Exploring the meaning of unresolved loss and trauma in more than 1,000 Adult Attachment Interviews

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

Mary Main's conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

Using the DRS-8 to measure unresolved/disorganized attachment: Associations with states of mind on the adult attachment interview, psychopathology, and offspring social-emotional development

BACKGROUND

Unresolved/disorganized (U/d) attachment states of mind are associated with poor outcomes across numerous domains of functioning. However, the validity of existing self-report instruments measuring this construct remains questionable.

OBJECTIVES

The aim of the current study was to validate the DRS-8, an alternative version of the Disorganized Response Scale (DRS), by assessing its construct validity, internal consistency, and criterion validity with the U/d attachment scales on the Adult Attachment Interview (AAI).

PARTICIPANTS AND SETTING

Date were collected from 222 expectant parents (78 % women) at T1 and from 67 of them at 12 months postpartum (T2).

METHODS

Participants completed the DRS-8 and questionnaires assessing childhood trauma, romantic attachment, and psychological symptoms during pregnancy (T1). Seventy-four of them participated in the AAI at T1. At T2, parents completed a questionnaire assessing their infants' social-emotional development.

RESULTS

The DRS-8 has two highly correlated dimensions, i.e., lapses in the monitoring of reasoning (four items) and discourse (four items). A confirmatory factor analysis supported a bifactor structure of the instrument, showing good fit indices and internal consistency (ω = 0.87). The DRS-8 was significantly correlated with U/d states of mind on the AAI, r(72) = 0.28, p = .016, and demonstrated excellent construct validity. Significant indirect effects of the DRS-8 were found in the associations between childhood trauma and psychological symptoms, and between parental trauma and infant social-emotional development.

CONCLUSIONS

The DRS-8 appears to be a promising self-report measure of U/d states of mind showing criterion validity with the AAI.

The in-session discourse of unresolved/disorganized psychotherapy patients: An exploratory study of an attachment classification

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.