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

Objective: The aim of this article was to construct an em-pirical bridge between object relations theory and attachment theory by investigating how researchers in both traditions have contributed to understanding and assessing identity diffusion (a keystone of personality pathology) and object relations in patients with borderline personality disorder during year of transference-focused psychotherapy (TFP).Methods: The Adult Attachment Interview (AAI) and the Struc-tured Interview of Personality Organization (STIPO) were ad-ministered to patients (N5104, all women) before and after year of treatment. This studywas part of a randomized controlled trial in which 104 patients with borderline personality disorder were randomly assigned to receive either TFP (a manualized, structured psychodynamic treatment approach) or treatment experienced community psychotherapists. Changes on the AAI attachment representations, narrative coherence, and reflective function were examined for their associations with changes the STIPO in identity, object relations, and aggression.Results: Patients who shifted from disorganized (unresolved) to organized attachment on the AAI after 1 year of TFP (but not treatment by experienced community psychotherapists) showed hypothesized improvements in domains of per-sonality organization on the STIPO, including identity, object relations, and aggression. Those who did not change from disorganized (unresolved) to organized attachment im-proved only in the domain of aggression. Conclusions: These findings highlight the centrality of identity diffusion to borderline personality disorder pathology and the importance of targeting it in treatment. Furthermore, the results suggest that identity may be indexed by measures of attachment security, narrative coherence, and personality organization.