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Psychopathy, the word itself raises fear and entails a feeling of darkness. In the coming text we will take time to explore the construct of psychopathy and better understand why it has such a profound effect on all of us. Will we find solace in the rarity of the pathology, its detectability, and treatability, or will we be haunted by the lurking presence of evil and its influence in the corruption of bonding in our societies?

Research on the question brought us to the works of Theophrastus (c. 371–287 BCE), a Greek philosopher who studied under Plato and Aristotle. During his life, he published many treatises on different subjects. His series of sketches of individuals from everyday Athenian life, “The Characters of Theophrastus (δεισιδαιμονίας Ισ᾽) ” could be considered one of the first “scientific” description of personality types. In his text, translated from ancient Greek by Charles E. Bennet and William A. Hammond, professors at Cornell University, we came across a description of “The Vicious Man”:

The Vicious Man

Viciousness is love of what is bad. The vicious man is one who associates with men convicted in public suits, and who assumes that, if he makes friends of these fellows, he will gain in knowledge of the world, and so will be more feared. Of upright men, he declares that no one is by nature upright, but that all men are alike, and he even reproaches the man who is honorable.

While Theophrastus does not talk of psychopathy proper, his portrait of “The Vicious Man” includes three characteristics that would be recognized by any of us has basics continuants of a psychopathic personality structure: love of evil, the exploitation of others for power, and a fundamental conviction of human amorality. But do we have enough evidence to say for sure that the vicious man is a psychopath?

The short answer is no. This is why we will give you an overview of the development of the construct and an insight into the roots of contemporary definition of psychopathy.

Ps. Veronica Steiner

Veronica Steiner Segal is a Chilean clinical psychologist who graduated in 1998. Since her beginnings she has been working with patients with Severe Personality Disorders in different health institutions in her country, and since 2018 she is a certified TFP therapist. In 2019 she obtained her accreditation as a teacher and supervisor. Since the same year she is coordinator of Grupo TFP Chile. She is the Executive Officer for the Board and she collaborates with the T&E Committee. She also teaches at the University of Valparaiso, in the Department of Psychiatry, where she also teaches in the Diploma of Severe Personality Disorders.
She collaborates in different courses looking for the diffusion of TFP. Together with Luis Valenciano and Pepa Gonzalez she directs an important training in TFP for Spanish speaking students, Instituto TFP Hispanoamerica.

TFP Chile WebsitE

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

Read author’s Blog

Dear Colleagues,

My thoughts are inspired by the rich and varied, but related, topics that our Public Relations Committee has put together in this newsletter. There is a sobering integration of many themes in the different articles. Silvia Bernardi writes of loss, embodied in the death of our colleague and friend Michael Stone. As Silvia points out, that loss is tempered to some degree by an appreciation of what Michael gave us, of the gift we had in him. Michael’s long association with us at the Personality Disorders Institute in New York is a reminder of something we may not reflect on enough: the degree to which our thinking and experience can be enriched by colleagues whose interests overlap with ours without fitting narrowly into the TFP world. Reflecting our years of association with Michael is a reminder that our community will continue to grow by both refining what we do and also by turning to close colleagues who may have somewhat differing perspectives to expand on what we do.

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Frank E. Yeomans, MD, PhD

Frank E. Yeomans, MD, PhD, is a Clinical Professor of Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. He is a Senior Consultant in and teaches internationally for the Personality Disorders Institute, and is in private practice in White Plains and New York City.

Author’s Website

Dear members,

As you all know part of the mission of our society is to disseminate the model of Transference Focused Psychotherapy. This is achieved through many channels, including lectures, trainings and scientific articles. Today I suggest we take a look at where and how information about the model is communicated on the internet.

dataportal.com, a web platform dedicated on gathering data about the internet tells us that 60 % percent of people worldwide look online for information. That implies it is the same for information about treatments for personality disorders. That is why we asked the members of the Public Relations and Communications Committee to send me the first 10 results they obtain when conducting a Google search in their country for “transference focused psychotherapy” in English and in the country’s official language. In doing this, we hoped to monitor the information circulating about TFP on the internet and assess the ranking of TFP-Group websites.

Generally, information we found about transference focused psychotherapy mostly ranged from clear to adequate but, has you will see, we also came across some disturbing findings.

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

Read author’s Blog

My name is Frank Denning, I am Chair of the Ethics Committee, and I wish to highlight the fundamental importance of ethics in the practice of Transference-Focused Therapy (TFP). In this newsletter, we will explore the role and relevance of our Ethics Committee, as well as the principles that guide therapists and professionals in this field.

First, though, I would like to acknowledge the help of my colleague Iván Arango, in putting together this introduction. Iván is a valued member of the Ethics Committee, along with Monica Carsky, Sergio Dazzi, Petra Holler, Alan Weiner and Teresa Ribalta. Had time allowed, and in keeping with the collaborative spirit of the committee, I would have consulted all the members about the content of this introduction. Hopefully, the thoughts of Iván and myself reflect the thinking of the whole committee.

Iván and I are grateful to Diana Téllez from the ISTFP Public Relations and Communication Committee, for her help in putting this introduction together. 

Amid the current situation, marked by global conflicts, wars, and health crises, the concept of loss and grief becomes especially relevant for our community. Each of us has been confronted with this painful experience.

Grief emerges as a universal phenomenon, an inescapable constant in human experience that transcends cultures, times, and geographies. Throughout history, it has captured the attention of philosophers, physicians, psychologists, and sociologists who have sought to understand its complexities and have contributed diverse perspectives to its comprehension.

The contribution of psychoanalysis

At the intersection of these disciplines, the psychodynamic perspective emerged as especially insightful regarding the intricate process by which individuals cope with death, other major losses, and subsequent grief… mainly by recognizing that the latter does not present itself as a series of isolated symptoms but as a holistic and deeply personal experience.

Ps. Veronica Steiner

Veronica Steiner Segal is a Chilean clinical psychologist who graduated in 1998. Since her beginnings she has been working with patients with Severe Personality Disorders in different health institutions in her country, and since 2018 she is a certified TFP therapist. In 2019 she obtained her accreditation as a teacher and supervisor. Since the same year she is coordinator of Grupo TFP Chile. She is the Executive Officer for the Board and she collaborates with the T&E Committee. She also teaches at the University of Valparaiso, in the Department of Psychiatry, where she also teaches in the Diploma of Severe Personality Disorders.
She collaborates in different courses looking for the diffusion of TFP. Together with Luis Valenciano and Pepa Gonzalez she directs an important training in TFP for Spanish speaking students, Instituto TFP Hispanoamerica.

TFP Chile WebsitE

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

Read author’s Blog

Dear members,

I would like to give a special thanks to our remarkable ISTFP Public Relations Committee for the particularly relevant and moving newsletter they have produced. We can all benefit from the reflections on mourning they have written. At a time when loss and threat are very present in the world and in our lives, it is important to be reminded that we can continue to build our lives and our community.

Frank E. Yeomans, MD, PhD

Frank E. Yeomans, MD, PhD, is a Clinical Professor of Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. He is a Senior Consultant in and teaches internationally for the Personality Disorders Institute, and is in private practice in White Plains and New York City.

Author’s Website

Let’s start by wishing everyone a healthy, safe, and productive year for all the members of the ISTFP in 2024! That being said we, at the Public relations and Communications Committee, decided to start the new year with a review of 2023 so all members are aware of general health of our society. We hope it will encourage those of you who have worked tirelessly doing volunteer work to contribute to the society and spark interest in others to get involve.

To us, the ISTFP is like a living organism so we have made a list of health indicators that we will try to review each year. And, since we love empirical evidence, we will show you numbers that we will refresh every year. Let’s see what the data tells us. Is the ISTFP growing or slowly fading away?

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

Read author’s Blog

Consistent with the theme of this newsletter, the research digest will focus on a paper where Dr. Kernberg elaborates on some observations regarding the process of mourning. Our intention is to review some psychoanalytic literature on this complex process, which certainly does not lack heterogeneity.

