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Changes in Attachment Representation in Psychotherapy: Is Reflective Functioning the Crucial Factor?

Anna Tmej1, Melitta Fischer-Kern1, Stephan Doering1

  • 1Department of Psychoanalysis and Psychotherapy Medical University of Vienna Währinger Gürtel 18-20, A-1090 Wien Austria Department of Psychoanalysis and Psychotherapy,Medical University of Vienna.

Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie
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Higher reflective functioning (RF) predicts positive changes in attachment representation during psychotherapy for borderline personality disorder (BPD). Low RF hinders representational change, impacting treatment outcomes.

Keywords:
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Area of Science:

  • Psychotherapy Research
  • Clinical Psychology
  • Attachment Theory

Background:

  • Attachment representation significantly influences psychological well-being.
  • Reflective functioning (RF) is crucial for mentalizing and emotional regulation.
  • Borderline personality disorder (BPD) is often associated with insecure attachment and difficulties in RF.

Purpose of the Study:

  • To investigate the interplay between changes in attachment representation and reflective functioning (RF) in female BPD patients undergoing psychotherapy.
  • To examine RF as a moderator and outcome variable in relation to attachment changes.
  • To analyze RF changes over a one-year treatment period.

Main Methods:

  • Analysis of RF data from 63 female BPD patients.
  • Assessment of attachment representation changes (insecure to secure, unresolved to resolved).
  • Statistical evaluation of RF as a moderator, outcome, and over time.

Main Results:

  • Patients achieving resolved attachment showed significantly higher RF pre-treatment and at follow-up compared to unresolved patients.
  • Similar positive associations were observed for transitions from insecure to secure attachment.
  • Higher baseline RF moderated the change in attachment representation.

Conclusions:

  • Elevated reflective functioning (RF) is a positive predictor for achieving secure and resolved attachment representations in psychotherapy.
  • Patients with unresolved attachment and low initial RF demonstrated limited representational change within the first year of treatment.
  • RF plays a critical role in facilitating representational change, impacting therapeutic progress in BPD.