Attachment Theory & Treatment: 4 Maxims for Therapeutic Change

Attachment-Oriented Therapists Live by Four Strategies for Working Through Attachment Theory and its Associated Disorders

Mary Sykes Wylie and Lynn Turner

Are there any downsides to basing clinical treatment on attachment theory? David Schnarch, a leading advocate of differentiation in the therapy process, believes that attachment theory keeps clients functioning as needy children.

While there are no formal protocols, standardized techniques, or formal methodology for "doing" attachment-based therapy (other than the adult attachment interview), over the years, some general maxims have emerged informally for bringing attachment issues deep into clinical work.

Four of these maxims of attachment theory or conditions for therapeutic change upon which most attachment-oriented therapists would probably agree are:

  1. Insecure, ambivalent, avoidant, or disorganized early attachment experiences are real events, which--according to attachment theory--can substantially and destructively shape a client's emotional and relational development. The client's adult problems don't originate in childhood-based fantasies.

  2. The attachment pattern learned in early childhood experiences will play out in psychotherapy.

  3. The right brain/limbic (unconscious, emotional, intuitive) interaction of the psychotherapist and client is more important than cognitive or behavioral suggestions from the therapist; the psychotherapist's emotionally-charged verbal and nonverbal, psychobiological attunement to the client and to his/her own internal triggers is critical to effective therapy.

  4. Reparative enactments of early attachment experiences, co-constructed by therapist and client, are fundamental to healing.

This isn't psychotherapy for the fainthearted. Any therapist working within attachment theory or working with those with the associated attachment disorders must stay present, not only to the client's emotions, but also to their own.

This may sound suspiciously like the familiar, old rubric, "be aware of transference and countertransference," but it actually calls for something tougher than merely intellectually performing that task.

With attachment theory and attachment-based therapy, the therapist is asked to stay in the right brain and fully experience the client's feelings, no matter what comes up for them or what raw emotion is triggered from their own history. In other words, the therapist isn't just an observer of the client's emotional journey or even a disinterested guide, but a fellow traveler, resonating with the client's sadness, anger, and anxiety.

Rather than recoiling from the intensity of the client's experience, the therapist is providing the stability (the ballast, so to speak) to keep the client feeling not only understood, but safely held and supported, through tone of voice, eye contact, expression, posture, as well as words.

Obviously this kind of demanding work, more than some other modalities, requires therapists to have their own inner act together. "We are the tools of our trade, the primary creative instrument with which we do the work," says California clinical psychologist David Wallin, author of Attachment in Psychotherapy. Our ability to use ourselves effectively in this intense work is therefore inhibited by our own core emotional vulnerabilities.

As Wallin has written, "If in childhood a certain quality of expression such as anger cannot be felt or experienced, then we cannot relate to this expression in a patient."

Therapists need "binocular vision," says Wallin, to keep "one eye on the patient, and one eye on ourselves." In fact, the therapist may need something like "triocular" vision as he tries to be in the client's mind, in his own mind, and in between the two minds, establishing and maintaining between himself and the client mutually resonant affective, cognitive, and physical states of being.

Topic: Attachment Theory | Anxiety/Depression

Tags: Adult attachment interview | attachment disorder | attachment disorders | attachment issues | attachment-based therapy | clinical psychologist | Countertransference | psychologist | psychotherapist | psychotherapy | right brain | therapist | therapists | Transference | transference and countertransference

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8 Comments

Friday, December 27, 2013 3:17:20 PM | posted by Miriam Bellamy
One of the most poignant things Murray Bowen suggested was that the only difference between the human animal and all others is the human potential to be able to step back and see the larger patterns of one's own family and one's own behavior. He noted the inability to step back is the cause of all mental illness. The kind of therapy described in this article encourages both therapist and client to remain entrapped by the emotions and needs of the individual and of the system, thereby prohibiting the development of the ability to step back and see and separate and grow. I agree with David Schnarch - this kind of therapy keeps clients (and us) functioning as needy children.

Friday, December 27, 2013 6:45:23 PM | posted by John Burik
It is unfortunate that attachment is one of those words that mean very different things in different contexts. A frequent popular meaning, also held by professionals unfamiliar with Bowlby's work or theory, is mistaken for enmeshed or entangled as in the phrase "attached at the hip." Securely attached individuals let go and explore much more often than they hold onto their attachment figure, whether it's mother or a lover, because they're secure support is there when and if needed. It's the polar opposite of what Schnarch contends.

Saturday, December 28, 2013 1:36:45 PM | posted by Colleague Last Name
Good Morning, John. I'm not sure if you were responding to my comment, but I'd like to respond under the premise that you were. My comment was largely about methodology, application, and results - not definitions. My comment, Bowen's work, (and Schnarch's for that matter) all fall in line with how you are defining secure attachment - free and able to both connect and separate. That is what "differentiation" means. My comment was about methodology in that we don't differentiate by focusing on emotion and need. We differentiate or have a "secure attachment" when we can step back from all that and reflect thoughtfully and bravely on the larger patterns and our parts in them. We don't do that when we feel safe. Neither I nor my clients act that way. It is only when we are pushed up to and beyond our limitations that we can break out of our needs and emotions and face hard truths. Not to mention, that the severely manipulative clients use the feelings and needs stuff against their spouses and us on such a micro level that therapists who don't focus on the larger patterns never know what hits them. And then they deem these manipulative types "untreatable." Many of them are - but not with the methodology described above.