While some brain regions have been indicated as possible candidates related to mourning (see Chambers J 2023 for a review), we chose not to focus on the neurobiology underlying mourning, given the lack of consensus over the definition, the dynamic and complex nature of the processes, and the different responses to different losses, which, combined with the limitations of biological investigations in humans, exponentially increase the number of variables to account for rigor.

We will, however, mention how circadian rhythms, heart rate, blood pressure, and other homeostatic regulatory mechanisms are impacted by the loss of a close relationship.

Silvia Bernardi

Silvia Bernardi, MD, is an Assistant Professor of Psychiatry at Columbia University. After graduating from medical school in Florence Italy in 2006, Silvia emigrated to the USA to work intensively in neuroscience research, studying the bases of the interaction between emotions and cognition. Silvia completed her residency in Psychiatry at Columbia and has since practiced privately in New York. She trained in Transference Focused Psychotherapy and continues to see patients for medication management and psychotherapy while conducting her research to unlock further knowledge to support the biological underpinnings of TFP and borderline personality disorder.

Author’s website

Glauco Valdivieso

Glauco Valdivieso is a Peruvian psychiatrist, psychotherapist, and researcher based in Lima, Peru. He completed his medical degree at the Universidad Nacional Mayor de San Marcos and specialized in psychiatry at the Hospital Nacional Víctor Larco Herrera, becoming a board-certified psychiatrist in 2018.

He is a certified psychotherapist in Transference-Focused Psychotherapy (TFP), trained by the International Society of Transference-Focused Psychotherapy (ISTFP). In addition, he has completed formal training in Cognitive Psychotherapy, Dialectical Behavior Therapy (DBT), and Mentalization-Based Treatment (MBT).

More information

Dr. Valdivieso is the co-founder and medical director of the Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad (IPEP), where he also coordinates the TFP Peru division. He founded and currently leads the Chapter on Personality Disorders within the Peruvian Psychiatric Association (APP), and works at the Mental Health Unit of Hospital de Villa El Salvador in Lima.

He is also a co-founder and editorial board member of the Latin American Journal of Personality, a collaborative initiative with the Instituto Argentino para el Estudio de la Personalidad y sus Trastornos (IAEPD). Additionally, he serves on the editorial board of the Peruvian Journal of Psychiatry. Internationally, he is a Board Member of the International Society for the Study of Personality Disorders (ISSPD), where he chairs the Communications Committee and leads the Latin American Regional Group.

His main clinical and research interests include the treatment of personality and mood disorders, with a particular focus on advancing research in Transference-Focused Psychotherapy (TFP).

Author’s facebook page

Dear members,

I am Chiara De Panfilis, co-chair of the Applied TFP Committee. Together with my co-chair, Richard Hersh, I will present you the members of our committee, its history and achievements.

Our committee is comprised of twelve members: Eve Caligor (USA), Sergio Dazzi (Italy), Chiara De Panfilis (Italy), Richard Hersh (USA), Tennyson Lee (UK), Jonathan Radcliffe (UK), Michael Rentrop (Germany), Eulalia Ripoll (Spain), Christiane Roesch (Switzerland), Maria Jesús Rufat (Spain), Luis Valenciano (Spain), Jo-anna VanDenBosch (UK). 

We aim to bring together, to study, and to develop the various applications of TFP principles in mental health settings other than the standard, twice-a-week outpatient individual psychotherapy setting.

Examples include, but are not limited to:

• Modifications of TFP for family interventions, group therapy, or forensic settings
• Implementation of inpatient treatment for personality disorders (PD) with TFP principles techniques and strategies
• Application of TFP principles within a variety of clinical situations and experiences such as:
  • general outpatient psychiatric care for PD
  • consultation-liaison psychiatry or medical settings
  • psychoeducation interventions.

Broadly speaking, such initiatives are referred to as “Applied TFP”. Examples of some of the elements of TFP that can be brought into these different settings are an emphasis on the role of a clear treatment frame and the utility of conceptualizing any clinical encounter in terms of the internal representations of self and other that are activated.

Chiara De Panfilis

MD, Associate Professor in Psychiatry

Chiara De Panfilis, MD, is an associate professor of Psychiatry in the Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy. Her main research interests are the potential social-cognitive mechanisms that shape the clinical picture and the psychosocial functioning of individuals suffering with personality disorders. She was previously a visiting research fellow at the Personality Disorders Institute of Weill Cornell Medical School, New York. For her research she received a grant from the International Psychoanalytic Association and awards from the International Society of Transference-Focused Psychotherapy (ISTFP) and the Society for Personality Assessment. She is co-founder and research coordinator of the Personality Disorders Lab (Parma-Milan, Italy). She is a board member of the ISTFP and is clinically active in implementing general psychiatric care for personality disorders with TFP principles. She authored
more than sixty peer-reviewed publications.

Richard G. Hersh

MD, Special Lecturer, Department of Psychiatry, Columbia University 

Richard G. Hersh, MD, was an attending psychiatrist at Massachusetts General Hospital and McLean Hospitals while an Instructor in Psychiatry at Harvard Medical School before coming to Columbia University Medical Center where he was a psychiatrist on the inpatient service before serving for fifteen years as the Associate Director of the Department of Psychiatry’s Intensive Outpatient Program. He has been trained in Transference-Focused Psychotherapy (TFP) for treatment of personality disorders and has fulfilled the requirements for Teacher and Supervisor status for TFP. He as serves on the Scientific Advisory Board of the National Education Alliance for Borderline Personality Disorder (NEA-BPD) and recently co-authored the textbook “Fundamentals of Transference-Focused Psychotherapy: Applications in Psychiatric and Medical Settings” published in 2017 by Springer.

Exploring the Therapeutic Universe of Aurora Döll Gallardo

In the captivating realm of mental health, I came across Aurora Döll Gallardo, a woman from Madrid whose life is dedicated to Psychotherapy, Psychiatry, and Medicine, and who has become an ardent advocate for Transference-Focused Psychotherapy (TFP).

Let’s begin with Aurora’s mornings. Before immersing herself in the daily hustle, she indulges in the luxury of a morning run in a nearby natural park—a ritual that provides her with peace and balance, the perfect starting point for the day ahead. More than a routine, she sees it has a revitalizing ritual.

As a true Madrilenian, Aurora shares her love for Zarzuela and the rich history of her city. From intriguing tidbits like the meaning of “Mayrit” (spring) to her detailed knowledge of medieval coats of arms, she guides us through a unique version of Madrid, a place she considers “the most beautiful city in the world.”

Transitioning from everyday life, we dive into her professional journey. From being a Community Psychiatrist at the CSM de Villa Vallecas to becoming the head of the Alcohol Addiction Unit at Hospital Dr. Rodríguez Lafora, Aurora has woven a diverse and enriching network. We look forward to her helping us appreciate the usefulness of a TFP approach in treating substance abuse, a topic on the program of the ISTFP Biennial Conference in September.

TFP takes center stage as the protagonist of this story. Aurora discovers her calling during five years of work in a Therapeutic Community for Personality Disorders. This is when she had a transformative encounter with TFP that motivated her to learn the treatment. Although TFP training was initially unavailable in Madrid, her determination led her to embrace it as soon as the opportunity arose in 2019-2020.

Reflections and Challenges in the Spanish Landscape

In our conversation, Aurora highlights the duality of TFP practice in Spain: despite currently being predominantly a private practice model of therapy, she envisions the potential for applying its principles in the public healthcare system. She acknowledges challenges, from overcoming prejudices to retaining patients in forms of treatment even when contracts are broken, but she is motivated to meet these obstacles with optimism.

Exploring the future of TFP in Spain, Aurora advocates for its dissemination and continuous training, adapting to various clinical environments without losing sight of necessary standards. While recognizing the power of technology, she emphasizes the importance of human connection and enriching supervision that only professionals can provide.

