A brief psychodynamic intervention for couples with unresolved grief: a case study report

Two case reports of couples with unresolved grief who received a short-term psychoanalytically oriented intervention for couples are presented. The sixteenweek intervention is based on the unresolved grief triad (UGT) which links empirically based predictors of prolonged or complicated grief, including a history of unmourned losses and couple dynamics that prevent mourning, to couple manifestations of unresolved loss. In the first and second phases of therapy, experienced analytic couple therapists identified these factors and linked them into a unique UGT for the couple which is made explicit and worked with in the middle phase of treatment in relation to the day-to-day experiences that they bring to the sessions. In the final (third) phase of the intervention the loss of the therapy and therapist constitutes links that have been identified and processed with the couple during the intervention. The two case studies presented shared important similarities that offer insights into how couples become mired in unresolved grief. Their successful treatment using a short-term psychoanalytically based couple therapy suggests that the underpinning model on which it is based may be cost-effective in treating unresolved grief in couples.

Childhood Trauma in Women and Fragmented Interview Narratives – Some Interdisciplinary Methodological and Clinical Implications

Trauma experience is understood through its expression in language, with implications for psycholinguistic and clinical research and analysis. Clinical research approaches often approach childhood trauma through investigative, semi-structured, retrospective interviews (e.g. Childhood Experience of Care and Abuse, CECA). This facilitates the narration of abuse history for systematic analysis in relation to clinical disorder. Interview techniques assist such history-telling, for example by ‘scaffolding’ the account, aiding memory through chronological questioning, using a factual focus and using probing questions to collect detail and resolve inconsistencies. However, some personal narratives are fragmented, incomplete, contradictory or highly emotional/dissociated from emotion. This can be explained by trauma impacts such as being emotionally frozen (forgetting and avoidance) or overwhelmed (emotional over-remembering) and is termed ‘unresolved trauma’ with links to attachment vulnerability. These narratives can make investigative interview research more challenging but can offer opportunities for secondary psycholinguistic analysis. Illustrative interview quotes from CECA childhood physical and sexual abuse narratives of three women are provided with comment on style of reporting. The women had recurrent trauma experience and later life depression and anxiety. The interview responses are examined in terms of seven characteristics taken from available literature (e.g. incoherent, contradictory, lack recall, time lapses, emotionality, blame and vividness). The concept of unresolved loss is discussed and whether the linguistic characteristics are specific to a trauma or to an individual. Factual investigative interviews and psycholinguistic analysis of narrative may find ways of combining for greater depth of understanding of unresolved trauma, to extend available methods and aid therapy.

Attachment Patterns in Children and Adolescents With Gender Dysphoria

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

Psychophysiological responses underlying unresolved loss and trauma in the Adult Attachment Interview

Unresolved loss/trauma in the context of the Adult Attachment Interview (AAI) has been theorised to result from dissociative processing of fear-related memories and ideas. To examine the plausibility of this model, this study tested hypothesised associations between unresolved loss/trauma and indicators of autonomic nervous system (ANS) reactivity. First-time pregnant women (N = 235) participated in the AAI while heart rate (interbeat interval; IBI) and indicators of parasympathetic reactivity (respiratory sinus arrhythmia; RSA) and sympathetic reactivity (pre-ejection period; PEP, skin conductance level; SCL) were recorded. Using multilevel modelling, ANS reactivity was examined in relation to topic (loss/trauma versus other questions); discussion of actual loss/trauma; classification of unresolved/disorganised; and unresolved responses during the interview. Responses to loss/trauma questions and discussion of loss were associated with respectively larger and smaller IBIs. There was no moderation by unresolved/disorganised status. Unresolved responses about loss were associated with smaller IBIs. Participants classified as unresolved/disorganised showed decreasing PEP and blunted SCL throughout the whole interview. The findings suggest that unresolved speech about loss co-occurs with physiological arousal, although the inconclusive findings regarding parasympathetic and sympathetic nervous system responses fail to clearly support the role of fear.

