Domestic Violence Update

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 “Contact Dr. Sonkin by email” 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 it’s 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 one’s 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.

Bowlby’s central proposition…

….that beginning in early infancy, an innate component of the human mind -- called the “attachment behavioral system” -- in effect asks the question: Is there an attachment figure sufficiently near, attentive and responsive?

If the answer is yes…..

…then 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 no…

…a 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 no…

…the 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 figure’s availability. In the strange situation these infants are very distressed when the parent leaves the room, can’t settle down after the parent leaves and can’t 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 didn’t 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 “fear without solution.”

Assessing Infant Attachment: The Strange Situation

The ”Strange 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 “status” 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 “attachment style” to designate a person’s 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 “Can not classify” (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.

“In childhood, particularly the first two years of life, attachment relationships help the immature brain use the mature functions of the parent’s brain to develop important capacities related to interpersonal functioning. The infant’s 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.”

“When 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 “a secure base” in the world. These positive mental models of self and others are carried into other relationships as the child matures.”

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 caregiver’s 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;

(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 child’s ongoing activity rather than being geared in both timing and quality of the child’s state, mood and current interests.

What helps a parent to be “psychologically-able?”

• 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.

• Let’s 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 parent’s attachment status.

• Prebirth AAI show 69% three-way agreement: When pregnant parents’ 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:

· 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.

· • 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, therefore…

– …they 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 needs…

– …therefore their infants respond by minimizing their attachment needs and becoming avoidant.

• Preoccupied parents do not respond to their children’s 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. Their…

– …infants respond by chronic attempts to feel secure and therefore, are clingy and difficult to emotionally soothe.

• Disorganized parents are abusive or otherwise frightening so their…

– …infants respond by approach - avoidance oscillation. They are needing protection from the person they fear and therefore, are experiencing “fear without solution.”

Adult Attachment Relationships

In the 1980’s, 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 adult’s 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 one’s 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, let’s 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 Bowlby’s 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.

”There 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 partner’s 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 partner’s 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 it’s correlated with higher rates of psychiatric disorders. It is thought that insecurity creates the risk of psychological and interpersonal problems.

· Avoidant: leads to deficits in social competence, and have higher rates of schizophrenia.

· Disorganized: higher rates of dissociation, PTSD, attention and emotion disregulation problems.

· 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:

· Cassidy J. & P. R. Shaver (Eds.)(1999), Handbook of attachment: Theory, research, and clinical applications. New York: Guilford Press.

· 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 theory…

…email Dr. Sonkin.

Assessing Attachment Status

Interview approaches

· Coherence (Main - Adult Attachment Interview )

· Self-reflective function (Fonagy, described earlier)

· Projective test (Adult Attachment Projective - George & West)

Self-report (Two examples)

· Anxiety and Avoidance (Shaver - Experiences in Close Relationships-Revised)

· 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 subject’s narrative.

According to Mary Main, the developer of the AAI, “…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 inter-twinned and interrelated.”

The coherence of the interview is evaluated using a number of scales that were developed from Grice’s 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 narrative’s 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 Grice’s maxims.

• Dismissing (Ds): Not coherent. Minimizing of attachment-related experiences and relationships. Normalizing (“excellent, very normal mother”), with generalized representations of history unsupported or actively contradicted by episodes recounted, thus violating Grice’s 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., “dadadada”; “or whatever”) thus violating Grice’s 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, uhm…[3 secs], and , it’s just, you know, I knew she really cared, and (Uh huh), and uhm, was interested. Even when my father was there he wasn’t 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, it’s just that it’s 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 that’s the case today. In fact, last week my son was sent to the principal’s office and they called me at work to pick him up. I wasn’t able to so I had to call my mother. I heard the judgment in her voice. I thought, another narcissist heard from. My son’s 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 I’d have to pay my lawyer. It’s 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 “reflective function.” 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.

“A mother’s capacity to reflect upon and understand her child’s internal experience is what accounts for the relation between attachment status and her child’s sense of security and safety.” (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 don’t 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 “not at all like me” to “very much like me.” 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 Bowlby’s 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 Shaver’s 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 Fraley’s web site at: http://www.psych.uiuc.edu/~rcfraley/pubs.htm

Or Phil Shaver’s 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 doesn’t mean that is’t not possible. It just means that a method has yet to be developed.

