At the Sheffield conference this year, we had 4 linked workshops in which researchers described the use of the Adult Attachment Interview with forensic populations. There has been resurgence of interest in attachment theory over the last 10 to 15 years and the AAI provides a valid and reliable way of studying an individual's state of mind with regard to attachment. There may be a bigger question about the relevance of attachment theory to forensic psychiatry and psychotherapy. Attachment theory, as a paradigm, may offer some advantages for other accounts of object relations.
First, attachment theory is interested in the influence of the external word, and the way the individual acts in the external world in relation to his interpersonal relations. This obviously has a link with forensic patients, and forensic psychotherapy, which always has to engage with an external world perspective, such as that of the court or the forensic institution.
Second, there is an emphasis on security and the need for security in the face of anxiety and arousal, which links in if only metaphorically, with the need for security that is occasioned by violence.
Third, in a majority of forensic patients, their violence will have occurred in an interpersonal context, which represents some aspect of a failed relationship whether in fantasy or reality. Therefore, internal working models of attachment (Bowlby's term) may be a helpful way of examining the index offence that brought our patients into contact with services.
Finally, it is possible how individuals think about attachments in their minds may have considerable implications for how they get on in therapy.
Several different researchers presented their work in Sheffield. Alice Levinson described her work using the AAI in a sample of prisoners. (Unsurprisingly she rated them as insecurely attached on the AAI; she also found an excess of dismissing styles of attachment. Such a style of attachment indicates that individuals try and dismiss the importance of attachment from their minds either by emphasising that they cannot remember the past, or by idealising it.) Gwen Adshead has found a similar excess of dismissing style in her study of child abusing women, and Alla Rubitel and Gill McGauley also found a similar preponderance of dismissing style in their study of patients in a special hospital with a personality disorder.
Finally, Pippa Hugo also found an excess of dismissing style in her group of these adolescence who had murdered; However, she also found a small sub-group of adolescents who had murdered who described a secure style of attachment. The implications of this, particularly in relation to resilience and vulnerability factors, were widely discussed at the end of the day.
All the presentations generated a great deal of discussion. All the researchers there found it helpful to discuss with other researchers the difficulties as well as the advantages of using the AAI in forensic populations. There are considerable question marks about how to interpret the data, especially as many of the researchers were presenting work in progress.
It is hoped that a similar workshop could occur in Boston next year, where further data will be available. Finally, it might be helpful to think about setting up a forensic attachment network. If you are carrying out research based on an attachment theory, and especially if you are using measures of attachment in your research and would like to be part of a network we could meet up formally or informally, then contact me at the address below. 1 look forward to seeing you in Boston next year.
Dr Gwen Adshead
Psychotherapy Department
Richard Dadd Centre
Broadmoor Hospital
Crowthorne
Berkshire RG45 7EG