Treating Assaultive
Men from an Attachment Perspective
Sonkin, D. and Dutton, D
(2003). Treatment assaultive men from an attachment perspective. In Dutton,
Don and Sonkin, Daniel (eds). Intimate Violence: Contemporary Treatment Innovations.
New York: Haworth Publishing. Copyright 2002.
BIOGRAPHY
Daniel Jay Sonkin, Ph.D. is a Licensed Marriage and Family
Therapist in an independent practice in Sausalito, California. His work focuses
on the treatment of individuals and couples facing a variety psychological
problems including domestic violence and child abuse. In addition to his clinical experience, he has testified as
an expert witness in criminal cases where domestic violence is an issue. He has also evaluated defendants facing
the death penalty conducting social histories with a focus on their childhood
abuse and it’s impact on adult criminal behavior. He has also testified as an expert
wintess in malpractice cases and licensing actions. As one of the early investigators and specialists in the
field of family violence he has developed a widely used protocol for treating
male batterers. He is the
author of numerous articles and
books on domestic violence and child abuse including: Learning to
Live Without Violence: A Handbook for Men, The Male
Batterer: A Treatment Approach, Domestic Violence on
Trial: Psychological and Legal Dimensions of Family Violence, and Wounded
Boys/Heroic Men: A Man’s Guide to Recovering from Childhood Abuse, The
JurisMonitor Stabilization Program for Stalkers, A Counselors Guide to
Learning to Live Without Violence and Domestic Violence: The
Court-Mandated Perpetrator Assessment and Treatment Handbook. He has written software for assessing
perpetrators of violence for both the Macintosh and IBM compatible computers.
He has conducted trainings nationally and internationally for mental health
professionals on the treatment of male batterers. He is a former chair of the state ethics committee of
the California Association of Marriage and Family Therapists and a former
member of the Board of Directors for that organization. In addition to his clinical practice,
he is an adjunct faculty in the Department of Counseling at Sonoma State
University. Dr. Sonkin provides consultation,
training and supervision in his unique model outlined in his books to
individuals and agencies providing services to male batterers and their
families.
Don Dutton received his Ph.D. in
Psychology from the University of Toronto in 1970. In 1974, while on faculty at the University of British
Columbia, he began to investigate the criminal justice response to wife
assault, preparing a government report that outlined the need for a more
aggressive response, and subsequently training police in “domestic
disturbance” intervention techniques. After receiving training as a group
therapist at Cold Mountain Institute, he co-founded the Assaultive Husbands
Project in 1979, a court mandated treatment program for men convicted of wife
assault. During the fifteen years he spent providing therapy for these men, he
drew on his background in both social and clinical psychology to develop a
psychological model for perpetrators of intimate abuse. This model views
intimate abusiveness as emanating from a trauma triad and comprised of
witnessing abuse, being shamed and experiencing insecure attachment. He has
published over 100 papers and three books, including the Domestic Assault of
Women (1995), The
Batterer:A Psychological Profile(1995) and The
Abusive Personality
(1998). The Batterer has
been translated into French, Spanish, Dutch and Polish and Dutton has provided
numerous workshops to professionals based on this work, including talks at the
Sorbonne in Paris, Washington, D.C.and New York City. Dutton frequently serves as an expert witness in civil
trials involving domestic abuse and in criminal trials involving family
violence, including his work for the prosecution in the O.J. Simpson trial
(1995). The latter led to an interest in spousal homicide and to
“abandonment killing”. He is currently Professor of Psychology at
the University of British Columbia, Vancouver, BC, Canada.
Abstract
This chapter explores the
relationship between attachment theory and treatment of perpetrators of
domestic violence. First the
authors present a brief overview of attachment theory. This is followed by a discussion of how
domestic violence research findings suggests that attachment theory is a good
paradigm to understanding the phenomenon of intimate violence. Lastly, the authors describe the
elements of attachment oriented psychotherapy as they might apply to working
with perpetrators of domestic violence.
Keywords: attachment
theory, attachment, psychotherapy, domestic violence, perpetrator treatment.
In a landmark series of studies entitled Attachment
and Loss, Bowlby (1969,
1973, 1980) outlined a remarkable theory that posited that early attachment had
sociobiological significance and constituted a powerful human survival
motive. The theory has
implications for anger in interpersonal relationships and for the seemingly
irrational outburst that accompany real or imagined separation. Primary attachment (usually to the
mother[i])
is governed by three important principles: first, alarm of any kind, stemming
from any source, activates an attachment survival system in an infant that
directs and motivates it to seek out soothing physical contact with the
attachment figure. Second, when
activated, only physical attachment with the attachment figure will terminate
it. Third, when the system has
been activated for a long time without soothing and termination, angry behavior
appears; if soothing and protection is not eventually found, the system can
then become suppressed.
Bowlby reported
observations he made of young children (15 –30 months) separated for the
first time from their mothers. He witnessed a three phase behavioral display:
anger, despair, and detachment. He
concluded from these observations that the primary function of anger was to
generate displays that would lead to the return of the absent mother. Anger is thus an attempt to recapture
the object that can soothe tension and anxiety at a developmental stage where
the child cannot yet self soothe through signaling the mother that she is
wanted and/or needed. Anger is an
emotion “born of fear” of loss. Dysfunctional anger, occurring later in adult affectional
bonds, was defined as anger that distanced the attachment object instead of
bringing (her) closer.
Subsequent empirical studies by Ainsworth
and her colleagues (1978) showed that different “attachment styles”
existed for infants. Initially
these were classified as “secure,” anxious-avoidant, and
anxious-ambivalent. A fourth
category emerged in their research that was eventually called
disorganized. Subsequent terms for
the three insecure patterns were dismissing, preoccupied, and fearful (see
Figure 1). The pre-occupied and
fearful types sought attachment but experienced anxiety as a consequence of
attachment. Also, both experienced
anxiety at the disappearance of the mother and were difficult to soothe upon
reunion. The fearful children were
particularly ambivalent upon reunion with their attachment figure, both
approaching and avoiding contact.
Bowlby (1969) described these children as “arching away angrily
while simultaneously seeking proximity” when re-introduced to their
mothers. Interestingly, although
the avoidant or dismissing children seemed content in the absence of their
attachment figure and not particularly interested in reconnecting upon reunion,
when physiological measures were taken, these children were quite anxious
during separation, but somehow learned to repress their feelings.
Figure 1
In 1987, Hazan and Shaver published a landmark
study that showed that adult “attachment styles” resembled infant
attachment styles. (The spate
of research that emerged on adult attachment styles is too voluminous to review
here; however, the interested reader is referred to Karen (1977) or Sperling
and Berman (1994) for a discussion on the history of attachment theory).
