josh.spurlock

• Value the importance of mourning
• Pay attention to secondary losses arising from trauma: lost sense of parental protection, loss of childhood, loss of innocence
• Notice when clients are avoiding mourning, as they use:
  • Minimization
  • Precipitous forgiveness
• Invite the client to look at the emotional experience of the loss and its aftermath, focusing on feeling states such as:
  • Rejection
  • Sadness
  • Neediness
  • Disappointment
• Notice when the emotional thread has been lost in the session, and bring the client back to the affect
• Help the individual link feelings to bodily sensations
• Notice discrepancies between expressed emotions and nonverbal physical behaviors
  • Ask the client what he is feeling in the moment
• Look at loss-related emotional themes in the context of specific autobiographical memories
• Get to know the client’s experiences in a more immediate, personal sense:
  • Be on the lookout for detailed images, memories, and specific experiences that can bring stories to life
• Help the individual make emotional connections between more recent losses and earlier ones
• Explore the loss that comes with giving up an idealized view of caregivers.  
• What difficult feelings go along with a shifting view of one’s parents and family?
• Diagnosis & Treatment of Any Associated Mental Disorder

Introduction

Grief and mourning are critical components of life in a sinful, fallen world.  There’s really no way of getting around them.  This fact creates a special level of difficulty for clients with attachment issues.  What we have covered, thus far, is the high level of energy dedicated by such individuals to insulate themselves from their own emotions.  Our job, as therapists, is to work with them to achieve goals which will involve encountering a great deal of their own resistance.

Let’s start by reviewing, what many of us learned in our graduate studies, about the effects of separation.  Bowlby conducted experiments in which he separated young children from their mothers and observed their responses.  He grouped the responses into 3 distinct phases:

1. Protest: refers to acute distress associated with unbearable loss.  In the young children this meant crying, shaking, screaming, throwing themselves around, and searching for signs that the parent had returned.
2. Despair: this phase included a tendency to withdraw, to become inactive, and to make few demands on others, with more intermittent crying.
3. Detachment: the child demonstrates more interest in the immediate environment rather than the absence of the relationship.

Bowlby noted that sometimes adults incorrectly came to believe the child was not less distressed and showing signs of recovery.  In fact, the child had not recovered.  When the mother would visit, these would be a troublesome absence of normal attachment behavior.  The child would seem distant, remote, uninterested in her, detached from attachment-related feelings and behaviors.  In those children for whom the period of separation continued, detachment would become worse still, particularly if there was a succession of institutional caregivers.  Describing the effect on children, Bowlby observed that the child would become interested in material things such as candy and toys and would stop showing feelings when parents would arrive and leave on visiting days; over time, the child would become interpersonally aloof.  That is:

“He will appear cheerful and adapted to his unusual situation and apparently easy and unafraid of anyone.  But this sociability is superficial, he appears not longer to care for anyone.”

What Does Emotional Detachment Look Like in Adults:

Using the term affect phobia to describe the tendency in some individuals to avoid internal affective states, McCullough and colleagues explained that certain experiences and emotions are intolerable because of the conflicted feelings they arouse.  Traumatic experiences are associated with difficult, complicated emotions.  In addition to the expressed and unexpressed anger that client feels towards those who have hurt them, there are a host of affective states of which the individual is often unaware: painful longing for what might have been, distress about having been abandoned by the person trusted most, and the wish to complete the relationship that was somehow derailed too soon.

Adults who are detached from their emotions are at a disadvantage when they meet attachment-related challenges in the interpersonal world.  When relationships become too close, emotional, or complicated, the individual is “afraid to allow himself to become attached to anyone for fear of a further rejection with all the agony, the anxiety and the anger to which that would lead.” (Bowlby).  The tendency toward self-sufficiency provides a sense of comfort and control, keeping relationships safe, but leads to a life that is rather lonely.

Mourning:

To a great extent, trauma is about loss.  In families in which the child has been subjected to physical or sexual abuse or neglect from parents or there is severe parental rejection, abandonment, or harsh criticism, there is a lost sense of caregiver protection, loss of childhood and innocence (Cloitre, Cohen & Koenen).  Additionally, many destructive parents feel moments of regret or shame, leading them to make promises about future changes, causing the child to vacillate between hope and despair.  There can also be significant damage in the event of the loss of a caregiver to death.  In all the above, the therapist is paying attention to aspects of the client’s environment and family such as:

• What were the reactions of the other adults to the destructive behavior/loss?
• Does/did the family talk about it?
• What did they say about it when they talk about it?
• Did the child end up feeling they were to blame?
• Did the child feel secure in the attachment to the other/surviving caregivers?
• Was there another parent/caregiver to attach to?
• Did the destructiveness/loss of one parent mean the emotional loss of the other?

