Domestic
Violence Update #2
Daniel
Sonkin, Ph.D.
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How to complete this program
Just read the material online, save a copy to your computer
or print out a copy.
You may have questions as you watch the program. If
so, just click on the highlighted ÒContact Dr. Sonkin by emailÓ link placed on many pages to contact me.
I hope you find the presentation useful in your clinical
practice.
What will you learn in this training?
¥ Legal Update
¥ An overview of attachment theory
¥ Attachment theory and domestic violence
¥ Assessment of attachment
¥ Psychotherapy and attachment theory
¥ Clinical examples
Click on the link below to read the California Rules of Court:
http://www.courtinfo.ca.gov/rules/index.cfm?title=five
Click on the link below to read the current Family Law Codes as they relate to Domestic Violence
Domestic Violence and the California Family Code
Attachment Theory and Domestic Violence Treatment
This section will provide you an overview of attachment
theory and then will discuss itÕs application to domestic violence.
Rationale for Attachment Theory
¥ Violence occurs in the context of
attachment relationships.
¥ Anger and loss is integral to attachment
theory.
¥ Very high insecure attachment rates
among batterers and victims of abuse.
¥ Due to high re-offense rates
(particularly non-physical violence), we may need to expand our treatment
paradigm.
¥ Attachment theory can be helping us understand
why so many victims return to their abuser and ways to help reverse this
pattern.
¥ High rates of childhood trauma among
perpetrators and victims of violence.
¥ Attachment theory is a good lens through which
to conceptualize parenting abilities.
Who is an attachment figure?
¥ A caregiving figure who provides
protection from danger or threat
– In childhood, can be parents or parent
figures
– In adulthood, can be oneÕs spouse or
partner
¥ Humans form all types of attachment
relationships throughout their life, but some are more significant than
others. In the first few years of life when children are learning about
relationships, their primary attachment figures are parents and caregivers; in
adulthood, that is usually a spouse or significant other.
BowlbyÕs central propositionÉ
É.that beginning in early infancy, an innate
component of the human mind -- called the Òattachment behavioral systemÓ -- in effect asks the question: Is
there an attachment figure sufficiently near, attentive and responsive?
If the answer is yesÉ..
Éthen certain emotions and behaviors are triggered, such as playfulness, less inhibited, visibly happier and more interested in
exploration. In the
Strange Situation, developed by Mary Ainsworth, these infants are distressed
when the parent leaves the room, but eventual go back to playing with the
stranger. When the parent returns, these infants are distressed (protest)
but will quickly settle down and return to playing and exploration. These
infants are securely attached.
If the answer is consistently noÉ
Éa hierarchy of attachment behaviors develop due to
increasing fear and anxiety (visual checking; signaling to re-establish
contact, calling, pleading; moving to reestablish contact). If the set of attachment
behaviors repeatedly fails to reduce anxiety (get the caregiver to respond
appropriately) then the human mind seems capable of deactivating or suppressing
its attachment system, at least to some extent, and defensively attain self
reliance. This leads to detachment. In the strange situation, these
infants seem to be not phased by the parent leaving and disinterested when the
parent returns. But when their heartbeat is measured, they are indeed
quite anxious. These infants are anxious-avoidant.
If the answer is inconsistently noÉ
Éthe attachment behaviors described previously become
exaggerated as if intensity will get the attachment figure to respond (which
may or may not work). Like the dynamic between a gambler and the slot machine,
the attachment figure will pay off or respond in sufficient frequency that the
infant becomes preoccupied or anxious or hypervigilant about the attachment figureÕs availability. In the
strange situation these infants are very distressed when the parent leaves the
room, canÕt settle down after the parent leaves and canÕt settle down when the
parent returns. These infants are anxious-resistent.
The Development of Attachment
Attachment disorganization
Originally attachment researchers described three attachment
categories, secure, anxious-avoidant and anxious-ambivalent. Later Main
and colleagues discovered a group of infants who evidenced very distressing
behavior upon the return of their attachment figure. They might back into
a corner with their hands stretched out. Others would walk toward the
parent and then collapse onto the floor. Unlike the other categories,
they didnÕt seem to have an organized approach to attachment distress - hence
this category was named disorganized.
It was later discovered that these infants were behaving
this way because they were afraid of their caregiver. In fact, many of
these children experienced abuse at home. The quandary these children
experienced was they were distressed and wanting soothing, but the figure they
turned to was also frightening to them. They experienced what Main referred to
as Òfear without solution.Ó
Assessing Infant Attachment: The Strange Situation
The ÓStrange Situation" is a laboratory procedure used
to assess infant attachment style. The procedure consists of eight
episodes. The parent and infant are introduced to the experimental room.
Then the parent and infant are left alone. Parent does not participate while
infant explores. The stranger enters, converses with parent, then
approaches infant. The parent leaves inconspicuously. During the first
separation episode the stranger's behavior is geared to that of infant.
Assessing Infant Attachment:
The Strange Situation
During the first reunion episode the parent greets and
comforts infant, then leaves again. During the second separation episode the
infant is alone. During the second separation episode the stranger enters and
gears behavior to that of infant. At the second reunion episode the
parent enters, greets infant, and picks up infant; and stranger leaves
inconspicuously. The infant's behavior upon the parent's return is the basis
for classifying the infant into one of three attachment categories.
Attachment Terminology
¥ Status versus style: In the child development
field, researchers use the term ÒstatusÓ indicating that infants may have a
different attachment to different caregivers, as well as may change over
time. Social psychologists who study adult attachment use the term
Òattachment styleÓ to designate a personÕs pattern of attachment in
relationships.
¥ Categorical versus dimensional: One of the controversies in the
field is whether or not there are degrees of security and insecurity.
Social psychologists have addressed this issue by viewing attachment styles on
a two dimensional grid, where a person can have degrees of a particular
attachment style. Developmental psychologists have identified a number of
sub-categories of attachment status that suggests one can be secure, but have
qualities of dismissing or pre-occupied.
Attachment Terminology
¥ Secure versus insecure: One way to break down
attachment is simply to identify those who are secure and insecure. Some
researchers do not believe that it is fruitful to break down the insecure
categories into different types.
¥ Organized versus disorganized: Individuals with secure,
dismissing and preoccupied attachment status have a consistent strategy for
dealing with attachment distress. Infants who are disorganized and adults
who are ÒCan not classifyÓ (CC) use both dismissing and preoccupied
strategies..
¥ Earned autonomy: A termed used for adults
whose history leads one to expect that they would be insecure, but in fact are
assessed as secure based on the Adult Attachment Interview (AAI).
¥ AAI (Adult Attachment Interview): A twenty-question interview that is
recorded, and transcribed. The transcript is assessed for coherence (this will
discussed in detail later) of the narrative. The final classification may
be secure, dismissing, preoccupied, unresolved or can not classify.
¥ Self-report measures of attachment: Any one of a number of
questionnaires that are used to assessed adult attachment. The questions
are usually answered directly by the subject. Attachment is deconstructed
differently on a two dimensional continuum depending on the scale (will describe
two different scales later). The final classifications may be secure,
dismissing, preoccupied or fearful.
Neurobiology of attachment
What mental capacities result from infant secure attachment
relationships that lead to an ability to tell a coherent life story (via the
AAI) as an adult? Daniel Siegel describes these capacities in his book, The
Developing Mind.
– Autonoetic consciousness: Knowing
oneself over time.
– Social cognition: Empathy and the
ability to look into the minds of others.
– Self reflection: Ability to look
into your own mind.
– Emotion regulation: Ability to soothe
oneself and be soothed by others
– Response flexibility: Weigh
options before acting.
