T he c linic al use fulne ss of the DMM- AAI in individual tr e - PowerPoint PPT Presentation

T he c linic al use fulne ss of the DMM- AAI in individual tr e atme nt Ke nic hi Mikami Ho kkaido Unive r sity o f E duc atio n

T hr e e ways of using the DMM- AAI in individual tr e atme nt ฀ a to o l fo r a sse ssme nt to g uide tre a tme nt ฀ a te st o f the e ffe c tive ne ss o f psyc ho lo g ic a l tre a tme nt ฀ a to o l to o ve rc o me rupture s in the the ra pe utic a llia nc e the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

฀ a tool for asse ssme nt to guide tr e atme nt (Cr itte nde n & L andini, 2011, p.372) T he DMM-AAI c a n b e use d fo r a sse ssme nt to (a )fo rmula te the spe a ke r’ s pro b le m, (b )fo c us the tre a tme nt, (c )se le c t a mo de o f tre a tme nt, (d)se le c t a spe c ific tre a tme nt te c hniq ue s, (e )e va lua te whe the r the individua l c a n b e ne fit fro m spe c ific pro po se d tre a tme nt. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

฀ a te st of the e ffe c tive ne ss of psyc hologic al tr e atme nt (Cr itte nde n & L andini, 2011, pp.374-375) • I n o rde r to te st the e ffe c tive ne ss, no t o nly a re lia b le c o de r who is b lind to a c a se is ne e de d, b ut a lso a n inte rvie w whic h re ta ins the struc ture a nd pro c e ss o f the AAI b ut, a t the sa me time , ha s diffe re nt se t o f q ue stio ns so tha t it c a n surprise the mind o f the spe a ke r is ne e de d. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

฀ a te st of the e ffe c tive ne ss of psyc hologic al tr e atme nt (Cr itte nde n & L andini, 2011, pp.374-375) • F o rm B o f the AAI (Critte nde n, 2006)ha s b e e n de ve lo pe d fo r this purpo se . • I t re ta ins so me o f the o rig ina l q ue stio ns while ha s ne w q ue stio ns whic h surprise the spe a ke r into a c c e ssing diffe re nt re c a lle d e xpe rie nc e s a nd using the se to unde rsta nd c urre nt func tio ning . the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅰ : Aiko(Mikami, 2018) • Aiko wa s a fe ma le a nd sing le c lie nt in he r 30’ s who a ppa re ntly ha d no intima te re la tio nships so fa r. She fe lt de pre sse d e ve ry ye a r fro m the e nd o f Autumn until the b e g inning o f Winte r. • I t wa s so o n re ve a le d tha t she ha d a tra uma tic e xpe rie nc e in this se a so n. One da y she fo und o ut tha t he r mo the r wa s no t a t ho me in the mo rning , a nd the n he r mo the r c a lle d he r, sa ying tha t she wo uldn’ t c o me b a c k ho me a nymo re , a nd ha ng e d up the pho ne just a fte r sa ying ‘ Go o d L uc k’ . the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅰ : Aiko • Altho ug h she c a me b a c k ho me la te r, this e xpe rie nc e ha d re pe a te dly fla shb a c ke d e spe c ia lly whe n she fe lt de pre sse d. I n he r c hildho o d, she a lwa ys ha d to wo rry if he r pa re nts mig ht ha ve se rio us q ua rre ls a g a in. • T he DMM-AAI wa s a dministe re d a fte r # 5, a nd she to ld me tha t it re minde d he r o f lo ne ly lo o k o n he r fa the r’ s fa c e a fte r he r mo the r le ft ho me . She a lso re me mb e re d tha t she tho ug ht she ha d to b e stro ng , o the rwise he r fa mily wo uld fa ll a pa rt. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅰ : Aiko • I to ld he r tha t, pro b a b ly, she ha d a c tua lly wa nte d a stro ng fa the r b ut c o uldn’ t a dmit suc h a de sire . She sa id tha t she ha d no inte ntio n to b la me he r pa re nts b ut wa s a lwa ys o ve rly c o nc e rne d a b o ut the m. • Gra dua lly, she sta rte d linking he r pa st a tta c hme nt re la tio nships to he r pre se nt inte rpe rso na l re la tio nships. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅰ : Aiko • F o r e xa mple , she to ld me she ha d re pe a te dly suffe re d fro m se xua l ha ra ssme nts b y he r pa st b o sse s. • She spo nta ne o usly linke d this fa c t to he r de sire in whic h she ha d wa nte d a stro ng a nd g e ntle fa the r, whic h the n mig ht ha ve ma de he r b o sse s misunde rsta nd tha t she ha d se duc e d the m. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅰ : Aiko • Be c a use o f he r jo b , we ha d to finish this the ra py a t the # 23. • I n the se c o nd fo llo w-up se ssio n, mo st o f he r sympto ms suc h a s de pre ssio n, sle e p diso rde r, a nd fla shb a c ks disa ppe a re d, a nd she se e me d to do we ll in he r jo b . • T he n the F o rm B o f the DMM-AAI wa s a dministe re d. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

