Conference Agenda

Child abuse and neglect within the caregiver–child relationship can have profound and enduring effects on children’s emotional and behavioral development and relational functioning. Many of these children and adolescents struggle with attachment difficulties, emotion regulation problems, behavioral challenges, and post-traumatic stress symptoms. For children and adolescents who experience severe consequences of abuse and neglect, standard evidence-based trauma treatments may be insufficiently effective. Severe dysregulation or avoidance during assessment or treatment can interfere with engagement, thereby compromising the initiation and continuation of trauma-focused interventions. The Integrative Attachment Trauma Protocol for Children (IATP-C) is the Dutch adaptation of an evidence-informed American treatment model developed for children aged 6–16 with who experience profound consequences of abuse and/or neglect. The Dutch name of the treatment is "Integratieve Gehechtheidsbevorderende Traumabehandeling Kinderen" (IGT-K). Following a structured diagnostic phase, IATP-C comprises three phases delivered over approximately one year. IATP-C is a family-based intervention that integrates trauma- and attachment-informed parenting (Phase 1), enhancement of attachment and emotion regulation (Phase 2), and trauma processing using EMDR (Phase 3). The primary treatment objectives are to strengthen the caregiver–child attachment relationship, improve children’s emotion regulation, and reduce behavioral problems and post-traumatic stress symptoms. In this talk, we will outline the IATP-C treatment model and illustrate some key intervention techniques, including attachment-promoting techniques (A-RDI) and self-regulation-promoting techniques (S-RDI). We will also present the results from the first multiple-case single-case experimental design (SCED) study of IATP-C, describe the design of the ongoing Dutch evaluation study and show a case example from this study.

Reflective Function (RF) represents a central milestone in the study of mental functioning and is considered to play a key role in the development of mental disorders such as psychosis.
The gold-standard instrument for assessing RF remains the Adult Attachment Interview (AAI) coded according to the RF Manual. The assessment does not aim to classify early experiences but rather to evaluate the mental states associated with those experiences as they are evoked during the interview. In other words, it measures the individual’s metacognitive capacity-the ability to reflect on and interpret their early attachment experiences.
However, the AAI and other narrative-based assessment tools are highly complex, time-consuming, and require extensive training, which limits their applicability in public mental health services. It has also been suggested that these methods may not be suitable for individuals currently experiencing acute positive psychotic symptoms.
To address these limitations, several self-report questionnaires have been developed in recent years to make RF assessment more accessible and efficient. Nevertheless, these instruments do not capture all dimensions of RF; in fact, some may measure constructs such as impulsivity or emotional lability rather than RF itself.
In light of this, the authors have developed a new narrative instrument designed to assess RF in young patients experiencing a first episode of psychosis and attending a specialized mental health service.
The Interview on the Intersubjective Experience of Being Listened To (EISE, from its Catalan acronym) is a semi-structured interview derived from the Feeling Heard Scale (FHS) and theoretically grounded in Colwyn Trevarthen’s theory of intersubjectivity. It explores the crucial, yet insufficiently researched, concept of “being heard” during a life stage in which this experience can be particularly transformative. The interviews are video-recorded, transcribed, and coded according to the Reflective Functioning Manual through a process specifically adapted to ensure feasibility in clinical practice contexts.

Introduction: Studies on etiopathogenesis of BPD highlighted a history of impairments in parenting such as difficulties in mentalization and emotion regulation. Moreover, research in adolescence – a critical developmental period for the emergence of BPD – remains limited particularly regarding the impact of fathers. The present study examines the extent to which maternal and paternal intrapsychic variables, including mentalization (as parental reflective functioning; PRF) and difficulties in emotion regulation (ER), as well as parenting behaviors (PBs), contribute to adolescents’ BPD features.
Method: Community-recruited adolescents (N = 146; M_age = 15.7 yrs, SD = 1.2) completed self-report measures assessing: borderline personality features (Borderline Personality Features Scale–11; Sharp et al., 2014) and perceived PBs (Parental Bonding Instrument; Parker et al., 1979; Invalidating Childhood Environment Scale; Mountford et al., 2007; Parentification Inventory; Hooper et al., 2009). Parents completed the Parental Reflective Functioning Questionnaire (Luyten et al., 2017) and the Difficulties in Emotion Regulation Scale (Kaufman et al., 2016).
Results: Independent hierarchical regression analyses revealed distinct maternal and paternal pathways to adolescents’ BPD features. Fathers’ contribution was primarily linked to intrapsychic factors, with PRF accounting for a significant portion of the variance, whereas mothers’ contribution was related to PBs. Mediation analyses showed that, for fathers, difficulties in ER (impulsivity subscale) were indirectly associated with BPD features through increased invalidation. For mothers, higher PRF (Interest and Curiosity subscale) was indirectly linked to greater BPD features via increased invalidation.
Discussion: These findings indicate distinct contributions for mothers and fathers highlighting the role of paternal PRF and maternal PBs. Furthermore, while paternal difficulties in ER play a role through increased invalidation, for mothers, even a typically protective mentalizing dimension (interest and curiosity) became a risk pathway to greater invalidation and higher BPD features. Overall, these results highlight the importance of both parents in research on adolescent BPD.

Introduction: Individuals with borderline personality disorder (BPD) are characterized by pronounced relational difficulties, particularly with intense, unstable interpersonal relationships. Attachment theory has guided understanding these patterns, and the Adult Attachment Interview (AAI) is considered the gold-standard method for assessing adult attachment. This is due to a combined focus on narrative content and the process and coherence that respondents describe their upbringing. Although considerable empirical work has examined AAI classifications in individuals with BPD, findings across studies remains heterogeneous.

Objective: To quantitatively synthesize the literature and estimate the distribution of AAI classifications among individuals diagnosed with BPD.

Data Sources: Systematic searches were conducted using MEDLINE, Embase, and PsycINFO from 1985, the year the AAI was published, through 2024.

Study Selection: Studies were included if participants were diagnosed with BPD, completed the AAI, and attachment classifications were coded using the Main and Goldwyn system, yielding data for two-way (secure vs. insecure), three-way (secure, dismissing, preoccupied), and/or four-way (including unresolved) classifications.

Data Extraction: Variables extracted included sample size, AAI classification counts, participant age, geographical location, and sex (% female).

Results: Across the included studies, insecure attachment was highly prevalent in individuals with BPD. Two-way classifications indicated 89% of participants were classified as insecure. Three-way classifications revealed comparable rates of dismissing and preoccupied attachment (approximately 45% each). In four-way classifications, unresolved was most prevalent (62%).

Limitations: Many of the studies were conducted in North America or Europe with a greater proportion of female participants, limiting the generalizability beyond these populations.

Conclusions: Across multiple forms of AAI classification, individuals with BPD had high rates of insecure attachment, and a high prevalence of unresolved/disorganized styles when assessed. These findings underscore the relevance of attachment insecurity and unresolved status in BPD and highlight the need to incorporate attachment focused and trauma informed perspectives in interventions.