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Talia A, Taubner S, Miller-Bottome M, Muurholm SD, Winther A, Frandsen FW, Harpøth T, Onofri A, Kongerslev MT, Simonsen S, Poulsen S, Duschinsky R. The in-session discourse of unresolved/disorganized psychotherapy patients: An exploratory study of an attachment classification. Front Psychol 2022; 13:985685. [PMID: 36275246 PMCID: PMC9581270 DOI: 10.3389/fpsyg.2022.985685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
The Unresolved/disorganized (U/d) attachment classification has generated considerable interest among clinicians. This is in part based on its empirical associations with adult mental health, parenting practices, and treatment outcomes. Despite decades of theorizing, however, we have little empirical information regarding how patients with a U/d classification assigned by accredited coders actually behave or speak in psychotherapy sessions. Here, we take a step towards bridging this gap by reporting our observations of the psychotherapy session transcripts of 40 outpatients who were independently classified as U/d on the Adult Attachment Interview (AAI), the gold standard measure of adult attachment research. These patients were extracted from a larger sample of 181 and compared to others without a U/d classification. In this paper, we discuss two different discourse styles associated with a U/d classification. Some U/d patients did not seem to sufficiently elicit the therapist’s endorsement of what they said. For example, they did not justify their claims with examples or explanations, or did not consider others’ intentions or experiences. Other U/d patients were credible, but left the listener uncertain as to the underlying point of their discourse, for example, by glaringly omitting the consequences of their experiences, or interrupting their narratives mid-way. In the discussion, we place these observations in the context of recent thinking on attachment and epistemic trust, and discuss how this study may form the basis for future quantitative studies of psychotherapy.
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Affiliation(s)
- Alessandro Talia
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Alessandro Talia,
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg,
Germany
| | | | | | - Anna Winther
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Tine Harpøth
- Department of Psychiatry Mental Health Services East, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Antonio Onofri
- School of Specialization in Psychotherapy Training School of Rome and Jesi, Rome, Italy
| | - Mickey T. Kongerslev
- Department of Psychiatry Mental Health Services East, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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