Therapy For Attachment Challenges
Attachment Theory
According to attachment theory created by John Bowlby, attachment patterns are formed in the context of early experiences with caregivers and maintained by later interpersonal relationships in adulthood. Attachment can been defined as a ‘lasting psychological connectedness between human beings’ (Bowlby 1958). It is an emotional connection that develops between an infant and their primary caregiver and it is also where we learn about safety and begin to create a baseline for our future relational expereinces.
John Bowbly, Mary Ainsworth (See the strange situation) Ed tronick (See the Still face experiment) and many others have contributed much research and insight on the topic of attachment theory. By observing how infants respond when separated from their mothers as well as observing infants responses to still faces.
What we have discovered, is that our early experiences with attachment impact and shape our interactions as we develop through adulthood. We also see a correlation between early childhood trauma and the impact trauma has on attachment styles.
Attachment Theory and Attachment Styles
Attachment can be understood within an evolutionary context in that the caregiver provides safety and security for the infant. Attachment is adaptive, in that infants must find a way to attach to their caregivers as it enhances the infant’s chance of survival. This is illustrated in the work of Lorenz (1935) and Harlow (1958).
According to Bowlby infants have a universal need to seek close proximity with their caregiver when under stress or threatened (Prior & Glaser, 2006). When children have a sense of confidence that their caregivers will be responsive to their needs and will be there in times of distress or if they cry out they are able to form what’s known as a secure attachment.
This secure attachment establishes a template or schema for which the child then constructs their future relationships with others.
When a child has a secure attachment we find that they are more able to develop a sense of safety and security because they have had a caregiver provide a secure base from which they can explore the world. Children who experience secure attachment are able to develop resilience, find a way to regulate their emotions, make sense of life challenges and create meaningful intimate relationships with others.
Why Is Attachment Important?
When an infant comes into the world, they have an extremely limited repertoire when it comes to regulating their emotions and being able to self-soothe. The 3 strategies they can call on to regulate include:
The Sucking Reflex:This is why babies suck their thumb or can be soothed with a pacifer, breast feeding or a bottle. When the sucking reflex is evoked infants are able to experience a sense of soothing.
Averting Eye Gaze:The second tool an infant has is that they can look away or avert their eye gaze. This is where we sometimes see children look away in an attempt to regulate and teenagers who might roll their eyes - its a reflexive instinct.
Dissociation: Dissociation can be defined as a mental process that involves disconnection from ones thoughts, feelings, memories or sense of identity. When adults are dissociated they often describe it as ‘being out of my body’, ‘feeling as though I am on the ceiling’ or a sense of disconnect from their body, “I’m here…but not really here.” When a child or adult is in a constant state of emotional dys-regulation or trauma they will at some point dissociate. When a child is unable to receive regulation you may see a baby gazing off into the distance. They may be taking a mental time out. Dissociation is an instinctual survival behaviour.
Given that these are the only soothing mechanisms that a child has access to we can see the significance of attachment because everything else needs to come externally. As children we are relying on something outside of ourselves to experience this inter-regulation (regulation through relationship). We need someone to pick us up when we want to be held, to feed us when we are hungry and to comfort us when we feel sad. If we have access to a caregiver that is consistent, loving and attuned to our needs we are able to internalize what is known as a secure attachment, which results in our ability to develop auto-regulation (being able to regulate feelings and emotions on our own) as adults.
Secure Attachment
When a child has experienced secure attachment with a caregiver they have experienced a level of empathy, bonding and reflection. This experiences enables children to ‘borrow’ their care givers pre-frontal cortex, so to speak as they learn how to regulate emotions like fear, anxiety, anger and shame and they begin to experience themselves as being seen and accepted as well as a sense of identity.
Children who are securely attached generally become upset when their caregivers leave and are happy when they return. They will also look for comfort from their caregivers when they feel distressed or afraid.
