T he c linic a l ma tc hing : inte r ac tions be twe e n patie - - PowerPoint PPT Presentation

T he c linic a l ma tc hing :

inte r ac tions be twe e n patie nt’s and the r apist’s attac hme nt str ate gie s in a DMM pe r spe c tive .

F ra nc o Ba ldoni, MD, PhD

Attac hme nt Asse ssme nt L ab, De par tme nt of Psyc hology, Unive r sity of Bologna (Italy) fr anc o.baldoni@unibo.it

• De spite me tho do lo g ic a l limita tio ns a nd so me c o nflic ting re sults, re se a rc h

ha s e vide nc e d tha t a tta c hme nt pa tte rns o f the pa tie nt a nd the the ra pist sig nific a ntly influe nc e the the ra pe utic pro c e ss a nd the o utc o me o f the tre a tme nt.

• Me ta -a na lyse s
• Pa tie nt

sa fe ty a nd tre a tme nt e ffe c tive ne ss a re re la te d to the de ve lo pme nt o f a va lid wo rking a llia nc e (Do zie r e t a l. 1994; Die ne r, Hilse nro th &

We inb e rg e r, 2009; Mo nro e & Die ne r, 2011).

• T

he c ha ra c te ristic s o f the the ra pist e xpla in 5-7% o f the the ra pe utic va ria nc e (e ffe c t o f 5-8 time s hig he r tha n the type o f tre a tme nt)(Ba ld win &

I me l 2013)

• T

he ma tc hing b e twe e n the a tta c hme nt pa tte rns o f the pa tie nt a nd the the ra pist influe nc e s the wo rking a llia nc e , the the ra pe utic pro c e ss a nd its

• utc o me (Mo hr, Ge lso e Hill, 2004; Ro ma no , Ja nze n e F

itzpa tric k, 2009; Ba ldo ni, 2008, 2013; Hill, 2015).

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Atta c hme nt, Working Allia nc e a nd the ra pe utic re la tionship: Wha t ma ke s a psyc hothe ra py work?

F r anc o Baldoni & Ale ssandr

• Campailla (2017)

Gio rnale italiano di psic o lo g ia, 4 (De c ): 823-846. do i: 10.1421/ 88770

F a c tors tha t influe nc e the ra pe utic e ffic a c y

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Wa mpo ld , 2014, c o urte sy o f the a utho r; Ba ldo ni & Ca mpa illa , 2017)

How the DMM wor ks (in psyc hothe r apy)

• The DMM pays attention to the attachment patterns of the patient

and the therapist and considers their matching

• The therapist may organize the most appropriate relational and

therapeutic interventions by considering the patient’s (and his family) specific ability to process cognitive and affective information

• The therapist
• needs to be B in the clinical relationship (whatever his attachment pattern is)
• becoming a transitional attachment figure and offering a secure base that

supports the exploration of mental processes and encourages new experiences (Hill, 2015)

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

T he r apists’ Attac hme nt patte r ns

T e nd to diffe r fro m tho se o f the g e ne ra l po pula tio n, with mo re fre q ue nt e xpre ssio n o f A+ a nd C+ pa tte rns a nd, in pa rtic ula r,

unr e solve d tr auma or losse s

(suc h a s illne ss o r de a th o f a fa mily me mb e r) tha t ma y b e the b a sis o f the ir mo tiva tio n to c ho o se a he lping pro fe ssio n

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt (Do zie r, Cue & Ba rne tt, 1994; Wilkinso n, 2003; L a mb rusc hi, 2008; Ding e r e t a l., 2009; Ho lme s, 2009; Wilkinso n 2003, 2008; Ba ld o ni, 2010; Ba ld o ni & Ca mpa illa , 2017).

