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Transference Focused Psychotherapy (TFP) is a structured, evidence-based psychodynamic treatment developed by Dr. Otto Kernberg and his colleagues at the Personality Disorders Institute at Weill Cornell Medicine. It was designed specifically for borderline personality disorder and narcissistic personality disorder — conditions characterised by significant identity disturbance, unstable and intense relationships, and the defensive operation of splitting.
TFP works through a specific therapeutic mechanism: the systematic analysis of the patient's relationship with the therapist as it unfolds in real time. The transference relationship is the primary instrument of change.
TFP operates on the premise that personality disorders — particularly borderline and narcissistic — are characterised by identity diffusion: the patient holds contradictory, split representations of themselves and others, unable to integrate positive and negative aspects into coherent, stable, and realistic wholes.
In borderline personality disorder, this manifests as extreme idealisation and devaluation — people are experienced as entirely good or entirely bad, shifting suddenly and dramatically. Relationships are intense, unstable, and characterised by abandonment fears. The patient's sense of self is fragmented and contingent on the responses of others.
TFP works directly with these split representations as they emerge in the therapeutic relationship. When the patient idealises the therapist, fears abandonment by them, or becomes suddenly hostile — these are not reactions to be managed. They are clinical material: they reveal the patient's internal object world and provide the opportunity for interpretation and integration.
The goal of TFP is the integration of split self and object representations — what Kernberg calls identity consolidation — which produces not only symptomatic improvement but a more stable, coherent, and realistic sense of self and of relationships.
TFP is conducted in twice-weekly individual sessions, with a clear treatment contract established at the outset. The contract defines the frame of treatment — boundaries, expectations, and procedures — and provides the stable structure within which the therapeutic work unfolds.
The primary technique is interpretation: the therapist observes, clarifies, and interprets the patterns of relating that emerge in the therapeutic relationship, linking them to the patient's characteristic ways of relating in other contexts and to the underlying internal representations.
The sequence moves from clarification — making explicit what is happening — through confrontation — drawing attention to contradictions and inconsistencies — to interpretation — making explicit the underlying meaning of what is being enacted.
TFP does not use skills training or homework. It works by creating, within the therapeutic relationship, the conditions for integration to occur.
TFP has the strongest evidence base for borderline personality disorder — with research demonstrating improvement in suicidality, self-harm, impulsivity, and reflective functioning, as well as structural personality change. It is also used for narcissistic personality disorder, other severe personality pathology, and complex presentations involving significant identity disturbance.
TFP is conducted directly in English, Russian and Hebrew — without an interpreter. The interpretive precision TFP requires — tracking subtle shifts in the patient's relational stance and naming what is happening in the room — demands the full communicative range that direct language provides.
TFP is a longer-term treatment, typically conducted over a minimum of one to two years. The treatment contract is established with the patient before treatment begins.
For patients with borderline personality disorder where both stabilisation and deeper structural change are goals, TFP may be preceded by a period of DBT — which provides the behavioural stabilisation that makes the intensive relational work of TFP possible — or offered alongside schema therapy at different stages.
All TFP at IsraClinic is delivered within the framework of the Psychoergonomic Method — ensuring the approach accounts for this specific patient's personality organisation, clinical history, and treatment goals.
TFP is indicated for borderline personality disorder — particularly with prominent identity diffusion, unstable intense relationships, and splitting — and for narcissistic personality disorder with significant identity pathology.
TFP requires sufficient stability to maintain the therapeutic frame and engage with twice-weekly sessions over an extended period. It is not appropriate during active psychiatric crisis or for patients whose current state does not permit sustained engagement with interpretive work.
IsraClinic accepts patients for in-person consultation in Tel Aviv and online, in English, Russian and Hebrew. No referral is required.
Clinical Programme Curator: Valery Kravitz | IsraClinic | Last reviewed: 2026
TFP works where others have not — through the depth of the therapeutic relationship itself. If you would like to discuss whether TFP is right for your situation, our team is available in English, Russian and Hebrew.