Assessment of adult attachment can be done through interviews (Main
& Goldwyn, 1998), projective tests (West & George, 1999) or self reports
(see http://psyweb2.ucdavis.edu/labs/Shaver/). Sperling and Berman (1994) define adult
attachment as “the stable tendency of an individual to make substantial
efforts to seek and maintain proximity to and contact with one or a few specific
individuals who provide the subjective potential for physical and/or psychological
safety and security” (p. 8).
One of ways attachment styles have been
deconstructed involves what are called representational models of self and other (Bartholomew &
Horowitz, 1991). Each of these
representations is a network of beliefs and expectancies about how the
relationship will function. It is
a cannon of attachment theory that these representational models are
internalized through the attachment process. They include positive and negative views of self,
expectancies about what will be received from another and generalized
projections about relationship outcome.
Bartholomew (1990) systematized these into a 2x2 arrangement for each of
four attachment styles, each having a positive or negative self-concept and
expectation of another (via relationships). These beliefs present another aspect of attachment that is
open to therapeutic intervention.
In Bartholmew’s schema, Preoccupied attachment styles have negative
self-images, while Dismissing attachment styles have negative other
images. Fearful attachment styles
have both negative self and other images.
Fearful attachment styles also expect the worst from an intimate
relationship but need such a relationship to heal their damaged self-image. Hence, they are thrown into an
ambivalent double avoidance (aloneness versus engulfment) that may serve as the
basis for borderline alternation (see Dutton, 1998).
Dutton, Saunders, Starzomski, and
Bartholomew (1994) attempted to relate attachment style in adults to abusive
behaviors. In a sample of 120 men
in treatment for wife assault and 40 demographically matched controls, they
assessed men’s attachment style using a self report measure called the
Relationship Style Questionnaire and
abusiveness through wives’ reports using the Psychological Maltreatment
of Women Inventory (PMWI; Tolman, 1989).
A Fearful attachment style in the male perpetrator was highly related to
abusiveness, correlating +.46 with the Domination/Isolation subscale of the
PMWI, and +.52 with the Emotional Abuse subscale. These relationships were highly significant. To a lesser extent, an attachment style
called Preoccupied also correlated significantly with abuse. Fearfully attached men also reported
high levels of chronic anxiety and anger.
Bartholomew, Henderson, and Dutton (2001) also found that women in
shelters escaping abusive relationships could be classified with Preoccupied
(53%) or Fearful (35%) attachment styles.
These styles were related to the woman’s difficulty in leaving the
relationship.
Dutton (1998) described what he called
the “abusive personality,” a constellation of psychological traits
that, when assessed in males, are highly related to partners’ reports of
abusiveness. Fearful attachment
was an important component of this personality constellation and, according to
Dutton, directed the anger to an intimate target. Men whose violence was predominantly or exclusively in
intimate relationships probably have an attachment disorder. This disorder may be related to
personality disorder diagnoses such as Borderline or Dependent personality;
however, it has an attachment aspect to its’ origin and plays itself out
in intimate relationships. Dutton
has suggested that such men have both a public and private (intimate)
personality that may be quite dissimilar.
Typically, batterer treatment has not
included specific work on attachment, yet therapists regularly hear of
delusional construals of or pre-occupation with the spouses behavior (deemed
“conjugal paranoia”).
For example, one of the authors (Don Dutton) had a client who was
convinced that his wife was having an affair when he found “a key with a
man’s name on it” (the key manufacturer). Many batterers present as cold, unemotional, and
non-empathetic, similar to persons with avoidant attachment and those suffering
from psychopathy. Likewise, it is
common for batterers to show patterns of approach/avoidance as seen with
disorganized attachment and borderline personality disorder. Spousal homicide committed by males is
frequently in response to real or perceived abandonment (Dutton & Kerry,
1999). Browning and Dutton (1986)
obtained pronounced anger/arousal responses in batterers who witnessed a
videotape depiction of an “abandonment” (a woman unilaterally
deciding to visit another city with female friends and join a woman’s
consciousness- raising group).
Their anger/arousal scores were significantly higher than control groups
of men, and were especially pronounced on this “abandonment”
scenario. The relationship between
fear of abandonment and rage thus appears strong in this group of partner
abusive men. The conversion of
fear to rage could occur because the latter is more consistent with male sex
role conditioning. Regardless, the
confrontation of this emotional contribution to abuse deserves therapeutic
attention.
These data suggests that incorporating
attachment theory into batterer treatment is well founded. First, it can enable batterers to
perceive a broader pattern in their reactions to loss and separation in their
intimate relationships. Second,
this theory supports the prevailing notion that clients need to learn emotion
self-regulation during periods of attachment-anxiety. Third, attachment theory suggests that through altering the
internal working models of self and other the client can break a perceptual
mold in which attachment-anxiety is reduced to either distancing, clinging, or
approach/avoidance.
Theory
to Practice: Attachment Theory Informed Psychotherapy
Although psychotherapy with adults from
an attachment perspective is still in early development, some significant
clinical ideas and applications exist.
Some clinical scholars have incorporated attachment theory into other
theories (Masterson & Klein, 1995; Schore, 1994), which has served to
enhance general psychoanalytic theory and practice. However, other psychoanalytically oriented theorists have
criticized this theory based on it’s interpersonal versus intrapsychic
focus and the categorical, mutually exclusive attachment categories (Fonagy,
1999). To date, there exists
little (Slade, 1999) or no specific models of attachment theory informed
psychotherapy with adults. It is
beyond the scope of this chapter to debate the strengths and weaknesses of
attachment theory as it applies to psychotherapeutic intervention, but
regardless of the final outcome of such a debate, Arietta Slade sums up the
controversy by stating, “In essence, attachment categories do tell a
story. They tell a story about how
emotion has been regulated, what experiences have been allowed into consciousness,
and to what degree an individual has been able to make meaning of his or her
primary relationships” (p. 585).
Given this perspective, let’s first look at the road map Bowlby
has laid out when applying his theory to clinical practice.
Bowlby explicitly saw the therapist as a
surrogate mother who encouraged the client to explore the world from a secure
base he or she creates. In the
context of therapeutic work with individuals, Bowlby (1988) defined five tasks:
1.
Create a
safe place, or Secure Base, for client to explore thoughts, feelings and
experiences regarding self and attachment figures;
2.
Explore
current relationships with attachment figures;
3. Explore relationship with psychotherapist as an
attachment figure;
4. Explore the relationship between early childhood
attachment experiences and
current relationships; and
5. Find new ways of regulating attachment anxiety (i.e.,
emotional regulation)
when the attachment behavioral
system is activated.
