TFP was developed as a form of intensive disorder-specific outpatient treatment with two weekly sessions and a duration of about two or three years.
In many countries (e.g., Germany, Netherlands, Switzerland) intensive inpatient treatment of Borderline patients or patients with other severe personality disorders is still very common, whereas in other countries (e.g., USA) longer inpatient treatment is no more paid by health care insurances or limited to very short crisis intervention.
Inpatient TFP addresses the common problems of nonspecific inpatient treatment like, e.g., regression or severe enactments. Indications for inpatient TFP are (acute or chronic) suicide ideations, severe or risky impulsive behavior, substance abuse, severe psychosocial problems, or negative therapeutic reactions impairing or precluding outpatient psychotherapy. The aim of the inpatient treatment is to capacitate the patient for successive outpatient TFP by stabilizing the patient and beginning to work with conflicts and structural internal object relations. International collaboration of psychiatric or psychotherapeutic hospitals employing TFP in the treatment of borderline patients has considerably increased the knowledge about essentials of inpatient TFP and feasibility of contract setting in an inpatient setting. Specific modifications of standard TFP are:
- integrating individual therapy and group therapy,
- balancing flexibility and structure according to the demands of the individual patient and the other patients as well as the staff,
- working in a time-limited setting (focus) and regulating transferential processes and mourning,
- object relational view on multidisciplinary teams (psychiatrists, psychologists, psychotherapists, nurses, social workers, therapists of nonverbal therapies) and relations within the group of patients,
- combining TFP and psychopharmacotherapy,
- considering important psychiatric and somatic comorbidity,
- integrating behavioral elements (e.g. psychoeducation) into a psychoanalytical psychotherapy
- considering short treatment phases of TFP inpatient therapy
- taking into account the external world.
New York, USA
Richard G. Hersh, MD
Chiara De Panfilis, MD