HEALING THE BROKEN BOND

HEALING THE BROKEN BOND

Using Attachment Centred Therapy as a means to assess and intervene with

addictive disorders and other dysfunctional behaviours

Presented by:

Charley Shults, Psychotherapist12 Harley Street

London+44 1483 539 759+44 75075 62864

[email protected]

mailto:[email protected]

http://www.charleyshults.co.uk/

A Basic Idea

If the AAI (Adult Attachment Interview) can be used as an accurate instrument for assessing attachment and the information processing

inherent,then it can be used also as an instrument for

correctingattachment difficulties and information

processing errors

Attachment: a new paradigm

• Has more explanatory power• Effects global changes in affect and behaviour• Gets everyone “off the hook”• Corrects the errors of information

programming that create the problems• Empowers the client for lasting and ongoing

change and improvement and development• Empowers “catch-up” development

Research Discrepancies

• Attachment styles are not transferred by the mother to the child in an unbroken pattern

• Attachment styles are relatively stable across the lifespan within the secure and insecure divisions

• Attachment styles within the insecure patterns can swing from A to B depending on life changes

The George, Kaplan and Main Interview (AAI)

• Based on Carol George’s dissertation• Modified by Crittenden• Can modified to meet your needs• An idea for modification: describe your

relationship with your spouse; 5 words or phrases

Methods of Classification

• Main and Goldwyn created the first– A, B, C, D, U

• Dynamic Maturational Model (Crittenden)– A, B, C, A/C, AC, plus additional subclassifications

• In M&G danger disorganizes• In DMM danger organizes• DMM is a strengths model• M&G intergenerational transmission of attachment• DMM complex parent/child patterning

Methods of Classification (cont.)

• M&G has disorganized, unresolved, cannot classify classifications

• DMM uses multiple classifications• DMM expands Ainsworth’s ABC model from

the Strange Situation and allows it to develop across the lifespan

• M&G assumes continuity across the lifespan

Copyright P. Crittenden, 2006

A Dynamic- Maturational Model of Patterns of Attachment in Adulthood

Compulsively Caregiving/Compliant

Delusional Idealization/

ExternallyAssembled

Self

Compulsively Promiscuous/Self-Reliant

Socially Facile/Inhibited

ComfortableB3

ReservedB1-2 B4-5

Reactive

A1-2

A3-4

A7-8

A5-6

C7-8

C5-6

C3-4

C1-2Threatening/

Disarming

Aggressive/Feigned Helpless

Punitive/Seductive

Menacing/ParanoidAC

Psychopathy

A/ C

True Cognition True Negative Aff ect

False Positive Aff ect False Cognition

I ntegrated True I nformation

I ntegrated False I nformationOmitt

ed aff

ect &

dist

orte

d co

gniti

on Omitted cognition & distorted affect

Patricia Crittenden

• Family Relations Institute, Miami, FL• http://www.patcrittenden.com/• John Bowlby• Mary Ainsworth• Patricia Crittenden

http://www.patcrittenden.com/

http://www.patcrittenden.com/

Classification Categories

• A: Avoidant; Dismissing; • B: Balanced; Secure; Free Autonomous• C: Coercive; Preoccupied; Ambivalent; Anxious• A/C: Fearful; Disorganized• AC: Psychopathy

Porges’ Polyvagal Theory

• Highest level: social interaction - in the absence of danger

• Middle level: fight or flight - in the presence of danger

• Lowest level: freeze/submit – in the fear of death

Porges’ Polyvagal Theory

• Social Interaction – does this correspond to secure, B attachment?

• Fight or Flight – does this correspond to preoccupied, C attachment?

• Freeze/Submit – does this correspond to avoidant, A attachment?

WordsWords are more than mere

concepts, they are the tools that we use to grasp and grapple with reality.

Split Brain Research

Time after time, the left hemisphere made up explanations as if it knew why the response was performed [by the right hemisphere]. For example, if we instructed the right hemisphere to wave, the patient would wave. When we asked him why he was waving, he said he thought he saw someone he knew.

