Adult Attachment Interview – DMM method
The Adult Attachment Interview (AAI, George, Kaplan & Main, 1984; DMM-AAI Crittenden & Landini, 2011) consists of a series of questions that ask the speaker to consider their childhood experience and how this might affect their thoughts and behavior in the present, especially as parents. A particular feature of the AAI is that it asks for the same information in multiple ways; this permits exploration of conflicting ideas that could motivate incompatible behaviors. Individuals with less integration of thought and feeling, i.e., with varied and incompatible answers to the same question, are more likely to behave in unexpected and unacceptable ways than individuals with greater awareness of how the past motivates their current behavior. In addition, the AAI explores possible past traumas that could trigger extreme behavior.
The AAI is audio-recorded and then transcribed verbatim. Information is gained by attending both to the individual’s speech and their relationship with the interviewer. The DMM-AAI is analysed using a system of discourse analysis in which the content of the interview (what happened) is less important than how the speaker thinks about their childhood, as an adult.
The DMM-AAI has been validated in a number of empirical studies focussing on clinical issues: anxiety disorders (Hughes, Hardy & Kendrick, 2000); avoidant personality disorder (Rindal, 2000); borderline personality disorder (Crittenden & Newman, in press); eating disorders (Ringer, & Crittenden, 2007; Zachrisson & Kulbotten, 2006); factitious illness by proxy (Kozlowska, Foley, & Crittenden, 2006); maltreating mothers (Seefeldt, 1997); PTSD (Crittenden, & Heller, under review); sexual abuse (Haapasalo, Puupponen & Crittenden, 1999) and treatment outcomes (Gullestad, 2003). An AAI yields 6 types of information:
1. An attachment strategy, i.e., the way the speaker uses information to organize their behavior when they feel endangered or believe their children to be endangered (see figure 1);
2. A possible set of unresolved traumatic experiences that distort the person’s behavior without their being aware of it.
3. An over-riding distortion of the strategy such as depression;
4. A pattern of information processing
5. An interpreted developmental history of the speaker. This history combines information provided directly by the speaker with information derived from the pattern of errors (i.e., dysfluence) in the discourse. The interview cannot directly establish what actually happened to the speaker, but its interpretation can assist in understanding why the speaker thinks and behaves as he or she does. Level of parental reasoning (LPR, see figure 2, Crittenden, Lang, Claussen, & Partridge, 2000), i.e., how the parent thinks about making caregiving decisions for the children.
The levels range from
(0) abdication to
(3) individualistic and
(4) integrative reasoning.
Most parents function at levels 2-3. Level 0 is indicative of substantial risk, with level 1 reflecting risk of repeating or reversing to the opposite extreme the problems of one’s childhood. The LPR suggests the flexibility and sensitivity with which the parent will be able to interpret and respond to the child’s behaviour. References Crittenden, P. M., Lang, C., Claussen, A.H., & Partridge, M. F. (2000). Relations among mothers' procedural, semantic, and episodic internal representational models of parenting. In P. M. Crittenden and A. H. Claussen (Eds). The organization of attachment relationships: Maturation, culture, and context (pp. 214-233). New York: Cambridge University Press.
Crittenden, P. M., & Newman, L., (2010).
Comparing models of borderline personality disorder: Mothers’ experience, self-protective strategies, and dispositional representations. Clinical Child Psychology and Psychiatry, 15, 433-452. George, C., Kaplan, N., & Main, M. (1985-1996).
Adult Attachment Interview (third edition). Unpublished manuscript, Department of Psychology, University of California, Berkeley. Gogarty, H. (2002). Attachment relationships in the triad of foster-care: A retrospective analysis. Thesis submitted in partial fulfilment of the requirement for Doctor of Philosophy, University of Ulster, Coleraine, Ireland. Gullestad, S. E. (2003).
The Adult Attachment Interview and psychoanalytic outcome studies. International Journal of Psychoanalysis, 84, 651-668. Haapasalo, J., Puupponen, M. & Crittenden , P .M. (1999). Victim to victimizer: The psychology of isomorphism in a case of a recidivist pedophile. Journal of Child Sexual Abuse, 7, 97-115. Hautamäki, A., Hautamäki, L., Neuvonen, L., & Maliniemi-Piispanen, S. (2010). Transmission of attachment across three generations.
European Journal of Developmental Psychology, 7, 618- 634. Hughes, J., Hardy, G., & Kendrick, D. (2000). Assessing adult attachment status with clinicallyorientated interviews: A brief report. British Journal of Medical Psychology, 73, 279-283. Kozlowska, K., Foley, S., & Crittenden, P. M. (2006). Factitious illness by proxy:
Understanding underlying psychological processes and motivations. Australia and New Zealand Journal of Family Therapy, 27, 92-104. Main, M., & Goldwyn, R. (1984-1994). Adult attachment scoring and classification system. Unpublished manuscript, University of California at Berkeley, Department of Psychology. Rindal, G. (2000). Attachment patterns in patients diagnosed with avoidant personality disorder (Maskespill, Tilknytningsmxxnster Hos Pasienter med Unnvikende Personlighetsforstyrrelse) Dissertation presented to the Institute of Psychology, University of Oslo, ISBN 82-569-1568-4. Ringer, F., & Crittenden, P. M. (2007). Eating disorders and attachment:
The effects of hidden processes on eating disorders. European Eating Disorders Review, 15, 119-130. Seefeldt, L. (1997). Models of parenting in maltreating and non-maltreating mothers. Dissertation presented to the Faculty of the School of Nursing, University of WisconsinMilwaukee. Milwaukee, USA. Strathearn, L., Fonagy, P., Amico, J.A., Montague, P.R. (2009).
Adult attachment predicts mother's brain and peripheral oxytocin response to infant cues. Neuropsychopharmacology. Worley, K.O., Walsh, S. & Lewis, K. (2004). An examination of parenting practices in male perpetrators of domestic violence:
A qualitative study. Psychology and Psychotherapy: Theory, Research, and Practice. 77, 35-54. Zachrisson, H. D., & Kulbotten, G. R. (2006). Attachment in Anorexia Nervosa: An exploration of associations with eating disorder psychopathology and psychiatric symptoms. Eating Weight Disorders, 11, 163-170.
Attachment in Adulthood
Several competencies differentiate adult attachment from attachment in the transition to adulthood. Overall, they could be described as achieving ‘clarity’ and ‘balance’ for the function of raising children. For example, adults can differentiate needs from desires; because children cannot, adults must decide whether a child’s demand needs a response or is merely a desire. Similarly, adults can consider the needs and desires of several family members simultaneously and reach decisions about which to prioritize at any particular moment. It is particularly important to note that all family members (including parents) have needs and, as much as possible, needs should be met. Balance is the issue, that is, distributing the family’s resources as productively (as opposed to ‘equitably’) as possible. Adults can foresee consequences in the long-term, thus acting in the present in ways that will have long-term positive consequences. Children, often even adolescents, cannot do this. Adults form long-term committed love relationships. These relationships are mutually protective and comforting. Adults build conflict resolution skills that, together with their emotional commitment to one another, sustain the relationship through difficult periods. Finally, adults use these competencies to generate the resources to care for their children until they reach reproductive maturity (Crittenden, 2008; Rholes & Simpson, 2004)
Adults who were at risk in childhood have the possibility to use balanced reflective functioning (a late developing cortical process, not complete until the mid-thirties) in adulthood. Balanced reflective functioning can override the distorted neurological pathways (laid down in childhood) that lead to extreme self-protective behaviour. Being able to do this, however, requires:
(1) a period of reorganization (that usually begins in the transition to adulthood),
(2) sufficient time to engage in reflective thought,
(3) a stable life context that prevents crises (real or imagined) from catapulting one into self-protective action prior to reflection,
(4) practice, such that new response pathways are laid down, and
(5) gentle tolerance of mistakes - because mistakes are certain and punitive responses lead to increased self-protective behaviour.
The choice of attachment partner is crucial to being able to achieve stability and forgiving tolerance of mistakes. In cases of adult risk, adults have children without having the competencies described above. Being unclear about circumstances, they necessarily act in ways that are not protective and comforting, sometimes even endangering their children, each other, or themselves. Being unable to differentiate needs from desires and long-term benefits from short-term preferences, they often mis-direct their efforts. Being unable to manage competing needs, they often favor one person’s needs over another’s, either prioritizing the children, their spouse, or themselves, but failing to find a balance that promotes everyone’s development. When lack of money is the only issue, this can be provided and the family will function adequately. More often, however, it is the information processing that underlies attachment that is awry. When adults cannot process information to yield clarity of understanding and balanced responses, whole families are placed at risk (Busch, 2008).
Busch, F.N. (ed) (2008) Mentalization: Theoretical Considerations, Research Findings and Clinical Implications, New York: The Analytic Press. Rholes, W.S. and Simpson, J.A. (2004) Adult attachment: Theory, research, and clinical implications. New York: The Guilford Press