When a child has experienced secure attachment they are able to develop a a sense of confidence that their care giver will be responsive when needed in times of distress. Research has shown that most functions of the pre-frontal cortex are outcomes of secure attachment and that all functions of the pre-frontal cortex are strengthened in mindfulness practice (Graham, 2010).
The form of attachment will establish the template with which a child will construct their future relationships with others, develop a sense of security about exploring the world, to develop resilience to stress and the ability to balance emotions, makes sense of their life, and creates meaningful interpersonal relationships. A secure attachment will provide the best foundation for these developments.
Avoidant Attachment
If we look at avoidant attachment, we see this develop when the primary care taker is dismissive, emotionally or physically. They may be somewhat unavailable or unwilling to attend to the child’s needs. they might disengaged when the child reaches out and the parent might ridicule or reject the child.
As a consequence, the child learns that they can rely upon others to meet their attachment needs and attempts to meet those needs themselves. Often times the child is lost more in their own inner world and avoids emotional connection. They can appear physically and emotionally distant and are more comfortable with distance and can appear self-centred and un responsive
Ambivalent Attachment
If we look at ambivalent attachment we sometimes see that a parent or caregiver isn’t consistently available to the child. This can be seen in the case caregivers who struggle with addiction.
When the caregiver is in an altered state they are unavailable and when they are sober they may be able to engage. Sometimes this results in an over involvement by the caregiver and a sense of enmeshment is seen. For the child it is never really clear when the parent is going to be available.
Similarly for parents who experience high levels of anxiety, depression or trauma, there are going to be times when the child is not being responded to because it is difficult to securely attach or attend to the needs of your child when you are in highly dys-regulated states.
Unlike children who have avoidant attachment patterns these children do reach out for closeness, but they may be unsure and anxious about relationships. They may self sabotage intimacy when people get close, which can feel confusing for them and those they are in relationship with. Their behaviour is often experienced as unreliable as they can move from bing available one moment and rejecting the next.
Disorganized Attachment
Disorganized Attachment is often where we see a correlation with complex trauma.
If you have grown up in a family system where your caretaker was frightened of you and or frightening towards you, you may have developed a disorganised attachment. When a child’s need emotional closeness remains unseen or ignored and the parent’s behaviour is erratic and unpredictable, children can become disoriented and disorganized.
When a caretaker is frightened of an infant or child they may display behaviours like:
· Backing away physically when the child has needs
· Having a frightened/startled look on their face
· Not responding to the child, flat, numb or collapsed affect
We can think of these care givers as being in flight or freeze mode
When a caretake is frightening to an infant or child they may display behaviours like:
· Looming over the child or being physically intrusive
· Attacking postures or sudden movements
· Aggressive teasing and mocking
· Emotional reactivity (going from 0-100)
· Threatening abuse -shaking, hitting, pushing
We can think of these caregivers as being in fight mode
As an adult, someone with a disorganized attachment pattern may experience a fear of relationships as well as challenges in communication and interaction with those they want to develop intimate relationships with. This includes, partners, friends and family members.
How Is Attachment Disrupted?
When children experience disrupted and insecure attachment through abuse, traumatic loss, betrayal, or as a result of chronic dysregulation in the caregiver, they are unable to develop the capacity required for soothing and self-regulation. The result is that they may experience intense feelings and emotions and an inability to modulate these themselves, or to rely on safe and consistent caregiving relationships for support (Cook et al. 2005, van der Kolk 2005).
Research tells us that the optimal condition for an infant to grow into a healthy child, adolescent and adult is to feel securely attached to at least one primary caregiver.
Lack of consistent care can happen for several reasons including; sexual or physical abuse, neglect, abandonment, inconsistent care due to substance abuse, mental illness, significant adversity within the family like domestic violence, complicated bereavement, being raised in out of home care (specifically if ‘home’ changes regularly.
Early childhood research shows us that human infants need to be attended to and responded to appropriately. For example, when a baby cries in hunger she/he is fed, when a child is upset she/he is comforted, when she/he is frightened she is made feel secure.
