Discussions with a Project Lead.
An ordinary conversation about the DMM Adult Attachment Interview and LBF.
At its basic level the DMM- AAI is a way of accessing memories from the past to see what strategies you are using in the present to identify, prevent and protect yourself from what you perceive as dangerous.
Comments about the AAI from users has been varied: “it’s hard”,” I’ve finally been able to talk to someone”,” I’ve been left with things I haven’t talked about for a long time”, some have been “thankful” and found it “helpful”. Some “go away thinking about the AAI and its impact”.
Is it set out intentionally to have an impact?
Yes, it was designed to access memory systems that otherwise lay dormant. The interview will attempt to elicit memories from the subject’s memory systems. There are five of them used in the AAI.
Structure is therefore paramount?
The structure, the way the questions are written and said, the training necessary to be a reliable interviewer, the follow up questions; all are designed to gather the sufficient evidence necessary to truly understand the strategies a person initiates in a perceived dangerous situation. However, it is important that it does not become a counselling session.
That can be achieved in an hour?
The average length of an AAI is an hour to an hour and a half dependent on the information a subject is giving. On average it is no longer than that and there are ways of helping the subject to move on.
Why would the Interview take longer?
Someone may over-run with feelings or pause a lot. They may be dismissive. As an aid to the actual interview the interviewer has follow-up questions to prompt the subject in to revealing evidence contained in the memory systems.
What kind of follow-up questions?
Well if someone isn’t saying how they felt then you have to probe more for what their feelings were. Follow up questions are tailored to the answers given, therefore they have to be asked. People don’t reveal themselves. They don’t know how to. If someone is over-running with feelings, which frequently happens, you try to get them to think about it. If they’re thinking but not revealing their feelings then you would try to get them to access their feelings.
So are you trying to constantly balance what is being said by the subject in regards to feelings and thoughts?
To be balanced means having balance between cognition and affect, these two things working together. Someone who dismisses feelings you would try to elicit their feelings from their stories told. This is done to try and access their memory systems. You are trained to ask a set of questions for a reason.
Does that mean that the AAI cannot be used as a stand-alone tool? The interviewer is just as important?
There has to be a balance between the interviewer and the subject. Not just anyone can do it. The structure of the AAI will access the memory systems needed but further guidance is needed from the interviewer.
Is that why a questionnaire wouldn’t be beneficial?
You know the answer to that yourself. Would you have revealed or been able to reveal what you gave in the AAI? How could a questionnaire test how dismissive or overwhelmed a subject is?
I asked you a while ago whether a robot could ask the follow-up questions because of what the interviewer may bring to the AAI.
Human interaction is needed to get the human responses.
Why would those responses be available now? Why would they be able to access emotions if they have never done it before?
We’re not trying to get them to access emotions. We’re trying to see if they can. Evidence of clear examples is needed to back up the classification.
Do you therefore assume a role?
You have to be harder in a way because in many therapies you are trained not to ask questions. The subject is faced with a series of direct questions and the interviewer and the subject can struggle with the bluntness of them. Some professionals are helping professionals therefore they can veer off in a direction to help rather than follow protocol.
Do you therefore assess moment to moment what is happening?
You try to watch it more but it’s difficult and you can get lost in it. For example, someone may have been in the same situation as you the interviewer and you find yourself self-monitoring.
Sounds as if it’s done in two parts. I thought the interviewer wasn’t that important but the follow-up questions probe further to access vital evidence.
You have to look at the whole picture rather than image to image. If you want to get it right first time it’s paramount in understanding as much as possible before moving forward. When working with complex families sound theory is needed if changes are to be implemented.
What if the interviewer highlights things because of their own thoughts and feelings?
It can happen. Or you may not ask difficult questions because of what has been highlighted.
What about body language, for example moving in the interview. Is it frowned upon?
How could you not when someone is in distress? This is symbolic of our relationship. The AAI has a humanistic part. You have a different opinion on empathy than I do. The interviewer may not get the information needed unless connected in some way.
Why do you need to be connected to someone to talk about trauma? For instance, you told me about a situation in which you empathised with a woman and she blew up at you.
That’s not wrong. That’s information. She had cancer and I said it must be hard. I thought it was a reasonable thing to say. She looked upset. It was awful. Why should it not be okay to empathise if you feel it?
She saw it as unreasonable.
She saw it as too threatening. She was absolutely dismissive of any affect to do with her cancer and died soon afterwards.
What about leaning in? You leant inwards in my AAI.
I also leant back after the reaction because it wouldn’t have been helpful. Many professionals would find it a challenge to tolerate distress and would feel compelled to help. The need to comfort because of this is a major issue. What did it do when I leant in?
It didn’t do anything particularly. I was just aware of it and I’ve always been aware of it since. I thought the AAI was designed to hold the interviewer in check also?
Empathy in itself does have an element of not being able to tolerate. It can buffer, placate or subdue.
You don’t like it do you? I always feel a bit strange when we talk about empathy. We have different stances on it.
It can cause damage. Be deceitful.
It depends on what you think empathy is.
Empathy can be manipulative. I can feel empathy but then feel it isn’t true empathy and then think it is something else. I’ve done it and seen it. It could have altered the interview, perhaps the classification?
I think your point about empathy, as in people use it is true, they do. It happens sometimes. What would probably happen is that the information wouldn’t have been said because the interviewer wouldn’t have been capable of hearing it. It’s like a shutting down because the interviewer hearing it can’t bear it.
It wasn’t videoed. Would someone pick up on the alteration of the interview?
Yes. Someone trained and who is balanced. It’s how trustworthy the interviewer is to judge what messages to give, when to lean in or not etc.
Should someone who is unbalanced in terms of DMM classification be conducting an interview? Is an interviewer screened or their classification taken into account?
No one would be conducting interviews if that was the case. Training teaches you to balance even if you are not.
How does that work?
Self-checking? Nobody wants to look at themselves when they do this kind of work. Pat Crittenden (founder of DMM) sometimes has a hard time convincing people to look at themselves.
Why would you not? How can you do this kind of work and not realise what you bring and the impact it can have?
I suppose there are different levels of what you possibly bring. You will always bring something. Being balanced is something. There are different levels of accepting what you may bring. A lot of people will be using the AAI and many won’t have the certificate to say that they have passed. They just use it.
Is there a ‘showbiz’ element to the AAI?
Some would say it looks good on a CV. Academics are interested. The AAI-DMM has been highly researched and validated. It offers more layers of thinking in understanding what the problems are if applied correctly.
The AAI once completed is transcribed, coded and then a classification is given according to the DMM. Is the classification shared with the subject?
Not necessarily. Lots of professionals use it for them as a tool, rather than sharing it with the subject. It may not be relevant to share it. It can be used and shared a bit at the time if it becomes purposeful to do so. What did the classification do for you?
It was the concept of revealing me for the first time perhaps. It wasn’t so much the AAI but the classification that Pat gave back. She knew me quite deeply. No family member, consultant, psychiatrist or counsellor has gone to the levels that Pats classification did. It made complete sense to me.
How does the subject understand if the classification isn’t revealed to them?
It depends on what the subject comes with and its usefulness to them. You have to be able to take the feedback and that will depend on the subject’s level of vulnerability. The AAI is used to help the professional to understand how best to help the subject, regardless if the subject knows it or not.
The AAI is done to help you rather than the subject?
The AAI shows up things in a way that the subject’s don’t think about psychologically. People will find ways, even to the extent of becoming a non-person, to escape from the awfulness of the situations they are in.
So trauma will affect someone’s classification?
Unresolved trauma will disrupt a person’s attachment pattern and you want to try and get the strategy they use working. You look at the losses and traumas first because they get in the way. For instance, a person could be relatively balanced, have a traumatic incident and be all over the place because the trauma has stopped the strategy from working due to being overwhelmed. If the trauma can be resolved then it becomes possible for the strategy they used to start functioning again.
I wanted to ask you if it was possible to have a memory system based on delusion.
It’s not real.
It would be real to the person.
You find evidence to the contrary. The delusion comes from the person finding a way of coping with the unresolved trauma and its impact. Therefore delusion comes from trauma and not the memory system. Delusion is a way of coping and it can work.
The person may perceive it as real but it isn’t?
A person at the top of the DMM, Type B can be integrated. A person at the bottom of the DMM, Type AC, is really in trouble but is still integrated. However, it is distorted. Type B people have true thinking and feeling and Type AC people have false thinking and feeling but because it is so well integrated the person interviewing may think that they’re okay. Some people have a real ability of deception; of themselves as well as you.
What impact has the AAI-DMM had on Love Barrow Families?
It has been crucial. It has been crucial in understanding because we wouldn’t be where we are. Families wouldn’t be where they are. We never would have gotten to the position we are in. Outcomes would have been different; people probably would be in prison and children taken away.
As a result of using these tools how many people have you helped in stopping them going to prison or having their children taken away?
That was part of the evaluation; seventeen or eighteen children were on the child protection register and after the evaluation period it was one. The AAI was used with all the families. Families had different complications and complexities therefore the level of help was different. For some families there was no way help could have been given without the AAI and the DMM. These tools are a different way of thinking about people. If you asked the person to tell you things needed they wouldn’t be able to do so. These tools go under the surface and have been instrumental in understanding the complexity of strategy when in perceived danger.