Each of these five tasks is described in
detail below.
Creating a Secure Base
The primary task that Bowlby states as
necessary to addressing attachment in psychotherapy is the development of the
secure base. In this section, we
will define the secure base, and discuss its development and function in the
therapeutic relationship.
What is a Secure Base?
In order to understand Bowlby’s
concept of the secure base in psychotherapy, one must look at how this is
developed between the mother and child.
The infant’s inability to communicate in adult terms makes
parenting a challenging task.
Parents (and mothers in particular) must develop skills in empathy and
attunement in order to understand the needs of the developing child. An attuned mother (or father) can tell
the difference between a full diaper cry, a hungry cry, and a tired cry. Even if they can’t tell the exact
difference, they are quick to assume that the baby is distressed and in need of
some form of caretaking, and if in their response one strategy does not work,
they quickly employ another.
Compare this to an insensitive or misattuned parent, who either ignores
that child’s needs altogether, considers the crying a problem and loses
sight of the underlying needs, or is overwhelmed by the baby's needs.
The attachment behavioral system,
according to Bowlby however, does not just activate when the child is hungry or
needs a diaper change. The
attachment system activates when there is fear or vulnerability for some
reason. Perhaps the baby heard a
loud noise or woke up in the dark.
These experiences activate the attachment system, which serves to
motivate the infant to seek protection from threatened danger. The infant is like, as Cassidy (1999)
describes, a heat-seeking missile, looking for an attachment object (typically
the parent) that is sufficiently near, available, and responsive. When this attempt for protection is met
with success, the attachment system de-activates, the anxiety is reduced, the
infant is soothed, and play and exploration can resume. When these needs are not met the infant
experiences primal anger accompanied by extreme arousal and terror. These reactions, according to Bowlby,
set a template for later adult reactions to abandonment.
The parental caretaking system
compliments the infant’s attachment behavioral system. It is the caretaking system that
responds with the goal being to protect and reassure in order to reduce the
child’s anxiety. Behaviors
that can accomplish this goal can range from the practical (e.g., putting the
child down for a nap, or feeding or removing a child from a dangerous or
frightening situation) to the more complicated process of mirroring the
child’s inner life in words that help the child to learn self-reflection
and understanding. For example,
for the two-year-old who is involved in a full-fledged tantrum, the parent may
reflect the child’s feelings (e.g., “you must be so tired,”
or “I know it hurts when I say no sometimes”). As the child gets older, this mirroring
process becomes more complex reflecting the child’s more sophisticated
understanding of their feelings, needs, and relationships.
No parent always knows how to respond, or
even how to respond constructively.
Mis-attunements are an inevitable part of the parenting process. This is beneficial for the child, because
if a child grew up with a perfectly attuned parent, they would not be prepared
for the vicissitudes of life. They
would be sadly disappointed to discover that other people in the world did not
provide the same sensitivity as their mother or father. Mis-attunements are opportunities for
the child to develop realistic expectations about the world in response to
their needs. These mis-attunements
and attunements are also an opportunity for parents to help children learn
about the give and take of relationships.
Through the rupture and repair process, children learn about how people
become intimate in spite of differences and conflict. They develop a sense of poignancy and tolerance for the
ambiguities of intimate relationships.
This process of the activated attachment
behavioral system and the complimentary caretaking system helps to create the
secure base necessary for healthy development, exploration, and play. According to Bowlby’s theory,
this healthy developmental process gets derailed when the parental caretaking
system is not adequately or appropriately near, attentive, or responsive to the
child’s attachment behavioral system.
The Secure Base in Psychotherapy
The parent who provides a secure base for
their child through attunement, sensitivity, caring, setting limits, and
teaching helps the child to learn to soothe the anxiety generated by the
activated attachment system, and hence return to exploration and play. It is through this exploration and play
process that the child is developing a sense of self. In the case of psychotherapy, the clinician is the
caretaking figure who likewise provides a secure base so that the
client’s attachment system is sufficiently deactivated and the client is
free to explore and play. In
therapy, however, the exploration is the inner world of feelings, thoughts, and
experiences, and the play is, for example, trying on new identities and
responses to stress and conflict.
Developing a secure base in psychotherapy
would be very easy if it were as simple as therapists being available,
attentive, responsive, and attuned.
Unfortunately, it is not so elementary. What is interesting about
psychotherapy is that, like the strange situation (Ainsworth et. al., 1978), it
too creates a degree of emotional stress, can be threatening emotionally to
clients, and can be detected by observing the coherence of the client’s
stories about their attachment experiences (Main & Weston, 1981). Sitting in the room with a stranger and
talking about emotionally laden material can be quite anxiety provoking and
likely to activate the attachment behavioral system right from the start of
therapy. Unlike the infant whose
attachment experiences are not yet solidified into firmly established working
models of self and others, the adult client has already developed a response
set to stress and vulnerability within the interpersonal context. That set, depending on the attachment
style, will be similar to responses to other interpersonal relationships in
their life, behaviors that contribute to problems that they are seeking help
for in the first place.
Those attachment behaviors may be obvious, but can also be so subtle
that the therapist will not recognize that they are present and interfering
with the change process. So on one
hand the client is seeking help, yet on the other hand the client’s
attachment behavioral system may be the very thing that presents obstacles to
actually receiving assistance from the therapist.
Research in domestic violence suggests
that male batterers represent all three insecure attachment classes: avoidant,
pre-occupied, and disorganized or fearful (Holtzworth-Monroe, et. al.,
2000). Each form of insecure
attachment has particular defense mechanisms as a method of coping with
attachment anxiety. Batterers with
an avoidant style present as disconnected emotionally, lacking empathy, cold,
and uninterested in intimate relationships. They can vacillate between being distant and cut-off
emotionally to critical and controlling.
These clients need to incorporate an emotional soundtrack, as one client
put it, into their life. Batterers
with a pre-occupied style try to please others in order to receive
approval. They can present as
extremely self-controlled except when experiencing loss anxiety, when they can
become extremely clingy and angry.
When experiencing emotion, these clients are overwhelmed by their
attachment needs and are often unable to contain themselves. Unlike their avoidant counterparts,
these clients need cognitive structures necessary to contain their intense
emotional reactions. The fearful,
or disorganized, batterer can manifest elements of both the avoidant and
pre-occupied batterers. They
experience attachment anxiety, and fear of rejection or being hurt if they are
too close and anxiety if they are too distant. Like the disorganized children in the strange situation,
these clients do not have an organized strategy for dealing with attachment
anxiety. Dutton (1998) has written
extensively about the fearful/disorganized or borderline batterer.
