (TFP). Ss (aged in their late 20s) completed the Adult Attachment Interview (AAI), the Patient-Therapist Relationship Interview, Bartholomew's Four-Category Adult At...

Structured clinical interviews of 107 female inpatients diagnosed with borderline personality disorder (BPD) were used to determine whether antisocial personality disorder (APD) diagnostic criteria evident prior to age 15 could be used to predict current Axis I and Axis II psychopathology. Diagnostic information was gathered using the Structured Cl...

Structured clinical interviews of 63 female inpatients diagnosed with borderline personality disorder were used to study the relations of comorbid mood disorders to treatment response. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for D...

The study sought to identify aspects of borderline personality disorder and comorbid axis I conditions associated with multiple hospitalizations in a sample of patients with borderline personality disorder. Data were collected as part of a larger study of treatment course of inpatients with this disorder. Predictors of multiple hospitalization from...

This study aimed to identify patient factors that predict early dropout from psychodynamic psychotherapy for borderline personality disorder (BPD). Thirty-six BPD patients began an open-ended course of twice per week psychodynamic psychotherapy that was defined in a treatment manual and supervised. Dropout rates were 31% and 36% at 3 and 6 months o...

The relationship of antisocial traits to treatment response in 35 female inpatients with borderline personality disorder was studied. Antisocial traits were measured with the Personality Assessment Inventory. Treatment response was measured by weekly ratings on the Symptom Checklist-90-Revised over 25 weeks of hospitalization. Treatment course was...

The authors studied 42 hospitalized female borderline patients in terms of level of depression, interpersonal relations, and concurrent DSM Axis II diagnoses in an effort to identify risk factors for self-destructive behavior. A poor quality of interpersonal relations characterized the patients who had a history of serious self-destructiveness. Thi...

High patient drop-out rates have traditionally interfered with both treatment and study of patients with borderline personality disorder (BPD). The authors tested hypotheses that an adequate treatment contract, a positive therapeutic alliance, and the severity of illness would all correlate with continuation of treatment versus drop-out in a BPD co...

Patients with borderline personality disorder provide an ideal sample for a study of impulsive sexual behavior and factors related to it in psychiatrically ill women. Even though impulsive sexual behavior is one of the DSM-III-R criteria for borderline personality disorder, not all patients with the disorder manifest such behavior. While controllin...

A pilot study on the process of psychodynamic psychotherapy of borderline personality disorder at the Cornell University Medical College is designed to investigate the teaching and application of a specific model of treatment for borderline patients (Clarkin et al. 1992; Kernberg and Clarkin 1992). The project has involved teaching a group of self-...

DR. Soloff’s discussion provides a comprehensive review of current theories of borderline pathology and the related approaches to treatment. We have no disagreement with many of his points, in particular with the need for limit setting and the place for judicious use of medication. However, our experience in applying Kemberg’s model to the practice...