Clinical use of the adult attachment interview in parent–infant psychotherapy

Abstract

This article provides an illustration of how the use of the Adult Attachment Interview (AAI; George, can be extended beyond the research arena to its use as a clinical instrument in parent-infant psychotherapy. The article is based on the ongoing work of the Parent-Infant Project team at the Anna Freud Centre, London, where psychoanalytically trained therapists routinely administer the AAI early in the therapeutic process. In the first part of the article, we introduce the thinking behind the use of the AAI as a clinical tool and its particular relevance to the field of parent-infant psychotherapy. In the second part, we track the accruing clinical picture built up from a case example of the initial clinical sessions with a father who attended the Parent-Infant Project with his partner and two young children, and from the father's AAI. The discussion of the AAI material illustrates the distinct, yet related, interpretations of the parent-infant psychotherapist and the independent AAI coder as each made sense of the father's interview transcript. The resulting dialogue, between the psychodynamicclinical and the attachment-research based approaches to the AAI, aims to highlight the added value the interview provides to the clinical understanding and process in parent-infant psychotherapy, which may ultimately help bridge the gap between the research and clinical domains.RESUMEN: Este ensayo aporta una ilustración de cómo el uso de la Entrevista de la Afectividad Adulta (AAI) puede ser extendido más allá del campo de la investigación para ser utilizado como un instrumento clínico en la sicoterapia entre padre e infantes. Este artículo se basa en el trabajo actual del equipo del Proyecto Padres-Infantes en el Centro Anna Freud, donde terapeutas sicoanalíticamente entrenados dan rutinariamente la mencionada entrevista en los primeros momentos del proceso terapéutico. En la primera parte de este artículo, introducimos el pensamiento que apoya el uso de la AAI como una herramienta clínica, así como la particular relevancia que la misma tiene en el campo de la sicoterapia entre padres e infantes. En la segunda parte damos seguimiento a la imagen clínica procedente de la construcción de un caso que sirve como ejemplo de las sesiones clínicas iniciales, con un padre que asistió al Proyecto Padres-Infantes con su pareja y sus dos niños pequeños, y de la Entrevista de la Afectividad Adulta de dicho padre. La discusión del material de la AAI sirve para ilustrar las distintas, aunque relacionadas interpretaciones del sicoterapeuta de padres e infantes y las del codificador independiente de la AAI, tal como cada una trató de buscar el mejor sentido de la transcrita entrevista del padre. El diálogo resultante, entre los acercamientos a la AAI, tanto los sicodinámico-clínicos como los basados en la afectividad y la investigación, busca subrayar el beneficio adicional que la entrevista les provee a la comprensión y proceso clínicos en la sicoterapia entre padres e infantes, el cual pudiera en última instancia ayudar a l...

Trauma, dissociation, and disorganized attachment: Three strands of a single braid.

“…Not infrequently in this clinical sample a switch in ego state signals the narration of a horrifying history of abuse suffered at the hand of an attachment figure that is not accessible to the preceding ego state. Steele and Steele (2003), while reporting the preliminary findings of their study, call attention to an observation that can be confirmed by many clinicians dealing with the traumatic memories of adult survivors of child abuse: "while psychic pain certainly accompanies the recall of the abuse per se, this pales in comparison to the much greater pain that accompanies the recall of being betrayed by trusted caregivers and siblings" (Steele & Steele, 2003, p. 116-117). That is, the memory of an attachment figure who fails to protect the child from the abuse perpetrated by another member of the family may be more painful than the memory of the abuse per se.…”

“…Interestingly, most "cannot classify" interviews are also rated high for unresolved traumas and/or losses (Hesse, 1996;Steele & Steele, 2003). This is a further hint that "cannot classify" interviews may indicate the presence of a type of sub-clinical post-traumatic dissociative process, characterized both by poor metacognitive monitoring and by autobiographical memories that are split as to the meaning attributed to events.…”

“…Interestingly, most "cannot classify" interviews are also rated high for unresolved traumas and/or losses (Hesse, 1996;Steele & Steele, 2003). This is a further hint that "cannot (2003), while reporting the preliminary findings of their study, call attention to an observation that can be confirmed by many clinicians dealing with the traumatic memories of adult survivors of child abuse: "while psychic pain certainly accompanies the recall of the abuse per se, this pales in comparison to the much greater pain that accompanies the recall of being betrayed by trusted caregivers and siblings" (Steele & Steele, 2003, p. 116-117).…”

“…In samples that are at high risk of emotional disorders, in violent families and in clinical samples, the percentage of "unresolved" and "cannot classify" interviews (and the corresponding frequency of disorganized attachment classifications in the infants) rises sharply, from the 15% found in non-clinical samples to over 70% (Lyons-Ruth & Jacobvitz, 1999;. Steele and Steele (2003) reported some preliminary findings of a clinical study of severely dissociative patients involving the AAI that show a very high percentage of "cannot classify" interviews in this clinical population. When used with patients suffering from DID, the AAI regularly elicits multiple narratives, and sometimes multiple narrating voices, in the same individual.…”

Le transfert dans le traitement des personnes présentant un trouble dissociatif de l’identité : une revue de la documentation scientifique et une illustration clinique

“…De plus, des recherches et des théorisations récentes (Barach, 1991 ;Blizard 1997Blizard , 2001Blizard , 2003Carlson, 1998 ;Liotti, 1992Liotti, , 1995Liotti, , 1999Liotti, , 2004Liotti, , 2006Lyons-Ruth, 2003, 2006Ogawa, Sroufe, Weinfeld, Carlson et Egeland, 1997 ;Pasquini, Liotti et The Italian Group for the Study of Dissociation, 2002 ;Steele et Steele, 2003) démontrent que l'attachement désorganisé (AD) jouerait un rôle tout aussi important, sinon plus important, que le trauma dans le développement de la dissociation pathologique et du TDI. L'attachement se forme lors d'interactions où un enfant cherche du réconfort auprès d'une figure affective importante.…”