T he c linic al use fulne ss of the DMM- AAI in individual tr e - - PowerPoint PPT Presentation

T he c linic al use fulne ss

• f the DMM- AAI in

individual tr e atme nt

Ke nic hi Mikami Ho kkaido Unive r sity o f E duc atio n

T hr e e ways of using the DMM- AAI in individual tr e atme nt

฀ a to o l fo r a sse ssme nt to g uide

tre a tme nt

฀ a te st o f the e ffe c tive ne ss o f

psyc ho lo g ic a l tre a tme nt

฀ a to o l to o ve rc o me rupture s in the

the ra pe utic a llia nc e

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

฀ a tool for

asse ssme nt to guide tr e atme nt

(Cr itte nde n & L andini, 2011, p.372)

T he DMM-AAI c a n b e use d fo r a sse ssme nt to (a )fo rmula te the spe a ke r’ s pro b le m, (b )fo c us the tre a tme nt, (c )se le c t a mo de o f tre a tme nt, (d)se le c t a spe c ific tre a tme nt te c hniq ue s, (e )e va lua te whe the r the individua l c a n b e ne fit fro m spe c ific pro po se d 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

฀ a te st of the e ffe c tive ne ss of

psyc hologic al tr e atme nt

(Cr itte nde n & L andini, 2011, pp.374-375)

• I

n o rde r to te st the e ffe c tive ne ss, no t o nly a re lia b le c o de r who is b lind to a c a se is ne e de d, b ut a lso a n inte rvie w whic h re ta ins the struc ture a nd pro c e ss o f the AAI b ut, a t the sa me time , ha s diffe re nt se t

• f q ue stio ns so tha t it c a n surprise

the mind o f the spe a ke r is ne e de d.

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

฀ a te st of the e ffe c tive ne ss of

psyc hologic al tr e atme nt

(Cr itte nde n & L andini, 2011, pp.374-375)

• F
• rm B o f the AAI

(Critte nde n, 2006)ha s b e e n de ve lo pe d fo r this purpo se .

• I

t re ta ins so me o f the o rig ina l q ue stio ns while ha s ne w q ue stio ns whic h surprise the spe a ke r into a c c e ssing diffe re nt re c a lle d e xpe rie nc e s a nd using the se to unde rsta nd c urre nt func tio ning .

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

CaseⅠ: Aiko(Mikami, 2018)

• Aiko wa s a fe ma le a nd sing le c lie nt in he r 30’ s

who a ppa re ntly ha d no intima te re la tio nships so fa r. She fe lt de pre sse d e ve ry ye a r fro m the e nd o f Autumn until the b e g inning o f Winte r.

• I

t wa s so o n re ve a le d tha t she ha d a tra uma tic e xpe rie nc e in this se a so n. One da y she fo und

• ut tha t he r mo the r wa s no t a t ho me in the

mo rning , a nd the n he r mo the r c a lle d he r, sa ying tha t she wo uldn’ t c o me b a c k ho me a nymo re , a nd ha ng e d up the pho ne just a fte r sa ying ‘ Go o d L uc k’ .

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

CaseⅠ: Aiko

• Altho ug h she c a me b a c k ho me la te r, this

e xpe rie nc e ha d re pe a te dly fla shb a c ke d e spe c ia lly whe n she fe lt de pre sse d. I n he r c hildho o d, she a lwa ys ha d to wo rry if he r pa re nts mig ht ha ve se rio us q ua rre ls a g a in.

• T

he DMM-AAI wa s a dministe re d a fte r # 5, a nd she to ld me tha t it re minde d he r o f lo ne ly lo o k

• n he r fa the r’ s fa c e a fte r he r mo the r le ft

ho me . She a lso re me mb e re d tha t she tho ug ht she ha d to b e stro ng , o the rwise he r fa mily wo uld fa ll a pa rt.

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

CaseⅠ: Aiko

• I

to ld he r tha t, pro b a b ly, she ha d a c tua lly wa nte d a stro ng fa the r b ut c o uldn’ t a dmit suc h a de sire . She sa id tha t she ha d no inte ntio n to b la me he r pa re nts b ut wa s a lwa ys o ve rly c o nc e rne d a b o ut the m.

• Gra dua lly, she sta rte d linking he r pa st

a tta c hme nt re la tio nships to he r pre se nt inte rpe rso na l re la tio nships.

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

CaseⅠ: Aiko

• F
• r e xa mple , she to ld me she ha d

re pe a te dly suffe re d fro m se xua l ha ra ssme nts b y he r pa st b o sse s.

• She spo nta ne o usly linke d this fa c t to

he r de sire in whic h she ha d wa nte d a stro ng a nd g e ntle fa the r, whic h the n mig ht ha ve ma de he r b o sse s misunde rsta nd tha t she ha d se duc e d the m.

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

CaseⅠ: Aiko

• Be c a use o f he r jo b , we ha d to finish

this the ra py a t the # 23.

