Transference-Focused Psychotherapy in New York City
Structured, depth-oriented psychotherapy for adolescents and adults experiencing persistent difficulties with identity, self-esteem, relationships, emotional regulation, and personality functioning. TFP uses patterns that emerge in the therapeutic relationship to support a more integrated understanding of self and others and guide meaningful change.
In-person and clinically appropriate telehealth
What TFP Addresses
The relationship with the therapist becomes a place to recognize, understand, and change patterns that shape life outside the consulting room.
Transference-Focused Psychotherapy, or TFP, is a structured psychodynamic treatment developed for significant difficulties in personality functioning. It pays close attention to recurring ways a person experiences themselves and other people, especially when identity, self-esteem, trust, closeness, collaboration, or emotional stability can shift sharply under stress.
In TFP, the word transference refers to relationship patterns and related emotions that become active in the present relationship with the therapist. These patterns are examined collaboratively because they can provide immediate information about conflicts that may also appear with family, partners, friends, school, work, and other clinicians.
The aim is not simply insight for its own sake. Treatment works toward a more integrated, realistic, and flexible sense of self and others, greater capacity to reflect before acting, more stable relationships, and improved emotional and behavioral regulation. TFP aims at addressing the root causes of personality difficulties that produce painful symptoms, to help the person with ongoing personality development towards a more fulfilling and flourishing life. At The Sheppe Group, TFP may be coordinated with psychiatric care, medication consultation, family work, or an existing treatment team when the broader clinical picture requires it.
Two providers.One integrated lens.
Alexander H. Sheppe, MD, FAPA, DFAACAP, and Aliza Spruch-Feiner, PhD, bring advanced training in Transference-Focused Psychotherapy to a shared model that integrates psychiatry, clinical psychology, personality assessment, psychodynamic treatment, family systems, and coordinated care.
Alexander H. Sheppe, MD, FAPA, DFAACAP
Double board-certified child, adolescent, and adult psychiatrist with advanced expertise in TFP, personality assessment and development, psychoanalysis, complex psychiatric presentations, family systems, and integrated treatment planning.
Aliza Spruch-Feiner, PhD
Clinical psychologist with advanced training in TFP, personality assessment, psychodynamic formulation, and treatment planning.
When TFP May Be Helpful
TFP may be considered when difficulties in identity, self-esteem, relationships, emotional regulation, or personality functioning are persistent, disruptive, and not fully explained by a single symptom-based diagnosis. A comprehensive evaluation is used to determine whether TFP, another psychotherapy, or a broader treatment plan is the best fit.
Identity feels unstable or divided
A person may feel like a very different version of themselves depending on the relationship, emotion, success, failure, praise, or criticism of the moment. TFP helps examine these shifts and work toward a more continuous and integrated sense of self.
Relationships become intense or unpredictable
Idealization, disappointment, fear of abandonment, distrust, withdrawal, control, repeated conflict, or difficulty holding mixed feelings about another person may create painful and recurring relationship cycles.
Emotions escalate quickly
Anger, shame, anxiety, emptiness, jealousy, impulsivity, shutdown, or rapid changes in closeness and distance may be difficult to understand in the moment and can interfere with judgment, safety, or functioning.
Treatment repeats the same pattern
Therapy may stall when the same misunderstandings, ruptures, crises, absences, testing of limits, idealization, devaluation, or fear of dependence emerge across multiple treatment relationships.
Borderline personality features are present
TFP has been studied most extensively for borderline personality disorder and related difficulties involving identity, relationships, affective instability, impulsivity, anger, self-harm risk, and sharply conflicting views of self and others.
Self-esteem depends heavily on outside response
Vulnerabilities may include extreme sensitivity to criticism, shame, envy, entitlement, withdrawal, perfectionism, unstable self-worth, or difficulty balancing one’s own needs with the reality of other people.
Adolescent or emerging-adult development is off course
Developmentally adapted TFP principles may help when identity formation, autonomy, school, work, family relationships, emotional regulation, or movement toward adulthood is repeatedly disrupted by rigid interpersonal patterns.
A more structured treatment frame is needed
TFP establishes clear goals, roles, responsibilities, safety priorities, and expectations so that difficult patterns can be examined without losing sight of functioning, risk, and the practical requirements of treatment.
What to Expect in Transference-Focused Psychotherapy
TFP begins with assessment and then establishing a clear treatment frame. The exact structure is individualized, but the work is active, focused, and organized around understanding the patterns that interfere with identity, relationships, emotional stability, safety, and day-to-day functioning.
Build a shared formulation and treatment frame.
The assessment considers the patient’s concerns, history, current functioning, risk, prior treatment, the patterns that appear to maintain the difficulty, and the patient’s goals. Once assessment is complete, the clinician and patient discuss the results together and may consider whether TFP is appropriate and what other care may be needed.
A clear treatment agreement addresses goals, safety, crises, attendance, communication, outside treatment, medication, substance use, and the responsibilities of both patient and therapist. The frame creates enough structure for difficult patterns to be examined directly.
Observe and clarify patterns in the therapeutic relationship.