How the therapist proceeds in the early
stages of therapy with domestic violence clients is critical to the creation of
the secure base. If the therapist
fails to notice the client’s strategies and their psychological function,
the therapist’s responses will most probably confirm the client’s
inner working models of self and others and reinforce the attachment behavioral
system as it currently manifests.
However, if the therapist responds with empathy and attunement, two
things can happen. First, the client
gets a different experience of him/herself. The attuned therapist, like the attuned parent, will look
beyond the client’s response set and help them recognize their
unconscious motivations, needs, and emotions. The therapist also helps the client view their response set
(attachment behaviors) from a different perspective - how they undermine their
getting their needs met in interpersonal relationships. This rudimentary process is the
beginning of the client altering their inner working models of self.
The second possible outcome of therapist
empathy and attunement is that the client experiences the therapist in a
positive way, in that they feel understood, seen, and cared for by the
therapist. When the client feels
understood and not judged, that experience in and of itself can be relieving
and soothing, thereby beginning to alter their inner working models of
others. These processes,
feeling understood and recognizing underlying needs and feelings, is the
rudimentary beginning of the creation of a secure base in psychotherapy, a
necessary first step in the process of altering the attachment behavioral
system so that it is not likely to wreak havoc in interpersonal relationships.
However like parenting in the real world,
even the most sensitive and talented therapists are not always going to be
perfectly attuned; therefore, clients are likely to experience ruptures in this
state of understanding and perfect attunement by the therapist. Like with the developing child, these
ruptures are not only inevitable but necessary to the process of therapy and
the development of a more adaptive attachment behavioral system. We will discuss these opportunities
later in the section on utilizing the therapeutic relationship to effect
change.
However, most batterers present in
therapy with severe acting-out problems.
These can range from physical or non-physical abuse towards their family
members or others to substance abuse, missing sessions, hostility toward the
therapist, or other oppositional behavior. The therapist is confronted with the following dilemma. On one hand, the client requires
understanding and support for the pain they are experiencing that leads to
these behaviors. On the other
hand, continued acting-out will interfere with the client benefiting from the
therapeutic experience. Therefore,
a combination of interpretation, which is necessary to facilitate the
development of a secure base with the therapist, and confrontation, which is
also necessary in setting limits on the self or other destructive acting-out
behaviors, is needed.
An Empirical Descriptions of Secure Base Priming
The idea of creating a secure base in
psychotherapy sounds good, but is this a real concept or just another variation
of the therapeutic alliance?
Researchers in adult attachment have been able to empirically test the
notion that creating a secure base experience for individuals may temporarily
alter an individual’s inner working models of others and therefore change
behaviors or emotional states. The
idea of “secure base priming” has been gaining attention in the
adult attachment literature. Mario
Mikulincer and Phil Shaver (2001) examined the effects of secure base
priming on intergroup bias. They
hypothesized that having a secure base could change how a person appraises
threatening situations into more manageable events without activating insecure
attachment-like behaviors such as avoidance, fear, or preoccupation. They
utilized a series of well-validated secure base priming techniques (described
below) that have appeared to create in subjects a sense of security one would
find in individuals who would might otherwise be assessed as having a secure
attachment style. These techniques
were quite creative and had powerful effects on subjects.
One group was primed using subliminal
presentation of words that exemplify a secure schema (e.g., love, support)
within a word relation task (Arndt, Greenberg, Pyszczynski, & Solomon,
1997). This is not unlike the
therapist who gives verbal as well as non-verbal messages to clients
communicating support, caring, and empathy. In another study, participants performed a guided
imagination task in which they visualized an interpersonal episode containing
the prototypical if-then sequence of the secure base schema (Mikulincer &
Arad, 1999). This method seemed
close to the process of helping clients imagine a situation with positive
outcomes, such as one used by cognitive-behaviorists called rehearsals with a
positive outcome. What would it be
like if they got the love and support that they deserve? The third priming technique was
Baldwin, Keelan, Fehr, Enns, and Koh Rangarajoo's (1996) visualization task, in
which participants visualized a real person who served as a secure base for them. Here again, it is not unusual to ask
clients to talk about positive experiences in their life, or for the client to
report thinking about the therapist (or another positive attachment figure such
as a peer in the batterer's group) outside of the session as a means to
self-soothe, feel reassured, or bolster confidence.
In all five of these studies, those
subjects exposed to secure base priming acted in the experimental condition
similar to securely attached individuals who did not receive priming but were
nevertheless exposed to similar conditions assessing intergroup bias. The authors suggest that secure base
priming enhances motivation to explore by opening cognitive structures and
reducing negative reactions to out-group members or to persons who hold a
different world view. The observed
effects of secure base priming may reflect cognitive openness and a reduction
in dogmatism and authoritarianism (Mikulincer & Shaver, 2001). Other similar studies have found that
secure base priming will have a positive effect on cognitive and affective
states (Mikulincer, 1998).
Although these studies are not meant to be applied to clinical
situations, they have powerful implications for the clinical setting. Aspects of the psychotherapy process
are similar to these descriptions of secure base priming and through that
process clients may begin to change their internal representations of self and
others or attachment styles.
Exploring Current Relationships with Attachment Figures
As the therapy proceeds and the therapist
works to create the secure base environment, Bowlby’s second task
eventually begins to become a focus of the psychotherapy: exploring current
relationships with attachment figures.
These attachment figures include family members, friends, relatives,
partners, and spouses. Here the
client is exploring patterns in their close relationships, while the therapist
is listening for patterns of relating that suggest secure or insecure
attachment patterns, and if the latter, which particular insecure attachment
style. The exploration of these
relationships helps the therapist understand the client’s attachment
style as it manifests in the significant relationships of his or her life. Research suggests that people may
demonstrate different attachment styles in different relationships (Feeney,
1999). This makes a certain amount
of sense. Since the attachment
system is closely tied to the attachment figure’s caretaking system, then
how the attachment figure responds to the client will in part determine the
client’s response to attachment system activation. In addition, in adult relationships
(unlike a child-mother relationship) both adults are acting in the capacity of
caretaker and seeking attachment for their own needs. This fact is likely to complicate the issue of stability of
attachment style within differing contexts.
It is not completely clear how attachment
style correlates with the issue of personality disorders (Dozier, Stovall,
& Albus, 1999). It is
generally thought that people suffer from one personality disorder rather than
multiple personality disorders.
Neither attachment theory or the empirical literature on personality
disorders can say they have spoken the final word on this issue. What is seen clinically, however, is
that people do seem to have consistent core issues, but these issues may
manifest differently in different contexts. Like attachment relationship dynamics, personality disorders
are likely to manifest differently depending on the context or relationship. It is believed that attachment styles
are not so much categorical as much as degrees; hence, different
client-attachment figure relationships are likely to evoke different degrees of
insecurity. For example, one
relationship may generate a mild avoidant response by the client, whereas
another relationship may evoke an extreme avoidant reaction. Even in the same relationship,
different degrees of avoidance or anxiety may be evoked depending on the
situation. The same can be said
about personality disorders.
Therefore, determining the attachment style of a particular client is
only part of the goal of this process; more importantly, assessment is also
done on how the attachment system is being activated with the client in a
particular relationship or context.
Domestic violence perpetrating clients
spend a great deal of time talking about their experiences with the partner
they have abused. The tendency to
focus on the relationship or partner is great in this population. These clients grew up in families where
the attachment figure was not sufficiently present, attentive, or responsive;
therefore, a great deal of personal energy was expended focusing on the
attachment figure - are they present?
Are they going to respond positively? Are they even going to know what I need? These same questions are evoked in
their adult relationships, either consciously or unconsciously. Directing the clients to their inner
experience is key to turning this pattern of externalizing behavior to one of
personal awareness and responsibility.
Because so much focus in traditional domestic violence treatment is on
anger management and power and control dynamics, therapists do not pay enough
attention to the client’s inner psychological experience of
relationships. Here attachment
theory can enhance the current domestic violence treatment paradigms. By exploring the unconscious internal
working models of self and other, clients can begin to understand why they may
have the difficulties in regulating affect or why they experience a need to control
others as a means to regulate attachment-related affect.
Exploring the Relationship between Early Childhood Attachment Experiences and Current Relationships
An important and necessary aspect of
psychotherapy from an attachment perspective is the exploration of early
childhood experiences and their effect on the inner experience of self and
others. Those experiences with
caregivers formed the representational models of self and others from which the
client views self and the significant attachment relationships in their
life. Although Bowlby’s description
of this process seems primarily cognitive in nature, there is a significant
emotional component to this task of psychotherapy. In many cases, domestic violence perpetrators present with
unresolved trauma, loss, and other emotionally laden relationship experiences
that must be worked through cognitively, emotionally, and physically. Victims of physical, sexual, and
psychological maltreatment will experience a range of emotional reactions to
this exploration process from depression to rage. The therapist must be willing to work these painful
minefields with the client. Much
has been written on addressing childhood abuse in psychotherapy (e.g., Herman,
1992; Van der Kolk, McFarlane & Weisaeth, 1996), a topic that is beyond the
scope of this chapter. But even
with clients whose experiences would not be classified as “abuse,”
painful recollections of subtle and no-so-subtle rejections and misattunements
by parents evoke powerful feelings of sadness, loss, and anger. Research in domestic violence
treatment outcomes suggests that some perpetrators may need to address
unresolved trauma before, or at least concurrently to, addressing violent
acting-out behavioral patterns.
An important part of this process
involves the exploration of the representational models of self and attachment
figures that resulted from these experiences with the goal being to reappraise
them and restructure them in light of the understanding and insight gleaned
from this process. Most often
children’s strategy for dealing with unpleasant experiences is to put
them out of mind. In
psychotherapy, the client can revisit these experiences but with the benefit of
having an adult mind that can understand the reasons for their experiences and
how they affected them psychologically.
Where the therapist has the most leverage in assisting the client in
changing these representational models is through new relational experiences
that the client has in therapy with the therapist him/herself. The goal of this historical exploration
is helping the client to be less “under the spell” of historical
experiences with attachment figures.
In doing so, current relationships with attachment figures will be less
charged.
Another important aspect of this process
is to explore the more pathological aspects of insecure attachment. Jealousy in batterers was first
described by Walker (1979) and reiterated in Sonkin, Martin, and Walker
(1985). It was described as taking
the form of frequent questioning of whom a spouse has been with or where she
has been, accusations of her attraction to other men, and suspiciousness that
she being flirtatious with other men.
In extreme cases, this serves as a motive for
“pseudo-incarceration,” the literal isolation and confinement of
the woman to the home and monitoring of her phone contacts. It can also involve frequent phone
calls to her place of work and insistence upon picking her up from work. Duluth Model “explanations”
for these behaviors has been to label them as “Power and
Control.” Dutton (1998)
pointed out that the use of power and control was relationship-specific to
batterers, and that people exercise control most when they are anxious and
afraid. The control of batterers
is exercised because of a fear, the same anger “born of fear” that
Bowlby described. Because
men often look to external causes of their discomfort, they assuage the fear
and anxiety within themselves by controlling their partner, who is the
perceived source of their anxiety.
Although insight into attachment patterns
is an important task in treating male batterers from an attachment perspective,
the strong agent of change in this form of psychotherapy is the development of
new strategies for coping with attachment related anxiety. On a practical level, one immediate
therapeutic objective is developing the ability to recognize an anxious
reaction to loss and the ability to self-soothe. However, because this ability should have developed through
sensitive attunement by the attachment figure as a child, it now must also be
learned through the attunement of an attachment figure such as a
therapist. The therapist must be
that soothing voice until the client learns to find that voice within him or
herself.
In an group psychotherapy format, this
could be established through the introduction of a topic such as “fear of
losing her,” in which “abandonment” scenarios are described
(e.g., you call and she’s not home, she’s late returning from work
or shopping, or she pursues a job or hobby that takes more of her time). It is possible to have men generate
loss-fear diaries the same way they would generate anger diaries. A discussion of the timing and
frequency of daily contact might help establish a pattern: who initiates the
contact? Is it by phone? How frequently does it occur? What are the reactions to a failure to
establish contact?
In a more unstructured domestic violence
therapy, the client will eventually bring in material where attachment or
separation anxiety has been triggered and the therapist can be a soothing voice
with a more objective perspective that helps the client learn to do similarly
for him or herself. It is also
possible to structure systematic desensitization exercises to loss-fear in the
same fashion as any other fear based cognitive-behavioral intervention (e.g., fear
of flying), where an anxiety gradient is established with the most
fear-inducing scenarios at the top, less serious at the bottom. The client then visualizes the less
serious scenarios and is taught relaxation techniques to extinguish the anxiety
at the lower levels. When these
are mastered, the therapist proceeds to a more anxiety-producing level.
Clulow (2001) discussed working with
insecure attachment in a couples therapy context. In this context the focus is on establishing a secure base
in the couples relationship.
Although couples therapy is not advisable in some domestic violence
situations, attachment theory can provide a valuable perspective to
understanding and treating domestic violence with couples as well as individual
or groups.
