Attachment and Psychotherapy Dr. Kristýna Haluzíková Bušková ⚫ Attachment concerns the development of the self through close relationships. ⚫ Secure attachment affords us the potential to love, feel, and reflect with the freedom that flows from secure attachment. ⚫ “Psychotherapy, at its best, provides, just such a healing relationship” (David, Wallin). What is attachment • An affectional tie that one person or animal forms between himself and another specific one – a tie that binds them together and endures over time, enhances child’s chances of survival and provides him her with a secure base to explore the world from while protected. What is attachment • Whenever a young human infant feel anxious, in danger or need, their attachment systems are activated. This triggers attachment behaviour, the goal of which is to recover proximity to the care giver where safety and comfort lie. • It is a biological system enhancing the child’s chances of biological survival Evolutionary beginnings • Ethology – the science of animal behaviour in the wild, in its natural habitat • Behaviour cannot be understood without some knowledge of the environment to which the species has become adapted through evolution • Environment of evolutionary adaptedness – Careseeking and caregiving behaviour, good communication and social skills, behaviour by function – Identification of such behaviour (Bowlby) Danger and staying safe • Bowlby quoating William James: • “the great terror in infancy is solitude” • Attachment figures protect infants in two ways: by removing dangers and by caregiving – Need for empathy with the child’s point of view – Secure vs insecure response – when is the insecure attachment behaviour adaptive? The importance of fear • Attachment system: Fear activates attachment behaviour the goal of which is to regain safety. Then the attachment system switches off. • Equally important: what triggers danger but also what terminates the act – Concept of feedback (Bowlby) – Leads to different DRs or internal working models. From attachment behaviour to dispositional representations (IWM) • This leads to the gradual formation of representational patterns of behaviour stored in different systems of implicit and explicit memory – to the formation of the internal working model. • IWM of attachment contains representations to act! • The healthiest patients in therapy have the most flexible, “truly working”model. From the research of Marie Main to Fonagy ⚫ Attachment behaviour as assessed by the SSP can predict representational patterns of attachment as assessed by the AAI (Main). ⚫ SSP behaviour with the primary caregiver at 12 months correlates with the structure of the inner world of the child at the age of 6 (Main). ⚫ In securely attached children there is a successful development of mentalization (Fonagy). ⚫ In insecure attachment, it can be said that there are multiple models of attachment ⚫ Conflicting attachment related information leads to defenses. ⚫ Narrowing of attention in order to deal with the problem. ⚫ It creates discrepancies between information stored in different memory systems ⚫ “My mother was wonderful...One day we had a Sunday lunch where all the relatives were invited. She wanted me to perform on the piano. When I did she slapped me in front of others for making mistakes while playing (opposite episode). ⚫ Unknowingly known information From affect regulation to mentalization ⚫ Good affect regulation leads to a good potential for mentalization ⚫ Contingent mirroring ⚫ Marked mirroring ⚫ Failure of contingent mirroring – predisposition to empty self disorders, narcissism / grandiosity ⚫ Failure of marked mirroring – predisposition to borderline personality disorder Successful development of mentalization ⚫ Parents recognize their child as a separate entity having their own mind ⚫ Parents convey their empathy and capacity to cope through mirroring. ⚫ Successful contingent affect mirroring − The parents are giving back to the baby the baby’s own self (Winnicot) ⚫ Successful marked affect mirroring − We become who the child needs us to be. ⚫ The achievement of intersubjectivity – relationship between two subjectivities ⚫ The importance of enabling the patient to find an image of him or herself in the mind of the therapist as a thinking and feeling being counts. As well as the ability to contain the patient’s emotions. What breaks the cycle of insecure attachment? ⚫ Research showed that a strong reflective capacity could break the cycle of disadvantage. ⚫ Ordinarily parents with adverse attachment histories raise insecure children. ⚫ Capacity to mentalize is a protective factor ⚫ For Fonagy, this means that attachment is not an end goal in itself – it is mentalization. ⚫ It enables us to understand the minds of others as well as our own and thus enhances our chance of survival. We can predict other people’s behaviour. ⚫ Strong argument for therapy (The case of Kitty). Affect Disregulation ⚫ Research showed where there is not sufficient affect regulation, there is flooding stemming from the activated amygdala of the Broca’s area responsible for speech, hipocampus, responsible for memory processing ⚫ This leads to the failure in processing of these traumatic memories and the overall ability to mentalize gets compromised due to dissociation, disowning of experiences, underdevelopment in certain areas, etc… ⚫ People may get stuck in ways of thinking and processing associated with lower levels of mentalization. ⚫ Resulting projective identification, etc. – different levels of mentalization Levels of mentalization ⚫ Mode of psychic equivalence − The internal world and the external reality are simply equated. What we think and feel seems to mirror what occurs to us in the physical world and vice versa. When we are treated badly we are likely to feel that we ARE bad. The self as psychological agent is submerged: There is no I that interpretes or creates experience but only a me to whom experience happens. Basis for PROJECTIVE IDENTIFICATION (proneness to shame, guilt). ⚫ Pretend mode − The internal world is decoupled from the external one. We are unfettered by actualities. Whatever we imagine is felt to be real and whatever we ignore is rendered immaterial. Dissociation, denial, and extreme narcissistic grandiosity are all examples of this. Taking reality into account threatens what has been imagined and opens the door to what has been ignored. ⚫ Levels of mentalization cont. ⚫ Mentalizing (relfecting mode) − We are able to recognize that the internal world is separate from but also related to external reality. Here we can relfect on the ways in which our thoughts, feelings, and fantasies both affect, and are affected by, what actually happens to us. In this mode, our subjective experience is felt to have interpretative depth and thus – because we can grasp the difference between events and our reaction to them – we can enjoy a measure of internal freedom. Mentalizing reveals a world of self and others that is rich, complex, and ambiguous – and one in which we have the potential to revise our mental representations of external reality as our actual realities change. − Truly flexible internal working model − Experience of danger streamlines our thought process and makes our perceptions more black and white. Lack of resolution of past trauma ⚫ The parent’s lack of resolution of past trauma or loss leads to radically discontinuous states of mind that necessitate the rigid denial of disturbing experience. ⚫ The dissociated and dangerous working models of unresolved parents and the associated foreclosure of self-reflection place their children at severe risk for disorganised attachment as well as psychopathologies with which it is all too often linked. Precoccupied lack of resolution ⚫ Too much information on danger is retained ⚫ Overemphasis on danger and too little emphasis on one’s contribution to it – ability to protect oneself. ⚫ Contained vs. uncontained. ⚫ Preoccupied attachment - preoccupation with relationships, compromised exploration − The case of Nina – traumatic divorce of parents, father seen as danger, mother intrusive thoughts – exhibited frightening behaviour when her daughter would not oblige her. - now co-dependence, difficulty sleeping outside home, going on trips alone, etc. Everything is everybody else’s fault. Lack of resolution ⚫ Dismissing − Too little information on danger is retained − Overattribution of responisbility – Thinking I have it under control. − Avoidant attachment – overactivated exploration, underactivated attachment seeking. − The case of Roman – took a long time studying different fields, successful academic, left home at the age of 14 to live with his grandmother, married much later. Idealized mother who was in reality exhibiting dangerous behaviour – this behaviour is dissocciated. Blame placed on the father…. Lives in prence mode to a degree, non-contingent mirroring. General things to consider in therapy ⚫ Type of attachment ⚫ Narrative coherence vs incoherence ⚫ Tendency to overshare or hold back ⚫ Affect regulation ⚫ Transference and countertransference − Caring behaviour − Annoyance, seeing the patient as helpless − Seeing the patient as overly independent − From attachment to narrative identity (Dallos).