The therapist pays close attention to experiences of self and others including the therapist, changes in emotion, closeness, distance, trust, anger, disappointment, dependence, control, and misunderstanding as they occur in the session. These moments are connected to the patient’s broader relational world without assuming that every reaction has only one meaning.
TFP commonly uses clarification, careful bids for reflection when contradictions emerge, and interpretation of underlying motivations. The purpose is not criticism. It is to slow down what is happening, compare different experiences, and make patterns available for reflection rather than immediate action.
Work toward integration and change outside therapy.
Over time, sharply divided or conflicting experiences of self and others can be held together with more nuance. A person may become better able to recognize mixed feelings, tolerate disappointment, reflect under stress, repair relationships, and make choices that are less driven by the emotional state of the moment. There is a movement from action to thinking, from coercion to collaboration, from anger to appropriate mourning.
Progress is reviewed in relation to concrete goals such as safer behavior, steadier relationships, improved school or work functioning, stronger identity, reduced crises, and more consistent use of treatment. Psychiatric, family, or team-based care may be coordinated when clinically appropriate. When goals have been adequately met, treatment ends, typically after 18 to 36 months of therapy.
TFP is a structured treatment, not a fixed package. Session frequency, duration, family involvement, medication care, and coordination with outside clinicians depend on the patient’s needs, safety, developmental stage, and the treatment agreement.
What Transference-Focused Psychotherapy May Include
The treatment combines a consistent frame with close attention to the patient’s current emotional and relational experience. Each element serves the larger goal of improving personality functioning and translating insight into more stable experiences, relationships, and choices.
Assessment and clinical formulation
A detailed understanding of symptoms, personality functioning, identity, relationships, development, trauma, risk, prior treatment, strengths, and current context.
A clear treatment frame
Shared goals and expectations for attendance, communication, safety, crises, outside treatment, medication, substance use, and collaboration with other clinicians.
Here-and-now relationship work
Careful attention to how expectations, fears, emotions, and perceptions become active between patient and therapist and how they may relate to patterns outside therapy.
Clarification, bids for reflection, and interpretation
Structured techniques used to define what is happening, examine contradictions without blame, and understand the emotional meaning of recurring patterns.
Risk and treatment priorities
Ongoing attention to safety, self-harm, suicidality, aggression, substance use, treatment-interfering behavior, and the hierarchy of concerns that must be addressed first.
Coordination when appropriate
Psychiatric care, medication consultation, family work, school or program collaboration, and communication with an existing treatment team when permission and clinical need support it.
TFP may be the central psychotherapy or one part of a broader plan. It is not automatically the right treatment for every diagnosis, crisis, developmental concern, or level-of-care need, which is why the consultation and formulation come first.
TFP Compared With Related Treatments
Several evidence-based and depth-oriented treatments can address complex emotional and personality difficulties. The best match depends on the clinical formulation, treatment goals, safety needs, learning style, available supports, and prior response to care.
General psychodynamic psychotherapy
Psychodynamic psychotherapy explores unconscious conflict, development, relationships, defenses, and recurring patterns. TFP is a specific, manualized psychodynamic model with an especially structured frame and an explicit focus on how personality patterns emerge in the present relationship with the therapist.
Dialectical behavior therapy (DBT)
DBT emphasizes behavioral analysis, skills, crisis management, mindfulness, emotion regulation, and building a life worth living. TFP emphasizes the integration of conflicting self-and-other representations through the therapeutic relationship. Some patients may receive these approaches sequentially or even together.
Mentalization-based treatment (MBT)
MBT focuses on strengthening the ability to understand one’s own and other people’s mental states, especially under attachment stress. TFP also supports reflection and mentalization, but also works more directly with the emotional meanings and sharply divided relationship patterns that become active in the session.
Psychiatric and medication treatment
Medication may be useful for co-occurring mood, anxiety, attention, sleep, trauma-related, or other symptoms. It does not replace psychotherapy for enduring difficulties in identity, relationships, self-esteem, and personality functioning, but psychiatric care can be an important part of an integrated plan.
When emotional and relationship patterns keep repeating, the first step is not to force a label. It is to understand the pattern well enough to determine whether TFP, another psychotherapy, or a broader treatment plan offers the clearest path forward.
Transference-Focused Psychotherapy Across Developmental Stages
Personality functioning changes across development. TFP must account for age, autonomy, family context, culture, school or work demands, safety, and the patient’s capacity to use a structured relationship-focused treatment.
Adolescents
Developmentally adapted TFP can address identity formation, intense relationships, emotional and behavioral dysregulation, self-harm risk, family conflict, and disruptions in school or peer functioning while recognizing that adolescence is a period of active change.
Emerging adults
Treatment may focus on identity, self-direction, relationships, college or work, independence, failure to launch, and the emotional patterns that interfere with movement toward adult roles and responsibilities.
Adults
TFP may address longstanding patterns involving unstable relationships, self-esteem, anger, shame, emptiness, impulsivity, work difficulties, identity, and repeated treatment disruptions that continue across different stages of adult life.
Families and care teams
Parents, partners, psychiatrists, schools, programs, and other clinicians may be involved when their participation supports safety, developmental progress, coordinated expectations, or a more stable treatment environment.
