[World’s First] Visualizing the "Interpersonal Prediction Model" of Attachment Disorder: Research Published in an International Medical Journal

>> 日本語で読む (Read in Japanese)

This article is an author's commentary based on the paper published in the international medical journal Cureus in January 2026.

1. The Persistent Mystery of Attachment Theory

John Bowlby, the pioneer of attachment theory, hypothesized that through early interactions with caregivers, we develop an "Internal Working Model" (IWM)—a mental mechanism for predicting and simulating relationships with others.

However, for over 50 years, the IWM remained a "black box." Its definition was ambiguous, and its actual components—what it is truly made of—remained unidentified.

While diagnostic criteria exist for "minor" attachment disorders where caregiver interaction can be observed, no globally unified criteria exist for "adult" attachment disorders. It is presumed that adults face IWM-related issues, but because the model is invisible, it defies clinical diagnosis. Without diagnosis, standardized treatment remains elusive.

Those suffering from adult attachment issues are often left stranded, wondering: "I don't even know what to do..."

My paper, published in Cureus (part of the Springer Nature Group), titled “Visualization of Internal Working Models Through Transactional Analysis (TA) Developmental Collage Therapy: A Case Report,” successfully identifies and visualizes the components of this long-mysterious IWM.

Building on my doctoral research, this study structurally integrates Transactional Analysis (TA) and Attachment Theory. By identifying IWM components as "Ego States" within TA, we have taken a significant first step toward clarifying the therapeutic mechanisms for adult attachment disorder.

2. The Core Discovery: Reconstructing the Damaged "Structure" Beyond Words

The key to resolving attachment issues lies in the "pre-verbal" stage—before we acquire language. Deep-seated non-verbal memories are often beyond the reach of conventional talk therapy (verbal approaches).

Furthermore, attachment bonds, even if once stable, can be re-injured and become unstable due to later experiences. The case of "Ms. F" in this study serves as evidence. A once-established foundation can be distorted by adverse experiences such as severe betrayal or loss, manifesting as an indescribable "living difficulty" (attachment insufficiency) in adulthood.

TA Developmental Collage Therapy repairs this "damaged structure" through two steps:

Bridging the non-verbal to the verbal is the only path to fundamentally rewriting a distorted structure, whether the issues stem from the pre-verbal period or later trauma. This aligns with the natural trajectory of human cognitive development.

3. The Challenge: An "Interdisciplinary" Journey Beyond Specialized Silos

Finding a venue to present this research took many years. My method is highly unique, crossing multiple boundaries: Clinical Psychology, Medicine, and Art Therapy.

Furthermore, it attempts a structural integration of two fields—Attachment Theory and Transactional Analysis—that were previously considered entirely separate frameworks.

In Japan, academic societies are highly specialized and fragmented. I struggled to find a place that would accept such broad, integrative research. After 26 years of clinical practice, this journey has finally culminated in an international open-access medical journal.

When fields are divided, one must find a "common language." For me, that was scientific verification through objective data. While experts debated within their silos, I worked alongside my clients to accumulate "facts of recovery" that no domain could deny. This publication is based on the simple principle: "Proof over theory."

4. The Verification Process: Choosing the Door of "Medicine"

To elevate my hypothesis to "objective evidence," I chose to knock on the door of Medicine, which maintains more rigorous review standards than many psychology journals.

As an independent clinician—not a medical doctor and not affiliated with a university hospital—passing the peer review of an international medical journal as a single author is a powerful testament. it proves that the Nakano Method transcends personal experience and is a "scientifically valid therapeutic approach."

My encounter with Cureus was decisive. The journal champions the "Democratization of Medical Knowledge," valuing clinical insights regardless of traditional academic frameworks. I wish to express my deepest gratitude to the editors and reviewers of Cureus for recognizing the value of my interdisciplinary approach and providing this platform.

5. Conclusion: To "My Past Self" in the Dark, and to You

This first paper (Case Report) is merely the "basic design" (what to measure and how to fix it).

In truth, I was once one of those who suffered deeply from attachment issues. Carrying an IWM distorted by pre-verbal terror and later adversity, I walked through an endless darkness for years, asking: "Why is my life so difficult?" The Nakano Method was originally born from my desperate search to save myself.

Since then, as an independent therapist, I have supported over 3,500 individuals in overcoming their struggles. The 26-year trajectory I painstakingly built has finally been illuminated by the light of science.

This successful visualization is only the beginning. I am currently preparing "Paper 2," using data from 31 cases to statistically clarify the mechanism by which the mind's structure is dramatically rewritten.

To those standing still, not knowing what to do—and to you, who are in the same darkness I once inhabited:

I promise to continue building scientific evidence and illuminating a clear "pathway to recovery." My journey continues from here, together with you...

Thank you for reading until the end.

Read the Full Peer-Reviewed Paper

For those who wish to delve deeper into the clinical data and the complete methodology of this study, the full paper is available on Cureus.

Access the Full Article on Cureus

Related Reading: If you would like to learn more about the theoretical foundation of this research, I encourage you to read: [The Laws of Attachment: The "Mental OS" that Governs Human Relationships]

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