Comparing the Effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) and Transference-Focused Psychotherapy (TFP) on Attachment Styles and Guilt in Patients with Borderline Personality Disorder

Abstract

Introduction and Aim: This study aimed to investigate the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) and Transference-Focused Psychotherapy (TFP) on attachment styles and guilt in patients with Borderline Personality Disorder (BPD).

Methodology: The quasi-experimental study employed a pretest-posttest design with a control group and a 3-month follow-up. The study population comprised patients with BPD attending psychiatric and psychological clinics in Tehran, Region 3, during the first three months of 2025. The sample consisted of 45 participants who met the inclusion criteria, selected via purposive sampling and randomly assigned to three groups: ISTDP, TFP, and control. The research instruments included the Hazan and Shaver (1987) Attachment Questionnaire and the guilt measure developed by Kugler and Jones (1992), which were completed by all three groups at pretest, posttest, and 3-month follow-up stages. Data were analyzed using repeated measures multivariate analysis of variance (MANOVA) via SPSS 26.

Findings: Results indicated that TFP significantly altered avoidant and disorganized attachment styles compared to the control group, whereas ISTDP only significantly affected secure attachment (p < 0.05). Both approaches were effective in reducing guilt traits and states; however, only TFP improved moral criteria (p < 0.05).

Conclusion: Findings suggest that TFP, by focusing on mental representations and analysis of the therapeutic relationship, corrects insecure attachment patterns and chronic guilt, whereas ISTDP primarily aids in reducing temporary guilt states and accessing repressed emotions.