Transference-Focused Psychotherapy (TFP) was originally developed as a treatment designed to promote “integration” in the personality organization of patients whose identity is characterized by rigid dysjunctures between positive and negative representations of self and other in the patient’s internal world. Supported by splitting-based (“primitive”) defenses in patients in whom frank reality testing was broadly intact, this syndrome was deemed the “Borderline Personality Organization” (Kernberg, 1984). The work of promoting the integration of positive and negative sectors of experience and internal representation in TFP involves the careful tracking of splitting-based defenses in the treatment process, the confrontation of these splits as they manifest between patient and therapist, and between the patient and others in their surround, and the interpretation of the defensive functions of these defensive operations.
Chief among such splitting-based defenses is that of projective identification, i.e., where conflictual or negative aspects of the self with which the patient is still identified, albeit unconsciously, are perceived or experienced in the other (e.g., needy, aggressive, exploitative, judgmental). The projection of these conflictual representations of the self onto others results in a distortion of the perception of the other that can leave the projecting patient consumed by intense anxieties, for example, fear of attack, or devaluation.
In addition to its defensive function in the lives of patients organized at the borderline level, and as a mode of implicit communication throughout the lifespan and spectrum of health and pathology, projective identification is also the primary clinical motif that has been at the heart of object relational models of couple therapy since the pioneering work of Henry Dicks (1963; 1967), who conceptualized couple conflict through its lens. Functioning both as an intrapsychic (Klein, 1946) and an interpersonal (Bion, 1959) form of communication, the concept of projective identification has proved useful not only in understanding dyadic interactions between the therapist and the individual, but also in structuring what unfolds between the therapist and the couple, as well as within the couple itself.
Shaped by early interpersonal experiences with primary caregivers, now internalized as parts of the self, each partner in a couple brings their own personality structure into the relationship. Partners inevitably project conflictual aspects of their internalized objects onto their mates, leading to patterns of idealization (projecting good parts), and paranoia / devaluation (projecting bad parts), reflecting a repetition of these earlier, unresolved relational conflicts. The greater the internal instability of a partner’s internal object relations, the greater their propensity to be “activated” in the context of the normal wishes stimulated by coupled life, and the normal hurts invariably inflicted by the same. The more fraught either or both partner’s internal object relations, the greater the anxiety of the partners, each agitating for the other to embody an idealized / wished-for partner, and fearing with great vigilance the failure to meet these expectations, which can often deteriorate into a severely disappointing, persecutory experience. Said differently, the couple dynamic can be viewed as a stage upon which early attachment anxieties and defenses are re-enacted. However, and critical to our view of how TFP-related insights and principles can be therapeutic, couple relationships not only serve as reenactments of past object ties but also create a potential space for reparative emotional experiences, paralleling the development of integrative capacities in personality maturation (Kernberg, 2024).
Related to the working through of these fraught internalized object relations in the couple relationship, Kernberg describes the “capacity to love” as a developmental achievement closely linked to personality development, emphasizing the need to integrate sexual desire and idealization with frustration and aggression (Kernberg, 2011; Kapusta et al., 2018). The ability to regulate oneself along this spectrum of libidinal and aggressive impulses, enables both partners to develop a mature and realistic recognition of each other in a relationship that is authentic and reciprocal. As such, a central focus of any transformative therapeutic endeavor that is TFP-informed involves the exploration of aggressive object-relation dyads, the acknowledgement and working through thereof being a necessary precondition for activating reparative cycles of interaction in therapy. This process allows for the emergence of depressive anxiety, concern for the other, and guilt, which serve as transitional stages toward reparation, gratitude, and forgiveness (Kapusta et al., 2018; Kernberg, 2011; Segal, 1988), elements often absent in dysfunctional relationships.
The difficulty integrating positive and negative aspects of both self and partner is not only characteristic of couples in which one or both partners is characterized by BPO. Although such couples present major challenges manifesting in repetitive cycles of idealization and devaluation, sometimes escalating into mutual accusations and rapidly shifting roles, these cycles are not limited to couples wherein one or both partners are in the BPO range. Such “focal cycles,” even in healthier couples, are often characterized by deep regressive dynamics, where partners unconsciously attempt to resolve unmet developmental needs through one another (Stern, 2024), potentially leading to symbiotic fusion, sadomasochistic interactions, or perverse dynamics within the paranoid-schizoid position (Kernberg, 1991). Narcissistic dynamics in couples may also manifest as mutual exploitation, where one or both partners use the relationship to bolster self-esteem rather than engaging in genuine intimacy and tenderness.
