Borderline Patients Before And After One Year Of Transference-Focused Psychotherapy (Tfp): A Detailed Analysis Of Change Of Attachment Representations

In a mixed-methods approach, this study applies qualitative analysis to Adult Attachment Interview texts of 11 patients with borderline personality disorder, who changed from an insecure attachment representation to security after 1 year of treatment with transference-focused psychotherapy (TFP). Analyses were guided by 3 research questions about changes in (a) attachment strategies, (b) narrative content, and (c) themes to form a theory about the way psychic structure in the form of attachment representation changes during TFP treatment, encompassing the changes of self- and other-representations and of defense mechanisms such as splitting and idealization as they appear in the discourse about attachment-related themes. Analyses yielded 2 groups of changes. Patients who changed in a "straightforward" way reduced their defenses and were able to produce more balanced and detailed narratives. These patients changed from an insecure-preoccupied attachment representation to a secure attachment representation with preoccupied aspects, or from an insecure-dismissing to a secure representation with dismissing aspects. On the other hand, some insecure-dismissing patients changed in a "diverted" way to a secure attachment with preoccupied aspects, that is, originally dismissing defenses were reduced while attention toward negative aspects of attachment was somewhat intensified. Exact comparisons of narratives from the beginning and from after 1 year of therapy also revealed relevant thematic changes above and beyond attachment, showing that patients could use TFP to gain deeper and more significant understanding of their early experiences.