Systemic Therapy and Attachment Narratives

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Systemic Therapy and Attachment
Narratives

• Arlene Vetere (and Rudi Dallos)
• ACAMH
• Northampton
• University
• July 3, 2014

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Dynamic Systems
Many of the most intense emotions arise during
the formation, the maintenance, the disruption
and the renewal of attachment relationships. The
formation of a bond is described as falling in
love, maintaining a bond as loving someone, and
losing a partner as grieving over someone.
Similarly, threat of loss arouses anxiety, and
actual loss gives rise to sorrow whilst each of
these situations is likely to arouse anger. The
unchallenged maintenance of a bond is experienced
as a source of security and the renewal of a bond
as a source of joy. (Bowlby, 1980)
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Our Need for a Secure Base

• For not only young children, it is now
  clear, but human beings of all ages are found to
  be at their happiest and to be able to deploy
  their talents to best advantage when they are
  confident that, standing behind them are one or
  more trusted persons who will come to their aid
  should difficulties arise. The person trusted
  provides a secure base from which his (or her)
  companion can operate.
• Bowlby, 1973, p407

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THEORETICAL PERSPECTIVES

• ATTACHMENT NARRRATIVE THERAPY
• Why the 3 perspectives need each other?
• Social Constructionist - Narrative practice
• Attachment Theory
• Systemic Theory and practice
• Persons and families in social/cultural contexts
• Competencies and resiliencies

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SYSTEMIC THERAPY and ATTACHMENT NARRATIVES
Constructing Safety and Resilience
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Implications for Therapy

• Naming and regulating emotions
• Standing in the emotional shoes of the other
• Comforting and self soothing
• Information processing
• Transformations in representational systems

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ATTACHMENT REPRESENTATIONS
The layers of attachment

• PROCEDURAL MEMORY memory for how we do things
  compare systemic patterns / process (R)
• SENSORY MEMORY visual images, smell, touch,
  auditory (R)
• SEMANTIC MEMORY cognition, beliefs, attitudes
  (L)
• EPISODIC MEMORY narratives, stories,
  inter-connected experiences (L and R )
• INTEGRATIVE MEMORY reflection, meta-cognition,
  on-going monitoring of our speech and thought (L
  and R)
• Right Brain Implicit Left
  Brain - Explicit

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Exploring Patterns of Comforting

• When you were upset or frightened as a child
  what happened?
• How did you get to feel better? Who helped you to
  feel better? How did they do this?
• What have you learnt from this for your own
  family?
• What do you want to do the same?
• What do you want to do differently?
• How do people comfort each other in your own
  family/relationship?
• How do you comfort your children?
• How do they comfort you?
• What do you want your children to learn about
  comforting?
• How do you hope your children will offer comfort
  to others in the future?
• Can be held as a family or couple interview or as
  a one-to-one conversation explore the impact of
  substance use across the generations.

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Change and Re-Organisation
Triangulation

• MOTHER FATHER
• Child also has an
• attachment relationship with the
  parents relationships

Conflict/stress
CHILD Relationship with each parent Pulled in
to take sides Conflict in construing relationship
with each parent Conflict in understanding impact
on parents relationships is it my fault?
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Corrective and Replicative Scripts

• This utilises ideas from John Byng-Hall that
  families make comparisons across the generations
  in terms of similarities and differences between
  how our own parents were with each other and us
  (the children) and how this is repeated or
  altered in the next generation. We can explore
  the relationship with, for example, substance
  use, and its impact on relationships, across the
  generations.
• Importantly it allows us to work in a positive
  frame with the family in that we may construe the
  intentions of the parents positively, i.e. they
  have tried to repeat what was good or correct
  what they felt was unhelpful about their own
  experiences. This can then lead to a discussion
  of whether these attempts have been successful or
  not, and possibly how they might be altered,
  strengthened, elaborated etc.
• What are your thoughts about how similar or
  different your relationship with each other and
  your children is to your parents (grandparents)
  relationships ?
• What have you tried to make similar or different
  to either of these relationships?
• What do you value vs feel critical about in
  either of your parents relationships?
• Does what you have tried to repeat/change work?
  Is there anything that you want to alter,
  strengthen, abandon about what you have been
  trying to repeat or change?