• I

n the se c o nd fo llo w-up se ssio n, mo st o f he r sympto ms suc h a s de pre ssio n, sle e p diso rde r, a nd fla shb a c ks disa ppe a re d, a nd she se e me d to do we ll in he r jo b .

• T

he n the F

• rm B o f the DMM-AAI

wa s a dministe re d.

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

DMM-AAI

#6 ― #23 #1 ― #5

23 se ssio ns (8mo nths)

F

• llo w-up # 1

(3mo nth la te r) F

• llo w-up # 2

(1.5 ye a r la te r)

DMM- AAI (F

• rm B)

c ompar ison of the two AAIs

I O(R)฀ Utr(dn)PAN A+(6)

Utr(dn & dpl)PA-b urn R(Utr(dn)ma ny A+→ A6→฀ )

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 his re sult sug g e ste d tha t, b e c a use mo st o f he r unre so lve d tra uma s we re re so lve d b y the the ra py, he r dysfunc tio na l A6 stra te g y wa s re pa ire d, whic h le d to impro ving he r sympto ms.

What the two AAIs sugge sts

• Also , it sug g e sts tha t 23 se ssio ns a re

pro b a b ly no t lo ng e no ug h to c ha ng e he r stra te g y fro m A6 to B.

• T

hus, the DMM-AAI wa s no t o nly use ful fo r a sse ssme nt b ut a lso se e me d to c a pture wha t ha d c ha ng e d a nd wha t ha d no t in this 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

฀ a tool to ove rc ome the rupture s

in the the ra pe utic a llia nc e (Mika mi, unde r re vie w)

• T

he third o ne mig ht b e pa rtic ula rly use ful fo r individua l tre a tme nt b e c a use individua l tre a tme nt c a n b e e xpe c te d to b e mo re o fte n a ffe c te d b y tra nsfe re nc e a nd c o unte rtra nsfe re nc e tha n fa mily o r g ro up tre a tme nt whic h c a n e ve ntua lly le a d to the rupture s in the the ra pe utic a llia nc e .

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

Ruptur e s in the the r ape utic allianc e

• Sa fra n a nd Mura n (1996) po inte d o ut

tha t “rupture s o fte n o c c ur whe n the ra pists unwitting ly pa rtic ipa te in ma la da ptive inte rpe rso na l c yc le s tha t re se mb le tho se c ha ra c te ristic s o f pa tie nts’ o the r inte rpe rso na l c yc le s, thus c o nfirming the ir pa tie nts’ dysfunc tio na l inte rpe rso na l sc he ma s o r g e ne ra lize d re pre se nta tio ns o f se lf-

• the r inte ra c tio ns”(p.417).

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

CaseⅡ: T akako (Mikami, unde r r e vie w)

• T

a ka ko wa s a lso a sing le a nd fe ma le po stg ra dua te stude nt in he r 30s.

• T

a ka ko so ug ht the ra py b e c a use she wa nte d to unde rsta nd he rse lf in o rde r to c ha ng e he r wo rka ho lic life style .

• He r fa the r wa s fre q ue ntly vio le nt

to wa rd he r mo the r. T a ka ko ha d o fte n fo und he r mo the r c rying in the kitc he 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

CaseⅡ: T akako

• Sinc e he r c hildho o d, she wa s o fte n to ld

b y ma ny pe o ple tha t she wa s a lwa ys smiling whic h she wa sn’ t a wa re o f.

• T

a ka ko ha d two lo ng te rm re la tio nships with he r pa st b o yfrie nds, whic h la ste d a b o ut 10 ye a rs fo r e a c h b ut e nde d up b re a king up e ve ntua lly.

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

CaseⅡ: T akako

• Onc e the the ra py sta rte d, she so o n

de ve lo pe d lo ve tra nsfe re nc e to wa rd me . Also , she wa s o fte n wo rrie d a b o ut whe the r she wa s b o the ring me .

• At first, I

trie d to a c c e pt a nd e mpa thize with he r fe e ling 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

CaseⅡ: T akako

• Ho we ve r, g ra dua lly, I

sta rte d fe e ling tha t o ur

• c c a sio na l me e ting s we re b e c o ming a

b urde n a s tho ug h he r “se lf-fulfilling pro phe c y” wa s b e c o ming a c tua lize d in this the ra pe utic re la tio nship. Also , I sta rte d fe e ling irrita te d whe n she sho we d he r smile whe n she wa s ta lking a b o ut he r pro b le ms.

• Be c a use o f my c o unte rtra nsfe re nc e ,

e ve ntua lly I sug g e ste d to he r tha t, b e c a use she se e me d to g e t impro ve d, we c o uld te rmina te the the ra py, whic h, o b vio usly, wa s to o e a rly a t tha t sta g e .

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

CaseⅡ: T akako

• Be c a use she ha d fe lt sc a re d b y e xplo ring he r

pa st, she a lmo st a g re e d with the te rmina tio n b ut a lso sho we d so me a nxie ty.

