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Borderline Disorder

Journal of Consulting and Clinical Psychology 2006, Vol. 74, No. 6, 1027–1040

Copyright 2006 by the American Psychological Association 0022-006X/06/$12.00 DOI: 10.1037/0022-006X.74.6.1027

Change in Attachment Patterns and Reflective Function in a Randomized Control Trial of Transference-Focused Psychotherapy for Borderline Personality Disorder
Kenneth N. Levy, Kevin B. Meehan, Kristen M. Kelly, Joseph S. Reynoso, and Michal Weber
City University of New York
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. Keywords: attachment, reflective function, borderline personality disorder, randomized controlled trial

John F. Clarkin and Otto F. Kernberg
Joan and Sanford I. Weil Medical College of Cornell University

Attachment theory and research have proven to be a powerful paradigm...