This quarter POI focuses on the relationship between attachment, trauma and dissociation with a selection of recent publications. Note that the first two articles on the list are available free to members. I hope you enjoy reading this. If you have any ideas for themes for POI make sure you let me know at firstname.lastname@example.org.
Sachs, Adah (2019) Attachment as a Second Language: Treating Active Dissociative Identity Disorder. Frontiers in the Psychotherapy of Trauma and Dissociation, 3(1):107–122.
Available to ISSTD Members on the Member Resources page in ISSTDWorld.
Evidence is accumulating (Brand, Classen, McNary, & Zaveri, 2009, Brand, Loewenstein, & Spiegel, 2014; Brand et al., 2013; Brand et al., 2012; Dorahy et al., 2014) to show that by and large, Dissociative Identity Disorder (DID) is well amenable to psychotherapeutic intervention along the lines of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for treatment of DID in adults (ISSTD, 2011), based on the Three Phase Approach (Van der Hart, Nĳenhuis, & Steele, 2006). In this paper, however, I would like to draw our attention to those cases where improvement is not reached, despite high-quality, dedicated therapeutic efforts. I refer particularly to patients with Active DID (Sachs, 2013c, 2017): patients who remain persistently victimized and apparently unable to establish even the most basic safety needed for the therapeutic process (“phase one” of the threephase approach). I suggest that the therapeutic problem in these cases may lie in mis-attunement (Stern, 1998) between the therapist’s and the patient’s attachment language; and that this mis-attunement is due to a uniquely disordered attachment-pattern which characterises people with Active DID. I thus propose that, in these cases, phase one needs to be substantially modified and focus on therapeutic attunement rather than on safety. “Attachment as a second language” is proposed for treating people with persistent (“Active”) DID, while considering the clinical, theoretical and practical aspects of this therapeutic approach.
Forner, Christine (2019). Mindful Attachment: An Organic Way to Work with Children who have been through Complex Trauma and Neglect. Frontiers in the Psychotherapy of Trauma and Dissociation, 3(1):91–106.
Available to ISSTD Members on the Member Resources page in ISSTDWorld.
Small children, due to development limitations, use nonverbal communication over verbal communication, especially when they have experienced traumatic events. As more advanced verbal communication takes years to develop, most children rely on their first language of sensations, movement and emotions when communicating to and with others. This creates obvious challenges when many therapeutic modalities heavily rely on verbal communication. By examining mindfulness from a human bonding lens, one can understand that there are many functions of mindfulness that are better understood from a neurobiological affect-regulation perspective than from a simple relaxation stance. By translating what is known about mindfulness into the realm of attachment, human bonding and care for our young, we can understand that mindfulness can also be seen as a skill involved in social engagement. This skill can then be utilized to effectively work with traumatized infants and small children. Mindful Attachment is intended to bridge the gap between nonverbal and verbal expression in order to help childrenthrough overwhelming and traumatic events.
Lillian Wieder & Devin B. Terhune (2019) Trauma and anxious attachment influence the relationship between suggestibility and dissociation: a moderated-moderation analysis, Cognitive Neuropsychiatry, 24:3, 191-207. DOI: 10.1080/13546805.2019.1606705
Introduction: Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterised by superior imagination. Methods: This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility. Results: In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model. Conclusions: These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.
Ringel, Shoshana (2019) Developmental trauma and unresolved loss in the Adult Attachment Interview, Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 13(1), pp. 1-14. https://www.ingentaconnect.com/content/phoenix/at
This article describes attachment perspectives on unresolved loss and dissociation beginning with Bowlby’s conceptualisation of grief and bereavement, and subsequent discussion of unresolved/traumatic loss on the Adult Attachment Interview (AAI). An AAI selected by the author will be utilised to show how traumatic factors in the speaker’s childhood, including sexual abuse and maternal neglect and rejection, may result in an unresolved, complicated grief process. The author intends to illuminate the implications of early trauma and subsequent loss on one’s sense of self and relational life, and to suggest an integrative treatment model that would address early traumatic experience and subsequent bereavement.
