Wednesday, 1 February 2017

Attachment - the impact on therapy and the client- therapist relationship.


On Saturday I went to a workshop with Carolyn Spring of the PODS group -  Positive Outcomes for Dissociative Survivors

The workshop was on 'working with Relational Trauma' which included some really useful insights into working with people who have had poor attachment experiences in their childhood. Attuned response from the mother (or other caregiver) changes the baby's brain because it interrupts the flow of stress hormones and helps the baby produce oxytocin and serotonin (the feel-good hormones). What do we mean by attuned? Well the mother understands her baby's needs and responds appropriately. This will usually happen within the first 6 - 9 months and set the pattern for the rest of that baby's life. When it is absent or sporadic, the baby's brain is changed; having less receptors for the feel-good hormones and less connections between the developing front brain (cortex) and the survival brain (brainstem, cerebellum and limbic system). The baby becomes an adult who can have disordered behaviour stemming from inaccurate beliefs about themselves.

I've blogged already about the differences between organised and disorganised attachment strategies (see here) but what was interesting about this particular workshop was the impact it has on therapy and the relationship with the therapist.
we are talking about relational trauma after all- these people were not born this way but learnt how to survive in families in which the primary relationships were not secure. the main feeling in these situations is lack of safety and it is therefore something that the therapist must ensure is present in all dealings with the client.
But more than this there are pitfalls that I know I have fallen into before that occur because the 3 main strategies that I see (insecure-avoidant AV who become 'Dismissing' in adult life), insecure-ambivalent (AM become preoccupied) and disorganised (DIS become unresolved) have very particular failings that will carry through in the beliefs of that person into adulthood. And they have interactions with our attachment styles too

Now, it is a well-known fact that most therapist and clients are NOT the secure style so I will leave that condition out of my matrix.
Peer Relationships
AV and AM tend to be attracted to one another but have difficult communication; AV will close down when under threat emotionally while AM will tend to want to 'have it out then and there' and will chase the AV which closes them down further. AM then feels AV is ignoring them or blocking them out and a destructive cycle ensues.
Therapeutic relationship
As AV clients will tend to intellectualise (they are more thinking than feeling) the style of therapy should emphasise their thoughts more in language and not collude in ignoring their feelings by mirroring emotional control. Boundaries need to be kept soft and one needs to metaphorically and in some cases physically STEP FORWARD in the therapy. Get enthusiastic about their successful negotiation of getting their needs met to help build reliance on others. Allow some self-disclosure that builds trust and shows how emotions can be survived when dealt with well.
.AM clients tend to be all feeling; they will rush to tell you everything straight away with  much feeling of overwhelm. We need to praise their successes as this builds resilience.
Both styles were adaptive at the time of their inception but have become maladaptive in adult life. The therapist acts to build secure attachment over time with consistency and support.

Everyone needs to know that they are not at the mercy of their history - there is hope for recovery. This is my life's work and I am very proud to say I have helped many people achieve release and mastery of their lives.

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