To Be Met as a Person: The Dynamics of Attachment in Professional Encounters

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TO BE MET AS A PERSON
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TO BE MET AS A PERSON
The Dynamics of Attachment in
Professional Encounters
Una McCluskey
KARNAC

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Contents
Acknowledgments xi
Foreword by Peter D. Campion xiii
Preface xv
1 The dynamics of careseeking and caregiving
Introduction 1
Origins of interest in attunement in therapy 9
Structure of the book 13
2 Research on the process of interaction in adult psychotherapy
Introduction 15
The work of the Chicago Group: 1940–1960 18
From a focus on the individual to a focus on interaction: 1960–1980 23
Psychotherapy research: 1980–2000s 25
Conclusion 28
3 Infant/caregiver interactions: the process of affect identification,
communication, and regulation
Introduction 30
From deduction to construction: from Melanie Klein to Gyorgy Gergely 32
Affect regulation is linked with caregiving from the start of life 35
Correct identification of affect by the caregiver affects the infant’s
developing sense of self 37
How caregivers communicate to infants that they understand their
affective state: the process of affect attunement 40
Infants’ responsiveness to affective interaction with caregivers and
their response to loss of contact with caregivers 43
Caregiver/infant interactions: the patterning of relationship 46
Patterns of affect attunement associated with effective caregiving 47
Affect attunement and empathy 49
Summary 51
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4 Patterns of careseeking/caregiving relationships: research into
