Change In Attachment Patterns and Reflective Function In a Randomized Control Trial of Transference-Focused Psychotherapy for Borderline Personality … (original) (raw)
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Journal of Consulting and Clinical Psychology, 2006
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.
Clinical Psychology & Psychotherapy, 2019
Attachment characteristics play a key role in understanding borderline-specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a one-year outpatient Dialectical Behavior Therapy (DBT) for patients with Borderline Personality Disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP; George & West, 2012) before treatment.
Psychodynamic Psychotherapy Research, 2011
It is generally believed that psychoanalytically or dynamically oriented clinicians are not interested in research for a host of reasons ranging from the challenges of designing a randomized controlled trial that would demonstrate the effi cacy of a psychoanalytic approach to epistemological and philosophical disagreements about the nature of science (see debates for an illustration). Although many in the psychoanalytic community have in the past been cautious regarding the value of research, some of the earliest psychotherapy research was performed by psychoanalysts . Additionally, psychoanalyst and psychodynamic clinicians are increasingly becoming interested in testing psychodynamic hypotheses and establishing a stronger evidence base for treatments based on psychodynamic ideas . This increased interest in psychotherapy outcome research has been particularly fruitful with regard to the study of borderline personality disorder. Severe personality disorders such as borderline personality disorder are increasingly seen as the mainstay of psychoanalytic clinical work.
The British journal of psychiatry : the journal of mental science, 2015
Borderline personality disorder is associated with deficits in personality functioning and mentalisation. In a randomised controlled trial 104 people with borderline personality disorder received either transference-focused psychotherapy (TFP) or treatment by experienced community therapists. Among other outcome variables, mentalisation was assessed by means of the Reflective Functioning Scale (RF Scale). Findings revealed only significant improvements in reflective function in the TFP group within 1 year of treatment. The between-group effect was of medium size (d = 0.45). Improvements in reflective function were significantly correlated with improvements in personality organisation.
Studies in Medical Sciences, 2020
Background & Aims: The purpose of the present study was to investigate the changes in borderline personality structure at different time serials of treatment. Materials & Methods: The present study is a quasi-experimental and single-subject (A/B) study. The sample of study was a 35-year-old man who was selected as a borderline personality disorder among the patients referred to Health Center through a preliminary clinical interview and performing Millon clinical multiaxial inventory -III (MCMI-III) by available sampling method. The interview with the Semi-Structured Interview of the Personality Organization (STIPO) was conducted in four stages including one pre-test and three post-tests after time series treatment. Single-Subject was studied for 11 months in a format of 51 sessions of transference focused psychotherapy. Results: The findings showed that the mean scores of personality structure (identity, dimensions of object relations, aggression, personality rigidity, deference mechanisms, and morality) in the first post-test were not significantly different from the pre-test; but there was a significant clinical difference in the mean scores of personality structure at the second and third post-tests compared to the pre-test. Conclusion: Based on the results, this treatment has significant effect in improving the personality dimensions of borderline patients, especially in advanced stages of treatment.
Dialogues in Clinical Neuroscience & Mental Health 4 (2), 91-104, 2021
Borderline personality disorder (BPD) is a persistent pattern of instability in terms of emotion regulation, impulsiv-ity, self-image, interpersonal relationships with extreme 'splitting' between idealisation and devaluation of others, including also stress-related paranoid ideation and dissociative symptoms. Self-harming behaviour is also common amongst BPD patients. The manifestation of these symptoms may lead to serious disturbances of quality of life for patients, families and their significant others along with problems in professional and personal development. Several evidence-based psychotherapeutic approaches have been developed to address these issues. In this review two of them were put into scrutiny; Dialectical Behaviour Therapy or DBT, and Transference-Focused Psychotherapy or TFP. These were reviewed by examining RCT studies published in Cochrane and Clinicaltrials.gov databases. The efficacy of these two interventions was examined on similar outcomes, such as therapy dropout, general BPD symptoms, global functioning, self-harm, and social adaptation. No prominent superiority for either of the treatments in comparison was identified, however both TFP and DBT show greater efficacy when compared to other, non-BPD specific psychotherapeutic approaches.
Http Dx Doi Org 10 1080 00107530 2014 880316, 2014
Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in the literature in identifying the clinical characteristics of these NPD/BPD patients. In this article, we present recent research describing patients with comorbid NPD/BPD, as compared with patients with BPD without NPD (BPD), from two randomized clinical trials for the treatment of borderline personality disorder, with a particular emphasis on attachment status and mentalization. We anchor our discussion of these patients in object relations and attachment theory, and we describe our treatment approach, transference focused psychotherapy (TFP). We conclude by using case material to illustrate our research findings, highlighting the significant differences between patients with NPD/BPD and BPD/non-NPD in terms of their attachment classification.
Attachment and Borderline Personality Disorder
Journal of the American Psychoanalytic Association, 2000
The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: `My caregiver thinks of me as thinking and therefore I exist as a thinker.` This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having t...