Dear Colleagues, оn December 5, 6, and 7, 2025, Module II of the didactic course Transference-Focused Psychotherapy (TFP) for Borderline, Narcissistic, and Other Severe Personality Disorders was held.
The course trainer was Tennyson Lee, FRCPsych, psychiatrist, psychoanalyst, and TFP trainer and supervisor (United Kingdom).

This part of the TFP training served as a logical continuation of the study of the fundamental principles of TFP while also offering a more detailed examination of how this model integrates the assessment of personality structure, diagnostic formulation and communication with the patient, the discussion and establishment of treatment goals, the contracting process, and the technical principles of therapeutic work.

The central theme of Module II was:

“Assessment and setting the frame. Introduction to Technique”

We worked very intensively. Theory did not remain abstract, largely due to the creative structure of the training. In addition to addressing a wide range of thoughtful questions from participants, the program included full-length live demonstration sessions. In these demonstrations, the role of the patient was played by a well-known British actor - Josh Higgott, who is also trained as a TFP therapist.

The first role-play illustrated an initial session with a patient who showed limited motivation for therapeutic work. The second demonstration represented the fourth session with the same patient, focusing on the discussion and formulation of treatment goals.

To further support the integration of TFP theory into clinical thinking, the trainer, Dr. Lee, reviewed two real clinical cases submitted by course participants. These cases vividly illustrated the theoretical material and deepened participants’ clinical understanding. During the discussion, additional role-plays emerged spontaneously, including one situation in which Tennyson Lee unexpectedly found himself in the role of the patient, while a course participant assumed the role of the therapist.

And now, a more detailed look at all of this.

The lecture component of the module covered the following topics:

- TFP Approach to Patient Assessment

- Structural Features at the Center of the Diagnostic System

- Structural Diagnosis and Levels of Personality Organization

- The Structural Classification of Personality Disorders by Levels of Severity

- Treatment Implications of Personality Organisation

- Identity. Pathology of Identity Formation

- Borderline Personality Organization: Basic Characteristics, Defining Psychological Characteristics and their Clinical Correlates

- The Structural Interview by Otto Kernberg

- The Structured Interview of Personality Organisation: STIPO-R

- Sharing diagnosis

- Neuroscience: The patient’s feelings

- Kernberg’s and Panksepp’s Model of Emotional Drives

- Formulation – a neuropsychoanalytic approach

- Formulation of diagnosis in TFP

- Common challenges in the assessment of a patient with severe PD:  the contribution of TFP

- Theory: Contracting in Psychotherapy

- Practice: How contracting contributes to the practice of TFP. Objectives of treatment contract

-  Patient responsibilities

- Therapist’s Responsibility

- Setting Treatment Goals

- 3 main dimensions in life

- The Techniques of TFP

- Transference and Countertransference

- The interpretive process: Clarification, Confrontation and Interpretation

- Technical Neutrality

These theoretical blocks laid the foundation for the transition to the practical part of the module, where the focus shifted to applying the acquired knowledge within the actual therapeutic process, including the specifics of contracting, the analysis of transference and countertransference reactions, and the interpretative process.

The comments of Oleksii Lemeshchuk, a certified TFP therapist and Director of the Ukrainian Association of Transference-Focused Psychotherapy, were particularly valuable. He shared how TFP strategies for establishing and maintaining treatment boundaries can be adapted to clinical practice in the context of the war in Ukraine—circumstances that require therapists to approach their work with greater flexibility and clinical creativity.

The practical component:

It represented a distinctive combination of the following elements:

- Role-play demonstrations, presented live, illustrating how a therapist works with a patient within the Transference-Focused Psychotherapy (TFP) model.

In the first demonstration (two sessions), the role of the therapist was performed by Tennyson Lee, while the patient was portrayed by Josh Higgott.

The module also included the discussion of clinical cases presented by course participants. These discussions were complemented by role-plays in which, in one case, Tennyson Lee assumed the role of the therapist while the participant took the role of the patient, and in another case, the roles were reversed.

Role-play provides a unique opportunity to observe how a therapist, in real time, finds the appropriate “keys” to a patient — attuning to the patient’s understanding, mode of perception, and the gradual development of the therapeutic alliance.

This format allows participants to see how TFP techniques facilitate shared understanding with the patient and help establish access to experiences and themes that had previously remained unavailable for therapeutic work.

- Two clinical cases submitted by participants of Module II for group discussion.
Dr. Tennyson Lee independently selected the cases, focusing on those that allowed for a deeper exploration of psychopathological structure and contributed to the development of participants’ clinical thinking and learning process.

It was particularly important to observe how the principle of technical neutrality is implemented in an actual clinical session. This is clearly not the abstinence or indifference formulated in the early twentieth century. Today, we understand that emotional detachment does not work. Technical neutrality, instead, involves empathic engagement, which differs fundamentally from abstinence.

The practical component also included the viewing and discussion of two video-recorded sessions:

• A violation of the therapeutic contract related to self-harming behavior at an early stage of treatment
  
  
• Work with a patient experiencing difficulties in interpersonal and intimate relationships, characterized by a high level of borderline personality organization with histrionic and sadomasochistic features

Each lecture and practical block was accompanied by a Q&A session, ensuring that participants’ questions were integrated into the module in real time, clarifying key concepts and enhancing comprehension of the material. Below are several questions raised by participants:

- Could you provide examples of flexible moral functioning characteristic of healthy personality, and more rigid functioning characteristic of neurotic personality?

- Could you illustrate different levels of reality testing?

- What should a therapist do during assessment when they have a strong impression that the patient is presenting distorted or fabricated information?

- How can reality testing be assessed using only the STIPO-R?

- What is the difference between a psychiatric diagnosis and a descriptive formulation of the patient?

- What is recommended when therapists remain uncertain about the diagnosis even after the assessment (e.g., when verbal responses suggest a higher level of organization, yet countertransference signals unconscious withholding or deception)?

- How can the therapist explain the value of video recording so that patients do not become anxious or feel their confidentiality is threatened?

- How should the duration of the therapeutic contract be determined?

- And others.

Active interaction with the trainer in this segment helped clarify complex clinical situations, demonstrated the application of TFP techniques with patients at different levels of personality organization, and allowed participants to immediately integrate the material into their own clinical practice. This discussion-based format became an essential component of the learning process and significantly strengthened its practical value.

The combination of theoretical depth, live demonstrations of real clinical processes, and active interaction between the trainer and participants created a rich and effective learning environment in which complex theoretical concepts became clear, tangible, and observable in clinical action.

The materials presented offered a renewed perspective on structural diagnosis, its practical value, and reinforced the understanding that TFP is not merely a set of techniques but a comprehensive framework for conceptualizing personality and guiding therapeutic work.

This module became an important step in shaping a professional community of clinicians who work with some of the most challenging manifestations of personality pathology. The experience gained not only expanded participants’ therapeutic tools but opened new perspectives for clinical decision-making, patient engagement, and the structuring of treatment frames.

For these reasons, the Second Module marks not an end, but a point of departure for deeper exploration — especially as the upcoming Third Module will focus on “Techniques, complications, and advanced stages of treatment. Narcissism”.

For those who wish to further explore the depth of working with personality through the TFP method, enrollment for the course remains open. Both the I and II Modules are already available in video recording.

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TFP-Group Ukraine

Ukrainian Institute for Personality Disorders Studies

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