Split Brain Research

When we instructed the right hemisphere to laugh, he told us that we were funny guys. The spoken explanations were based on the response produced rather than knowledge of why the responses were produced. ...the patient was attributing explanations to situations as if he had introspective insight into the cause of the behaviour when in fact he did not. (LeDoux, The Emotional Brain)

Differences from Bowlby

• The attachment system is “always on”• There are three levels of attachment needs• These levels or needs are cumulative• Thus if one level of need is not satisfied, it is

carried forward as a deficit to the next level, and so on

• When attachment needs are met, those are carried forward as strengths to the next level

Always On

• Bowlby uses the analogy of a radar system guiding a missile to it’s target

• But radar is useless if it is not on before the threat approaches

• More like driving a car: accelerator, brakes, steering

• Becomes active when needed, inactive when not needed, but it is always on

3 Attachment Needs

• Survival– Have sustenance needs met– Avoid predators– Avoid environmental dangers

• Freedom– Explore the environment– Learn the skills necessary to enable continued survival

• Reproduction– Find a partner– Produce offspring

Attachment Needs

• Ensure survival of offspring– Provide sustenance– Protect from predators

• Freedom– Allow exploration while protecting– Teach about the environment

• Reproduction– Nurture offspring’s offspring

In an infant’s world

• Wolves in the closet• Monsters under the bed• “Not only will I not save you from the wolves, if

you keep on like that, I’m going to throw you to the wolves” (the best strategy here is to not protest, lie low)

• “Oh all right! I’ll come there now just because I’m tired of hearing you howl!” (the best strategy here is to escalate until your protector comes)

Attachment complications

• Layering • Switching• Regression• Dispositional representations (DRs)

Case example: couple A

• She is anxious in the relationship• He is avoidant in the relationship• Vacation

– For him: he has ‘filled the tank’– For her: she can get all she wants whenever she

wants• He is anxious with caregivers• She is avoidant with caregivers

Case example: Couple A (cont.)

‘Oh yes, he is with me the way I am with my mom,

and I can’t stand it when he is that way with me.’

Grice’s Cooperative

Principle

Grice’s Maxims

• Relevance – does the information being presented relate to the subject being discussed?

• Quality – is there evidence to support the information and conclusions being presented?

• Quantity – is there enough information without being too much: The Goldilocks Principle?

• Manner – is the information being presented in a manner that is coherent and makes sense?

ERRORS OF INFORMATION PROCESSING LEAD TO THE

CONTINUANCE OF INSECURE ATTACHMENT PATTERNS

Discourse Markers

Discourse Markers

• Used to identify the pattern of attachment• Multiple markers• No single marker or set of markers can be

used• All must be considered• By correcting the errors, a coherent narrative

can be achieved

‘A’ pattern information errors

• distort information by deleting negative emotions and information

• Maintain when possible a false positive affect• As the numbers get higher (more pathological)

cognition begins to be more distorted• Violates relevance by leaving out important

information• Violates quantity by not giving enough

information

‘C’ pattern information errors

• Process information based on feelings rather than facts• Ignores information contrary to emotional conclusions• As the numbers get higher (more pathological) feelings

become more distorted also• Violates relevance by giving irrelevant information• Violates manner by using poor temporal order• Violates quality by giving information without evidence

to support it, or by outright lying

A/C pattern information errors

• A combination of A and C• May be one with one caregiver and another

with another• May have a different relationship with the

interviewer

‘AC’ pattern information errors

• Distort both facts and feelings• Use intentional deception to mislead others• This includes giving information in such a way

as to lead the listener to reach false conclusions

• A very well developed and “balanced” strategy in that both cognition and emotion are deceptive to self and others

The Interview

• NOT the place to confront denial• 1.5 hours usually• Needs to be done in one go• CANNOT be done in writing• Must be transcribed by a trained

transcriptionist (unless you want to do it yourself)

Drawbacks

• Requires a commitment of time and money– For training for the therapist– For the client as well

• Needs to have a sufficient and significant length of time for processing and application

• Must be titrated carefully: it can overwhelm the client

Advantages

• Requires a commitment of time and money– For training for the therapist– For the client as well

• Needs to have a sufficient and significant length of time for processing and application

• Gets very deep very quickly• Used correctly it is a way of reprogramming the

mind and correcting errors of information processing when integrated with other techniques

Advantages (cont.)