The secure base relationship creates the
safe container from which representational models of the client and his
attachment figures can be explored. Bowlby (1988), in one of his last papers,
outlined this surrogate task as follows:
A
therapist applying attachment theory sees his role as being one of providing
conditions in which his client can explore his representational models of
himself and his attachment figure with a view to reappraising and restructuring
them in the light of the new understanding he acquires and the new experiences
he has in the therapeutic experience. (p. 138)
The
therapeutic alliance appears as a secure base, an internal object as a working,
or representational, model of an attachment figure, reconstruction as exploring
memories of the past, resistance as a deep reluctance to disobey the past
orders of parents not to tell or not to remember. (p. 151)
Exploring the Relationship with the Psychotherapist
In any ongoing psychotherapeutic process,
the client may begin to consciously or unconsciously view the therapist as an
attachment figure (Farber, Lippert, & Nevas, 1995). If this indeed occurs, there is a great
possibility that the attachment behavioral system will activate at various points
in the therapy process. Although
talking about events and relationships outside of therapy is helpful, therapy
from an attachment perspective must include, at some point, a discussion of the
attachment dynamics between the therapist and the client - Bowlby’s third
task for the attachment informed psychotherapist. Psychotherapy may be viewed as common place for many people
who have participated in the process, particularly for therapists who live and
breathe the profession. However,
for most domestic violence clients, the act of entering a therapist’s
office and disclosing private thoughts and feelings is likely to raise a degree
of attachment-related anxiety.
Therefore, it is important that therapists pay close attention to their
client’s verbal and non-verbal behaviors from the moment they make contact
to begin to hypothesize how their particular attachment behavioral system is
activated.
Most clients rarely readily admit to
having feelings about their therapist, or at least being in therapy. Their rational mind takes over and they
tell themselves, “of course I feel comfortable with my therapist”
or “why would I be here if I didn’t feel comfortable?” In reality, however, it would be
considered highly problematic if the client only had positive feelings while in
therapy. Not all clients will be
able to directly confront their feelings about the therapy and therapist early
in the therapeutic relationship.
Individuals with some attachment styles are not likely to admit that the
relationship is significant, let alone admit that they have deep emotional
reactions to the therapist. Just
as differential diagnosis guides the clinician about treatment planning and
pacing, so does understanding a clients particular attachment style inform the
attachment-oriented psychotherapist about how and when to address the
therapeutic relationship with a particular client.
Addressing therapeutic relationship from
an attachment perspective is important for a number of reasons. First, it is through the intimate
relating that occurs within the clinical hour that there is the opportunity to
explore and hopefully change the representational models that determine a
client’s attachment style.
Second, working with the client when feelings arise in therapy helps
him/her find ways of regulating attachment anxiety and patterns of avoidance
when attachment system is activated.
Viewing attachment from the perspective of anxiety and avoidance (Hazan
and Shaver, 1987) suggests that changing attachment styles involves the client
learning to regulate attachment anxiety and/or finding other means of
expressing attachment needs other than through avoidance. Lastly, there is some evidence that
long term psychotherapy can affect the neuro-circuitry that gives rise to
attachment related representations as well a emotion regulation (Perry, 1995;
Vaughan, 1997).
Regulating Attachment Anxiety when Attachment System is Activated
As mentioned above, the activation of the
attachment behavioral system in the therapeutic hour can be the most effective
way to address attachment anxiety with the client. The distancing of the dismissing attachment style, the
pleasing and idealizing behaviors of the preoccupied attachment style, and the
erratic dependency and distancing of the fearful attachment style will
eventually manifest in therapy in subtle and no-so-subtle ways. When the therapist develops a secure
base relationship with the client and the client has some of the above
mentioned insight into his/her attachment relationships, the ground is set to
address these behaviors as they manifest in the relationship with the
therapist. Through both the
interpretation and confrontation of these behavioral manifestations of the
activated attachment system, the client can learn to face the pain and
vulnerability that underlie these defenses. This approach also allows the
clients to understood and supported by the therapist, and eventually develop
within themselves new skills in self-soothing, reassurance, and
relaxation. The net result is the
client is able to reduce the reactivity and sensitivity to perceived cues of
threatened safety or protection.
Much of what’s published in the
domestic violence field speaks to this task of the attachment-oriented
therapist. Education, cognitive
interventions, and behavioral therapy all focus their efforts at assisting the
client (or student in the case of educational based programs) in learning new
methods of coping with anger, conflict, or any emotionally difficult
situations. Although some programs
address childhood abuse issues (Bowlby’s fourth task), it has been promulgated
by leaders in the domestic violence field that it is more effective to focus on
the here and now and less on childhood abuse experiences, which can be
addressed later in the treatment process.
This mythology seems to contradict research that suggest otherwise
(Saunders, 1996). Saunders found
that some batterers may actually improve faster by focusing on childhood abuse
issues earlier in psychodynamically oriented treatment. Additionally, Dutton’s (1998)
research on male batterers suggests that for a significant percent of men,
childhood trauma has led to borderline personality organization. Thus, it appears that addressing
childhood abuse issues is a necessary element of the treatment process. Although cognitive and behavioral
interventions are an important element in domestic violence treatment, they
clearly are not sufficient given the fact that a significant percentage of
persons who complete domestic violence treatment do seem to re-offend. In addition, even though physical rates
of violence do significantly decrease post treatment, psychological or
non-physical violence do persist at relatively high rates (Rosenberg,
2001). Dutton (1998) found a 21%
arrest rate for an eleven-year follow-up, with partner interview violence rates
at approximately 16%. These data
suggest that at least 20% of persons completing treatment will re-offend. Higher rates of physical and
non-physical violence have been found in other studies (Gondolf, 1997).
Taken together, this data suggests that
the treatment programs developed to date may still be missing important
elements necessary to long term cessation of physical and non-physical
abuse. Cognitive and behavioral
interventions are necessary but not sufficient for long-lasting, successful
treatment. Treatment of domestic
violence from an attachment-informed perspective may include the missing
elements that can ultimately lead to lasting change with clients, manifested
not only by the cessation of violence but also by a significant change in their
experience of close relationships in general.