Because strength can be seen as a virtue, especially in attachment deficient or struggling families, when there is loss a sense of pride can develop over behaving as if everything is fine.  The client makes attempts to detach herself from feelings of hurt, sadness, sorrow, or other expressions of dependency, isolating herself from friends, especially when there is a risk that signs of “weakness” will leak out.  Often times, the effort to act as if everything is “fine” backfires.  While the client is working hard to convince themselves, those around them, and perhaps, their therapist everything is all right, they behave in ways which make it obvious they are not.  Another chance to thoughtfully draw attention to an inconsistency.  Remember where pride is involved, and insecure and weak ego is present, so therapist will have to support while pointing this out, even with client who would balk at such support.  After all, they are “better off” & “stronger for it” in regards to what they have been through.

Avoidance – It seems appropriate here to list some of the things to look for in clients who are avoiding mourning.

• Minimizing by:
  • Excessive involvement in intellectual or instrumental activity (work, school, etc)
  • Excessive involvement in leisure activities
• Precipitous Forgiveness
  • Forgiveness as much benefit, at least full and genuine forgiveness.  But there can be no real forgiveness without acknowledgment of the damage done.  Precipitous forgiveness is different.  It appears virtuous and ideal.  It demonstrates maturity and the ability to let go.  It connotes a position of strength, a rejection of the victim role, and a gesture of return to normalcy (Baumeister, Exline & Sommer).  Forgiveness “takes the high road.”  This kind of forgiveness is used in a way that is emotionally dishonest and not terribly helpful, that is, as a way of avoiding the painful experience of mourning.  Herman wrote that some individuals attempt to “bypass their outrage altogether through a fantasy of forgiveness . . . The survivor imagines that she can transcend her rage and erase the impact of the trauma through a willed, defiant act of love.”  The one who grants forgiveness is far more powerful than the one awaiting an apology.  This kind of forgiveness does not allow for the pain of the experience to be incorporated into the client’s reality, preventing any meaningful understanding.

Genuine Mourning – mourning is meaningful, honest & healing.  It comes about through the painful, hard work of acknowledging and experiencing the emotions related to loss, accepting the many complicated, contradictory feelings that accompanied a traumatic history, making sense of the impact such varying emotions have had on the individual’s life and integrating this understanding into the person’s view of himself within his relational word.  Herman wrote:

• True forgiveness cannot be granted until the perpetrator has sought and earned it through confession, repentance and restitution   Genuine contrition in a perpetrator is a rare miracle.  Fortunately, the survivor does not need to wait for it.  Her healing depends on the discovery of restorative love in her own life; it does not require that this love be extended to the perpetrator.  Once the survivor has mourned the traumatic event, she may be surprised to discover how uninteresting the perpetrator has become to her and how little concern she feels for his fate.  She may even feel sorrow and compassion for him, but this disengaged feeling is not the same as forgiveness.

What to Mourn? – Clients mourn the physical or emotional loss of a caregiver due to death, divorce, abandonment during a sensitive period of development or during childhood at large or when clients have experienced the psychological loss of a caregiver due to events surrounding intra-familial abuse, it is important to encourage discussion of such losses in therapy, particularly discussion that is grounded in the emotional experience of the event and its aftermath.

Therapist Strategy – Remember that therapy is not a linear process.  Often times, clients “lose” connections gained weeks or even days earlier, only to find them later along the path.  

The therapist listens for affective themes associated with such losses and invites the individual to clarify, label, and experience different emotions she may have felt both at the time and now, particularly feeling states that the client is not accustomed to considering, such as rejection, sadness, and neediness.  Watch for idealization of the parents and possible struggles for the client as this view point is questioned.

Remember, that these clients “talk around” issues of attachment.  The therapist must be attentive and bring the client back to the affect, not in a pushy or mechanical way, but in a manner that is sensitive to the moment.  As the therapist brings the client back to the affect, notice that emotions related to loss, such as rejection, sadness, and neediness are all difficult to own.  This is because when they arise, they tend to provoke feelings of dependency and a sense of shame for inadequacy.  For example, ” I am sorry for crying, its silly.”

