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Denver Attachment Based Therapy

If left untreated early attachment problems can result in different problems including addictions, relational problems, codependency, depression, and anxiety, etc. Only 55% of people have “secure attachment” as infants, and this concerning because it means the other 45% of people suffer “insecure attachment.” The attachment we had as children continues all our lives in our relationships, and therefore 45% of people have trouble with committed relationships as the result of “insecure attachment.” This “insecure attachment” is learned from growing up in a dysfunctional family and unfortunately many people pass “insecurity” on to our own children.

The good news for those of us who were not raised in functional environments in which secure attachment was nurtured is that there is such a thing as “earned-secure” attachment. Those with insecure attachment styles benefit from reconsidering and understanding their current expectations and tendencies in close relationships which were ingrained and reactionary after years of existing in insecure attachment patterns. According to Mary Main, the primary characteristics of “earned secure attachment” are meta-cognitional and integrative thinking. This includes the capacity to elaborate an understanding of the other’s mind or other people’s perspectives (Peter Fonagy’s idea of mentalization or Daniel Siegel’s idea of mindsight; “thinking about thinking”), the ability to reflect on one’s mental states, and the establishment of a sense of mastery and personal worth, genuine self-esteem (not other-esteem). “Earned-secure” individuals are defined as those who acknowledge that they experienced dysfunctional parenting experiences in childhood, but as adults are able to describe these memories in an accurate, coherent, and contained manner. Secure attachment allows the individual to feel safe deconstructing childhood events, cognitions, and affective responses and reconsidering conclusions, then and now.

When attachment style is insecure a vicious cycle begins: insecurity leads to more and more isolation from others, and therefore perpetuating the insecure attachment style. This is a crucial concept for counselors to understand in their efforts to modify the treatment plan to aid the individual in decreasing shame that is so often attached to harmful coping strategies (addiction, codependency). Learning the skills needed to take control of your life, to stop dysfunctional behaviors that do not serve you well, to achieve greater life satisfaction, and to have fulfilling relationships is a common goal.

Adult Attachment Interview (AAI)

The adult attachment interview (AAI) is a procedure for assessing attachment in adults. Developed by Mary Main and others in 1984, the AAI takes about an hour to an hour and a half to complete and follows a prescribed format in which twenty questions are asked in a set order. The interview begins with the interviewee being asked to give a general description of their childhood relationships, followed by a request to list five adjectives which best represent the relationship between them and each of their parents. After adjectives are provided, the interviewee is asked to remember and describe specific episodic memories which best illustrate why a particular adjective was chosen. In addition to questions about the interviewee’s childhood relationship with his or her parents, the adult attachment interview includes questions to assess the nature of the participant’s current relationship with his or her parents. The adult attachment interview has a scoring and classification system focused on four categories:

1. Autonomous: They value attachment relationships, describe them in a balanced way and as influential. Their discourse is coherent, internally consistent, and non-defensive in nature.

2. Dismissing: They show memory lapses. Minimize negative aspects and deny personal impact on relationships. Their positive descriptions are often contradicted or unsupported. The discourse is defensive.

3. Preoccupied: Experience continuing preoccupation with their own parents. Incoherent discourse. Have angry or ambivalent representations of the past.

4. Unresolved/Disorganized: Show trauma resulting from unresolved loss or abuse.

A person falls under a certain category based on whether or not he or she follows a particular ‘strategy’ when answering questions during the interview. The AAI has extensive research validation to support it. The interview taps into adult representation of attachment (i.e. internal working models) by assessing general and specific recollections from their childhood. The interview is coded based on quality of discourse (especially coherence) and content. A good description can be found in Chapter 25 of Attachment Theory, Research and Clinical Applications (2nd ed.), edited by J. Cassidy and P. R. Shaver, Guilford Press, NY, 2008. The chapter title is "The Adult Attachment Interview: Historical and Current Perspectives," and is written by E. Hesse.

The Adult Attachment Interview has been an important contribution to modern attachment study. Proper administration and scoring of the AAI requires extensive training. David Summers is a certified as a highly reliable coder of the Adult Attachment Interview (AAI) trained with Dr. Mary Main and Dr. Eric Hesse at UC Berkeley AAI training institute. As important background, the institute starts with a brief summary of Bowlby’s original attachment theory, a description of the Infant Attachment categories of Mary Ainsworth (including the Strange Situation Procedure), adult attachment theory and the Adult Attachment Interview. Following this preliminary review, the bulk of the training is focused on the AAI scoring and coding system developed by Mary Main. Upon completion of the institute, David completed and passed the demanding certification testing. David was found highly reliable during the certification process which takes an additional 18 months and consists of extensive testing. Many professionals claim to be “attachment experts” but very few mental health care professionals have received this training. There is a vast difference between knowing about the Adult Attachment Inventory and being certified in administering and coding the Adult Attachment Inventory (AAI).

Attunement, Disruption, and Repair

In the attunement phase, consists of the forging of a personal relationship between the therapist and the client, it is the first step for the client toward creating healthy attachments. Attachment clients live in stressful lives with very little emotional attachments to people, thus it is the counselor’s job to create a secure, accepting, caring, non-judgmental, and reliable environment where the client can feel comfortable sharing their most traumatic experiences.

In the disruption phase, the therapist will probe the client on any traumatic experiences that may have happened to them in their childhood and that connect to any disruptions in their lives at the time. The therapist pays special attention to the relationship between the client and their parents because the lack of responsiveness of a parent early in a child development can lead to dysfunctional relationships later on in their life. This part of the therapy treatment is called disruptive because by having the clients talk about their traumatic experiences and relationship with their parents in depth, the therapist is getting them to re-experience the trauma. As the client shares their experiences the therapist is expected to be actively listening and express empathy and acceptance to the client.

The repair stage of the therapy aims to alter the client’s current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective interpretation they hope create a new reality of the traumatic events for the client in order to get rid of unwanted emotions. EMDR is also a very effective tool while undergoing this work.