Thus, our conversation concludes, leaving us with the image of a passionate woman, dedicated to TFP and convinced that, in the therapeutic universe, the balance between technology and human connection is key. We sincerely thank Aurora Döll Gallardo for sharing her journey with us and hope that her story inspires others to learn and extend the application of TFP, with a commitment to understanding the importance of the human relation in the context of institutional work.

Diana Téllez Quiroz

Diana Téllez Quiroz, PhD

Diana Téllez has been a Psychodynamic Psychotherapist since 2005. She obtained a Master’s in Psychotherapy for Children, Adolescents, and Adults in 2009 and a Doctorate in Psychoanalytic Psychotherapy from the Mexican Psychoanalytic Association in 2012.

She holds a PhD and Master’s in APM. Certified supervisor, teacher, and therapist in TFP, Circle of Security, and AAI. Psychologist with experience in personality disorders, specializing in MBT and EFT. Member of ISTFP and ISSPD.

Author’s website

The ISTFP supervisors’ congress was hosted for the third time last October 6th and 7th. This meeting of the event, held every two years, brought together over 60 therapists and supervisors from all over the world in the vibrant city of Milan, Italy, under the name of the “Gerard Dammann Conference” in honor of our deceased colleague who hosted the first of these meetings at his hospital in Münsterlingen, Switzerland in 2019. The gathering was widely anticipated as it was the first time we could finally meet face-to-face after the pandemic.

This meeting of the congress, organized by our Italian ISTFP colleagues, stood out for its richness in content, for the quality of the speakers, and for the attention given to organizing welcoming spaces both for the academic meetings and for the social and entertainment events that were greatly appreciated by the attendees. It has proven to be enriching on multiple levels, including academic, professional, social, and human. In this paper, I will give you a brief summary of a congress program packed with enriching talks and social activities.

On the first day, before the official inauguration, a fruitful meeting was held between the teaching and research committees, led by Emanuele Preti. The meeting highlighted and consolidated the union between the two committees, focusing on ways to co-ordinate their efforts. Then the congress officially began with opening remarks given by Irene Sarno, on behalf of the local organizing group, followed by Luis Valenciano on behalf of the Training and Education Committee and Frank Yeomans as president of the ISTFP. It was followed with a reflection on the main difficulties in TFP learning by Nel Draijer and Stephan Doering. This was followed by a discussion of the role of treatment goals in TFP training, supervision, and practice by Richard Hersh and Eve Caligor. The first day concluded with an engaging case analysis, skillfully presented by Mark Petrini, Diana Diamond, and Frank Yeomans, with discussion by Eric Fertuck.

On the second day, Alvise Orlandini and Sergio Dazzi led a session on how to better understand affect and affective dominance when practicing TFP. Their presentation was followed by an exploration of how to teach TFP supervisors to elicit richer input from group members using a video provided by Petra Holler and Mathias Lohmer. Then, online from his home in Maine, Otto Kernberg guided us through common dilemmas faced by supervisors, which are important to think about in our practice. Finally, the event culminated with a reflection on the treatment of patients with concrete thinking and low reflective capacity, presented by Luis Valenciano and Frank Yeomans, thereby concluding one of the most fruitful meetings of our organization.

The common emphasis on the role of affect in therapeutic practice and supervision that was mentioned in all presentations stood out as an integrative guideline for the proceedings.

In addition to the academic sessions, each day ended with a social gathering, giving attendees the opportunity to interact, share experiences, and strengthen professional ties.
The meeting was very inspiring, and the all the comments enriched those two intense days. Finally we could chat, eat and dance together! And we thank our Italian colleagues of the PDLab for hosting the conference lunches.

“As a member of the PDLab organizing committee, it has been a pleasure to organize this important meeting, a wonderful opportunity to see many colleagues from other countries in person. We all missed that direct contact.”

Alvise Orlandini

Perhaps the best way to explain what we have lived and learned in Milan, is the one explained by Sergio Dazzi:

Teaching TFP is an exciting experience but arduous for the many different variables implied when we try to understand how best it can be done: differences in severity of pathology among patients suitable for TFP, differences in personal characteristics of a single therapist (as we privilege the channels of communication of non verbal communication and induction of countertransference reactions it comes clear that different therapists can follow individualized paths to reach the same goal while coherently moving accordingly to the manualized indications), and finally the different stages of treatment. To these we could add the choreography of the supervision, individualized or in group, and the different level of expertise of the presenting candidate.

So, the issue can be afforded from many different angles and I have learned much from each one. The idea of interviewing a candidate (Nel and Stephan), or of telling about the work of three different supervisors in New York who debate and integrate (Eric), or of directly showing in the same video a segment of a session, a segment of a supervision and a role playing (Petra and Mathias), or of affording in a creative way what once were called (if I may dare) the aspecific aspects of psychotherapy (Luis and Frank), all this tells us how much space all of us have to enrich our way of teaching. I have named just a few coming to my mind but all presentations deserved much attention and kept me awake in a very hot Italian September, until Alvise reminded us that It’s Only Rock’n Roll.

Sergio Dazzi

Dear members of the ISTFP, as you can see, the Third ISTFP Supervisors Congress has not only strengthened training and supervision in PFT, but has also reaffirmed the commitment of the global community of TFP therapists and supervisors to continue pursuing excellence in clinical practice.

For now, Milan bids us farewell, but we can all meet again in New York in September 2024!

We look forward to seeing you all!

Ps. Veronica Steiner

Veronica Steiner Segal is a Chilean clinical psychologist who graduated in 1998. Since her beginnings she has been working with patients with Severe Personality Disorders in different health institutions in her country, and since 2018 she is a certified TFP therapist. In 2019 she obtained her accreditation as a teacher and supervisor. Since the same year she is coordinator of Grupo TFP Chile. She is the Executive Officer for the Board and she collaborates with the T&E Committee. She also teaches at the University of Valparaiso, in the Department of Psychiatry, where she also teaches in the Diploma of Severe Personality Disorders.
She collaborates in different courses looking for the diffusion of TFP. Together with Luis Valenciano and Pepa Gonzalez she directs an important training in TFP for Spanish speaking students, Instituto TFP Hispanoamerica.

TFP Chile WebsitE

Dear Colleagues,

This is a frightening and dangerous time, and a time to try to call on the best within us to help each other through. The horrific terrorist attack on Israel has ignited a situation with no end in sight. And yet we all hope for an end to the bloodshed … we hope that terrorism will be eliminated from our world and peaceful solutions can be found.

We continue to have news of war, slaughter, and violence elsewhere as well. As indirect as our efforts may seem, we must continue to try to help people have a better understanding of the irrational forces of the mind that contribute to the violence and to try to make progress in increasing reason over unchecked passion.

In the world of TFP, we tend to be optimistic that our efforts can help those individuals who come to us with their pain and suffering. Issues of pain and suffering outside the consulting room are much more challenging. 

As therapists whose thinking is rooted in Freud, it is good to remember his very sobering view of the human condition.

In Civilization and its Discontents, he wrote: “We are threatened with suffering from three directions: from our own body… from the external world, which may rage against us with overwhelming and merciless forces of destruction; and, finally, from our relations to other men. The suffering which comes from this last source is perhaps more painful to us than any other.”

In the immediate situation, we have the challenge of consoling those who are suffering in so many ways… physically and psychologically. And, while it may seem quixotic, we have the challenge of helping spread an understanding of the basic psychological processes that stir up division and hatred between people and among peoples.

Otto Kernberg increasingly emphasizes the role of a solid system of moral values as part of a healthy personality. This is one of the reasons that he had an hour-long meeting with Pope Francis in September. The meeting was a validation of Dr. Kernberg’s role not only as a psychoanalytic thinker but as a moral leader, linking topics such as the importance of a solid system of moral values as part of identity to complex issues such as the appeal of narcissistic leaders to large masses of people.

In introducing this newsletter, I’d like to again thank the Public Relations Committee for their great work. 

Mathieu Norton-Poulin’s article introduces us to ISTFP-PRESS and the ISTFP Online Library, exceptional new services that will benefit all our members. 