The therapist also does well to notice the client’s tendency to avoid emotions by making observations, giving analytic statements, and talking about feelings instead of experiencing them.  Psychologist Leslie Greenberg and colleagues have emphasized the importance of attending to emotional experience, stating:

• Emotional awareness is not thinking about feeling, it involves feeling the feeling in awareness   Only when emotion is felt does its articulation in language become an important component of its awareness   The therapist thus needs to help clients approach tolerate, and accept their emotions.  Acceptance of emotional experience as opposed to its avoidance is the first step in emotion work.

Along this theme, it is often very useful for the therapist to invite the client to link the emotions they are experiencing with bodily sensations.  McCullough emphasized the importance of the bodily experience of affect, particularly when such emotions have not been often talked about or are difficult to put into words.  She noted that, in treatment, the feeling should create physiological arousal in the body.  “Behavior change does not follow the mere intellectual imaging of affective scenes.  The body must be activated for change to occur.”  Many clients who are avoidant have a strong disconnection between emotional experience felt in the body and conscious awareness.  It is helpful to ask the client:

• What are you experiencing in your body?
• Where are you feeling tension?
• When does your breathing become faster?

It is also helpful to draw out discrepancies between expressed emotions and nonverbal physical behaviors.  Such contrast can be quite pronounced.  For example, a client may talk about not feeling much about a past trauma while she is flushing or her hands are fidgeting.    In as non-shaming language as possible, notice these behaviors and ask the client what she is feeling in the moment.  As greater trust develops in the relationship you will notice such questions are met with less resistance.

Another strategy is to listen for emotional themes and associate these emotions with specific autobiographical memories of the client.  Rather than talking about events in a more intellectualized manner, the therapist fosters emotional connection.  For example, if a highly independent man has themes of isolation, a therapist might ask where else in his life he feels “its all up to me/I’m on my own.”  It may also be helpful to ask for more detailed images and memories of specific affect experiences.  The therapist might ask:

• Can you remember an incident that illustrates that (Ex: the loneliness mentioned above).
• When did you start feeling that way?
• Whereabouts in your body do you experience that feeling?

The therapist can also pull the client away from referring to people in his stories by their title (“my ex”, “my son”, “my doctor”) and use the person’s name.  It makes the story just a bit more personal, keeping the client from maintaining a comfortable distance that comes when referring to people by their roles or titles.

By having the client to address loss-related emotions in the context of specific remembered episodes can help with the process of integrating and making sense of such feelings.  The therapist invites the individual to make meaning of the event or loss and possible effects it may have had on how he views himself and on how she functions within his relational world.

Expect that these conversations will be experience initially by such clients as awkward and difficult.  After all, in many such families of origin, in moments of intense stress in which attachment needs were activated, attachment was withheld.  Such clients now have a tendency to deactivate attachment needs when such emotions are kindled.  

The therapist can also take current situations the client is concerned about which are emotional and draw the client into considering when these emotions have been experience before.  Interpersonal experiences across the life span and connected largely by the emotions they arouse.  This kind of contextualizing loss-focused conversations within the here and now makes it easier for clients who are avoidant of attachment to consider such discussion to be relevant and worthwhile.

Finally, the therapist helps the client develop a more balance view of parents and family.  Coming to realize our family’s imperfections is an important part of development.  In families in which there is adequate security in the parent-child relationship, there is space for the child to develop balance, realistic mental representations of her caregivers, so that parental flaws are seen for what they are.  With an internalized sense of security comes a certain measure of freedom and flexibility.

However, when there is not such security, freedom, and flexibility within the parent-child relationship, it becomes necessary for the child to develop defensive maneuvers to protect her view of one or both parents.  Parent idealization is an important aspect of avoidant attachment and comes about in a defensive effort to keep faith in caregivers.

As such, the therapist helps the client navigate the process of developing a balanced view of family.  The therapist takes seriously the loss of the idealized family/parent for the client, as this loss can be very destabilizing.  It means helping the client examine the painful feelings and the sense of loss that comes with giving up an idealized view and the disorientation that arises when seeing attachment figures through a different lens.  They will need help establishing a new construct in which to view family.