Dutton’s research suggests that
batterers will present with all three types of insecure attachment styles in
similar frequencies (Dutton, Saunders,
Starzomski, & Bartholomew, 1994). However, Fearful, and to a lesser extent Preoccupied, styles
are correlated with partner’s reports of abuse. These findings suggest that the subcategories/typologies of
batterers are sufficiently different enough to justify therapists approaching
treatment from an assessment based perspective, as opposed to using a
cookie-cutter approach to treatment whereby all batterers are treated as if
their violence has a single origin or etiology. In addition, studies on drop-out rates of individuals in domestic
violence treatment (Daly and Pelowski, 2000) suggest that one factor,
psychopathology, may be related to this phenomenon. Therapists who begin to recognize that they will need to
vary their conceptualization and intervention with different clients may be
able to reduce the drop-out rates in their treatment program. Attachment informed psychotherapy
recognizes that different attachment styles may need different therapeutic
conceptualizations and interventions (Slade, 1999).
The Assessment
of Adult Attachment Status
Numerous
measures of adult attachment have been developed over the past ten years each
with their own strengths and weaknesses (Crowell & Treboux, 1995). Generally, these measures fall into two
categories: self-completed questionnaires (questions or statements responded to
with a Likert type scale) and those administered by a trained evaluator. We would like to discuss three of these
instruments because each one deconstructs attachment somewhat differently, and
we believe that each method has clinical relevance to treating domestic violence
clients.
The Adult Attachment Interview. Main and Goldwyn (1998) developed the Adult Attachment
Interview (AAI), as system based on the structural qualities of narratives of
early experiences. The interview
consists of eighteen questions about childhood experiences with attachment
figures. The trained evaluator is
not so much interested in the content, as much as the coherence of the
interviewee’s narrative.
Arieta Slade (1999) explains Main’s definition of coherence as the
following:
For
Main, the capacity to represent past experiences in a coherent and
collaborative fashion is the most significant and compelling aspect of adult
security, and is clearly the most predictive of infant security. A coherent interview is both believable
and true to the listener; in a coherent interview, the events and affects
intrinsic to early relationships are conveyed without distortion, contradiction
or derailment of discourse. The subject collaborates with the interviewer,
clarifying his or her meaning, and working to make sure he or she is
understood. Such an subject is
thinking as the interview proceeds, and is aware of thinking with and
communicating to another; thus coherence and collaboration are inherently intertwined
and interrelated. (p. 580
While
autonomous individuals value attachment relationships and are able to integrate
memories into a coherent narrative, insecure individuals are poor at
integrating memories of experience with the meaning of that experience. Those persons classified as having a
dismissing attachment style tended to deny negative memories, and idealize
early relationships. Their
stories were very brief, general, and often full of contradictory data (e.g.,
describing negative experiences but talking about the parent in a positive
light). Preoccupied individuals
tend to be preoccupied with childhood attachment experiences, often still
complaining of childhood slights, echoing the protests of the resistant infant. Their stories are often long and
grammatically entangled with vague usages (“dadadadada,” or
“and that”).
Unresolved individuals give indications of significant disorganization
in their attachment relationship representation via either semantic or syntactic
confusions in their narratives concerning childhood trauma or a recent loss
(Fonagy, 1999). These individuals
show striking lapses in monitoring of reason or discourse (George, Kaplan and
Main, 1996).
The relevance of the AAI to clinical work
with batterers is that clinicians can listen to their client’s narratives
from the beginning of treatment so as to begin to form hypotheses about
attachment status. Additionally,
as the narratives begin to evidence certain forms of incoherence, the clinician
can also strategize treatment interventions that specifically address the
client’s defensive patterns that have led to the particular form of
incoherence. For example, for the
avoidant or dismissing client who presents little data, idealizes their
attachment experiences, and is unable to express affect, the therapist can begin
to formulate strategies that help draw out the client’s story, listen for
inconsistencies in their recollections of childhood experiences and begin to
point them out, and slowly help the client connect with the emotional track of
their narratives. The pre-occupied
client, whose narratives are convoluted and saturated with uncontained affect
about attachment experiences, will need to learn how to better self-soothe so
that their narratives will have a certain degree of objective distance or
cognitive structures that contain the appropriate degree of affect. With the fearful or disorganized
batterer, the therapist will need to address the early childhood trauma
experiences, whose resultant repressed affect leads to dissociation and other
forms of maladaptive emotion regulation.
When treating domestic violence perpetrators, it would be our hope that
as the client learns more about himself and his attachment relationships and
becomes more effective at modulating attachment anxiety, his/her narratives
will become more coherent.
Experiences in Close Relationships
Questionnaire. Brennan, Clark and Shaver (1998)
developed the Experiences in Close Relationships (ECR) questionnaire, a
self-report measure that assesses adolescent and adult romantic-attachment orientations
(secure, anxious, and avoidant--the three patterns identified by Ainsworth,
Blehar, Waters, & Wall, 1978 in their studies of infant-caregiver
attachment). They deconstruct
attachment on two continuums: anxiety (need for approval, preoccupation with
relationships, fear of being abandoned) and avoidance (discomfort with intimacy
and closeness). Persons with low
anxiety and low avoidance are within the secure range. Those with high anxiety and low
avoidance are within the preoccupied range, while those with low anxiety and
high avoidance are within the dismissing range. Finally, persons with high anxiety and high avoidance are
within the fearful range. Clients
can fill out the 36 questions fairly quickly. The client is asked to read each statement and answer to
what degree it reflects how they see themselves. They can even take the test online and receive the results
immediately (http://www.geocities.com/research93/). Unlike the AAI, the ECR scores the
person in degrees of avoidance and anxiety, and therefore is somewhat less
categorical in nature.
The Relationship Questionnaire. Another self-report adult attachment measure is the Relationship Questionnaire, developed by Bartholomew and Horowitz (1991). This measure, although similar in form to Brennan, Clark and Shaver’s (1998), conceptualizes attachment in terms of internal working models of self and others. This deconstruction of attachment is based on Bowlby's (1973, 1979) original conceptualization of attachment. Bartholomew provides two theoretically unrelated dimensions giving four quadrants or categories. Positive working models of the self and positive working models of others give rise to the secure attachment status. Negative working models of the self and positive working models of others give rise to the preoccupied attachment status, while positive working models of the self and negative working models of others give rise to the dismissing attachment status. Finally, negative working models of both the self and others give rise to the fearful attachment status.
Understanding attachment from the
internal working model perspective helps to explain many of the behaviors
evident in perpetrators of domestic violence. The pre-occupied client who is trying to please or receive
validation from the therapist, or his partner, is avoiding experiencing the
sense of defective self or self-hatred that would result from focusing on
himself. Addressing issues of
self-esteem is critical with this client, whereas the avoidant client has
learned to protect himself from others by distancing and may experience his
partner or the therapist as intrusive and/or controlling and may act out
violently or aggressively in retaliation.
An
important issue being discussed among researchers developing these methods of
measuring or identifying attachment styles is the notion of categorical
typologies versus dimensions of security or insecurity. In the real world, clients present with
varying degrees of mental illness.
