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The Unresolved/disorganized (U/d) attachment classification has generated considerable interest among clinicians. This is in part based on its empirical associations with adult mental health, parenting practices, and treatment outcomes. Despite decades of theorizing, however, we have little empirical information regarding how patients with a U/d classification assigned by accredited coders actually behave or speak in psychotherapy sessions. Here, we take a step towards bridging this gap by reporting our observations of the psychotherapy session transcripts of 40 outpatients who were independently classified as U/d on the Adult Attachment Interview (AAI), the gold standard measure of adult attachment research. These patients were extracted from a larger sample of 181 and compared to others without a U/d classification. In this paper, we discuss two different discourse styles associated with a U/d classification. Some U/d patients did not seem to sufficiently elicit the therapist's endorsement of what they said. For example, they did not justify their claims with examples or explanations, or did not consider others' intentions or experiences. Other U/d patients were credible, but left the listener uncertain as to the underlying point of their discourse, for example, by glaringly omitting the consequences of their experiences, or interrupting their narratives mid-way. In the discussion, we place these observations in the context of recent thinking on attachment and epistemic trust, and discuss how this study may form the basis for future quantitative studies of psychotherapy.

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Borderline personality disorder (BPD) is a serious mental health condition associated with severe symptoms of distress and poor quality of life (QoL). Research outside the field of BPD suggests that ego-resiliency is negatively associated with psychopathology and positively associated with a range of positive life outcomes. Thus, ego-resiliency may be a valuable construct for furthering our understanding and treatment of BPD. However, the mechanisms linking ego-resiliency to psychopathology and QoL in relation to BPD have not been examined and explored by research. This study has addressed this gap in the collective knowledge by evaluating whether within-person associations between daily reports of positive affect (PA) and negative affect (NA) mediated the relationship between ego-resiliency, BPD symptom severity, and QoL. For 21 consecutive days, 72 women diagnosed with BPD completed end-of-day electronic assessments regarding ego-resiliency, PA and NA, symptom severity, and QoL. Multilevel structural equation modelling established that PA and NA were parallel mediators linking ego-resiliency with BPD symptom severity and QoL. As hypothesized, the path to QoL was stronger through PA than through NA. The mediation paths through NA and PA to BPD symptom severity were both significant, but their strength did not differ. Our findings align with the assertions of theories on emotion, thus suggesting a two-factor approach to PA and NA. Future research can build on these findings by developing psychotherapeutic interventions designed not only to reduce symptom severity but also to enhance PA in individuals with BPD and determine whether an increase in PA is associated with improved QoL.

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Evidence-based treatments for borderline personality disorder (BPD), including mentalization-based treatment (MBT), have not adequately examined changes in positive affect (PA) in the treatment of BPD. Therefore, we developed a new intervention, "mentalizing positive affect," and evaluated its effect on PA, negative affect, BPD severity, ego-resiliency, and quality of life during MBT treatment for BPD. In a single-case multiple-baseline design, 4 female BPD patients received 6 months of individual MBT, after which they were followed up for 2 months. Intensive repeated measurements data were subjected to hierarchical linear modeling to analyze whether the positive intervention was related to changes in self-reported outcome measures. Our results failed to support a co-occurring increase in the reporting of PA related to the "mentalizing positive affect" intervention. However, the slope of PA increased at a quicker rate after the end of treatment, perhaps indicating a delayed treatment effect. "Mentalizing positive affect" was related to a marginally significant decrease in the mean level of BPD severity compared with standard MBT. Moreover, focusing on PA in MBT seemed feasible for maintaining a good working alliance. Our findings call for more research to test interventions aimed at enhancing PA in the treatment of BPD. Such efforts might well involve treatment of longer duration and higher intensity to increase the number of sessions, as well as longer follow-up periods, than we used. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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RESUMEN

In general, research has primarily focused on understanding the psychopathology of borderline personality disorder (BPD), but there has been a paucity of research on processes associated with positive mental health. The present study sought to address this gap in knowledge by investigating associations between daily positive and negative emotions and ego-resiliency and quality of life (QoL) in a clinical sample of 72 women diagnosed with BPD. Using electronic diaries, participants completed end-of-day reports on positive and negative emotions, ego-resiliency, and QoL over a period of 21 days. Multilevel lagged analyses indicated that daily positive emotions were prospectively associated with increased ego-resiliency and QoL the next day, even when adjusting for same-day negative emotions and general psychopathology severity. In addition, the association of daily positive emotions was significantly stronger than the association of negative emotions with both next day ego-resiliency and QoL. Based on these results, we suggest extending the future research agenda to focus more on positive processes associated with ego-resiliency and QoL to achieve a more comprehensive understanding of BPD. We discuss the implications of these findings and argue that symptom reduction alone may not be sufficient. Rather, the research into treatments should be broadened to include testing the effect of interventions on positive emotions and their associations with positive mental health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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