https://doi.org/10.4081/ripppo.2025.810
Transference-focused psychotherapy in an inpatient setting for borderline personality disorders: changes in symptomatology
Submitted: July 8, 2024
Accepted: November 12, 2024
Published: January 28, 2025
Accepted: November 12, 2024
Abstract Views: 1924
PDF: 227
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
This prospective, naturalistic, longitudinal study examined changes in borderline-specific symptoms in a six-month, manualbased transference-focused psychotherapy (TFP) inpatient treatment for patients with borderline personality disorder (BPD) in comparison to a waitlist control group. Seventy-four patients with BPD received TFP in a multi-professional inpatient setting, of whom 27 patients represented the waitlist control group. 31 patients completed six months of treatment. Borderline-specific symptoms were measured by means of the Borderline Symptom List (BSL-23) prior to treatment (waitlist control group), at the beginning, after 3 months, and at the end of it. BSL-23 scores decreased significantly from the beginning to the end of the six-month inpatient therapy program with a medium effect size of d=0.54. There was no change in symptoms for the waitlist control group. Our findings suggest that inpatient TFP is effective in terms of the reduction of borderline-specific symptoms. In terms of this, the duration of the treatment seems to be a meaningful factor. Further research will investigate changes in specific psychodynamic aspects as well as in the follow-up measurement.
Agarwalla, P. A., Küchenhoff, J., Sollberger, D., Gremaud-Heitz, D., Riemenschneider, A., Walter, M., & Dammann, G. (2013). Ist die stationäre störungsspezifische Behandlung von Borderline-Patienten einer herkömmlichen psychiatrischen/psychotherapeutischen stationären Behandlung überlegen [Is inpatient, disorder-specific treatment of borderline patients superior to conventional psychiatric, psychotherapeutic inpatient treatment]. Swiss Archives of Neurology and Psychiatry, 164(6), 194–205.
DOI: https://doi.org/10.4414/sanp.2013.00182
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: (DSM-5) (5th ed.). Washington, DC: American psychiatric association. doi:10.1176/appi.books.9780890425596
DOI: https://doi.org/10.1176/appi.books.9780890425596
Barnicot, K., Katsakou, C., Marougka, S., & Priebe, S. (2011). Treatment completion in psychotherapy for borderline personality disorder: A systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 123(5), 327–338. doi:10.1111/j.1600-0447.2010.01652.x
DOI: https://doi.org/10.1111/j.1600-0447.2010.01652.x
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software, 67(1). doi:10.18637/jss.v067.i01
DOI: https://doi.org/10.18637/jss.v067.i01
Bateman, A. W., & Fonagy, P. (2014). Psychotherapie der Borderline-Persönlichkeitsstörung. Ein mentalisierungsgestütztes Behandlungskonzept [Psychotherapy of borderline personality disorder. A mentalization based treatment] (2nd ed.). Gießen: Psychosozial.
Black, D. W., Blum, N., McCormick, B., & Allen, J. (2013). Systems training for emotional predictability and problem solving (STEPPS) group treatment for offenders with borderline personality disorder. The Journal of Nervous and Mental Disease, 201(2), 124–129.
DOI: https://doi.org/10.1097/NMD.0b013e31827f6435
Bohus, M., Limberger, M. F., Frank, U., Chapman, A. L., Kühler, T., & Stieglitz, R. D. (2007). Psychometric properties of the Borderline Symptom List (BSL). Psychopathology; 40(2):126-132. doi:10.1159/000098493
DOI: https://doi.org/10.1159/000098493
Buchheim, A., Hörz-Sagstetter, S., Doering, S., Rentrop, M., Schuster, P., Buchheim, P., Pokorny, D., & Fischer-Kern M. (2017). Change of Unresolved Attachment in Borderline Personality Disorder: RCT Study of Transference-Focused Psychotherapy. Psychotherapy and Psychosomatics, 86(5):314-316. doi:10.1159/000460257
DOI: https://doi.org/10.1159/000460257
Clarkin, J. F., Foelsch, P., Levy, K. N., Hull, J. W., Delaney, J. C., & Kernberg, O. F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorders: a preliminary study of behavioral change. Journal of Personality Disorders 15, 487-495.
