Attachment narrative therapy: integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders

This paper proposes that recent developments in attachment theory, especially the move to the study of representations, offers some helpful new directions for systemic family therapy. Some of the findings of a close association between early attachment experiences and the coherence of the narratives are reviewed. It is suggested that this offers a useful link for systemic approaches in showing how early interactions in families promote not only particular emotional attachment patterns, but also shape the content and style of the narratives that are formed. These implications are then explored in the context of work with anorexia nervosa. It is suggested that commonly observed patterns, such as avoidance of conflict and apparent difficulties in discussing relationships and feelings, is consistent with transgenerational experiences of insecure/avoidant attachments. Some implications for systemic therapy with families are outlined and an illustrative case study is offered.     

Cross-cultural perspectives: implications for attachment theory and family therapy

Cross-cultural perspectives have always been useful for understanding behavior. They clarify the distinction between aspects that are essentially part of the human condition and those that are the most responsive to variation. The interesting article by Rothbaum and his colleagues is in that tradition, contrasting the cultural values and family patterns in Japanese society with those of Western cultures, including our own, and suggesting that these differences shape the nature and course of attachment. It stimulates questions about what we have taken for granted in our theories and in our evaluations of dysfunctional behavior.     

The Adult Attachment Projective Picture System: integrating attachment into clinical assessment

This article summarizes the development and validation of the Adult Attachment Projective System (AAP), a measure we developed from the Bowlby-Ainsworth developmental tradition to assess adult attachment status. The AAP has demonstrated excellent concurrent validity with the Adult Attachment Interview (George, Kaplan, & Main, 1984/1985/1996; Main & Goldwyn, 1985-1994; Main, Goldwyn, & Hesse, 2003), interjudge reliability, and test-retest reliability, with no effects of verbal intelligence or social desirability. The AAP coding and classification system and application in clinical and community samples are summarized. Finally, we introduce the 3 other articles that are part of this Special Section and discuss the use of the AAP in therapeutic assessment and treatment.     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

Dimensional models of psychopathology: research agenda and clinical utility

This commentary emphasizes the implications for a mental health research agenda that stem from the papers in this special section on dimensional models of psychopathology. These include the need to extend dimensional models to a wider range of psychopathology; the relationship of the dimensions described in these papers, largely based on symptom and self-report measures, to findings from current research in genetics, neuroimaging, and other domains of neuroscience; the need for new scales that can assess the entire range of relevant dimensions with modern psychometric techniques; and ways to employ these dimensions in applied clinical situations. It is concluded that hierarchical dimensional models offer powerful ways of organizing our thinking about psychopathology and will serve to guide many promising avenues of future research.     

Behavioral-systems marital and family therapy: Integration and clinical application

Abstract

This paper describes our integration of two of the more prevalent approaches to marital and family therapy: the behavioral (social learning) and the family systems (communication theory) approaches. A discussion of the development of family rules from a behavioral point of view is presented as an example of conceptual integration. However, the major intent of the paper is to present a rather detailed explication of the authors' multivaried strategies for intervention, which are designed to integrate and innovate upon the major behavioral and family systems treatment techniques.     

Epistemological confusion in family therapy and research

Family therapy began as a movement sparked by a small group of behavioral scientists who challenged the orthodoxies of medical and psychodynamic therapies. This movement signalled the beginning of an epistemological shift, the roots of which can be found early in this century in the physical sciences. As the field has grown and become for many a means of livelihood rather than an experimental thrust, though exploration of epistemological issues has continued, a split has developed in the field that mirrors the epistemological split currently visible in Western society. The predominant reality system of the Western world remains rooted in Cartesian/Newtonian, nineteenth-century mechanistic and reductionistic "common sense," even though the basis for a new, nonmechanistic and nonreductionistic reality system has been emerging in the twentieth century. The juxtaposition of both reality systems in the field of family therapy has produced much confusion. This article attempts to clarify the basis for that confusion.     

Attachment within family systems: An overview

A family systems approach provides a context for the development and maintenance of dyadic attachment relationships. An attachment approach provides a focus on the expression of and response to attachment behavior within a family. Uniting the two approaches has implications for both research and intervention. Characteristics of attachment theory and family systems theory are briefly outlined: Both involve systemic thinking. Different styles of interacting at the level of the family as a whole, working models of relationships, and dyadic interactions appear to correspond in a coherent way. Further research is needed in order to identify which dimensions of family functioning are relevant to the development of secure attachments, and how the relevant dimensions may change with age and stage in the family life cycle. This will provide targets for preventive interventions, with the development of secure relationships as a primary goal.     

Systemic family therapy can be manualized: research process and findings

Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self-report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned.
A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described.
The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.     

The Adult Attachment Interview and self-reports of attachment style: an empirical rapprochement

Although 10 studies have been published on the empirical overlap of the Adult Attachment Interview (AAI) and measures of self-reported attachment style, results in this literature have been inconsistently interpreted in narrative reviews. This report was designed as a rapprochement of the AAI and attachment style literatures and includes 3 studies. Study 1 (combined N = 961) is a meta-analytic review showing that by J. Cohen's (1992) criteria (mean r = .09), the association between AAI security and attachment style dimensions is trivial to small. Study 2 (N = 160) confirms meta-analytic results with state-of-the-art assessments of attachment security and also examines attachment dimensions in relation to the Big 5 personality traits. Finally, Study 3 is an investigation of 50 engaged couples that shows that developmental and social psychological measures of attachment security predict somewhat distinct--though theoretically anticipated--aspects of functioning in adult relationships.     

Attachment theory and systemic practice: research update

Attachment theory offers a way of thinking about the dyadic relationships within the family system. Family systems theory and therapy can contribute to attachment theory, as dyadic relationships do not exist in isolation but within the context of other relationships. Research at the interface between systemic practice and attachment theory is reviewed with examination of the central role they may play together in the developing understanding of family relationships.     

Work-life benefits and organizational attachment: Self-interest utility and signaling theory models

This study examines two competing theoretical explanations for why work-life policies such as dependent care assistance and flexible schedules influence organizational attachment. The self-interest utility model posits that work-life policies influence organizational attachment because employee use of these policies facilitates attachment. The signaling model posits that these policies facilitate attachment indirectly through perceived organizational support. Regression analyses explored both models using a sample of 286 full time employees. Results supported both the signaling model and the self-interest utility model. For women, the availability of work-life benefits influenced organizational attachment irrespective of use, and these effects were mediated by support perceptions, consistent with the signaling model. In contrast, the self-interest model was also supported for men only. Specifically, the availability and use of flexible schedules interacted in predicting affective commitment among men such that flexible schedule availability was positively related to commitment only when use was high and negatively related to commitment when use was low. Dependent care assistance and schedule flexibility also interacted in predicting affective commitment, turnover intentions, and perceived organizational support, suggesting that the effect of policy implementation may depend on what other policies are already offered by the organization. Findings are discussed in terms of implications for theory and organizational practice.     

Guidelines for clinicians considering family therapy research

This paper is written by clinicians for clinicians who are thinking about or planning to evaluate family therapy. The basic premise is that to be successful a research project must be built from the beginning on a very solid foundation. This foundation is built from a careful consideration of various research problems which are interrelated yet which can be solved when addressed in a particular sequence. The paper describes eight stages which must be followed in any research project. The authors illustrate these stages with examples from their own experience with a family therapy process research study lasting five years. This project did not produce reliable results, but the authors learnt important lessons about such things as the way a particular theory may lead a researcher to select data which cannot be reliably observed; and the way in which practical constraints can erode the reliability of the outcome. Discussion of why and where the project went wrong offers direction and warnings for the prospective clinician/researcher.     

Applying Delphi methodology in family therapy research

The Delphi technique, which is increasingly seen in family therapy publications, encourages the articulation of refinement in family therapy practice and theory. Combining both quantitative and qualitative methodology, this technique involves consideration of information that might otherwise have been overlooked. Due to lack of clarity on this approach, a dilemma exists in applying this research procedure in family therapy. To remedy this deterrent, this paper reviewed 11 studies and outlined use of the technique in regard to design, procedure, and sampling.     

Introducing research methods and reflexivity into family therapy training

Research training does not always sit easily with family therapy trainees due to the perceived difficulty of the terrain and the mismatch between the primacy given to research and their developing expertise in the clinical work. Despite these tensions, research forms a core component to advanced training and is a requisite module for students completing an M.Sc. Following the provision of suboptimal teaching in research methods for M.Sc. candidates, a substantial redesign of the course was undertaken, taking into account the context of students' learning. This paper reports on the contextual influences on this new approach, and outlines the key pedagogical strategies that support student learning within the formal teaching sessions and beyond. We present a summary of the outcomes so far.     

Attachment, caregiving, and altruism: boosting attachment security increases compassion and helping

Recent studies based on J. Bowlby's (1969/1982) attachment theory reveal that both dispositional and experimentally enhanced attachment security facilitate cognitive openness and empathy, strengthen self-transcendent values, and foster tolerance of out-group members. Moreover, dispositional attachment security is associated with volunteering to help others in everyday life and to unselfish motives for volunteering. The present article reports 5 experiments, replicated in 2 countries (Israel and the United States), testing the hypothesis that increases in security (accomplished through both implicit and explicit priming techniques) foster compassion and altruistic behavior. The hypothesized effects were consistently obtained, and various alternative explanations were explored and ruled out. Dispositional attachment-related anxiety and avoidance adversely influenced compassion, personal distress, and altruistic behavior in theoretically predictable ways. As expected, attachment security provides a foundation for care-oriented feelings and caregiving behaviors, whereas various forms of insecurity suppress or interfere with compassionate caregiving.     

Talking to children about family therapy: a qualitative research study

In an exploratory study a number of children were interviewed some time after family therapy. Their responses were analysed using grounded theory methodology. Outcomes indicate that for children, family therapy is potentially a complex arena in which ambiguities and ambivalences are present. The children's position in the therapeutic session is discussed in terms of their role in the 'therapeutic circle'.     

Reflecting team processes in family therapy: a search for research

Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.