The in-session discourse of unresolved/disorganized psychotherapy patients: An exploratory study of an attachment classification

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The Unresolved/disorganized (U/d) attachment classification has generated
considerable interest among clinicians. This is in part based on its empirical
associations with adult mental health, parenting practices, and treatment
outcomes. Despite decades of theorizing, however, we have little empirical
information regarding how patients with a U/d classification assigned by
accredited coders actually behave or speak in psychotherapy sessions. Here,
we take a step towards bridging this gap by reporting our observations of the
psychotherapy session transcripts of 40 outpatients who were independently
classified as U/d on the Adult Attachment Interview (AAI), the gold standard
measure of adult attachment research. These patients were extracted from
a larger sample of 181 and compared to others without a U/d classification.
In this paper, we discuss two different discourse styles associated with a
U/d classification. Some U/d patients did not seem to sufficiently elicit the
therapist’s endorsement of what they said. For example, they did not justify their
claims with examples or explanations, or did not consider others’ intentions or
experiences. Other U/d patients were credible, but left the listener uncertain
as to the underlying point of their discourse, for example, by glaringly omitting
the consequences of their experiences, or interrupting their narratives mid-
way. In the discussion, we place these observations in the context of recent
thinking on attachment and epistemic trust, and discuss how this study may
form the basis for future quantitative studies of psychotherapy.
TidsskriftFrontiers in Psychology
Antal sider16
StatusUdgivet - 2022

ID: 339636389