The in-session discourse of unresolved/disorganized psychotherapy patients: An exploratory study of an attachment classification

Abstract

The Unresolved/disorganized (U/d) attachment classification has generated considerable interest among clinicians. This is in part based on its empirical associations with adult mental health, parenting practices, and treatment outcomes. Despite decades of theorizing, however, we have little empirical information regarding how patients with a U/d classification assigned by accredited coders actually behave or speak in psychotherapy sessions. Here, we take a step towards bridging this gap by reporting our observations of the psychotherapy session transcripts of 40 outpatients who were independently classified as U/d on the Adult Attachment Interview (AAI), the gold standard measure of adult attachment research. These patients were extracted from a larger sample of 181 and compared to others without a U/d classification. In this paper, we discuss two different discourse styles associated with a U/d classification. Some U/d patients did not seem to sufficiently elicit the therapist’s endorsement of what they said. For example, they did not justify their claims with examples or explanations, or did not consider others’ intentions or experiences. Other U/d patients were credible, but left the listener uncertain as to the underlying point of their discourse, for example, by glaringly omitting the consequences of their experiences, or interrupting their narratives mid-way. In the discussion, we place these observations in the context of recent thinking on attachment and epistemic trust, and discuss how this study may form the basis for future quantitative studies of psychotherapy.

An exploratory study on how attachment classifications manifest in group psychotherapy

“…This is because, until recently (Talia, et al . 2022 ), there have been no empirical means of identifying markers of this attachment classification in psychotherapy. Future studies should consider this attachment classification as well.…”

“…In the past decade, we have learnt much about what interactive processes and discourse characteristics tend to be linked with secure, dismissing, and preoccupied patients in individual psychotherapy (as well as, most recently, unresolved/ disorganized patients, Talia, et al ., 2022 ). Although such research has not so far focused on group psychotherapy, knowledge of attachment-related differences in individual therapy may be salient in this paper.…”

Adapting Short-Term Mentalization-Based Therapy to ICD-11 Personality Disorder in Adolescents

“…We suspect that disorganized attachment may have an important role to play in how adolescents can make use of psychotherapy. Recently, Talia and colleagues [33] presented data suggesting that disorganized adult patients display patterns of speech that may hinder the development of epistemic trust in their therapists, which may be an important obstacle to using the therapy process as a vehicle for enhancing a sense of agency and identity. If these results are replicated in adolescents, studying how therapists can intervene would be an important next step in studying the most severe personality-disordered patients described in the ICD-11.…”