Working therapeutically with insecure attachment patterns

“The first thing I learnt about love is Distance”

In attachment terms the self is constructed through the relationship a child has with their caregiver. Bowlby’s attachment theory is bound by the importance of loss and missingness that a child experiences when caregiving suffers the consequences of neglect and maltreatment. Attachment theory has been supported by extensive empirical research. The attachment classification created by Ainsworth (1978) emphasises a set of attachment patterns categorised as secure, avoidant and ambivalent/resistant interactions between parent and infant.

Relationships are complex, intricate and richly nuanced, with the added complications of intergenerational  transmission of trauma. As such, attachment theory runs the risk of simplifying human interactions with a new bias. Nonetheless, using the attachment categories helps to conceptualise the relationship dynamics (transference/countertransference) of feelings, thinking and responses that offers an effective framework and minimises confusion in therapy.

This webinar will discuss the avoidant relationship pattern of a client whose avoidant adaptation and significant self-reliance helped him to be high functioning at work, yet this was disguising a lifetime of vulnerability and loss, that protected him against the pain of attachment and rejection. The secure relationship that therapy offered helped the client to shift these defences from their position of unreachable self-reliance to a place of growing sensitivity towards self and other, mutual recognition and reciprocity. The webinar aims to demonstrate these dynamics created through the mourning process, transference and countertransference.

“The Almostness of you”

In attachment terms the self is constructed through the relationship a child has with their caregiver. Bowlby’s attachment theory is bound by the importance of loss and missingness that a child experiences when caregiving suffers the consequences of neglect and maltreatment. Attachment theory has been supported by extensive empirical research. The attachment classification created by Ainsworth (1978) emphasises a set of attachment patterns categorised as secure, avoidant and ambivalent/resistant interactions between parent and infant.

Relationships are complex, intricate and richly nuanced, with the added complications of intergenerational  transmission of trauma. As such, attachment theory runs the risk of simplifying human interactions with a new bias. Nonetheless, using the attachment categories helps to conceptualise the relationship dynamics (transference/countertransference) of feelings, thinking and responses that offers an effective framework and minimises confusion in therapy.

Bowlby considered ambivalent attachment as chronic unresolved grief. In childhood, the client’s attachment with their caregivers can leave them unable to self-regulate, resentful and full of self-loathing whilst feeling stuck between dependency and despair. The client Orit Badouk Epstein will be presenting went to therapy with a soaring depression after she had suddenly been abandoned by her partner. The intense and enmeshed relationship she had with her mother was equally charged and was full of erroneous misunderstanding and disappointments. The client’s pursuit of unrequited love made her inhabit a world “without”, always yearning and pining for something more ideal only to be met by a thundering disappointment. The security of the relationship offered in therapy has paved the way to resolving general confusion, cope with her disappointments, her unresolved grief and the move towards self-regulation and earned security. 

“The development of the self in the presence of a scaregiver”

In attachment terms the self is constructed through the relationship a child has with their caregiver. Bowlby’s attachment theory is bound by the importance of loss and missingness that a child experiences when caregiving suffers the consequences of neglect and maltreatment. Attachment theory has been supported by extensive empirical research. The attachment classification created by Ainsworth (1978) emphasises a set of attachment patterns categorised as secure, avoidant and ambivalent/resistant interactions between parent and infant.

Later Mary Main (1981), a student of Ainsworth, observed infants who didn’t have sufficient strategies against the parents’ threatening behaviour, when the child faced a dilemma of simultaneously seeking care from and fearing the caregiver, resulting in a collapse of strategies. She called this Disorganised attachment.     

It is our attachment bonds and connection with primary caregivers which organise our sense of self often resulting in secure attachment. Childhood trauma and the exposure to a frightening and unpredictable caregiver can disrupt this organization, resulting in self-disorganization, fragmentation and dissociated self-states that make separation and individuation from the caregiver harder to achieve.

In this webinar Orit Badouk Epstein will discuss a client who suffered extensive abuse and mind control at the hand of her parents and other family members. The client’s attachment to her “scaregivers” intensified her struggles, leading to suicidal ideation, eating disorder and other forms of self-harm. The desire to return to the scene of abuse complicated her healing journey.

When working with complex trauma, the therapeutic process involves sitting with the dissociated unknown, fostering a polyphonic dialogue among the fragmented parts to allow trust and a sense of safety to develop. Gradually, as the relational safety was established, the client was better able to self-regulate, and there was a reduction in suicidal ideation and better functioning. Ultimately, this journey paved the way for the emancipation of her imprisoned body and mind.