Therapeutic progress and symptom elevation in treating dismissive attachment: A case study

A dismissive or avoidant attachment style can present clinical challenges in psychotherapy as the attachment style may interfere with the development of a constructive therapeutic alliance and impact the level of disclosure, expressions of distress, and risks for premature drop-out. This paper reports a naturalistic case study and offers an in-depth examination of a treatment with a client with dismissive attachment, including a detailed examination of relational interventions and countertransference struggles. Furthermore, this paper considers the notable differences between quantitative scores on a well-validated, practice-based clinical symptom inventory and the qualitative outcomes for this client to offer clinical and research implications in treatment with dismissive attachment.     

The treatment of psychological trauma from the perspective of attachment research

This paper looks at the implications of attachment research for the treatment of psychological trauma. This is particularly important in the field of family therapy given that PTSD both impacts on the immediate family system and can be transmitted down the generations. After an initial review of current research in the field, the paper focuses on the assessment and treatment of PTSD, emphasizing the importance of integrating techniques from different models that enable clients to modulate their emotions as part of the therapeutic process. The paper concludes by emphasizing the importance of support and supervision for the therapists in order to avoid secondary traumatization.     

Electroencephalographic responses to photographs: a case study of three women with distinct adult attachment interview classifications

This preliminary study explored whether neurophysiological responses to visual stimuli, including attachment-related pictures, differed based on attachment status. Along with self-reported valence ratings and reaction times, recorded electroencephalographic (EEG) responses to a total of 100 images, 25 each of Positive, Negative, Neutral, and Personal (each participant's parents and child), were analyzed within and among three mothers with three attachment statuses (Dismissing, Preoccupied, and Secure), as judged by the Adult Attachment Interview (AAI). All three mothers gave their highest pleasantness ratings for Personal photographs. However, differences emerged when cross-region Alpha2 activation patterns in response to each picture type were compared amongst attachment categories. Alpha2 activation recorded during viewing of the participants' children's photographs was similar to viewing Negative pictures for mothers with insecure (Dismissing and Preoccupied) status; whereas the Alpha2 activation of the mother with Secure status towards photographs of her child was similar to Positive pictures. Different patterns of hemispheric asymmetry in Beta1 frequency when processing different picture types were also found. The mother with Dismissing status showed significantly stronger left-hemisphere Beta1 activation across all image types. The Preoccupied mother showed significantly stronger right-hemisphere Beta1 activation for all but the Neutral images, during which activation did not differ between the two hemispheres. The mother with Secure status showed significantly stronger Beta1 activation in the left hemisphere for all but parental Personal photos, during which activation did not differ between the two hemispheres. Implications from the current findings and future research possibilities are discussed.     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.     

Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment.

Associations between self-blame and anxiety and depression symptoms in a sample of 76 women with breast cancer were investigated. At diagnosis, behavioral self-blame was associated with increased distress; at 3 months postdiagnosis, characterological self-blame was positively associated with affective symptoms and behavioral self-blame approached significance (p = .07); and at 6 months, behavioral self-blame was related to increased distress. Prospective analyses revealed that characterological self-blame at diagnosis approached significance in predicting distress at 3 months (p = .055) and was significant in predicting distress at 6 months and at 1 year after diagnosis. These data indicate that behavioral self-blame is a correlate of concurrent affective symptoms, whereas characterological self-blame predicts increased distress over time. Implications for social-cognitive processes in adaptation to breast cancer are discussed.     

Psychoanalytic treatment of a woman with anxiety attacks and conversion

This case study describes the psychoanalytic treatment of a young woman presenting with symptoms of overwhelming anxiety, panic, and conversion. The emphasis is on technique with detailed reporting on the psychoanalytic process. Attention is paid to transference-countertransference paradigms at critical junctures in the treatment. The role of clinical supervision in the unfolding of the process is described also. This patient developed an identifiable transference neurosis during the course of the treatment, which became the focus of the analysis. Follow-up observations on this patient are also presented, as she returned for a brief course of treatment 4 years following initial termination.     

Functional assessment and treatment of pica: a single‐case experiment

The pica of a 6‐year‐old girl diagnosed with autism was initially shown to persist in the absence of socially mediated consequences. In an attempt to provide a competing source of oral stimulation, we used a stimulus preference assessment to identify food items that were subsequently presented noncontingently. However, the noncontingent schedule could not be thinned to a practical variation while still maintaining reductions in pica. A subsequent multielement evaluation of response blocking and verbal reprimands demonstrated that neither intervention both produced and maintained low levels of pica. Verbal reprimands were then used in conjunction with noncontingent food presentation, but this intervention did not produce significant reductions in pica. Suppression of pica was ultimately obtained in both a clinic setting and in the child's natural environment using contingent, varied auditory stimulation. The results are discussed in the context of the ‘least restrictive alternative’ model of treatment selection. Copyright © 2001 John Wiley & Sons, Ltd.     

Therapeutic assessment of a man with "ADD"

In this article I present the first published complete case study of a psychological assessment done by the methods of Therapeutic Assessment. A client-therapist pair had been working together for several years but felt "stuck" in the treatment. The man had been previously diagnosed with attention deficit disorder (ADD) and sought help for disorganization and difficulties in romantic relationships. The therapist asked for diagnostic clarification but gradually revealed a deeper confusion about how to work with the client. Through the collaborative process of the assessment, the client gradually concluded that he did not have ADD, and he and the therapist reached a joint understanding of their next steps in treatment. This case illustrates how collaborative psychological assessment (a) can help clients revise their "stories about themselves and the world" and (b) provides an effective, non-threatening way for a consultant to intervene in a client-therapist system that has reached an impasse.     

Attachment, assessment, and psychological intervention: a case study of anorexia

Attachment patterns and personality dimensions have always been considered important to the development and adaptation of the individual. The first aim of this article was to address some basic questions about the place of attachment in a multimethod assessment when compiling a complete picture of the patient's personality functioning. The second aim was to present the Adult Attachment Projective Picture System (AAP; George & West, 2001) as a valid and productive assessment measure. Based on a single case study of an anorexic young woman, the article demonstrates how the AAP is integrated with the Rorschach Comprehensive System (Exner, 1991, 1993) and other assessment tools in both the assessment and in developing a treatment plan.     

An attachment perspective on human-pet relationships: Conceptualization and assessment of pet attachment orientations

In a series of studies we used attachment theory as a framework to examine human-pet relationships. We proposed that, as in interpersonal relationships, people differ in their degree of anxious or avoidant attachment to their pets, and that these individual differences influence pet-related cognitions, emotions, and behavior. We constructed a self-report scale, the Pet Attachment Questionnaire (PAQ), and examined its factorial structure, associations with attachment patterns in human relationships (Studies 1-2), relation to explicit and implicit expectations concerning a pet (3-4), and reactions to the loss of a pet (5). We found that individual differences in pet attachment do occur in the domains of attachment anxiety and avoidance, and these differences contribute uniquely to the prediction of expectations about the pet and emotional reactions to its death.     

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety.

Design: Semi-structured interviews of patient-caregiver dyads (N?=?21), coded using NVivo Software.

Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC.

Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms.

Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.     

Multi-component behavioral treatment of trichotillomania: a case study.

A 21-year-old female with a 13-year history of compulsive hair pulling was treated via a multi-component behavioral intervention strategy. Dependent variables included both quasi-direct behavioral frequency counts (i.e., number of hairs pulled) and physical trace, natural erosion measures (i.e. size of bald areas). Results indicated dramatic decrease in number of hairs pulled from treatment through 40 weeks post-initiation of baseline. These findings were discussed with regard to situational-specificity of trichotillomania and reliance upon experimenter-derived rather than subject-controlled data collection sources.     

Supervising counsellors and psychotherapists who work with trauma: a Delphi study

In this study the Delphi technique was used to identify the main supervision issues that require attention and consideration when supervising counsellors and psychotherapists working with trauma. A panel of supervisors, who were additionally experienced in working with trauma in adulthood, completed a series of three questionnaires comprising two qualitative and one quantitative round. Themes and key concepts were identified from the data, and the respondents rated the importance of the themes using a visual analogue scale. This iterative process identified areas where there was consensus amongst the respondents and areas where contention was apparent. The results revealed significant issues pertinent to the supervision of trauma therapists, with a particularly strong emphasis around training, experience and organisational issues. Directions for further research emerging from the study are also discussed.     

Attentive processing of threat and adult attachment: a dot-probe study

We examined selective attention to threat stimuli as a function of individual differences in adult attachment. Participants completed a dot-probe task in which a general threat word, attachment-related threat word, general positive or attachment-related positive word was presented together with a neutral word. Results showed that attachment anxiety and avoidance were associated with an attentional bias away from attachment threat words. This attentional avoidance effect was best predicted by the interaction between attachment anxiety and avoidance and not by their unique main effects. The findings are discussed in terms of attachment theory and its relation to attentional biases observed in psychopathology.     

Insecure attachment and personality disorder: a twin study of adults

This study used 239 twin pairs from a volunteer community sample to investigate how anxious and avoidant attachment are related to personality disorder (PD). Factor analysis showed that self‐reported anxious attachment and 11 PD scales from the Dimensional Assessment of Personality Problems loaded onto one factor (emotional dysregulation), and avoidant attachment and four PD scales loaded onto a second factor (inhibitedness). Biometric models indicated that 40% of the variance in anxious attachment was heritable, and 63% of its association with corresponding PD dimensions was attributable to common genetic effects. Avoidant attachment was influenced by the shared environment instead of genes. Correlations between avoidance and corresponding PD dimensions were attributable to experiences in the nonshared environment that influenced both variables. Copyright © 2006 John Wiley & Sons, Ltd.