Changes in Attachment Representation and Personality Organization in Transference-Focused Psychotherapy

Area of Science:

• Psychiatry and Psychology
• Psychodynamic Psychotherapy Research
• Personality Disorders

Background:

• Object relations theory and attachment theory offer complementary perspectives on personality pathology.
• Identity diffusion is a core feature of borderline personality disorder (BPD).
• Transference-focused psychotherapy (TFP) is a psychodynamic treatment for BPD.

Purpose of the Study:

• To empirically link object relations and attachment theories in understanding BPD.
• To assess identity diffusion and object relations in BPD patients undergoing TFP.
• To investigate changes in attachment representations and personality organization.

Main Methods:

• A randomized controlled trial involving 104 women with BPD.
• Administered the Adult Attachment Interview (AAI) and Structured Interview of Personality Organization (STIPO) pre- and post-treatment.
• Assessed changes in attachment, narrative coherence, reflective function, identity, object relations, and aggression.

Main Results:

• Patients achieving organized attachment on the AAI after TFP showed improvements in identity, object relations, and aggression.
• Patients not achieving organized attachment improved only in aggression.
• These changes were specific to TFP, not general community treatment.

Conclusions:

• Identity diffusion is central to BPD and a key treatment target.
• Attachment security, narrative coherence, and personality organization may index identity.
• Empirical links between attachment and object relations theories are established.