Transference-focused psychotherapy: Structural diagnosis as the basis for case formulation

Transference-focused psychotherapy (TFP) is a psychodynamic, empirically supported psychotherapy for personality disorders based on Otto Kernberg’s object relations theory. Case formulation and treatment planning in TFP is based on the patient’s level of personality organization (i.e., capacity for reality testing, predominant defence mechanisms, and consolidation of identity) as assessed at the beginning of treatment using the structural interview. Following a brief overview of object relations theory, we provide detailed description of the structural interview, which consists of assessment of the patient’s: main presenting symptoms, pathological personality traits, identity consolidation, and mental status. Guiding principles for determining the patient’s level of personality organization (‘structural diagnosis’) are provided as well as an illustrative case example. We conclude by reviewing the empirical support for the structural interview, and for its semistructured version, the Structured Interview of Personality Organization (STIPO) showing evidence for the reliability and validity of structural diagnoses derived from these interviews.