Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74(6), 1027-1040

Department of Psychiatry, Cornell University, Итак, New York, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 01/2007; 74(6):1027-40. DOI: 10.1037/0022-006X.74.6.1027
Source: PubMed


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.

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    • "for women and .64 for men). Additionally, Levy and colleagues (2006) reported correlations around .50 between RF and AAI coherence in a sample of patients with borderline personality disorder. Researchers have also found that RF scores differ significantly based on AAI classifications (i.e., secure, dismissing, preoccupied); secure individuals typically score higher on RF than do insecure individuals (Bouchard et al., 2008; Fonagy, Steele, Steele, Moran, & Higgitt, 1991). "
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    ABSTRACT: This investigation examined the structure of reflective functioning (RF) - an understanding of the links between mental states and behaviors - and adult attachment scales. Both RF and traditional adult attachment scales were coded based on 194 prebirth Adult Attachment Interviews (AAI). Correlational and factor analyses indicated considerable overlap between RF and traditional AAI coding. Exploratory factor analyses of RF and AAI state-of-mind scales indicated that RF loaded, along with coherence of mind, on the primary factor distinguishing between individuals categorized as secure and dismissing. These findings indicate substantial overlap between RF and AAI scales; however, the magnitude of the correlations between these scales indicates that they are not redundant.
    Full-text · Article · Jan 2016 · Attachment & Human Development
    • "e final outcome or follow-up were assessed. Attachment as outcome. Can attachment change or be modified during treatment? It has been suggested that change in attachment can be conceptualized as a proximal outcome, not just a predictive client characteristic, but also as an outcome variable in and of itself (Bohart & Wade, 2013; Levy et al., 2011). Levy et al. (2006) assessed change in attachment organization (on the AAI and Reflective Function scale) in an RCT with BPD patients assigned to one of three 12-month treatments: transference-focused therapy (TFP), dialectical behavior therapy, or psychodynamic supportive therapy. A significant increase after 12 months was found in the number of patients "
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    ABSTRACT: Objective: This paper focuses on the need for connection as a common core theme at the heart of both close relationships and therapeutic relationships and explores ways to connect these two research domains that have evolved as separate fields of study. Bowlby's attachment theory provides a strong conceptual and empirical base for linking human bonds and bonds in psychotherapy. Method: The growing body of research intersecting attachment and psychotherapy (1980-2014) is documented, and meta-analytic studies on attachment-outcome and attachment-alliance links are highlighted. Results: Five ways of studying attachment as a variable in psychotherapy are underscored: as moderator, as mediator, as outcome, client-therapist attachment match, and as process. By integrating conceptualizations and methods in studying relational narratives of client-therapist dyads (Core Conflictual Relationship Theme), measures of alliance, and client attachment to therapist during psychotherapy, we may discover unique client-therapist relational dances. Conclusions: Future fine-grained studies on how to promote core authentic relational relearning are important to clinicians, supervisors and trainers, who all share the common quest to alleviate interpersonal distress and enhance wellbeing. Directions for advancing research on interpersonal and therapeutic relationships are suggested. Learning from each other, both researchers of close relationships and of psychotherapy relationships can gain a deeper and multidimensional understanding of complex relational processes and outcomes.
    No preview · Article · Jan 2016 · Psychotherapy Research
    • "BPD patients are particularly likely to fall back on automatic mentalizing at moments of intense emotional arousal (e.g., in attachment contexts, challenging interpersonal situations, feelings of shame, guilt, anger, or inadequacy), often with severe impairments in social cognition as a consequence (e.g., being overly distrustful or trustful, being idealizing or overly denigrating). The dramatically reduced capacity of BPD patients for reflective functioning (Fonagy et al., 1996) that is necessary for controlled mentalizing has been shown to be reversible by psychotherapy (Levy et al., 2006). The task of the therapist, then, is to help slow down the patient's thinking and move them to a more reflective, explicit form of mentalizing that requires more conscious, verbal attention; all without generating a process of pseudo-reflection or hypermentalizing (Sharp et al., 2011, 2013). "
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    ABSTRACT: The role of mentalizing in relation to borderline personality disorder (BPD) is examined with a view to achieving improved levels of mentalizing in BPD patients as a therapeutic target. The article seeks to explain why mentalizing works as a treatment target for BPD, and suggests that a mentalizing approach to BPD may be at the core of any successful intervention. (PsycINFO Database Record
    No preview · Article · Oct 2015 · Personality Disorders: Theory, Research, and Treatment
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