Irene Sarno’s article describes the working and plans of the Training and Education Committee, headed by Luis Valenciano, emphasizing the Committee’s current work on the supervisory process, which was the focus on the recent Dammann Supervisors’ Conference in Milan, and also describes projects involving videorecordings and a blog on microprocess in TFP. 

Verónica Steiner’s article communicates some of the specific topics that were discussed at the Milan conference, providing an idea of the themes that were elaborated and future directions that were proposed for us to pursue in improving the supervisory process.

Glauco Valdivieso and Silvia Bernardi’s article reviews the role of supervision in TFP and refers to the development of the “Pilot’s List” for supervision. This “Pilot’s List” was introduced by Otto Kernberg to be further developed by the Subcommittee on Supervision. It promises to be a core document in organizing how we think about and practice supervision.

Diana Tellez’ article introduces us to Marina del Hoyo. Marina is a model of how to combine practicing TFP, teaching it, and planning important research. Teaching TFP to psychiatric residents is especially important and requires combine traditional TFP and applied TFP. Marina emphasizes how TFP helps get to know any patient in any setting at a deeper level and how TFP supervision supports the therapist in the therapist’s emotional journey through the therapy, which can be difficult at times.

In ending, it’s important to remember that the ISTFP’s work is about connecting with deep affects, affects that many people, whether they are patients or not, often split off from awareness and act out. The current polarization in many of our groups and societies offers beleaguered individuals simplistic but false solutions to complex problems. I hope we can try to teach in a way that helps us avoid the risk that our societies devolve into personality disordered entities.

Sincerely,

Frank Yeomans

Frank E. Yeomans, MD, PhD

Frank E. Yeomans, MD, PhD, is a Clinical Associate Professor of Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. He is a Senior Consultant in and teaches internationally for the Personality Disorders Institute, and is in private practice in White Plains and New York City.

Author’s Website

When I was studying psychology at Laval University, in the beautiful city of Quebec, Canada, one of my great pleasure was to go to the main library and randomly read from compendiums of articles on psychoanalysis. I remember the quiet excitement of having access to so much knowledge at the tip of my fingers. I felt surrounded by a warm community of thinkers that were, like me, striving to understand the human heart.

This is why graduation came with a sense of loss. Working as a psychologist in private practice in a different city, I would no longer have free access to my intellectual kindred spirits. I quickly understood that yearly subscriptions to scientific papers were just too expensive for a beginning psychologist. I also noticed that the articles I was interested in were published in different journals and that it would be impossible to gain access to all of them. Even if I bought different book editions of the works of Freud, Melanie Klein, or Bowlby, I felt alone in a relationship with ghosts. I needed access to new research, contemporary scholars. That was one of the joys I experienced when I started reading books and articles by Kernberg , Clarkin, Yeomans, Caligor, Diamond and others.

During my TFP training, the word wide web was developing and beginning to give me access to recent scientific articles. I gradually noticed that with TFP supervisions, I experienced the best of both worlds: a community of colleagues that treated patients with personality disorders and a community of thinkers that would reflect on the psyche from a psychoanalytic angle. Still, I had mainly access to new research because of the generosity of my supervisors or colleagues that would share some PDF’s with me. It was better, but not enough to feel surrounded by science as I did during my university years.

As I got involved in the ISTFP, I started dreaming. I dreamt of a repository of all TFP related articles. A virtual place that would make me feel surrounded by my peers. My nomination as co-chair of the Public Relations and Communications Committee gave me the team and the means to make it a reality.

Dear members, in this article, I will present two new services provided to ISTFP members for disseminating TFP articles to all of those who wish to join the reflexion on personality and its disorders. All of the members of the PR committee hope it will ensure that a next generation of TFP therapists and supervisors will feel embraced by a community of minds thinking about the different aspects of the theory and practice of TFP.

ISTFP-PRESS

ISTFP-PRESS provides a way for any member of the ISTFP to send their new paper to the entire ISTFP community by using this email service. Currently, we have sent three articles in the last two month.

September 17th 2023 – Treating Narcissistic Personality Disorders: a case illustration of key clinical contributions from Transference Focused Psychotherapy for psychoanalytic practitioners.

October 8th 2023 – Rothko’s Tears

October 15th 2023 – Conversion to Transference-Focused Psychotherapy from Other Treatments by the Same Therapist: Pitfalls and Benefits

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The TFP Online Library

This project is the full embodiment of our dream. It is a searchable database of all Transference Focused Psychotherapy publications with a link to the full-text PDF. It is incomplete for now and the Full-Text links are from different sources on the Web but it the first step in making all TFP papers freely available to all members.

You can try it by following this link: TFP Online Library

As you will see, the search function is now limited to one search term at a time and limited keywords. We will gradually add more keywords for each publication and hope that the technology permit us to use several search terms. We plan to bring full text access to all ISTFP members. Non-members will also be able to search the database but will have access to a limited number of full-text PDFs.

The complexity of sharing scientific knowledge

When we started this project, it was hard to assess the legal roadblocks that would limit its creation and scope. That is why we propose a collective reflexion on sharing our knowledge on personality disorders and transference focused psychotherapy.

What we found is that many of you are willing to share their papers with everyone but it became very hard to know the rights you have, as author, for sharing your published work. There are many scientific journals and each one has its own regulations and legal agreements. So I decided to find more information to solve this problem.

The Coalition for Responsible Sharing

The Coalition for Responsible Sharing, formed in 2017, is a group of publishers that worked together for bringing copyright compliance to scholarly collaboration networks and to article-sharing platforms that many of you are using, like ResearchGate or Academia.edu. As you can read in this well documented page of the University of Oklahoma, these social platforms for scholars are owned by for-profit organizations that use unethical practices like not peer-reviewing articles that are uploaded on their platform and offering authors to pay for having their articles appear more often in search results. They were sued for illegal distribution of copyrighted articles. Recent news mentions that many litigations between publishers and ResearchGate were resolved, but not with Academia. The latter improperly uses an “.edu” top-level domain (TLD). This is considered by many as an unacceptable use of a TLD that was meant to represent true educational institutions worldwide.

This is why we decided to link the articles you made accessible through ResearchGate with the TFP Online Library but not the ones that are hosted by Acedemia.edu. We also noticed that some of you have no PDFs of any of your articles on the web. If you want to make them accessible, you can open a ResearchGate account and send us the links that the platform will provide for your papers. But before doing so, be sure to read ResearchGate’s copyright information page. If you don’t want to create a ResearchGate account, contact us, and we will host your work on the ISTFP website if the copyright terms of your publishers allow it.

Are you allowed to share your work?

Before submitting a paper to our project, this is the most important question you have to ask yourself. It will ensure that the ISTFP is protected from any liability.

In my research, I discovered that many of you have published in Taylor & Francis or Routledge journals. They are a good example of publishers that hand out clear sharing guidelines for sharing scientific articles. I strongly suggest that you all visit the Taylor & Francis or Routledge website to get a sense of how copyrights work for scientific papers. If you come across guidelines from other publishers, I will gladly add them to this article.

Our team is eager to see if can all unite in a common ideal of sharing scientific knowledge about personality disorders and are looking forward to see how you will contribute to this considerable endeavour.

Warm regards,

Mathieu Norton-Poulin

Representing the voice of the members of the ISTFP’s Public Relations and Communications Committee

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

Read author’s Blog

Transference Focused Therapy (TFP) is one of the therapies that over time has been strengthened with scientific evidence and enriched with the findings of its learning process. Just as supervision in many therapeutic currents is necessary to help with the application with the theoretical and practical elements necessary to address our patients’ needs, in the case of TFP, supervision is an essential element throughout the therapist’s life. Why is that? Supervision, which means “looking from above”, allows the therapist to see aspects of his or her experience in the session and application of technique that are not clear during the therapy itself. Simply put, too much is being experienced in the therapy session for the therapist to be aware of it all. Supervision combines attention to structure and boundary setting (the macro level, as Luis Valenciano describes it) with a careful attention to the unconscious processes that unfold in the session and how the therapist explores them with the patient in relation to the activated object relations (the micro level). All this is in the service of maximizing the mechanism: enhancing understanding of the transference and the ability to reflect of it and on the deep conflicts that become clear in reflecting on shifting transferences.