Epstein, Orit Badouk (2019). “The most tender place in my heart is for strangers”: sexual addiction, the fear system, and dissociation through an attachment lens. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 13(1), pp. 43-60. https://www.ingentaconnect.com/content/phoenix/at
Sexual assault and other forms of abuse on a young child and its psychological aftermath cascades down through the decades of a person’s life. Apart from shattering the mind and sense of selfhood, it later manifests in what we would consider as the client’s repetitive, reckless, and self-harming behaviour. When working with clients with complex trauma, we soon learn that paradoxically these harmful ways carry meaning and make sense within the context of the child having spent the majority of their time with an abusive, frightening, and unpredictable attachment figure I named “scaregiver” (Badouk Epstein, 2015). Fran, a survivor of familial organised abuse, was diagnosed with Dissociative Identity Disorder (DID). She had many parts, some suicidal, some had an eating disorder, some parts were disabled and others very capable. This paper focuses on Fran’s sexual part and consequently her sex addiction. While still in recovery, the secure base and the relational journey which we embarked upon demonstrate how a non-pathologising and non-objectifying approach to the client’s many attachment cries eventually paved the way towards the growth of a sense of safety, intersubjectivity, and the abandonment of her sex addiction.
Mikami, Kenichi (2019). Using the DMM–AAI to overcome ruptures in therapeutic alliance. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 13(1), pp. 64-80. https://www.ingentaconnect.com/content/phoenix/at
This article discusses a university counselling case in which an Adult Attachment Interview based on the Dynamic-Maturational Model of Attachment and Adaptation (DMM–AAI), was used to overcome ruptures in a therapeutic alliance. A female client in her thirties came to see the counsellor to change her workaholic lifestyle; however, she soon developed erotic transference towards the counsellor. Because of countertransference, the counsellor proposed termination too early which she almost accepted due to her difficulty in reflecting on her past, and the alliance was ruptured. However, the administration of the DMM–AAI allowed the client to gain awareness of the reason for her seeking to terminate her counselling early; that is, a fear of losing her counsellor, which she realised had been a recurring fear in her past relationships. It also allowed the counsellor to renew his empathy towards the client. The present article discusses the effects and features of the DMM–AAI that made it possible to overcome the ruptures in the therapeutic alliance and proposes that it would be interesting to explore how its use during the therapeutic process can facilitate reflective processes in both client and clinician, particularly when the therapeutic alliance is at risk.
Berry, K., Fleming, P.,Wong, S & Bucci, S. (2018). Associations between Trauma, Dissociation, Adult Attachment and Proneness to Hallucinations. Behavioural and Cognitive Psychotherapy Volume 46 (3), pp. 292-301. DOI:10.1017/S1352465817000716
Background: Childhood adversity, dissociation and adult attachment have all been implicated in the development of hallucinations or ‘voice-hearing’. Testing psychological models in relation to subclinical phenomena, such as proneness to hallucinations in non-clinical samples, provides a convenient methodology to develop understanding of the processes and mechanisms underlying clinical symptoms. Aims: This paper investigates the relative contribution of childhood adversity, dissociation and adult attachment in explaining hallucination proneness in a non-clinical sample. Methods: Students and staff with no previous contact with secondary care at the University of Manchester were recruited. Participants completed a series of self-report measures: the Launay‒Slade Hallucination Scale (LSHS), the Relationship Scale Questionnaire (RSQ), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Schedule (DES II) and the Positive and Negative Affect Schedule (PANAS). Results: As hypothesized, insecure attachment, childhood adversity and dissociative symptoms were correlated with hallucination proneness. Multiple regression analysis, controlling for confounds of age and negative affect, indicated that the RSQ, CTQ and DES II predicted hallucination proneness. Only DES II and RSQ avoidant attachment were significant independent predictors in the final model. Conclusions: This study provides further evidence to support the idea that attachment and dissociation are important psychological mechanisms involved in voice-hearing proneness. Further testing is required with a clinical population.