Attachment in Therapy

Attachment and Healthy Development

Healthy development requires more than an absence of trauma. The psyche of an infant and child needs emotional nurturance, just as their body needs food.

Attachment is all about a felt sense of connectedness. An infant’s existence starts with nine months of in-utero experience in which they are physically attached to their mother. After birth, the connection with care-givers is through physical holding, loving gaze, and affirming words and acts.

Over the years of childhood, this nurturing is internalized allowing the child to grow into an adult secure in themselves and capable of healthy and satisfying interdependence.

Sculpture by Kathy Klein

Developing A Secure Self

Insecure Attachment

Our relationships with early caregivers have an enormous impact on who we become as adults. If for one reason or another, the infant/child misses out on the relatively consistent, loving, attuned presence and responsiveness needed for healthy development, as adults, they may have:

  • little sense of self and low self-esteem
  • a sense of alienation, of not belonging
  • an inability to tolerate and regulate emotions
  • an inability to empathize
  • impaired interpersonal relationships

They may suffer from:

  • depression
  • anxiety (including obsessions and compulsions)
  • addictions
  • eating disorders
  • a tendency towards dissociation that has left them vulnerable to PTSD.

Attachment and Trauma

The quality of our connections with others provides the context of our lives. It is diffuse, unlike discrete disturbing events that occur within that context. Moreover, the extent of the impact of such events in childhood depends significantly on how secure the relationships with care-givers are. It makes sense to me to recognize that trauma and deficits are conceptually distinct:

  • A trauma is a discrete event that happened, perhaps once, perhaps chronically, that optimally wouldn’t have happened.
  • A deficit, in attachment terms, is something that didn’t happen that optimally would have – insufficient positive attachment experience over time.

Attachment in therapy and an epiphany

In therapy, early deficits are often left to be somehow compensated for through a supportive therapeutic relationship between the therapist and the adult client. While this relationship is very important, it’s the young parts of the client who are especially in need. They need to be acknowledged and to know that they are not alone and that they do matter.

Disturbing memories from childhood often involve an attachment figure, but processing the memory doesn’t provide the “good stuff.” This first became clear to me in a session with a client….

We were processing a memory from age 2 or 3 in which she was in a crib crying and nobody came. The SUD was coming down and the visual memory was growing less distinct as one expects with EMDR, when I realized that I was not comfortable with leaving the child in the crib in that scene. It wasn’t congruent with reality.

I didn’t just want the memory to become desensitized, I wanted the client to deeply understand that the little girl wasn’t still back there alone and crying, but rather here in the present, as part of her self. She was not alone anymore.

So I asked her to go into that scene and bring the little girl out of there “to be here with us now.” When she did that, expressing delight, “She’s so cute!”, I realized that I too needed to acknowledge the child in the room with us. This was the beginning of my “talking to the child” and what evolved into Imaginal Nurturing.

I wanted to come up with a way of addressing attachment deficits that is as focused and as direct as EMDR is with traumatic memories.