Attachment, Trauma, and Life Stories in EMDR Therapy

ATTACHMENT

RELATED TRAUMA

AND EMDR

Patterns of Insecure

Attachment

Sandi Richman

ATTACHMENT



Adult attachment classification can be an

important aspect of case formulation



Attachment literature suggests in the context

of the AIP model that patterns of attachment

shaped in early caregiver experiences

influence all later adaptive and maladaptive

coping responses



Daniel Siegel (2010) :  The best predictor of a

child’s security of attachment is how his/her

parents 

made sense

 of their own childhood

experiences



By asking certain kinds of autobiographical

questions, we can discover how people have

made sense of their past



Each individual’s life story is defined by :



The way we feel about the past



Our understanding of why people behaved as

they did



The impact of those events on our development

into adulthood



This internal narrative may be limiting an individual

in the present.



Parents who had a rough childhood and

were unable to make sense of what

happened would be likely to pass on that

harshness to their own children who would in

turn pass on this legacy to the next

generation



Parents who had a tough time in childhood

but did make sense of those experiences

were found to have children who were

securely attached to them : they had

stopped handing down the family legacy of

insecure attachment



When taking a history, how an adult tells his or

her story can be revealing



Securely attached people acknowledge

both positive and negative aspects of family

experiences



Securely attached people can give a

coherent

 account of their past and how they

came to be who they are as adults



In contrast, people who had challenging

childhood experiences often have a life

narrative that is 

incoherent



We can change our lives by developing a

“coherent” narrative even if we did not start out with

one



Through EMDR treatment, and the AIP model, our

clients who had difficult experiences early in life find

a way to make sense of how those experiences have

affected them and their current responses



Through analysis of questioning in the Adult

Attachment Interview, the AAI questions reveal an

‘adult state of mind’ with respect to attachment



A child’s attachment behaviour in childhood

predicted the type of narrative developed as an

adult

ADULT NARRATIVE



Secure



Dismissing



Preoccupied



Unresolved/Dis-

organised

   INFANT STRANGE

SITUATION BEHAVIOUR



Secure



Avoidant



Ambivalent



Disorganised/Dis-

oriented

SECURE NARRATIVE

My Dad struggled to get a job and support us.

He was irritable and often shouted at us.  I

didn’t feel close to him but my Mom helped me

to understand how painful his situation was for

us all.  As I got older I felt sympathy for him, got

over my anger and had a much closer

relationship with him.  It is easy for me to

become emotionally close to others.   I am

comfortable depending on others and having

others depend on me.   I don’t worry about

being alone or having others not accept me.

DISMISSING NARRATIVE

My childhood was fine.  My Dad was an accountant

and my mother was an excellent normal mother.   I

had a normal childhood.

In answer to specific questions, answers with ‘I don’t

remember’  (cannot give details)

I am comfortable without close emotional

relationships.  I like being on my own.  It is very

important for me to feel independent and self-

sufficient, and I prefer not to depend on others or

have others depend on me.

Or ‘my parents were excellent parents.  What’s all

this got to do with the RTA?’

PREOCCUPIED NARRATIVE

My father was mad.   He didn’t like me.

He’d always say ‘don’t ever talk to me that

way again’.  And Mummy never said

‘don’t’ to him.  (Talking as if parents were

actually present).

I want emotionally close relationships, but I

find it difficult to trust others completely, or

to depend on them.  I worry that I will be

hurt if I allow myself to become too close to

others.

PREOCCUPIED NARRATIVE

OR

I want to be completely emotionally

intimate with others, but I often find that

others are reluctant to get as close as I

would like.  I am not comfortable being

without close relationships, but I sometimes

worry that others don’t value me as much

as I value them.   I find it intolerable when

people let me down.

UNRESOLVED/DISORGANISED

NARRATIVE

At times I fall apart, so I can’t depend on

myself.  My child drives me crazy.  I flip out

whenever he gets upset.  I feel like I m

falling apart when he resists me.  I feel like I

become at first frightened and frozen, and

then I’m afraid something will snap and I’ll

scream or worse, I’ll hit him.   I feel like I am

losing my mind.  Sometimes I just get stuck

and I’m unable to move.