ÒIn childhood,
particularly the first two years of life, attachment relationships help the
immature brain use the mature functions of the parentÕs brain to develop
important capacities related to interpersonal functioning. The infantÕs
relationship with his/her attachment figures facilitates experience-dependent
neural pathways to develop, particularly in the frontal lobes where capacities
such as social cognition (the ability to put yourself into the mind of others),
response flexibility (being able to weight different options, problem-solving),
emotion regulation, reflective-function (the ability to reflect on ones own
experience) and autonoetic consciousness (the ability to have an
autobiographical sense of self over time - past, present and future) are wired
into the developing brain.Ó
ÒWhen caretakers are psychologically-able to provide sensitive parenting
(e.g. attunement to the infants signals and are able to soothe distress, as
well as amplify positive experiences), the child feels a haven of safety when
in the presence of their caretaker(s). Repeated positive experiences
become encoded in the brain (implicitly in the early years and explicitly as
the child gets older) as mental models or schemata of attachment, which serve
to help the child feel an internal sense of what John Bowlby called Òa secure
baseÓ in the world. These positive mental models of self and others are carried
into other relationships as the child matures.Ó
But how does this attachment develop?
John Bowlby and Mary Ainsworth believed that secure
attachments developed due to maternal or paternal sensitivity and cooperation.
Sensitivity
This involves the caregiverÕs ability to perceive and to
interpret accurately the signals and communications implicit in the infant's
behavior, and given this understanding, to respond to them appropriately and
promptly. Sensitivity has four
essential components:
(a) awareness
of the signals;
(b) an accurate
interpretation of them;
(c) an
appropriate response to them; and
(d) a prompt
response to them.
Cooperation
The extent to which the parents interventions or initiations
of interaction break into, interrupt or cut cross the childÕs ongoing activity
rather than being geared in both timing and quality of the childÕs state, mood
and current interests.
What helps a parent to be Òpsychologically-able?Ó
¥ What allows a parent to have the
capacities of sensitivity and cooperation?
¥ With a better understanding of adult
attachment and brain research, it has now been shown that the most robust
predictor of attachment of a child is the state of mind of attachment of the
caregiver vis-a-vis their own parents.
¥ LetÕs look at the research first before
exploring the reasons for this phenomenon further.
Parent-Infant Attachment Correspondence
A meta-analysis was conducted of 13 studies using three
major categories. They found that:
¥ 75% secure vs. insecure agreement: If a parent was secure as assessed
by the AAI, there was a 75% chance that their child would be securely attached.
This was true for insecure parents as well.
¥ 70% three-way agreement: When taking into account all
three organized categories (secure, dismissing, preoccupied), there was a 70%
prediction of the attachment of the child based on the parentÕs attachment
status.
¥ Prebirth AAI show 69% three-way
agreement: When
pregnant parentsÕ attachment status was assessed, researchers were able to
predict the attachment status of their children by age 12 months with 69%
certainty.
A meta-analysis of 9 studies using all four major categories
found:
á
63%
four-way agreement. Which means that the researchers could predict with
63% certainty whether the infant will be secure, avoidant, ambivalent or
disorganized, based on the attachment status of the parent (secure, dismissing,
preoccupied or disorganized) using the AAI.
á
¥
Prebirth (similar to last slide) the AAI showed 65% predictability based on all
four attachment categories.
What does these data suggest?
The attachment status (or state of mind regarding
attachment) of the parent, is going to have a direct effect on the attachment
of the infant to that parent - as high as 75% predictability. In other words,
secure adults engender security in their children, dismissing adults tend to
engender avoidant relationships with their children, pre-occupied adults
engender ambivalent attachment in their children and adults with unresolved
trauma or disorganization may act frightening or confusing with their children,
causing disorganized attachment in their children.
Link between caregiver attachment status and infant
attachment status
¥ Adults who are securely attached know how to adaptively
regulate their own attachment distress: they are flexible, can regulate their
emotions in a constructive way, they are sensitive and cooperative parents, can
give care to partners and can receive care from others, thereforeÉ
– Éthey will engender these same qualities in
their infants. Their infants can use them as a secure base to explore the
world and grow.
¥ Dismissive parents avoid acknowledging their
own attachment needs as well as those of their infant and/or may be critical of
their infants attachment needsÉ
– Étherefore their infants respond by
minimizing their attachment needs and becoming avoidant.
¥ Preoccupied parents do not respond to their
childrenÕs attachment needs predictably, (sometimes being sensitive and other
times not), because they are still entangled in their own attachment
experiences that emotionally intrude in their present relationships. TheirÉ
– Éinfants respond by chronic attempts to
feel secure and therefore, are clingy and difficult to emotionally soothe.
¥ Disorganized parents are abusive or otherwise
frightening so theirÉ
– Éinfants respond by approach - avoidance
oscillation. They are needing protection from the person they fear and
therefore, are experiencing Òfear without solution.Ó
Adult Attachment Relationships
In the 1980Õs, two lines of research into adult attachment
evolved - one by developmental psychologists (e.g. Mary Main and Erik Hesse),
the other with social psychologists (e.g. Phil Shaver and Kim Bartholomew).
Both used different methodologies to assess adult attachment (the Adult
Attachment Interview & self report scales respectively). Both lines
of research deconstructed adult attachment differently. The developmental
psychologists state that the only way to truly know an adultÕs attachment
status is to have measured them as an infant in the strange situation.
Short of that, they assess adult attachment by measuring the coherence of oneÕs
life story vis a vis relationships with their attachment figures. The
social psychologists deconstruct adult attachment in different ways.
Rather than to debate the advantages and disadvantages of
these two approaches to adult attachment, letÕs look at the characteristics of
adults who are secure, preoccupied, dismissing and disorganized, and more
importantly, how these qualities relate to domestic violence.
Mary Ainsworth, the American researcher who brought John
BowlbyÕs ideas to the United States, highlighted the function of the
attachment behavior system in adult life, suggesting that a secure attachment
relationship will facilitate functioning and competence outside of the
relationship.
ÓThere is a seeking to obtain an experience of security
and comfort in the relationship with the partner. If and when such
security and comfort are available, the individual is able to move off
from the secure base provided by the partner, with the confidence to engage in
other activities."
Adult Attachment Development (Shaver and Clark, 1994)
Secure adults have mastered the complexities of close
relationships sufficiently well to allow them to explore and play without
needing to keep vigilant watch over their attachment figure, and without
needing to protect themselves from their attachment figures insensitive or
rejecting behaviors.
Secure Adult Patterns (Shaver and Clark, 1994)
¥ Highly invested in relationships
¥ Tend to have long, stable relationships
¥ Relationships characterized by trust and
friendship
¥ Seek support when under stress
¥ Generally responsive to support
¥ Empathic and supportive to others
¥ Flexible in response to conflict
¥ High self-esteem
Preoccupied: What begins with attempts to keep track of or hold onto an
unreliable caretaker during infancy leads to an attempt to hold onto partners,
but this is done in ways that frequently backfire and produce more hurt
feelings, anger and insecurity.
Preoccupied Adult Patterns
¥ Obsessed with romantic partners.
¥ Suffer from extreme jealousy.
¥ High breakup and get-back-together rate.
¥ Worry about rejection.
¥ Can be intrusive and controlling.
¥ Assert their own need without regard for
partnerÕs needs.
¥ May have a history of being victimized
by bullies.
Dismissing: What begins with an attempt to regulate attachment
behavior in relation to a primary caregiver who does not provide, contact,
comfort or soothes distress, becomes defensive self-reliance, cool and distant
relations with partners, and cool or hostile relationships with peers.
Dismissing Adult Patterns (Shaver and Clark, 1994)
¥ Relatively un-invested in romantic
partners.
¥ Higher breakup rate than pre-occupied.
¥ Tend to grieve less after breakups
(though they do feel lonely).
¥ Tend to withdraw when feeling emotional
stress.
