Understanding Attachment, Trauma, and Life Stories in EMDR Therapy
Explore the impact of attachment-related trauma on adult attachment classifications, the significance of life stories in shaping our present, and how EMDR therapy helps individuals make sense of challenging childhood experiences to create a coherent narrative for healing and growth.
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ATTACHMENT RELATED TRAUMA AND EMDR Patterns of Insecure Attachment Sandi Richman
ATTACHMENT CLASSIFICATION 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
LIFE STORIES 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.
LIFE STORIES 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
LIFE STORIES 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
LIFE STORIES 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
CORRESPONDENCE OF ADULT AND CHILD ATTACHMENT INFANT STRANGE SITUATION BEHAVIOUR ADULT NARRATIVE Secure Dismissing Preoccupied Unresolved/Dis- organised 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.
DAVID WALLIN, 2007 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
DIANA FOSHA, 2000 Secure Attachment Affective competence Feeling and dealing (while relating) Capable of auto- and interactive regulation I m OK
DIANA FOSHA, 2000 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!
DIANA FOSHA, 2000 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!
DIANA FOSHA, 2000 Disorganised Attachment Not Feeling and Not Dealing Alternates between hyper- and hypoaroual Not capable of auto- or interactive regulation I m not sure
ATTACHMENT CATEGORIES 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
HISTORY TAKING : CLIENT S COMMUNICATION 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
HISTORY TAKING 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
HISTORY TAKING 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
HISTORY TAKING DISMISSIVE clients : Express discomfort with history-taking Therapist feels frustrated as taking a history feel like pulling teeth and case conceptualisation becomes very difficult
HISTORY TAKING 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
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
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
HISTORY TAKING 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
HISTORY TAKING 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
PREPARATION PHASE 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
PREPARATION PHASE 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
PREPARATION PHASE 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
PREPARATION PHASE 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
PREPARATION PHASE 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
PREPARATION PHASE 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
ASSESSMENT PHASE 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
ASSESSMENT PHASE 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
ASSESSMENT PHASE 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
ASSESSMENT PHASE 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+ !
ASSESSMENT PHASE 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
PROCESSING 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
PROCESSING 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
PROCESSING 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
PROCESSING 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
PROCESSING 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
PROCESSING 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 / AIP MODEL 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 and INTERNAL WORKING MODEL 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
DIAGNOSIS : ATTACHMENT 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