UNRESOLVED/DISORGANISED

NARRATIVE

My Dad was scary.   If I didn’t eat all my

food he would scream at me and banish

me to my room.  Sometimes he would hit

me with his belt.  His face was very

frightening when he was like that.  Then

later, he would come to my room and get

into my bed and hold me and tell me he

loved me.  And I felt very good and safe in

his arms.



Secure/Autonomous Attachment

Free to connect, explore and reflect



Avoidant/Dismissive Attachment

Not-so-splendid isolation



Ambivalent/Preoccupied Attachment

No room for a mind of one’s own



Disorganised/Unresolved Attachment

Scars of trauma and loss



Secure Attachment



Affective competence



Feeling and dealing 

(while relating)



Capable of auto- and interactive

regulation



‘I’m OK’



Insecure Dismissive (Avoidant)

Attachment



Not Feeling but Dealing



‘Goes on automatic’, eradicating feelings

in order to cope.



Less capable of interactive regulation



I’m FINE, Really!’



Insecure Preoccupied

(Ambivalent/Resistant) Attachment



Feeling but Not Dealing



Being overwhelmed with feeling and

unable to cope



Capable of interactive regulation but not

easily soothed



Less capable of auto-regulation



‘I’m dying, help!’



Disorganised Attachment



Not Feeling and Not Dealing



Alternates between hyper- and hypoaroual



Not capable of auto- or interactive

regulation



‘I’m not sure’



Research on attachment offers a

powerful tool



But, each person is a one-of-a-kind



Honouring uniqueness is essential



But when we can ‘name it we can tame

it’!

POSSIBLE PROBLEMS

CREATED BY

ATTACHMENT

PATTERNS IN EMDR

PROTOCOL



SECURE 

clients communicate



Truthfully and succinctly while remaining

relevant



Talk thoughtfully and with vivid affect



Are capable, even when absorbed in

strong feeling, of staying connected



Are mindful of the purpose of history taking



Therapist feels connected with client and

optimistic about treatment



DISMISSIVE 

clients :



Have a hard time being coherent and

collaborative



Have trouble being truthful, often failing to

support, and may contradict, what they

assert



Are over succinct



‘Don’t remember’ attachment-related

experiences or needs for connection



DISMISSIVE

 clients



Often have little to say about the difficulties

that bring them to therapy



The past does not influence the present



Don’t need others for anything



Often come to therapy because partner

thinks they have a problem



Cannot describe any situation from before

turning, say, 15



DISMISSIVE 

clients :



Express discomfort with history-taking



Therapist feels frustrated as taking a history

feel like pulling teeth and case

conceptualisation becomes very difficult



PREOCCUPIED 

clients :



May be truthful but are rarely succinct



When asked about family patterns, they

seem to unravel and become tangential



May start to describe past situation and slip

into what happened last week



Can easily become emotional and

overwhelmed during history taking



PREOCCUPIED

 clients:



Become preoccupied during history taking



Suddenly the adult tone shifts into a

desperately unhappy forlorn little boy



Therapist feels swamped by client’s

emotional responses during history taking



DISORGANISED

 clients, during history

taking :



May demonstrate sudden changes in

speech



Or fall silent for 2 minutes in mid-sentence

and then continue on an unrelated topic



May give extreme attention to details

surrounding loss



Indicate that a deceased  individual is

simultaneously dead and alive



DISORGANISED

 clients



May place the timing of an event, i.e. death, at

several widely separated periods



May indicate that they were responsible for the

loss where no material cause is present



May claim to have been absent at time of a

traumatic event and then a bit later claim to

have been present



May describe an extremely traumatic event in

flat tone and eerie detachment, when 5

minutes previously the client had been

engaged and  emotionally available



DISORGANISED

 client



Therapist feels fragmented and unable to get

a clear picture of client’s history



Case conceptualisation becomes a

challenge!