Saturday, December 28, 2013 1:43:46 PM | posted by Colleague Last Name
Just to clarify - "colleague last name" is Miriam Bellamy. I forgot to login!

Wednesday, January 1, 2014 8:14:15 PM | posted by Sandra Johnson
One great option is to check out the Sensorimotor Psychotherapy Institute of Pat Ogden's. They offer incredibly comprehensive trainings that address the very issues raised in this article. Training Level 1 deals with healing trauma. Level 2 is all about healing Attachment wounding/ trauma. I've been practicing for over 30 years, but the attachment education from this program has been a game changer for me. It is fascinating how we all wear our attachment issues/wounds within our bodies, not just within our beliefs, relationships, and affective states etc.. (Disclaimer: Beyond being a recent alumnus of these trainings, I am not in any way associated with the Institute)

Thursday, January 2, 2014 3:31:43 AM | posted by Guy Diamond
A Family Systems Approach to Attachment
Wylie and Turner suggest four principles of attachment therapy. But these principles are limited to an individual therapy context. We recommend that attachment theory can guild a family systems therapy approach where reworking the real relationships might have more potency.

Attachment theory has increasingly become attractive as a theoretical frame work to explain and guild clinical intervention (see Fosh; Siegel; Wallen; Johnson; Hughs; Morettit, Powell et al). The basic assumption that makes this theory attractive is the conceptualization of the interaction between actual interpersonal relationships (initially parent and children) and the intrapsychic models or schemas of self and other. In particularly infants and young children seek comfort and protection from parents when they feel threatened. If parents are sensitive and available, children learn to down regulate their fear or anxiety and feel once again safe and secure. Over time, they gain confidence that the “other” will be available and that they themselves are worthy of being cared for (Bowlby). Confidence in the expectation that parents will be available helps children internalize these self-soothing, emotion regulation strategies (Kobak; Sheber).
For Bowlby and Main, the interaction between real relationship and schemas about self and other continues throughout the life cycle. Negative events (e.g., trauma) can move an adult from a secure view of the world to an insecure view. In addition, even those with negative family environment in childhood can earn security by “working though” this relational disappointments (Main). Thus, attachment theory not only helps us understand normative and deviant development, but also can inform the change process in psychotherapy.

Attachment based family therapy (ABFT; Diamond, Diamond & Levy, 2014) grows out of this emerging tradition of attachment informed therapies. However, unlike individual focused attachment informed therapy models where the therapists serves as the “good parent,” ABFT (and the other child focused attachment therapies like Hughs, Morretti) aim to revitalize parental care giving instincts and teach more emotion focused, attachment promoting parenting practices. This helps resuscitate the normative attachment context of development. In ABFT, we then use this more secure environment to help adolescents talk about the attachment ruptures that have damaged trust in the parent child relationship. These conversations service to resolve past events or conflicts (abandonment, abuse, neglect) and or ongoing negative family processes (e.g., parental over control, harsh criticism, unavailability). These conversations also improve reflective functioning where the adolescent becomes free to explore more complex feelings, thoughts and memories, and the parents is better able to empathize with and understand the adolescents point. Finally, these conversations serve as a corrective attachment experience, where adolescents express vulnerable, primary feelings and thoughts and parents provide comfort, support, validation, and protection. As adolescents’ expectations of the parents’ availability increases (e.g., “Maybe I can go to my mother for help”) parents increasingly serve as a safe haven where adolescent can seek support and comfort. This also strengthens the secure base that supports adolescent’s emerging exploration of autonomy and competency. As safety and trust emerge so does the capacity to have more emotionally regulated conversations about day to day tasks. Thus a “goal-corrected partnership” becomes reestablished where parents and adolescent can effectively negotiate autonomy while maintaining a mutually gratifying and supportive relationship.

In a project lead by Gary Diamond in Israel, we are using this same model of attachment therapy with adults. For adults in individual therapy, we invite the parents into the treatment process for a short, focused course of family therapy. Parents are prepared to be responsive and open to their (adult) child’s, usually long standing unresolved thoughts, feelings and memories. In this way, attachment is renegotiated, not in the transference relationship, but in the real relationship between child and parents, regardless of age.

Thursday, December 26, 2013 9:59:14 PM | posted by pegs
I think this type of therapy sounds very dangerous. There are so many things that could separate the client from the attuned therapist before the work is finished. It seems like that could lead to the client being wounded in a way that is akin to losing a parent as a child. Is it ethical to risk that?

Friday, August 11, 2017 7:46:20 PM | posted by Anne hedelius
Thursday, December 26, 2013 9:59:14 PM | posted by pegs "I think this type of therapy sounds very dangerous. There are so many things that could separate the client from the attuned therapist before the work is finished. It seems like that could lead to the client being wounded in a way that is akin to losing a parent as a child. Is it ethical to risk that?" No, I personally experienced this with a therapist and it was deeply wounding. She abandoned the work when she became overwhelmed by the emotions that were brought up.