• Because it is changing how information is processed it is:– Global: it leads to improvement in all areas of

functioning– Lasting: these changes are permanent and give

the clients the tools that they need to deal with life situations

How I use the AAI

• Introduction of attachment concepts and how they apply to the clients presenting problem(s)

• Explanation of ACT and the AAI process• Administration of the AAI: recorded, then

transcribed, then the transcribed interview is “coded” using discourse markers

How I use the AAI (cont.)

• Working through the AAI with the client, education the client further about attachment concepts

• Relating the patterns within the AAI to the clients present patterns of behaviour – this includes their mental and emotional processing of information

• Improving or creating coping skills using other therapies

How I use the AAI (cont.)

• 2 hour sessions typical• Work may be completed in months• More likely will take years• Behavioural and Affective indicators of

progress are assessed periodically

Other therapies

• REBT – Rational Emotive Behaviour Therapy created by Dr. Albert Ellis, the original and in my opinion still the best CBT

• NLP – Ericksonian languaging patterns; reframing; elicitation of highest purpose; sometimes hypnotherapy; “parts” therapy

• Gottman’s (and Notarius and Markman’s) marriage and family therapy techniques

Other therapies (cont.)

• Maslow’s hierarchy of needs/affective therapy• Dreamwork/journaling• Meditation and breathwork• Bibliotherapy• Psychoeducation• Time Line Therapy®• Medication

The Pattern in addiction

• Idealizing with regard to one parent (usually the opposite sex parent)

• Demonizing with regard to the other parent• Fails to see the dynamic played out between the

two parents• More importantly fails to see how the deception

inherent in this dynamic leads to errors of information processing adopted in childhood as a means of coping with a dysfunctional relationship

Case examples: Laura

• Laura: 45 y.o., lawyer, married for 12 yrs., both sexually anorexic, sexually abused by uncle from ages 2-6 approximately

• Met a climbing guide while trekking in the Himalayas

• Got “psychic” messages that they were “meant to be together”

• Long distance relationship

Case examples: Laura (cont.)

• “Psychic Stalking” – in one year spent $300,000 on “psychics”

• Created multiple false facebook identities in order to stalk & manipulate

• Eric, the object of her obsession, was revealed to be a sex addict not in recovery

• Paul, a former high school friend, was also encountered as a mountain guide and she had a fling with him

Case example: Laura (cont.)

• Why do you think you felt closer to him than –

• L: because I had an emotional connection. I trusted him, I felt special, I felt adored. We had something that felt real

• okay.

Laura

• Then became infatuated with a junior lawyer at her firm

• All of these 3 men:– Were younger– Were in much less responsible positions– Earned much less

• Laura has become the predator!!!

Case example: Henry

• my father lost all his money basically because he spent this three, four years in this no man’s land between staying with my mother and going with the secretary so they lost the business, lost the money,

Dismissing discourse

• DMM model:– ‘A’s dismiss self– ‘C’s dismiss others– Looks to the function of the discourse

• ABCD model:– Dismissing discourse gets classified as ‘A’ or ‘DS’

Larry

• Sexual acting out• Only started in the last 5 yrs. After the deaths

of father and sister• 12 step program• “I must work with myself to minimize negative

feelings”

Larry (cont.)

• Text from daughter A to say that daughter B had ‘passed out’ and was taken to hospital

• 1 a.m.• Larry thought ‘nothing can be done she is in

hospital and triaged – go back to sleep’• Wife – a C – upset wanting something to be

done (even though they could not influence the outcome)

Larry (cont.)

• Wife was upset, wanted to call hospitals to locate daughter

• Larry was coming from A4 position, ‘whatever can be done is being done’

• Therefore no problem to be fixed• Cognitive distortion (A5-6) the wife’s and his own

emotional needs were ignored• Emotions related to daughter’s potential death

were ignored

Larry’s AAI

• Well what if you needed comfort? What would you do?

• {9 sec} And we’re talking up to 12 or some… something like that. I’d probably read.

• Yeah.• You know or something. Uhh, uh no I don’t you

know.• Don’t remember needing comfort?• {..} I don't remember. {…} Yeah.

Larry’s AAI (cont.)• Ok. Umm can you recall how your parents would touch

you in childhood whether it would be gentle as in a caress or harshly as in punishment?

• Umm {….} well I’ll start with my father. Umm I don't really remember him touching……me. The only thing I remember is that we’d have a game with my sister, the three of us. My sister, me and my father where he would sit on the couch and we would uh have a ra… we’d have a contest uhh to see who could kiss him the most times. So I’d be on one cheek. She’d be on the other cheek.

Larry’s AAI (cont.)

• Mm-hm.• He’d have a beard. I mean not a beard but you know

like rough skin.• Mm-hm.• Um and we’d have a race to see ok we’ll you’d literally

go like (kissing noises) you know see and someone would win. Of course then we’d be completely chap lipped for the next day (Hm.) but... That’s pretty much all I can remember in (Ok.) terms of um {..} physical contact.

Seductive Parenting

• Mothers with first born sons• Intrusive• Sexualized touching: bum, genitals, kissing• Interrupts the child’s activities in order for the

mother to seek affection• Disparaging to daughters• Lack of an appropriate sexual/romantic partnership

(“Development of the Person”, Sroufe, et al)


• And how about Mom?• Umm with .. Mom … the times I remember her

touching me umm well there’s….… well .. the bed time ritual. She you know… I remember her caressing my face. I remember kk you know uh-uhh kissing me. I remember she’d have a thing where she’d kiss my fore… you know like kiss me here, here, here, here. Umm, umm …. that’s really where I remember most in terms of the physical affection.


• Um there was one umm uhh sexual memory which I remember umm which is that uh I remember a time when my… uh, uh the way I discovered masturbation was I remember a time when I was in the bath. Uh I don’t remember how old I was but again it must have been post uh, uh five or older because we’re in this house in New York ‘cause I can visualize it.


• I remember her bathing me umm which obviously I was already past five. That’s a second story now that I think about it um (ha) but uh and I remember her umm ww uhh .. washing or whatever my penis and, and I what I remember is saying, “Oh that feels good. Do it again.”


• Um I don't remember what her response was or anything but then what I recall is then when I would be bathing myself…

• Mm-hm.• Way before preadolescence…• Mm-hm.• …umm I would and way before I’d you know

have an orga… you know have a ejaculation.


• when you were young did you ever feel rejected by your parents even though they might not have meant it or even been aware of it?

• Umm {..} there was one time because I remember uh… well with my father rejected is the wrong word. Umm {…} you know where he umm {..} didn’t uhh {..} approve or whatever uhh www (Mm-hm.) one thing which was remember at one point I tried knitting and I remember umm {….} knitting in front of him.

• Mm-hm.


• I think to show him what I was doing or something like this and him being like ‘no’ you know ve… eh very……’you don’t do that.’

• How old were you then?• (sigh) {….} Probably like nine.• Nine. Ok.


• Something like that. Again I go more by the grades. I’m trying to put which of the grade I…

• Um so you said rejected wasn’t the right word.• He was… I don't know that it… rejected sounds

permanent, more permanent. I don’t think I’ve ever had a sense of…

• Ok. What did you, what did you think it was? What… how would you describe it?

• Umm…


• The feeling.• {..} I think it was umm {5 sec} disappointment. • Ok.• For me and anger at my mom.• Why?• That she let me do this.• Oh really?• Yeah, yeah.

Larry’s First separation

• Sister 2.5 yrs younger• Mom & dad go on a trip to Europe for “a

month or two.”• Mom was pregnant with his sister• How old was client? 2 yrs? Approximately.

Cat

• 37 y.o. SWF, lesbian/bi• Very butch, very attractive• A series of limerent relationships• In a committed relationship with a woman for

six years; they plan to marry• Had cheated on her partner several times with

men

Cat 2

• First sexual intercourse at 15 w/a much older married male (old enough to be her father!)