An application of TFP principles to work with couples represents a new contribution to an already well-developed literature on treating couples from an object-relations frame of reference. The early work of Dicks (1963; 1967) and the extensive contributions of numerous writers affiliated with the Tavistock group and approach reflect a nuanced and rigorous application of modern Kleinian principles to couples, including the management of paranoid and depressive states, the elaboration of the effect of narcissistic object relations on the couple relationship, the balancing of individual dynamics with the couple as a system, and, of course, the operation of projective identification in couples. The specific object relations couple theory developed by David and Jill Scharff (1991) emphasizes the therapeutic disentanglement of mutual projective cycles in couple therapy. By fostering insight into unconscious individual needs and how they interact in the partnership, the therapeutic process gradually enables clarification, differentiation, and the containment of these differences within the relationship. This fosters greater emotional autonomy and mutual recognition of needs in both partners.
Our application of TFP principles to the treatment of couples supplements this literature in a few specific ways. TFP, with its focus on multiple internalized object relations that are managed projectively, with shifting identifications between the poles of those dyads, provides a model for tracking the activation of internalized object relations in the treatment process that can be useful in work with couples. The principle of identifying the affectively dominant object relation at any moment in the treatment process allows for an approach that is clinically near, entering the interventional space through patients’ subjectivities in ways that can be particularly impactful on members of the couple. Further, these aspects of TFP have informed a model for diagnosing the escalatory cycles of conflict in couples from an object-relations framework, one that diagnoses the simultaneous activation of different dyads in the partners of the couple, while providing guidelines for intervention (Stern, 2024).
Last, with its clearly elaborated theory of technique, principles derived from TFP can provide a clinically useful supplement to the existing object relational couple therapy literature. Indeed, other than the work of the Scharff’s (1991), more recent object-relationally-informed couple therapy literatures (including systemic, relational, and purely object relational [e.g., Tavistock]), although rich in theory and conceptualization, have less to contribute on matters of technique. In addition to tracking the affectively dominant object relations, working from surface to depth at any “activated” point on the couple’s unique “focal cycle,” or at any point in the treatment process, guides the therapist in uncovering the object-relational drivers of the couple’s surface conflict. Psychoanalytic techniques that have been adapted by TFP for patients who significantly employ splitting-based defenses are also being elaborated in our work with couples, including, an couple-specific conceptualization of technical neutrality, balancing containment and interpretation (Lafarge, 2000), and working with resistances.
From a TFP perspective, we emphasize the importance of helping couples recognize and work through the aforementioned unconscious cycles of projection, defensive structures, and activated dyads with tact and precision. In doing so, TFP theory and technique, modified for the specific framework of conjoint couple therapy, provides a framework for understanding how internal personality structures shape the interpersonal dynamics of couple therapy. This application of TFP for work with couples can be effective for couples with one or both partners in the moderate borderline range, through the range of higher-level and normal personality functioning, with greater emphasis on interventions that promote containment required with couples of greater individual or collective acuity.
The Working Group for Applied TFP for Couples is preparing a curriculum set to launch in 2026. If you are interested in learning more, we warmly welcome your interest and invite you to contact us.
Dr. Barry L. Stern (New York) and Dr. Nestor D. Kapusta (Vienna)
Literature
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Clarkin JF, Yeomans F, Kernberg OF. 2006. Psychotherapy for Borderline Personality. Focusing on Object Relations. American Psychiatric Publishing, Inc., Washington DC.
Dicks, HV. 1967. Marital Tensions: Clinical Studies towards a Psycho-Analytic Theory of Interaction. Maresfield Library, London.
Kapusta ND, Jankowski KS, Wolf V, et al. 2018. Measuring the Capacity to Love: Development of the CTL-Inventory. Front Psychol. 9:1115. doi:10.3389/fpsyg.2018.01115
Kernberg OF. 2011. Limitations to the capacity to love. Int J Psychoanal. 2011;92(6):1501-1515.
Kernberg, OF. 1991. Sadomasochism, Sexual Excitement, and Perversion. Journal of the American Psychoanalytic Association 39:333-362.
Kernberg, OF. 2024. Psychoanalytic Object Relations Theory Revised: Affect Systems and the Notion of Drives. International Journal of Psychoanalysis 105:790-803.
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Laing RD. 1961. The Self and Others. Tavistock Publications Limited, London.
Lafarge, L. (2000). Interpretation and containment. International Journal of Psychoanalysis, 81: 67-84.
Scharff DE and Scharff JS. 1991. Object Relations Couple Therapy. Jason Aronson, Northvale, NJ.
Segal H. 1988. Introduction to the Work of Melanie Klein. Hogarth Press [for] the Institute of Psycho-Analysis, Karnac Classics, Maresfield Library, London. Stern BL. 2024. The “Fact of the Matter”: A Model for Working with Activated Internal Object Relations in Psychodynamic Couple Therapy. J Am Psychoanal Assoc. Published online. doi:10.1177/00030651241257525
This page posted May, 2026.