¥ Tend to cope by ignoring or denying
problems.
¥ Can be very critical of partnerÕs needs.
¥ May have a history of bullying.
Unresolved/Disorganized/Fearful: What begins with conflicted,
disorganized, disoriented behavior in relation to a frightening caregiver, may
translate into desperate, ineffective attempts to regulate attachment anxiety
through approach and avoidance.
Disorganized Adult Patterns (Shaver and Clark, 1994)
¥ Introverted
¥ Unassertive
¥ Tend to feel exploited.
¥ Lack self confidence and are self
conscious.
¥ Feel more negative than positive about
self.
¥ Anxious, depressed, hostile, violent.
¥ Self defeating and report physical
illness.
¥ Fluctuates between neediness and
withdrawing.
Insecure Attachment & Psychopathology
Insecure attachment is not the same as psychopathology,
though studies indicate that itÕs correlated with higher rates of psychiatric
disorders. It is thought that
insecurity creates the risk of psychological and interpersonal problems.
á
Avoidant:
leads to deficits in social competence, and have higher rates of schizophrenia.
á
Disorganized:
higher rates of dissociation, PTSD, attention and emotion disregulation
problems.
á
Pre-occupied:
high rates affective disorders, substance abuse, borderline personality
disorder.
Attachment theory
If you would like to read more about attachment theory
consider purchasing one of the most finest books on this topic. It covers
the most extensive variety of topics relating to child and adult attachment:
á
Cassidy
J. & P. R. Shaver (Eds.)(1999), Handbook of attachment: Theory,
research, and clinical applications. New York: Guilford Press.
á
Also
consider the extensive material on Attachment Research and Theory at Stony
Brook at: http://www.johnbowlby.com
If you have general questions about attachment theoryÉ
Assessing Attachment Status
Interview approaches
á
Coherence
(Main - Adult Attachment Interview )
á
Self-reflective
function (Fonagy, described earlier)
á
Projective
test (Adult Attachment Projective - George & West)
Self-report (Two examples)
á
Anxiety
and Avoidance (Shaver - Experiences in Close Relationships-Revised)
á
Internal
working models of self and others (Bartholomew-Relationship Status
Questionnaire)
Clinical interview
Adult Attachment Interview
The Adult Attachment Interview is a 20-question interview
that asks the subject about his/her experiences with parents and other
attachment figures, significant losses and trauma and if relevant, experiences
with their own children. The interview takes approximately 60-90
minutes. It is then transcribed and scored by a trained person (two weeks
of intensive training followed by 18 months of reliability testing). The
scoring process is quite complicated, but generally it involves assessing
the coherence of the subjectÕs narrative.
According to Mary Main, the developer of the AAI, ÒÉa
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 inter-twinned and
interrelated.Ó
The coherence of the interview is evaluated using a number
of scales that were developed from GriceÕs Maxims of Discourse. These maxims are as follows:
¥ Quality: Be truthful and believable,
without contradictions or illogical conclusions.
¥ Quantity: Enough, but not too much
information is given to understand the narrative.
¥ Relevance: Answers the questions asked.
¥ Manner: Use fresh, clear language,
rather than jargon, canned speech or nonsense words.
In addition to evaluating the narrativeÕs coherence, there
are specific scales related to secure and insecure categories.
AAI Questions
Oriented re
family, where you lived, moved much, what family did for
living?----Grandparents seen much, or died when parents young--know much about
grandparent who died before your birth?-- Other persons in household? -Sibs
nearby? (Keep short/demographic. no more than 2 or 3 minutes).
2. I'd like you to try to describe your
relationship with your parents as a young child...if you could start as far
back as you remember?
3. Five adjectives describing your
childhood relationship with mother, as early as you can remember but about 5-12
is fine (write down adjectives). Probe each in sequence given, asking for
memories, incidents before moving on to next adjective. When a well-elaborated
specific incident is given, very briefly enquire regarding a second. When
poorly elaborated specific incident is given, ask for a second. When another
adjective is used for a first adjective, repeat query once with reference to
original adjective. When general or scripted memories are given, probe once for
a more specific memory.
4. Five adjectives father. As above.
5. To which parent closest, and why?
Why not same feeling with other parent?
6. When upset as a child, what do?
Pause. (a) Upset emotionally? -- incidents? (b) Physically hurt--incidents? (c)
When ill--what would happen?
7. First
separation? How did you respond? How did parents respond? Other separations
that stand out?
8. Felt
rejected as a child? How old? What did you do? Why parent did these things?
Realize he/she was rejecting you?
8a.
Were
you ever frightened or worried as a child?
9. Parents ever threatening--for
discipline, jokingly? (Elective per researcher: Select one specific form of
punishment used in researcher's community--ever happened to you?). Some people
have memories of some kind of abuse in family--happen to you or in your family?
--what exactly happened, describe-how old, how severe, how frequent? --this
experience affect you as adult? – affect approach to child?
10. In general, how do you think your overall
experiences have affected your adult personality? Any aspects of early
experiences you consider a set-back to your development?
11. Why do you think your parents behaved as
they did, during childhood?
12. Other adults close like parents as a
child? Or other adults especially important though not parental? (Your age at
time-did they live in household? --had caregiving responsibilities?--why
important?).
13. Loss of parent, other close loved
one (sibs) as child? -- circumstances? --age? --how respond at time? --sudden
or expected? --recall how felt at time? --feelings changed over time? --attend
funerai? --what was it like? (If parent or sib lost, effect on remaining parent
and on household?)---effect ofthis loss on adult personality? --on approach to
own ~hild?
13a.
Other important losses in childhood. Queries as above.
13b.
Important Iosses in adulthood. Queries as above.
14. Ever had any other experiences you regard
as potentially traumatic? -- after participant interprets for himself or
herself, make clear you mean rare ovenvhelmingly and immediately terrifying
events-probe using best judgment.
Elective per researcher.
15.
Were there many changes in your relationship with parents between
childhood and adulthood?
16. What is relationship with parents like for
you currently as an adult? much contact with parents at present? what is
relationship like currently? current sources of dissatisfaction? Of satisfaction?
17. Feel now when separate from child? (or
imaginary one year old child). After sufficient time has passed for subject to
describe response add, Do you ever
feel worried about (imagined) child?
18. If 3 wishes for child 20 years from now,
what? Thinking of kind of future you'd like to see for child. Minute or two to
think.
19. Any one thing learned from own childhood
experience? I'm thinking here of something you feel you might have gained from
the kind of childhood you had.
20. What
would you hope child will have learned from his/her experience of being
parented by you?
The complete protocol can be downloaded from the measurement
library at: http://www.johnbowlby.com/
in the measurements library.
AAI Scoring
¥ Secure:/autonomous (F): Coherent and collaborative
discussions of attachment-related experiences relationships. Valuing of
attachment but seems objective regarding any particular event or
relationship. Description and evaluation of attachment-related experiences
is consistent, whether experiences are favorable or unfavorable.
Discourse does not notable violate any of GriceÕs maxims.
¥ Dismissing (Ds): Not coherent. Minimizing of
attachment-related experiences and relationships. Normalizing
(Òexcellent, very normal motherÓ), with generalized representations of history
unsupported or actively contradicted by episodes recounted, thus violating
GriceÕs maxim of quality. Transcripts also tend to be excessively brief,
violating the maxim of quantity.
¥ Pre-Occupied (E): Not coherent. Preoccupied with or
by past attachment relationships or experiences, speaker appears angry, passive
or fearful. Sentences often long, grammatically entangled or filled with
vague usages where something is left unsaid (e.g., ÒdadadadaÓ; Òor whateverÓ)
thus violating GriceÕs maxims of manner and relevance. Transcripts are
often excessively long, violating the maxim of quantity.
