Abstract
This paper proposes that clinical practice based on psychiatric diagnoses and categories of harmful behavior may be inadequate at best and harmful at worst. An alternative model of functional family formulations is proposed based on exposure to danger, developmental processes around danger, information processing regarding danger, and strategies for coping with danger. These are encompassed by the dynamic-maturational model of attachment and adaptation (DMM). DMM theory is outlined, then four types of harmful behavior that have resisted treatment are described, each with a case and treatment outcomes: physical abuse, disruptive child behavior, psychosis, and autism. We conclude by describing how these four cases address both children’s and parents’ need for safety and developmental progress in representing and responding to threats, and also professionals’ need for a treatment-relevant nosology of human suffering.
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(Used with permission, Crittenden 2016)
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30 January 2020
The original version of this article unfortunately contained errors in the “Abstract”, “Introduction”, “Formulation” and “References.”
References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association (APA).
Barkley, R. A., & Murphy, K. R. (2006). Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford Publications.
Bowen, M. (1971). The use of family theory in clinical practice. In J. Haley (Ed.), Changing families: A family therapy reader (pp. 159–192). New York: Grune & Stratton.
Bowlby, J. (1969/1982). Attachment and Loss: Vol 1. Attachment. New York: Basic Books.
Brewerton, N., Robson, K., & Crittenden, P. M. (2017). Formulating autism systemically: Part 2—A 12-year prospective case study. Clinical Child Psychology and Psychiatry https://doi.org/10.1177/1359104517714381.
Centers for Disease Control and Prevention. (2016). About the CDC-Kaiser ACE Study. Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html
Crismon, L., Argo, T. R., & Buckley, P. F. (2014). Schizophrenia. In J. T. DiPiro, R. L. Talbert, & G. C. Yee (Eds.), Pharmacotherapy: A pathophysiologic approach (9th ed., pp. 1019–1046). New York: McGraw-Hill.
Crittenden, P. M. (1992). Children's strategies for coping with adverse home environments: An interpretation using attachment theory. Child Abuse and Neglect. https://doi.org/10.1016/0145-2134(92)90043-Q.
Crittenden, P. M. (1997). Patterns of attachment and sexuality: Risk of dysfunction versus opportunity for creative integration. In L. Atkinson & K. J. Zuckerman (Eds.), Attachment and psychopathology (pp. 47–93). New York: Guilford Press.
Crittenden, P. M. (2016). Raising parents: Attachment, representation, and treatment (2nd ed.). London: Routledge.
Crittenden, P. M. (2017). Formulating autism systemically: Part 1—A review of the published literature and case assessments. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/1359104517713241.
Crittenden, P. M., Dallos, R., Landini, A., & Kozlowska, K. (2014). Attachment and family therapy. London: McGraw-Hill.
Crittenden, P. M., & Heller, M. B. (2017). The roots of chronic PTSD: Childhood trauma, information processing, and self-protective strategies. Chronic Stress. https://doi.org/10.1177/2470547016682965.
Crittenden, P. M., & Landini, A. (2011). Assessing adult attachment: A dynamic-maturational approach to discourse analysis. New York: W.W. Norton.
Crittenden, P. M., Landini, A., & Zhang, W. (2018). The roots of the DMM and DMM Integrative Treatment: Autism as an example. In G. Crocetti (Ed.) La psicoterapia psicoanalitica per l'infanzia e l'adolescenza nei contesti socio-culturali attuali. Roma: Armando.
Crittenden, P. M., & Spieker, S. J. (2018). Dynamic-maturational model of attachment and adaptation versus ABC+D assessments of attachment in child protection and treatment: Reply to Van IJzendoorn, Bakermans, Steele, & Granqvist (2018). Infant Mental Health Journal. https://doi.org/10.1002/imhj.21750.
Dallos, R. (2019). Don’t blame the parents: Intention and change in family therapy. Maidenhead: Mcgraw Hill.
