Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy

Disclosure of a personality disorder (PD) diagnosis is a clinically sensitive moment that may influence patients’ engagement with treatment, identity, and therapeutic relationships. Despite its importance, little is known about how patients themselves experience and interpret this process within specialized psychotherapies. The present study explored how patients in Transference-Focused Psychotherapy (TFP) experience and make sense of receiving a PD diagnosis. Using a qualitative design, we analyzed written accounts from 17 patients engaged in TFP. Data were examined using reflexive thematic analysis. Participants described diagnostic disclosure as a complex and emotionally charged experience that evoked a wide range of reactions, including fear, relief, curiosity, and validation. Most reported an ambivalent relationship to the diagnosis, with its meaning evolving over time through therapeutic work and reflection. Six themes captured how patients understood and integrated the diagnosis into their therapeutic experience. For many, the diagnosis initially disrupted self-narratives and was experienced as an external verdict; however, over time it often became a framework that helped organize distress, support self-understanding, and guide therapeutic change. The relational context of disclosure emerged as central: when communicated within a supportive therapeutic relationship, the diagnosis was more often experienced as meaningful and containing rather than stigmatizing. These findings suggest that diagnostic disclosure in PD treatment functions not merely as the communication of clinical information but as a relational and meaning-making process embedded in psychotherapy. Understanding patient experiences may help clinicians approach diagnostic discussions in ways that support engagement, reflection, and therapeutic collaboration.