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

By Kenneth N. Levy, K. Meehan, Kristen M Kelly, Joseph S. Reynoso, Michal Weber, J. Clarkin, O. Kernberg. Journal of Consulting and Clinical Psychology, 2006

767 citations recorded by the source corpus.

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.

Subfields: Clinical Psychology

View Paper: https://www.semanticscholar.org/paper/30fea322634d91ed9ab6b1ee6e5c2dacbb07645d

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In Clinical Psychology

1. Jon G. Allen
2. Peter Fonagy
3. J. Shedler
4. Anthony Bateman
5. P. Luyten
6. Adam M. Grant

Citations in the corpus

• Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology (2007, background): “Reflective functioning, a measure closely tied to the capacity to appreciate and understand the nature of internal thoughts and feelings—both one’s own and those of others1—significantly improved in the TFP group but not in the dialectical behavior therapy or supportive treatment groups (Levy et al.”
• THE RELATIONSHIP BETWEEN PERSONALITY ORGANIZATION, REFLECTIVE FUNCTIONING, AND PSYCHIATRIC CLASSIFICATION IN BORDERLINE PERSONALITY DISORDER (2010, background): “This result is in line with the Cassel-Hospital study, where a mean RF of 2.7 in BPD was reported (Fonagy et al., 1996), and consistent with the New York TFP study, where the mean RF in the TFP group was 2.9 at baseline (Levy et al., 2006).”
• The efficacy of psychodynamic psychotherapy. (2010, background): “102 February–March 2010 ● American Psychologist also showed changes in underlying psychological mechanisms (intrapsychic processes) believed to mediate symptom change in borderline patients (specifically, changes in reflective function and attachment organization; Levy et al., 2006).”
• Insight, but not self-reflection, is related to subjective well-being (2009, background): “For example, improved self-reflection is a significant outcome of transference-focused therapy for people with borderline personality disorder (Levy et al., 2006) and Wampold, Imel, Bhati, and Johnson-Jennings (2007) suggest that insight is a common factor in all effective psychotherapies.”
• Mentalizing in the Development and Treatment of Attachment Trauma (2013, background): “In Clarkin and colleagues’ study, all treatments were generally equivalent in effectiveness; yet, pertinent to my interests, based on results of Adult Attachment Interviews administered before and after one year of treatment, TFP was superior to DBT and supportive psychotherapy in showing improvemen”