Research and development of TFP was conducted at the Personality Disorders Institute at the Weill Cornell Medical College. In an RCT by Clarkin et al., which compared TFP with dialectical behavioral therapy and supportive psychodynamic therapy. All therapists were monitored and supervised weekly by more experienced therapists. They observed video recording sessions, provided feedback, and evaluated therapists on fidelity and adherence to the principles and techniques of the treatment they were providing. Given the emphasis on affect and nonverbal communication in TFP, video recordings of the sessions were essential to effectively supervise and study the clinical cases. It was concluded that observation of the video recordings helped to understand aspects of the technique that had not been fully appreciated when supervision only used progress notes in the clinical records. Thus, Yeomans highlights that one of the principles of TFP theory and technique is the importance of non-verbal, as well as verbal, communication, in a therapy that emphasizes the central role of splitting defenses in personality disorders at the borderline level. Additionally, authors such as Valenciano-Martinez, in accordance with the importance of supervision, highlight the first 3 minutes at the beginning of a session as crucial in considering the dominant countertransference as the session begins, in evaluating the dominant affect in verbal and non-verbal communication in those moments, and in assessing the client’s ability to speak freely and diagnosing at difficulty they have with speaking freely. All this is reflected upon while keeping in mind the objectives they wish to work towards (the macro level).

During the COVID-19 pandemic, something unprecedented happened that resulted in more useful tools for the supervision process in TFP. Due to the emphasis on non-verbal communication in therapy, switching to teletherapy was initially challenging. However, experience showed that the virtual sessions could be recorded and provided sufficient data on non-verbal communication, thus aiding the practice and learning of TFP. Nevertheless, we encourage in person sessions as the ideal.

To help the supervisor address the multiple aspects of treatment, Kernberg and Yeomans have developed a checklist that covers all necessary aspects of supervision. It is called “The Pilot’s List” since it is analogous to the list of items a pilot must keep in mind before taking off and while flying. When it has been established that the fundamental “macro” elements of therapy on the checklist are in place, the focus can turn to refinement in the supervision process that emphasize analysis of the “here-and-now” interaction and interventions, and can include analysis of group and parallel processes in supervision groups that can be used to deepen understanding of the patient’s dynamics as reflected in group reactions. The “Pilot’s list” ensures that all necessary conditions are present for meaningful therapy to take place, monitors the therapist’s adherence, and helps refine the TFP exploratory process.

Specifically, the “Pilot’s list” addresses the following elements: clarification of the diagnosis, treatment goals, description of the therapeutic method and treatment framework, as well as ensuring how the therapist explores the patient’s internal world as it develops in the transference or in extratransference relationships. In this way, the supervisor helps the therapist remain faithful to exploratory work with the goal of identifying and interpreting the affectively charged maladaptive representations of self and others in the patient’s mind.

The role of the supervisor occupies an important place in the therapist’s training. The supervisor’s interventions help shape the therapist’s ability to apply technical interventions such as maintaining technical neutrality, using countertransference reactions, and applying interpretive interventions. In sum, it strengthens the ability to pay attention to the nature of one’s own interventions and encourage reflection on the nature of the patient’s speech. And finally, the group at the PDI has found that supervision groups are the best laboratory for advancing our understanding of the therapeutic process in TFP.

References:

Yeomans F, Caligor E, Diamond D. The Development of Transference-Focused Psychotherapy and Its Model of Supervision. Am J Psychother. 2023 Mar 1;76(1):46-50. doi: 10.1176/appi.psychotherapy.20220019. 

Clarkin JF, Levy KN, Lenzenweger MF, et al: Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007; 164:922–928

Martinez LV, Hersh RG. A Novel Approach to Supervision of Transference-Focused Psychotherapy (TFP): Examining the First Three Minutes of the TFP Session. Psychodyn Psychiatry. 2021 Spring;49(1):110-130. doi: 10.1521/pdps.2021.49.1.110.

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Glauco Valdivieso

Glauco Valdivieso is a Peruvian psychiatrist, psychotherapist, and researcher based in Lima, Peru. He completed his medical degree at the Universidad Nacional Mayor de San Marcos and specialized in psychiatry at the Hospital Nacional Víctor Larco Herrera, becoming a board-certified psychiatrist in 2018.

He is a certified psychotherapist in Transference-Focused Psychotherapy (TFP), trained by the International Society of Transference-Focused Psychotherapy (ISTFP). In addition, he has completed formal training in Cognitive Psychotherapy, Dialectical Behavior Therapy (DBT), and Mentalization-Based Treatment (MBT).

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Dr. Valdivieso is the co-founder and medical director of the Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad (IPEP), where he also coordinates the TFP Peru division. He founded and currently leads the Chapter on Personality Disorders within the Peruvian Psychiatric Association (APP), and works at the Mental Health Unit of Hospital de Villa El Salvador in Lima.

He is also a co-founder and editorial board member of the Latin American Journal of Personality, a collaborative initiative with the Instituto Argentino para el Estudio de la Personalidad y sus Trastornos (IAEPD). Additionally, he serves on the editorial board of the Peruvian Journal of Psychiatry. Internationally, he is a Board Member of the International Society for the Study of Personality Disorders (ISSPD), where he chairs the Communications Committee and leads the Latin American Regional Group.

His main clinical and research interests include the treatment of personality and mood disorders, with a particular focus on advancing research in Transference-Focused Psychotherapy (TFP).

Author’s facebook page

Silvia Bernardi

Silvia Bernardi, MD, is an Assistant Professor of Psychiatry at Columbia University. After graduating from medical school in Florence Italy in 2006, Silvia emigrated to the USA to work intensively in neuroscience research, studying the bases of the interaction between emotions and cognition. Silvia completed her residency in Psychiatry at Columbia and has since practiced privately in New York. She trained in Transference Focused Psychotherapy and continues to see patients for medication management and psychotherapy while conducting her research to unlock further knowledge to support the biological underpinnings of TFP and borderline personality disorder.

Author’s website

Dear Colleagues,

When it was formed, the ISTFP established the Training & Education Committee to uphold quality standards for international TFP training and supervision, to promote the development of standardized teaching tools, and to work on ways we can improve how we educate our students and supervise both our students and each other. The T&E Committee also plays a crucial role in shaping the educational policy of the ISTFP, preparing certification regulations, and establishing guidelines and documents for examinations.

The T&E Committee currently comprises 15 members, including two co-chairs (Luis Valenciano and myself), from various countries: Marion Braun (GR); Peter Bucheim (GR); Eve Caligor (USA); Sergio Dazzi (IT); Stephan Doering (AU); Diana Diamond (USA); Frank Denning (UK); Nel Draijer (NL); Katarzyna Gwozdz (PL); Otto Kernberg (USA); Judit Lendvay (USA); Mathias Lohmer (GR); Philipp Martius (GR); Verónica Steiner (CL); Frank E. Yeomans (USA).

I became involved with the T&E Committee in 2018 during the 5th Biennial ISTFP Conference in Barcelona, taking on the role of secretary to the then-chair, Nel Draijer. In this capacity, I began assisting with the various committee tasks, and as of 2022, I have become a co-chair with Luis Valenciano.

The Committee meets regularly every about three months and addresses various issues, particularly in light of the increasing number of TFP therapists and TFP Teacher and Supervisors. Our objectives for this year include:

• Organizing therapist exams for countries without a local TFP organization, as well as organizing Trainer-Supervisor exams.
• Arranging the Bi-Annual ISTFP Supervisors’ Meeting on October 6-7, 2023, in Milan.
• Promoting pedagogical methods that facilitate the learning of our therapy.
• Fostering the exchange and discussion of technical challenges among members.

