Associations between staff sex/gender identity and their perceptions of patients’ attachment style in a medium secure unit
Cardiff Metropolitan University
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Background - The major premise in medium secure services is attachment theory (Adshead, 2007, 2008; Bagshaw, Lewis & Watt, 2012; Fonagy et al, 2000; Pfafflin & Adshead, 2004, van IJzendoorn et al, 1997). Assumptions are made based on staff interpretation of patients’ attachment styles which, in turn, influence a host of patient outcomes (Duxbury, 2002). However, there is paucity regarding assessing the inter-rater reliability of staff making such decisions. Bagshaw et al (2012) conducted the first piece of research to assess inter-rater reliability among forensic staff and found that agreement may be mediated on sex/gender (in)congruence. If there is sex/gender disparity influencing staffs’ attachment decisions then any inferences made thus far, may lack validity and reliability. Given the importance of attachment based knowledge in this context, it is imperative to explore this in greater detail. Aim - To determine extent to which staff perceptions of patients approach to treatment and confidence in making those decisions, are determined by their own sex or gendered identity. Methods - 88 nursing staff from a medium security clinic were given two questionnaires; Bem Sex Role Inventory (BSRI) and Patient Approach to Treatment Questionnaire (PATQ). The latter of which contained a 10 point likert scale regarding confidence in decision making. A mixed, factorial and between-subjects design was used to test the following; staff/patient sex (in)congruence and levels of inter-rater agreement, staff gendered identity and categorisation of patients’ attachment styles, staff/patient sex and confidence in decision making and finally, staff gendered identity and confidence in decision making. Results - Fleiss Kappa yielded, at best, only fair levels of agreement (k<.4), regardless of patient/staff sex blend. Chi Square (X2) indicated comparable usage of attachment categories across all gendered identity types (P>.05). This suggests that attachment style decisions are not associated with staff/patient sex (in)congruence, nor staff gendered identity. However, sex-based asymmetry was found regarding confidence in correct decision-making (male: p<.05 and female staff: p<.0001). Conclusions – Overall, findings indicate that there is a systemic lack of inter-rater agreement between staff regarding patient attachment styles. However, staff are confident in their ability to interpret the behavioural cues of same sex patients’ correctly. Alternative interpretations of the findings are discussed; specifically regarding the concerning implications to current understanding of attachment theory and its application in a forensic settings. Additionally, recommendations for future research are proposed.
BSc (Hons) Psychology
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