Dear Colleagues,
From March 6–8, 2026, the third module of the didactic course Transference-Focused Psychotherapy (TFP) for Borderline, Narcissistic, and Other Severe Personality Disorders took place.
Trainer — Tennyson Lee, FRCPsych (United Kingdom).
Many participants awaited this module with particular interest.
On the one hand, this was due to topics that touch on some of the most challenging moments in psychotherapy:
- crises
- intense emotional states
- suicidal behavior
- therapeutic passivity
- situations in which treatment approaches its conclusion
On the other hand, special attention was drawn to a topic that occupied an entire day of the training: narcissism and narcissistic personality disorder.
Throughout the three days, participants repeatedly returned to a central question of TFP:
How does the therapeutic interaction between patient and therapist actually work?
We reviewed how transference and countertransference are used within this model, how to maintain technical neutrality, and how to formulate interpretations that help patients tolerate and become aware of their internal conflicts.
In other words, this module was devoted to the various complications that arise in psychotherapy. We know that patients with borderline and narcissistic pathology often engage in acting out—that is, they replace the experience and mental processing of psychic states with actions, which may at times be dangerous, such as self-harm, eating disorders, or substance abuse.
For this reason, particular attention was given to moments when therapy enters a zone of turbulence:
What should the therapist do when a patient experiences intense affective states?
How should therapists work with impulsivity, suicidal threats, self-harming behavior, and the risk of treatment interruption?
How can one understand the secondary gain of symptoms while maintaining therapeutic direction?
These questions generated the most extensive discussion.
A second important focus of the module was narcissism. Over the course of an entire day, participants explored Dr. Otto Kernberg’s theory of narcissism and narcissistic personality disorder —from its conceptual foundations to the structure of the pathological grandiose self.One question attracted particular interest:
What approaches does TFP propose for working with narcissistic patients?
Participants explored possible answers not only through theory but also through the discussion of clinical situations. Throughout the module, attendees actively reflected on the material, considered how the techniques might apply to their own clinical practice, and analyzed publicly presented clinical cases.
Throughout the module, participants analyzed clinical cases involving the treatment of narcissistic patients, discussed video excerpts from therapy sessions with the instructor’s commentary, asked questions, and practiced TFP interventions through role-play.
During the module, we also discussed three clinical cases presented by participants, which made it possible to observe how a clinician’s TFP-oriented thinking operates in a specific clinical situation.
These moments made it possible to see how the theoretical concepts of TFP begin to function within the realities of the therapeutic process.
Module III once again demonstrated that TFP is not only a therapeutic approach but also a way of thinking about psychotherapy, one that helps clinicians orient themselves even in the most complex and emotionally charged clinical situations.
Below is a detailed list of the topics discussed during the module:
1. Application of TFP to a case
2. Assessment
3. Treatment Contract
4. Key Messages re Self Harm
5. Suicide Prevention
6. Self-harm
7. Eight truths about suicide
8. TFP Overview: How TFP helps address the alliance rupture
9. Therapist’s reaction to patient’s DSH
10. Countertransference hate
11. Narcissism: Different psychoanalytic uses of term
12. The Etiology of Narcissism. Theoretical models: Attachment theory (Bowlby)
13. Attachment and Mentalization in the Comorbidity of Narcissistic and Borderline Personality Disorders.
14. Levy (2017): The Impact of Narcissism on Treatment Dropout in a Study of Three Treatment Methods for Borderline Personality Disorder.
15. Comparison of BPD and NPD in DSM-5 alternative model DSM for PDs (AMPD)
16. The core issue in Narcissism
17. Narcissistic Personality Organization
18. Implications of core aspects narcissism for TFP: a structured approach
19. Tactics: Setting of the Treatment Frame
20. Passivity and the treatment contract
21. Typical Narcissistic Transferences and Countertransferences
22. Difficulties in the Treatment of Narcissistic Individuals
23. Counter-transference with NPD Patients
24. Clarification, Confrontation, Interpretation - Modification of the Technique for Formulating Interventions for Patients with Narcissistic Personality Disorder.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy