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Adult Attachment Assessment in Therapy: Client and Therapist Experiences

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Adult Attachment Assessment in Therapy: Client and Therapist Experiences ADULT ATTACHMENT ASSESSMENT IN THERAPY: CLIENT AND THERAPIST EXPERIENCES Aoife Kilroe B.A., H.Dip.Psych., M.Sc. Academic Supervisor: Dr Patrick Ryan, Course Director D. Clin. Psych. BA(Hons.) Psychology., D.Clin.Psych., Chartered Clin.Psych., PsSI. Field Supervisor: Simon Wale., Snr. Clinical Psychologist, M.Sc. Clinical Psychology Thesis submitted to the University of Limerick in fulfilment of the requirements for the degree of Doctor of Clinical Psychology (PhD in Clinical Psychology) Department of Psychology, University of Limerick. 2017. DECLARATION I declare that this thesis is my own work and has not been submitted as part of another degree at the University of Limerick or any other academic institution. _______________________ Aoife Kilroe April 2017 i ACKNOWLEDGEMENTS I would like to thank my academic supervisor Dr. Patrick Ryan for his expert advice and support. Thank you for your enthusiasm about this topic, and your encouragement throughout the research process. Your expertise and knowledge, of attachment theory and thesis writing, have contributed especially to this research. I would also like to express my gratitude to my field supervisor Simon Wale, for your guidance, advice and provision of immense clinical knowledge throughout this research. You were exceptionally helpful in getting the study up and running; and your insightful comments were always valuable. Thank you also for your support as my clinical supervisor and for your understanding of the pressures of completing research whilst on placement. I wish to express a sincere thank you to the nineteen participants who so kindly agreed to take part in this study. This research would not exist without your honest and open sharing of experiences. I greatly enjoyed meeting each of you, and have learned so much from your conversations. Finally I would like to thank my family and friends. In particular my parents, Lorna and James for your constant support and love throughout this thesis and my career journey. I can’t thank you enough. My sister Michelle for your encouragement all the way from New Zealand. To my grandmother, Margaret for your continued support and belief in my success. And to James, for all of your encouragement and motivation which has been so valued. All of you have helped me to achieve this piece of work, thank you. ii ABSTRACT Introduction: Previous research has suggested the potential value of assessing client attachment styles (e.g., Burke, Danquah, & Berry, 2016; Quijada, Kwapil, Tizón, Sheinbaum, & Barrantes-Vidal, 2015), and the value of using assessments therapeutically (e.g., De Saeger, Bartak, Eder, & Kamphuis, 2016; Ward, 2008). There however appears limited research exploring the lived experience of assessing client attachment styles. The present study sought to address this gap in research by exploring the impact of learning and discussing client attachment styles in therapy, for both clients and psychologists. Method: The attachment styles of nine clients, currently attending an adult mental health service, were assessed using the Experiences in Close Relationships-Revised questionnaire. Following this, five clinical psychologists delivered written feedback to these clients on their attachment styles within a therapy session. Semi-structured interviews were conducted and Interpretive Phenomenological Analysis was used to explore participant experiences. Results: Five main themes were found. Three themes portrayed client experiences, and two represented those of therapist. Client themes included: ‘Conceptualising the Self,’ ‘Towards Recovery,’ and ‘The Process of Attachment Style Learning.’ Therapist themes comprised: ‘“Both Going Forward Together,”’ and ‘Appraisal’. Discussion: This study contributes to the literature on adult attachment theory and the therapeutic use of assessments. The results suggest the value and impact that may be achieved through the provision of client attachment information. These findings are discussed in the context of existing literature. Implications, recommendations for future research, strengths, and limitations of this study are provided. iii TABLE OF CONTENTS Declaration .................................................................................................................................. i Acknowledgements .................................................................................................................... ii Abstract .................................................................................................................................... iii Table of Contents ...................................................................................................................... iv List of Tables ........................................................................................................................ iviii List of Figures ........................................................................................................................... ix List of Appendices .................................................................................................................... xi 1 Chapter 1: Introduction.................................................................................................... 1 1.1 Overview of Present Study .......................................................................................... 1 1.2 Thesis Structure ........................................................................................................... 2 1.2.1 Chapter 2: Literature Review ............................................................................... 2 1.2.2 Chapter 3: Methodology ...................................................................................... 2 1.2.3 Chapter 4: Research ............................................................................................. 2 1.2.4 Chapter 5: Discussion .......................................................................................... 3 2 Chapter 2: Literature Review .......................................................................................... 4 2.1 Chapter Introduction ................................................................................................... 4 2.2 Attachment Theory ...................................................................................................... 5 2.2.1 Core Concepts of Attachment Theory ................................................................. 5 2.2.2 Internal Working Models ..................................................................................... 7 2.2.3 Measurement of Attachment in Infants................................................................ 8 2.2.4 Adult Attachment Theory .................................................................................. 10 2.3 Measurement of Adult Attachment ........................................................................... 13 2.3.1 Attachment as Categorical or Dimensional ....................................................... 13 2.3.2 Stability of Adult Attachment over Time .......................................................... 17 2.3.3 Informal Assessment of Attachment .................................................................. 18 2.4 The Value of Assessing Client Attachment .............................................................. 19 2.4.1 ‘Red Flags’ ......................................................................................................... 19 iv 2.4.2 To Guide Formulation and Therapeutic Approach ............................................ 20 2.4.3 To Function as a Learning Experience for Clients ............................................ 22 2.5 The Therapeutic Utility of Assessments ................................................................... 22 2.5.1 The Impact of Psychological Assessments ........................................................ 24 2.6 Research Aim and Question ...................................................................................... 28 3 Chapter 3: Method .......................................................................................................... 30 3.1 Chapter Introduction ................................................................................................. 30 3.2 Rationale for Methodology ....................................................................................... 30 3.3 Interpretive Phenomenological Analysis .................................................................. 31 3.3.1 Phenomenology.................................................................................................. 31 3.3.2 Hermeneutics ..................................................................................................... 31 3.3.3 Idiography .......................................................................................................... 32 3.4 Participants ................................................................................................................ 32 3.4.1 Inclusion Criteria ............................................................................................... 34 3.5 Instruments ................................................................................................................ 34 3.5.1 Measure of Attachment Styles ........................................................................... 34 3.5.2 Interview Schedule............................................................................................. 35 3.6 Procedure ..................................................................................................................
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