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

TLDR

The study examined whether changes in attachment organization and reflective function mediate improvement in borderline personality disorder patients undergoing transference‑focused psychotherapy compared to other treatments. Ninety BPD patients were randomized to transference‑focused psychotherapy, dialectical behavior therapy, or modified psychodynamic supportive psychotherapy, and attachment organization and reflective function were measured using the Adult Attachment Interview and a reflective function coding scale. After one year, transference‑focused psychotherapy significantly increased secure attachment classification, narrative coherence, and reflective function, whereas the other treatments showed no such changes.

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.