ABSTRACT
There are very few less contentious issues than the role of attachment in psychotherapy. Concepts such as the therapeutic alliance speak directly to the importance of activating the attachment system, normally in relation to the therapist in individual therapy and in relation to other family members in family-based intervention, if therapeutic progress is to be made. Borderline personality disorder (BPD) is a complex and serious mental disorder that is characterized by a pervasive pattern of difficulties with emotion regulation, impulse control, and instability both in relationships and in self-image, with a mortality rate, associated with suicide, that is fifty times that of the general population. Discussing the therapeutic action of psychotherapy with BPD patients assumes that psychotherapy is indeed therapeutic. Whatever the immediate cause of the decoupling, its consequence is the re-emergence of modes of thinking about internal states that antedate the fully fledged mentalizing capacity of the adult.