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Disfavoured as a child, hit by his
father..implicit memory of humiliations and
fear triggered
DAN SIEGEL EXAMPLE
DAUGHTER DAD Mommy cleans Daddy will do it
my teeth better insists.. .flight Insists.an
gry fight or freeze !
Im not a good enough father, broken my promise
to myself
Father hits daughter.. Fear Cycle repeats
Symmetrical escalation.. Mirroring her anger.
Neurological activation..mirror neurons
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Empathy and the Therapeutic Alliance

• Reaffirming and clarifying clients experiences
• Modelling acceptance of all family members
  experiences
• Slowing down the session, enabling people to
  process their experiences
• Helping to organise different aspects of clients
  experiences into a more integrated whole
• Comforting in response to a difficult emotional
  experience
• Exploring the meaning of important and powerful
  human experiences

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SYSTEMIC THERAPY - patterns and escalations

• secretive
• JOHN
  PARENTS
• suspicious
• FEEDBACK - PATTERNS are mutually maintaining
• ATTACHMENT emotional needs, attachment
  insecurities may fuel the cycle
• ESCALATION, e.g. polarisation of actions, beliefs
  and feelings

Emotion Attachment
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DEVELOPMENT of ATTACHMENT
STRATEGIES

• Attachment system triggered by DANGER ! !
• Each parents response to childs fear, distress,
  comfort seeking .......
• shapes the
  childs attachment pattern to that parent

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ATTACHMENT STRATEGIES AS A CONTINUUM
Styles of protective defensive processes

• DISMISSING/DE-ACTIVATING
  PRE-OCCUPIED

• Learn that cannot rely on words and cognition
  inability and failure to predict. Increasingly
  rely on affective information. Split feelings of
  anger and vulnerability so display one and
  suppress the other. Cognitive defences may
  involve passive thinking, reducing complexity by
  blaming of others and avoiding consideration of
  own contribution, rationalising/justifying own
  actions
• anger towards others
• anxiety and vulnerability

Learn that expressing emotions cannot reliably
elicit comfort or caring defensive strategy
develops of distancing or excluding emotions.
Cognition is relied on and can be employed to
help omit or distort emotional information
inhibit affect, falsify, deny physiological
discomfort and pain - idealise, care for
others - deny need for others compulsive
reliance on self
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ATTACHMENT ALWAYS TWO SIDED

• Attachment always has TWO sides. Responses to
  non-availability of the attachment figures
• PROTEST - anger (hope and despair)
• and
• VULNERABILITY sadness, fear, shame
• One may be shown more than the other, or shown in
  rapid alternation.

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ANGER AVOIDANT PATTERNS

• Negative feelings and their expression are
  inhibited, e.g. child development
• Intrusions negative feelings, such as anger may
  break through
• Sense of shame and failure at expression of anger
• Family history - may be pattern of inhibiting
  anger - fear that it is dangerous, uncontrollable
• Strategies for managing the negative feelings are
  not developed leading to possible pathologising
  of the anger

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ANGER ANXIOUS AMBIVALENT PATTERNS

• Semantic understanding is inhibited
• Emotions anger or vulnerability are exaggerated
• Explanations are reduced in attempts to manage
  unpredictability
• Simplified beliefs - eg, he is a cold fish
• Strategies for processing negative affect, and
  understanding its consequences on others, are
  inhibited

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ATTACHMENT NEEDS - MUTUAL

• PARENT (care-giving seeking)
• needs attachment needs
• CHILD (careseeking giving)
• Parents meet childs needs but also
  child meets parents needs

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Secure Attachment

• what sustains our relationship is, Im
  extremely happy with her, and part of it has to
  do with the fact that she is at once completely
  familiar to me, so that I can be myself and she
  knows me very well and I trust her completely,
  but at the same time she is also a mystery to me
  in some ways. And there are times when we are
  lying in bed and I look over and sort of have a
  start. Because I realise here is this other
  person who is separate and different and has
  different memories and backgrounds and thoughts
  and feelings. Its that tension between
  familiarity and mystery that makes for something
  strong, because, even as you build a life of
  trust and comfort and mutual support, you retain
  some sense of surprise or wonder about the other
  person.
• Barack Obama. The New Yorker, January 19, 2009,
  P50

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Felt security in a relationship

• Affect regulation (less reactivity, hyper-arousal
  under-arousal)
• Support seeking
• Information processing (curiosity, open, more
  toleration of uncertainty)
• Communication (meta-communication, disclosing,
  collaborative, assertive, empathic)
• Sense of self (elaborated, articulated,
  positive) (Mikulincer and Goodman)

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Attachment Injury

• A betrayal of trust/abandonment at a crucial
  moment of need
• Like a form of relationship trauma defines
  relationship as insecure (you werent there for
  me!)
• An impasse in recovery/repair process
• Attachment significance is key, not content as
  such
• The only way out is through
• Acknowledgement, listening, appreciation,
  recovery and apology
• Johnson (1998)

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Attachment Injury Resolution

• Help articulate injury and impact.
• I promised myself Never again!!
• Acknowledgement of hurt partners distress,
  elaborates on development of event
• Hurt partner connects thoughts emotion,
  attachment issues into an expanded narrative
• Other explains intent (owns responsibility if
  appropriate), expresses regret while staying
  attuned connected
• Hurt partner asks for comfort
• Other responds
• Relationship redefined as a safe haven new
  narrative of recovery healing
• Johnson (1998)

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Internal Working Models

• Beliefs and expectations about
• Ones own and other peoples behaviour
• Views of the SELF How loveable, worthy and
  acceptable am I?
• How available and interested are others in me,
  and in caring for and looking after me?