Creating a relationship in which the client can

feel safe becomes a lengthy and fraught

process



SECURE

 clients :



Can engage in the Safe Place exercise with

ease



Generally do not need resource installation

exercises as they are resilient enough



Can collaboratively select targets for EMDR

processing with therapist



DISMISSIVE

 clients :



Generally reject Safe Place and RDI

exercises



Cannot self soothe



Don’t allow anything ‘good’ to come their

way from the therapist



SP and RDI can lead to internal

physiological distress or client reports no

observable response



DISMISSIVE

 clients



Are either devaluing of resource work



Or idealising



Or controlling



Target selection is thwarted by the client

‘not remembering’ any disturbance from

the past



Therapist works hard to identify possible

memories for targeting which are rejected

as not eliciting any emotion by the client



PREOCCUPIED 

 clients



Can work with Safe Place and RDI



But choose a Safe Place with someone else

looking after them



May become overwhelmed with sadness in their

SP (I never got to feel this sense of security with

my mother)



Target selection becomes a challenge as too

many memories of insecurity and cannot

choose a touchstone event



Present and past become entangled in target

selection



DISORGANISED 

clients



Require lengthy preparation



Could easily dissociate whilst doing the SP

and RDI exercises



If one ego states becomes relaxed in the

SP, sabotaging or frightened parts could be

in conflict



RDI with unprepared ego states could also

lead to conflict with other ego states



DISORGANISED

 clients



find target selection a huge challenge



Identifying certain targeted memories

could destabilise ego states which are using

denial as a way of coping



Targets may also be relevant to one ego

state and completely irrelevant to another

ego state



SECURE

 clients



Have little or no problem with identifying

the different elements comprising the basic

protocol



Are completely able to collaboratively

identify the elements of the disturbing event

with the therapist



DISMISSIVE 

clients



May thwart therapist’s attempts to find a

positive cognition



Similarly, the negative cognition never quite

captures the feeling state



No negative cognition is ‘good enough’



As these clients ‘dismiss’ emotion, no NC will

be acceptable, given that the NC is

elicited to access the emotion inherent in

the event



DISMISSIVE 

clients



Identifying the elements of the Assessment

Phase and basic protocol could become a

power struggle with the client



PC may be given a VOC of 7



Wording used to elicit the NC could be a

source of conflict and opposition



Therapist could end up feeling quite

beleaguered



Body sensation completely dismissed



PREOCCUPIED 

clients



Could find it hard to settle on one NC and

one PC



NC may spark a distressing feeling state, re-

associating the client to the traumatic

event too intensely leading to activation of

dissociative defences



Identifying the NC may be interpreted by

client as the therapist abandoning them



SUDs are often 20+ !



DISORGANISED

 clients



Identifying the baseline information in the

Assessment Phase can trigger dissociation



Elements of Assessment Phase for one

target may be very different for different

ego states



Could go into a trance or become terrified



SECURE 

clients



Can usually process distressing material,

thoughtfully, with appropriate emotions

and physical sensations, making adaptive

links



Need limited intervention from the therapist

in the form of therapeutic interweaves to

reach adaptive resolution



DISMISSIVE 

clients



May struggle to get into a mindful state



Answer ‘nothing’ to therapist’s question ; What

do you notice now?  Or ‘I’m just watching your

fingers go back and forth’



Need to be told exactly what they are

‘supposed’ to do



‘I’m wondering if this is working



‘Isn’t your arm getting tired?’



‘This seems like a waste of time’



DISMISSIVE 

clients



If they access emotion, dismiss it : ‘well, isn’t

that normal?’



