Regarding therapeutic goals, different approaches have developed various perspectives. In Transference-Focused Psychotherapy (TFP), we consider the discussion and establishment of therapeutic goals to be one of the essential foundations for the success of therapy.
Patients do not always come to therapy fully aware of what motivates them to engage in the process. Already during the assessment phase, we compare the patient’s initial complaints with the problems that become apparent to us as clinicians. Our task is to help the patient become aware of these issues as well.
After discussing diagnostic impressions, the next crucial step is to explore the patient's motivations (or goals) for therapy. If the goals of the patient and the therapist diverge, therapy cannot proceed. At minimum, there must be at least one shared goal between therapist and patient.
What do the patient’s goals represent?
The goals are based on the patient’s conscious motives—motives that often become clearer through the initial diagnostic process and the discussion of the diagnostic impressions. These goals serve as a motivational foundation that helps the patient remain engaged in the psychotherapy process.
For example, if a patient recognizes that they have chronic difficulties in romantic relationships, a treatment goal might be framed as improving functioning in the area of intimate relationships. If the patient struggles in the professional sphere, the goals would accordingly involve improvements in that domain.
What is the role of goal-setting in Transference-Focused Psychotherapy?
Transference-Focused Psychotherapy (TFP) is a manualized, evidence-based treatment model designed for borderline, narcissistic, and other severe personality disorders.
The goal of TFP is to help patients integrate all aspects of their internal world (rather than defensively split off shameful, painful, or “unacceptable” thoughts, feelings, and motivations) in order to experience themselves and others in a coherent, balanced way.
The TFP therapist helps integrate these disparate psychological states using the transference relationship as a vehicle for understanding internal relational patterns that underlie feeling states and behaviors but are outside of the patient’s awareness.
TFP has its well-defined strategies, tactics, and techniques that ensure clarity in the therapeutic process.
The tactics of TFP are the maneuvers the therapist uses to set the stage for and to guide the proper use of techniques within the individual session.
One of the tactical principles of TFP is establishing treatment goals.
TFP goes beyond symptom reduction and aims to achieve the following objectives:
-To effect change in personality functioning - improve self functioning and interpersonal functioning
-To achieve a coherent sense of self, characterized by stability, depth, self-awareness and positive affect, and capacity for mutual relations with others marked by empathy and concern
-Ultimately to find satisfaction in work, love, friends, and leisure
In other words, the goals of TFP involve moving from lower levels of integration to higher levels, or from borderline personality organization toward the neurotic level and, ultimately, toward psychological health.
Research suggests TFP associated with changes in social cognition in addition to symptom change, specifically:
– changes in Reflective Functioning, Attachment Security, and Narrative Coherence
– functional changes associated with predicted fMRI changes in amygdala and dorsal prefrontal cortex
- TFP principles can be applied across psychiatric settings
How are treatment goals defined in TFP?
In TFP, defining treatment goals creates the conditions for lasting changes in personality functioning, leading to an improved quality of life and the capacity for mature, empathic relationships.
To define these goals, the therapist first conducts a diagnostic interview.
After conducting the assessment, the therapist discusses diagnostic impressions with the patient, which forms the basis for a conscious therapeutic alliance, because the therapist connects the patient's presented problems with the underlying psychological dynamics (usually unconscious or preconscious) that were identified during diagnosis. Additionally, the therapist determines the patient's primary types of personality disorders, the treatment of which should occur during therapy.
During the discussion of diagnostic impressions, the therapist links the patient’s initial complaints with deeper underlying issues. This process forms the foundation for the subsequent exploration of the patient’s motivations for entering therapy.
Moreover, such a discussion leads naturally to the formulation of the therapeutic contract, as the patient now has a clearer understanding of the purpose behind embarking on this long-term process.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy