Clinical Applications of the Adult Attachment Interview

Edited by Howard Steele and Miriam Steele
Foreword by June Sroufe
Afterword by Deborah Jacobvitz

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March 3, 2008
ISBN 9781593856960
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501 Pages
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The Adult Attachment Interview (AAI) is both a mainstay of attachment research and a powerful clinical tool. This unique book provides a thorough introduction to the AAI and its use as an adjunct to a range of therapeutic approaches, including cognitive-behavioral therapy, psychoanalytic psychotherapy, parent-infant psychotherapy, home visiting programs, and supportive work in the context of foster care and adoption. Leading authorities provide detailed descriptions of clinical procedures and techniques, illustrated with vivid case material. Grounded in research, the volume highlights how using the AAI can enhance assessment and diagnosis, strengthen the therapeutic alliance, and facilitate goal setting, treatment planning, and progress monitoring.

“This book provides a thorough introduction to the instrument, its coding, and classification system. But its main contribution is the way in which it brings together leading experts in the field to present research findings and case material to show how the AAI can systematically be used in assessment and diagnosis, to design and tailor interventions, to facilitate goal setting and treatment planning, to inform and strengthen the therapeutic alliance, and to monitor therapeutic progress....[A] timely, well-presented, and valuable book, every chapter of which provides illuminating insights and evidence of the range and depth of the AAI's multiple uses. It should be of considerable interest to clinicians and practitioners from all disciplines, as well as to researchers, and students.”

British Journal of Psychiatry


“Because the AAI is such a pervasive technique for conducting attachment research and understanding attachment relationships, this detailed volume is worthwhile for any practitioner interested in applying the theory of attachment.”

EABP Newsletter


“Steele and Steele have brought together a really valuable set of data and ideas concerning the Adult Attachment Interview (AAI), one of the more intriguing and powerful clinical and research tools available in psychology. The book stands out as a serious and ambitious attempt to translate the AAI—and attachment theory more broadly—to multiple clinical contexts. Chapters are written by leading clinicians and scientists, and each is focused and thoughtful, showing, for example, how the AAI informs case conceptualization in individual treatment. This volume deserves to be widely read. It is highly accessible for those just beginning to apply attachment theory to research and practice, but there is also enough that is new to please experienced fans of the AAI.”

—Thomas G. O'Connor, PhD, Department of Psychiatry, University of Rochester Medical Center


“Exceptionally coherent and immensely helpful, this book comprehensively reviews how the Adult Attachment Interview (AAI) can be used to guide clinical work in a range of high-priority contexts. This remarkable instrument, which has more than proved itself in the developmental laboratory, also turns out to be a marvelous and versatile tool in the hands of the creative clinician. An essential book for all those who work with children and adults.”

—Peter Fonagy, OBE, FMedSci, FBA, FAcSS, Head, Division of Psychology and Language Sciences, University College London, United Kingdom; Chief Executive, Anna Freud Centre


“This impressive volume reports novel theoretical insights and clinical practices inspired by the Adult Attachment Interview (AAI). The authors use groundbreaking empirical studies, illustrated with fascinating and emotionally moving case examples, to show how AAI-related interventions help troubled, disadvantaged parents and children. The book illustrates beautifully how science and society benefit from a coherent integration of profound theory, clinical creativity, and ambitious but careful research. It is highly relevant to researchers, clinicians, and child welfare policymakers, as well as advanced students in psychology, psychiatry, social work, social policy, and related fields.”

—Phillip R. Shaver, PhD, Distinguished Professor of Psychology, University of California, Davis

Table of Contents

Foreword, June Sroufe

I. The AAI in Clinical Context

1. Ten Clinical Uses of the Adult Attachment Interview, Howard Steele and Miriam Steele

2. Studying Differences in Language Usage in Recounting Attachment History: An Introduction to the Adult Attachment Interview, Mary Main, Erik Hesse,and Ruth Goldwyn

3. The Distribution of Adult Attachment Representations in Clinical Groups: A Meta-Analytic Search for Patterns of Attachment in 105 AAI Studies, Marinus H. van IJzendoorn and Marian J. Bakermans-Kranenburg

II. Intervention Research with Mothers, Infants, and Toddlers

4. The AAI Anticipates the Outcome of a Relation-Based Early Intervention, Christoph M. Heinicke and Mónica Susana Levine

5. Adult Attachment, Parental Commitment to Early Intervention, and Developmental Outcomes in an African American Sample, Douglas M. Teti, Lauren A. Killeen, Margo Candelaria, Wendy Miller, Christine Reiner Hess, and Melissa O’Connell

6. Attachment-Theory-Informed Intervention and Reflective Functioning in Depressed Mothers, Sheree L. Toth, Fred A. Rogosch, and Dante Cicchetti

III. Parent–Infant Relationships, Adolescents, and Adults in Psychotherapy

7. The AAI as a Clinical Tool, Amanda Jones

8. Integrating the AAI in the Clinical Process of Psychoanalytic Parent–Infant Psychotherapy in a Case of Relational Trauma, Tessa Baradon and Miriam Steele

9. Obsessive–Compulsive Disorder in Adolescence: An AAI Perspective, Tord Ivarsson

10. The AAI in a Clinical Context: Some Experiences and Illustrations, Massimo Ammaniti, Nino Dazzi, and Sergio Muscetta

11. The Reciprocal Impact of Attachment and Transference-Focused Psychotherapy with Borderline Patients, Diana Diamond, Frank E. Yeomans, John F. Clarkin, Kenneth N. Levy, and Otto F. Kernberg

IV. The AAI and Trauma

12. The AAI and Its Contribution to a Therapeutic Intervention Project for Violent, Traumatized, and Suicidal Cases, Sonia Gojman de Millán and Salvador Millán

13. Adult Attachment and Posttraumatic Stress Disorder in Women with Histories of Childhood Abuse, K. Chase Stovall-McClough, Marylene Cloitre, and Joel F. McClough

14. AAIs in a High-Risk Sample: Stability and Relation to Functioning from Adolescence to 39 Years, Judith A. Crowell and Stuart T. Hauser

15. Exploring the Mind Behind Unresolved Attachment: Lessons from and for Attachment-Based Interventions with Infants and Their Traumatized Mothers, Greg Moran, Heidi Neufeld Bailey, Karin Gleason, Carey Anne DeOliveira, and David R. Pederson

16. Hostile–Helpless States of Mind in the AAI: A Proposed Additional AAI Category with Implications for Identifying Disorganized Infant Attachment in High-Risk Samples, Sharon Melnick, Brent Finger, Sydney Hans, Matthew Patrick, and Karlen Lyons-Ruth

V. The AAI, Foster Care, and Adoptive Placements

17. Forecasting Outcomes in Previously Maltreated Children: The Use of the AAI in a Longitudinal Adoption Study, Miriam Steele, Jill Hodges, Jeanne Kanuik, Howard Steele, Saul Hillman, and Kay Asquith

18. Helping Foster Parents Change: The Role of Parental State of Mind, Johanna Bick and Mary Dozier

Afterword, Deborah Jacobvitz


About the Editors

Howard Steele, PhD, is Professor and Chair of the Clinical Psychology Faculty and Co-Director of the Center for Attachment Research at The New School for Social Research. Dr. Steele is senior and founding editor of the journal Attachment and Human Development and founding and past president of the Society for Emotion and Attachment Studies. He has published more than 100 journal articles and book chapters, many in collaboration with Miriam Steele, in the areas of attachment theory and research, intergenerational patterns of attachment, mourning in response to trauma and loss, and attachment-based interventions to prevent child maltreatment and promote secure, organized attachments. With Miriam Steele and Anne Murphy, Dr. Steele has pioneered the development of Group Attachment-Based Intervention (GABI©), aimed at preventing child maltreatment and promoting attachment security. He is a recipient of the 2017 Bowlby–Ainsworth Award from the Center for Mental Health Promotion, which cited his contributions as a scientist, editor, and clinical innovator.

Miriam Steele, PhD, is Professor of Psychology and Co-Director of the Center for Attachment Research at The New School for Social Research. She trained as a psychoanalyst at the Anna Freud Centre. Her work aims to bridge the world of psychoanalytic thinking and clinical practice with contemporary research in child development. She initiated the London Parent–Child Project, a major longitudinal study of intergenerational patterns of attachment that gave rise to the concept of "reflective functioning." She has published more than 100 journal articles and book chapters, many in collaboration with Howard Steele. With Howard Steele and Anne Murphy, Dr. Steele has pioneered the development of Group Attachment-Based Intervention (GABI©), aimed at preventing child maltreatment and promoting attachment security. She is a recipient of the 2017 Bowlby–Ainsworth Award from the Center for Mental Health Promotion, which cited her innovative longitudinal studies and translational research on attachment and mental representation.

Contributors

Massimo Ammaniti, MD, Department of Dynamic and Clinical Psychology, University of Rome, Rome, Italy

Kay Asquith, MSc, Anna Freud Centre, London, United Kingdom

Heidi Neufeld Bailey, PhD, Department of Psychology, University of Guelph, Guelph, Ontario, Canada

Marian J. Bakermans-Kranenburg, PhD, Center for Child and Family Studies, Leiden University, Leiden, The Netherlands

Tessa Baradon, MA, Parent–Infant Project, Anna Freud Centre, London, United Kingdom

Johanna Bick, BA, Department of Psychology, University of Delaware, Newark, DE

Margo Candelaria, PhD, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, MD

Dante Cicchetti, PhD, Mt. Hope Family Center, University of Rochester, Rochester, NY; Institute of Child Development and Department of Psychiatry, University of Minnesota, Minneapolis, MN

John F. Clarkin, PhD, Personality Disorders Institute, Department of Psychiatry, New York Presbyterian Hospital, Weill Cornell Medical College and Graduate School of Medical Sciences of Cornell University, New York, NY

Marylene Cloitre, PhD, Child Study Center, Institute for Trauma and Stress, New York University School of Medicine, New York,NY

Judith A. Crowell, MD, Department of Child and Adolescent Psychiatry, State University of New York, Stony Brook, NY

Nino Dazzi, PhD, Department of Dynamic and Clinical Psychology, University of Rome, Rome, Italy

Carey Anne DeOliveira, PhD, Department of Psychology, University of Western Ontario, London, Ontario, Canada

Diana Diamond, PhD, Department of Psychology, The City College and Graduate Center, City University of New York; Personality Disorders Institute, Department of Psychiatry, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY; New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, New York, NY

Mary Dozier, PhD, Department of Psychology, University of Delaware, Newark, DE

Brent Finger, BA, Department of Comparative Human Development, University of Chicago, Chicago, IL

Karin Gleason, CPsych, Riverside Educational Services, London, Ontario, Canada

Ruth Goldwyn, PhD, Academic Department of Child and Adolescent Psychiatry, University of Manchester, Manchester, United Kingdom

Sydney Hans, PhD, School of Social Service Administration, University of Chicago, Chicago, IL

Stuart T. Hauser, MD, PhD, Judge Baker Children's Center and Department of Psychiatry, Harvard Medical School, Cambridge, MA

Christoph M. Heinicke, PhD, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA

Christine Reiner Hess, PhD, Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD

Erik Hesse, PhD, Department of Psychology, University of California, Berkeley, CA; Center for Child and Family Studies, Leiden University, Leiden, The Netherlands

Saul Hillman, MSc, Anna Freud Centre, London, United Kingdom

Jill Hodges, PhD, Brain and Behavioral Sciences Unit, Institute for Child Health; Anna Freud Centre; Department of Child and Adolescent Mental Health, Great Ormond Street Hospital, London, United Kingdom

Tord Ivarsson, MD, PhD, Department of Child and Adolescent Psychiatry, Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden

Amanda Jones, DSysPsyc, NHS Parent–Infant Mental Health Service, North East London Mental Health Trust, London, United Kingdom

Jeanne Kaniuk, BA, Coram Family, London, United Kingdom

Otto F. Kernberg, MD, Personality Disorders Institute, Borderline Personality Disorder Resource Center, Department of Psychiatry, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY; Columbia University Center for Psychoanalytic Training and Research, New York, NY

Lauren A. Killeen, MS, Department of Psychology, Pennsylvania State University, University Park, PA

Mónica Susana Levine, LCSW, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA

Kenneth N. Levy, PhD, Department of Psychology, Pennsylvania State University, University Park, PA; Personality Disorders Institute, Department of Psychiatry, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY

Karlen Lyons-Ruth, PhD, Department of Psychiatry, Harvard Medical School, Cambridge, MA

Mary Main, PhD, Department of Psychology, University of California, Berkeley, CA

Joel F. McClough, PhD, Child Study Center, Institute for Trauma and Stress, New York University School of Medicine, New York, NY

Sharon Melnick, PhD, private practice, New York, NY

Salvador Millán, MD, Seminario de Sociopsicóanálisis A.C., Mexico City, Mexico

Sonja Gojman de Millán, PhD, International Federation of Psychoanalytic Societies and Seminario de Sociopsicóanálisis A.C., Mexico City, Mexico

Wendy Miller, PhD, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, MD

Greg Moran, PhD, Department of Psychology, University of Western Ontario, London, Ontario, Canada

Sergio Muscetta, MD, Department of Dynamic and Clinical Psychology, University of Rome, Rome, Italy

Melissa O.Connell, PhD, Child Development Program, Children's National Medical Center, Washington, DC

Matthew Patrick, MD, Tavistock Clinic, London, United Kingdom

David R. Pederson, PhD, Department of Psychology, University of Western Ontario, London, Ontario, Canada

Fred A. Rogosch, PhD, Mt. Hope Family Center, University of Rochester, Rochester, NY

Howard Steele, PhD, Department of Psychology, The New School for Social Research, New York, NY

Miriam Steele, PhD, Department of Psychology, The New School for Social Research, New York, NY

K. Chase Stovall-McClough, PhD, Child Study Center, Institute for Trauma and Stress, New York University School of Medicine, New York, NY

Douglas M. Teti, PhD, Human Development and Family Studies, Pennsylvania State University, University Park, PA

Sheree L. Toth, PhD, Mt. Hope Family Center, University of Rochester, Rochester, NY

Marinus H. van IJzendoorn, PhD, Center for Child and Family Studies, Leiden University, Leiden, The Netherlands

Frank E. Yeomans, MD, Personality Disorders Institute, Department of Psychiatry, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY

Audience

Psychotherapists who treat adults and children, including clinical psychologists, psychiatrists, social workers, and counselors; developmental and clinical researchers; students in these areas.

Course Use

May serve as a supplemental text in graduate-level courses in attachment theory or attachment-based psychotherapy.