The "gift of love" as a candidate mechanism of psychopathology and change in interpersonal reconstructive therapy for patients with high-acuity clinical needs.

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A key mechanism of psychopathology and change proposed by the theory of interpersonal reconstructive therapy (IRT; Benjamin, 2003, 2018) is termed the "gift of love" (GOL). The GOL hypothesis is that wishes to receive love and acceptance from specific internalized attachment figures shape and maintain problem patterns and their associated symptoms for many patients across a wide range of psychopathology. According to IRT theory, optimal intervention is defined by therapist alignment, or "adherence," to a core algorithm of principles that are tailored individually and bring awareness to (a) attachment-based yearnings for love and acceptance from internalized figures and (b) how those yearnings shape and motivate current problems and symptoms. The method then seeks to enhance choice about those relationships and their attendant feelings, hopes, and fears. The study sample includes 30 patients, referred while receiving inpatient treatment and followed on an outpatient basis, with complex, high-acuity clinical needs (i.e., histories of multiple psychiatric hospitalizations, recurrent suicidality, ineffectiveness of prior treatment, and significant personality pathology). Reliable measures were developed to track therapist adherence to IRT principles, as well as patient stages of change coming to terms with the GOL. IRT adherence was associated with retention, reduced depression and anxiety, and improved self-treatment. Mediation analyses support the proposition that change in IRT is contingent upon patient progress at grieving the losses and associated wishes linked to attachment figures. Implications for theory-guided research and practice at the level of underlying principles are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).