عنوان مقاله [English]
Introduction: The present study aims to determine the effectiveness of a transference-focused psychotherapy (TFP) on reflective functioning (RF) and symptomatic reduction in clients with Borderline Personality Disorder(BPD).
Method: This applied research was a semi-experimental, single-subject A-B-A design. Among the clients with BPD who referred to Ibn-e-Sina Hospital in Mashhad, 3 persons, were selected by purposeful sampling, and were subjected to TFP for one year. Data were collected using (RFQ) and Borderline Personality Questionnaire (STB) in three stages of baseline, treatment and follow-up in 15 months.
Results: The findings revealed significantly increased RF total scores and decreased BPD symptoms in the treatment and follow-up stages. Reflective function of certainty has been significantly increased whereas no change detected for uncertainty. Further, a significant reduction in hopelessness and impulsivity observed, but this changes was not evident in paranoia and dissociation symptoms.
Conclusion: The one year TFP treatment could effectively increase the reflective functioning and create important structural and symptomatic changes in the BPD patients. Future research is required for deeper understanding of the treatment dimensions.
1- Debashi L NM, Rahimian-Boogar I. The effectiveness of cognitive-analytic therapy on impulsivity and dissociative experiences of borderline personality disordered patients. Journal of Clinical Psychology. 2018; 10(2): 15-27.
2- RJ B. DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders. Journal of Psychiatric Practice. 2015; 21(2): 171-3.
3- Paris J. Treatment of borderline personality disorder: A guide to evidence-based practice: Guilford Press. 2008.
4- Kaplan HI, Sadock BJ, Grebb JA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences, clinical psychiatry: Williams & Wilkins Co. 1994.
5- Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. Journal of personality disorders. 2004; 18(3: Special issue): 226-39.
6- Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. The Lancet. 2004; 364(9432): 453-61.
7- Gunderson JG, Bender D, Sanislow C, Yen S, Rettew JB, Dolan-Sewell R, et al. Plausibility and possible determinants of sudden “remissions” in borderline patients. Psychiatry: Interpersonal and Biological Processes. 2003; 66(2): 111-9.
8.- Clarkin JF, Cain NM, Lenzenweger MF. Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: clinical insights with a focus on mechanism. Current opinion in psychology. 2018; 21: 80-5.
9- Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. American journal of psychiatry. 2007;164(6):922-8.
10- Busch FN. Mentalization: Theoretical considerations, research findings, and clinical implications: Taylor & Francis. 2011.
11- Fonagy P, Luyten P, Moulton-Perkins A, Lee Y-W, Warren F, Howard S, et al. Development and validation of a self-report measure of mentalizing: The reflective functioning questionnaire. PLoS One. 2016; 11(7): e0158678.
12- Fonagy P. Attachment, the reflective self and boderline states: The predictive specificity of the adult attachment interview and patholical emotional development. 1998.
13- Kelly K, Slade A, Grienenberger JF. Maternal reflective functioning, mother–infant affective communication, and infant attachment: Exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment & human development. 2005; 7(3): 299-311.
14- Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, et al. The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of consulting and clinical psychology. 1996; 64(1): 22.
15- Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF. The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. Journal of personality disorders. 2001; 15(6): 487-95.
16- Levy KN, Clarkin JF, Yeomans FE, Scott LN, Wasserman RH, Kernberg OF. The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of clinical psychology. 2006; 62(4): 481-501.
17- Verheugt‐Pleiter A, Deben‐Mager M. Transference‐Focused Psychotherapy and Mentalization‐Based Treatment: Brother and Sister? Psychoanalytic Psychotherapy. 2006; 20(4): 297-315.
18- Doering S, Hörz S, Rentrop M, Fischer-Kern M, Schuster P, Benecke C, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry. 2010; 196(5): 389-95.
19- Giesen-Bloo J, Van Dyck R, Spinhoven P, Van Tilburg W, Dirksen C, Van Asselt T, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of general psychiatry. 2006; 63(6): 649-58.
20- van Asselt AD, Dirksen CD, Arntz A, Giesen-Bloo JH, van Dyck R, Spinhoven P, et al. Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy. The British Journal of Psychiatry. 2008; 192(6): 450-7.
21- Rashn Sh M-HS, Rezaei AM, Tabatabaee SM. The effect of long-term dynamic psychotherapy on the personality structure of patients with dependent personality disorder. Journal of Clinical Psychology. 2018; 9(4): 1-12.
22- Clarkin JF KO. Transference-focused psychotherapy for borderline personality disorder: A clinical guide.: American Psychiatric Pub; 2015.
23- Gurvits IG, Koenigsberg HW, Siever LJ. Neurotransmitter dysfunction in patients with borderline personality disorder. Psychiatric Clinics of North America. 2000; 23(1): 27-40.
24- Badoud D, Luyten P, Fonseca-Pedrero E, Eliez S, Fonagy P, Debbané M. The French version of the Reflective Functioning Questionnaire: validity data for adolescents and adults and its association with non-suicidal self-injury. PLoS One. 2015; 10(12): e0145892.
25- Leichsenring F. Development and first results of the Borderline Personality Inventory: A self-report instrument for assessing borderline personality organization. Journal of Personality Assessment. 1999;73(1):45-63.
26- Mohammadzade A. Validation of the borderline personality inventory in Iran. 2011.
27- Jackson M, Claridge G. Reliability and validity of a psychotic traits questionnaire (STQ). British Journal of Clinical Psychology. 1991; 30(4): 311-23.
28- Rawlings D, Claridge G, Freeman JL. Principal components analysis of the schizotypal personality scale (STA) and the borderline personality scale (STB). Personality and Individual Differences. 2001; 31(3): 409-19.
29- Mohammad Zadeh A GM, Taghavi MR, Molazadeh J. The study of factor structure, validity, reliability and standardization of borderline personality scale (STB) in Shiraz University Students. The Quarterly Journal Of Fundamentals Of Mental Health. 2005; 7(27-28): 75-89.
30- Nazari MA DM, Hashemi T. . Effectiveness of cognitive rehabilitation on dictation errors of students with dysgraphia. Journal of Research in Rehabilitation Sciences. 2015; 11(1): 32-41.
31- Zahra D, Hedge C. The reliable change index: Why isn’t it more popular in academic psychology. Psychology Postgraduate Affairs Group Quarterly. 2010; 76(76): 14-9.
32- Choi-Kain LW, Gunderson JG. Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry. 2008; 165(9): 1127-35.
33- De Meulemeester C, Lowyck B, Vermote R, Verhaest Y, Luyten P. Mentalizing and interpersonal problems in borderline personality disorder: The mediating role of identity diffusion. Psychiatry research. 2017; 258: 141-4.
34- De Meulemeester C, Vansteelandt K, Luyten P, Lowyck B. Mentalizing as a mechanism of change in the treatment of patients with borderline personality disorder: A parallel process growth modeling approach. Personality Disorders: Theory, Research, and Treatment. 2018; 9(1): 22.
35- Levy KN, Meehan KB, Kelly KM, Reynoso JS, Weber M, Clarkin JF, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of consulting and clinical psychology. 2006; 74(6): 1027.
36- Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: rationale, methods, and patient characteristics. Journal of Personality Disorders. 2004; 18(1): 52-72.