Dallos, R., & Draper, R. (2010). An introduction to family therapy: Systemic theory and practice. London: McGraw-Hill Education.
Felitti, V. J. (2009). Adverse childhood experiences and adult health. Academic Pediatrics. https://doi.org/10.1016/j.acap.2009.03.001.
Flåm, A. M., & Handegård, B. H. (2015). Where is the child in family therapy service after family violence? A study from the Norwegian Family Protection Service. Contemporary Family Therapy. https://doi.org/10.1007/s1059
Garety, P. A. (2003). The future of psychological therapies for psychosis. World Psychiatry,2, 147–152.
Heller, M. B. (2002). An accident waiting to happen. Bulletin of the British Psychoanalytic Society, 38, 76–80.
Insel, T. R. (2014). The NIMH Research Domain Criteria (RDoC) Project: precision medicine for psychiatry. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2014.14020138.
Johnson, M. (1995). Patriarchal terrorism and common couple violence: Two forms of violence against women. Journal of Marriage and the Family. https://doi.org/10.2307/353683.
Johnstone, L., & Dallos, R. (2013). Formulation in psychology and psychotherapy: Making sense of people's problems. Abingdon: Routledge.
Kaslow, F., & Patterson, T. (2006). Relational diagnosis—A brief historical overview: Comment on the special section. Journal of Family Psychology. https://doi.org/10.1037/0893-3200.20.3.428.
Marvin, R. S., & Stewert, R. B. (1990). A family systems framework for the study of attachment. In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 51–86). Chicago, IL: University of Chicago Press.
Minuchin, S., Rosman, B., & Baker, L. (1978). Psychosomatic families: Anorexia Nervosa in context. Cambridge: Harvard University Press.
Moreno-Küstner, B., Martín, C., & Pastor, L. (2018). Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS ONE. https://doi.org/10.1371/journal.pone.0195687.
Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and treatment options. P & T: A Peer-Reviewed Journal for Formulary Management,39(9), 638–645.
Perkins, S. N., Glass, V. Q., & D’Aniello, C. (2019). It’s all about the balance: Therapists’ experience of systemic alliance development. Contemporary Family Therapy. https://doi.org/10.1007/s10591-019-09500-1.
Ringer, F., & Crittenden, P. (2007). Eating disorders and attachment: The effects of hidden processes on eating disorders. European Eating Disorders Review. https://doi.org/10.1002/erv.761.
Roberts, A. L., Lyall, K., Rich-Edwards, J. W., Ascherio, A., & Weisskopf, M. G. (2013). Association of maternal exposure to childhood abuse with elevated risk for autism in offspring. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2013.447.
Sammut Scerri, C., Vetere, A., Abela, A., & Cooper, J. (2017). Intervening after violence: Therapy with couples and families. Berlin: Springer.
Sayal, K., Mills, J., White, K., Merrell, C., & Tymms, P. (2015). Predictors of and barriers to service use for children at risk of ADHD: longitudinal study. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-014-0606-z.
Selvini, M. P., Boscolo, L., Cecchin, G., & Prata, G. (1980). Hypothesizing—circularity—neutrality: Three guidelines for the conductor of the session. Family Process. https://doi.org/10.1111/j.1545-5300.1980.00003.x.
Stedman, A., Taylor, B., Erard, M., Peura, C., & Siegel, M. (2018). Are children severely affected by autism spectrum disorder underrepresented in treatment studies? An analysis of the literature. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3844-y.
Timimi, S., Gardner, N., & McCabe, B. (2011). The myth of autism. Basingstoke: Palgrave MacMillan.
von Bertalanffy, L. (1968). General system theory. New York: Braziller.
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry. https://doi.org/10.1002/wps.20238.
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Dallos, R., Crittenden, P.M., Landini, A. et al. Family Functional Formulations as Guides to Psychological Treatment. Contemp Fam Ther 42, 190–201 (2020). https://doi.org/10.1007/s10591-019-09525-6
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DOI: https://doi.org/10.1007/s10591-019-09525-6