Developmental trauma and unresolved loss in the Adult Attachment Interview

This article describes attachment perspectives on unresolved loss and dissociation beginning with Bowlby’s conceptualisation of grief and bereavement, and subsequent discussion of unresolved/traumatic loss on the Adult Attachment Interview (AAI). An AAI selected by the author will be utilised to show how traumatic factors in the speaker’s childhood, including sexual abuse and maternal neglect and rejection, may result in an unresolved, complicated grief process. The author intends to illuminate the implications of early trauma and subsequent loss on one’s sense of self and relational life, and to suggest an integrative treatment model that would address early traumatic experience and subsequent bereavement.

Attachment and the loss of fertility: the attachment strategies of prospective adoptive parents

Purpose The purpose of this paper was to determine the attachment strategies of prospective adoptive parents and any correlation between attachment and the defensive strategies they used when talking about loss of fertility. The study also examined whether attachment strategy of the applicants had a bearing on the decision by the local authority to place a child. Design/methodology/approach The sample was comprised of 48 respondents (21 couples) representing 84 per cent of all people who applied to one UK Social Services Department in a 12-month period. Placement of a child was reviewed two years following the assessment. The study used the dynamic maturational model version of the adult attachment interview (DMM-AAI), together with added questions on loss of fertility to assess the applicants’ attachment strategies together with unresolved loss and trauma and the DMM modifiers. Findings Unlike adoption studies using the Main and Goldwyn system, this study rated very few of the applicants’ AAIs as secure (13 per cent), 48 per cent were in the normative low-risk range and 52 per cent of the AAIs were coded in the more complex DMM insecure strategies. There was a significant bias towards marriages where the partners deployed opposite low-risk/DMM strategies (13 (62 per cent) of couples). Compared with data on non-clinical populations the AAIs showed a high level of unresolved loss or trauma (58 per cent). Using a six-way distribution (A1-2, C1-2, B, A3-4, C3-6 and A/C) there was an 87 per cent correspondence between discourse about loss of fertility and that about attachment, thereby supporting the established proposition that reproduction is part of the attachment system. Twenty one per cent of the AAIs were coded as “disorientated” and this is discussed in terms of conflict for adoptive of parents concerning the raising of a child who carries their own genes or those of strangers. A case is made to conceptualise negative impact of infertility in terms of unresolved trauma rather than loss. Research - limitations/implications This study adds to research showing that the DMM approach is more finely calibrated than the ABC+disorganised model with the latter likely over coding for security. The results emphasise that fertility and reproduction are legitimate subjects for attachment studies and that AAI discourse analysis is a valid methodology for future research. However coder agreement as to whether or not loss of fertility was resolved was only fair (64 per cent) κ. 0.25 (po0.33). More work is required in order to determine what constitutes unresolved loss of fertility and what impact, if any, this has on parenting an adopted child. Practical implications The practice implications are considered in a separate paper. Social implications The findings are contentious in that they suggest a significant number (48 per cent) of adoptive parents have needs not dissimilar to other clients of psychological services. Originality/value This is the first DMM-AAI study with prospective adoptive parents and the findings show significant differences when compared with previous studies using the Main and Goldwyn AAI. It is also the first study to establish fertility as a legitimate area for attachment studies by using AAI discourse analysis.

The intersection of unresolved loss, trauma, and psychotic symptoms: a dyadic case illustration

Traumatic experiences affect the brain in a variety of ways, causing issues with memory and cognition, attention, affect regulation, self-esteem, and dissociation. Symptoms of PTSD are often experienced as breaks from reality (e.g., intrusive thoughts about the traumatic event; re-experiencing of the frightening moment). In the most general terms, a psychotic experience can be described as a “loss of contact with reality” (Kleiger & Khadivi, 2015). This paper presents a dyadic therapy case with a mother and her three-year-old son that illustrates the intersection of psychotic symptoms, unresolved loss, trauma, and disrupted attachment. The challenges of diagnosis and treatment for the parent and child are explored, and the flexible approach to intervention is described in detail.