• T

hus, b o th o f us trie d to e sc a pe fro m the the ra py, le a ding to c o llusive ly se e king fo r the te rmina tio n o f the the ra py.

• Ho we ve r, b e c a use I

fina lly re a lize d tha t she fe lt a nxie ty a nd lo ne line ss in the fa c e o f po ssib le te rmina tio n, I de c ide d to use the DMM–AAI to o ve rc o me this rupture .

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

DMM-AAI

#1 ― #37 #38 ― #46

46se ssio ns (15mo nths)

T akako’s c lassific ation

• f the DMM- AAI

DO Utr(dx)PAE

N & unc e rta in pa re nta g eA4C3(5)∆

• T

he DMM-AAI re ve a le d tha t the re ’ s suc h a c o mple x se lf-pro te c tive stra te g y b e hind he r pro b le ms.

E ffe c t o f using the DMM–AAI to o ve r c o me the r uptur e s in the the r ape utic allianc e

• Afte r the DMM-AAI

, she re a lize d tha t she wa s trying to te rmina te the the ra py

• ve rly e a rly in o rde r to re duc e the

sho c k o f se pa ra tio n fro m the the ra pist in the sa me wa y tha t she ha d do ne with he r fo rme r b o yfrie nds.

• Also , she sto ppe d sho wing he r usua l

smile a fte r the AAI ; fo r the first time , I fe lt I wa s a b le to fe e l he r true fe e ling 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

E ffe c t o f using the DMM–AAI to o ve r c o me the r uptur e s in the the r ape utic allianc e

• Also , the AAI

he lpe d me to re fle c t o n my c o unte rtra nsfe re nc e a nd re c o ve r my e mpa thic a ttitude to wa rd he r.

• Afte r se ve ra l ye a rs, she c o nta c te d me

to le t me kno w tha t she c ha ng e d he r pla c e o f wo rk, tha t she wa s no t a s b usy a s b e fo re , a nd tha t she ha d fina lly ma rrie d a ne w pa rtne r.

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

Disc ussion

• I

think the se two c a se s c a n c o ntrib ute to the DMM a s the y illumina te the po ssib ility o f c linic a l use fulne ss

• f the DMM-AAI

.

• F

irstly, b o th c a se s sug g e ste d tha t the c la ssific a tio ns

• f the DMM-AAI

we re use ful to c a pture the ir c o mple x se lf-pro te c tive stra te g ie s whic h wo uldn’ t ha ve b e e n po ssib le with the M & G me tho d.

• T

hus, the DMM-AAI c a n b e use d to a sse ss the c lie nt’ s se lf-pro te c tive stra te g y in the b e g inning a nd, a lso , to e va lua te the e ffe c tive ne ss o f tre a tme nt in the e nd with the fo rm B.

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

Disc ussion

• Se c o ndly, the DMM-AAI

wa s use ful to fa c ilita te the re fle c tive pro c e ss o f the c lie nt.

• Be c a use o f its we ll-struc ture d q ue stio ns a s we ll

a s the inte rvie we r’ s a ttitude o f just liste ning to sto ry witho ut inte rpre ta tio n o r inte rve ntio n, the AAI a llo we d my c lie nts to e xplo re the a tta c hme nt e xpe rie nc e s whic h we re to o thre a te ning fo r the m to think a b o ut b e fo re ha ving the AAI .

• T

his wo uldn’ t b e impo ssib le if the se lf-re po rt q ue stio nna ire o f a tta c hme nt style wa s use d.

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

Disc ussion

• F

ina lly, the DMM-AAI wa s use ful to fa c ilita te the re fle c tive pro c e ss o f the the ra pist a s we ll, e spe c ia lly whe n the the ra pe utic a llia nc e wa s a t risk.

• I

t wo uld a llo w fo r a po se in whic h no a c tio n wa s ta ke n a nd g ive b o th c lie nt a nd the ra pist a n

• ppo rtunity to re fle c t o n ne w info rma tio n g a ine d

fro m the DMM-AAI .

• T

ra ditio na lly, c o unte rtra nsfe re nc e ha s b e e n re g a rde d a s a use ful to o l to o ve rc o me suc h rupture s b y re fle c ting o n ho w the c lie nt’ s pa st a tta c hme nt re la tio nships a re b e ing e na c te d in the the ra pe utic re la tio nship.

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

Disc ussion

• Ho we ve r, c o nside ring tha t lo ve

tra nsfe re nc e c a n c o nfuse a the ra pist’ s fe e ling s mo re e a sily tha n o the r type s o f tra nsfe re nc e (Ba b a , 1997), it wo uldn’ t b e a lwa ys e a sy to utilize c o unte rtra nsfe re nc e .

• I

n suc h a diffic ult c a se , the DMM–AAI c o uld b e a n additio nal the ra pe utic to o l to o ve rc o me rupture s in the the ra pe utic a llia nc e 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

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