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Few studies have compared different systems in classifying Adult Attachment Interview (AAI) transcripts. In this study, the AAI was administered to 90 Italian parents (45 couples), and the AAI transcripts were independently classified according to Main, Goldwyn, and Hesse’s (Berkeley) and Crittenden’s (Dynamic-Maturational Model [DMM]) criteria. The two classification systems were not significantly associated, with some limited convergent results only when the interviews resulted in organized (Berkeley) and normative (DMM) attachment classifications. Otherwise, the Berkeley system identified more secure individuals than the DMM system, and many texts judged secure on the Berkeley system were identified as insecure on the DMM system. Since the Berkeley and the DMM systems rest on remarkably different conceptualizations of the nature and functioning of the attachment behavioral system (e.g. fear is conceived as organizing in the DMM and as potentially disorganizing in the Berkeley), the attachment classifications resulting from their applications should not be considered measurements of the same phenomena.

Background Although childhood endangerment often precedes adult posttraumatic stress disorder (PTSD), the mechanism from danger to disorder is unclear. We proposed a developmental process in which unprotected and uncomforted danger in childhood would be associated with “shortcuts” in information processing that, in adulthood, could result in PTSD if the adult experienced additional exposure to danger. Information processing was defined as the basic associative, dissociative, and integrative processes used by all humans. Individual differences in parents’ (or primary caregivers’) protective and comforting behavior were expected to force unprotected children to use psychological shortcuts that linked early trauma to later vulnerability for PTSD. Method We compared 22 adults with chronic PTSD to (a) 22 adults with other psychiatric diagnoses and (b) 22 normative adults without any diagnosis, in terms of information processing around childhood danger. The Adult Attachment Interview was used to derive information processing variables, including self-protective strategies, childhood traumas, and depression. Results The two patient groups differed from the normative group on all variables. Adults with chronic PTSD differed from other psychiatric patients in having more childhood traumas and using more transformations of associative and dissociative processes. Within the PTSD group, there were three psychologically different subgroups. Conclusion Our findings suggest that (1) prediction of risk for adult PTSD may be possible, (2) treatment might be facilitated by provision of a protective and supportive therapist, (3) who included a focus on correction of information processing errors and use of more adaptive strategies, and (4) subgroups of adults with PTSD may require different forms of treatment.

This is the first of three issues of the DMM News dedicated to the Adult Attachment Interview (AAI)! In these long-awaited special editions, the applications of the AAI based on the Dynamic-Maturational Model (DMM-AAI) in different fields (clinical, research, forensic) are presented by several of our AAI trainers. The three articles of this issue are centered on parents, their self-protective needs, and how knowledge about these issues may be helpful in court proceedings and treatment planning. Andrea Landini, Rebecca Carr-Hopkins and Alison Dunkerly describe the assessment of parents in family court proceedings to decide whether and how parents will be allowed to raise their children. They also highlight parental self-protective needs and resources, rather than focusing solely on parental limitations. Treatment plans are outlined in which parental self-protective needs, their influence, and sometimes interference in their relation to their children become a prominent focus. At the end of this newsletter, there is a list of upcoming 2013 DMM Courses. If – after reading – you want to learn more, you can also check The Family Relationship Institute website www.familyrelationsinstitute.org. The next training for the DMM-AAI will take place at the Tavistock Center, London (Jun. 4-9, Oct. 8-13 and Nov. 18-23, 2013). The Trainer is Andrea Landini (for information and to register contact: pmcrittenden@gmail.com).

Preterm birth is a stressful and potentially traumatic event for the family. In this critical situation, the psychological characteristics of the father are important for the protection of the family and for the child development. The paternal function is manifested not only by supporting and encouraging his partner to foster a good mother-child bond, but also directly in the relation with the child. Aim of this research was to study the influence of attachment forerunners and dyadic sensitivity of the father in the child development. A sample of 110 father-child couples, 55 with preterm born children (birth weight < 1500 g) and 55 with term born children were assessed from the first 6 months of corrected age. At 3 months of corrected age of the baby, all couples were subjected to CARE-Index, a video-recorded procedure of adult-child spontaneous interaction evaluating parental sensitivity and attachment forerunners. The child’s psychomotor development was assessed at 6 months of corrected age by the Bayley Scales of Infant Development (BSID III). Fathers of preterm children, compared to controls, showed lower dyadic sensitivity scores (p < .01) and more frequent insecure attachment forerunners (p < .01). 75% of these “preterm” fathers falls into the high risk category of the CARE-Index (requiring psychological and/or pharmacological treatment). These factors were associated with lower scores on the psychomotor development of the children at 6 months of corrected age (p < .01). The presence of insecure attachment forerunners and poor dyadic sensitivity – even in fathers with term children – seems to have a negative effect on the psychomotor development of child (p < .05). The results underlines the extreme importance of the quality of the relationship of the father with his baby from the first months of life. Poor parental sensitivity and insecure attachment forerunners influence negatively the psychomotor development of the newborn.

The interest of the University of Bologna in the Dynamic-Maturational Model (DMM) began in 2000, when Patricia Crittenden was contacted regarding a longitudinal research, founded by the Italian Ministry of Education, University, and Research (MUIR) on “The development of attachment and the onset of psychological suffering in pregnancy and post-partum”. In 2001, the Attachment Assessment Lab (AAL) was founded at the Department of Psychology, and Patricia Crittenden and Andrea Landini became official partners and advisers. AAL activities includes many DMM based research, in particular on the transmission of attachment, on the attachment in families of preterm born children, and on attachment in psychotherapy. Annual conferences, seminars and training courses on the DMM are organized by the AAL, including a course from 2001 to 2005 on the administration and coding of the Adult Attachment Interview (AAI) following DMM criteria. This led to the training of the first Italian reliable coders, very active in Italian and international research. Franco Baldoni, Head of the Attachment Assessment Lab, is the International Editor and the editor of the Italian Edition of DMM News, the official journal of IASA. In 2008, at the University Centre of Bertinoro, University of Bologna, the 1st Biennial Conference of IASA was held, attended by about 200 researchers from 10 different countries. The teaching of the DMM in academic programs at the University of Bologna includes the fundamentals of the DMM, taught by Franco Baldoni in the “Clinical Methodology” course and short workshops on the CARE-Index and on DMM based AAI conducted by AAL collaborators, at the “Magistrale” degree in Clinical Psychology (a two years degree after the bachelor in Psychology). These classes are taught in Italian, but the degree course provides also some English lessons. Finally, AAL activities include internships and stages for students and mentorships for thesis and research.

Desperation is a helpless mental state that drives people to abandon their usual behavior and to seek help from others (Crittenden 1997). It represents a last attempt to protect oneself by communicating one’s state to someone else. Therefore, it reflects a final shred of hope and has adaptive value. A case study will illuminate this concept.

Le désespoir est un état mental d’impuissance qui conduit les gens à abandonner leur comportement habituel et à chercher de l’aide auprès d’autres. (Crittenden 1997). Il représente une dernière tentative de se protéger en communiquant son état à quelqu’un d’autre. Il reflète donc une dernière lueur d’espoir et a une valeur adaptative. Une étude de cas éclaire ce concept.

Verzweiflung ist ein hilfloser mentaler Zustand, der Menschen dazu bringt, ihr gewöhnliches Verhalten aufzugeben und nach Hilfe von anderen zu suchen (Crittenden 1997). Es repräsentiert einen letzten Versuch, sich selbst zu schützen, in dem der eigene Zustand jemandem anderen mitgeteilt wird. Daher spiegelt es einen letzten Fetzen Hoffnung wider und hat einen adaptiven Wert. Eine Fallstudie wird dieses Konzept beleuchten.

La desesperación es un estado mental de indefensión que lleva a la gente a abandonar su conducta habitual y buscar la ayuda de otros (Crittenden, 1997). Representa un último intento de protección hacia el sí mismo, al comunicar el estado de uno mismo a un otro distinto. Por lo tanto, refleja una última señal de esperanza y posee un valor adaptativo. Un estudio de caso iluminará este concepto.

Отчаяние – это психическое состояние беспомощности, которое заставляет людей отступить от их обычного поведения и искать помощи у других (Криттенден, 1997). Это представляет собой последнюю попытку защитить себя, сообщая о своем состоянии кому-то еще. Поэтому, это отражает последний клочок надежды и имеет адаптивное значение. Тематическое исследование освещает это понятие.

The exposure to maltreatment and to conditions of danger during childhood and adulthood is very common among humans. In serious conditions of danger, when attachment strategies fail, adaptive defensive reactions can manifest themselves: the alternation of the expression of unsure avoidant and preoccupied patterns (A/C), as in PTSD, the desperation state, the depression state, up to the final state of learned hopelessness/helplessness (Crittenden, 1997). Desperation is a helpless mental state in which the help from others is actively researched. For this reason it preserves an adaptive value. This state can lead to a radical change in attachment strategy and promote the elaboration of traumatic experiences and the reorganization towards strategies more protective for the Self. A case of a women saved by her desperation state will be discussed. She suffered from anxiety, irritability, aggressive behaviour, endocrinal disease and was sexually abused by her father during adolescence. Using DSM-IV criteria the first diagnosis was: Anxiety Disorder associated with general medical condition (hyperthyroidism). Patient was submitted to two periods of Dynamic-Oriented Psychotherapy (one time a week). During first period, that lasted one year, a medical therapy was administered for an hyperthyroidism with exophthalmia. During the second period of psychotherapy, that lasted two years, an anti-depressive therapy was administered. Two months after the restarting of the psychotherapy attachment was assessed by AAI using DMM criteria. A few months after the second period of therapy, the physical state was normal, the psychological symptoms decreased, the spousal relationship improved and the relation with daughter and the patient’s mother improved. The attachment assessment with AAI revealed a partial Depression as a modifier, an unresolved trauma (preoccupied) for sexual abuse (no more blocked) and a A+ pattern. The configuration was: (Dp) Utr (p) sexual abuse A4-5 (7).

The aim of the research unit is to study the development of attachment, the psychological difficulties and the role of Father-Mother-Child relationship in the family with preterm birth child. We intend to study an experimental group consisting in 25 families with preterm-born children (birth weight < 1500gr) and a control group consisting in 25 families with term-born children (birth weight > 2500gr). The study is based on a longitudinal survey with gathering of data in four phases (1-3-6-12 months corrected age of the baby). The attachment assessment is conducted following the Dynamic-Maturational Model (DMM) criteria. The assessment instruments (CARE-index, Strange Situation, AAI) are administered and codified in blind conditions by expert and reliable operators trained in specific courses. The research unit will assess successively at 24 months the psycho-motor development of the child administrating the Bayley Scales of Infant Development (second edition, BSID II). At present, 10 preterm couples and 10 term couples were studied at 3 months corrected age. Preterm mothers and fathers presented high risk interactive behaviours at CARE index (low scores at Dyadic Sensibility Scale, p

Somatization is a generic and ambiguous concept widely utilized for pathological conditions where somatic symptoms are interpreted as the consequence of psychological problems or stress. It could be defined as “the transitory or persistent tendency to experiment or communicate psychological suffering as somatic symptoms and to search help for them” (Lipowski, 1988). In these patients symptoms are mainly visceral, but a lot of them also undergo psychological suffering (in particular, anxiety, depression and hypochondria) and the co-morbility with psychiatric diseases is very high. In most cases clinical or laboratory tests fail to find biological alterations that explain somatic symptoms, and the diagnosis is made by exclusion, becoming only an alibi for cultural ignorance or therapeutic inefficacy. In clinical practice, somatization is a complex problem that presents in a continuum from normal physiology to psychiatric suffering. The perception of the body activity in somatic or psychological ways depends on Illness Behaviour, i.e. “the ways in which individuals react to aspects of their own functioning which they evaluate in terms of health and illness” (Pilowsky, 1978). This disposition is highly conditioned by development, family education, cultural factors and by attachment experiences. In DMM perspective the tendency to deny or falsify negative forbidden affects (anger, fear, vulnerability, sexual excitation) is a characteristic of A configurations, especially type A+. In these cases, specific Abnormal Illness Behaviors are frequent and accompanied by somatization symptoms or functional syndromes. In some cases, the increase of emotional arousal is subjectively perceived only by its somatic aspects, the only ones that can be recognized and communicated. In this way, the subject can search help (from his attachment figure or from the doctor) for his somatic needs and not for psychological problems. In other cases, denial of the bodily signals of danger (pain, altered somatic perceptions, body function alterations) don’t permit an adequate search for psychological or medical help, resulting in the development of serious organic alterations and medical illnesses.