The Affective Origin and Treatment of Recurrent Maladaptive Patterns

Recurrent maladaptive patterns (RMPs) have been a foundational concept in psychodynamic therapy (PDT) and psychoanalysis for over a century. Typically associated with character pathology (i.e., personality disorders), they highlight the remarkable correspondences frequently observed between relationship patterns in a person’s family of origin, their current adult relationships, and the transference relationship with the therapist. These patterns can be understood as an expression of schemas and therefore share a common conceptual foundation with other major psychotherapy modalities. Yet, the centrality of affect in the origin/development of these maladaptive patterns and their treatment may not be widely appreciated among practitioners of PDT or any other modality. The basic thesis of this chapter is that RMPs as described in the PDT literature could potentially become more widely recognized, understood, and treated in an integrated manner if their developmental and affective origin were more generally appreciated. Doing so would not only improve interpersonal functioning but could also alter the affective dysfunction that predisposes to the development of symptoms that are a common reason for seeking treatment. Consistent with newer developments in psychodynamic theory grounded in observations from early childhood development, this chapter briefly reconsiders the fundamental elements of RMPs, including unconscious processes, development, conflict, defenses, and mechanisms of change from the perspective of affective science and computational neuroscience. In so doing, the goals are to broaden appreciation of the importance and ubiquity of RMPs by explaining them in nonclinical language, to increase the likelihood of enduring change by promoting an integrative approach to their treatment focusing on new emotional experiences in meaningful contexts and to facilitate research that can potentially establish the benefits of such an approach.