DIDACTIC – Attachment 101
CEU TRAINING: Attachment 101
DATE: 02-16-2022
TIME: 11:00-1:00 CST
OUTSIDE STUDY: 1 hour
DIDACTIC PRESENTATION: 2 hours
EDUCATOR: Melissa Abello
SOURCES: Cradle to Grave, Attachment and the Transformation Process, AEDP Interventions
Introduction:
Attachment theory does what we have never been able to do. It gives clinicians a secure base to stand on. To look at the complex dramas that individuals, couples, and families are in and then to be able to systematically change the elements! We could go on forever addressing symptoms in a distressed person, couple, and family. It allows us to see what’s going on and to create profound and lasting change (Cradle to Grave).
What is Attachment?
A newborn infant clings to her caregiver. A baby gazes wide-eyed in his mother’s eyes as he nurses. A toddler cries out for solace when overcome with distress, and finds comfort and reassurance in a soothing voice and warm embrace. It is well known by now that our brains are wired from birth to connect, not only at the microscopic level of synapses and dendrites, but also at the macroscopic level of primary relationships (Solomon and Siegel, 2003).
Early attachment relationships shape an infant’s neurobiology and set the course for his or her future biopsychosocial self (Schore, 1994, 2009). Mediated by the greater social environment, this bi-directional, dyadic process directly influences the final wiring of our brains and organizes (or disorganizes) our future social and emotional coping capacities.
“The attachment relationship…directly shapes the maturation of the infant’s right brain, which comes to perform adaptive functions in both the assessment of visual and auditory socio-emotional communication signals and the human stress response…The ultimate product of this social-emotional development is a particular system in the prefrontal areas of the right brain that is capable of regulating emotions…including positive emotions such as joy and interest as well as negative emotions such as fear and aggression” (Schore, 1996, p. 63). Because subcortical systems of the infant brain are dominant for the first three years of life, and because the neurobiology of emotional experiencing “resides” in the right brain, infant attachment, seen through the lens of neurobiology, occurs primarily through what have come to be known as right-brain-to-right-brain interactions (Schore, 1996, 2001, 2009; Trevarthen, 2001). Put simply, early history is recorded experientially, not linguistically, through face-to-face, body-to-body processes of affective communication between infant and caregiver.
Predictable physical and/or emotional connection with an attachment figure often a parent, sibling, longtime friend, mate, or spiritual figure clams the nervous system and shapes a physical and mental sense of a safe haven where comfort and reassurance can be reliably obtained and emotional balance can be restored or enhanced. The responsiveness of others, especially when we are young, tunes the nervous system to be less sensitive to threat and creates expectations of a relatively safe and manageable world.
The emotional balance promotes the development of a grounded, positive, and integrated sense of self and ability to organize inner experience into a coherent whole. This grounded sense of self also facilitates the congruent expression of needs to attachment figures; such expressions are likely to result in more successful bids for connection, which then continue to build positive models of close others and accessible sources of support.
A felt sense of being able to depend on a loved one creates a secure base–a platform from which to move out into the world, take risks, and explore and develop a sense of competence and autonomy. This effective dependency is a source of strength and resilience, while the denial of attachment needs and pseudo self sufficiency are liabilities. Being able to reach out to and depend on reliable others are internalize a felt sense of secure connection with others is the ultimate resource that allows our species to survive and thrive in an uncertain world.
The key factors that define the quality and security of an attachment bond are the perceived accessibility, responsiveness, and emotional engagement of attachment figures. These factors can be translated as the acronym A.R.E. (are they there for me?)
Those who are securely attached as comfortable with closeness and their need for others. Their primary attachment strategy is then to acknowledge their attachment needs and congruently reach out in a bid for attachment figure to make or maintain contact. When this figure responds, this response is then trusted and taken in, calming the nervous system of the one who reached out. By providing one with such an effective strategy, attachment security appears to buffer stress and potentiate positive coping throughout life (Cradle to Grave).