DMM- F o llo w-up # 2 AAI DMM-AAI (1.5 ye a r la te r) (F o rm B) 23 se ssio ns (8mo nths) #6 ― #23 #1 ― #5 F o llo w-up # 1 (3mo nth la te r) the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

c ompar ison of the two AAIs O(R) ฀ Utr(dn) PAN A+(6) I Utr(dn & dpl) PA-b urn R(Utr(dn) ma ny A+ → A6 → ฀ ) T his re sult sug g e ste d tha t, b e c a use mo st o f he r unre so lve d tra uma s we re re so lve d b y the the ra py, he r dysfunc tio na l A6 stra te g y wa s re pa ire d, whic h le d to impro ving he r sympto ms. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

What the two AAIs sugge sts • Also , it sug g e sts tha t 23 se ssio ns a re pro b a b ly no t lo ng e no ug h to c ha ng e he r stra te g y fro m A6 to B. • T hus, the DMM-AAI wa s no t o nly use ful fo r a sse ssme nt b ut a lso se e me d to c a pture wha t ha d c ha ng e d a nd wha t ha d no t in this tre a tme nt. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

฀ a tool to ove rc ome the rupture s in the the ra pe utic a llia nc e (Mika mi, unde r re vie w) • T he third o ne mig ht b e pa rtic ula rly use ful fo r individua l tre a tme nt b e c a use individua l tre a tme nt c a n b e e xpe c te d to b e mo re o fte n a ffe c te d b y tra nsfe re nc e a nd c o unte rtra nsfe re nc e tha n fa mily o r g ro up tre a tme nt whic h c a n e ve ntua lly le a d to the rupture s in the the ra pe utic a llia nc e . the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Ruptur e s in the the r ape utic allianc e • Sa fra n a nd Mura n (1996) po inte d o ut tha t “rupture s o fte n o c c ur whe n the ra pists unwitting ly pa rtic ipa te in ma la da ptive inte rpe rso na l c yc le s tha t re se mb le tho se c ha ra c te ristic s o f pa tie nts’ o the r inte rpe rso na l c yc le s, thus c o nfirming the ir pa tie nts’ dysfunc tio na l inte rpe rso na l sc he ma s o r g e ne ra lize d re pre se nta tio ns o f se lf- o the r inte ra c tio ns ” (p.417). the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅱ : T akako (Mikami, unde r r e vie w) • T a ka ko wa s a lso a sing le a nd fe ma le po stg ra dua te stude nt in he r 30s. • T a ka ko so ug ht the ra py b e c a use she wa nte d to unde rsta nd he rse lf in o rde r to c ha ng e he r wo rka ho lic life style . • He r fa the r wa s fre q ue ntly vio le nt to wa rd he r mo the r. T a ka ko ha d o fte n fo und he r mo the r c rying in the kitc he n. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅱ : T akako • Sinc e he r c hildho o d, she wa s o fte n to ld b y ma ny pe o ple tha t she wa s a lwa ys smiling whic h she wa sn’ t a wa re o f. • T a ka ko ha d two lo ng te rm re la tio nships with he r pa st b o yfrie nds, whic h la ste d a b o ut 10 ye a rs fo r e a c h b ut e nde d up b re a king up e ve ntua lly. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅱ : T akako • Onc e the the ra py sta rte d, she so o n de ve lo pe d lo ve tra nsfe re nc e to wa rd me . Also , she wa s o fte n wo rrie d a b o ut whe the r she wa s b o the ring me . • At first, I trie d to a c c e pt a nd e mpa thize with he r fe e ling s. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt

Case Ⅱ : T akako • Ho we ve r, g ra dua lly, I sta rte d fe e ling tha t o ur o c c a sio na l me e ting s we re b e c o ming a b urde n a s tho ug h he r “se lf-fulfilling pro phe c y” wa s b e c o ming a c tua lize d in this the ra pe utic re la tio nship. Also , I sta rte d fe e ling irrita te d whe n she sho we d he r smile whe n she wa s ta lking a b o ut he r pro b le ms. Be c a use o f my c o unte rtra nsfe re nc e , • e ve ntua lly I sug g e ste d to he r tha t, b e c a use she se e me d to g e t impro ve d, we c o uld te rmina te the the ra py, whic h, o b vio usly, wa s to o e a rly a t tha t sta g e . the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt