Attachment-based psychotherapy

Last updated

Attachment-based psychotherapy is a psychoanalytic psychotherapy that is informed by attachment theory. [1] [2]

Contents

Attachment-based psychotherapy combines the epidemiological categories of attachment theory (including the identification of the attachment styles such as secure, anxious, ambivalent and disorganized/disoriented) with an analysis and understanding of how dysfunctional attachments get represented in the human inner world and subsequently re-enacted in adult life. Attachment-based psychotherapy is the framework of treating individuals with depression, anxiety, and childhood trauma. [3] Psychotherapy, or talk therapy, can help to alleviate dysfunctional emotions caused by attachment disorders, such as jealousy, rage, rejection, loss, and commitment issues that are brought on by the lack of response from a parent or the loss of a loved one. Events, such as domestic abuse or lack of a parental figure, can result in these dysfunctional emotions. These issues can also have effects of the child in their adulthood, by making them incapable of making and keeping healthy relationships or by making them have false beliefs that they will be abandoned. [4] The use of Psychotherapy helps modify dysfunctional emotions in order to give the patient a healthy understanding of the traumatic experiences they have gone through. It is important for psychotherapists dealing with Attachment disorders to create a personal relationship with the patient in order to help the patient to make intimate attachments in their normal lives. Effective psychotherapy for patients dealing with attachment disorders must be supportive and consist of effective communication between the patient and therapist. [4] Child attachment trauma leads into attachment issues as an adult. Individuals with attachment problems may show signs of distress during difficult situations, have trouble caring for others and letting themselves be cared for, are easily angered, and have difficulty focusing.

When an individual does not have security in their relationships, they rely on themselves and their emotions, resulting in unhealthy behavior and cognitive functioning. [5]

Treatment

Therapists apply psychotherapy to patients with attachment disorders by applying a method of listening and reflecting on the experiences of the patient that caused their difficulty in making emotional connections. The primary treatment for a child with attachment-based trauma is having a reliable caregiver. The next most important treatment is having a psychotherapist. [6] The therapist's objective is to get the patient to open up to them so the patient can explore the experiences that are causing them to have dysfunctional relationships and to recreate the experience from the point of view of the therapist in order to resolve any emotional or social disruptions within the patient's life. According to Dan Hughes this process is known as “attunement, disruption, and repair”. The first part of the treatment, the attunement, consists of the forging of a personal relationship between the therapist and the patient, it is the first step for the patient toward creating healthy attachments. Attachment patients live stressful lives with very little emotional attachments to people, thus it is the therapist's job to create a secure, accepting, caring, non-judgmental, and reliable environment where the patient can feel comfortable sharing their most traumatic experiences. [7]

Once the patient and therapist have created a trust worthy and reliable relationship the therapist will probe the patient on any traumatic experiences that may have happened to them in their child hood and that connect to any disruptions in their lives at the time. The therapist pays special attention to the relationship between the patient and their parents because the lack of responsiveness of a parent early in a child development can lead to dysfunctional relationships later on in their life. The therapist may even ask the parent or caregiver to attend the therapy sessions in order to correct any complications in their relationship. The therapist will ask the parent to be present if they want to help the child and parent repair their relationship. The therapist will facilitate in their communication and have them share in an “affective/ reflective” way. Having the parent in the room, such as in group therapy, may also help the patient face the root of their problems, which most psychologists believe stems from the parents. In this sense the parent or care giver will be taking on the role of the therapist in order to resolve issue that directly impact the parent's life [7] :274–5 This part of the therapy treatment is called disruptive because by having the patients talk about their traumatic experiences and relationship with their parents in depth, the therapist is getting them to re-experience the trauma. Getting the patient to face their own trauma has the effect of getting them to accept their own ego and understand why they have trouble creating healthy attachments with people. [4] As the patient shares their experiences the therapist is expected to be actively listening and express empathy and acceptance to the patient. The therapist creates an even deeper relationship with the patient by treating the patient's experiences as their own experiences and coming up with their own interpretations to the events while constantly be understanding of and engaged with the patient. The therapist may also mimic the patient's emotions in order to show their understanding and to encourage the patient to keep sharing. [7]

After the patient shares the traumatic events from their life and the therapist integrates them as their own, the therapist begins the repair of the patient. The repair stage of the therapy aims to alter the patient's current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective interpretation they hope create a new reality of the traumatic events for the patient in order to get rid of unwanted emotions. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Abnormal psychology</span> Sub-discipline of psychology

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis followed by synthesis.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

<span class="mw-page-title-main">Play therapy</span> Childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

<span class="mw-page-title-main">Ronald Fairbairn</span> Scottish psychiatrist and psychoanalyst (1889–1964)

William Ronald Dodds Fairbairn FRSE was a Scottish psychiatrist, psychoanalyst and a central figure in the development of the Object Relations Theory of psychoanalysis. He usually used, and was known as and referred to as, "W. Ronald D. Fairbairn".