attachment behaviour in infants and young children
Introduction 54
Attachment theory 56
Internal working models of the experience of relationship 56
Attachment classification: stable and persistent over time 57
The adult attachment interview 58
Careseeker/caregiver dyads: communication patterns in relation
to affect 59
Careseeker/caregiver dyads: interaction patterns in relation to play 60
Careseeker/caregiver dyads: interaction strategies based on secure
or insecure relationships 61
Effective caregiving: attunement to a range of affect 64
Summary 66
5 Presenting the concept of goal-corrected empathic attunement:
effective caregiving within psychotherapy
Introduction 70
The attachment dynamic 71
The system for exploration 73
Goal-corrected empathic attunement: a process involved in
effective caregiving 74
The psychotherapeutic relationship: an account of interactional
sequences using the concept of goal-corrected empathic attunement 75
Where have we come so far? 83
6 First experiment: the identification of affect attunement in
adult psychotherapy
Introduction 89
The reasearch design 90
First experiment 91
Materials and procedure 92
Subjects 93
Results 93
Table 1: Ratings of excerpts given by the experts 94
Table 2: Rating of the excerpts by experts and students 94
Characteristics of an ‘attuned’ therapist 96
Characteristics of a ‘non-attuned’ therapist 97
Discussion 98
Summary 101
7 Second experiment: is empathic attunement interactive?
Introduction 102
Hypothesis 102
Overview of the experiment 102
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CONTENTS VII
Methodology: subjects 103
Method of allocation to groups 103
Table 3: The experimental group and the control group 103
Confidentiality 104
Materials and practical arrangements 104
Procedure 104
Rating instruments 105
The mechanics of the debriefing 105
My experience of the debriefing sessions 106
Manging and collating the qualitative material 106
Statistical analysis 107
Correct identification of attuned and non-attuned excerpts by the
experimental group and the control group 107
Qualitative analysis 108
Chart 1: Correct and incorrect identification of verbal and
non-verbal behaviour 110
Chart 2: Interpretation of non-attuned extract 115
Discussion 118
Summary 120
8 Third experiment: an experiment designed to test whether
secure attachment style correlates with empathic attunement
and whether empathic attunement can be improved with
training
Introduction 122
Overview 123
Table 4: The design and rationale for the study 124
Reasons for employing professional actors 124
Hiring the actors 125
Reasons for deciding the number of actors and students to be
involved 125
Constructing the scenarios 126
Creating a control group and an experimental group for the
purposes of training 127
The process of creating matched pairs 127
Creating a measure of caregiving: the careseeker’s and
caregiver’s perspectives 127
Briefing for the students 128
Briefing for the actors 129
Briefing for the cameramen 129
Observations of the day 130
Training 132
Discussion 132
Experiment time two 133
Attachment questionnaires 133
Summary 135
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9 The process of obtaining a reliable measure for
goal-corrected empathic attunement
Introduction 136
Phase one: method 137
Creating a measuring instrument 137
Obtaining the clinical material 139
Modifying the rating instrument 143
Creating a second measuring instrument 143
Rating procedure 145
Issues arising from the first attempt at getting a reliable rating 147
Involving a second independent rater 147
Table 5: Empathic attunement score correlation between two
independent raters and self 148
Phase two: method 148
Table 6: Empathic attunement between independent rater and self 150
Table 7: Scores of all three raters for each of the 12 students 150
Learning from our mistakes or repeating our mistakes 151
Analysis of our attempts so far 152
Example 1: Goal-corrected empathic attunement within the
context of psychotherapy 155
Example 2: Poor goal-correctedempathic attunement 156
Phase three: method 157
Technique for managing defensive processes 158
Table 8: Correlation between the two independent raters on
21 segments of tape taken from four interviews 159
Table 9: Correlation between the two independent raters on the
average of 1.5-minute segments of tape from twelve interviews 160
Table 10: Correlation between the two independent raters on
twelve tapes 160
Summary 161
10Results of the Third Experiment
Introduction 162
Measures 163
Table 11: Internal consistency of the scales involved in caregivers’
measure of caregiving 164
Table 12: Frequency of distribution: caregivers’ (students’) score 164
Subjective measures of empathic attunement: careseekers’ (actors’)
score 164
Chart 3: Students’ score/frequency of distribution 165
Table 13: Internal consistency of the scales involved in careseekers’
measure of caregiving 166
Table 14: Frequency of distribution: careseekers’ (actors’) score 166
Chart 4: Actors’ score/frequency of distribution 167
Chart 5: Independent measure of GCEA/frequency of distribution 167
Correlations between the measurers 168
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CONTENTS IX
Table 15: Correlation between measures of careseeker/caregiver
interaction 168
Chart 6: Student score by actor score 169
Analysis of variance 170
Table 16: Analysis of variance student score 170
Table 17: Analysis of variance actor score (total score) 170
Table 18: Analysis of variance: independent measure 171
Summary 171
Goal-corrected empathic attunement and attachment style 172
Table 19: Correlation between measures of compulsive caregiving
and insecure attachment with the careseekers’, caregivers’
and the independent scores for empathic attunement 173
Chart 7: Goal-corrected attunement score by attachment score 174
Chart 8: Mean goal-corrected attunement score by predicted
GCEAscore 175
Results of training: Experimental group 176
Table 20: Trained students’ average scores: day one and day two 177
Table 21: Student, time and student score: an analysis of variance 177
Table 22: Student, time and actor score: an analysis of variance 178
Table 23: Student, time and independent score: an analysis of variance 178
Results of training: Control group 179
Table 24: Average scores for untrained students on day one and day
two: self-assessment. Actors’ scores and empathic attunement scores 179
Table 25: Student, time and score: an analysis of variance 180
Table 26: Student, time and actor score: an analysis of variance 180
Improvement score 181
Table 27: Students’ average score at time 1: independent rater 181
Table 28: Caregivers’ (students’) average score at time 2: independent
rater 181
Table 29: Improvement score for experimental and control groups 182
Table 30: Improvement score for careseeker (actor) and caregiver
(student) 182
Table 31: Student, time and independent score: an analysis of variance 183
Measures 184
Attachment style and independent measure of goal-corrected
empathic attunement 185
Training 186
Conclusion 188
11Patterns of functional and dysfunctional careseeking-caregiving
partnerships
Introduction 189
Extended attachment theory and goal-corrected instinctive systems 191
Data 193
Interactions patterns and the emotive messages that accompany them 196