Scientific fondations of TFP series
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:
In the first paper, Kernberg provides a clear depiction of personality as a dynamic “umbrella” organization comprising various major component systems.
- Temperament
- Object relations
- Character
- Identity
- Ethical value system
- 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
Otto Kernberg, 2016
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.
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.
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.
Through his research, Panksepp identified seven networks of neurons that, when stimulated in mammals, elicit the following responses:
- Specific behaviors, such as facial expressions.
- Specific cognitive activities, including distinct attention states and states of effortful control.
- 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.
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.
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.
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.
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.
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.
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.
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.”
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.
SEEKING-Expectancy 
PLAY-Social joy 
LUST-Sexual arousal 
CARE-love
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.
FEAR-Anxiety 
RAGE-Anger 
Panic-Sadness 
Panic-Sadness
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
Bibliography
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.