Review Points:

• Value the importance of mourning
• Pay attention to secondary losses arising from trauma: lost sense of parental protection, loss of childhood, loss of innocence
• Notice when clients are avoiding mourning, as they use:
  • Minimization
  • Precipitous forgiveness
• Invite the client to look at the emotional experience of the loss and its aftermath, focusing on feeling states such as:
  • Rejection
  • Sadness
  • Neediness
  • Disappointment
• Notice when the emotional thread has been lost in the session, and bring the client back to the affect
• Help the individual link feelings to bodily sensations
• Notice discrepancies between expressed emotions and nonverbal physical behaviors
  • Ask the client what he is feeling in the moment
• Look at loss-related emotional themes in the context of specific autobiographical memories
• Get to know the client’s experiences in a more immediate, personal sense:
  • Be on the lookout for detailed images, memories, and specific experiences that can bring stories to life
• Help the individual make emotional connections between more recent losses and earlier ones
• Explore the loss that comes with giving up an idealized view of caregivers.  
• What difficult feelings go along with a shifting view of one’s parents and family?

Discussion Video

Topic: MCOTeam Meeting
Date: Mar 14, 2018 10:08 AM Mountain Time (US and Canada)

Gallery View-0 (972 MB)
https://mycounselor.zoom.us/recording/play/J6HP3Qo8ZssLWoHIbQa6YGwkQ4W7bJmdMmaHdAHugnlgMX2WN7ZsHqGFvPchbRl2

PRACTICE MANAGEMENT:

• CEU Tracking
• ATD Updated: it was suggested that a place for listing client medications be added to the form & this is now completed.  Great idea Jesse!

DIDACTIC: ACTIVATING THE ATTACHMENT SYSTEM PT. 2

1. Introduction to Attachment Theory
   1. What is it?
   2. 4 Types of Attachment
   3. Christian Integration
2. Defenses in Attachment
   1. Minimization of Attachment
   2. Positive Ending
   3. Intellectualized Speech or Activity
   4. Talking Around
   5. Activation of Other Behavioral Systems
   6. Cutting Off
   7. Perception as Self-Reliant, Independent, Strong & Normal
   8. Diagnosis & Treatment of Any Associated Mental Disorder
3. Interventions to Activate Attachment in Therapy
   1. Watch & Listen
   2. Recognition of Affect
   3. Committed to the Truth
   4. “I am not a victim”
   5. Using Symptoms as Motivators
   6. Listening for, Noticing & Using Ambivalence
   7. Asking Questions Around Themes of Care-giving & Protection

Intervention #4: Using Symptoms as Motivators

Understand that regardless of an individual’s prior history, the actual decision to come for therapy often occurs at a time when defenses have broken down in the here and now.  Trauma theorists refer to the “disguised presentations” that bring individuals into treatment, especially those with histories of childhood abuse.  Judith Herman wrote:

• They come for help because of their many symptoms or because of difficulty with relationships, problems in intimacy . . . and repeated victimization.  All too commonly, neither patient nor therapist recognizes the link between the presenting problem and the history of chronic trauma.

Some other very common presentations for clients who are avoidant of attachment often seek therapy because of loneliness & depression.  Understand this, know this is the case, or you will mislabel what is in front of you as Major Depression or Generalized Anxiety.  These struggles are accompanied by symptoms of depression, isolation & anxiety.  And why would they not be?  Life was not meant to be experienced alone.

For the therapist, such crisis in cause/opportunity for deeper exploration & perhaps healing.  For the client, the focus is the symptoms going away.  And here is our chance.

• Make the Symptoms Meaningful: Early in treatment, it is important to help the client make a motivational shift from simple symptom relief to one in which therapy starts to feel important on a deeper level.  A shift in which the person begins to experience a more meaningful connection to the process.  If the individual’s motivation for therapy stays at the level of simple symptoms relief, he may become rapidly disillusioned with the process, terminating treatment long before it is complete.  It is common that symptoms abate relatively quickly (for a brief time) following the initiation of therapy.  As such, the client believes they are better.  This relief may start as quickly as placing the call to make the first session. Why does this occur?  There is a direct symptomatic benefit to experiencing an increase in social support.  Simply by bringing the counselor in, research shows there will be an improvement.  Specifically, support from a perceived authority figure has shown to be helpful.
• Clarifying Motivation: Individuals with attachment histories have a checkered past of trying to get help and stopping (help can take various forms and is not limited to formal counseling).  The client was motivated temporarily by times of decompensation.  Here we must be curious.  The following are the types of questions we should ask:
  • What did you find to be the most difficult about therapy/the last time you had this problem?
  • Why would this time be different?
  • If they have not been in therapy before: Why enter it now?
  • Why would therapy help now?