Neurobiology of Attachment:
Beginning at birth, right-brain-to-right-brain, contingent processes such as holding, touch, gaze sharing, face to face contact, entrained vocal rhythms, and spontaneous moments of play and delight are crucial for (i) the regulation of the autonomic nervous system, (ii) optimal brain development, (iii) the emergence of stress- and affect-regulation, and (iv) the creation of secure attachment (Lyons-Ruth, 2006; Porges, 2009; Schore, 1996). Our earliest perceptions of both safety and danger are pre-linguistic and somatosensory: we carry these non-verbal markers of self-states with us throughout our lives. Additionally, because the hippocampus, a region of the brain responsible for organizing our memories in an “autobiography” of time and space, is not fully functioning until 1.5 to 3 years of age (Nelson, Thomas & De Haan, 2006), early organization of emotional experience remains quite literally a felt experience that emerges untethered by chronology or geography.
Just as the feeling and experience of secure attachment discussed earlier is rooted in the pre-linguistic, somato-sensory-motor structures of the right brain, so too is the feeling and experience of danger (van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005), as well as the feeling and experience of rejection, abandonment, and neglect (Schore, 2009). Recalling that the hippocampus is not fully available for processing memories until a child is 18 to 36 months of age (Nelson, Thomas & De Haan, 2006), early attachment trauma can be understood as the result of a caregiver’s failure to regulate body-based stimuli, and the feeling of danger and chronic stress that results. The child’s perceived danger in these situations is right-brain mediated and, at this point in her development, implicitly, not explicitly, remembered (Ogden, 2009; Schore, 2009). As van der Kolk (1996) now famously states, “the body keeps the score.” It is this recognition of the salient role of somato-sensory-motor, right-brain mediated processes in chronic, early relational trauma that provides us with a neurobiological context for making sense of PTSD symptoms, i.e., flashbacks, body sensations, startle responses, behavioral impulses, shame; and a fortiori, of the symptoms of complex PTSD, i.e., somatic and emotional dysregulation, hyper- and/ or hypoarousal, profound mistrust, shame, dissociation, etc. (Fosha, Paivio, Gleiser & Ford, 2009; Gleiser, Ford & Fosha, 2008). In the absence of external assistance with affect regulation, or when the caregiver is the source of stress and danger, overwhelming emotional events suppress hippocampal activity and may cause permanent shrinking to this part of the brain; they also leave the amygdala, the part of the brain with the primary role of appraising danger and threat, on high alert in a chronic state of activation (Schore, 2003).
Overwhelming threat may also lead to the simultaneous activation of the SNS and PNS resulting in the dissociative freeze response (Levine, 1997; Ogden, Pain, & Minton, 2006; Porges, 2009). States of greatest threat may lead to the activation of the dorsal vagal branch of the parasympathetic nervous system (PNS) and accompanying symptoms of hypoarousal, such as muscle weakness, depression, chronic fatigue and gastro-intestinal symptoms, as well as the potentially life-threatening analgesic effects of tonic immobility in the face of mortal danger (Porges, 2009).
Later, the threshold lowered, traumatic events may then be more easily recorded in sub-cortical, implicit memory either because the amygdala does not succumb to stress hormones and/or because the hippocampus is under-developed due to earlier, chronic trauma. Trauma also compromises the flow of information between the hemispheres: it activates the right brain, it deactivates the left brain (Lanius, Williamson, Densmore et al., 2001; Rausch, van der Kolk, Fisler et al., 1996); and it compromises the corpus callosum (Teicher, 2002).
Traumatic experience and contingent communication are like oil and water: They don’t mix: “Exposed to traumatic reminders, subjects had cerebral blood flow increases in the right medial orbitofrontal cortex, insula, amygdala, and anterior temporal pole, and a relative de-activation in the left anterior prefrontal cortex, specifically in Broca’s area, the expressive speech center in the brain, the area necessary to communicate what one is thinking and feeling. {these studies demonstrated that] when people are reminded of their traumas, they activate brain regions that support intense emotions, while sharply decreasing the capacity to inhibit emotional expression and to translate experience into communicable language” (van der Kolk, 2006, p. 2).
