Mind the gap: AEDP interventions translating attachment theory into clinical practice.

There has been a gap between the prolific attachment theory and research literature and a relative paucity of guidance about how to apply attachment theory to clinical practice. AEDP (Accelerated Experiential-Dynamic Psychotherapy) explicitly fills this theory/practice gap. This article will explore three aspects of clinical practice that foster secure attachment bonds, and will also address what kind of therapist an attachment therapist is. It will outline the importance of nonverbal communication; it will start to catalogue what I call experiential language: specific words and interventions that are evocative of experience and emotion. Finally it will assert that self-disclosure is an essential attachment-creating intervention, and it will explain the importance of metaprocessing and Metatherapeutic processing to titrate therapeutic interactions moment-to-moment in session and to promote metacognitional thinking as well. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attachment disorganization and the controlling strategies: An illustration of the contributions of attachment theory to developmental psychopathology and to psychotherapy integration.

Attachment theory may be instrumental in providing a framework for psychotherapy integration, but to cope with the complexities of clinical realities it should be considered within an overall evolutionary approach to the basis of human interpersonal behavior and also in the perspective of developmental psychopathology. To illustrate these premises with materials that can be of immediate interest to practicing psychotherapists, this article focuses on the example of the clinical applications of research findings on attachment disorganization and its developmental sequels. The controlling strategies that usually follow in the preschool years infant disorganized attachment illustrate the relevance of considering the dialectics and the dynamic tensions between attachment motives and other evolved motives such as caregiving and dominance–submission. The role played by the disorganized-controlling strategies in psychopathological developments and in the relational dilemmas that often characterize the psychotherapy of difficult patients is discussed and exemplified through two clinical vignettes. It is argued that the model based on attachment disorganization and controlling strategies relies on concepts that are understandable and potentially acceptable to psychotherapists of different orientations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attachment theory and research and the psychoanalytic process.

Attachment theory, along with relevant research, is reviewed in terms of its usefulness as a developmental theory for conceptualizing aspects of the psychoanalytic process. Because of its emphasis on the development of relationships through the process of dyadic interaction, attachment theory offers an alternative conceptualization for understanding the relationship aspects of the clinical psychoanalytic process. Manifestations of early attachment behavior can be understood as being recreated in the course of psychoanalysis and can contribute to a developmental understanding of the process. Because many psychiatric problems can be attributed to difficulties in the development of an attachment relationship, it is also possible that attachment theory may be helpful in providing further understanding of the etiology of deviations in development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment theory and psychotherapy integration: An introduction and review of the literature.

As an introduction to the special issue on attachment theory as a foundation for psychotherapy integration, this article will review the uses to which the theory has been employed by integrative theorists and clinicians during the past four decades. Reasons that this theory has been so influentially within psychotherapy integration are discussed, as are some of the models that are explicitly based on attachment theory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of adult attachment styles in psychopathology and psychotherapy outcomes.

Attachment theory provides a model for understanding how the attachment styles formed in infancy systematically affect subsequent psychological functioning across the life span. Attachment styles provide the cognitive schemas, or working models, through which individuals perceive and relate to their worlds. In turn, these schemas predispose the development of psychopathologies and influence outcomes when people undergo psychotherapy. After reviewing recent empirical findings, the authors conclude that an understanding of attachment theory facilitates the conceptualization of clients' problems and the selection of appropriate interventions. Accordingly, attachment styles should be assessed as a standard part of treatment planning. Furthermore, the authors propose that attachment styles should be assessed as individual difference variables in psychotherapy outcome research because adult attachment styles dictate how people perceive and respond to their environments and, therefore, how clients respond differentially to various treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of adult attachment theory to group member transference and the group therapy process.

Although clinical researchers have applied attachment theory to client conceptualization and treatment in individual therapy, few researchers have applied this theory to group therapy. The purpose of this article is to begin to apply theory and research on adult dyadic and group attachment styles to our understanding of group dynamics and processes in adult therapy groups. In particular, we set forth theoretical propositions on how group members’ attachment styles affect relationships within the group. Specifically, this article offers some predictions on how identifying group member dyadic and group attachment styles could help leaders predict member transference within the therapy group. Implications of group member attachment for the selection and composition of a group and the different group stages are discussed. Recommendations for group clinicians and researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing violence and prejudice in a Jamaican all age school using attachment and mentalization theory.

A study is reported of a psychoanalytic intervention in a very violent and prejudiced Jamaican school with disenfranchised children 7–9 grades who had failed academic streaming examinations. Over the period of 3 years of the intervention using mentalization and power issues approaches grounded in attachment theory, children were assisted to feel connected and valued by their school. There were striking improvements in academic performance, decreased victimization, and increased helpfulness especially in boys including significant trickle down effects to grades 1–6. Overall, the school became a place teachers wanted to join and the Jamaican government recognized their success and built a new school for them in a better location. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Working alliance as a mediator of client attachment dimensions and psychotherapy outcome.

