Monday, 30 June 2014
Therapist Training for Good Attachment
SAMPLE INTERVENTIONS
- Responsive parenting – becoming an attachment figure
- I sense you might be feeling a little nervous as we begin our session today. Is that right?
- You’re feeling discouraged about where you are in your life right now. Can you say more about that?
- As I hear your talk about your brother, I notice something starts to come up in me, right here, in my chest. Can I check that out with you? I’m feeling…an ache, maybe some sadness, a loneliness. Are you feeling anything like that right now?
- When you say you can’t trust your wife any more, is there something underneath? Some sadness underneath…some deep, deep sadness?
- Moment-to-moment tracking of non-verbals
- Something just shifted; did something just change for you? Can you let me know what you’re feeling in your body right now?
- I notice your hands shaking and scratching as we talk; is there something happening in your hands we need to know about? If your hands had a voice, what would they be saying to us right now?
- I notice your energy is different in your body now…more relaxed? Lighter? What’ your sense now?
- Privilege relational-emotional experiences in therapeutic dyad; make focus explicit
- What are you experiencing right now, here with me, as we sit together? What’s it like to be experiencing this here now with me?
- What are you feeling right now? Where are you feeling that in your body? What’s it like to feel that with me? What are you feeling between us right now?
- Is it hard for you to look me in the eyes as you share this with me? What happens as you try to look me in the eye? What do you see in my eyes as we experience this here together? What do you see in my eyes as I feel what you feel?
- Stop attacks; cultivate self-empthay, self-compassion
- Whoa! There’s that inner critic again. Can we just set that voice aside for now and go back to what you were feeling just before?
- What would happen if you let in that I care about you? That I am so deeply moved by the work you are doing?
- You can be so harsh o yourself for feeling upset with me! I feel so tender toward that part that feels upset, that needs to be upset with me. Can you feel some compassion for that part that feels upset, that needs to feel upset? If your daughter Kelly were that upset, how would you feel toward her? How would you comfort or soothe her?
- Soften, bypass, confront any defenses
- It seemed like you were about to respond to what I just said and then you backed off. What comes up as you begin to respond directly to me?
- Any time we begin to get near the emotions around your father leaving, you seem to change the subject. Is there something difficult about feeling those feelings and sharing them with me?
- If we could set the anxiety about being weak or vulnerable in front of me aside for just a moment, what would your heart want to say; what would your heart want me to know about you?
- Experience and regulate feelings
- You know I want to go back to something that happened just a moment ago. You were saying something about your boss and your eyes flinched, just for a moment, and I let it go by, but I wonder if something came up just in that moment that we should pay attention to?
- You seem angry right now, yet you’re holding back on letting that anger out. Can you let me know just how hard it is for you to let the anger out; what do you imagine would happen if you began to let your anger out?
- So much pain; so very much pain. I can feel the pain as we sit here. Can you let me feel that pain with you? Can you feel that pain with me, just let it be there?
- Let it come, let it come. It’s OK, I’m right here; it’s been wanting to come for such a long time.
- You’re not alone; I’m right here with you.
- Co-create and reflect on relational-emotional moments; meta-processing
- I’m feeling touched as I hear you say that. I’m so moved that you would share this with me.
- We’ve been through such a wave of grief here, and now….there seems to be something else. A letting go…a sigh of relief? What’s happening now?
- Whew! That was quite a ride! And what’s going on now? What are you feeling now?
- What’s your sense of what’s happened here today? How do you make sense of what we’ve experienced here together today?
- You’ve opened up and shared of much of your frustration and anger with me today. How do you feel about your anger now?
- You started out today by saying you weren’t sure what was going on with you, what to focus on. Then here we did this deep piece of work about the loss of your best friend in high school, and felt so much loss, so much loss. How are you feeling about yourself now, having experienced so much loss, really letting yourself feel it? What’s your sense of your self now?
- Create new attachment experiences
- Do you think you could stand up for yourself with your sister now the way you did to me last week about the fee?
- How can you remember what it’s like in here, trusting yourself to know how you feel and what you need, when you speak to your boss next week?
