Table 2.
Selection of PACS in-session attachment markers.
| Selected scales and markers | Examples of the markers used by patients during rupture resolution |
|---|---|
| Proximity seeking | |
| (1) Asks for help | I mean I just - - - hope that you can help me (cries) |
| (5) Discloses distressful emotions experienced in the present | I’m feeling angry at you right now. |
| (6) Gives a vivid narrative of a past distressful event | Last session, at some point, I think we were talking about my relationship with my parents, and you made a comment that made me feel rejected. |
| (8) Discloses unmet relational needs | I need to talk openly and not feel judged. I feel like I’m not getting the support I really feel like I need. |
| Contact Maintaining | |
| (11) Praises therapist’s ability to establish closeness | I’m glad I brought it up. Even though it’s hard, you’re listening, I can tell you really care. |
| Exploring | |
| (16) Expresses independent will | I really want to be completely honest with you in here. |
| (17) Proposes tasks goals for therapy | Yeah, can we talk through a plan, ‘cause this is what I need, I think I need a plan. |
| (18) Expresses misgivings about the therapeutic tasks | The last couple weeks I felt like I wasn’t really getting to what I had been intending to talk about or the things that I thought were important to address here. |
| (24) Reflects in the present, assuming alternate perspective on self/other experience, beyond what is apparent | Even though we’ve finally established a space where you can give me real feedback on this, I feel like you’re wanting me to share right now and it is almost like - I’m pulling back. |
| Avoidance | |
| (25) Fails to respond to inquiry about distress | T: What are your feelings right now? |
| P: Well, it’s weird, I was just thinking about this situation…yeah, it’s a little strange. | |
| (28) Dismisses offer of support |
T: It seems like this is hard, talking about this issue we’re having. P: Yeah, maybe a little bit. But these things happen all the time. |
| (35) Attributes distress to an external cause | P: Yea, at times I’ve thought that I’m not sure therapy was useful, but I shouldn’t focus on the negative. I think it’s also the election and everything going on in the world right now that brings me down. |
| (36) Reject own complaints as pointless | P: It may be a little frustrating, but there’s no use in dwelling on it. |
| Resistance | |
| (41) Does not respond to therapist’s support and changes to another distressing topic. |
T: That was hurtful when I said that P: Most people just don’t really listen. The other day, my boyfriend yelled at me for forgetting the milk and it just hurt, y’know? |
| (44) Enlists other’s opinion to reinforce one’s own | P: I have a certain kind of depression that’s just inherited. My cousin the other day, she said you have a genetic depression, therapy won’t hurt you, but it’s not going to help you |
| (52) Changes topic abruptly | P: I thought that’s what therapy is for, to fix these things. Do you have any idea how to change this? The other thing is I told Marty at the store that we were out of supplies and then all of a sudden we had to go to four different stores to find what we were looking for. |
| (54) Speaks in a vague and confusing way | P: Given the choice between this therapy and what I had before … my dissatisfaction would be in that part of me was thinking this is the element that I said would happen all along. It of course nears my progress “in here” like here I am in therapy, sort of thing. |
Note. Only the PACS markers relevant for resolving a rupture are presented in this table. The examples represent instances of the markers occurring in the context of a rupture, but each marker can be coded in reference to any topic. The numbers refer to the original numeration of the PACS markers (see Talia, et al., 2015)