Considering Transference-Focused Psychotherapy for BPD

I’ve always maintained that it was transference-focused psychotherapy (TFP) with my former psychiatrist, Dr. Lev, which saved my life and gave me a life worth living. I’ve recently been looking at posts on Instagram and TikTok about borderline personality disorder (BPD) and some mention dialectical behavior therapy (DBT) as the gold standard treatment. None mention TFP.

Before managed care, I spent 10 months in a long-term inpatient unit that treated patients diagnosed with BPD with dialectical behavior therapy. Then I was discharged to that hospital’s day program for patients with BPD. We were treated with DBT by many of the same staffers. I stayed in that program for 18 months.

TFP is a psychodynamic treatment, as opposed to DBT, which is a skills-based treatment. DBT is based in the here and now, while TFP treats BPD by focusing on the relationship — or the “transference” — between the therapist and the patient.

Transference-focused psychotherapy most often takes place twice weekly, and treatment lasts between one and three years. I worked with Dr. Lev for 11 years, with twice-weekly sessions. Before Dr. Lev and I started working together, we created a contract the purpose of which was to identify any behaviors that might interfere with treatment. The three items on my contract were:

• If I fell below a certain weight, I had to enter inpatient eating disorder treatment.
• If I cut myself, even a scratch,…