When the client responds in global, impressionistic, stereotypic ways with goals like, “I don’t want to be so negative all the time,” without any clear justification, it is helpful to take the opportunity to gently challenge the client as to why.  What is in it for them to “stop being so negative?”  What might they gain, and what might they lose?

• Connecting Symptoms to Attachment: Connecting symptoms to attachment refers to the idea that the therapist helps the client explicitly connect symptoms to psychologically meaningful reasons for treatment.  How to do this?  There are a number of options, but the basic theme is the same, going back to the relationship.  One tactic is to have the client sharing about current symptoms in life and then have them recall the earliest time in their life they can remember feeling in a similar way.  From there, the therapist explores their connections and relationships at that time in life.  Another option would be to explore who the client allows to help them currently with their struggles.  Be creative, but take things back to the relationship.  Thus, the individual who allows himself to make the shift from viewing the problems as “depression & loneliness” to that of “self-isolation” or to that of “keeping people at arms’ length” is far more likely to find therapy meaningful.  One warning, especially to the beginning therapist, none of these interventions should take the form of pontificating possible theories to the client.  These individuals will experience this as artificial and contrived.  You must work with what the client is giving you, do not over-reach or you will lose them.
  • All of the questions follows this basic path:
    • What is the effect of (symptom) on (relevant attachment theme)?
    • What is the effect of (relevant attachment theme) on (symptom)?
    • In practic, this may look something like, “How has depression affected your relationship with Paul?”  Or “How has your engagement to Paul effected your depression?”  Or perhaps “How did the performance anxiety affect your decision to have children?”  Or “How did fear of having children effect your performance anxiety?”
    • The questions themselves are not as important as the therapist repeatedly demonstrating assigning meaning to the symptoms.  The client will often respond that outside of therapy something happened and they heard the therapist’s line of questioning and it caused them to look in depth at such matters.  It is a position which is not assigned but caught.
• Dismissing Disillusionment:  Know that the very process of becoming symptomatic is in, and of itself, often a kind of injury to the attachment avoidant client.  Theorists refer to this as “dismissing disillusionment.”  As the term suggests, when they become symptomatic, clients who are avoidant (dismissing) of attachment tend to experience a profound sense of feeling disillusioned.  Such individuals can cope with emotional ups and downs in life provided these issues do not touch on attachment related hurts.  A therapist can ally with the distress of the disillusionment.  They can do this by allying with the individual’s motivation to understand why she would be feeling much worse than before.  Given the tendency toward strength and self-reliance, such individuals feel considerable disappointment in themselves for becoming symptomatic.  There is a sense of personal failure and humiliation or anger at themselves for “falling apart” and a desire to figure out how to protect themselves from falling apart in the future.  The therapist aligns with this strong motivation.  (example: “This week has really been tough for you.  I’d like to see if we can figure out how to keep you from getting knocked off your feet like that again.  An important part of that will be understanding what was going internally for you.”)
• Focusing on Themes of Vulnerability: The therapist should be listening for the meanings attached to symptoms.  Understand we are all, even the avoidant, trying to make sense of life.  Often times, their symptoms have very curious meanings.  The meanings and symptoms can be brought back to vulnerability.  Know this, the word “vulnerable” is offensive to the attachment avoidant.  It is a disease, a weakness.  When individuals have experienced histories of trauma, particularly when suffering comes at the hands of those trusted most, there is a painful awareness of the price to be paid for excessive vulnerability. Vulnerability can mean weakness and may be frightening or dangerous.  Avoidance of attachment is the pursuit of invulnerability, the pursuit of an illusion that offers strength, reassurance, and a promise of safety.  Part of the reason the client feels so profoundly disillusioned when she becomes symptomatic is that she has become painfully aware, again, of the harsh reality of her human weakness and all the dangers that go along with it.  An important component of treatment is in helping the client gain greater acceptance of her vulnerabilities integrating them into her overall sense of self, so that they can eventually feel less dangerous and frightening.
  • For example, consider the person who declares “weakness” as his word to describe the meaning of fear to him.  This word can be contrasted with the individual’s more usual backdrop of “strength.”  The therapist and client can then reflect on this weakness.  The therapist enquires about it’s history in the person’s life.  “When was the first time you showed anyone your weak side?”  “On the rare occasions that it occurred, how did your parents deal with such weakness on your part?”  “How have you reacted to such weakness in others?”  “How is it others got the chance to be so weak and you had to be so strong?”  Again, the questions & their answers are not nearly as important as process of self-reflection.  Recognizing feelings around having become symptomatic and then connecting them to other experiences of vulnerability helps the client integrate a far more textured and realistic view of self, a view in which stories of strength and weakness, independence and fear, can come to coexist.