Intensive short-term dynamic psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a psychological disorder that is theorized to develop in response to exposure to a series of traumatic events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is prolonged or repetitive. It is not yet recognized by the American Psychiatric Association or the DSM-5 as a valid disorder, although was added to the eleventh revision of the International Classification of Diseases (ICD-11). In addition to the symptoms of post-traumatic stress disorder (PTSD), an individual with C-PTSD experiences emotional dysregulation, negative self-beliefs and feelings of shame, guilt or failure regarding the trauma, and interpersonal difficulties. C-PTSD relates to the trauma model of mental disorders and is associated with chronic sexual, psychological, and physical abuse or neglect, or chronic intimate partner violence, bullying, victims of kidnapping and hostage situations, indentured servants, victims of slavery and human trafficking, sweatshop workers, prisoners of war, concentration camp survivors, and prisoners kept in solitary confinement for a long period of time, or defectors from authoritarian religions. Situations involving captivity/entrapment can lead to C-PTSD-like symptoms, which can include prolonged feelings of terror, worthlessness, helplessness, and deformation of one's identity and sense of self. C-PTSD is linked to adverse childhood experiences, especially among survivors of foster care.

Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. It was originally developed by Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy.

Attachment therapy is a pseudoscientific child mental health intervention intended to treat attachment disorders. It is found primarily in the United States, and much of it is centered in about a dozen clinics in Evergreen, Colorado, where Foster Cline, one of the founders, established his clinic in the 1970s.

Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from adult psychiatry or psychological medicine, which evolved a separate child psychiatry specialism.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children with mothers who have experienced traumatic or stressful events during pregnancy can increase the child's risk of mental health disorders and other neurodevelopmental disorders. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

The developmental needs meeting strategy (DNMS) is a psychotherapy approach developed by Shirley Jean Schmidt. It is designed to treat adults with psychological trauma wounds and with attachment wounds. The DNMS is an ego state therapy based on the assumption that the degree to which developmental needs were not adequately met is the degree to which a client may be stuck in childhood. This model aims to identify ego states that are stuck in the past and help them get unstuck by remediating those unmet developmental needs. The processing starts with the DNMS therapist guiding a patient to mobilize three internal Resource ego states: a Nurturing Adult Self, a Protective Adult Self, and a Spiritual Core Self. The therapist then guides these three Resources to gently help wounded child ego states get unstuck from the past by meeting their unmet developmental needs, helping them process through painful emotions, and by establishing an emotional bond. The relationship wounded child parts have with these Resources is considered the primary agent for change.

Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

Trauma Systems Therapy (TST) is a mental health treatment model for children and adolescents who have been exposed to trauma, defined as experiencing, witnessing, or confronting "an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others". TST focuses on the child's emotional and behavioral needs as well as the environments where the child lives. The treatment model includes four components that are fully described in a published manual. A clinical trial showed that TST is effective in improving the mental health and well-being of children who have been traumatized. TST has also been successfully replicated.

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies. Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including cognitive behavioral therapy, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Child psychoanalysis is a sub-field of psychoanalysis which was founded by Anna Freud. Freud used the work of her father Sigmund Freud with certain modifications directed towards the needs of children. Since its inception, child psychoanalysis has grown into a well-known therapeutic technique for children and adolescents.

Control mastery theory or CMT is an integrative theory of how psychotherapy works, that draws on psychodynamic, relational and cognitive principles. Originally the theory was developed within a psychoanalytical framework, by psychoanalyst and researcher Joseph Weiss, MD (1924-2004). CMT is also a theory of how the mind operates, with an emphasis of the unconscious, and how psychological problems may develop based on traumatic experiences early in life. The name of the theory comes from two central premises; the assumption that people have control over their mental content, and the belief that patients who come to therapy are fundamentally motivated to master their lives.

Diana Foșha is a Romanian-American psychologist, known for developing accelerated experiential dynamic psychotherapy (AEDP), and for her work on the psychotherapy of adults suffering the effects of childhood attachment trauma and abuse.

Psychodynamic Therapy with Infants and Parents aims to relieve emotional disturbances within the parent(s), the baby, and/or their interaction, for example, postnatal depression and anxiety, infant distress with breastfeeding and sleep, and attachment disorders. It rests on attachment theory and psychoanalysis. Sigmund Freud suggested that a modification of his method could be applied to children, and child analysis was introduced in the 1920s by [Anna Freud].., [Melanie Klein], and Hermine Hug von Hellmuth. Klein speculated on infantile experiences to understand her patients' disorders but she did not practice PTIP. Donald Winnicott, a pediatrician and analyst, focused on the mother-baby interplay in his theorizing and his brief parent-child consultations, but he did not work with PTIP.

References

  1. Slade, A. (1999) Attachment Theory and Research: Implications for the theory and practice of individual psychotherapy with adults. Handbook of Attachment: Theory, Research and Clinical Applications eds Cassidy, J. & Shaver, P. (1999) Guilford Press: New York and London. pp. 575–594
  2. Special Issue: Attachment-based psychoanalytic psychotherapy. Attachment & Human Development, 6, June 2004, pp. 113–207. doi : 10.1080/14616730410001695358
  3. "Attachment Based Therapy Program". Newport Academy. Retrieved 2021-05-29.
  4. 1 2 3 Holmes, J. (1996) Attachment, Intimacy, Autonomy: Using Attachment Theory in Adult Psychotherapy"
  5. "Counseling for Secure Attachment — Modalities". Integrative Psychotherapy & Trauma Treatment. Retrieved 2021-05-29.
  6. "Treatment | Trauma-Informed Therapist". Attachment and Trauma Network. Retrieved 2021-05-29.
  7. 1 2 3 4 Hughes, D. (2010) Attachment and Human Development"