An Investigation of an Attachment Formulation Workshop within a Specialist Autism Inpatient Service

Main Article Content

Gemma Evans Kara McTiernan

Abstract

Background: There is a dearth of research regarding the process of attachment within autistic individuals. There is also an emerging emphasis to attend directly to clients’ mental health and recovery.


Case report: This case report details an attachment intervention with a client, presenting with behaviors that challenged within a specialist inpatient autism service. It was hypothesized that attachment was partially underpinning the behavior that challenged. This was further explored by: undertaking a notes review, interviewing the direct care team, formulating within the multidisciplinary team, delivering a Psychology attachment formulation workshop as well as by meeting regularly with the client. The workshop involved facilitating staff to integrate: Crittenden's dynamic-maturational attachment model with the client’s experience whilst utilizing a CBT framework. This resulted in identifying that the client was presenting with the strategy of ‘aggression and feigned helplessness’, which emerged within a context encompassing: physical health issues, intellectual disability as well as trauma. Formulating resulted in an enhanced understanding of attachment and the client within the team. Interventions directly addressing attachment were devised in order to further mange the behavior that challenged, particularly in relation to family interactions as well as changes to the staff.


Conclusion: This case report demonstrates the clinical utility of an attachment formulation workshop within a specialist autism service. It would therefore be informative to undertake similar research within autism services.

Keywords: Autism, intellectual disability, attachment, mental health, formulation workshop, inpatient service

Article Details

How to Cite
EVANS, Gemma; MCTIERNAN, Kara. An Investigation of an Attachment Formulation Workshop within a Specialist Autism Inpatient Service. Medical Research Archives, [S.l.], v. 11, n. 8, sep. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4271>. Date accessed: 04 dec. 2024. doi: https://doi.org/10.18103/mra.v11i8.4271.
Section
Case Reports

References

1. American Psychiatric Association (APA). Diag-nostic and Statistical Manual of Mental Disor-ders: DSM-V (5th ed). Arlington, VA: American Psychiatric Publishing; 2013.
2. Bougeard C, Picarel-Blanchot F, Schmid R, Campbell R, Buitelaar J. Prevalence of autism spectrum disorder and co-morbidities in chil-dren and adolescents: a systematic literature review. Front. Psychiatry. 2021; 12: 744709. doi: 10.3389/fpsyt.2021.744709.
3. National Institute for Health and Care Excel-lence. Challenging Behaviour and Learning Disa¬bilities: Prevention and Interventions for People with Learning Disabilities whose Behaviour Chal¬lenges. London: NICE; 2015.
4. Oliver C, McClintock K, Hall S, Smith M, Dagnan D, Stenfert‐Kroese B. Assessing the severity of challenging behaviour: Psychometric properties of the Challenging Behaviour Interview. J Appl Res Intellect Disabil. 2003; 16, 53-61.
5. Fletcher K, Flood A, Hare D. Attachment in Intel¬lectual and Developmental Disability. A Clini¬cians’ Guide to Practice and Research. Sussex: Wiley; 2016.
6. Duran VM, Crimmins DB. Identifying the varia-bles maintaining self-injurious behavior. J. Au-tism Dev. Disord. 1988; 18, 99117.
7. Dagnan D, Grant F, McDonnell A. Understand-ing challenging behaviour in older people; the development of the Controllability Beliefs Scale. Behav Cogn Psychother. 2004; 32(4), 501-506.
doi 10.1017/S1352465804001675
8. Weiner, B. An Attributional Theory of Motivation and Emotion. New York: Springer-Verlag; 1986.
9. Division of Clinical Psychology (DCP) (2011). Good Practice Guidelines on the use of Psycho-logical Formulation. Leicester: BPS; 2011.
10. Crittenden P. Attachment theory, psychopathol¬ogy and psychotherapy: the dynamic-matura¬tional approach. Psicoterapia. 2005; 30, 171-182.
11. Ainsworth MDS, Blehar M, Waters E, Wall S. Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum; 1978.
12. Bowlby J. Attachment and Loss: Vol. 1. Attach-ment. New York: Basic Books; 1969.
13. Teague SJ, Gray KM, Tonge BJ, Newman LK. Attachment in children with autism spectrum dis¬order: A systematic review. Res Autism Spectr Disor. 2017; 35, 35-50.
Doi 10.1016/j.rasd.2016.12.002
14. McKenzie R, Dallos R. Autism and attachment difficulties: Overlap of symptoms, implications and innovative solutions. Clin. Child Psychol. Psy¬chiatry. 2017, 22(4), 632-648. doi 10.1177/ 1359104517707323
15. Crittenden P. Raising Parents: Attachment, Rep-resentation and Treatment. London: Routledge; 2016.
16. Crittenden PM. A dynamic‐maturational model of attachment. Aust N Z J Fam Ther. 2006; 27, 2, 105-115. doi 10.1002/j.1467-8438. 2006. tb00704.x
17. Baim C, Morrison T. Attachment Based Practice with Adults. Understanding Strategies and Pro-moting Positive Change. London: Pavilion; 2011.
18. Rees C. Childhood attachment. Br. J. Gen. Pract. 2007; 57, 544, 920-922. doi: 10.3399/096 016407782317955
19. Fonagy P, Gergely G, Jurist E, Target M. Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press; 2005.
20. DeGregorio LJ. Intergenerational transmission of abuse: Implications for parenting interven-tions from a neuropsychological perspective. Traumatology. 2013; 19, 2, 158.
Doi 10.1177/1534765612457219
21. Landa S, Duschinsky R. Crittenden’s dynamic-maturational model of attachment and adapta¬tion. Rev Gen Psychol. 2013; 17, 3, 326-338. doi 10.1037/a0032102
22. Hewitt OM. Using psychological formulation as a means of intervention in a psychiatric rehabil¬itation setting. Int. J. Psychosoc. Rehabilitation. 2007; 12, 2.
23. Crittenden P. Landini A. Assessing Adult Attach-ment: A Dynamic-Maturational Approach to Dis-course Analysis. London: ‎W. W. Norton & Com-pany; 2011.
24. Crittenden P, Landini A, Kozlowska K. The effect of parents' psychiatric disorder on children's at¬tachment: theory and cases. In: Reupert A, May¬bery D, eds. Parental Psychiatric Disorder. 3rd ed. Cambridge: Cambridge University Press; 2015:20-28.
25. Wilcox DT, Baim C. Applications of the dy-namic‐maturational model of attachment with children involved in care and family proceed-ings. Child Abus. Rev. 2015; 25, 4, 287-299. doi. 10.1002/car.2380
26. Holmes P, Farnfield S. The Routledge Handbook of Attachment: Theory. London: Routledge; 2014.
27. Cassidy J. Emotion regulation: Influences of at-tachment relationships. Monogr. Soc. Res. Child Dev. 1994; 59(2-3), 228-249.
Doi 10.1111/j.1540-5834.1994.tb01287.x
28. Richmond JS, Berlin JS, Fishkind AB, et al. Ver-bal de-escalation of the agitated patient: con-sensus statement of the American Association for emergency psychiatry project BETA de-eca¬lation workgroup. West J Emerg Med. 2012;13,1,17-25.
doi 10.5811/west¬jem. 2011.9.6864