- http://lindagraham-mft.net/resources/published-articles/the-neuroscience-of-attachment/
The Neuroscience of Attachment
http://lindagraham-mft.net/resources/published-articles/the-neuroscience-of-attachment/
Emotional Deprivation
Emotional Disability
This often occurs through a childhood of traumatic events such as verbal abuse, physical abuse, sexual abuse, witnessing violence, witnessing marital stress provoked by adultery or alcoholism, parental emotional dysfunction, moving home several times, emotional neglect, periods of attachment breakdown, early years trauma or severe illness resulting in enforced hospital stays which are traumatic and in some cases, like meningitis, an illness which causes some level of brain damage. If traumas like these occur in childhood the likelihood of further trauma in adulthood increases as the adult is vulnerable and fragile from previous emotional deprivation and trauma.
Emotional disability can manifest outwardly but often manifests inwardly with such symptoms as withdrawal, or preoccupation with high achieving, eating disorders, depression, persistent sadness and hopelessness.
What is interesting is if the child is highly intelligent to start with, the coping strategies can be so effective as to mask the problem, even though they may be damaging to the child, to their sense of self or their physical health. They can often go unnoticed if the child 'appears' to be succeeding at school. Such a child may be labelled overly sensitive or emotional unstable at times. A clever child will then do all they can to cover up these perceived failings.
When the child reaches adulthood the emotional disabilities are still there and may range from mild to moderate to severe. There may be many coping strategies in place to paper over the cracks. Professionals have often totally over looked the possibility of a severely emotionally disabled child if that child/adult is able to pretend to be sufficiently 'able' when necessary. Most professionals agree that without touch and affection, a baby will not thrive and will most likely die. They don't have any answers for : what if that baby survives?
What is tragic is that there are campaigns to help understand and treat other disabilities (physical, mental or behavioural) and procedures in place to help and also to assist those with learning disabilities. A highly intelligent emotionally disabled adult is overlooked and misunderstood.
I think they receive the rawest deal. They are often blamed, shamed and mocked for their disability in a way that most of society thinks is acceptable. They are rarely given help or assistance. Their plight goes unrecognised and they are termed: 'difficult' 'overly emotional' ' a little unstable' ' 'a little odd' or 'manipulative'. This is discrimination. This is prejudice. This is ignorance. The time for change has come.
If a child acts out their emotional disturbance with behavioral problems, they have a small chance of their disability being picked up at school. If a child withdraws inwardly and creates a socially acceptable front outwardly, it will rarely be noticed that they have a disability. But that child/adult can suddenly break apart. If the history of the child is explored, the reasons for the internal fractures can be traced back to the neglectful, deprived abandonment in childhood. Even children from seemingly well off educated middle class homes can be bearing the brunt of emotional neglect and deprivation. If we know that lack of touch and affection can kill babies, why do we expect children who are consistently not emotionally met, to survive into adult life with good emotional skills?
If an adult is suffering extreme loneliness, we do not say ' be a friend unto yourself' but send in a befriender. If we meet an adult who was never parented, never was the apple of someone's eye, never felt cherished or that their fears, worries, aspirations or anxieties mattered, then why do we tell them ' be a good parent to yourself'? They can't. They don't have the neural programming in place. They need to learn by limbic resonance what it feels like by being with someone who is loving and trusted and consistent and attached back to them. It is a learned one to one experience, just as it was for a baby in a normal attachment scenario where the primary attachment figure (usually the mother) bonds and loves the baby.
This often occurs through a childhood of traumatic events such as verbal abuse, physical abuse, sexual abuse, witnessing violence, witnessing marital stress provoked by adultery or alcoholism, parental emotional dysfunction, moving home several times, emotional neglect, periods of attachment breakdown, early years trauma or severe illness resulting in enforced hospital stays which are traumatic and in some cases, like meningitis, an illness which causes some level of brain damage. If traumas like these occur in childhood the likelihood of further trauma in adulthood increases as the adult is vulnerable and fragile from previous emotional deprivation and trauma.
Emotional disability can manifest outwardly but often manifests inwardly with such symptoms as withdrawal, or preoccupation with high achieving, eating disorders, depression, persistent sadness and hopelessness.
What is interesting is if the child is highly intelligent to start with, the coping strategies can be so effective as to mask the problem, even though they may be damaging to the child, to their sense of self or their physical health. They can often go unnoticed if the child 'appears' to be succeeding at school. Such a child may be labelled overly sensitive or emotional unstable at times. A clever child will then do all they can to cover up these perceived failings.