Studies that employ multidimensional attachment measures to explore the impact of attachment style on psychotherapy process and outcome are virtually absent in the literature. Further, the role of the working (therapeutic) alliance as a mediator of the influence of attachment on treatment outcome has not been formally investigated. In order to address these gaps in the research, archival data from 66 psychotherapy clients treated at a university graduate program training clinic were used to examine the influence of three adult attachment dimensions (Comfort with Closeness, Comfort Depending on Others, and Rejection Anxiety) on the therapeutic alliance and outcome, as well as to assess whether the alliance mediates the relationship between attachment and therapy outcome. Both Comfort with Closeness and Comfort Depending on Others were significantly related to alliance and outcome, whereas Rejection Anxiety was not significantly related to either variable. Alliance was a significant partial mediator of the effect of Comfort with Closeness on outcome. The results suggest that multidimensional measures of attachment capture important influences on alliance and psychotherapy and that Comfort with Closeness promotes successful outcome by virtue of its influence on alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reunion process: A new focus in short-term dynamic psychotherapy.

Short-term dynamic psychotherapy (STDP) has established itself as an effective treatment for common psychological disorders, but little attention has been given to cases of treatment failure or relapse. In this article, I present a case of relapsing panic disorder. I suggest that STDP has focused mainly on the memories of disturbing past experience, but we have not systematically explored the positive memories of early attachment experiences. The negative memories are explored and processed until they are revised, resulting in less disturbing versions of the original events and new meanings for the patient. In the language of memory research, the patient has now established more than one memory trace of a particular situation, and the therapist hopes that the newer version will have "trace dominance"; that is, it will be the memory that governs the patient's behavior. In a new model called the reunion process, the therapist helps the patient reactivate and strengthen these distress associated with negative memories and experiences. positive memories to revise the internal working models of early attachment figures. The process also involves the use of imagined attachment scenarios that never actually happened to compensate for gaps in historical experience. The result is a sense of reunion with the patient's parents, and the internalization of an affect-regulating process to calm the distress associated with negative memories and experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revising memories and forming new connections: A comment on "The reunion process: A new focus in short-term dynamic psychotherapy."

It is both exciting and an honor to have the opportunity to comment on interesting articles in our field. And interesting this one is! It brings together multiple sources of information and ideas to create a revisioning of the therapeutic approach in a way that is stimulating and intriguing. Dr. Sandler (see record 2007-09422-001)presents what he terms a "reunion process," in which he proposes connecting with positive attachment experiences as a way to intervene with patients who, despite "having done the necessary work on the painful memories of attachment failures" face relapse and return of symptoms. His explanations of the process of connecting with positive attachments raise challenging questions about roles and functions of memory, therapeutic techniques and processes, and our explanations for how and why psychotherapy works. In this brief comment, I offer reactions and questions that I hope will be part of the continuing dialogue about this fascinating process we call psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of attachment theory and research for the assessment and treatment of eating disorders.

In this paper, we review the research literature on attachment and eating disorders and suggest a framework for assessing and treating attachment functioning in patients with an eating disorder. Treatment outcomes for individuals with eating disorders tend to be moderate. Those with attachment-associated insecurities are likely to be the least to benefit from current symptom-focused therapies. We describe the common attachment categories (secure, avoidant, anxious), and then describe domains of attachment functioning within each category: affect regulation, interpersonal style, coherence of mind, and reflective functioning. We also note the impact of disorganized mental states related to loss or trauma. Assessing these domains of attachment functioning can guide focused interventions in the psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case formulation, and group psychotherapy of eating disorders that are informed by attachment theory. Tailoring treatments to improve attachment functioning for patients with an eating disorder will likely result in better outcomes for those suffering from these particularly burdensome disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Of the self, by the self, and for the self: An intra-relational perspective on intra-psychic attunement and psychological change.

This article explores the concept of self-relatedness, integrating ideas drawn from attachment theory, developmental studies, object relations, and interpersonal neurobiology with a multiplicity model of self. I suggest that because self-regulation begins as a dyadic interpersonal process between child and attachment figure, the mind renders such regulatory abilities across the life span via an analogous, intra-relational dyad. This “internal attachment system,” comprising states representing our subjective experience and states reflecting on and appraising that experience coordinates its activity in ways that best regulate the individual's affects, thoughts, perceptions, and behavior. Chronic trauma and neglect create patterns of intrapsychic relatedness that compromise connection, receptivity, adaptive engagement, and harmony among elements of the self system, thereby disrupting the mind's development toward greater coherence and complexity (Siegel, 2007). This article will also discuss the clinical application of intra-relational principles with pervasively maltreated people using a method called Intra-relational (I-R) Accelerated Experiential Dynamic Psychotherapy (Lamagna & Gleiser, 2007). Applying Accelerated Experiential Dynamic Psychotherapy's use of dyadic affect regulation, the tracking of emergent somatic experience, and the processing positive effects associated with transformation to inner work with various internal parts of the self, I-R seeks to foster attunement and receptivity among previously dissociated parts of the individual. Creating intrapsychic safety provides an opening through which defensively excluded memories and associated emotions, thoughts, and impulses can be processed and integrated and increasingly coherent and complex forms of self-organization can be achieved. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy.

This study utilized a theory-specific measure to examine client relational change over the course of time-limited dynamic psychotherapy in 84 Ss (aged 26–64 yrs). Specifically, this study examined change and stability in clients' attachment style. Categorical and dimensional ratings attachment styles were obtained. Pretreatment and posttreatment measures of attachment styles were then examined in association with Global Assessment Scale (GAS) scores and symptoms. Results show that at posttreatment, a significant number of clients were evaluated as having changed from an insecure to a secure attachment style. Additionally, the sample as a whole demonstrated significant changes toward increased secure attachment. Significant relationships were also found among changes in attachment style, GAS scores, and symptom levels. Implications for psychodynamic/interpersonal psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The developmental roots of narrative expression in therapy: Contributions from attachment theory and research.

A central element in many forms of psychotherapy is the narrative articulation of client experience. From both theory, training, and practice, clinicians learn that structural aspects of client narratives may reveal important information about the client, but there is still limited research-based knowledge on this topic. This article explores and discusses the relevance of attachment theory and research to understanding structural and stylistic aspects of client narration in adult psychotherapy. Research into patterns of narrative expression identified by the Adult Attachment Interview (AAI) suggests that the emotional tone and structural organization of narratives are related to patterns of information processing and affect regulation originating in experiences in attachment relationships. Attachment research thus holds the potential of linking client in-session narration to findings in developmental psychology. Clinical implications of the AAI-related research are discussed in terms of the therapeutic significance of narrative coherence and the possible meaning of different kinds of narrative incoherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma and dismissing (avoidant) attachment: Intervention strategies in individual psychotherapy.

Intrafamilial trauma is known to be associated with mental health-related challenges that place the individual at risk for the development of psychopathology. Yet, those trauma patients who are primarily dismissing (avoidant) of attachment also demonstrate significant defensiveness, along with a tendency to view themselves as independent, strong, and self-sufficient. Paradoxically, such patients present as highly help rejecting, despite concurrent expressions of need for treatment and high levels of symptomatic distress. Consequently, working with such individuals in psychotherapy can present a number of challenges. Prior theory and research has suggested that therapeutic change may be facilitated through direct activation of the attachment system and challenging defensive avoidance. Treatment strategies for working with this population are presented along with illustrative case examples. Such strategies include addressing the “I'm-no-victim” identity, using symptoms as motivators, noticing and using ambivalence, and, finally, asking activating questions around themes of caregiving and protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment and history of psychotherapy in a normative sample.

The willingness to trust and self-disclose to others, key aspects in the decision to seek psychotherapy, is expected to vary across attachment classifications. The current study examined the association between internal working models of attachment and history of psychotherapy in a middle-class sample of 120 women, who were administered the Adult Attachment Interview (C. George, N. Kaplan, & M. Main, 1985/1996) and the Mental Health Survey (S. A. Riggs & D. Jacobvitz, 2002). Findings supported predictions that security of attachment is linked to history of psychotherapy. Specifically, adults classified as Dismissing were less likely than other adults to report a history of psychotherapy, whereas Secure adults reported the highest rates of couples therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment at (not to) work: Applying attachment theory to explain individual behavior in organizations.

In this article, we report the results of 2 studies that were conducted to investigate whether adult attachment theory explains employee behavior at work. In the first study, we examined the structure of a measure of adult attachment and its relations with measures of trait affectivity and the Big Five. In the second study, we examined the relations between dimensions of attachment and emotion regulation behaviors, turnover intentions, and supervisory reports of counterproductive work behavior and organizational citizenship behavior. Results showed that anxiety and avoidance represent 2 higher order dimensions of attachment that predicted these criteria (except for counterproductive work behavior) after controlling for individual difference variables and organizational commitment. The implications of these results for the study of attachment at work are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment style as a predictor of behavior in group counseling with preadolescents.

This study investigated the role that attachment style plays in preadolescent behavior in group counseling. The study population consisted of 77 preadolescents referred to counseling services in their schools in Israel. They were treated in 11 small counseling groups led by novice counselors. Variables included self-disclosure, client behavior in therapy, and responsiveness to other group members--all assessed based on transcribed sessions. Participants also completed attachment questionnaires. The analyses were performed with hierarchical modeling (mixed) nesting individuals within groups. Results indicated differences on all dependent variables among the three attachment styles: secure, preoccupied, and avoidant. Secure adolescents showed the highest rates of self-disclosure, productive client behavior, and responsiveness to others, whereas avoidant participants showed the lowest scores on all measures. Gender, age, and group size showed little effect. The discussion focuses on implications for group therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)