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

ABSTRACT

OBJECTIVES: The study analyzed the interdependence of change in attachment representation and reflective functioning (RF) in psychotherapy. METHODS: RF data from 63 female borderline personality disorder (BPD) patients were analyzed with respect to change of attachment representation (from insecure to secure and from unresolved to resolved) fromthree angles (1) RF as a moderator variable, (2) RF as an outcome variable, and (3) RF changes over one year of treatment. RESULTS: Patients who changed to a resolved attachment classification showed higher RF before treatment and at follow-up than patients who remained unresolved (RF = 3.0 vs. RF = 2.14, p = 0.039; and RF = 3.4 vs. RF = 2.36, p = 0.002). Similar results were found for changes from insecure to secure. CONCLUSION: A higher RF level before psychotherapy proved to be a moderator for change in attachment representation. Patients with unresolved attachment and low-level RF at the outset had the least chance for representational change during the first year of psychotherapy.