A THEORY OF CAREGIVING IN ADULT LIFE Developing and Measuringthe Conceptof Goal-Corrected Empathic Attunement In Two Volumes VOLUME ONE Una A. M. McCluskey Submitted for the degree of D. Phil. University of York Department of Social Policy and Social Work 2001 ABSTRACT This thesis presentsa theory of caregivingin adult life. I have used the context of psychotherapyto develop the theory. Within this theory I have developed the concept of goal-correctedempathic attunement (GCEA) which relatesto a processof interaction betweencareseekers and caregivers. The first part of the thesis introducesthe concept and seeksto ground it in research on psychotherapy,on the interactions between mothers and infants, and the theory of attachment.The theory suggeststhat adult psychotherapycan be understoodas an attachmenteliciting activity which arousesthe dynamicsof attachmentin clients who come for help. When careseekingis arousedin adults, like infants they require attunementto affect and affect regulation from a sensitivecaregiver. In addition, however, they also require an empathicresponse. When successful,careseeking will shut down and the ever present instinctive exploratory systemwill resume. In this way the need of the careseekerand the responseof the caregiverare goal-corrected. To test the various elementsof the theory I devised a seriesof three experiments. The results of the first and secondexperiments supported the idea of GCEA in adult psychotherapy as being interactive and associated with exploration. The third experiment found: (i) a highly significant correlation between two subjective scores for GCEA; (ii) a significant correlation between the objective measureof GCEA and the two subjective measures;(iii) a significant correlation between a score for 'secure attachment' and the objective score for GCEA; (iv) a significant training effect as measuredby the objective GCEA score. A potential drawback of this experimentwas that it was conducted in 'artificial' conditions. If similar results could be achievedin practice, this work would have important implications for the selectionand training of thosejoining and working in the caring professions. 2 Index CONTENTS OVERVIEW 13 ............................................................... CHAPTER ONE: INTRODUCTION 18 ............................................................ ORIGINSOF WTERESTIN ATIUNEMENT IN TIH-iIWY 24 ........................................... STRUCTUREOFTI IE TI IESIS 29 ............................................................................ CHAPTER TWO: RESEARCH INTO THE PROCESS OF INTERACTION IN ADULT PSYCHOTHERAPY 32 .......................................................... INTRODUCTION 32 ................................................................................................ THEWORK OF THE CHICAGO GROUP: 1940 1960 35 - ............................................... TROMA FOCUSON THE INDIVIDUAL TOA FOCUSON INTERACTION: 1960 1980 42 - ....... PSYCHOTHERAPYRESEARCH: 1980 2000 45 - ....................................................... CONCLUSION 48 .................................................................................................... CHAPTER THREE: INFANT CAREG IVER- INTERACTIONS: THE PROCESS OF AFFECT IDENTIFICATION, COMMUNICATION, AND REGULATION 51 51 INT'RODUCTION............................................................................................... FROMDEDUCTION TO CONSTRUCTION: MELANIE KLEIN TO GYORGY GERGELY 53 .......... AFFECTREGULATION ISLINKED WM I CAREGIVINGFROM THE START OF LIFE 57 ........... CORRECTIDENTIFICATION OFAFFECT BY THE CAREGIVER AFFECTS THE INFANTS'DEVELOPING SENSE OF SELF 60 ............................................................... 110W CAREGIVERS COMMUNICATE TOINFANTS THAT 11 IEY UNDERSTAND THEIR AFFECTIVESTATE: THE PROCESS OF AFFECT ATrUNEMIWr 63 ................................ INFANT'S'RESPONSIVENESS TOAFFECTIVE INTERACUON WM I CAREGIVERS ANDTHEIR RESPONSE TOLOSS OF CONTACT WITH CAREGIVERS 67 ............................. CAREGIVER-INFANTINTERACTIONS: THE, PATIERNING OF RELATIONSHIP 71 ................ PATFERNSOF AFFECT ATrUNEMENT ASSOCIATED WITI I EFFECTIVE. CAREGIVING 73 ...... 74 AFFECT'ATIUNEMENTANDEWATHY.................................................................. 77 SUMMARY...................................................................................................... CHAPTER FOUR: PATTERNS OF CARESEEKING-CAREGIVING RELATIONSHIPS: RESEARCH INTO ATTACHMENT BEHAVIOUR IN INFANTS AND YOUNG CHILDREN 80 ........................................... INTRODUCTION 80 ................................................................................................ AITACIMNI'TUEORY 82 ....................................................................................... INTERNALwORKING moDELs OF RELA-noNsiup 82 ..................................................... ATTACIWENT CLASSIFICATION STABLE AND PERSISTENT OVER TINT 83 . ....................... 