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Clinical Applications of the Adult Attachment Interview. Edited by Howard Steele & Miriam Steele. Guilford Press. 2008. 486pp. US$48.00 (hb). ISBN: 9781593856960

Published online by Cambridge University Press:  02 January 2018

Penelope Turton*
Affiliation:
St George's University, Division of Mental Health, Cranmer Terrace, London SW17 0RE, UK. Email: pturton@sgul.ac.uk
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists 2009 

When, in the second half of the last century, John Bowlby was first developing his thoughts and observations on the primary human drive to form lasting attachment relationships, his intention was better to understand and help emotionally disturbed children and adults. The twin strands of theoretically driven empirical research and clinical practice have characterised attachment-related work ever since. The Adult Attachment Interview (AAI) admirably encompasses both these functions, having developed beyond its original role as the pre-eminent research tool describing and codifying adults' state of mind with regard to attachment and becoming a valued clinical tool.

This book provides a thorough introduction to the instrument, its coding and classification system. But its main contribution is the way in which it brings together leading experts in the field to present research findings and case material to show how the AAI can systematically be used in assessment and diagnosis, to design and tailor interventions, to facilitate goal setting and treatment planning, to inform and strengthen the therapeutic alliance and to monitor therapeutic progress.

In the context of such an abundant harvest, the minor limitations identified by this reviewer are perhaps not significant. The first concerns a practical issue – the considerable time and expense involved in becoming reliable in conducting and classifying the AAI impose real restrictions on its wider use. Coding the hour-long interview necessitates painstaking verbatim transcription and mastery of a laborious rating system. Untrained or inexperienced interviewers and coders can render transcripts unreliable at best and frankly misleading at worst. Other, less costly ways of processing the interview material have been developed, such as Q-sort techniques, and it would have been helpful to have a fuller evaluation of their role.

The book could possibly also have benefited from fuller discussion of some of the uncertainties that continue to abound in attachment research. For example, there is still only limited evidence that persons classified in adulthood as secure or as one of the insecure categories were classified similarly in childhood. The AAI seeks to capture the person's current mental representations of attachment relationships, but the processes whereby infant attachment patterns are transformed into representational systems are still insufficiently understood. Most studies of association between adult attachment patterns and psychopathology are correlational so that conclusions as to direction of effect cannot be drawn. More importantly, the great majority of people with insecure attachment do not develop psychological disorders, so insecure classifications can only be considered as general risk factors rather than specific aetiological factors.

Such omissions are perhaps legitimately beyond the scope of this timely, well-presented and valuable book, every chapter of which provides illuminating insights and evidence of the range and depth of the AAI's multiple uses. It should be of considerable interest to clinicians and practitioners from all disciplines, as well as to researchers and students.

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