¥ Unresolved/Disorganized (U): Not coherent. During discussions of
loss or abuse, individual shows striking lapses in monitoring of reasoning or
discourse. For example, individual may briefly indicate a belief that a
dead person is still alive in the physical sense, or that this person was
killed by a childhood thought. Individual may lapse into prolonged
silence or eulogistic speech. This speaker will ordinarily otherwise fit
Ds, E, or F categories.
Sample answers to the AAI: Secure
¥ Which parent would you say
you were closest to?
¥ Oh I felt, closest to my
mother
¥ And why was that?
¥ Uhm..[2 secs] simply because
she was, she was there, uhm, you
know, like I said when I, when I came home from school, she was there (Uh huh), uhm, you know,
when I, when I, had a question or a
problem, I knew I could talk with her, uhmÉ[3 secs], and , itÕs just,
you know, I knew she really cared,
and (Uh huh), and uhm, was interested. Even when my father was there
he wasnÕt really there, you know,
uhm, so-- (I understand what you mean)
okay.
Sample answers to the AAI: Dismissing
¥ Which parent would you say
you were closest to?
¥ Uhm, I, early on, probably, my
mom.
¥ And why was that?
¥ Eh, eh, I guess, during the
very early years because, eh, she
got stuck taking care of us, uhm later on it flipped around and I got probably closer to my Dad because
eh, I guess--too much eh, time with
my Mom.
¥ What do you mean by too
much time with your mom?
¥ Eh uhm, I got, I guess, of,
of, uhm-- kids get sick of their
parents or what they do and, even though it may be quite proper, itÕs just that itÕs annoying
and -- and you just get tired of
them.
Sample answers to the AAI: Preoccupied
¥ Which parent would you say
you were closest to?
¥ Neither, and thatÕs the case today. In fact,
last week my son was sent to the
principalÕs office and they called me at work to pick him up. I wasnÕt
able to so I had to call my
mother. I heard the judgment
in her voice. I thought,
another narcissist heard from. My sonÕs father is self-absorbed just like them. Did I tell you that he
abused me? Anyhow I had no choice but to call her, if his father got involved there would be another
blowup, letters to his attorney
and then IÕd have to pay my lawyer. ItÕs non-stop. I am not sure if this answered your
question.
Self-Reflective Function
Another method similar to the AAI was developed by
Peter Fonagy and Mary Target of the Psychoanalysis Unit of University College,
London. They use the AAI questions, but the transcript is
analyzed from from the perspective of Òreflective function.Ó
Scoring the narrative involves assessing the speaker's ability to reflect on
their own inner experience, and at the same time, reflect on the mind of others
(Fonagy and Target, 1997). This mentalizing ability is thought to be what
secure parents do to imbue security in their children. Fonagy writes that
reflective function is a cognitive process - how an individual understand the
self and others intentions, needs, motivations. It is also an emotional
process - the capacity to hold, regulate, and fully experience emotion. A
person with high reflective function exhibits a non-defensive, willingness to
engage emotionally, to make meaning of feelings and internal experiences
without becoming overwhelmed or shutting down. From a neurobiological
perspective, high reflective function includes neural capacities such as social
cognition, autonoetic consciousness, awareness of and regulation of complex
emotional states inherent in social relationships – all capacities of the
prefrontal cortex.
ÒA motherÕs capacity to reflect upon and
understand her childÕs internal experience is what accounts for the relation
between attachment status and her childÕs sense of security and safety.Ó (Slade, 2002).
Adult Attachment Projective
Another promising method of assessing adult attachment
is the Adult Attachment Projective (AAP) developed by Carol George
of Mills College, and Malcolm West of the University of Calgary (George and
West, 2001). The test consists of eight drawings (one neutral scene and seven
scenes of attachment situations). According to the authors, "the drawings were
carefully selected from a large pool of pictures drawn from such diverse
sources as children's literature, psychology text books, and photography
anthologies. The AAP drawings depict events that, according to theory, activate
attachment, for example, illness, solitude, separation, and abuse. The
drawings contain only sufficient detail to identify an event; strong facial
expressions and other potentially biasing details are absent. The characters
depicted in the drawings are culturally and gender representative" (page 31).
Like the AAI, the subject's responses are recorded and
transcribed and then scored based on the coherence of the responses.
Authors use some similar and different scales from the AAI coding
process. According to the authors the AAP takes less time to
administer and much less time to score, which makes it more useful for
clinicians. Unlike the AAI, the AAP is geared toward clinicians as
opposed to only researchers in attachment. For more information see their
web site at: http: //www.attachmentprojective.com/.
Self report measures
Social psychologist, Phil Shaver and his colleagues have
studied the relationship between adult attachment and interpersonal
relationships. They deconstructs attachment into two continuums - anxiety
and avoidance. Securely attached individuals feel low anxiety in
relationships and donÕt have to avoid closeness when difficulties arise.
They also conceptualize attachment style in terms of dimensional qualities
rather than distinct categories that you either belong to or not. For
example, one can be slightly preoccupied or dismissing, or extremely
preoccupied or dismissing. Using their model one can generally be secure,
but leaning toward preoccupied or dismissing. The following slide shows
the relationship between each of these variables and attachment style.
Experiences in Close Relationships
Shaver, Fraley and colleagues developed a number of
self-report measures that assess adult attachment. His most recent scale,
The Experiences in Close Relationships-Revised (ECR-R) is a 36 question scale
that asks about close relationship experiences, thoughts and feelings. Answers
are based on a 7-point likert-type scale from Ònot at all like meÓ to Òvery
much like me.Ó The following are sample questions. This scale can
be taken on the web and results are given to the subject at: http://www.web-research-design.net/cgi-bin/crq/crq.pl
Sample Questions: Experiences in Close Relationships -
Revised
¥ I'm afraid that I will lose my partner's love.
¥ I often worry that my partner will not want to
stay with me.
¥ I prefer not to show a partner how I feel deep
down.
¥ I feel comfortable sharing my private thoughts
and feelings with my partner.
Relationship Status Questionnaire
Kim Bartholomew has also conceptualized adult attachment,
but more in line with BowlbyÕs ideas. Like Shaver, she has created a two
dimensional grid representing adult attachment based on internal working models
of self and others - positive or negative. Her model may be understood as
being cognitive in nature, whereas ShaverÕs model is more affective/behavioral.
Here too, attachment style is viewed as dimensional rather than
categorical. Bartholomew has also
developed a measure of adult attachment that have evolved and changed over the
years. Her most recent rendition appears to be a combination of both
self-report and more interview type questions. You can access her scales
at her web site at: http://www.sfu.ca/psyc/faculty/bartholomew/research/index.htm
Sample Questions: Relationship Status Questionnaire
¥ I find it easy to get emotionally close to
others.
¥ I want to be completely emotionally intimate
with others.
¥ I am comfortable without close emotional
relationships.
¥ I worry that I will be hurt if I allow myself
to become too close to others.
To read a number of online articles on self-report measures
and their similarities and differences to the AAI visit Chris FraleyÕs web site
at: http://www.psych.uiuc.edu/~rcfraley/pubs.htm
Or Phil ShaverÕs web site at: http://psychology.ucdavis.edu/labs/shaver/publications/
Clinical Interview and Assessing Adult Attachment Status
A recent study examined how well clinicians are at assessing
adult attachment. The results were not very promising. Assessing
adult attachment via clinical interview alone is not very reliable.
However, this doesnÕt mean that isÕt not possible. It just means that a
method has yet to be developed.
If you have questions about assessing adult attachment
statusÉ
Domestic Violence and Attachment Theory
Don Dutton has developed a typology system consisting of
three types of batterers. Each type is associated with a different
attachment style as assessed by self-report measures. The Psychopathic
batterers are associated with a dismissing attachment. The
Over-Controlled batterers are associated with a preoccupied attachment.