'IIIhADUI; rATrACHmLNrM'ERVILV 84 ................................................................... CARESEEKIM-CAREGIVERDYADS: CON*XJNICA'nON I"All"ERN TO 85 IN RELATION AFFECT...................................................................................... 3 Index CARESEEKER-CAREGIVERDYADS: UTIERACnON PATTERNS IN RELATIONTD PlAY 87 ................................................................................... CARESEEKER-CAREGIVERDYADS INTERACTIONSTRATEGIES 88 ............................... EFFFCTIVECAREGIVING:ATTUNING TOA RANGEOFAFFECT 91 .............................. SUNWARY 93 .................................................................................................. CHAPTER FIVE: PRESENTING THE CONCEPT OF GOAL-CORRECTED EMPATHIC ATTUNENIENT: EFFECTIVE CAREGIVING WITHIN 96 PSYCHOTHERAPY ........................................................... 96 INTRODUCTION............................................................................................. lI1EATrACl9v0l4TDYNAMC ........................................................................... 97 THE SYSTEMFOR EXPLORATION ....................................................................... 99 GOAL-CORRECTEDEWAnllCATrUNElvffNF: A PROCESSINVOLVED IN EFFECTIVECAREGIVING 100 ................................................................................ THE PSYCIIOTHERAPEUTIC REIATIONSHIP: AN ACCOUNTOF M"ERACTIONAL SEQUENCESUSING ME CONCEPTOF GOAL-CORRECTED EMPA-1111CATTUNFIvIENT 101 ................................. WI IERF.HAVE WE CONE SO FAR? 110 ....................................................... CHAPTER SIX: FIRST EXPERIMENT: THE IDENTIFICATION OF AFFECT ATTUNEMENT IN ADULT PSYCHOTHERAPY 117 ..................... INTRODUCTION 117 ............................................................................................. THE RESEARCH DESIGN 118 .......................................................................... FIRSTEXPERIMENT 119 ....................................................................................... MATERIALSAND PROCEDURE 120 .......................................................................... SUBJECTS 122 ..................................................................................................... RESULTS 122 ...................................................................................................... CHARACTERISTICSOF AN'ATIlJNED'TllERAPIST 124 ............................................... ciiARAcTERis,ncs oFA'NoN-ATnNm' TIIERAPIST 127 .......................................... DISCUSSION 128 .................................................................................................. CHAPTER SEVEN: SECOND EXPERIMENT: IS EMPATHIC ATTUNEMENT INTERACTIVE? 133 ................................................................... INTRODUCTION 133 ............................................................................................... HYPOTHESIS 133 .................................................................................................... OVERVIEWOF TT IF EXIPFYdMFWr 133 ......................................................................... M-,-[IiODOI, OCYY 134 ................................................................................................ SUBJECT'S 134 ....................................................................................................... NEM IODOF ALLOCAT10N TO GROUPS 134 .................................................................. 135 CONFIDENTIALITY............................................................................................. MATERIALSAND PRACTICAL ARRANGI-: mWTS 135 ...................................................... PROGRAMNEAND INSTRUCTIONS 136 ....................................................................... 137 RATINGINSTRUWNTS ....................................................................................... 'll U-.PROCESS OF RATING 111E CLINICAL EKIRACTS 138 ................................................. 4 Index 138 CONDUCTING-nIEEXPERMWF ............................................................................. OF ME ]DEBRIEFING 139 '111E NECHANICS .................................................................... COLLATINGTUE QUALFrATIVEMATERIAL 140 .............................................................141 STATISTICALRESULTS ........................................................................................ 143 QUALITATIVEANALYSIS ...................................................................................... DISCUSSION 156 ........................................................................................................160