‘No I’m not doing well, I never have’



Feedback very limited and brief



Therapist not sure the material is processing



SUDs do not decrease as little emotion is

processed



PREOCCUPIED 

clients



Need constant reassurance and comfort of

closeness



Have chronically incomplete sessions



Often get stuck with high levels of emotion

which does not resolve



Move from one distressing incident/memory

to the next without making adaptive links



High emotion may be a way of getting the

therapist to intervene to take care of them



PREOCCUPIED 

clients



May process in a very detailed, tangential

and fragmented way



Channels can slip from past to present with

little coherence



Can become overwhelmed and helpless

without resolution, and little adaptive

response to cognitive interweaves offered

by therapist



Endless processing with little resolution



DISORGANISED

 clients



Processing is just that, disorganised



Primary, secondary and tertiary dissociation

to be expected



Therapist needs to work very hard to keep

the client connected to present safety



Expect dissociation, projective identification

and counter-transference



EMDR is so much more than an

evidenced-based treatment for PTSD.



The AIP Model explains why.



Research and particularly ‘practice

based’ research indicates that EMDR

brings about symptom relief in a great

number of distressing conditions



EMDR not only brings about ‘state’

changes but also ‘trait’ changes



AIP has much in common with Bowlby’s

Internal Working Model



Both assert that early experiences drive

perceptions and responses later in life



Bowlby stated that the child’s early

experiences with attachment figures

determined the child’s Internal Working

Model, i.e. core beliefs about self, others

and the world



No all-encompassing diagnosis for adults

affected by severe attachment-related

trauma



Attachment disorganization in adults is

identified by disorientation, poor logic and

extreme behavioural effects related to

caregiver abuse or major loss



‘Complex Trauma’ is not a formal diagnosis



 But outlines the complexity and severity of

symptoms in adults suffering from chronic

abuse by attachment figures



Can EMDR treatment focussing on early

attachment-related trauma change the

attachment status in the affected adult or

child?



If EMDR can successfully reprocess mal-

adaptively stored distressing memories and

create new adaptive associations in the

brain, then targeting early attachment-

related memories with EMDR should have a

positive impact on the individual’s Internal

Working Model



Thus, improvement of attachment status

through EMDR treatment should



 help adult clients to function more

adaptively in relationships



and respond more sensitively to their

children



3 case studies illustrating pre- and post- EMDR

adult attachment status as measured by the AAI

(Adult Attachment Interview)



All 3 categorised with an insecure or disorganized

attachment status at pre-treatment



Mood and anxiety symptoms related to problems

in current marital and family relationships



Received 10 – 15 EMDR sessions utilising all 8

phases



Following EMDR treatment, all made positive

changes in attachment status



Describes a method of using EMDR to repair

maternal-infant bonding failures



Case of a mother of a 5 year old girl who

reported only negative emotions re her

experience of being a mother : ‘She drains

me, she’s a pest’



Early negative bonding experiences identified



Standard EMDR protocol used to desensitize

and process these experiences



Mother reported only positive feelings towards

daughter

CASE : ANNIE



30 year old woman with extreme anxiety about 8 month old

baby.   Worries about the baby stopping breathing, that the

baby will die and it will be her fault.   Feels she is a terrible

mother.   She has found the last 8 months ‘too much’ and at

times wishes she was not around.



After 5 EMDR sessions says :

“I am so much more positive now and have gained a much

clearer sense of who I am, and importantly of how my

interactions with the world are shaped.   I know I’m an OK

mom, I’m a good enough partner, and if I think I’m not, I really

know why I think this.   I feel so good about sharing my

daughter’s ups and downs with her and just being there for her

in a way I never thought was possible”

Sent a picture of baby with card saying 

“

We

 are both doing

very well these days

!”



Recent studies provide preliminary

evidence that clients who lack adequate

emotional regulation skills and social

supports can, with support and

preparation, and EMDR treatment :



Resolve attachment injuries



Improve attachment status



Improve emotional stability



Improve present day relationships



More randomized controlled studies are

needed to evaluate changes following EMDR

in adults and children who have experienced

early relational trauma



Wesselman (2012) indicates that more

research is needed to examine effects of

EMDR on



Attachment status



Relationship stability



Emotional regulation, self-concept, beliefs and

expectations



And Interpersonal behaviours and functioning

EFFECTIVENESS OF EMDR ON

ATTACHMENT SECURITY



Wesselman :

“If continued research finds EMDR an

effective method for improving

attachment status, it seems reasonable

to expect that change in attachment

status in parents may increase

attachment 

security and organization

in their children.”