DOI: https://doi.org/10.1521/pedi.15.6.487.19190
Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: a multiwave study. The American Journal of Psychiatry, 164(6), 922–928. doi:10.1176/ajp.2007.164.6.922
DOI: https://doi.org/10.1176/ajp.2007.164.6.922
Dammann, G., Riemenschneider, A., Walter, M., Sollberger, D., Küchenhoff, J., Gündel, H., Clarkin, J. F., & Gremaud-Heitz, D. J. (2016). Impact of Interpersonal Problems in Borderline Personality Disorder Inpatients on Treatment Outcome and Psychopathology. Psychopathology, 49(3), 172–180. doi:10.1159/000446661
DOI: https://doi.org/10.1159/000446661
Delacre, M., Lakens, D., & Leys, C. (2017). Why Psychologists Should by Default Use Welch’s t-test Instead of Student’s t-test. International Review of Social Psychology, 30(1), 92–101. doi:10.5334/irsp.82
DOI: https://doi.org/10.5334/irsp.82
DGPPN e.V. (2022). Hrsg. für die Leitliniengruppe: S3-Leitlinie Borderline-Persönlichkeitsstörung. [S3 guideline Borderline Personality Disorder]. Version 1.0 retrieved 14.11.2022, from https://www.awmf.org/leitlinien
Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010). Transference-focused psychotherapy vs. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry: the journal of mental science, 196(5), 389–395. doi:10.1192/bjp.bp.109.070177
DOI: https://doi.org/10.1192/bjp.bp.109.070177
Dulz, B., Grimmer, B., Lohmer, M., Wlodarczyk, O., & Dammann, G. (2023, in press). Using Transference Focused Psychotherapy (TFP): Principles in short-term and extended inpatient hospitalizations settings. In R. Hersh & M. Petrini (Eds.). Implementing Psychiatric Care for Personality Disorders with Principles of Transference Focused Psychotherapy (TFP). Springer Nature.
DOI: https://doi.org/10.1007/978-3-031-68062-5_7
Dulz, B., Lohmer, M., Kernberg, O. F., Wlodarczyk, O., & Dammann, G. (2022). Borderline-Persönlichkeitsstörung. Stationäre Übertragungsfokussierte Psychotherapie [Borderline personality disorder. Inpatient transference-focused psychotherapy ]. Hogrefe Verlag GmbH & Company KG, Göttingen.
DOI: https://doi.org/10.1026/02588-000
Edel, M.-A., Raaff, V., Dimaggio, G., Buchheim, A., & Brüne, M. (2017). Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder - A pilot study. The British Journal of Clinical Psychology, 56(1), 1–15. doi:10.1111/bjc.12123
DOI: https://doi.org/10.1111/bjc.12123
Fischer-Kern, M., Doering, S., Taubner, S., Hörz, S., Zimmermann, J., Rentrop, M., Schuster, P., Buchheim, P., & Buchheim, A. (2015). Transference-focused psychotherapy for borderline personality disorder: change in reflective function. The British Journal of Psychiatry: the journal of mental science, 207(2), 173–174. doi:10.1192/bjp.bp.113.143842
DOI: https://doi.org/10.1192/bjp.bp.113.143842
Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21(4):1355-1381. doi:10.1017/S0954579409990198
DOI: https://doi.org/10.1017/S0954579409990198
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry 63(6), 649-658.
DOI: https://doi.org/10.1001/archpsyc.63.6.649
Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual review of psychology, 60, 549–576. doi:10.1146/annurev.psych.58.110405.085530
DOI: https://doi.org/10.1146/annurev.psych.58.110405.085530
Grund, S., Lüdtke, O., & Robitzsch, A. (2016). Multiple Imputation of Multilevel Missing Data. SAGE Open, 6(4), 215824401666822. doi:10.1177/2158244016668220
DOI: https://doi.org/10.1177/2158244016668220
Grund, S., Lüdtke, O., & Robitzsch, A. (2021). mitml: Tools for Multiple Imputation in Multilevel Modeling. https://CRAN.R-project.package=mitml
Herzog, P., Feldmann, M., Voderholzer, U., Gärtner, T., Armbrust, M., Rauh, E., Doerr, R., Rief, W., & Brakemeier, E.-L. (2020). Drawing the borderline: Predicting treatment outcomes in patients with borderline personality disorder. Behaviour Research and Therapy, 133, 103692. doi:10.1016/j.brat.2020.103692
DOI: https://doi.org/10.1016/j.brat.2020.103692
Iliakis, E. A., Ilagan, G. S., & Choi-Kain, L. W. (2021). Dropout rates from psychotherapy trials for borderline personality disorder: A meta-analysis. Personality Disorders, 12(3), 193–206. doi:10.1037/per0000453
DOI: https://doi.org/10.1037/per0000453
Jahn, C., Wieacker, E., Bender, S., & Krischer, M. (2021). Reduktion selbstverletzenden Verhaltens bei Jugendlichen mit Borderline-Persönlichkeitsorganisation mittels der übertragungsfokussierten Psychotherapie [Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A]. Praxis der Kinderpsychologie und Kinderpsychiatrie, 70(8), S. 728-747.