The Borderline batterers are associated with a fearful (similar to
disorganized) attachment. LetÕs look at each of these types more closely.
The Psychopathic / dismissing batterers are also described as
using violence that is instrumental - cold and calculating (like JacobsonÕs
Òvagal reactorsÓ). These batterers characteristically lack empathy - a
quality one learns through sensitive caretaking as a child. These batterers
tend to be more interested in getting what they want (and violence is a
justified means to that end) than maintaining positive relationships (other
than it serves their needs). Therefore, you find these batterers both
violent inside and outside of the home, and are often involved in the criminal
subculture. This group may be diagnosed antisocial or
aggressive-sadistic.
Unlike the dismissing batterer, the Over-controlled or
Preoccupied batterer is very focused on attachment, but in an angry way - as if
staying angry will maintain an emotional connection. Irritations and
resentments experienced toward parents is played out with his current partner
with little or no awareness that this misplacement is occurring. Some
preoccupied batterers appear very passive as a strategy to avoiding conflict
(and possibly losing connection); however, the tension eventually builds to the
point that a blowup occurs (particularly when under the influence of alcohol).
Lastly, the Fearful or Disorganized batterer has both
dismissing and preoccupied qualities. He can abruptly shift from
distancing to dependency, a pattern characteristic of persons suffering from
borderline personality disorder - Dutton diagnosed this group as borderline
based on the MCMI. These batterers are the most difficult to treat because
of the sudden shifts in states of mind with regard to attachment and their
extreme dysregulation of emotion. These batterers find relationships very
distressful in that getting close is terrifying and yet being disconnected is
just as terrifying. These individual are similar to the disorganized infants
who wanted soothing from their parent but were afraid of them at the same time.
Attachment and victims of abuse
As mentioned earlier, a significant percentage of victims of
abuse have been assessed as having a preoccupied attachment status. Like
their male counterparts, they can be extremely clingy when distressed and look
outside themselves for soothing and reassurance. Some victims of abuse
have been found to be Òfearfully preoccupiedÓ rather than angrily preoccupied,
like many male perpetrators. Many of these women have been victimized as
children.
In addition, many victims of abuse have been assessed as
having a disorganized or unresolved attachment status. Like the
disorganized infants, these woman have an approach-avoidance pattern in
relationships. Unresolved trauma could also result in dissociative
process during times of emotional distress, such as during a violent episode,
recalling a violence episode or during separation or reunion with their abuser.
Although it hasnÕt been discussed in the literature, there
are also victims of abuse who have a dismissing status. From what we know
about this category, it would be expected that these individuals would probably
have an easier time leaving their relationship. They are also likely to
meet up with a preoccupied partner.
Lastly, it is also possible that some victims of abuse are
securely attached. Again, it would be expected that these individuals
would have the easiest time, psychologically speaking, leaving their
relationship. They are more likely to have higher self esteem, more
flexible and pro-social - all skills that would assist in a transition out of a
relationship/marriage.
Attachment and Same-sex couples
¥ Domestic violence in gay and lesbian
relationships is a serious problem.
¥ In one study the researchers found
lesbian relationships were significantly more violent than gay relationships
(56% vs. 25%).
¥ A study of 1,099 lesbians found that 52%
had been a victim of violence by their female partner, 52% said they had used
violence against their female partner, and 30% said they had used violence
against a non-violent female partner.
¥ In a survey of 350 lesbians, rates of
verbal, physical and sexual abuse were all significantly higher in the lesbian
relationships than in heterosexual relationships: 56.8% had been sexually
victimized, 45% had experienced physical aggression, and 64.5% experienced
physical-emotional aggression. Of this sample of women, 78.2% had been in a prior
relationship with a man.
¥ Reports of violence by men in gay
relationships are lower than reports of violence in prior relationships with
women (sexual victimization, 41.9% (vs 56.8% with women); physical
victimization 32.4% (vs. 45%) and emotional victimization 55.1% (vs. 64.5%).
What does this data mean?
á
Feminist
explanations for violence that focus on patriarchy and sex role stereotyping
does not hold true for same sex relationships.
á
That
there may be greater rates of attachment insecurity among lesbian couples than
gay couples.
á
Lenore
Walker has tried to explain higher rates of violence in lesbian relationships
as being due to equality of size and weight, fewer normative restraints on
fighting back and tacit permission to talk about fighting back. However, Murray
Straus found that power equalization produced less violence in couples rather
than more.
á
DonÕt
make assumptions about dynamics of power and violence in same-sex couples.
If you have questions about domestic violence and
attachmentÉ
Psychotherapy, attachment theory and domestic violence
Tasks of attachment-informed psychotherapy according to
Bowlby
¥ Create a safe place, or secure base, for
client to explore thoughts, feelings and experiences regarding self and
attachment figures;
¥ Explore current relationships with
attachment figures;
¥ Explore relationship with
psychotherapist as an attachment figure;
¥ Explore the relationship between early
childhood attachment experiences and current relationships;
¥ Find new ways of regulating attachment
anxiety (i.e., emotional regulation) when the attachment behavioral system is
activated.
Reconceptualizing Domestic Violence
If rage and the resultant violence can be understood, in
part, as being the result of maladaptive defense mechanisms stemming from
insecure attachment and that many victims have difficulty coping with violence
because of their own attachment insecurity, then the process of therapy will
involve helping the client move from insecurity to greater security as
manifested by the capacities described by Daniel Siegel in his book, The
Developing Mind.
Developing these capacities will be critical to changing how men and women
experience themselves and others.
Task of Attachment Informed Domestic Violence Treatment
from an Attachment/Neurobiological Perspective
¥ Past, present and future orientation
¥ Focus on understanding what is happening
in the mind of others
¥ Learning to reflect on the self
¥ Develop adaptive emotion regulation
skills
¥ Focus on flexible response to situations
¥ Address unresolved trauma and loss
¥ Work with what is in the room
¥ Rupture and repair: use the natural separations
and ruptures in therapy to help the client develop more adaptive ways of coping
with attachment distress.
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 individualÕs inner working models of others and therefore
change behaviors or emotional states. The idea of Òsecure base primingÓ
has been gaining attention in the adult attachment literature. Mario
Mikulincer and Phil Shaver 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 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.
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.
Other similar studies have found that secure base priming
will have a positive effect on cognitive and affective states. 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 status.
Creating a secure base in psychotherapy
According to attachment theoryÉ..
¥ É.an attachment is a tie or bond that
binds two people that serves a psychological and biological function across the life span.
¥ The biological function is both physical
protection and the development of neurological capacities in the developing
brain of the infant.
¥ The psychological function is the development
of a sense of self and an understanding of self in relation to others.
¥ For the adult, the biological function
can be physical protection, but can also be more a psychological protection
(emotional care-taking) so that the adult feels free to go out and explore the
world outside the family.
¥ Unlike a child/parent relationship where
one person is the caregiver and another is the care receiver, in adult
attachment relationships, each person will at times be the caregiver and at
other times be the care receiver. However, the balance of these two roles
will vary from relationship to relationship.
Characteristics of attachment relationships
¥ Proximity maintenance
– One wants to be in close proximity to
attachment figure.
– One feels loss when the attachment
figure is not available and there may be anger or frustration at reunion.
¥ Safe haven
– One retreats to attachment figure(s)
when feeling anxious or fearful.
¥ Secure base
– The attachment figure serves as a base
of security so as to explore the physical and social world. Knowing
that you can return when feeling anxious or fearful or needing support or
protection.
How does this relate to psychotherapy?
¥ Most therapists are hoping that their
clients will:
– Want to meet with their therapist to talk
about their problems. It is expected that some clients will feel loss
during separations and may express anger or frustration upon reunion.