Putting it all together: chronic misattunement between caregiver and child leads to non-optimal levels of stress and eventually to insecure or disorganized attachment; disorganized or insecure attachment both causes, and predisposes the individual to, trauma (i.e., being alone with and overwhelmed by unbearable, unregulated affective experiences); stress and trauma damage both cortical and subcortical structures of the brain, further reinforcing a cycle of persistent and pernicious stress in the absence of affect regulatory strategies, which interferes with optimal attachment (Lyons Ruth, 2006), and regulated, contingent emotional expression and communication. Put simply, early relational trauma carves its way deeply into the body, brain, and nervous system. At the microscopic level, this may look like a shrunken hippocampus, or an overactive right amygdala, or chronically high levels of cortisol wreaking havoc on one’s physiology (Schore, 2009). At the macroscopic level, we are likely to see the familiar symptoms of affect dysregulation that present extreme challenges to developing safe, adaptive and satisfying relationships both intra-psychically and interpersonally (van der Kolk, et al., 2005).
Secondary Models and Attachment Strategies:
If others have been perceived as inaccessible or unresponsive or even threatening, when needed, then secondary models and strategies are adopted. These secondary insecure models can take the form of vigilant, hyperactivated, anxious ways of engaging with others and regulating attachment emotions or of avoidant dismissing, and deactivated strategies. The first of these secondary models
- Anxious attachment is characterized by sensitivity to any negative messages coming from significant others and by fight responses designed to protest distance and get an attachment figure to pay more attention and offer more reassuring support.
- Deactivated avoidant responses are flight responses designed to minimize frustration and distress through distancing oneself from loved ones who are seen as hostile, dangerous, or uncaring. Attachment needs are minimized, and compulsive self reliance becomes the order of the day. Vulnerability in the self or perceived vulnerability in others then triggers distancing behaviors.
- Disorganized attachment: This secondary model arises when a person has been traumatized by an attachment figure. He or she is then in a paradoxical situation in which loved ones are both the source of the solution to fear. Under these circumstances, this person often vacillates between longing and fear, demanding connection and then distancing, and even attacking when connection is offered. This type of response is called disorganized attachment in children but it is termed fearful avoidant attachment in adults and is associated with especially high distress in adult relationships
All people use fight or flight strategies at times in relationships; they are not dysfunctional per se. They can become generalized and habitual, rigidifying into a style that ends up constraining a person’s awareness and choices and limiting his or her ability to engage constructively with others (Cradle to Grave).
Building Attachment
Therapeutic Stance:
- The primary agent of this change is a patient’s emergent capacity for deep, somatically based connection to her emotional experience in the context of a safe, secure relationship with a therapist who embodies the characteristics of a loving, attuned and self-possessed other (Fosha, 2000).
- From the get-go, attachment therapists strive to actively and explicitly foster secure attachment by offering a new experience of emotional safety. The stance is intentionally positive. The positive tone of the relational experience is crucial. Positive vitalizing experiences and positive dyadic interactions are the stuff of secure attachment, the stuff of resilience, and the stuff of growth and expanding health and mental health (Fosha, 2009; Fredrickson, 2001; Lyons Ruth, 2006; Russell & Fosha, 2008; Schore, 2001).
- The therapeutic stance is welcoming, encouraging, affirming, and emotionally engaged. It is focused not only on the patient’s intrapsychic experience, but also on the “we-ness” of the therapeutic process (Fosha, 2000, 2001; Prenn, 2009).
- Recognizing relational trauma as a result of unbearable aloneness in the face of overwhelming emotions (Fosha, 2003), aloneness that stems from failures of earlier attachment relationships to sufficiently regulate affective experiences, an AEDP therapist explicitly conveys– through his self-possessed warmth, emotional availability, and desire to know and embrace the full range of a patient’s emotional experiences– that, this time around, things will be different (Fosha, 2000, 2003, 2009).
- To begin with, we want the patient to experience that we welcome all his or her feelings, including those which his or her relational history required her to disavow, defend against, or cordon off from experience and expression.