DOI: https://doi.org/10.13109/prkk.2021.70.8.728
Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press. http://www.jstor.org/stable/10.2307/j.ctt32bf53 doi:10.2307/j.ctt32bf53
Kernberg, O. F. (1996). A psychoanalytic theory of personality disorders. In J. F. Clarkin & M. F. Lenzenweger (Eds.), Major theories of personality disorder (pp. 106–140). Guilford Press.
Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. International Journal of Psychoanalysis, 89(3), 601–620.
DOI: https://doi.org/10.1111/j.1745-8315.2008.00046.x
Kleindienst, N., Jungkunz, M., & Bohus, M. (2020). A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23). Borderline Personality Disorder and Emotion Dysregulation, 7(1), 11. doi:10.1186/s40479-020-00126-6
DOI: https://doi.org/10.1186/s40479-020-00126-6
Kösters, M., Burlingame, G. M., Nachtigall, C., & Strauss, B. (2006). A meta-analytic review of the effectiveness of inpatient group psychotherapy. Group Dynamics: Theory, Research, and Practice, 10(2), 146–163. doi:10.1037/1089-2699.10.2.146
DOI: https://doi.org/10.1037/1089-2699.10.2.146
Kröger C., Harbeck S., Armbrust M., Kliem S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Researh and Therapy, 51(8):411-416. doi:10.1016/j.brat.2013.04.008
DOI: https://doi.org/10.1016/j.brat.2013.04.008
Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline Personality Disorder – A Review. Journal of the American Medical Association, 329(8), 670-679. doi:10.1001/jama.2023.0589
DOI: https://doi.org/10.1001/jama.2023.0589
Leichsenring, F., & Rüger, U. (2004). Psychotherapeutische Behandlungsverfahren auf dem Prüfstand der Evidence Based Medicine (EBM) [Psychotherapeutic treatment methods under the scrutiny of evidence-based medicine (EBM)]. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 50(2), 203–217. doi:10.13109/zptm.2004.50.2.203
DOI: https://doi.org/10.13109/zptm.2004.50.2.203
Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., & Kernberg, O. F. (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(6), 1027–1040. doi:10.1037/0022-006X.74.6.1027
DOI: https://doi.org/10.1037/0022-006X.74.6.1027
Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford.
R Core Team. (2020). R: A Language and Environment for Statistical Computing. https://www.R-project.org/
RStudio Team. (2019). RStudio: Integrated Development Environment for R. http://www.rstudio.com/
Rubin, D. B. (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons, Inc. doi:10.1002/9780470316696
DOI: https://doi.org/10.1002/9780470316696
Ryle, A., Leighton, T., & Pollock, P. (1997). Cognitive analytic therapy and borderline personality disorder: The model and the method. John Wiley & Sons Inc.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177. doi:10.1037/1082-989X.7.2.147
DOI: https://doi.org/10.1037//1082-989X.7.2.147
Sollberger, D., Gremaud-Heitz, D., Riemenschneider, A., Agarwalla, P., Benecke, C., Schwald, O., Küchenhoff, J., Walter, M., & Dammann, G. (2015). Change in Identity Diffusion and Psychopathology in a Specialized Inpatient Treatment for Borderline Personality Disorder. Clinical psychology & psychotherapy, 22(6), 559–569. doi:10.1002/cpp.1915
DOI: https://doi.org/10.1002/cpp.1915
Stoffers J. M., Völlm B. A., Rücker G., Timmer A., Huband N., & Lieb K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane database of systematic reviews, 15 (8). doi:10.1002/14651858.CD005652.pub2
DOI: https://doi.org/10.1002/14651858.CD005652.pub2
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 5. doi:10.1002/14651858.CD012955.pub2
DOI: https://doi.org/10.1002/14651858.CD012955.pub2
Wittchen, H.-U., Fydrich, T., & Zaudig, M. (1997). SKID: Strukturiertes Klinisches Interview für DSM-IV; Achse I und II [SCID: Structured Clinical Interview for DSM-IV; Axis I and II]. Göttingen: Hogrefe.
