Your patient speaks in a calm, structured, “correct” manner during the session.

Instead of associations, you hear only dry reports: what happened, who said what, and what conclusions were drawn.

When you gently invite them to pause with their experience—for example, “What were you imagining at that moment?”—there is a pause. Tension.

And almost immediately—a retreat into explanation: “I don’t know… nothing special.”

Or another variant: the patient brings a great deal of “understanding”—insights, connections, interpretations of themselves. But as soon as you move closer to affect, a joke appears, or devaluation, or an abrupt shift of topic.

And then a question arises:

is there truly “no material” here—or is it that the patient is not yet able to tolerate it?

The tolerance of fantasy and an increase in symbolic awareness and containment of previously dissociated or acted-out affect states allow the patient to experience and play with emotions that he or she previously experienced as too threatening to allow into awareness and/or that he or she felt had to be hidden from the therapist.

In Transference-Focused Psychotherapy (TFP), this process is understood as a central mechanism of psychic change. The shift from enactment to symbolization occurs within the work with the transference, where affective states that were previously expressed through action or avoidance gradually become available for verbalization and reflection.

Within the context of the therapeutic relationship, the patient develops the capacity not only to act or avoid, but also to hold affect, name it, and integrate it into their internal experience. This creates the conditions for a more differentiated understanding of inner states and reduces the need for external enactment as a means of regulation.

This can be particularly relevant in the treatment of a borderline patient with narcissistic personality for whom an issue is the extent to which the patient may openly reveal free associations that are not under his or her control, with the implicit perceived danger that the therapist may gain understanding about what is going on in the patient’s mind before the patient is fully aware of it. The need for omnipotent control tends to inhibit free association and reduce the availability of fantasy material. 

In TFP, this fear often manifests in the transference as tension around being “read” or “exposed” by the therapist, which intensifies the need for control and restricts access to fantasy material. Accordingly, the task of TFP is not limited to interpreting content, but also involves the gradual reduction of this need for omnipotent control through clarification, confrontation, and interpretation of transference reactions. Indeed, this need for control tends to inhibit free association and limit the availability of fantasy material.

Within TFP, working with this control—as it emerges in the here-and-now of the interaction with the therapist—opens the possibility for integrating split affects and developing the capacity to tolerate one’s internal reality without resorting to immediate enactment or avoidance.

‍

(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy