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Psychotherapy's Greatest Debates - Page 2

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DAN SIEGEL: I basically agree with the factors that Jerry has outlined. His work has certainly shown the importance of temperament, especially with people born at the extreme of a particular dimension of temperament, like behavioral inhibition. But while genetically transmitted factors like temperament are important, development is so much more complicated than anything that can be explained by genes alone. For example, we know from identical-twin studies that there’s only a 50-percent concordance when one child develops schizophrenia. So we really need to think rigorously about other developmental issues.

Because the baby is born so immature, and we have such a complex social system, the brain is being shaped by experiences of all sorts, especially with our earliest caretakers. Where Jerry and I seem to disagree is how much weight we give to some of these factors—in particular, how the history of children’s interactions with their early caretakers shapes the quality of their later attachment relationships (whether they become secure), and how these attachment relationships then become the foundation for later personality development.

As a clinician, probably the most direct influence on my work that’s come out of Attachment Theory is the Adult Attachment Interview (AAI), which I use with almost all my clients to get a picture of how they view their early-life experience. The AAI is basically a semistructured questionnaire with which you ask the adult about his or her recollections of childhood. The assessment isn’t based on what actually happened—because you have no idea what happened. It’s on something called the “coherence of the narrative,” which, in plain English, is how you’ve made sense of your life.

What the research about the AAI shows is that if you were abused as a child and make sense of how that terrible traumatic experience affected you, your children will be securely attached to you. But if you had that horrible experience, but haven’t been able to reflect on it and make sense of it—the research is very clear—your children will have more psychological challenges in life.

The important thing for therapists to remember isn’t that a person’s attachment history is their fate—it’s just the opposite: the research shows it’s how you’ve made sense of your attachment history that makes the difference. We can help our clients understand, “Hey, even though something painful happened to me, if I make sense of it, I can actually do something about it.” So what I’m saying is that Attachment Theory has led to the development of the AAI, a relational measure with incredible predictive power.

KAGAN: I have no doubt that if I interviewed 10,000 people for 90 minutes, I’d make the same predictions, but I wouldn’t call my interview an Adult Attachment Interview.

SIEGEL: What would you call it?

KAGAN: Just because you and others call it an attachment interview doesn’t mean it has anything to do with attachment.

SIEGEL: OK. But Jerry, it’s an interview where the topic is people’s recollections of their early-life experiences.

KAGAN: But the interview could be about anything. It could be about the economic crisis in Europe, and the result would be the same. The content is irrelevant.

SIEGEL: Really? But then, why is it that when you talk with a parent about how they dealt with a terrifying experience they had as a child, you can tell whether or not they have children who are securely attached.

KAGAN: Because the interview indicates whether the person is currently free of an anxious or depressed state that would interfere with their effectiveness as a parent. The interview provides no evidence as to what actually happened in the first two or three years of life, the intensity of any trauma, or the kind of attachment they had with their parents.

SIEGEL: So forget for the moment the word attachment. The important thing for therapists is to help clients make sense of their lives.

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