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Adult attachment is an increasingly influential paradigm for better understanding how patients think about significant others and how representations of others influence ways of being in the world. As Holmes (1995) has stated, “A key question concerns the pathways by which ‘character’ and, for the clinician, character pathology or neurotic disposition emerge from the interactive matrix of the early years of life” (p. 27). Within this context, we have chosen to focus on the Axis II Cluster B diagnoses. These are the so-called “dramatic” personality disorders—histrionic, narcissistic, antisocial, and borderline. Patients with these types of character traits, particularly those with borderline and severely narcissistic tendencies, are typically some of our most challenging cases. Considering that patients with these sorts of issues often come to treatment because of ongoing problems with relationships and fundamental impairment in coping strategies, it is important to have a better understanding of underlying patterns of relating.
West and Sheldon-Keller (1994) have suggested that adult attachments are found in “dyadic relationships in which proximity to a special and preferred other is sought or maintained to achieve a sense of security” (p. 19). However, they qualify this definition by pointing out that for some people there is a certain expectancy of security that does not necessarily result in finding or establishing a secure relationship. We see time and again that one of the hallmarks of psychiatric impairment is difficulty in establishing social networks that provide adequate support in stressful times.
Masterson (1988), who has worked extensively with character disordered patients, has suggested that the patient who was not afforded the opportunity to develop a stable, positive sense of self in the course of