ADULT DISORGANISED ATTACHMENT: RELIEVING ASSOCIATED SUFFERING: Assessing, formulating and providing care within a client’s unique resilience/risk network. (Sydney)

Attachment Seminar Series: Final 5th Updated 2022 Series

This year’s newly revised, and final Attachment Seminar Series (5th)—(1) Lifespan Survey, (2) Adult Disorganisation and (3) Attachment and DV—seeks both to update our knowledge/skills and to contribute to closing the research-to-treatment gap for mental health practitioners. [The presenter is retiring at the end of 2022 after contributing a decade of attachment seminars with PDP].

Attachment Theory suffers twin challenges in achieving its therapeutic charge to bring relief for human suffering. First, like many robust theories, coping with permanent expansion and increasing research complexity requires continual updating. Next, empirical successes typically face a ‘research-to-treatment gap’ that resembles similar empirical conundrums in lifespan developmental sciences. In addition to integrating relevant attachment empirical findings for 2021 and 2022, the three workshops will bring greater focus on the underappreciated relevance of research such as the approach to lifespan attachment processes emerging form Karlen Lyons-Ruth and her team within the Cambridge (MA) Health Alliance.

This second seminar on Adult Attachment Disorganisation asks the question: Do we understand the various pathways that adult disorganisation may have followed? Can we change adult attachment, especially disorganised forms where suffering may seem to abound? The good news is a tentative, ‘yes’ and ‘yes’. However, to understand pathways, we must break our dependency on overly reductive, dualistic, linear, forced either-or binary and deterministic approaches. Biological science has demonstrated that development is ‘probabilistic’ with multiple causal inputs. Context, environment, processes—not just things—, social networks, cultural histories are all part of our shared biology. The seminar will also provide a view on how attachment researchers see their field of study evolving—which issues, which applications, which horizons for treatment. Armed with a more coherent and inclusive view of life and the lifespan, the seminar takes a decidedly practical turn to address suffering and adult disorganisation.

The seminar’s second more practical response [the final three quarters of the session] begins with an overview of our expanding knowledge of lifespan pathways for adult disorganisation. The seminar highlights several of Lyons-Ruth and team’s lifespan disorganisation measures, beginning with AMBIANCE infant measurement-recently made available for health workers. Traditional care-giver insensitivity and frightening/frightened behaviours from the 1970s and 80s have been empirically expanded to include three additional interactions: intrusiveness/ negativity, role/boundary confusion and withdrawal. These initial five interactions—which may continue or change into adulthood—, combine dynamically with further measures into later childhood young adulthood will assist us in practical history taking assessment for grasping disorganisation.

The workshop next highlights where we have arrived in terms of pathways into adult disorganisation. What are its multiple features, functions and symptoms in adulthood? What sort of variabilities (heterogeneity) within disorganisation might we expect? How have we sought to measure it? What does disorganisation look like in romantic relationships? And which treatments might be pursued? In addition to the 1980-90s generated measures—AAI Unresolved States and self-report Fearful-Dismissive—, additional insights have emerged from Lyons-Ruth team’s recoding/reemployment of the AAI the Hostile-Helpless positions and Paetzold’s measure of romantic disorganisation. This collection of facets captures potential multiple heterogenous disorganisation phenomena: granularity that supports (re-)assessment, planning and treatment progress. These will also be applied within specific case vignettes and raised for discussion.

Finally, understanding the major overlaps (or comorbidities) between disorganised attachment and other mental health realities is necessary: personality struggles, affective disorders (including schizoaffective spectrum and psychosis), dissociation and complex trauma. How do we conceive of these interactions as well as intersections with other contextual and socio-cultural factors? Three recent validated dimensional models offer assessment and treatment insights that may integrate well with attachment-informed psychotherapies. These dimensional scales and subscales permit us to both move away from purely symptom/problem saturation narratives and direct our work toward more granular capacities. This will include a look at the growth of a client’s overlapping reflective or mentalising capacities. A constructed inventory of our own practice will allow personalised discussion of how these skills might be fit into our current modalities. A practical engagement with several specific in therapy micro-skill realities concludes our day.