Insecure attachment states: their relationship to borderline and narcissistic personality disorders and treatment process in cognitive analytic therapy

Abstract

Currently little distinction is made in Cognitive Analytic Therapy (CAT) between groups of patients in terms of variations in therapeutic processes that they may require. Attachment theory and research may prove useful here. The Adult Attachment Interview (AAI) and its rating systems can be used to assess whether CAT patients are more preoccupied with, or dismissing of, affect in their ‘core states’. It is suggested that ‘narcissistic’ patients need to access unexpressed ‘core pain’ to a greater degree than do more ‘borderline’ patients, who need to understand how and why they move between dissociated ‘core states’. AAI research (a) supports Ryle's new model of borderline personality disorder, and (b) suggests that narcissistic problems may be understood in terms of defences against attachment. As attachment theory and the AAI become more widely known and used, the concepts of dismissing and preoccupied insecure attachment states may prove to be more meaningful than those concepts of personality disorders currently employed. Copyright © 2000 John Wiley & Sons, Ltd.