The problem is not that the person feels too much-it’s that they don’t know who they are.
—Otto Kernberg
What if the chaos we see in our most challenging clients is not simply about emotions, behaviors, or relationships, but about identity itself?
This is the radical foundation of Transference-Focused Psychotherapy (TFP)[1]: a treatment that dives deep, beyond symptoms and syndromes, into the very structure of the self.
TFP doesn’t ask, “What’s wrong with you?” It asks, “How do you see yourself? And how do you experience others?” These questions are not philosophical musings, they are clinical imperatives. Because without a stable, integrated identity, the rest is quicksand.
The Fragmented Self: Identity Diffusion as Core Pathology
For individuals with borderline or narcissistic personality organization, TFP posits that the primary issue is not mood instability, impulsivity, or even trauma, but identity diffusion.[2]
What is Identity Diffusion?
It’s the lack of a stable, coherent sense of self and others. The person may oscillate between feeling grandiose and worthless, idealizing, and devaluing others, or switching roles with dizzying rapidity. This isn’t manipulation, it’s a survival strategy when the internal world is split into disconnected parts.[3]
According to Kernberg and colleagues, identity diffusion results from unintegrated internalized object relations—the internal “representations” of self and other that form through early relationships. In healthy development, these representations become more complex and integrated over time. But in personality disorders, this integration fails.
The result? The client struggles to answer the most fundamental questions of human existence:
- Who am I?
- Who are you?
- Can I trust you? Can I trust myself?
The Therapist as a Mirror (and Sometimes a Battlefield)
TFP makes a bold move: it places the therapeutic relationship itself at the center of the healing process.[4]
In TFP, the transference is not just a tool, it’s the treatment. The therapist becomes the mirror in which the fragmented self plays out. The client’s split internal world gets projected onto the therapist in vivid, emotionally charged ways.
One moment you’re the rescuer. The next, the persecutor. The trick is not to defend yourself, but to hold the frame, observe the splits, and over time, help the client see that these contradictory parts can exist within one person, and be understood, tolerated, and eventually integrated.
This process is painstaking, often slow, and emotionally intense. But the outcome is profound: the birth, or rebirth, of a cohesive identity.
Beyond Insight: Why TFP is Not Just “Psychodynamic Therapy Plus”
Many therapists think they’re “doing TFP” if they’re exploring the past or interpreting transference. But TFP is not just a deeper version of standard psychodynamic work. It is a highly structured, technically precise intervention, backed by decades of research and clinical refinement.[5]
Its structure includes:
- A clearly defined treatment contract
- A strategic therapeutic frame
- A focus on the here-and-now transference
- Interpretation across three levels (defense, affective experience, and integration)
TFP is also time-limited (often 1–2 years), with clearly articulated goals. It is especially designed for clients who have previously “burned through” less intensive forms of therapy.
Studies show that TFP leads to reductions in suicidality, impulsivity, and identity disturbance. But more importantly, it fosters a core transformation in how the person sees themselves and relates to others, a shift that creates sustainable, long-term change.
Healing Through Relationship: Why Identity is Everyone’s Business
Even if you don’t work with personality disorders, TFP offers something essential for all clinicians: a roadmap for working with relational patterns and internal splits that live inside every human being.
Because truthfully, we all have moments of split thinking. We all struggle with conflicting parts. We all live in some degree of tension between how we see ourselves and how we want to be seen.
TFP teaches us that healing is not about “fixing” our clients, but about making space for all their parts to exist, be understood, and eventually come together.[6]
That’s the power of identity work. That’s the power of presence. That’s the power of TFP.
If this sparked something in you, if you’re ready to go deeper, sharpen your clinical skills, and transform your therapeutic presence, we invite look out for the upcoming registration opportunities to join our 8-week, 1-hour series on Transference-Focused Psychotherapy.
Sessions are held live on Thursdays.
Together, we’ll explore:
- How to recognize identity diffusion in the first five minutes of a session
- How to track and interpret the transference without losing the client, or yourself
- How to handle aggression, splitting, and enactments with clarity and compassion
- And how to become the kind of therapist who transforms, not just informs, the lives you touch
[1] Kernberg, Otto F., et al. “Transference focused psychotherapy: Overview and update.” The International Journal of Psychoanalysis 89.3 (2008): 601-620.
[2] Yeomans, Frank E. “Transference-focused psychotherapy in borderline personality disorder.” Psychiatric Annals 34.6 (2004): 449-454.
[3] White, Tony. “TRANSFERENCE BASED THERAPY: PSYCHOSEPARATION.”
[4] Hersh, Richard G., Eve Caligor, and Frank E. Yeomans. “Fundamentals of Transference-Focused Psychotherapy.” Cham, Switzerland: Springer (2016).
[5] Levy, Kenneth N., Yogev Kivity, and Frank E. Yeomans. “Transference-focused psychotherapy: Structural diagnosis as the basis for case formulation.” Case formulation for personality disorders. Academic Press, 2019. 19-40.
[6] Hersh, Richard G. “Applied Transference-focused Psychotherapy: An overview and update.” Psychodynamic Psychiatry 49.2 (2021): 273-295.