(proximity maintenance)
– Will want to talk to the therapist when they
feel distressed (safe haven)
– Will use the therapist as a secure base from
which to explore their physical, psychological and social world.
In other wordsÉ.
¥ É.form an attachment.
But how does this attachment develop?
John Bowlby and Mary Ainsworth (the American researcher who
developed a brilliant method of assessing child attachment call the Òstrange
situationÓ) believed that secure attachments
developed due to maternal or paternal sensitivity and cooperation. LetÕs explore these concepts
a little deeper.
Sensitivity
This involves the caregiverÕs ability to perceive and to interpret
accurately the signals and communications implicit in the infant's behavior,
and given this understanding, to respond to them appropriately and promptly.
Sensitivity has four essential components:
(a) awareness
of the signals;
(b) an accurate
interpretation of them;
(c) an
appropriate response to them; and
(d) a prompt
response to them.
Cooperation
The extent to which the parents interventions or initiations
of interaction break into, interrupt or cut cross the childÕs ongoing activity
rather than being geared in both timing and quality of the childÕs state, mood
and current interests.
Facilitating Secure Attachment
Sensitivity and cooperation is the basis for healthy
parent/child interactions. If this process breaks down the child experiences a
break in the connection with itÕs caregiver or feels ignored or intruded
upon. When these mis-attunements occur with considerable frequency, the
childÕs Òattachment behavioral systemÓ can become escalated (anxious) or
cut off altogether (avoidant).
In therapy, sensitivity to verbal and nonverbal
communication and cooperation is critical to developing the attachment or
connection between the client and therapist. Frequent mis-attunements by
the therapist will cause a chronic sense of frustration with the client and may
lead to their emotional withdrawal and dropping out.
Likewise, therapist are also in the position of balancing
the therapeutic goals with the material the client brings into the
session. When the therapist is too focused on their agenda and not enough
attuned the the clientÕs process, the client may experience the therapy as
intrusive or controlling, which may unconsciously remind them of their
experiences with the parent(s). This activates attachment distress which the
client will regulate in the ways they have learned in their family.
Understanding your clientÕs attachment status is critical to
breaking long-held beliefs about close relationships or what Bowlby described
as internal working models of self and other. If the therapist responds in a
manner that confirms these schema, the cycle is maintained or even exacerbated.
If, on the other hand, the therapist acts in a way that disconfirms the
clientÕs expectations, then the cycle can be broken and the door is opened for
a different type of relationship.
Daniel Siegel in his book, The Developing Mind, talks not
only about the importance of sensitivity in the healthy development of
children, but in therapy as well. He states that therapists put too much
stock into the discussion of categorical emotion (Anger, fear, surprise,
disgust, joy, excitement and shame) and not enough focus on what he calls,
primary emotion or affect. It is the amplification of positive primary
affect and the soothing or reducing of negative primary affect that
characterizes healthy attachment relationships.
Siegel breaks down the emotion process into three phases or
categories.
– First there is a sensory awareness or
orientating process. The mind picks up from the body (the body usually
knows what itÕs feelings before the mind knows) the message: Pay
attention, this is important
– The next phase he calls appraisal and
the arousal of primary affect: The mind makes a decision or judgment that this
is good or this is bad. This is also sometimes referred to as mood
– The process can be further elaborated
into categorical affect (Anger, fear, surprise, disgust, joy, excitement and
shame).
Siegel contends that most of the emotional communication
between parent and infant and between adults is this primary affect, rather
than the discussion of categorical emotions. In other words much is said
without saying it.
People who grew up in healthy families where primary
positive affect was shared and negative primary affect constructively soothed
are generally more sensitive in the way described earlier. Those
experiencing less positive parenting are often quite out of touch with or
unable to articulate their primary affect or categorical emotions. So much of
what they are feeling is communicated behaviorally rather than with words. Nor
are they sensitive to these emotions in others.
Like a child who has not yet learned the language of primary
affect or categorical emotion, many victims and perpetrators need an attuned
parent-figure who will pay close attention to their non-verbal cues (facial
expression, eye gaze, tone of voice, bodily motion and timing of response) and
help them connect with their internal experience. Through careful
observation and emotional attunement, the therapist can help the client identify
their internal experience to situations and offer them a language in which to
communicate those feelings.
When the therapist is sensitive to these non-verbal signals
and is able to help the client identify and articulate their inner emotional
experience, the client feels understood by the therapist because their state of
mind is being Òfelt by another.Ó
For this process to occur, the therapist allows his/her mind
to have an experience as close as possible to what the clientÕs subjective
world is like at that moment - not unlike the process that occurs between an
attuned parent and their child.
ItÕs important to state that the parallels between
parent/child attachment and therapist/client attachment have their limitations.
However, the similarities of these two relationships do lend themselves to
these comparisons.
If you have questions about attachment theory and
psychotherapyÉ
Case Examples
Robert
¥ 34 year old African-American
¥ Started therapy shortly after a divorce
from a 14 year marriage.
¥ No children.
¥ CPA for a bank.
¥ Wife reports that he smothered her, in
that he was excessively jealous, dependent and verbally abusive. Also
states that he refused to have children.
Robert presents as very friendly, talkative and
anxious. He seems interested in your ideas and asks you on numerous
occasions, ÒWhat do you think he should do to get his wife back?Ó When
asked about his childhood experiences, he launches into a tirade about his
fatherÕs unavailability (he worked three jobs to support the family) and his
motherÕs involvement with other men. He goes on for ten minutes and then
stops and says, ÒI donÕt know if that answers your question.Ó He goes on
to say that he has never found someone as committed as he is in relationships,
even friends are unreliable. There is a long pause and then he says, ÒYou
know, people are never there when you need them.Ó
¥ He explains, ÒMy problems with jealousy
in the marriage would not have been a problem if Elaine loved me and was
committed.Ó
¥ When ask about other problems in the
marriage he states that sex was also problem. She never seemed
interested. They hardly had sex. When you inquire as to frequency
he replies Ò..four or five times a week.Ó
¥ When you ask if he thinks that his
jealousy about his wife may be related to his experiences in his family he says
that he never thought about that.
¥ When asked about how he is feeling
recently since the separation, he states that heÕs feelings mostly angry, but
has been sending her flowers and emails apologizing for anything he can think
of. Robert has some insight that his jealous feelings are not founded in
reality (that his wife was not with other men), but when she worked or went out
with friends or even when she was on the phone, he felt these intense feelings
and believed if he could get her attention he wouldnÕt feel so bad. This
insight represented an open door that Robert might be able to focus on himself
long enough to make use of therapy.
Assessment
¥ He is preoccupied with keeping wifeÕs
and the therapistÕs attention. Probably this was his strategy with his
mother as well.
¥ He gets caught up in negative, analytic,
and angry discussions of his past attachment experiences, so much so he forgets
the original question, yet there is little insight into the connection between
those experiences and his current relationships.
¥ Describes his current relationship as
enmeshed, overly close, poorly bounded and anger-inducing at the slightest sign
of separation.
¥ He seems overwhelmed to the point that
he is unable to organize or contain his feelings in a useful manner.
Treatment
¥ Preoccupied individuals have learned to
become hypervigilant regarding their attachment figures. They are used to
hyperactivating their attachment distress in order to stay connected or get
their attachment figureÕs attention. Robert will need to:
– learn how his past experiences are
affecting current relationships;
– how to look less to his partner for
soothing and learn how to become more aware of and soothe his anxiety;
– realize that he has choices when feeling
anxious and become aware of how his clinging and dependency affects his
partner.
¥ These dynamics are likely to come up in
the therapy, so it will be important to use the natural ruptures that occur in
sessions as opportunities for growth and change as well.