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COUPLE THERAPY Trauma responses and attachment
injury

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FORMAT
WALKING AROUND IN DIFFICULT MOMENTS

• Identify with the person, couple, family etc a
  difficult event, episode, pattern
• Articulate the experience in the pattern for each
  person separately eg for both partners in the
  couple, or for family members, etc.
• Direct focus to the critical and difficult part
  of the pattern, for example the outburst of
  anger, conflict, criticism, hurt feelings, etc
• Identify the feelings, thoughts and actions at
  the critical moment in the episode (attachment
  triggers, threats and attachment injuries,
  resonances)
• Therapist supports the other partner in listening
  and staying responsive, (with couples reverse the
  experience before inviting them to turn to each
  other)
• Try to trace the thoughts and feelings that
  fuelled the action/connection to the persons
  underlying internal working model
• Consider with them where their working model
  derives from, eg some previous history in the
  family?
• Consider particular experiences of insults, shame
  and humiliation past attachment injuries etc
  that may also be a part of the working model

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ATTACHMENT NARRATIVE THERAPY Steps to
Constructing Safety and Resilience

• Integrating ideas from systemic, attachment and
  narrative approaches Work with both individual
  and systemic processes
• Creating a Secure Base
• Exploring Narratives, Attachments and Dilemmas
  within a Systemic Framework
• Considering Alternatives
• Future and Maintaining the Therapeutic Base

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Creating a secure base
Reflection, containment and emotional
safety Supporting, building the therapeutic
relationship Validation and support-
acknowledging emotional risks, demands of
therapy, temptation to withdraw Clarifying,
context how we will communicate Establishing
sense of safety, pacing Identifying, exploring
and de-escalating unhelpful patterns of
interaction
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Exploration - Narratives and Attachments within
a Systemic Framework
Identifying attachment dilemmas Identifying
attachment needs and wishes eg for reassurance,
underlying core patterns of feeling, thinking and
behaviour Discrepancies thoughts and
feelings, head and heart Divided loyalties
ambivalences in relationships Reflections on the
therapeutic relationship empathy and
listening Exploring problems, emotions and
competencies Access, illuminate, expand and
re-process emotional experiences
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Considering Alternatives emotional risks and
change
Loosening Attachment Dilemmas Considering
alternatives unique outcomes Acknowledging
risks of change, Threats to perceptions of self
and others Relational and emotional risk
taking, in therapy and outside conflict
resolution Re-bonding consolidating more
satisfying interactions
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The Future
Maintaining the Therapeutic Base
Shared narratives of healing Acknowledging
possibility of relapse temptation to retreat to
patterns of thinking and feeling Holding each
other in mind how we will think about each
other in the future What support will be able
to draw on in future consolidating
change Creating opportunities for future
reflection
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EMOTIONAL SCULPTING

• Sculpting with family members themselves, or
  sculpting with objects (coins, buttons, stones,
  figures etc )
• PROMPTS (can use direct or circular questions)
  For example
• Map the current attachment patterns,
  relationships who looks after whom, etc.
• How does it feel to be, for example, at the
  centre, on the edge, between your parents, and so
  on?
• Now that you and your brother are closer, how
  does that make you feel?
• If you were to get closer to your mother what
  would that be like?
• How do you think your sister feels being that
  distant from your father? And so on.....

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Exploring Attachment Narratives Through the
Family Genogram

• The relationship between the grandparents -
  questions about the grandparents relationship
  can bring out stories about the parents
  childhood experiences and prompt a consideration
  of how their own children experience their
  relationship (mother and father) questions can
  be contextualised with substance use
• How would you describe your parents relationship
  - cold, warm, distant, passionate, conflicts?
• What differences do you see in the relationships
  between mothers parents vs fathers parents?
• In what ways are either of your parents
  relationships similar to your own?
• Corrective and Replicative Scripts (Attachments
  and alcohol use)
• What have you tried to make similar or different
  to either of these relationships?
• What do you value vs feel critical about in
  either of your parents relationships?
• Influence on the parents relationship with their
  own children - questions which invite the parents
  to consider how their own experiences have
  consciously or unconsciously influenced and
  shaped their relationships with their children
• How do you see your relationship (mother and
  father in turn) with your children?
• How are you different with your children to how
  your parents were with you?
• Do you think you are closer or more distant to
  your children than your parents were with you?

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Some Useful References

• Dallos R and Vetere A (2009) Systemic Therapy and
  Attachment Narratives Applications in a range of
  clinical settings. London Routledge
• Dallos R and Vetere A (2010) Emotions,
  Attachments and Systems. Context, 107, 8-10
• Johnson S (2002) Emotionally Focused Couple
  Therapy with Trauma Survivors. New York Guilford
• Vetere A and Dallos R (2008) Systemic therapy and
  attachment narratives. Journal of Family Therapy,
  30, 374-385