Attachment and representational change in cognitive analytic therapy: developing a taxonomy

A number of studies suggest that the couple relationship is a crucial aspect of the individual's supportive network, playing an important role in the maintenance of mental health and the recovery from psychological disorder. The aim of this study was to investigate how Cognitive Analytic Therapy may change the patients' understandings of their couple relationships and, possibly, the relationships themselves. Eleven outpatients presenting mostly with neurotic and personality disorders were interviewed before and after treatment about their current couple relationships, while clinical improvement was also assessed on a number of scales. A qualitative analysis was conducted on the patients' accounts, revealing that the patients experienced their interpersonal space as being defined by three dichotomies: self vs. other, autonomy vs. relatedness, and dependent vs. depended-on positions. Moreover, the patients' perception of autonomy tended to change in reference to the dependent position, while that of relatedness did so in reference to the depended-on. In addition, post-therapy changes regarding autonomy were asymmetrical, with the self being presented as strengthened and the other as relatively weakened; in contrast, changes regarding relatedness were symmetrical, presenting both partners either as more, or as less emotionally available. On the basis of differences in change, three types of patients were identified. As the findings were considered within the framework of attachment theory three research questions were formulated for further investigation: (a) the patients' subjective experience may have revealed information about their deeper attachment representations; (b) changes in that experience may have suggested shifts in the patients' security of attachment; and (c) different types of change in that experience may have suggested diverse pathways through which shifts in attachment security may have been attained. (PsycINFO Database Record (c) 2019 APA, all rights reserved)