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

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.

The Efficacy of Psychodynamic Psychotherapy

“…A recent study of patients with borderline personality disorder (Clarkin, Levy, Lenzenweger, & Kernberg, 2007) not only demonstrated treatment benefits that equaled or exceeded those of another evidence-based treatment, dialectical behavior therapy (Linehan, 1993), but 9 The exceptions to this pattern are specific anxiety conditions such as panic disorder and simple phobia, for which short-term, manualized treatments do appear to have lasting benefits (Westen et al, 2004). 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). These intrapsychic changes occurred in patients who received psychodynamic therapy but not in patients who received dialectical behavior therapy.…”

Modèle de l’engagement et de l’abandon de traitement de l’adolescent avec trouble de personnalité limite

“…Le mode d'utilisation de services de ces patients est, en effet, connu pour être chaotique (Fallon, 2003;Runeson & Beskow, 1991). La consommation erratique des traitements, les difficultés d'assiduités à la psychothérapie, les refus de prendre la médication tel que prescrit ainsi que les abandons de traitement fréquents caractérisent en effet, leur parcours thérapeutique (Cailhol, 2008;Levy, Meehan, Kelly, Reynoso, Weber, Clarkin, & Kernberg, 2006). En dépit de cette apparente insoumission aux recommandations thérapeutiques, les patients présentant un TPL sollicitent beaucoup de services de santé et sont parmi les plus grands consommateurs des ressources (Cailhol, 2008;Levy, Meehan, Kelly, Reynoso, Weber, Clarkin, & Kernberg, 2006).…”

“…La consommation erratique des traitements, les difficultés d'assiduités à la psychothérapie, les refus de prendre la médication tel que prescrit ainsi que les abandons de traitement fréquents caractérisent en effet, leur parcours thérapeutique (Cailhol, 2008;Levy, Meehan, Kelly, Reynoso, Weber, Clarkin, & Kernberg, 2006). En dépit de cette apparente insoumission aux recommandations thérapeutiques, les patients présentant un TPL sollicitent beaucoup de services de santé et sont parmi les plus grands consommateurs des ressources (Cailhol, 2008;Levy, Meehan, Kelly, Reynoso, Weber, Clarkin, & Kernberg, 2006). Comparativement aux patients souffrant d'autres troubles de la personnalité ou de dépression, ces patients reçoivent significativement plus de traitements de toute nature en psychiatrie.…”

“…Considérant que cette pathologie est répandue, douloureuse, invalidante et parfois mortelle et que des coûts importants découlent des atteintes fonctionnelles qu'elle entraine, plusieurs soutiennent que le TPL devrait être considéré comme un problème majeur de santé publique (Cailhol, 2008;Levy et al, 2006). Il n'en demeure pas moins que les difficultés de ces patients à demeurer en traitement sont notoires.…”

Interactional Pathology among Couples with Borderline Personality Disorder Wives: A Qualitative Study

“…Hurlbert et al (1992) studied the sexuality of women with borderline personality disorder. Crowell (2016) attended to interpersonal causes, correlates, and consequences of borderline personality disorder; Levy et al (2006) and Linehan (1987), Turner (2000), Munroe-Blum and Marziali (1995) were interested in seeking treatment for them, Daros, Zakzanis, & Ruocco (2013) studied facial emotion recognition in borderline personality disorder, Dutton and Starzomski (1993) studied the correlation between psychological and emotional abusive with border line personality characters among couples. In Iran also some studies have been dedicated to borderline personality disorder.…”