• Other sexual encounters of a similar nature• Preferred females for romantic partners but

cheated on them with men• A recent flirtation w/a male work colleague

led her to seek therapy• Despair over her continued acting out

First memory

• what’s the earliest memory that you have as a child?

• C: Erm? It’s sitting in my back garden with my tortoise.

• Your? • C: Tortoise. • Tortoise. Okay. You still have your tortoise? • C: Apparently it ran away – ironically okay I mean

they don’t run very fast, but it ran away (giggle).

First memory

• When did it run away? • C: It might have been my mum telling me it ran away

when probably it died. It’s no I mean – so it was in childhood?

• C: Oh yeah yeah I was err, there is a picture of me actually with my tortoise – erm, I, I was very very small. I don’t know how old I was? Maybe five or something?

• Yeah – I saw a story in the paper about some guy who had one that was seventy years old or something like that – anyway.

First memory

• C: Yeah, I have no idea how old mine was (giggle).

• Alright. Erm, when do you – what else do you remember about that event?

• C: Erm? The tortoise event? • Yes – sitting in the back garden you said? • C: Err it was sunny mm but nothing else. • Okay. Anybody else there? • C: No okay just me.

First memory

• Erm? Why do you think you have that memory?

• C: Erm, possibly because of the photos. That’s a possibility okay. Erm, but it’s – it’s, it’s err a happy moment mm that’s the only other thing I can think of, I’m with – with a pet and the sun is shining and I’m in the garden yes it’s a nice –

Dysfluence

• So what happened when you went to bed as a child Cat?

• C: Erm? . . . . (4) nothing I guess. I mean err parents would tuck us in. I don’t remember mum being there, I remember dad being there more, to say goodnight. Erm I remember being absolutely petrified at night times and that was – err I didn’t like the darkness.

Dysfluence

• can you recall how your parents would touch you, whether it would be tender, caressing or harsh, punishing?

• The one thing I do remember from my dad is that he used to tuck us into bed at night and give me a cuddle and that was – nice and tender and you know – perfect.

Dysfluence

• Do you think that you may have been abused physically?

• C: Erm? . . . . . . . . (8) (sighs) . . . (3) there’s only one time (upset) and I am upset because I have only ever told one person this before okay erm, there, there was one time with my dad – erm and he you know I told you that he used to erm put us to bed and kiss us goodnight.

Cat, dysfluence (cont.)

Erm – I know that erm he used to kiss me for a little bit longer than he should have done, on several occasions, and that’s it. There was nothing more. It didn’t go any further than that. But it upsets me to talk about that because I have had such a good relationship with my dad but that happened and I don’t really know what to think about it.

Dysfluence

• Where was he kissing you? • C: Just on my lips on your lips but it wasn’t

a peck on the cheek or a peck on the lips like a parent should do it was – it was longer than that.

• A lingering kiss? • C: Yeah.

Dysfluence

• And how old were you then? • C: I was really tiny. I was – (cannot hear)

tiny erm – it, it would have been before the age of ten, before puberty anyway. Yeah. Mm I didn’t think anything of it at the time but you know – you don’t - you don’t have that kind of link when you are that age yeah.

Dysfluence

• So thinking back on it? • C: Thinking back on that – I try not to think about it,

because it conflicts with the relationship I had, but I know it’s important because it happened.

• Why do you think he stopped doing that – I mean I presume he stopped did he?

• C: Yeah, he did yeah. I don’t know you know, I can only remember it, I remember one particular time it happening and that was it – just that – but I am sure it – maybe it happened a few times mm. But yeah.

Bibliography

• Development of the Person, Sroufe et al• The Haunted Self, van der Hart et al• The Polyvagal Theory, Porges• The Emotional Brain, LeDoux• In Search of Memory, Kandel• Assessing Adult Attachment, Crittenden• Raising Parents, Crittenden

Bibliography for clients

• Becoming Attached, Karen• How to Break Your Addiction to a Person,

Halpern• We Can Work it Out, Notarius and Markman• The Seven Principles for Making Marriage

Work, Gottman• Raising an Emotionally Intelligent Child,

Gottman

HEALING THE BROKEN BOND

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