CASE :  ADAM



2

nd

 of 4 children



When 3 sent with sister and brother to live with

grandmother in Glasgow as parents couldn’t cope



8 years taken with sister and brother to London (not told

where going) to a home for boys and girls



Suffered physical, verbal and sexual abuse



Doesn’t feel much about his experience and ‘just got

on with it’



Became a successful lawyer



Has difficulty in relationships with women.   Started a

new relationship and really wants to make this one last

ADAM



Abandoned by parents



Attached to grandmother but she abandoned

the children by sending them to a home



Avoidant/dismissive attachment style



Secondary and some tertiary dissociation



Has black rages with women



Target :  Rejection by teenage son 

NC :I’m invisible



Floatback : 

Waiting (over 3 hours) for father to

collect him and brother and Kings Cross Station

11years

ADAM



Incredulity  ……. Just waiting



Waiting.   Looking at that boy.   How strange they

look.   Dressed in horrible thick short trousers and

grey scratchy shirts and big badly fitting boots



They look hopeless.   No life about them

Therapist : ‘Sitting in this chair, the adult you are

today, can you just look at that child’



Yes

Therapist : ‘Just see this child, just notice whatever

you see  

(BLS)



I can’t look at that child.   Pathetic!

Therapist : ‘What’s good about not looking at that

child?’

ADAM



I don’t have to see his fear, I don’t want to

see his fear  (BLS)



Well, I can look at him now’

Therapist : ‘When you look at the child, can you

see the child’s feelings?’



He doesn’t have feelings, he’s not looking at

me.  (BLS)



He’s not looking, not communicating (BLS)



He’s not anxious to connect at all, he’s just

closed  (BLS)

ADAM



Not anxious at all if he is collected or not, so what

(BLS)   So what.   

Voice is distant, a monotone

Therapist asks the client to come back to the room

(CIPOS)  (BLS)    ‘Come back to the room, We’ll get back

to that boy at the station is a minute.   But right now come

back out of it to the room’  (BLS, bringing him back into

therapy room)

‘OK, when you’re ready, close your eyes and just be

drawn back to the boy at the station again.   But let

yourself be sure to stay partly here.   Just look at that child,

that boy, just see and notice whatever you see (BLS)



I feel irritated with him, I can’t understand why he

does not ask someone, find out what’s happening

(BLS)

ADAM



Feeling twitchy

Therapist invites client to come back to present

safety, then back to the child.   ‘Just look at that

child.   Is there anything that you know as an adult,

that would be helpful to that child?’



(long pause)  I don’t know, I don’t know how to

comfort him, to get in.   I can’t look at him.

Therapist : ‘What’s good about not looking at him?’



I can’t bear his loneliness, his hopelessness (BLS)



I feel sad for that boy …. (becomes a bit tearful)

(BLS)

ADAM

Therapist : When you see this child, if you could go back

in time, the man you are today, and go to that boy

and tell him something that would help him with his

sadness, something you know that he doesn’t know,

that would really help him, what would you say to him?’



I could tell him he deserves better.   That he will be

OK  (BLS)

Therapist : Do you think that boy has it rough?’



Yes, yes, I do think he has it rough  (BLS)

Therapist: When you look at this boy, how do you feel

about him when you think of this?’



I feel sad for him because he has no-one taking care

of him  (BLS)

ADAM



He has good reason to feel frightened, even angry

(BLS)



I would never treat my boy, my son like that (BLS)

Tearful.

In this way, the therapist assists the client in

strengthening the part of the self that is oriented to

present reality, and then assists that present-oriented

ego state in witnessing the painful affect held in a

dissociated child ego state.   Often the affect within

a child ego state has never been compassionately

observed, either by another person, or by another

part of the self within the personality system