Transference-focused psychotherapy (TFP) is an evidence-based, psychodynamic psychotherapy empirically validated for patients with borderline personality disorder (BPD) and successfully adapted for the treatment of narcissistic personality disorder (NPD). Personality disorders are characterized by the behavioral and affective dysregulation associated with pathological identity formation. Based on contemporary object relations theory (ORT), the goal of TFP is symptom relief through improvement in self and interpersonal functioning. The TFP treatment frame, established through an initial contracting phase and combined with the therapist’s technical neutrality, facilitates activation, identification and containment of affectively charged perceptions of self and other. These perceptions, or object relations dyads, are repeatedly identified, labeled and explored through the interpretative process. Over the course of treatment, the patient’s capacity for affect containment and reflection improves and a better integrated, realistic sense of self develops consistent with healthier personality functioning. Utilizing a compilation of several patients, the treatment of NPD with TPF is described and the evidence for the efficacy of TFP for NPD is summarized.