T he c linic a l ma tc hing : inte r ac tions be twe e n patie nts - - 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 r anc o Baldoni, 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

Attac hme nt patte r ns

• f the patie nt and the c linic ian
• De spite ma ny 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 (Ba ldo ni & Ca mpa illa , 2017).

• Me ta -a na lyse s ha ve sho wn tha t
• Pa tie nt a nd the ra pist sa fe ty is 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 ldwin & I

me l 2013)

• By a na lyzing pa tie nt’ s a tta c hme nt stra te g y, the ra pist ma y o rg a nize

the mo st a ppro pria te inte rve ntio ns, c o nside ring the pa tie nt’ s spe c ific a b ility to pro c e ss c o g nitive a nd a ffe c tive info rma 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

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 (I SSN 0390-5349), 4 (De c ): 823-846. do i: 10.1421/ 88770

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

Abstr ac t

T he re sults o f the e vide nc e -b a se d re se a rc h ha ve c o nfirme d tha t va rio us mo de ls o f psyc ho the ra py pro duc e ve ry po sitive re sults, b ut no psyc ho the ra pe utic te c hniq ue ha s sho wn a sig nific a nt supe rio rity c o mpa re d to the o the rs. A fa c to r sig nific a ntly re la te d to pa tie nt sa tisfa c tio n a nd to the fina l re sult o f psyc ho the ra py se e ms to b e the q ua lity o f the the ra pe utic a llia nc e o r Wo rking Allia nc e , a nd the a tta c hme nt pa ra dig m ha s b e e n use d a s a ke y fo r inte rpre ta tio n a nd a sse ssme nt o f this dime nsio n. De spite me tho do lo g ic a l limita tio ns, a nd the va ria b ility o f the inve stig a te d dime nsio ns, re se a rc h ha s sho wn tha t a tta c hme nt se c urity o f the pa tie nt a nd the the ra pist po sitive ly influe nc e the q ua lity o f the re la tio nship, the the ra pe utic pro c e ss a nd the

• utc o me
• f the

tre a tme nt, while inse c urity in a tta c hme nt, pa rtic ula rly pre o c c upie d type , is a sso c ia te d with a lo we r q ua lity a nd insta b ility o f the a llia nc e a nd a de c re a se d the ra pe utic e ffic a c y.

How to use the DMM (in psyc hothe r apy)

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

and the therapist and considers their matching

• By analyzing the configuration of attachment of the patient, the

therapist may organize the most appropriate relational and therapeutic interventions (including interpretations) 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 is

his attachment pattern

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 a hig he r pro po rtio n o f inse c ure pa tte rns a nd, in pa rtic ula r, unre so lve d tra uma o r lo sse 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., unupulishe 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 diffe r e nt

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 o 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

• 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 o 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)

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 pa tie 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

• f e mo tio ns, e spe c ia lly ne g a tive o ne s.
• Pr

e oc c upie d pa tie nts (C) the the ra pist is 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 o f the the ra py, the re la tio na l a ttitude o f the the ra pist

c a n b e o rg a nize d in a re la tive ly c omple me nta r

y wa y, b y a vo iding

e xpo sing him 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 r a dually disc onfir me 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

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

A "dynamic " attac hme nt r e lationship (thr e e phase s)

• 1. I

nitia l a g re e me nt b y the the ra pist (a c c e pta nc e o f the ro le unc o nsc io usly a ssig ne d to him b y the pa tie nt)

• I

nte lle c tua l a nd ra tio na l a ttitude with A (Dismissing ) pa tie nts

• Gre a te r fle xib ility a nd e mo tio na l pa rtic ipa tio n with C (Pre o c c upie d)(slig ht vio la tio ns
• f the se tting , e xtra se ssio ns, pho ne me ssa g e s)
• 2. 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

• 3. Psyc ho lo g ic a l re o rg a niza tio n o f the pa tie 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

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

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 /