To effectively tackle these objectives, given the volume of issues we wish to address, we have formed sub-committees focusing on specific topics, such as:

• Subcommittee on Supervision, which is preparing a paper on TFP supervision, a curriculum for supervision, a reading list on TFP supervision, and developing a training tool for teaching and supervising microprocess.
• Subcommittee on Video Initiative, aiming to collect videos made by our members that can assist in teaching the basic aspects of TFP: techniques, tactics, and strategies.
• Subcommittee on a Blog on Technical Challenges, which will be incorporated into our ISTFP Newsletter, addressing clinical situations that TFP therapists encounter in therapy and supervision.

As you can see, one of our 2023 objectives was to organize the Bi-Annual ISTFP Supervisors’ Meeting, which took place on October 6 and 7 in Milan, my hometown. I had the honor and responsibility of actively participating in the organization of this conference, which welcomed 70 supervisors from around the world, with both in-person attendees from Mexico, Austria, Germany, Switzerland, the Netherlands, Hungary, Poland, the USA, Chile, Italy, Spain, the UK, Canada, and Belgium, and remote viewers as we live-streamed the event for those who couldn’t join us in Milan. The event featured prominent speakers who aimed to address central questions related to the role of supervisors, such as major difficulties in learning TFP and how we can provide support as supervisors, the role of treatment goals in TFP training and supervision, detecting and teaching to detect affects and affective dominance in supervisions, using the contribution from group members in a TFP supervision session, dilemmas of the supervisor, and working with and supervising concrete thinkers-low reflective patients. The conference provided a special and emotional opportunity to meet in person after a long period of exclusively online meetings, offering us a chance to engage in more intimate and fruitful exchanges, both professionally and personally, especially during the very congenial social moments.

Best regards,

Irene

Irene Sarno

Irene Sarno Ph.D. is a psychotherapist and a psychoanalyst of the International Psychoanalytic Association (IPA). In her clinical practice she works mainly with adolescents, young adults, and adults. She trained between USA and Italy with Otto Kernberg and coll. on Transference-Focused Psychotherapy for adults and adolescents, and she is a certified TFP teacher and supervisor for both adults and adolescents. She is a founding member of the Personality Disorders Lab (PdLab), branch society of the International Society of Transference-Focused Psychotherapy (ISTFP). With the PdLab she has organized a number of training programs on TFP in Italy.
She is Adjunct Professor of Psychotherapy and Counselling at the University of Milan-Bicocca, where she is also consultant at the Psychological Counselling Centre for University Students.
She is author of national and international scientific articles, books and book chapters on Non Suicidal Self-Injury, diagnosis and assessment, and personality disorders.

PD lab website

Last June, I had the pleasure of conducting an enlightening interview with Mariana del Hoyo, a dedicated and passionate psychiatrist who recently completed her residency. Our conversation focused on Mariana’s journey and her profound interest in Transference-Focused Psychotherapy. I am excited to share this experience with all of you.

Her educational background is diverse. Not only does she have a Bachelor’s degree in Medicine from UNAM but she as also completed a postgraduate degree in Rural Development from UAM Xochimilco, a postgraduate program in Competencies for Managing BPD from UIC Barcelona, and a specialization in Psychiatry at the National Institute of Psychiatry “Ramón de la Fuente” in Mexico.

Her fascination with TFP began during her psychiatric residency, where she was deeply intrigued by the wide-ranging symptomatology of personality disorders. It stood out as a powerful technique that empowers individuals who have experienced invalidation in the past, helping them recognize their capacity for self-reflection. She was particularly impressed by how TFP integrates the therapist’s introspection and tackles not only the complexities of borderline personality disorder, but also fundamental human concerns.

Throughout her journey, Mariana has actively sought additional training and education. She has completed theoretical courses offered by TFP-Group Mexico, the TFP course provided by the TLP group in Barcelona, and has attended seminars led by Dr. Otto Kernberg. These experiences have enriched her understanding of TFP and facilitated valuable connections with experts in the field.

Currently, Mariana’s professional activities include private psychiatric consultations, supportive psychodynamic therapy at the Fray Bernardino Psychiatric Hospital and collaborative research projects. She actively participates in research focused on studying behaviors and risk factors in young people with HIV, as well as research projects related to Borderline Personality Disorder and its clinical features.

One of the most profound impacts of TFP on Mariana’s practice has been the development of a holistic understanding of her patients’ symptoms and the cultivation of stronger therapeutic relationships. TFP allows her to use transference as a valuable source of information, providing insights into relational dynamics. She considers it vital to the success of psychiatric management and psychotherapeutic interventions when working with patients with significant psychopathology, such as Borderline Personality Disorder. It has transformed Mariana’s overall therapeutic practice by fostering deeper reflection in her interactions with patients.

Mariana’s dedication to TFP goes beyond her clinical practice. She aspires to conduct research that demonstrates the effectiveness of TFP in the Mexican population, recognizing the need for its wider adoption. Currently, the studies focus on gender differences in clinical presentation and symptoms among individuals with Borderline Personality Disorder in Mexico City.

Regarding the advantages and disadvantages of TFP, she emphasized its reflective and introspective nature, which allows for deeper engagement with patients and addresses the chronic sense of emptiness and identity diffusion. However, she acknowledged that TFP requires a longer training period and comes with a certain level of complexity.

That is why she actively participates in supervision, recognizing its pivotal role in her professional development. She is convinced that supervision has been invaluable in guiding her through challenging cases, providing diverse perspectives, and offering emotional support. It has also contributed to her understanding of significant moments in a therapist’s life and their influence on countertransference and transference dynamics.

Practicing TFP in Mexico presents unique challenges due to the complex social and economic context of the country. However, Mariana remains steadfast in her commitment to promote the use of TFP, conduct research, and provide high-quality care to her patients. She is truly an inspiration to all of us as we strive to provide the best possible care in less than ideal situations. Mariana’s story shows us how important it is to include some teaching about TFP in psychiatry residency programs. From that initial contact with TFP, Mariana has gone on to practice both standard and applied TFP and to begin important research.

I hope you had as much pleasure to meet her as I did.

Warm regards,

Diana

Diana Téllez Quiroz, PhD

Diana Téllez has been working as a psychodynamic psychotherapist in Mexico since 2005. In 2009, she successfully completed a master’s degree program in psychotherapy for children, adolescents, and adults. She went on to earn a PhD in Psychoanalytic Psychotherapy from the Mexican Psychoanalytic Association in 2012.

She’s a certified TFP Teacher-Supervisor and has clinical practice in TFP since 2011.  Since 2016, she is responsible for the Psychology department at a public hospital part of the Mexican Social Security Institute (IMSS) in Mexico City. She is also an active member of the Academic Committee of Mexico involved in the organization of multiple trainings and supervisions in TFP.

Author’s website

As a member of the ISTFP Public Relations and Communication committee, I have the privilege of connecting with professionals from diverse backgrounds who share their experiences and challenges in implementing Transference Focused Psychotherapy (TFP) in various therapeutic settings worldwide. One recurring challenge that has emerged is the persistent misconception that TFP lacks scientific validity. In this series of articles, my objective is to provide fellow members with the necessary tools to debunk this myth.

Thank you for randomized control trials

In my experience, one of the most effective strategies to address the challenge of perceived lack of scientific validity in Transference Focused Psychotherapy (TFP) is to begin communications by highlighting TFP as a psychodynamic treatment for personality disorders that has been validated by randomized control trials (RCTs). This approach tends to engage the interest of a wide range of audiences.

I hold great respect and gratitude for fellow members who have dedicated themselves to the development of these RCT’s and who continue to plan new RCT’s. Conducting such trial, which play an indispensable role in establishing the credibility of TFP requires a great deal of effort. Especially when pretigious entities like the Cochrane database of systematic reviews use those RCT’s to determine which treatments have the most empirical support. I was happy to see that in 2012 Transference Focused Psychotherapy was considered a promising treatment for BPD along with Dialectic Behavioral Therapy, Schema Therapy, and Mentalisation Based Therapy. Unfortunately, in Cochrane’s new iteration of the review (2020), only DBT and MBT are mentioned as promising treatments. For this reason, the ISTFP is actively pursuing new RCT’s. To ensure that all members have easy access to the existing data, I have included links to all the RCTs at the end of this article.

