HEALING THE BROKEN BOND

1. HEALING THE BROKEN BOND Using Attachment Centred Therapy as a means to assess and intervene with addictive disorders and other dysfunctional behaviours

2. Presented by: Charley Shults, Psychotherapist 12 Harley Street London +44 1483 539 759 +44 75075 62864 shults@virginmedia.com www.charleyshults.co.uk

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

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

17. 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

18. 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?

19. Words Words are more than mere concepts, they are the tools that we use to grasp and grapple with reality.

20. 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.

21. 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)

22. 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

23. 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

24. 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

25. 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

26. 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)

27. Attachment complications • Layering • Switching • Regression • Dispositional representations (DRs)

28. 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

29. 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.’

30. Grice’s Cooperative Principle

31. 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?

32. ERRORS OF INFORMATION PROCESSING LEAD TO THE CONTINUANCE OF INSECURE ATTACHMENT PATTERNS

33. Discourse Markers

34. 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

35. ‘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

36. ‘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

37. 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

38. ‘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

39. 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)

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. Other therapies • REBT – Rational Emotive Behaviour Therapy created by Dr. Albert Ellis, the original and in my opinion still the best CBT • NLP – Ericksonianlanguaging patterns; reframing; elicitation of highest purpose; sometimes hypnotherapy; “parts” therapy • Gottman’s (and Notarius and Markman’s) marriage and family therapy techniques

47. Other therapies (cont.) • Maslow’s hierarchy of needs/affective therapy • Dreamwork/journaling • Meditation and breathwork • Bibliotherapy • Psychoeducation • Time Line Therapy® • Medication

48. 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

49. 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

50. 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