Advancement in the assessment of object relations dyads in TFP: Setting the basis for a clinical tool

Transference-Focused Psychotherapy (TFP) is a psychodynamic treatment for personality disorders, recognized by the American Psychological Association as an evidence treatment for borderline personality disorder. Rooted in Kernberg’s theory of personality organization, TFP entails as a crucial therapeutic strategy the assessment and elaboration of patients’ object relations dyads, intended as representations of self and others linked together by a positive or negative affect. The inner world of individuals with personality disorders is characterized by split, polarized, and oscillating object relations dyads, which are played out in the transference dynamic, often challenging the therapeutic relationship. A systematic assessment method of object relations dyads for TFP practice is currently missing. We extracted one hundred object relations dyads from tables and clinical vignettes that were reported in TFP manuals. Such dyads were then presented to the TFP international community through an online survey. Clinicians were asked to: 1) evaluate each dyad’s relevance for their clinical work with personality disordered patients, 2) classify them into five relational themes (Aggression/Hostility, Control/Power, Worth, Care, and Sexuality), and 3) assign a positive or negative valence to each dyad. Our analyses combined quantitative and qualitative approaches and identified a finite set of 51 object relations dyads evenly distributed in relational themes, suitable for building a clinician-rated and a self-report assessment tool for clinical and research settings. Such tools will allow clinicians to gain a deeper understanding of the inner world of patients with personality disorders and to better manage intense transference and countertransference reactions that characterize therapeutic relationships with such patients.