Crittenden Patricia McKinsey - Assessing adult attachment : a dynamic-maturational approach to discourse analysis

This book is the result of the contribution of more people than can possibly be named. It is the result of reading several thousand individual AAIs, and we are grateful to each of those speakers for sharing important aspects of their lives. It also reflects the contributions of several hundred psychotherapists and researchers who attended AAI courses and who discussed both the AAIs themselves and the discourse methods. As is always the case with ideas, they evolve with dialogue, and, although it is difficult to attribute changes to specific persons, this dialogue, over two decades and in ten countries, has produced the ideas that we have written here.

We are especially grateful to Simon Wilkinson, Gordon Somerville, Steve Farnfield, Simon Howell, Peder Nrbech, Nicola Sahhar, and Sabrina Bowen for reading many of these chapters and giving us feedback that helped us to clarify the writing.

Dyou Know What I Mean?

E VERYONE WANTS TO BE UNDERSTOOD . I NDEED, THESE WORDS PEPPER THE discourse of the least clear speakers as if their best efforts were doomed to failureand they knew it.

In this volume, we offer a way to understand the meanings behind unclear communication. More than that, we offer a theoretical model of distorted communication and dysfunctional behavior. It is a simple, intuitive model that can be understood by troubled adults. It is also a sophisticated and complex model that can guide clinicians to select effective treatments and that can help researchers to test hypotheses about the intricate and interwoven pathways to maladaptation. We combine genetic potentials, history of exposure to danger, mental processing of information about danger, and communication about danger into a functionally coherent model of psychological processes, the Dynamic-Maturational Model of attachment and adaptation (DMM; Crittenden, 1995, 2008).

The DMM addresses normal thinking and behavior with the same principles that are used to describe dysfunctional thinking and behavior. The difference is that exposure to danger increases the probability of dysfunction. In this volume, we describe a wide range of human adaptation in ways that foster understanding of maladaptation. We also recommend an assessment tool to elicit the crucial information about danger and adaptation to danger and a method for extracting information from the assessment. The tool is the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985, 1996). The method is the Dynamic-Maturational Model of discourse analysis for the AAI, as presented in this book.

Our goal is to describe maladaptation in a way that connects the experiences of threatened and threatening people with the skills of mental health professionals so that professionals can reduce distress and maladaptive behavior more successfully. We also seek to guide researchers to fine-grained, theory-based hypotheses that can refine our understanding of developmental processes in a way that multifactorial modeling alone cannot. The key, we think, is understanding. When we understand the meanings that distressed people struggle to communicate, a pathway to safety and comfort will be opened.

Our ideas build on a century of effort to understand and ameliorate psychological suffering. In both DMM theory and our method for analyzing AAIs, we have sought to retain the best ideas from all theories of psychological disorder while reframing and recombining these ideas to reflect the most current developmental and neurocognitive knowledge. The result addresses problems in assessment, diagnosis, and treatment of disorder in a fresh manner.

We chose the AAI as the assessment tool because it lets people tell their stories in their own way, thus preserving their reality. At the same time, the questions elicit crucial information without obscuring it with irrelevancies. We think these two thingsthe speakers own words and pertinent questions, together with a method of discourse analysis that promotes understanding of what speakers meancan be the bridge that connects people who dare not be clear with caring healers who understand with clarity.

THE ROOT OF THE PROBLEM

Defining Psychological Disorder

Psychological disorder has stubbornly resisted understanding and treatment for more than a century. The lack of understanding has led to fragmentation among those clinicians who cling almost religiously to a single theory of treatment (e.g., psychoanalytic, behavioral, cognitive, cognitive-behavioral, cognitive-analytic, interpersonal, family systems). Because each theory describes the problems of suffering individuals differently and none is more effective than the others at easing psychological suffering, we think that none reflects the meaning of suffering well enough. The names of the treatments suggest what is needed: an integration of meaningful ideas, from all the theories, that goes beyond individual pathology to place people in their context of relationships and families. Add to that a focus on danger and the psychological and behavioral effects of exposure to unprotected and uncomforted danger and one has the rudiments of a new and integrative theory of the development and treatment of dysfunction.

Instead, by side-stepping differences in theory, two similar and explicitly nontheoretical systems for diagnosing disorders were developed: the Diagnostic and Statistical Manual of Mental Disorders ( DSM , North America) and International Classifications of Disease (ICD, World Health Organization). This was a major step toward describing behavior accurately. The previous focus on theory biased observation toward theory-based expectations. The focus on describing symptoms turned attention to accurate observation of the behavior of people who suffer. But we lost the meanings that theory had! With good observation, the number of disorders increased, comorbidity increased, and diagnoses of not otherwise specified increased (Angold & Costello, 2009; Goldberg, 2010). It seems we know in detail what troubled people do, but we do not know how to cluster them, how their behavior functions, what it means to them, or its implications for treatment.