However, even after presenting evidence of the treatment’s effectiveness, we often encounter a recurring weakness, which is the questioning of our theoretical foundation. I understand that some of you may disagree, emphasizing that our capacity to draw from the extensive psychoanalytic literature is indeed one of our greatest strengths. I completely agree , but we also have to recognize that in an evidence-based world, this reliance on psychoanalytic literature can sometimes undermine our credibility in the eyes of many.

Kernberg’s theory of personality

We are fortunate that Dr. Kernberg, the founding father of Transference Focused Psychotherapy (TFP), has successfully expanded the roots of psychoanalysis to create a psychodynamic treatment that integrates contemporary advancements in neurology with core concepts of psychoanalysis. In this series of articles, we will delve into the scientific evidence that substantiates the fundamental principles of Transference Focused Psychotherapy. Moreover, my aim is to present this information in a manner that is accessible to everyone, so it can be used in many contexts. To facilitate this, I will include links not only to scientific papers but also to the relevant images I have utilized.

Given the extensive nature of the topic, I will employ the following papers as guiding lights to navigate our exploration:

Kernberg, Otto. F (2016): What is personality?, Journal of Personality Disorders, Volume 30(2), 145-156

Otto F. Kernberg M.D. (2001) Object Relations, Affects, and Drives: Toward a New Synthesis, Psychoanalytic Inquiry, 21:5, 604-619

In the first paper, Kernberg provides a clear depiction of personality as a dynamic “umbrella” organization comprising various major component systems.

1. Temperament
2. Object relations
3. Character
4. Identity
5. Ethical value system
6. Cognitive capability (More precisely, attention and effortful control)

When I read the article, I was captivated by the elegant simplicity of the description, which not only established a connection with neurology but also provided bridges with other sciences.

For the time being, our exploration will focus on examining the temperamental components of this organization, deferring the investigation of its dynamic to a later point.

Temperament

I consider temperament as the fundamental constitutive structure of the
personality, represented by the general psychological reactivity of the or-
ganism, particularly psychomotor, cognitive, and affective reactivity. Affective reactivity Is the fundamental aspect of the organism’s psychic operation, in terms of constituting the primary motivational system, relating the individual to the environment in terms of positive, rewarding, or negative, aversive affective states reflected, particularly, in peak affect state activation.

Otto Kernberg, 2016

This is, in a nutshell, Kernberg’s theory of temperament and his psychodynamic conception of the the deep layers of the unconscious. A significant advance in supporting his theory of temperament came through the integration of data from Panksepp’s experiments in affective neurology. This integration has provided us with a robust scientific foundation to anchor our psychodynamic thinking.

Panksepp’s Affective Neuroscience

Scientific investigation of the brain is a formidable endeavor, as neurons intricately form vast and complex networks throughout an individual’s lifetime. Panksepp’s work stands out due to its unique focus on the sub-cortical networks of the brain. These networks exhibit minimal changes after birth and are present in all mammals, including humans like us.

Panksepp’s scientific protocol involves stimulating the sub-cortical networks of various animals through the application of small electric shocks or specific chemicals, followed by the observation of their resulting behaviors.

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Reminder

• The cortex is the seat of many high level functions like language and decision making
• Subcortical structures are located under the cortex and are the seat of primitive fonctions like emotions processing
• They represent networks of neurons that change very little during an individuals lifetime.

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Through his research, Panksepp identified seven networks of neurons that, when stimulated in mammals, elicit the following responses:

1. Specific behaviors, such as facial expressions.
2. Specific cognitive activities, including distinct attention states and states of effortful control.
3. Specific subjective experiences of positive or negative valence.

It is important to note that Panksepp aimed to differentiate affect from its subjective experience, which he denoted by writing the affect in capital letters and the associated subjective experience in lowercase. This distinction emphasizes that AFFECTS encompass a range of phenomena that include subjective experiences but are not limited to them.

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SEEKING-expectancy

The primary function of the affect is to prompt individuals to actively engage with their environment in order to acquire the necessary resources to fulfill basic needs such as hunger, thirst, security, or sexual arousal.

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FEAR-anxiety

The primary function of this affect is to safeguard against existential threats, such as heights, fire, or predators, by employing either a freezing or escaping mechanism.

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RAGE-anger

The primary function of this affect is to remove obstacles that hinder access to essential resources or the satisfaction of basic needs, often accomplished through acts of biting or killing.

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LUST-sexual arousal

The primary function of this affect is to facilitate reproduction by eliciting seductive behaviors, such as ear wiggles in rats or assuming a position that prominently displays sexual organs in female dogs.

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CARE-love

The primary function of this affect is to promote parental care and nurturing of the young by eliciting behaviors such as huddling or grooming. These behaviors help create a nurturing and protective environment that supports the well-being and development of the offspring.

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PANIC-sadness

The primary function of this affect is to prevent the risks associated with separation from primary caretakers by eliciting a sequence of behaviors that typically begins with crying, grasping, and other distress signals. If the caretaker does not return, this sequence may culminate in a decline of motor activity and drive.

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PLAY-social joy

The primary function of this affect is to foster attachment and establish dominance structures within social groups by engaging in a behavior commonly known as “rough and tumble play.”

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This neurological data provides support for the existence of primary motivational systems, aligning with Kernberg’s theory of affects. The findings indicate that specific neural mechanisms underlie the functions and expressions of these affects, reinforcing their role as fundamental drivers of behaviour.

Now we have to find empirical validation that they relate the individual to the environment in terms of positive or negative affects states.

Unveiling the Neural Mechanisms of Relating

Having mapped out the networks of each core affect, Panksepp devised an experiment to ascertain their subjective valence. To conduct this experiment, he placed rats within a maze, allowing them to freely explore their surroundings. Within a specific section of the maze, Panksepp stimulated one of the seven pre-identified affects using electric stimulation. Subsequently, he closely observed the rats’ behavior, aiming to discern the impact of the activated affect on their responses.

The affective precursors of ideal object relations

Through numerous trials, a consistent pattern emerged in Panksepp’s research, revealing that rats exhibited a distinct preference for the areas where specific affective states were triggered. Notably, the affects of SEEKING/expectancy, CARE/nurturing, PLAY/social joy, and LUST/sexual arousal. Based on their behavior and responses, it can be inferred that these affective states evoked a sense of positive subjective experience, prompting the rats to seek the repetition of such experiences.

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The affective precursors of persecutory object relations

Through an extensive series of trials, a notable pattern emerged, revealing that rats consistently avoided the areas where specific affective states were triggered, namely RAGE/anger, FEAR/anxiety, and PANIC/sadness. The observed avoidance of these affective states strongly indicates that the rats experienced negative subjective experiences when exposed to the corresponding affective stimulation, leading them to actively seek to avoid repeating such experiences.

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The preceding experiments not only confirms that affects are biologically encoded as either positive or negative experiences, but also shed light on the immediate contextualization that occurs when these affects are activated. This contextualization process leaves a lasting memory trace that takes the form of a dyadic relation. From the rat’s perspective, the memory of the experience encompasses the representation of their own body (self representation) being in a specific part of the maze (object representation) while experiencing a particular affect.

Because of Panksepp’s work, we now have compelling evidence that, as defined in Kernberg’s theory of temperament, affect are primary motivational systems that relate the individual to the environment in terms of positive or negative affects states.

What’s next?

At this time, it is pertinent to acknowledge that the seven affect systems discussed thus far might not represent all core affects. Others, like surprise, have yet to undergo neurologic exploration.

Furthermore, they do not encompass the entirety of our vast emotional life. Rather, they represent core affects, akin to primary colors in the realm of emotions. Analogous to how a combination of just three primary colors can produce an extensive range of hues, it is conceivable that these seven core affects can give rise to a diverse array of subjective experiences, spanning from admiration to contempt, compassion to indifference, and love to hate.