E xtre me Atta c hme nt Pa tte rns Unre so lve d T ra uma s Unre so lve d L

• sse s

(L a mb rusc hi, 2008; L a mb rusc hi e t a l., unpulishe d)

DMM-AAI

• I

ta lia n sa mple , N: 279

T he c linic al matc hing

In A+ and C+ the r e sults c o uld be ve r y c o mple x

(Ba ldo ni, 2008, 2013)

A T he r apist vs A Patie nt

• T

he ir a tta c hme nt stra te g ie s will pro b a b ly c o llude

• Mo re dire c tive inte rve ntio ns fo c use d o n ra tio na l a spe c ts (rig id

te c hnic a l-c o g nitive a ppro a c h, c o g nitive -b e ha vio ra l pre sc riptio ns, inte lle c tua l e xpla na tio ns o f diso rde rs, fo c using o n the so ma tic dime nsio n)

• Avo ida nc e o f pro b le ma tic a re a s tha t re ma in po o rly e xplo re d (re la tio na l

pro b le ms, de pre ssio n, fa nta sie s o f de a th o r suic ida lity, unre so lve d lo sse s

• r tra uma s)
• Syste ma tic dismissing o f ne g a tive e mo tio ns with the te nde nc y fo r b o th

to e xpre ss fa lse po sitive a ffe c ts (suc h a s smiling o r jo king whe n fa c ing pa inful o r sc a ry to pic s)

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Ba ldo ni, 2008, 2010; Ro ma no , Ja nze n & F itzpa tric k, 2009; Ba ldo ni & Ca mpa illa , 2017).

C T he r apist vs C Patie nt

• T

e nde nc y fo r b o th to e mpha size the e mo tio ns a nd fo ste r e xc e ssive a nd unre a listic e xpe c ta tio ns o f tre a tme nt.

• I

t will b e diffic ult to ma inta in re la tio nships within pro pe r limits, with the te nde nc y to e xte nd the c o nsulta tio ns a fte r a c o rre c t time .

• At the b e g inning the y c o uld ha ve the impre ssio n o f b e ing o n the

sa me wa ve le ng th (a s if the y we re frie nds), b ut, o ve r time , inte nse tra nsfe re nc e ne uro sis will te nd to ma nife st (due to the disa ppo intme nt o f mutua l e xpe c ta tio ns), with c o ntro ve rsy, q ua rre ls, re la tio na l c o nflic ts a nd po ssib le inte rruptio n o f the ra py

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Ba ldo ni, 2008, 2010; Ro ma no , Ja nze n & F itzpa tric k, 2009; Ba ldo ni & Ca mpa illa , 2017).

A T he r apist vs C Patie nt (or C vs A)

• A pa rtia l c o mpe nsa tio n c a n o c c ur. Studie s ha ve sho wn, in fa c t, tha t this

c o nditio n is o fte n re la te d to a sa tisfa c to ry the ra pe utic re la tio nship, e spe c ia lly if the the ra pist is dismissing (Me ye r & Pilko nis 2001; Bruc k e t a l. 2006).

• Co unte rtra nsfe re nc e e na c tme nts ma y a lso o c c ur, a lo ng with o missio ns

a nd misunde rsta nding s c o nc e rning the ne g le c te d o r pro b le ma tic a re a s

• f mutua l a tta c hme nt pa tte rns (suc h a s a ffe c tivity fo r dismissing sub je c ts

a nd c o g nitio n fo r pre o c c upie d), with the c o nse q ue nc e tha t diffic ulty a rise s in unde rsta nding a nd sha ring o f the re sults (Mo hr, Ge lso & Hill 2005).

• Co nse q ue nc e s ma y b e po o r the ra pe utic c o mplia nc e o r e ve n the

a b rupt withdra wa l o f tre a tme nt.

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Ba ldo ni, 2008, 2010; Ro ma no , Ja nze n & F itzpa tric k, 2009; Ba ldo ni & Ca mpa illa , 2017).

B T he r apist vs A or C or B Patie nt

• I

nte g ra tio n o f me nta liza tio n, c o g nitive info rma tio n, a ffe c ts a nd c o mmunic a tive skills with a g o o d a b ility to a na lyze pro b le ms

• T

he the ra pist will a ddre ss the c linic a l re la tio nship in a mo re c o nsc io us wa y a nd will wo rk to a da pt b e tte r to the pa tie nt’ s stra te g y a nd its spe c ific c ha ra c te ristic s a nd re q uire me nts (T a ilo re d tre a tme nt)

• T

his is pa rtic ula rly true with e a rne d B the ra pists

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Do zie r, Cue & Ba rne tt 1994; Sho re y & Snyde r 2005; Ro ma no , F itzpa tric k & Ja nze n 2008; Ba ldo ni, 2008, 2010; Ba ldo ni & Ca mpa illa , 2017)

A taylor e d attitude

• Dismissing patie nts (A) ne e d to re c e ive c le a r info rma tio n a nd o rg a nize tho ug hts in a

re la tive ly ra tio na l wa y, b ut a lso b e he lpe d in the e xpre ssio n o f e mo tio ns, e spe c ia lly ne g a tive o ne s.

