Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder

J Consult Clin Psychol. 2006 Dec;74(6):1027-1040. doi: 10.1037/0022-006X.74.6.1027.

Abstract

Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPD were randomized to transference-focused psychotherapy (TFP), dialectical behavior therapy, or a modified psychodynamic supportive psychotherapy. Attachment organization was assessed with the Adult Attachment Interview and the RF coding scale. After 12 months of treatment, participants showed a significant increase in the number classified secure with respect to attachment state of mind for TFP but not for the other 2 treatments. Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF. Future research should establish the relationship between these 2 constructs and relevant psychopathology, identify treatment components responsible for effecting these changes, and examine the long-term outcome of these changes.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Awareness*
  • Borderline Personality Disorder / diagnosis
  • Borderline Personality Disorder / psychology
  • Borderline Personality Disorder / therapy*
  • Cognitive Behavioral Therapy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Object Attachment*
  • Personal Construct Theory*
  • Personality Assessment
  • Professional-Patient Relations
  • Psychoanalytic Therapy / methods*
  • Social Support
  • Transference, Psychology*