Attachment in Psychotherapy

As we grow, our brains and minds adapt to our social and physical circumstances with the expressed purpose of optimizing our chances of survival. This means, among other things, that we attune to those around us and learn what to feel and not to feel. We also learn what to be aware of and what should be excluded from consciousness, and how to behave with and towards others. The central question is whether others are a source of safety or danger, comfort or anxiety. The way we behave based on the accumulation of these experiences is what shapes our attachment schema. Attachment exists on a spectrum; if you were fortunate enough to have grown up with at least one loving adult who made you feel consistently safe, then you likely developed a secure attachment with them.  

Clients who come to therapy with the ability to develop these types of secure attachments are able to use us to regulate their anxiety. Given the client already has experience with the ebbs and flows of a consistent and comforting relationship, they have an easier time connecting and regulating their emotions in the presence of the therapist. Thus, securely attached people are typically easier to soothe and more eager to participate in a therapeutic relationship. But what  happens with clients who are insecurely attached? 

Clients with insecure attachment may be sitting in the same seat with the same issues and even saying the same words, but they are watching the therapist from the other side of a protective screen. They established these defenses long ago to protect themselves from the pain and disappointment of a lack of availability, care, and emotional attunement from those upon who they depended. 

The big question…how do you help someone who is insecurely attached to develop a secure attachment with you? And how do you overwrite the memories of early negative experiences with a new set of experiences based on your abilities to be consistent, present, and attuned? Wouldn’t it be great if there were a simple and straightforward manual for that! The reality is that there is no one course of action that suits everyone, but the reparenting that can take place in therapy has proven effective at supporting the development of secure attachments and enhancing personal growth.  

Just like parenting the first time, reparenting can be long and difficult, with many bumps along the way. It takes patience, consistency, and emotional regulation on the part of the therapist. Often times the client will attempt to instigate a familiar reaction (unconsciously of course) in an effort to get you to respond to them the way their parents did, thus reinforcing the cycle that is most comfortable to them. If they expect rejection, they may make themselves worthy of rejection by acting out, being critical of you, missing sessions, and “forgetting” to pay their bill. If they expect to have their boundaries violated by being seduced, they will make themselves available for violation, act seductively, and become angry whether you do or don’t live up to their expectations. In a sense, the client’s job is to take you hostage into their past pain, and it is yourjob is to elude capture, while naming what is happening, and remaining supportive in the process. Thinking in terms of these three steps may be helpful:

Step One: Become the attachment figure they didn’t have: 

You have to be the parent they needed but didn’t receive – someone who is present, stays attuned to them, and respects their perspective. The goal of this is to get to the point in the relationship where the client realizes that they continue to use their defenses even though they are no longer necessary – Carl Rogers was great at this. 

Step Two: Encourage them to grieve the parenting they never received:

When a true connection is established, there is often the emergence of sadness and grief. These emotions are in reaction to having not gotten what they needed as a child and to the realization that their defensive reactions have kept them from getting these things in adulthood. This grief  should be attuned to, encouraged, and given the respect it deserves.  As time passes, you should encourage clients to begin experiments in new ways of connecting with others.  Remind them from time to time that grief is a stage to go through, not a lifestyle. This is not an emotional state that you want them to become trapped in.

Step Three: Experiment with new behaviors:

The neural reshaping process occurs during experiments in living after new ways of connecting and interacting with others are discussed and planned for. Each client with insecure attachment histories will have a long list of past experiences with negative outcomes. The first stage is to stop doing the things that don’t work. As they experiment with new behaviors, therapy becomes the crucible for planning and post hoc analysis of new forms of interacting. The biggest challenges that you can help clients with are their faulty and shame based thoughts, emotions, and behaviors. The second is to help clients deal with the anxiety of taking on the experiments and working with techniques for stress reduction, such as meditation, yoga, or whatever means they can to down-regulate amygdala activation.

When working with clients who are struggling with insecure attachment, it’s helpful to think of insecure attachment not as a form of resistance, but rather as a previously adaptive post-traumatic memory. This makes it easier to for the client to not feel shamed when they struggle with new ways of being. Their actions reflect deeply conditioned thoughts, emotions, and behaviors about who and what they are and what they deserve. All of us act out the roles we played  during childhood until we are able to exhaust this maladaptive narrative and move on to a new way of thinking about ourselves and others.