- It requires specific clinical actions. Informed by what decades of developmentalists and attachment researchers have shown to directly facilitate secure attachment between mothers and their babies (Ainsworth et al., 1978; Beebe & Lachmann, 2002; Fonagy, 1999; Stern, 1985; Trevarthen, 2001; Tronick 1998),
- The therapist, like the security-engendering caregiver, is proactively engaged, affirming, and available to actively help his patient regulate difficult emotions and organize confusing experiences (Fosha, 2000, 2001).
Therapeutic Technique In First Session:
- Our First session is SACRED with our clients. Only encounter that we will ever have that has no history. We are creating history and we come to it with no history of each other
- One way of understanding this finding is that the task element translates into a felt sense that the therapist is tuned in to and aligned with the client in a way that is relevant to the client’s concerns and goals.
- Below is what we are asking, but during that attachment is what we are doing!
- First Session:
- What brought you to counseling today?
- Supporting and Deepening the Client’s Exploration of the Presenting Issue (immediately “undoing aloneness”)
- Validation of their experience
- Assisting by giving new and deeper wording
- Summarize and reflect giving the deeper wording.
- Begin to emotionally attune (ie: stepping into feeling with the client not watching them feel)
- What are you goals for our times together?
- Repeat Goals and validate
- Identify desire for healing as a transformational glimmer and intensify it.
- Provide any treatment direction based on presenting issue
- Consider as you sat with the client if any of the following were more prominent/present and review protocol following session and process with supervisor how to apply protocol for your particular client.
- Meta-Process: What has the been like to do this with me today?know you have accomplished what you desire to in counseling?
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- Other Tips:
- Qualities such as flexibility, persuasiveness, affect modulation and expressiveness, warmth and acceptance, and the ability to communicate hope have also been found to impact the alliance and treatment outcome.
- Establish a way of being with each other
- Utilize self-disclosure
- Make implicit explicit
- Notice with them what it is like to have their first session with you
- Explicit experiential
- Encourage them to notice what it is like emotionally to sit with you (using the body)
- Dyadic affect regulation – you cannot do affect with a still face. People need to see us being engaged, openly empathic, delighting in them, loving them, confronting them, sharing our feelings. Fundamental to a stance of engagement and presence that will create that attachment. It is that which develops as a result of individual being alone in face of overwhelming emotion. Fundamentally has to do with aloneness. Undoing aloneness. From beginning we want to be with: not just as witnesses, supporters, or empaths. Existing in the heart and mind of the other. Our clients need to know and feel and are capable of reflecting on fact that they exist in our hearts that will contribute to attachment security.
Using Attachment for ASSESSMENT
- During and following the session – Notice their attachment style:
- We make sense of the world through attachment and how they respond to you tells you a lot about them. It allows us to know if they are able to access what is necessary to heal. This lets us know what we may need to help with, so they can get to a place of healing. If they cannot attach with us then they cannot heal because healing does not happen alone. How someone responds to us can indicate whether or not there is trauma present in their background and the potential need in the future for us to be able to help them with that as well. Some basic questions in helping us to assess this are:
- When you moved toward the client, how did they respond?
- Did they welcome this?
- Did they move away?
- Did they freeze?
During and following session – assess if client matches their affect with their words
Understanding how these things match indicates to us where they are at in their healing process.
- How integrated did the client seem when addressing what brought them into counseling.
- Did what they were saying one moment match what they are saying later?
- Did facial and body expression match content?
- Did the client seem over or under regulated?
Attachment History in Second Session:
Attachment History Questions: This form will gather information about your early attachment relationships and experiences and beliefs around emotion, comfort, and soothing [and sex, if applicable]. We do not send this to the client, but use it as we go through our second session with them. If working with a couple we do with both present in the session. In the second session, we notice based on their attachment histories how the wounds of their childhood occurred and how they developed their strategies for coping!
As the client shares their experiences it helps us to ask them what they did with that pain – this informs us of the attachment style they lean towards and allows us to understand what their defenses might look like and how we can honor and bypass them.
