|
While I include feminist, existential, and client-centered thinking in my approach to the work of therapy, my focus is on the role of unconscious forces in an individual’s response to trauma. My belief is that all of us experience trauma, even if the worst thing we have experienced was simply the painful separation of birth itself. I believe that the ultimate goal of therapy is the removal of all obstacles to the processing of the emotions that are locked inside the body, whether these have arisen as an adult, perhaps due to systemic causes, or in early childhood, as a result of attachment trauma.
A vast majority of presenting problems in therapy can be traced back to - or can have some active component involving – attachment issues. Anxiety provoking emotional states are created in us as children when we experience obstacles to our innate desire to bond to a primary caregiver (Abbass, 2015). As adults we bring this early formation of expectation for other’s behaviour to our relationships; it informs how we view ourselves and also the form and expression of any psychological problems we might experience (Kernberg, 1980). While many of the strategies and coping mechanisms we develop in response to our early attachment experiences originally function as the best available option for survival when we are young, they can become the prime source of psychological suffering as we become adults (Abbass, 2015). They can cause somatic disturbances (Abbass, 2015), anxiety, depression, personality disorders (Abbass, Town, & Driessen, 2012), and interpersonal problems (Solbakken & Abbass, 2015). It is important to be clear that this is automatic and unconscious behaviour, not something we are actively choosing to do. Psychodynamic theory understands the unconscious as having a major role in internal conflict and pathology and maintains that a resolution can be achieved through the therapeutic encounter - through two equally meaningful presences in the room who both share a commitment to addressing the anxiety, defenses, resistance, and complex feelings that arise during the work of therapy. ISTDP therapy (Davanloo, 1990, 2000), focused as it is on attachment and an individual’s unconscious reactions to it, can facilitate an understanding of and healing from what often remains hidden from view because of the general focus we tend to otherwise have on dealing with symptoms rather than dealing with their causes. It makes sense that getting to the roots is the only way to ensure the weeds you want removed from your garden cannot return. Abbass, A. (2015). Reaching Through Resistance. Seven Leaves Press: Kansas City, MO. Abbass, A., Town, J. M., & Driessen, E. (2012). Intensive short-term dynamic psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 20 (2), 97-108. doi: 10.3109/10673229.2012.677347 Davanloo, H. (1990). Unlocking the Unconscious: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. Kernberg, O. (1980). Internal World and External Reality. Aronson: New York, NY. Solbakken, O. A. & Abbass, A. (2015). Intensive short-term dynamic residential treatment program for patients with treatment-resistant disorders. Journal of Affective Disorders, 181, 67–77. doi: 10.1016/j.jad.2015.04.003 The suggestion that early childhood experiences shape adult functioning paved the way for attachment theory, which underpins the modern psychodynamic approach to therapy. John Bowlby (1958, 1969) developed attachment theory, maintaining that experiences with primary caregivers determined personality development, and Mary Ainsworth later furthered this work with her “Strange Situation” experiments (Ainsworth & Bell, 1970; Ainsworth, 1973).
In these, a child and its mother entered a room in which there was a person unknown to the child. The mother then left the child there, with the stranger, a situation a child would experience as dangerous. Their reactions were observed. After a few minutes, the mother returned, and observation of the child’s behaviour continued. The observed behaviours eventually led to the classification of four different attachment styles. Secure children would cry when left with a stranger, but then when the mother returned they would reconnect with her and would be soothed until they could self-regulate. Some children, though, seemed unconcerned by the mother’s departure - they acted as if the stranger (a real and present threat) didn’t exist, completely ignoring them, and then when the mother returned, would stay disengaged. These were described as insecure-avoidant. Others would cry when the mother left, but when she returned they could not be soothed by her, and were never able to self-regulate. These were described as insecure-resistant, or sometimes as insecure-ambivalent. The fourth kind would display odd, irrational behaviour when the mother left, like hitting themselves, and these were described as insecure-disorganized. Attachment theory went on to inform individual psychodynamic therapy approaches such as ISTDP (Davanloo, 1990, 2000), as well as both family and couples therapy approaches. Psychodynamic therapies such as ISTDP pay specific attention to the effect of early relationships with primary caregivers - to the child’s (sometimes pre-verbal) understandings and internalizations that resulted from these relationships, and how these manifest in individual attachment styles. These early patterns of relating to ourselves and to others can persist into adulthood, and go on to affect our lives and relationships. In extremely general terms, secure children often become autonomous adults, avoidant children often become dismissive adults, resistant or ambivalent children often become preoccupied adults, and disorganized children often become fearful adults. Why is any of this relevant to you? Because no matter what problems bring you to therapy, what is behind them, what is driving them, is likely something related to your relationship with others, and ultimately, to your relationship with yourself. Imagine a child who has been abandoned by one or both parents. Their unconscious, infant understanding of the situation may have led them to view themselves as somehow being repulsive - as having repulsed the abandoning parent. This might show up in adulthood as an impulse to please others for fear of ever being rejected again, or it might show up as a pattern of rejecting connection first before you yourself can be rejected once again. Your internal system – the way you make sense of the world and your relationships in it - might be centred upon the unconscious sense of somehow being less-than, of somehow lacking in inherent value. A person might respond to this by turning their feelings in upon themselves and becoming self-punitive, for example, or might turn their feelings outward, onto others, and become abusive. Attachment can thus be seen to have a very real effect on every aspect of your life, and without healing, perhaps through therapy, can also become generationally active - getting passed down in one way or another to your descendants. Ainsworth, M. D. S. (1973). The development of infant-mother attachment. In B. Cardwell & H. Ricciuti (Eds.), Review of child development research (3, 1-94) University of Chicago Press: Chicago. Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67. Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39, 350-371. Bowlby, J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. Basic Books: New York, NY. Davanloo, H. (1990). Unlocking the Unconscious: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. |
Thoughts on Counselling, Therapy, and Mental HealthArchives
August 2024
Categories
All
|
RSS Feed