AAI predicts patients’ in-session interpersonal behavior and discourse: a “move to the level of the relation” for attachment-informed psychotherapy research

Abstract

There is currently little empirical evidence regarding how patients’ attachment patterns manifest in individual psychotherapy. This study compared the in-session discourse of patients classified secure, dismissing, and preoccupied on the Adult Attachment Interview (AAI). Rather than focusing on content or form alone, this study analyzed how patients’ discourse elicits and maintains emotional proximity with the therapist. The AAI was administered to 56 patients prior to treatment and one session for each patient was rated with the Patient Attachment Coding System (PACS) by four independent raters, blind to patients’ AAI classification. Significant differences were found in the discourse of patients with different attachment patterns. Namely, secure and preoccupied patients showed more contact-seeking behavior than dismissing patients, who avoided emotional proximity more, while preoccupied patients resisted therapists’ help more than did secure and dismissing patients. These results suggest that the different attachment patterns may have distinctive manifestations in the psychotherapy process that can be tracked by external observers.

Keywords:

• attachment
• psychotherapy
• AAI
• adult attachment
• clients’ variables
• psychotherapy research

Acknowledgements

We would like to warmly thank Daniela Di Riso and Adriana Lis for their generous help in collecting the data for this study. The first author also thanks the dedicated Faculty of the Research Training Program in psychoanalysis (IPA) for their encouragement and inspiration. A special thanks to Francesco De Bei for his initial supervision of this work.

Notes

^1. The Proximity Seeking scale assesses the baby’s direct or indirect efforts to gain contact or proximity to a person, and the Contact Maintaining scale accounts for the baby’s efforts to maintain contact with the adult once he has gained it. The Avoidance scale rates the baby’s avoidance of proximity and interaction, and the Resistance scale the baby’s aggressive behaviors toward a person or resistance to being held. We disregarded the Distance Interaction scale because it is mainly used in the classification of the B1 sub-category.

^2. We considered that a distinction between Proximity Seeking and Contact Maintaining was not as easy to make in language as it is in the interactions observed in the Strange Situation, and collapsed these two scales into one, which we termed Contact Seeking.

^3. Julia Belotserkovsky trained in 2009 by Mary Main and Erik Hesse; Daniela Brambilla trained in 2011 by Nino Dazzi and Deborah Jacobvitz; and Miriam Steele.

^4. The first author was trained in 2011 by Nino Dazzi and Deborah Jacobvitz.

^5. Daphne Chessa and Giorgia Rondanini trained in 2009 and 2008, respectively, by Nino Dazzi and Deborah Jacobvitz.

^6. The criteria for rating the PACS scales are too extensive to be provided here comprehensively; however, details concerning this procedure are available from the corresponding author upon request.