If you have questions about RobertÉ
Howard
¥ 45 year old man of English/German decent
¥ Separated, 4 children (10, 12, 14, 16)
¥ Presents as cool, not engaged in
discussion and over-controlled.
¥ He has been referred to therapy as a
result of being arrested for intoxication in public and misdemeanor battery.
¥ States that wife is staying with her
sister for the past two weeks and that he misses her but is not able to
articulate what he misses about her.
¥ H: ÒI was eating out with my wife, I
wasnÕt drinking more than usual and then this guy at the next table tapped me
on the shoulder and says that I am talking too loud and asked if I could talk
quieter.Ó
¥ T: ÒHow did you feel when he said that?Ó
¥ H: ÒI didnÕt think I was talking any
louder than anyone else there.
¥ T: ÒWhat happened next?Ó
¥ H: ÒI just ignored him. Mary keep
ragging on me to stop embarrassing her. She wouldnÕt shut up so I
just reached across the table and closed her mouth. She wouldnÕt listen
to me so I shut her up myself.
¥ T: You must have been feeling pretty
angry at her.
¥ H: No. She wouldnÕt shut up, so I shut
her up.
¥ T: ÒWhere did you grow up?Ó
¥ H: ÒSonoma County.Ó
¥ T: ÒDo you still have family there?Ó
¥ H: ÒYes. Both parents and two
younger brothers and a younger sister.Ó
¥ T: ÒHow would you describe your
relationship with them?Ó
¥ H: ÒWeÕre close.
¥ T: How often do you have contact with
them?
¥ H: I see them once or twice a year.
Usually for the holidays.Ó
¤ In the following session:
¤ He reported in passing that his father
routinely drinks to intoxication, but only on the weekends and holidays.
¤ He denies having a problem with alcohol and
stated that he was in complete control that night.
¤ He described his father as authoritarian -
ruled with an iron fist. His mother was depressed and unable to care for
herself let alone her children. When asked about how those experienced affected
him he states that it made him stronger and more independent.
¤ He also states that he doesnÕt see his
children that often but blames this on his demanding job.
Assessment
¥ Howard presents as disengaged,
self-protective, self-sufficient, sensitive to being controlled or overly
influenced by others.
¥ When discussing his past attachment
relationships he presents few details, plays down negative experiences and even
presents contradictory information. He states that his negative family
experiences were actually good for him in that they made him more strong and
independent. This is a common statement with people who have a dismissing
attachment status.
Assessment
¥ Howard constricts and plays down his
emotional experience. When the therapist suggests that the client
may have felt angry, he denied such feelings. He also denies any negative
feelings about his family experiences.
¥ His answers tend to be short and he
doesnÕt offer the therapist much information about himself. This is also common
with people who have a dismissing attachment status.
¥ Dismissing negative feelings and
experiences is a way of avoiding the pain associated with family attachment
experiences.
Treatment
¥ Engaging Howard into therapy will be
difficult because his childhood experiences has taught him that survival is
based on deactivating his attachment needs and feelings. To need therapy
will require him to admit that he canÕt deal with his problems on his own - a
sign of weakness and vulnerability. So the first treatment issue will be
engagement and finding some way of framing therapy that is not threatening to
his defenses. With clients like Howard, going to therapy to stay out of
jail, may be as good as it gets initially. Focusing initially on the practical
aspects of therapy, skill building, is helpful with clients like Howard.
¥ Howard grew up in family with an
alcoholic father and depressed mother - self-reliance may have been the best
option at the time. If he stays in therapy long enough, redirecting his
attention to his internal emotional experience will be key to psychological
change. I would pay attention to when he might be experiencing primary
emotions that are communicated nonverbally, and slowly and sensitively help him
connect with those emotions. I am not talking about categorical feelings
such as anger, sadness or fear, but rather the basic primary emotions - I feel
good or I feel bad.
¥ This tact is not going to be very
rewarding to the therapist. When you use your best sensitivity skills to help
him with identifying his internal experience heÕll just look at you and say,
ÒSo what?Ó But persistence is key with this client. Years of
deactivating attachment needs is not going to change overnight. In fact,
your sensitivity is likely to cause him discomfort. He may become so
frightened that somebody sees him that he will begin to act out - come late or
miss sessions. A combination of skill building, setting limits to acting
out and persisting with sensitive interpretation will hopefully pierce his
protective defenses.
If you have questions about HowardÉ
Sandy
¥ 31-year old Jewish woman
¥ In recovery (3 years) from cocaine and
alcohol dependency.
¥ A survivor of child sexual abuse.
¥ Presents with a blunted affect,
introverted, insecure, analytical, cool and lifeless. She speaks with a
monotone voice and you find yourself asking her to repeat herself because she
speaks so softly.
¥ Referred by probation for attempting to
stab her husband with a knife.
¥ In the first session she arrives 15
minutes late. She immediately wants to know your emergency policy. She is
concerned that therapy brings up a lot of feelings for her and she wants to
know your availability between sessions. Her previous therapist, whom she
saw for three years about five years ago, was available between sessions for
emergencies.
¥ You discuss your policy of not having
24-hour coverage and go over what services are available to her in the
county. You also suggest that perhaps she may need to come in more than
once a week if she begins to feel overwhelmed. She says that she canÕt
afford to see you more than once a week and in fact, she was wondering if you
have a sliding scale. She says that her former therapist saw her at a
reduced rate.
¥ When asked about the incident that
resulted in her arrest she states that she and her husband had just had sex
when the telephone rang. It was his old girlfriend. She doesnÕt recall
all the details but she remembers getting angry and they started
fighting. She doesnÕt remember how she got the knife but she thought that
she was going to kill herself, but she must have started swinging the knife at
her husband. Her daughter called the police.
¥ She describes a long history of
short-term intimate relationships with both men and women that start off very
intense (sexually and emotionally) and then end abruptly. Sometimes she angrily
rejects her partner for no apparent reason. Other times she is rejected
and falls apart. Her relationship history is confusing and hard to
follow. You find yourself asking her clarifying questions. This
pattern continues into her discussion about her family of origin as well, when
she disclosed that she was sexually abused by her father.
¥ When asked about her previous therapy,
she states that it mostly focused on her chemical addiction issues. She states
that she didnÕt go back to her previous therapist because she feels that she
outgrew the therapist. When you follow up on this, it appears that she
felt angry at her therapist for disclosing too much information about herself.
¥ You inquire about how her sexual abuse
was addressed in her previous therapy. She states that her previous
therapist didnÕt really deal with it because the focus of the therapy was her
recovery. She explains that the philosophy of her sponsor is to first get
sober and then deal with family abuse issues. When you ask her if that is
something she would like to address in this therapy, there is a long silence,
she looks up to the ceiling and then says, ÒHe is dead now, you know my father,
but he is still inside of me.Ó When you ask how so, she replies, ÒI donÕt
know.Ó
Assessment
¥ Sandy has a mixture of dismissing and
preoccupied tendencies. She angrily leaves relationships and is reluctant
to come in more than once a week (dismissing tendencies) and other times she is
overwhelmed by rejection, is wanting the therapist to take care of her by being
available for emergencies and reducing the fee (pre-occupied tendencies).
¥ Her discourse of her attachment
experiences is disjointed and dissociated in speech and mental processes.
¥ Sandy shows some dissociative processes
when asked about sexual abuse. Her story about the incident that got her
arrested suggests some dissociation as well.
¥ SandyÕs attachment experiences included
trauma. States that she hasnÕt really worked on this issue because recovery has
been a priority.
¥ The incident of violence appears to be
more related to unresolved sexual trauma than substance abuse/dependency per
se.
¥ Some attachment researchers and
clinicians state that contrary to some preliminary findings suggesting that
preoccupied status is related to borderline personality disorder (BPD),
disorganization may be more related to this disorder.
