The relationship between client and therapist is generally seen as the best single predictor of successful outcomes. However, the process of forming an alliance is frequently made difficult by the presence of the relational scripts or models with which the clients enter the counseling or psychotherapy relationship. Attachment theory, a model originally constructed by both John Bowlby and Mary Ainsworth, is a crucial way of understanding this effectively.
For practitioners, applying an attachment perspective to clinical work can facilitate an enhanced appreciation for resistance, transference, and rupture. By identifying the attachment strategies that their clients use, practitioners can shape their clinical work to offer their clients a corrective emotional experience, aimed at facilitating their achievement of “earned security.”
Understanding the Common Attachment Patterns
Though every person is unique, there tend to be four styles of attachment behaviors. It is essential that these styles be recognized, not as pathologies, but as strategies for survival that have evolved out of specific environments.
Securely attached individuals tend to have a positive attitude towards the self and others. Clients with such an attachment style tend to be comfortable with intimacy and autonomy. They tend to see the therapist as a partner and are able to handle vulnerability to benefit from therapy.
Conversely, clients with the anxious-preoccupied style tend to hold negative views of themselves but positive views of others. Such clients tend to exhibit high levels of craving for gratification, fears of being abandoned in the therapeutic relationship, as well as diffusion of boundaries. Such client behaviors are actually an effort to keep them close.
Dismissive-avoidant patients display a positive sense of self and a negative sense of others. These patients feel that intimacy means losing their autonomy. These patients can be intellectually aware and objective about their emotions, deny their pain, or remain distant and maintain a superficial disconnect between the therapist and themselves.
Lastly, being fearful-avoidant or disorganized is a probable linkage with complex trauma. Such clients feel a desire for intimacy but feel fear in the process. This therefore leads to a situation where the client attracts and repels at the same time.
The Effect on the Therapeutic Relationship
Of course, these working models always come into play in a transference relationship. An anxious type of client might see disapproval or an impending termination in a noncommittal facial expression on the part of the therapist. They will often send numerous emails in between sessions or have difficulty leaving when the hour is over.
On the contrary, avoidant clients may contest the therapeutic relationship by downgrading the therapy or failing to show up when the emotional arousal becomes too intense. They may abandon the professional with an attitude that makes them feel excluded or irrelevant, thus eliciting the professional’s own feelings of boredom or frustration. The disorganized client constitutes the most challenging situation since the professional embodies both sources of safety and fear.
Adaptive Clinical Strategies
It is important to individualize the manner in which the therapy session will be conducted based on the attachment style of the client if trust is to be established. When dealing with an anxious-preoccupied person, consistency and containment are essential objectives of the therapy. Boundaries have to be established with rigidity while validating the person.
What the dismissive-avoidant clients need is the application of patience and respect for their defense structures. Otherwise, these clients risk dropping out if the discomfort of their exposure to their vulnerabilities is pressed for too early. Professionals should work towards developing a cognitive alliance with these clients.
Working with fearful-avoidant clients means needing a trauma-informed approach that puts the highest premium on feeling safe. The practitioner will have to manage the oscillation between approaching and withdrawing while keeping the balance himself. Zur training on attachment styles allows a greater understanding of this dynamic.
Providing Earned Security
The end result for an attachment-based therapist would be to foster an increase in the level of earned security within the client. As an attachment object, the therapist can become an identifiable and sensitive, as well as predictable, resource for the client to rely upon as their secure base. By so doing, professionals can change the nature of treatment from an information transaction to an attunement!
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