• Pr

e oc c upie d patie nts (C) the the ra pist ne e ds to b e mo re c a re ful no t to c o llude with his

me nta l sta te a nd a c ts mo re firmly ma inta ining a c o nsta nt psyc ho lo g ic a l c o nta inme nt a ttitude to impro ve the re g ula tio n o f e mo tio ns (Me ye r e t a l., 2001; Purne ll, 2010; Ba ldo ni, 2008, 2010).

• At the b e g inning , the the ra pist pro po se s himse lf a s a tra nsitio na l a tta c hme nt fig ure , his

re la tio na l a ttitude is o rg a nize d in a re la tive ly c omple me ntar

y style , b y a vo iding e xpo sing

the pa tie nt to o e a rly to e xc e ssive ly a nxio us o r o ve rly c o nfusing c o nditio ns.

• Sub se q ue ntly, the pa tie nt's ma la da ptive e xpe c ta tio ns ne e ds to b e g ra dua lly

disc o nfirme d (symme tr

ic al style) “Sure , b ut no t to o sure ” (Bro mb e rg , 2006).

• T

re a tme nt pro duc e s c ha ng e s thro ug h re o rg a niza tio n a fte r mo me nts o f c risis (Ruptur

e and Re pair) (Winnic o tt, 1956 ; De Be rna rt & L

a ndini, 2015 -Bumps in the Road to Change)

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Millinckrodt, Porter & Kivlighan 2005; Holmes, 2009; Baldoni & Campailla, 2017)

A "dynamic " attac hme nt r e lationship

(thr e e phase s)

• 1. Ag re e me nt: (Pro te c tio n) the ra pist a s a

tra nsitio na l a tta c hme nt fig ure , a c c e pta nc e o f the ro le unc o nsc io usly a ssig ne d b y the pa tie nt

• Mo re ra tio na l a nd inte lle c tua l a ttitude with A pa tie nts
• Gre a te r g ra tific a tio n a nd e mo tio na l pa rtic ipa tio n with C

(slig ht vio la tio ns o f the se tting , e xtra se ssio ns, pho ne me ssa g e s)

• 2. Rupture : pa tie nt's ma la da ptive

e xpe c ta tio ns ne e ds to b e g ra dua lly disc o nfirme d (E xplo ra tio n)

• 3. Re pa ir: Psyc ho lo g ic a l Re o rg a niza tio n

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

(Millinckrodt, Porter & Kivlighan 2005; Holmes 2009)

Agreement PROTECTION Disconfirmation EXPLORATION Psychological REORGANIZATION 1 2 3

T he po sitive o utc o me o f a the rapy is asso c iate d with po sitive re so lutio ns o f the rupture s o f the allianc e

(Safran e t al 1990; Ho rvath e t al 1991; Safran & Muran 1996, 2000; E ub anks e t al., 2010; Ardito & Rab e llino 2011; Mille r-Bo tto me e t al 2017; Baldo ni & Campailla 2017)

T ransitio nalAttac hme nt Re latio nship

Conc lusions (for the c linic ians)

• Wo rk o n yo urse lf a s a pa tie nt
• Be a wa re o f yo ur a tta c hme nt sta rte g ie s (inc luding

the ir so ma tic e xpre ssio ns) a nd po ssib le U/ T r o r U/ l

• Be B with pa tie nts (wha te ve r yo ur a tta c hme nt

pa tte rn is) a nd c ha ng e a ttitude c o nside ring the ir ne e ds

• Be impe rfe c t a nd le a rn a b o ut c risis a nd

disc re pa c ie s

the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

F rankfurt, 2012 Camb ridg e , 2010 Be rtino ro , 2008 Miami, 2015

T

• download pr
• gr

am mate r ials, c lic k he r e

https:/ / www.ia sa - dmm.org / ia sa - c onfe re nc e /