Infants communicate their needs by sounds, eye contact and movement and an attuned caregiver will learn the signs. A common example is when a child cries we adults tend to look atthem and go ‘there, there...its ok.’, using a particular tone of voice a facial expression that also tells the child we ‘see’ and ‘hear’ and ‘know’ their distress. We then respond to the need for food, a clean nappy, to be held, or explore a medical issue ie ear infection. Chronic mis-attunement is often part of the experience in the development of complex trauma.
Chronically traumatised children can struggle to identify and communicate their feelings. They may lack a sense of agency regarding their own internal experience and their ability to influence the world around them (Cook et al. 2005). The resulting helplessness can lead to excessive clinginess, excessive anxiety, internally or externally directed aggression and dissociation.
Developmental trauma occurs when a child’s development is compromised enough. Be that physically emotionally, intellectually, educationally or socially. It is often evident within the context of multiple forms of trauma. Adaptations to trauma are influenced by a Childs developmental age and stage.
Developmental delay is often associated with childhood maltreatment, leading to potential impaired cognitive functioning and learning difficulties . Research suggests that the need for chronically traumatised children to focus on survival through avoiding or being over-reliant on caregiver relationships and becoming hyper-vigilant towards potential threats leads to structural changes in brain development, impacting later on attention, learning and memory capacities.
During the first two years, children develop important cognitive capacities such as symbolism, the beginnings of language and autobiographical self-awareness (i.e. self which is aware of being a subject who has knowledge and can act upon the world). These capacities develop further during the third and fourth years to include consistent schemas of the self and others over time, the ability to differentiate between emotions/intentions and impulses/actions, and the capacity to anticipate future occurrences by integrating new information with past experience.
Chronic traumatisation during these developmental stages may lead to the faulty categorisation of information where almost all stimuli and experiences are interpreted as potentially traumatic and responded to accordingly (van der Kolk and Courtois 2005). Curiosity is therefore restricted and learning inhibited. This may result in over-developed memory for traumatic events and deficits in "attention, hypothesis testing, problem solving, semantic organisation and short-term and delayed semantic memory" The cognitive capacities necessary for an integrated, continuous sense of self may also be impaired.
Attachment Therapy
What is important in understanding attachment theory and patters is that regardless of the attachment style that an infant or child develops, attachment influences a person’s life long tendencies for relationships. This does not mean that childhood has to be perfect or that every disconnection with a parent leads to trauma. Minor disconnects (ruptures) happen all the time including in loving relationships. Whats important is that if there is a rupture in relationship between caregiver and child that there is also an opportunity for emotional repair.
What is also important to know is that we are able to rewire our neural pathways and many adults are able to develop what is known as an ‘earned secure attachment’ through counselling and psychotherapy with a therapist who understands attachment styles and patterns.
The goal of attachment therapy is supporting you in having the developmental experiences that you needed, but lacked, in childhood. Therapy can be an environment that allows you to foster s secure attachment. The first ingredient then is to find a secure base.
Working with a therapist who understands attachment theory can help us to understand the unique ways in which we coped with the challenges experienced in our family of origin. A therapist can also support us in understanding the underlying unmet needs that caused us to adapt our attachment the first place.When we have awareness of the ways we attempted to cope and get our needs met in our family growing up we can start to work with some of the emotional difficulties and fixed patterns that may be causing a us distress in our lives now. Your therapist will work with you to provide a secure and consistent relationship that supports you in learning alternative ways to get your emotional attachment needs met as well as skills that can support you in regulation emotions and communicating effectively in relationship.
If you are seeking attachment counselling in Brisbane for attachment challenges or developmental trauma please book a session HERE. Natajsa Wagner is a Clinical psychotherapist providing trauma informed psychotherapy and counselling in Brisbane. Natajsa's approach is deeply human and she works to recognise the wisdom inherent in all human beings. She is a passionate about seeing people as more than their "pathology" and advocates for clinicians look beyond a person's challenges or symptoms and begin to recognise the tremendous courage and resilience of the human spirit to cope with life's experiences.