Therefore, it would be expected that attachment status would be no
different. The strength of the ECR
and the Relationships Questionnaire is their use of the Likert-type scales that
allow respondents to rate themselves in degrees of similarity or dissimilarity
to each attachment related statement, rather than the categorical nature of the
AAI.
Discussion of Adult Attachment Measures. Each of these models of adult
attachment (coherence, anxiety/avoidance, and internal working models of self/others)
can be useful in understanding psychotherapy with perpetrators of domestic
violence. Although there is
considerable overlap in how each of these attachment categories manifest
interpersonally, they each suggest unique treatment goals. Based on the AAI, the goal of therapy
is helping the client reduce their anxiety sufficiently to reconstruct a
coherent narrative of their attachment-related experiences, both in the past as
well as currently. As Jeremy
Holmes suggests (2001), attachment based psychotherapy is a process of
story-making and story-breaking.
One needs to break the rigid, unemotional, and unrelated story of the
avoidant individual and create a story with greater emotional content, better
balance of positive and negative experiences, and a more descriptive and
realistic narrative description of relationships. With the pre-occupied individual, one must break the
emotional dysphoria by creating one that is also infused by logic and
perspective and balance of affect and reflective understanding.
Similarly, the Brennan, Clark, and Shaver (1998) model
suggests that by learning to self-soothe attachment anxiety and find other
mechanisms beside avoidance to deal with the fear and vulnerability that can be
activated within close relationships, clients can begin to develop more secure
relationship experiences. The
Bartholomew and Horowitz (1991) model suggests that working more on improving
self esteem and reassessing feelings of distrust and fear of others will
ultimately allow the client to experience relationships from a secure
perspective.
There
is some question as to whether or not Bowlby's concept of "internal
working models" is the same as attachment styles described in the current
literature. At a recent meeting of
the American Psychological Association, Adult Attachment Discussion, the issue
of working models attachment styles or attachment representations were explored
among researchers in the field and the following was noted (Adult Attachment
Lab web site, 1998):
There
was some initial disagreement over the use of the terms "working
models," "attachment styles," and "attachment
representations." It was generally agreed that the term "attachment
style" is best reserved for describing observable or manifest patterns of
behavior, and the term "working models" is best reserved for
describing the latent mental structures giving rise to variability in
attachment styles.
It
was suggested that the concept of working models is of relatively little use in
describing the psychological dynamics of attachment because the concept brings
to mind conscious-evaluative belief systems (positive/negative models of
self/others) operating with little input from motivational and defensive goals
or over-learned strategies of behavioral and emotional regulation. In contrast,
but also speaking to the limitation of the concept of working models, it was
suggested that the concept was broad enough to refer to both declarative and
procedural aspects of cognition and behavioral/emotional regulation.
It was generally agreed that the concept of working models is most useful when referring to organized strategies for regulating emotion, attention, and behavior with respect to attachment concerns. It was also suggested that a number of social-cognitive techniques exist that can be exploited to investigate the procedural and unconscious aspects of working models."
Main (1999) notes that there is research
that suggest there are in fact neurological correlates to internal working
models as either neurological circuits or patterns that are ingrained from
experience or a function of working memory. In either case, understanding the neurological basis of
internal representations of self and others may be an important element to understanding
attachment patterns in children and adults.
Conclusions
Psychotherapy with perpetrators of
domestic violence from an attachment perspective involves creating a secure
base environment so that clients can explore their current and past attachment
relationships within the safety of the therapeutic relationship. Safety is critical, because many
insecure batterers have experienced tremendous loss, hurt, and disappointments
within their close relationships; they therefore enter therapy with fears and
anxiety about opening up to someone who is perceived as having power over
them. This is particularly true
for the court-mandated client, where the therapist may indeed have a great deal
of influence over their criminal justice experience. For these reasons, creating a secure base environment is a critical
first step to achieving therapeutic goals, such as learning emotional self
regulation or resolving childhood trauma.
Another critical element to attachment oriented psychotherapy with
perpetrators of domestic violence is the "not-one-size-fits-all"
maxim. Different attachment
styles need different interventions and approaches. The batterer with the overly structured dismissing
attachment style needs to connect to their emotional life and acknowledge the
importance of attachment in their lives.
They need to learn that attachment relationships do not need to be
exploitative, hurtful, controlling, or rejecting. The batterer with the preoccupied attachment style needs
structures necessary to contain their emotional reactivity in attachment
interactions, while learning greater self-sufficiency and less dependency on
attachment figures for self-definition and security. The batterer with the fearful attachment style
likewise needs to heal the split that exists within them from childhood trauma
and losses so that they can both learn to self-soothe their attachment anxiety
through means other than avoidance or pushing others away through anger and
violence.
Using the therapeutic relationship (or
peer relations when utilizing a group intervention modality) is the most
powerful means to highlighting attachment behavioral system patterns in
psychotherapy. Through these
in-the-moment experiences, therapists can help raise the client's awareness of
these patterns, but most importantly strategize more adaptive responses to
attachment anxiety. This
process takes therapists out of their heads and challenges them to work within
the here and now with clients.
Quick thinking, self-awareness, and sensitive attunement to the client
are critical to making use of these "now-moments" (Stern, 1998). Making use of them on a continual basis
gives the client the message that he/she and the therapist can go to that
frightening place of emotions and the meaning of intimacy.
Because domestic violence clients are a
heterogeneous population, clinicians are likely to encounter all three insecure
attachment styles. An assessment
of the client's attachment status is necessary to understand how the client's
attachment behavioral system activates and the mechanisms they use to cope with
the anxiety associated with attachment. Understanding the client’s attachment status
helps us to form some hypotheses about the etiology of the client’s
violence. Psychotherapy offers the
domestic violence client the opportunity to learn more adaptive methods of
regulating attachment anxiety, reevaluate internal models of self and others,
and experience intimate relationships (with the therapist or fellow group
members) in new and positive ways.
Through long term exposure to these therapeutic experiences, changes in
the internal working models and attachment style is not only possible but
inevitable.
Although John Bowlby began his work on
attachment theory over fifty years ago, there are still varying ideas about how
one approaches psychotherapy from an attachment perspective. Unlike most clinical theories,
attachment theory has had the benefit of more than forty years of empirical
research before discussions even began on the clinical applications to adult
psychotherapy. So as the clinical
application of this theory evolves, clinicians will have at their disposal a
continually growing body of empirical data that will hopefully meld with
clinical experience. Through a
positive attachment between clinicians and academics, the application of this
theory will unfold in the years to come.
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