title: Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder.
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.
authors.affiliation: Department of Psychology.
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Levy
authors.affiliation: Clinical Psychology Doctoral Program.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Meehan
authors.affiliation: Department of Psychology.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Kelly
authors.affiliation: Clinical Psychology Doctoral Program.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Reynoso
authors.affiliation: Clinical Psychology Doctoral Program.
authors.forename: Michal
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Psychiatry.
authors.forename: John F
authors.initials: JF
authors.lastname: Clarkin
authors.affiliation: Department of Psychiatry.
authors.forename: Otto F
authors.initials: OF
authors.lastname: Kernberg
mesh_terms: D000328:Adult; D001364:Awareness; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D018187:Personal Construct Theory; D010552:Personality Assessment; D011369:Professional-Patient Relations; D011575:Psychoanalytic Therapy / Q000379:methods*; D012944:Social Support; D014167:Transference, Psychology