Attachment Styles in Psychotherapy

One of the most interesting findings from the research on attachment styles is that between 80 and 90 percent of those who seek psychotherapy have the Disorganized Attachment style. This statistic is pretty amazing, given that most clinicians aren’t aware of it, don’t know how to identify or treat it, and likely have the same style themselves. I keep thinking of our professional code of ethics that says, “do no harm.”

I discovered this statistic quite synchronistically during a three-day workshop on the disorganized attachment in May 2015. I can say that it has profoundly changed me, both personally and professionally. Knowing this information has reorganized my whole paradigm on attachment. The concept of disorganization fits the intergenerational patterns in my own family history. It also fits the histories of my clients, and it expands and softens the clinical concepts of developmental trauma, shock and stress that I’ve been working with.

The Disorganized Attachment Style

Disorganized attachment is commonly associated with childhood abandonment, neglect and abuse. Mothers are supposed to be children’s source of comfort, a refuge of protection, the person who comes alongside them when they are faced with overwhelming circumstances. When a parent is absent or abusive—the source of pain and feeling overwhelmed AND the source of comfort and protection—the child’s brain and nervous system short out. In such situations, children are faced with a terrible dilemma. “Do I move towards the person upon whom my life depends, or do I avoid this overwhelming source of pain?” It is this dilemma that causes children to develop a disorganized attachment style.

It is possible to actually witness children display their internal dilemma. At times they will use avoidant strategies and at other times behaviors associated with anxious attachment. There also may be a “freezing” or disassociation reaction to the mother. Because sometimes she took care of them, and sometimes hurt them, children are unable to develop a consistent way of relating to her. The freezing and/or disassociating is the point at which children’s brains short out from the conflicting signals or impulse. They literally are at a loss about which impulse to follow.

The minds of children with the Disorganized Attachment style are ambivalent regarding intimacy and relationships. Some of their behaviors look like Borderline Personality Disorder, running hot and cold in ways that reveal their internal ambivalence.  They have histories of abuse, neglect, loss and rejection, and parents who were unresponsive, inconsistent, punitive and/or insensitive. These children view others as unavailable, threatening and rejecting. They often fear genuine closeness and feel unworthy of love and support.

Disorganized adults may show signs of antisocial behaviors such as lack of empathy and remorse. They may also be selfish, controlling, refuse personal responsibility for their actions, and disregard rules. Individuals with experiences of severe attachment trauma are much more vulnerable to a variety of emotional, social and moral problems. They are also at high risk for alcohol and drug abuse and for abusing their own children.

disorganized attachmentThe Disorganized Attachment framework also emphasizes the significance of the relational aspect of attachment, particularly during the first year of life. Mary Main’s research is very clear on this. Her findings show that a child’s identified attachment style at age one is verifiable at age six and again at age 19. Only an intervention in the mother-child relational dynamics changes this. The chart to the right shows that by age six, children with disorganized attachment have either 1.) taken on a parental role, organizing the physical environment around the mother to make it more stable and supportive, or 2.) become an emotional caregiver for the mother. In order to sharpen the contrast between them, I’ve labeled these two forms of parentized behavior as 1.) The Little General and 2. ) The Solicitious Caregiver.

Main questioned why the children in her research projects displayed disorganized attachment behaviors, wondering what in the mother-child dyad might be causing it.

Mary Main’s Attachment Research

MainMBeginning in the 1970s and throughout the ’80s, Mary Main, a protégé of Mary Ainsworth and research psychologist at the University of California, Berkeley, began interviewing parents and studying the interactions with their babies. They found that attachment rejection or trauma in a mother’s childhood was systematically correlated to the same sort of attachment issues between her and her children.

From her research with mothers, Main and her colleagues devised an interview method—the Adult Attachment Interview (AAI)—to assess parents’ attachment style. The interview contains 20 open-ended questions about people’s recollections of their own childhood, such as:
1. Describe your relationship with your parents.
2.Think of five adjectives that reflect your relationship with your mother.
3. What’s the first time you remember being separated from your parents?
4 Did you ever feel rejected?
5. Did you experience the loss of someone close to you?
6. How do you think your experience affected your adult personality?

After years of repeated use, the AAI interview now has more than 80-percent predictability of how a child of the adult interviewee would be attached to his/her parent. While other variants of adult attachment measures have been developed, the AAI was the first to empirically validate the intergenerational transmission of attachment patterns and to document a relational lineage from parent to child to grandchild.

The Implications of the Therapist’s Attachment Style

mother-child attunementSymbolically and energetically, therapists recreate the mother-child dyad in their clinical work. When infants and young children feel upset, they want their mothers to hold them tightly in a loving hug so that they can relax and reset their emotions at a calmer baseline arousal level. Parents who can do this in a “good enough” fashion not only successfully soothe their child after a specific upset, they also train the child’s neurological system to self-soothe.

When clients feel upset, they need therapists who can hold them tightly in a loving environment so they also can relax and reset their emotions at a calmer baseline arousal level. Therapists who are able to do this in a “good enough” fashion not only successfully soothe their clients after a specific upset, they also train the client’s neurological system to self-soothe.

Given the reconstellation of the mother-child dyad in the therapist-client dyad, therapists’ own style of attachment affects everything in the clinical experience. It is their capacity to self-regulate strong emotions in themselves and their clients, to stay calm and constant when clients display erratic or ambivalent behavior, to overcome any issues remaining their own attachment style that determines the therapy’s effectiveness.

Because attachment patterns are established in early childhood and continue to function as a working model for adult relationships, the possibility of countertransference between therapists and clients seems very high. And the odds increase exponentially when therapists also have a disorganized style of attachment. This is an ethical dilemma for all of us in the mental health profession. What to do?

 

 

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