Review:    

• Take note of initial buy-in that has been prompted by the presence of symptoms.
• Clarify motivation for therapy:
  • Ask the client to reflect on her response for taking on therapy given that it raises uncomfortable, difficult feelings.
• Help the individual make connections between symptoms and attachment-related issues (to further strengthen motivation for therapy).
• Notice client disillusionment (over having become symptomatic).
  • Ally with the individual’s motivation to understand why she would be feeling so much worse than before.
• Be curious about and examine the meaning of symptoms that are suggestive of themes of vulnerability.  

Intervention #5: Listening for, Noticing & Using Ambivalence

Despite great efforts not to feel difficult emotions, some things are hard to avoid indefinitely.  The very nature of trauma and attachment related struggles is that they are bound to be triggered at some point.  In describing the process of deactivation (which we defined previously), Bowlby noted that the exclusion of significant information may be less than complete, and that there are times when “fragments of information defensively excluded seep through.”  Life changes, such as actual or perceived losses, medical illnesses, family crisis, and developmental shifts (becoming a parent, getting married, etc) can trigger such struggles.

When such triggers occur, the attachment avoidant individual may go back to relying on previous coping mechanisms such as minimization and denial.  However, the nature of trauma is that it is not so easily avoided.  The desire to discuss aspects of previous traumatic experiences and the reluctance to do so out of fear is the recipe for ambivalence.  Such naturally occurring ambivalence can serve as windows of opportunity in therapy.

A client will make reference to things that are triggered for them but may also note “I am over that.”  The therapist can ask about why, if this matter is irrelevant or dealt with, it was brought up.  The client may likely say they are unsure.  The therapist can catalog this for later.  Either the subject will be brought up again by the client at some point or another similar topic is brought up and the therapist can ask a question connecting the two events such as “Is this similar to how you felt when . . .?”

Therapist Feelings When Responding to Ambivalence: The others side of client ambivalence is the piece the therapist brings to the table, that is, the extent to which the clinician turns the attention toward trauma related material, and focuses on it, when it naturally arises in the treatment process.  The decision of whether or not to pursue is often a difficult one.  Such clients drop “fragments” (Bowlby) in places throughout their conversations with the therapist.  The therapist is trying to decide which of these references to focus on, encouraging greater clarification and embellishment.  In a sense, the therapist is left holding the ambivalence that the client cannot tolerate holding himself.  The “pull” is for the therapist to resolve this in the simplest and most comfortable manner by going along with what the individual is most obviously asking for.  When the client minimizes the magnitude of the trauma, there is pressure on the therapist to do so as well.  When the individual conveys dismissal of the therapist’s questions regarding trauma, the therapist may naturally accommodate and adjust her questioning.

Clients who are avoidant of attachment often respond to questioning about trauma-related feelings by rejecting them outright, minimizing therapist observations, or using defenses such as intellectualization to dampen the intensity of the therapist’s comments.  In response, the therapist may react to such rejection or minimization with a variety of normal emotions (frustration, irritation, hurt, disappointment) depending on the clinician’s personal history and attachment pattern.  The therapist may, over time, begin to collude with the client, avoiding talking about trauma related material or “watering it down.”

The therapist is challenged to make active attempts to turn attention toward trauma-related material, to listen for it, notice it, ask about it, and to facilitate rather than avoid such painful topics.  If not, the risk is that of replicated the rejecting response of the parent who reacts to the child’s abuse revelations by discounting or minimizing their importance or of replicating the weak and incapable parent who cannot tolerate her child telling her about what is really going on without squelching the information, failing to react, over-reacting, or falling apart emotionally.  A therapist must become comfortable with hearing the pain of the client, noting that even subtle reluctance and anxiety on the therapist’s part are often communicated to the individual, and that the client often withholds telling the full story out of fear the therapist might not be able to handle it.  We are to be able to “bear witness” of the client’s pain and must deal with any hesitation on our part.

