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Transference-Focused Psychotherapy (TFP) for Narcissistic Personality: Engaging Patients in the Early Treatment Process

The authors outline the application of Transference-Focused Psychotherapy (TFP), a structured, twice-weekly psychoanalytic psychotherapy, to patients with narcissistic pathology. The operation of splitting-based defenses in the maintenance of the pathological grandiose self that is characteristic of individuals with narcissistic personality disorders is described, as are the obstacles posed by this structure to therapists attempting to establish a viable treatment frame and engage patients in the early treatment process. The narcissistic patient’s difficulty tolerating the interpretive process in psychoanalytic psychotherapy is formulated based on the ideas of several writers in the modern Kleinian tradition as well as contemporary object relations theory. An extended case discussion illuminates the foregoing, and several modifications related to tact and timing, drawn from various analytic sources, are outlined to enhance the interpretive process in TFP.