Academic journal article American Journal of Psychotherapy

Prediction of Attachment Status from Observation of a Clinical Intensive Psychotherapy Interview

Academic journal article American Journal of Psychotherapy

Prediction of Attachment Status from Observation of a Clinical Intensive Psychotherapy Interview

Article excerpt

Objective: The present study addresses whether it is possible to accurately determine a subject's Adult Attachment Interview (AAI) classification by observing a video-recorded clinical psychotherapy discussion that uses the principles of Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Method: A random sample of eight of the author's (Robert J. Nebrosky) private practice patients particpated in an AAI administered by an experienced interviewer. The authors were blind to the results of the AAI, which were scored and classified by Erik Hesse, PHD (consultant and expert in AAI coding and classification). The authors used the Adult Attachment Clinical Rating Scale (AA-CRS), which is an adapted version of the AAI "states-of-mind scales," in conjunction with the structured ISTDP interview to obtain main classifications and subclassifications. The authors determined the pathway of unconscious anxiety according to the procedures described by Davanloo (1995, 2001) and ten Have-de Labije (2006), beginning with the structured ISTDP interview, then categorized the patient's defenses and quality of the patient's observing and attentive ego, discussed the clinican's knowledge of the patient's attachment history, and from this data drew first the major gateway of attachment using the AA-CRS. Then the authors categorized the subclassifications using the AA-CRS.

Results: The authors predicted seven out of eight AAI main classifications correctly, and five out of eight AAI subclassifications correctly, indicating that there was a statistically significant relationship between predicted and expected values for main classifications and subclassifications.

Conclusions: The authors conclude that the systematic ISTDP inquiry at the level of the stimulus (current, past, and therapeutic relationship) and response (defence, anxiety, and impulse/feeling) and combined with the clinician's knowledge of the patient's clinical history can effectively substitute for the AAI interview and therefore, yield an experiential reference from which to explore the patient's state of mind using the Adult Attachment Clinical Rating Scale (AA-CRS). The authors speculate that the differences in subclassification could be accounted for by variations and/or differences in biographical knowledge obtained by the the clinician versus that of the AAI coder (Hesse).

KEYWORDS: Adult Attachment Interview; Intensive Short-Term Dynamic Psychotherapy


The Adult Attachment Interview ([AAI] George, Kaplan, & Main, 1984, 1985, 1996) and associated coding scales and classification systems (Main, Goldwyn, & Hesse, 2003) are widely regarded to be reliable standards for assessing attachment classification in adults (Cortina & Marrone, 2003; Hesse, 2008; Mikulincer & Shaver, 2007; Rholes & Simpson, 2004; Siegel & Solomon, 2003; Steele, Steele, & Murphy, 2009; Steele & Steele, 2008). While recent research studies have used the AAI with diverse clinical populations (for a review, see Steele & Steele, 2008), there have been no research studies that directly examine the relationship between AAI classifications and predictions of AAI classifications using a clinical psychotherapy interview. The present study addresses whether AAI classification can be predicted by observing a videotaped Intensive Short-Term Dynamic Psychotherapy (ISTDP) interview using the general principles of the AAI scoring and classification systems together with an adapted version of the AAI "states-of-mind" scales, and the principles of ISTDP assessment.

In a recent book, Mary Main, Erik Hesse, and Ruth Goldwyn (2008) offer an introduction to the AAI and explain that two fundamental points of emphasis (described originally by John Bowlby) must be taken into account with the AAI system of analysis: The first point is that as much as it is possible to do so, the therapist must consider actual experiences that occur in an individual's life when looking into the origin of his or her emotional conflict. …

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