Don’t:

• Collude with general reluctance to address traumatic experiences. 

Do:

• Listen for and notice moments of client ambivalence in relation to trauma & attachment experiences.
• Consider ambivalence to be a therapeutic opportunity. 
• Take the opportunity to ask the client to reflect on and make meaning of traumatic experiences.
• Notice times you get pulled into colluding with avoidance.
• Think to yourself about what those times might say about you.

Intervention #6: Asking Questions Around Themes of Caregiving & Protection

By definition, clients who are avoidance of attachment are reluctant to turn their attention toward memories, thoughts, and feelings that remind them of early relationships.  This makes it a challenge for them to engage in therapy because virtually all modalities of therapy invite the person to take part in the act of self-reflection on problematic relationships, and the analysis of situation, thoughts, and feelings marked by interpersonal conflict.  We must look at the relational map, and clients who avoid doing so are unlikely to find therapy helpful.

While these individuals are often avoidant of looking at their own caregivers (parents) they are often willing to engage in discussion regarding the protection of others, such as romantic partners, their children, or even future imagined children.  Now, it is important to note that avoidant attachment in individuals is a strong predictor of insecure attachment with children.  As such, their desired relationship with others may not be like their actual relationship with those they care about.  In therapy, the act of thinking about protecting others is one in which such clients are willing to engage and do so much more readily than the act of thinking about their own history of failed protection.

It is not uncommon for these clients to bring up caregiving in other contexts as well.  These may include workplace and friendship experiences in which they figure as the one others came to in times of need or the one who protected a colleague: the benevolent team leader, the one who stuck out his neck to protect a friend, or the one who gave money to the secretary whose child really needed it.    There may be a certain bravado and self-indulgence in this helping, needing to be a rescuer or savior.  The stories may not be that accurate.  But that is secondary in importance.  What is of use in treatment is the knowledge that such stories are in the client’s mind.  The individual who is powerfully engaged by his role as protector, through his actions and words, is trying to work something through, to somehow complete the protection that never came to pass in his own life, and in the process, he is attempting to undo the pain of his own history.  

An example of utilizing this would be a man who has strongly identified with one of his children.  The client frequently brings up the child and concerns about him.  The therapist notices these protection stories and invites reflection on the meaning of protection for the person’s life.  Most importantly, it is critical to help the individual make a connection between protection outward and experience inward.  Once reflecting on caregiving has been initiated and discourse on the act of protecting others has been opened, the client can start to make connections to his personal story.  There will be some softening to the idea of looking inward.  The therapist can then ask about the similarities or differences between the client’s experiences of protecting others and his experiences around being protected (or not) as a child.  It is important to note that the parallels between protecting others and the client’s personal history of failed protection are most useful when drawn in emotional terms.  For example, once the client above is able to speak about his child being “heartbroken” and how he desperately wished he could fix that for him, he might be able to admit more freely to times in his own childhood when he wanted, more than anything else, to make that heartbroken feeling go away forever.

Review: 

• Pay attention to themes of caregiving and protecting others in the client’s life.
• Invite the client to reflect on the meaning around particular acts of protecting others.
• Help the client look at similarities/differences between protecting others and personal experiences around being protected (or not) as a child.

Source: Muller, R. T. (2010). Trauma and the avoidant client: attachment-based strategies for healing. New York: W.W. Norton & Co.

Team Meeting Discussion Video

Topic: MCOTeam Meeting
Date : Feb 21, 2018 9:57 AM Mountain Time (US and Canada)

https://zoom.us/recording/play/Z72J8oIPgwuIOCCziclbQR-6nwfSGtIQaA0Y4DXgkJOi7o_Ukp-ysRP_I07ZaSla

The practice managment and dydactic portion of this team meeting was moved to 02-21-18.

The Case Consult Discussion can be found here:

Topic: MCOTeam Meeting
Date: Feb 14, 2018 10:04 AM Mountain Time (US and Canada)

Gallery View-1 (584 MB)
https://zoom.us/recording/play/MZMlaeqKgqRnD5k9aYeGXxuyZfo4KmenTxFeJXyo66TtOF6qm0RtyO7XDKSoSot5