Can deeply rooted attachment styles, formed in early experience, undergo significant change in adulthood?
This question remains one of the central issues in contemporary psychotherapy and attachment theory—particularly in the context of disorders in which interpersonal functioning is a core difficulty.
The study we will examine today offers a new perspective on this question, demonstrating that even stable patterns of experiencing oneself and others can undergo profound transformation in the course of psychotherapy.
We present a brief review of a scientific study:
From Bench to Bedside: Examining the Interpersonal and Affective Context of Borderline Personality Disorder as It Unfolds Over Time in Psychotherapy
Nicole Cain, Kevin B. Meehan, Michael Roche, Julia Sowislo
which examines changes in interpersonal and affective functioning in the course of psychotherapy.
The aim of this study is to examine changes in the daily interpersonal and affective functioning of patients with borderline personality disorder undergoing evidence-based psychotherapy. It is among the first studies to analyze these changes within the interpersonal field over the course of psychodynamic treatment.
The study used data obtained through ecological momentary assessment (EMA), collected over 14-day periods at three time points: at the beginning of treatment, and after 9 and 18 months.
The psychotherapeutic model employed in the study was Transference-Focused Psychotherapy (TFP) — an empirically supported, manualized treatment for borderline personality disorder. TFP is aimed at addressing disturbances in self-functioning and interpersonal relationships through work with polarized mental representations of the self and others, particularly those that emerge within the therapeutic relationship.
The method is grounded in object relations theory, as developed by Dr. Otto Kernberg, and seeks to integrate these polarized representations into a more coherent and stable sense of self and others.
Thus, the central mechanism of TFP involves the gradual transformation of maladaptive ways of experiencing oneself in relation to others through the processing of experiences that arise within the therapeutic interaction.
The study included 45 patients diagnosed with borderline personality disorder. Participants recorded their interpersonal interactions in daily life, evaluating both their own behavior and affect, as well as their perceptions of others’ behavior and affect.
The study was published in Journal of Psychopathology and Clinical Science, July 2025, 135(1): 158–169.
The full text of the study is available at: https://www.researchgate.net/publication/393984243_From_bench_to_bedside_Examining_the_interpersonal_and_affective_context_of_borderline_personality_disorder_as_it_unfolds_over_time_in_psychotherapy
Results
The results indicate that, over the course of Transference-Focused Psychotherapy (TFP), patients with borderline personality disorder demonstrate gradual yet systematic changes in both emotional and interpersonal functioning.
Interpersonal functioning:
During TFP, participants increasingly perceived both themselves and others as more friendly, warm, and less conflictual. Their sense of agency increased, with patients experiencing themselves as more confident and capable of influencing interactions. Perceptions of others also became more positive, suggesting a shift toward more adaptive interpretations of social cues.
Affective functioning:
Over the course of TFP, there was an increase in positive affect and emotional activation. Patients more often experienced themselves as energetic and satisfied, and began to interpret their emotional intensity in a more positive way.
Negative experiences and identity:
There was a decrease in anger, experiences of rejection, and identity diffusion. At the same time, clarity of self-concept increased, indicating a gradual integration of self-representations—one of the central mechanisms of change in TFP.
Emotional and behavioral stability:
TFP was associated with a reduction in the volatility of negative states, including anger, rejection, and disturbances in identity. This suggests improved emotion regulation and more stable functioning in daily life.
Changes in interpersonal patterns:
Importantly, TFP influenced not only individual variables but also the relationships between them. Over time, the intensity and dominance of others became increasingly associated with perceptions of friendliness rather than hostility. Participants’ responses to others’ negative emotions became less emotionally distant, indicating the development of more flexible and adaptive interpersonal functioning.
Overall, the findings suggest that TFP contributes not only to symptom reduction but also to meaningful changes in interpersonal and affective functioning.
Conclusion
The findings suggest that therapeutic change in BPD involves not only symptom reduction but also a reorganization of how individuals experience themselves and others within the interpersonal field.
Over time, patients develop more flexible, differentiated, and adaptive ways of relating, as well as an increased capacity to tolerate emotional intensity without losing interpersonal connectedness.
These results are consistent with the theoretical framework of Transference-Focused Psychotherapy, according to which therapeutic change occurs through the integration of representations of self and others and the transformation of affective experience within relationships.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy