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Through detailed analysis of case examples, this work seeks to provide valuable insights for clinicians wishing to explore suicidality with their patients in ways that are informed both by existential and attachment-based perspectives. Specific case studies are used to explore and illustrate areas of intersection around the topic of suicidality using Interpersonal Reconstructive Therapy (IRT) theory and Terror Management Theory (TMT) lenses together. Intersecting themes focus on meaning-making, attachment, and how these together inform how patients experiencing chronic suicidal ideation appear to overcome the evolutionary desire to survive. In this view, suicidality can be seen as a maladaptive attempt at adaptation, miscued by learning about perceived safety and threat signals derived from close attachment relationships. Implications for theory, research and practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study tests ways in which the perception of intergenerational continuity in parenting behaviors among child‐maltreatment (CM) and non‐CM families conform to Benjamin's (2006) Copy Process Theory, which considers three copy processes: Identification (be like him/her), Recapitulation (behave as if he/she is still present and in charge), and Introjection (treat myself as he/she treated me). Method: Across two home visits and a laboratory session, 171 mothers of preschoolers (M = 3.7 years) completed the SASB Intrex Questionnaire relative to herself, her history with her parents, and her present relationship with her child. Results: Mothers' retrospective reports of her interactions with caregivers were correlated with the quality of self‐reported parenting processes in interactions with her preschooler. Analyses indicated high rates of intergenerational copying in both samples for each copy process. While copying in general was observed in nearly all mothers (roughly 80%−90%) and emphasized warm, securely attached patterns, the copying of hostility and/or lack of affiliation occurred in copied profiles for about one‐third of mothers. About the more problematic profiles, CM mothers tended to rate themselves as being in the child‐like position they experienced in their own childhood, with themes involving hostile control perceived from their child. By contrast, non‐CM mothers copied disaffiliative themes primarily in relation to themselves. Conclusion: Findings verify that interpersonal patterns and internalized relational histories are important keys for understanding CM risk. The use of a method that offers interpersonal specificity at the level of individual profiles has application to clinical practice with at‐risk parents. [ABSTRACT FROM AUTHOR]

Feature heterogeneity and diagnostic overlap occur regularly among patients in clinical settings. In interpersonal reconstructive therapy (IRT), a case formulation focused on patterns learned in close attachment relationships guides intervention choices. This study illustrates how IRT formulation and treatment proceed, and how it may also fail when there is not close adherence to underlying principles. Don is a music professor in his 40's with a significant trauma history and complex diagnostic profile that includes many hospitalizations and suicide attempts. He qualified for several diagnostic and statistical manual of mental disorders personality disorders via formal diagnostic interviews (obsessive‐compulsive, avoidant, passive‐aggressive, narcissistic), as well as major depression, generalized anxiety, and substance abuse. Don's formulation demonstrates how self‐destruction can function as a "gift of love" to internalized representations of important caregivers. Data from work with patients like Don confirm the usefulness of Benjamin's IRT lens for navigating comorbidity, as well as the importance of underlying principles of change. [ABSTRACT FROM AUTHOR]

In Interpersonal Reconstructive Therapy (IRT: Benjamin, 2003/2006; 2018) a case formulation is used to tailor interventions to each patient's unique patterns. Using the IRT lens, psychopathology is understood as reflecting attempts to adapt to current environments using maladaptive rules and values that were learned and internalized in the context of close attachment relationships. IRT identifies precise ways in which early learning shapes present experience. Additionally, the "gift of love" (GOL) hypothesis posits that motivation to repeat maladaptive ways is linked to the wish to receive love and acceptance from specific internalized attachment figures by repeating their ways and values for the patient. The IRT case formulation has been shown to be reliable and valid (Critchfield, Benjamin, & Levenick, 2015). The therapy adherence measure is also reliable (Critchfield, Davis, Gunn, & Benjamin, 2008) and correlates well with retention as well as reduced symptoms and rehospitalization rates (Karpiak, Critchfield, & Benjamin, 2011) among "difficult to treat" patients characterized as having high levels of personality disorder, chronic and severe problems, and prior failed treatment attempts. To illustrate the case formulation process, an IRT formulation is applied to the case of a 28-yearold female patient for whom a poor outcome was documented. [ABSTRACT FROM AUTHOR]

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including “reactive” counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed. © 2007 Wiley Periodicals, Inc., J Clin Psychol 64: 67–82, 2008. [ABSTRACT FROM AUTHOR]