If you have questions about assessing adult attachment status…

…email Dr. Sonkin.

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. Let’s 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 Jacobson’s “vagal reactors”). 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 “fearfully preoccupied” 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 hasn’t 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?

· Feminist explanations for violence that focus on patriarchy and sex role stereotyping does not hold true for same sex relationships.

· That there may be greater rates of attachment insecurity among lesbian couples than gay couples.

· 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.

· Don’t make assumptions about dynamics of power and violence in same-sex couples.

If you have questions about domestic violence and attachment…

…email Dr. Sonkin.

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 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 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 theory…..

• ….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 words….

• ….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 “strange situation”) believed that secure attachments developed due to maternal or paternal sensitivity and cooperation. Let’s explore these concepts a little deeper.

Sensitivity

Sensitivity has four essential components:

(a) awareness of the signals;

(b) an accurate interpretation of them;

(d) a prompt response to them.

Cooperation

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 it’s caregiver or feels ignored or intruded upon. When these mis-attunements occur with considerable frequency, the child’s “attachment behavioral system” 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 client’s 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 client’s 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 client’s 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 it’s 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 “felt by another.”

For this process to occur, the therapist allows his/her mind to have an experience as close as possible to what the client’s subjective world is like at that moment - not unlike the process that occurs between an attuned parent and their child.

It’s 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 psychotherapy…

…email Dr. Sonkin

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, “What do you think he should do to get his wife back?” When asked about his childhood experiences, he launches into a tirade about his father’s unavailability (he worked three jobs to support the family) and his mother’s involvement with other men. He goes on for ten minutes and then stops and says, “I don’t know if that answers your question.” 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, “You know, people are never there when you need them.”

• He explains, “My problems with jealousy in the marriage would not have been a problem if Elaine loved me and was committed.”

• 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 “..four or five times a week.”

• 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 he’s 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 wouldn’t 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 wife’s and the therapist’s 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 figure’s 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 Robert…

…email Dr. Sonkin.

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: “I was eating out with my wife, I wasn’t 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.”

• T: “How did you feel when he said that?”

• H: “I didn’t think I was talking any louder than anyone else there.

• T: “What happened next?”

• H: “I just ignored him. Mary keep ragging on me to stop embarrassing her. She wouldn’t shut up so I just reached across the table and closed her mouth. She wouldn’t listen to me so I shut her up myself.

• T: You must have been feeling pretty angry at her.

• H: No. She wouldn’t shut up, so I shut her up.

• T: “Where did you grow up?”

• H: “Sonoma County.”

• T: “Do you still have family there?”

• H: “Yes. Both parents and two younger brothers and a younger sister.”

• T: “How would you describe your relationship with them?”

• H: “We’re close.

• T: How often do you have contact with them?

• H: I see them once or twice a year. Usually for the holidays.”

§ 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 doesn’t 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 doesn’t 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 can’t 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 he’ll just look at you and say, “So what?” 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 Howard…

…email Dr. Sonkin.

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 can’t 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 doesn’t recall all the details but she remembers getting angry and they started fighting. She doesn’t 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 didn’t 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 didn’t 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, “He is dead now, you know my father, but he is still inside of me.” When you ask how so, she replies, “I don’t know.”

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.

• Sandy’s attachment experiences included trauma. States that she hasn’t 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 doesn’t 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 Sandy…

…email Dr. Sonkin.

Earned Security

“I 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?” – 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 “earned security” 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 “earned secure” 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 “earned security” 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: We’ve been arguing a lot about feeding the baby at night. I’m tired after working all day and going to school at night and I just can’t 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 it’s 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 wasn’t 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 baby’s room.

T: You must have felt pretty bad.

L: I swore that I would never be like my father in that way…(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 wouldn’t 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, that’s 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 didn’t 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 everyone’s family. I learned from my wife that it doesn’t 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 didn’t 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 he’d 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, “Just do your school work and don’t think about silly things.” 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, I’ve 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 see…. 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 it’s going to take more than just trying not to be like him.

T: So are you saying that you don’t want to be like your father?

L: No, not exactly. I am saying that I don’t want to be like him in that way. He had good qualities too,like he was a hard worker. But sometimes it’s 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, I’m just tired a lot, moody and there isn’t 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 don’t 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 doesn’t 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 security…

…email Dr. Sonkin.

Additional reading…

• 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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