Wolf, M., Limberger, M. F., Kleindienst, N., Stieglitz, R.-D., Domsalla, M., Philipsen, A., Steil, R., & Bohus, M. (2009). Kurzversion der Borderline-Symptom-Liste (BSL-23): Entwicklung und Überprüfung der psychometrischen Eigenschaften [Short Version of the Borderline Symptom List (BSL-23): Development and Psychometric Evaluation]. Psychotherapie, Psychosomatik, medizinische Psychologie, 59(8), 321–324. doi:10.1055/s-0028-1104598
DOI: https://doi.org/10.1055/s-0028-1104598
Yeomans, F. E. (2007). Questions concerning the randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 64(5):609-610. doi:10.1001/archpsyc.64.5.609-c
DOI: https://doi.org/10.1001/archpsyc.64.5.609-c
Yeomans, F. E., Clarkin, J. F., & Kernberg, O. F. (2017). Übertragungsfokussierte Psychotherapie für Borderline-Patienten: Das TFP-Praxismanual [Transference-Focused Psychotherapy for Borderline Personality Disorder. A Clinical Guide]. Stuttgart: Schattauer.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford.
How to Cite
Abel, T., Happel, M., Daerr, F., Spitzer, C., Benecke, C., & Dulz, B. (2025). Transference-focused psychotherapy in an inpatient setting for borderline personality disorders: changes in symptomatology. Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2025.810
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Claudia Capella, Loreto Rodríguez, Estrella Azócar, Ximena Lama, Lucía Núñez, Daniela Águila, Camila Gomez, Macarena Espeleta, Vania Vasquez, Psychotherapeutic change in children and adolescents who have been sexually abused: a model from participants’ perspectives , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 1 (2022)
- Annalisa Tanzilli, Antonello Colli, Laura Muzi, Vittorio Lingiardi, Clinician Emotional Response Toward Narcissistic Patients: A Preliminary Report , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 18 No. 1 (2015)
- Salvatore Gullo, Gianluca Lo Coco, Laura Salerno, Federica La Pietra, Vincenzo Bruno, A study of personality subtypes in treatment seeking obese patients , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 16 No. 2 (2013)
- Vasiliki Yotsidi, Charis Ntakolia, Ioanna Rannou , Pilios-Dimitris Stavrou, Panagiotis Ferentinos, Athanasios Douzenis, Nikolaos Smyrnis, Efthimia Gavriilidou, Rossetos Gournellis , Suicidality and self-compassion in patients with major depressive disorder: the mediating role of the avoidant attachment type , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 27 No. 3 (2024)
- Eunice Barbosa, Maria Amendoeira, Tiago Ferreira, Ana Sofia Teixeira, José Pinto-Gouveia, Joào Salgado, Immersion and distancing across the therapeutic process: relationship to symptoms and emotional arousal , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 20 No. 2 (2017)
- Gabriel Gònzalez, Vanetza E. Quezada, A brief cognitive-behavioral intervention for stress, anxiety and depressive symptoms in dental students , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 1 (2016): Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy: part 2
- Pedro Rodrigues Ribeiro, David Dias Neto, The real relationship: the Portuguese version of the Real Relationship Inventory-Client form , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 2 (2023)
- Giovanna Esposito, Francesco Cuomo, Angela Di Maro, Raffaella Passeggia, The assessment of therapist responsiveness in psychotherapy research: a systematic review , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 27 No. 2 (2024)
- Michela Gatta, Marta Sisti, Laura Sudati, Marina Miscioscia, Alessandra Simonelli, The Lausanne Trilogue Play within the outcome evaluation in infant mental health: a preliminary report , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 1 (2016): Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy: part 2
- Samuel F. Mikail, Paul L. Hewitt, Gordon L. Flett, Sabrina Ge, Group dynamic-relational therapy for perfectionism , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 3 (2022): SPECIAL ISSUE: "Group psychotherapy: between settled benchmarks and new horizons"
<< < 3 4 5 6 7 8 9 10 11 12 > >>
You may also start an advanced similarity search for this article.