To understand the process of how the integration of basic affects give rise to novel emotional experiences, it is imperative to turn our attention to the second article mentioned earlier “Object Relations, Affects, and Drives: Toward a New Synthesis”. But it would mean that we tackle the concept of character, another important component of personality.

In adherence to the framework of our discussion (we TFP therapists always strive to maintain frame adherence), I will refrain from diving into this new subject. However, I invite you to read the aforementioned paper and contemplate the significance of temperament and the fresh perspectives that emerge from Jaak Panksepp’s affective neurology within the context of your daily practice of TFP.

I hope that through the assimilation of these insights, you can highlight the unique strengths and advantages of our model, making a persuasive case for its implementation and widespread acceptance.

Looking forward to your feedbacks,

Mathieu Norton-Poulin

TFP Randomized Controlled Trials

Clarkin, J. F., Foelsch, P. A., Levy, K. N., Hull, J. W., Delaney, J. C., & Kernberg, O. F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, 15, 487–495.

Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164, 922–928.

Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: Randomized controlled trial. British Journal of Psy- chiatry, 196, 389–395.

Fischer-Kern, M., Doering, S., Taubner, S., Hörz, S., Zimmermann, J., Rentrop, M., Buchheim, A. (2015). Transference-focused psychotherapy for borderline personality dis- order: Change in reflective function. British Journal of Psychiatry, 207, 173–174.

Levy, K. N., Kelly, K. M., Meehan, K. B., Reynoso, J. S., & Weber, M. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74, 1027–1040.

Stoffers-Winterling JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews 2012, Issue 8.

Bibliography

Antonio Alcaro, Stefano Carta and Jaak Panksepp, The Affective Core of the Self: A Neuro-Archetypical Perspective on the Foundations of Human (and Animal) Subjectivity, Frontiers in Psychology, www.frontiersin.org, September 2017, Volume 8, Article 1424.

Christian Montag and Jaak Panksepp (2017), Primary Emotional Systems and Personality: An Evolutionary Perspective, Frontiers in Psychology, www.frontiersin.org April 2017, Volume 8, Article 464.

Douglas F. Watt (2017) Reflections on the neuroscientific legacy of Jaak Panksepp (1943–2017), Neuropsychoanalysis, 19:2, 183-198, DOI: 10.1080/15294145.2017.1376549.

Jaak Panksepp (2004). Affective consciousness: Core emotional feelings in animals and humans. Consciousness and Cognition 14, 30–80.

Jaak Panksepp (2011). Cross-Species Affective Neuroscience Decoding of the Primal Affective Experiences of Humans and Related Animals, PLoS ONE, www.plosone.org.

Jaak Panksepp, Andrea Clarici, Marie Vandekerckhove & Yoram Yovell (2019) Neuro-Evolutionary Foundations of Infant Minds: From Psychoanalytic Visions of How Primal Emotions Guide Constructions of Human Minds toward Affective Neuroscientific Understanding of Emotions and Their Disorders, Psychoanalytic Inquiry, 39:1, 36-51.

Jason S. Wright and Jaak Panksepp (2012), An evolutionary Framework to understand Foraging, Wanting, and Desire: The Neuropsychology of the SEEKiNG system, Neuropsychoanalysis, 2012, 14 (1).

Kenneth L. Davis and Christian Montag (2019), Selected Principles of Pankseppian Affective Neuroscience, Frontiers in Neuroscience, www.frontiersin.org, January 2019 Volume 12, Article 1025.

Mark Solms and Jaak Panksepp (2012), The “Id” Knows More than the “Ego” Admits: Neuropsychoanalytic and Primal Consciousness Perspectives on the Interface Between Affective and Cognitive, NeuroscienceBrain Sci. 2012, 2, 147-175; doi:10.3390/brainsci2020147

Otto F. Kernberg M.D. (2001) Object Relations, Affects, and Drives: Toward a New Synthesis, Psychoanalytic Inquiry, 21:5, 604-619.

Otto F. Kernberg, M.D. (2016) What is Personality?, Journal of Personality Disorders, Volume 30(2), 145-156, © 2016 The Guilford Press.

Mathieu Norton-Poulin, M.Ps.

Mathieu Norton-Poulin is a psychologist in private practice in Gatineau, Québec. He graduated from Laval University in 1995 and started his training in transference focused psychotherapy in 2005. Member of the TFP-Québec group he as been practicing as a certified TFP therapist for the last 11 years. Since 2009 he organized several training events and has given lectures on TFP for medical doctors and college students. He maintains a blog where he write, in plain words, articles to explain TFP to the general public.

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Dear fellow members of the ISTFP,

My thought after reading the excellent newsletter that our Public Relations Committee has put together is: “Never Bored!”

Why are we never bored? The articles included in the newsletter remind us of:

1. The increasing need for our services.
2. The never-ending efforts of our members to meet the need.
3. The challenge of sharing our knowledge and skills with colleagues from different parts of the world and from different cultures, and the opportunity to learn from them.

In addition, the newsletter, in its informal poll of what others think of TFP, tells us that we should reflect on some internal representations people outside our community have of TFP… and how to modify those representations when they contain inaccuracies. I found this poll very helpful since it contained information that I have been, to some extent, in denial of (like everyone, I have my defenses).

In Theophilus Kok’s interview with Xumei Wang, we read a first-person account of what may be the most common challenge in learning TFP: the shift from supportive psychodynamic to deep work that offers profound change but that usually requires a period of induction into an exploratory therapy in which the patient, and therapist, must tolerate levels of anxiety as the patient’s earlier maladaptive adjustment to life is questioned.

Xumei Wang’s reflection on her experience also reminds us that what we learn when we learn TFP can help us understand the systems and networks within which we work, and the individuals who compose those networks. This kind of reflection requires the utmost tact since we are seeking an understanding that will help us negotiate challenging situations, with the possible goal of making changes in a system, while having to understand how best to deal with individuals who may be challenging.

Finally, Xumei Wang’s thoughts introduce a topic that we, at the Personality Disorders Institute, have deferred for a long time: should the student of TFP have the opportunity to participate in TFP as a patient? I propose that the ISTFP address this question more directly.

The articles on TFP for adolescents and on applied TFP in this newsletter speak to how members of our Society are expanding the application of our basic model of treatment to help more people in more circumstances. The need for good treatment for adolescents with personality difficulties is reaching crisis proportions and our Society as a whole will do what it can to support our growing initiatives for adolescents.

In the introduction to Mathieu Norton-Poulin’s excellent first article about empirical support for concepts at the heart of TFP, he reminds us of the need for additional RCT’s to add to the evidence base for TFP itself. I can reassure all members of our Society the ISTFP Executive Board is working very actively to initiate more RCT’s on TFP.

Please also take note of the excellent work done by Diana Tellez who has organized the listings of TFP trainings in a very clear and user-friendly way. This way of presenting the trainings will help guide potential students to the training that best suits them. It is a very important development as interest in TFP training continues to grow throughout the world.

A very special announcement before ending my letter is to welcome TFP-Puerto Rico to the ISTFP as a group in formation. TFP-Puerto Rico is an important addition to our community and will provide much-needed help to people on the island. Congratulations to Francisco Ramos-Rivera for taking the initiative to organize this group and to Mónica Eidlin for providing guidance and mentoring.

So, to get back to my initial comment, we all have chosen to devote ourselves to a kind of work in which we will be NEVER BORED! The need for our help presents us with challenges that would be daunting if we faced them alone but, together in this Society, we can turn those challenges into opportunities to work creatively together to advance our skills and understanding.

In the spirit of advancing our knowledge, I remind you to please save the date for our next ISTFP Biennial meeting, September 27 to 29, 2024 in New York.

Wishing you some rest and relaxation in the second half or the summer as we prepare to resume our full-speed efforts in September. 

With best wishes,

Frank

Frank E. Yeomans, MD, PhD

Frank E. Yeomans, MD, PhD, is a Clinical Professor of Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. He is a Senior Consultant in and teaches internationally for the Personality Disorders Institute, and is in private practice in White Plains and New York City.

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