A few thoughts about dealing with an "Attachment Issue"

A Number of thoughts come to mind:

You mention both depression and PTSD. Have these both been treated successfully? In general, I'd deal with the more concrete problems which are causing problems in day-to-day functioning before addressing issues such as "attachment" or problems with intimacy.

What are the client's goals at this point in therapy? Are the "attachment" issues something that she wants to work on or they goals that the therapist sees as important but which the client is not interested in working on?

Assuming that the client wants to work on the "attachment issues" I'd want to develop a clearer idea of just what we are trying to accomplish. Suppose we work on these issues and are wonderfully successful, how would the client want things to be different when we are done? How would we know that we have been successful?

I'd also need to develop a better understanding of the problem. I'd start by finding out when the problems occur and then would take several of those occasions one at a time and pinpoint the thoughts, emotions, and actions that play a role in the problems. (Often we use a thought record as a way of doing this)

From what you've said so far, if sounds as though it is likely to turn out that she fears that if she allows intimacy in a relationship, she will be rejected or abandoned. However, I would want to use guided discovery to find out what she fears rather that assuming that my hunch is correct.

I'd work with her to help her state her fears explicitly and also to help her identify relevant beliefs. These might include beliefs regarding what one must do in order to be liked, what one must do in order for a relationship to last, what convinces her that she'll be rejected or abandoned, etc.

Once the relevant fears and beliefs are explicit, then we can start thinking about how we can test the beliefs which prove to be dysfunctional (I like to use behavioral experiments as much as possible) and we can start thinking about how to use in-vivo exposure to reduce her fears. It sounds as though you've already been doing quite a bit of in-vivo exposure within the session, at some point she'll need to start facing her fears in real life as well but it may take some thought to work out a good way for her to start risking more closeness in relationships.

Finally, it wouldn't surprise me if she has some idealized beliefs about being loved by a maternal figure which will need to be identified and addressed.

Replies:

Re:A few thoughts about dealing with an , by TM, 09/09/02 Re:A few thoughts about dealing with an , by Jim Pretzer, 09/16/02 Re:A few thoughts about dealing with an , by Linda Nauth, 11/10/02

| Behavior OnLine Home Page | Disclaimer |

Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.