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Diamond, D. Clarkin, J.F. Levy, K.N. Levine, H. Foelsch, P. (2002). The Clinical Implications of Current Attachment Research for Interventions with Borderline Patients*. J. Infant Child Adolesc. Psychother., 2(4):121-149.

(2002). Journal of Infant, Child & Adolescent Psychotherapy, 2(4):121-149

The Clinical Implications of Current Attachment Research for Interventions with Borderline Patients*

Diana Diamond, Ph.D., John F. Clarkin, Ph.D., Kenneth N. Levy, Ph.D., Hilary Levine, Ph.D. and Pamela Foelsch, Ph.D.


Over fifteen years ago I heard Mary Main speak at the International Infancy conference in Los Angeles, where she first presented data on the predictable relation between parents' narrative accounts of their early attachment experiences on the AAI, and the attachment behaviors infants display toward that parent in the Ainsworth Strange Situation. She introduced her findings by saying that she believed they fulfilled Socrates's dictum that the unexamined life is not worth living. I knew then that these findings had significant clinical implications, and indeed I have spent the last fifteen years grappling with how to apply them to clinical research and practice, particularly with borderline patients.

Insecure attachment is one of the hallmarks of borderline conditions. The features of borderline attachments, including the unpredictable shifts between clinging and repudiation, intense idealization and scathing devaluation, terrors of abandonment and unilateral rejection of others, have been reconceptualized as sequelae of insecure attachment organization and as failures of reflective function (Fonagy 1991, 1998, 2001, Gunderson 1996, West and Keller 1994). Indeed, several studies of the autobiographical narratives that borderline patients give on an Adult Attachment Interview (AAI; George et al.

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