When the child reaches adulthood the emotional disabilities are still there and may range from mild to moderate to severe. There may be many coping strategies in place to paper over the cracks. Professionals have often totally over looked the possibility of a severely emotionally disabled child if that child/adult is able to pretend to be sufficiently 'able' when necessary. Most professionals agree that without touch and affection, a baby will not thrive and will most likely die. They don't have any answers for : what if that baby survives?
What is tragic is that there are campaigns to help understand and treat other disabilities (physical, mental or behavioural) and procedures in place to help and also to assist those with learning disabilities. A highly intelligent emotionally disabled adult is overlooked and misunderstood.
I think they receive the rawest deal. They are often blamed, shamed and mocked for their disability in a way that most of society thinks is acceptable. They are rarely given help or assistance. Their plight goes unrecognised and they are termed: 'difficult' 'overly emotional' ' a little unstable' ' 'a little odd' or 'manipulative'. This is discrimination. This is prejudice. This is ignorance. The time for change has come.
If a child acts out their emotional disturbance with behavioral problems, they have a small chance of their disability being picked up at school. If a child withdraws inwardly and creates a socially acceptable front outwardly, it will rarely be noticed that they have a disability. But that child/adult can suddenly break apart. If the history of the child is explored, the reasons for the internal fractures can be traced back to the neglectful, deprived abandonment in childhood. Even children from seemingly well off educated middle class homes can be bearing the brunt of emotional neglect and deprivation. If we know that lack of touch and affection can kill babies, why do we expect children who are consistently not emotionally met, to survive into adult life with good emotional skills?
If an adult is suffering extreme loneliness, we do not say ' be a friend unto yourself' but send in a befriender. If we meet an adult who was never parented, never was the apple of someone's eye, never felt cherished or that their fears, worries, aspirations or anxieties mattered, then why do we tell them ' be a good parent to yourself'? They can't. They don't have the neural programming in place. They need to learn by limbic resonance what it feels like by being with someone who is loving and trusted and consistent and attached back to them. It is a learned one to one experience, just as it was for a baby in a normal attachment scenario where the primary attachment figure (usually the mother) bonds and loves the baby.
Martin Seager on Attachment in Adults and Therapy
In my new role as CHAMPION for Mental Health Issues, I have been talking with Martin about his views on Attachment and also on the concept of Emotional Disability. This came about from reading this summary of a chapter he had written:
Martin Seager argues that attachment theory should inform the design and delivery of mental health services in the most general sense. He suggests that adult mental health services are run in ways that remain blind even to the basic concept of attachment. However, as secure attachment is a core and universal factor underlying well-being for all humans, organisations that exist to forster mental health cannot afford to ignore the attachment needs of either their service users or providers. Seager makes a number of specific recommendations about how services could move to being more 'psychologically minded' and attachment-informed. These include suggestions for reducing the risk of attachment breakdown among inpatients, personalising services, promoting psychological safety, improving the availability and accessibility of the service system, de-stigmatising the concept of dependency, creating a secure family atmosphere in mental health organisations and ensuring that the attachment needs of staff members are recognised and met.
From :Attachment Theory In Adult Mental Health: A Guide to Clinical Practice
Therapist's Own Attachment History and Impact on Clients Treatment
David Wallin develops a theme initially introduced in Jeremy Holmes' chapter; namely the importance of considering the impact upon treatment of the therapist's own attachment history and patterning. Wallin suggests that, as therapists, our ability to generate a secure attachment relationship will be profoundly affected by the legacy of our own attachment relationships - a legacy that is for many of us who choose this work, marked by trauma. The chapter opens by addressing the advantages and vulnerabilities that derive from the therapist's characteristic career trajectory, with its roots in a history of trauma and adaptation to trauma. this adaptation occurs through the 'controlling-caregiving' strategy identified by attachment researchers and also described in Giovanni Liotti's chapter on borderline personality disorder. Wallin explores the ways in which clinicians can identify their own state(s) of mind with respect to attachment and the implications that flow from recognising that they are presently lodged in a state of mind that is secure, dismissing, preoccupied or unresolved. He also describes the uses of mindfulness and mentalising in recognising and working with the enactments of transference and countertransference that arise when the therapist's attachment patterns interlock with those of the client.
Attachment Theory in Adult Mental Health: A GUIDE to Clinical Practice.
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