In this first session, Nel asks some questions from Otto Kernberg's structural interview: describe yourself and a significant other. From these it can be seen that Anne's personality is characterized by a "borderline" organization: an unintegrated identity, characterized by "splitting," while the reality check is mostly intact. This feels "wobbly" inside and unsettled. Then Nel makes an inventory - as usual in TFP - of Anne's 'agitation': how Anne will 'act' instead of 'feel' when she feels bad, for example by cutting, using substances and becoming aggressive. In this session, Nel makes a 'contract' about this: agreements with Anne in which Anne is asked to do everything possible not to show this 'agitating behavior' and when this has happened anyway, to bring this up in the next session. In the case of suicidality, the agreement is that Anne takes herself responsible for reporting the crisis service to be assessed to ensure her safety. Finally, Nel asks Anne to summarize the agreements again: the better the contract, articulated by the patient, the better the prognosis.

In this 20th session, Anne enters the therapy room angry. Nel shows how she deals with Anne's anger: she looks along with Anne's perception of the other, or, in other words, what the patient 'makes' of the practitioner. The first intervention is 'looking along' with the patient in how she sees the practitioner and naming that 'dyad' of subject (the patient) - object (the practitioner) and the connecting affect (anger, hurt). You can see that Anne feels understood in this 'negative transference' and becomes calmer. Later, Nel connects this negative dyad with the repelled dyad, namely the desire to get it right with the practitioner (interpretation): "you are so angry because you actually needed me so much". This connects the negative dyad with underlying the positive one and leads to more integration (the goal of TFP).

In this 15th session it emerges that Anne has had a "breach of contract" and that she has been drinking too much (again). As agreed, Anne brings this up at the beginning of the session, downplaying her behavior. Nel then looks along with Anne and goes into detail about the feelings Anne had prior to the drinking. Here she uses different TFP interventions: clarification (asking for clarification), confrontation (offering contradictory statements at the same time and asking how Anne reconciles this) and if possible interpretation (connecting the 'pluses' and 'minuses').

In this 120th session, 3 years after the start of treatment, the themes of evaluation and farewell are central. Nel asks explicitly about negative comments, because it is integrative if this can be discussed within the relationship. Anne shows that she can reflect, sees the practitioner as a real person, an "other. Anne shows authentic guilt about the harm she has caused others, and talks about what she has learned and what her life looks like now.

In this video Nel Draijer will give you more insight into her choices as a therapist, illustrated by excerpts from key tipping points in the therapy sessions with Anne.