What TFP Is Designed to Help Change
No psychotherapy can guarantee a particular result. TFP is designed to support changes in personality functioning that can make experiences of self and others,emotions, choices, and day-to-day life more understandable and stable. The goal is optimal personality development for individual flourishing.
A more integrated identity
Greater continuity in the sense of self and pursuit of goals across success, failure, closeness, conflict, praise, criticism, and changing emotional states.
More realistic and stable relationships
Improved ability to hold both positive and negative qualities in the same person, tolerate disappointment, repair conflict, and reduce cycles of idealization, devaluation, control, withdrawal, fear, and anger.
Stronger emotional regulation
More capacity to identify emotions, understand what activates them, tolerate intensity, and choose a response rather than acting immediately from anger, shame, panic, or emptiness.
Greater reflective capacity
Improved ability to step back, consider multiple meanings, recognize one’s own contribution to a pattern, and remain curious about another person’s perspective under stress.
More consistent functioning
Progress in school, work, treatment participation, autonomy, self-care, safety, and decision-making as internal and relational patterns become less disruptive.
Related specialtiesand conditions
Related TFP Specialties
Conditions and Concerns That May Be Relevant to TFP
Transference-Focused Psychotherapy FAQs in New York City
These answers provide general information. Whether TFP is appropriate, how treatment is structured, and what other care may be needed depend on a comprehensive evaluation and the individual treatment plan.
What is Transference-Focused Psychotherapy?
Transference-Focused Psychotherapy, or TFP, is a structured psychodynamic treatment for significant difficulties in personality functioning. It examines patterns in identity, self-esteem, emotions, and relationships as they become active in the present relationship with the therapist, then works toward a more integrated, realistic, and flexible experience of self and other people.
What does “transference” mean in TFP?
Transference refers to automatic experiences of self and other, emerging from models and patterns in a person’s inner world, that become active in a current relationship, including with the therapist. TFP studies these moments carefully because they can reveal patterns that also affect family, partners, friends, school, work, and other treatment relationships.
Who may benefit from TFP?
TFP may be considered for adolescents or adults with persistent difficulties involving identity, unstable relationships, intense emotions, anger, shame, impulsivity, self-esteem, difficulties in personality functioning, repeated crises, or treatment patterns that have been difficult to understand or change. A consultation is needed to determine fit.
Is TFP only for borderline personality disorder?
No. Research support is strongest for borderline personality disorder, but TFP principles and adaptations are also used with narcissistic and other personality disorders and broader difficulties in personality functioning. The clinical formulation, rather than a single label, guides whether the approach is appropriate.
How is TFP different from regular talk therapy?
TFP is more explicitly structured around a treatment frame, agreed goals, safety and treatment priorities, and close examination of what is happening between patient and therapist in the present. The clinician actively clarifies patterns, addresses contradictions without blame, and helps connect immediate emotional experience with broader relationship patterns.
How often are TFP sessions?
TFP is a regular, structured treatment and its standard model is delivered two times per week. The actual frequency at The Sheppe Group is determined during consultation based on clinical need, safety, developmental stage, other treatment, scheduling, and the agreed treatment plan.
Can adolescents receive TFP?
Yes. Developmentally adapted TFP can be used with adolescents when identity, emotional regulation, relationships, self-harm risk, behavior, school functioning, or family conflict require a structured personality-focused approach. Parent or family involvement may be important while confidentiality and the adolescent’s treatment relationship are protected.
Can TFP be combined with medication or other treatment?
Yes. TFP may be coordinated with psychiatric care, medication consultation, family work, school or program support, DBT skills, or other services when the broader clinical picture requires them. Roles and communication should be clear so that each part of care supports the same treatment priorities.
Does TFP involve family members?
It can, especially with adolescents, emerging adults, safety concerns, dependence on family support, or complex treatment systems. Family meetings are used when they support assessment, safety, boundaries, communication, or the treatment plan, while the patient’s privacy and individual therapy remain carefully considered.
How long does Transference-Focused Psychotherapy take?
TFP is generally a longer-term psychotherapy rather than a brief fixed-length protocol, typically 18 to 36 months. Duration depends on the severity and stability of the difficulties, treatment goals, progress, safety, functioning, attendance, and whether other care is needed. The clinician and patient review progress and treatment direction over time.
TFP in Midtown Manhattan
The Sheppe Group provides Transference-Focused Psychotherapy at 122 East 42nd Street, 32nd Floor in New York, NY 10168, near Grand Central. TFP may be integrated with psychiatric evaluation, medication consultation, personality assessment, family work, and coordination with an existing treatment team.
122 East 42nd Street, 32nd Floor
New York, NY 10168
(646) 859-8585
Midtown Manhattan near Grand Central
TFP, psychiatry, psychodynamic psychotherapy, personality assessment, family consultation, and coordinated care.
Telehealth for New York and Other Licensed States
Telehealth may be available for patients located in New York, California, Florida, New Jersey, and Connecticut when TFP or related care is clinically appropriate for remote treatment and permitted by licensure, privacy, and the individual treatment plan.