¥ The characteristic oscillation between
closeness and distancing seen with persons suffering from BPD and the similar
process seen with disorganized attachment seems to make this hypothesis
reasonable.
¥ Sandy is disorganized because she doesnÕt have
a single strategy for dealing with separation anxiety and reunion distress. She
may oscillate between being helpless and needing caretaking and being
aggressive or distancing.
Treatment: Sandy
During the course of her therapy, Sandy talked
dispassionately about the sexual abuse by her father. Though her stories
were extremely detailed (semantic memory), her descriptions seemed more like a
report or observation of someone else being abused. The challenge for her
was to revisit those experiences but in the retelling to include a sense of
self (episodic memory) - which might involve feelings or thoughts about what
those experiences mean to her life. The problem with Sandy is that when
she experiences emotion, she is quickly overwhelmed and moves into rage states
or dissociation (Remember what the question about her father did in the first
session?). So the therapist will need to establish safety in the
relationship and then slowly address (through titration) these issues so that
she can learn to tolerate the affect sufficient enough to develop adaptive
regulation capacities.
If you have questions about SandyÉ
Earned Security
ÒI had a weak father, domineering mother,
contemptuous teachers, sadistic sergeants, destructive male friendships,
emasculating girlfriends, a wonderful wife, and three terrific children. Where
did I go right?Ó – Jules Feiffer, illustrator and satirist
In longitudinal studies, children assessed in the
strange situation as infants are administered the AAI as young adults to
determine the continuity of attachment patterns over time (Waters, Hamilton,
and Weinfield, 2000). According to these studies there is about an 80%
continuity between infant attachment patterns and adult attachment state of
mind (Fraley, 2002). In 20% of the cases the attachment status changes
over time (usually from insecure to secure, but sometimes the other way).
The term Òearned securityÓ is used for those individuals who were either
assessed in the strange situation as insecure and later in life are assessed as
secure, or whose experiences in childhood would ordinarily lead us to expect an
insecure state of mind (strange situation data is not available) but are
assessed as secure on the AAI (Roisman, Padron, Sroufe and Egeland,
2002). This category of Òearned secureÓ is significant for clinicians,
because it suggests that attachment status is changeable. In other words,
how a child or adult regulates attachment distress can change over time.
What factors contribute to earned security? Researchers (Roisman, Padron,
Sroufe and Egeland, 2002) have found that when a child changes from insecure to
secure, it is most likely to be affected by a relationship. This makes
sense because insecurity grows out of relationships, so one would expect
Òearned securityÓ to grow out of relationships.
Luis
Luis is 24 year old, first generation Mexican
American.
He has been married for 3 years and has a 6 month old
child. His wife is 21 years old.
He works as manager of a popular restaurant and is
going to night school to become a chef.
He contacted you the morning after a fight with his
wife where he hit her with his elbow and caused a black eye. You were able to
see him that afternoon.
T: Can you tell me what happened last night?
L: WeÕve been arguing a lot about feeding the baby
at night. IÕm tired after working all day and going to school at
night and I just canÕt focus at work when I have to get up and feed the
baby. I know she is feeling tired too and she is might be thinking that I
am here complaining about her, but I know I play a role in this situation too.
T: So what happened last night?
L: The baby was crying and I heard him. I
think I read somewhere that you can let the baby cry for five minutes and
sometimes they will put themselves back to sleep - like itÕs just a false
alarm.
T: I understand. We can talk about that later,
right now I am interested in what happened last night.
L: Well, she thought I was sleeping, so she
started pushing me to wake up. I just was waiting to see if the baby was
going to stop crying and so she kept pushing me harder and harder. I know
she wasnÕt trying to hurt me, she just wanted me to wake up because it was my
turn to feed the baby. Anyhow, after about the fifth time, I just got
angry and I took my arm, with my elbow, I was sleeping with by back to her, and
I just swung it to tell her to stop pushing me.
T: What happened then?
L: She started crying because I accidentally hit
her in the eye. She got up and fed the baby and slept the rest of the
night in the babyÕs room.
T: You must have felt pretty bad.
L: I swore that I would never be like my father in
that wayÉ(starts to get teary-eyed) I guess I was feeling more upset and
stressed out than I realized. But that is no excuse.
T: What do you mean you swore that you wouldnÕt be
like your father?
L: He used to beat my mother and all us
kids. What ever belt he had on that day was the weapon of choice.
T: Why do you think he acted that way?
L: I think it was his upbringing. He was
raised in poverty and his parents beat him. I mean, thatÕs no excuse and
I think what he did was bad, but I understand why he did it. Also, having
9 kids and being the sole supporter didnÕt help either.
L: I used to think that beating your wife and kids
was normal. No one ever talked about it so I just assumed it happened in
everyoneÕs family. I learned from my wife that it doesnÕt have to be that
way. She had 10 brothers and sisters and each one felt loved and cared
about.
T: What about your mom, what was that relationship
like?
L: She tried to be a good mother, but I think she
was pretty beaten down by him. She didnÕt have a lot of patience for
us. My older sister Rena was more like a mother to me. She was so
loving. We are still very close today.
T: Were their any other people who stand out in
your mind as having an effect on your life?
L: Definitely. I went to boarding school
between ages 8 and 14. There was this English teacher who I was very
close to. At first he and I would talk about school stuff, but then I
began to tell him problems. When I was younger it was stuff about
friends, but as I got older heÕd help me with feelings I was having about
girls. I could never talk to my father about anything and my mother would
just say things like, ÒJust do your school work and donÕt think about silly
things.Ó But he was, I could talk to him about anything. It seemed
like anything I said was important. It felt good. I was sorry that
I left the school.
T: What do you hope to get out of therapy?
L: Well, IÕve never been to a therapist
before. As I think about it I am not sure how you can help me. Wait
a minute, let me seeÉ. Well, I guess I need help with my anger and
stress. I think I have tried real hard not to be like my father, but as I
think about it now, I think itÕs going to take more than just trying not to be
like him.
T: So are you saying that you donÕt want to be
like your father?
L: No, not exactly. I am saying that I donÕt
want to be like him in that way. He had good qualities too,like he was a
hard worker. But sometimes itÕs easier to just remember the bad times.
T: Luis, you mentioned earlier that you are
stressed out lately. Can you tell me more about that?
L: Well, with work and school, and now the
baby, IÕm just tired a lot, moody and there isnÕt time for anything fun.
T: Has this been just since you have been in
school and the baby?
L: Well, my wife says that I tend to be a little
depressed at times.
T: Do you think this is true?
L: Maybe, I donÕt really know.
Assessment: Luis
Luis most probably will have an earned-secure
AAI. He was physically abused and witnessed violence as a child. He
mentioned two important relationships, his older sister and teacher, both seemed
to provide a secure base for him to develop many of the capacities of secure
attachment: his ability to reflect on himself and on the mind of others
(his wife). You get the sense that he is thinking as the interview
progressed and not just using canned speech or jargon. He was even
autonomous enough to disagree with or clarify his thoughts with the
interviewer.
Treatment: Luis
Luis will certainly be easier to work with than our
other examples. He is motivated, self-reflective and is able to put himself
into the mind of others. He has a balanced perspective on his childhood,
but nevertheless realizes he has some work to do if he doesnÕt want to repeat
the violence of his father. There is some suggestion of depression but
this needs further follow-up. The work with Luis will follow the same
protocol that Bowlby laid out, and continuing to focus on developing the same
capacities of secure attachment (capacities of the PFC).
If you have questions about Luis or earned securityÉ
Additional readingÉ
¥ Click on the link below to view the reading
list for this presentation on the web.
– http://www.daniel-sonkin.com/custody/additionalreading.htm
¥ Or download the reading list (MSWord document
by clicking on the link below.
– http://www.danielsonkin.com/custody/additionalreading.doc
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