Working with Anxious Attachment Style: (Natural Pursuers)
How this may show up: In the face of conflict the anxious attachment style often initiates communication and moves toward their partner or therapist. They are more likely to:
- Talk more, especially about emotions, and seek a response
- Initiate confrontation out of anxiety
- Take control, manage self and others
- Worry about being “too much”
- Initiate and reach out for couples therapy
Their goal is to get closer. They makes continuous efforts to check in and connect, seeking care and reassurance from their partner. When there’s an issue, they most often seeks to work things out together, to communicate. They would rather fight than suffer through silence. They can feel like they’re putting in more work than their partner to maintain the relationship; however, this can lead to resentment or burnout if they perceive their partner to be consistently absent.
Common Anxiously Attached Phrases:
- “I feel like I don’t matter”
- “I can’t get through to them”
- “I can’t rely on them”
Often their fear is rejection. They take risks to share their feelings and needs, explore others experiences, and address problems, so it is so painful for them to receive little or no response from others. These tendencies are born out of a history of abandonment, of one’s feelings not being heard, one’s needs not being met. Anxiety thrives in distance and in attempts to reach out to their partner their anxiety and fear can be expressed as control, criticism or anger. There is more hope in anger and fighting than there is in silence. While their actions can feel like overwhelming pressure for their partner, their intention is to reestablish safety and closeness.
When needs are being met — when they feel heard, connected, seen — their anxiety dissipates. They experience calm, warmth, and hope. They are energized to care for their others and relax.
Working with Avoidant Attachment Style (Withdrawers):
How they might show up:
- Placate or avoid confrontation
- Struggle to find language for their emotions
- Say “I don’t want to talk about it”
- Leave the room out of overwhelm or anxiety
- Shut down, numb out
Their goal is to have less fighting. Since a fight can feel so overwhelming, filled with anger and pressure, they would rather have space to cool down and self-soothe. They tries to work things out on their own and may need more time to organize their thoughts or figure out how they feel in the first place. Withdrawers tend to compartmentalize their feelings to maintain the status quo, which may look like using positivity (e.g., “let’s just have a good night”) to avoid difficult conversations.
Common Avoidant Attachment Phrases:
- “I can’t do anything right”
- “You’re overreacting”
- “I wait for the fight to blow over”
- “I don’t know”
- “There’s no point”
Their greatest fear is failure. Withdrawing tendencies are most often born out of a history of failed emotional interactions. Someone’s pattern of avoidance can be a protective shield, an indication that they’ve been hurt before. Withdrawing serves as a skill of survival keeping one safe from overwhelming or threatening external forces. They may hear you or other attempts to communicate as complaints or criticism that they’ve done something wrong. Rather than engaging in confrontation, they often seek to alleviate pressure through positivity, humor, or deflection. While this may be frustrating for you as a therapist their goal is to protect themselves and your relationship.
Disorganized Attachment Style:
How They Will Show Up:
- Contradicting messages from behavior in intimate relationships (“I hate you, but don’t leave me.”)
- An inability to regulate emotions or how to respond to the emotions of others
- Alternating between clinginess and distancing
- Difficulty bonding with, opening up to, and trusting other people
- A blend of the behaviors of anxious and avoidant attachment styles
Common Phrases:
- I will never be good enough for someone
- I am not worthy of being loved.
- No one will ever truly love me.
- I deserve to be alone and lonely.
Adults with a disorganized attachment style fear intimacy and avoid proximity, similar to individuals with an avoidant attachment style. The main difference for disorganized adults is that they want relationships.They have trouble believing that their partner will love and support them as they are. These adults expect and are waiting for the rejection, disappointment, and hurt to come. In their perception, it is inevitable.This mindset can turn into a form of self-sabotage, causing the disorganized adult to end a relationship prematurely. It might also be a type of self-fulfilling prophecy. So, the disorganized adult expects and predicts that they will be rejected by their partner. Even when there are no such signs, he or she starts behaving in a way that leads to fulfilling the expectations (the end of the relationship). It is also a self-fulfilling prophecy when an individual with a disorganized attachment style chooses partners that induce fear. Thus confirming their perception that they can’t trust other people (emotionally or physically), no matter what.
Download the Didactic Attachment 101 Slides Here
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Interventions To Working With Attachment Styles: (We Will Process in Meeting)
Kristi Pitts 
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