Systemic Therapy and Attachment Narratives

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

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)

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

THEORETICAL PERSPECTIVES

ATTACHMENT NARRRATIVE THERAPY Why the 3 perspectives need each other?

1.

2.

3.

Social Constructionist - Narrative practice Attachment Theory Systemic Theory and practice Persons and families in social/cultural contexts

Competencies and resiliencies

SYSTEMIC THERAPY and ATTACHMENT NARRATIVES: Constructing Safety and Resilience Exploring Narratives and Attachments within a Systemic Framework Contemplating the Future and Maintaining the Therapeutic Base

Creating a and Maintaining

Secure Base Considering Alternatives and Attempting Change

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

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

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.

Change and Re-Organisation: Triangulation

MOTHER FATHER

Conflict/stress

Child also has an attachment relationship with the parents’ relationships CHILD

Relationship with each parent Pulled in to take sides Conflict in construing relationship with each parent Conflict in understanding impact on parent’s relationships ‘

is it my fault?’

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

elaborated etc. 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,  What are your thoughts about how similar or different your relationship with each other and your children is to your parent’s (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 parent’s 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?

DAN SIEGEL EXAMPLE

DAUGHTER ‘Mommy cleans my teeth better’… Insists….angry

Father hits daughter.. Fear Cycle repeats Disfavoured as a child, hit by his father…..implicit memory of humiliations and fear triggered DAD ‘Daddy will do it’ insists.. .flight

fight

or freeze !

I’m not a good enough father, broken my promise to myself Symmetrical escalation….. Mirroring her anger…. Neurological activation..

mirror neurons

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

SYSTEMIC THERAPY - patterns and escalations

secretive

Emotion

JOHN PARENTS

Attachment

suspicious

i.

ii.

iii.

FEEDBACK -

PATTERNS are mutually maintaining ATTACHMENT – emotional needs, attachment insecurities may fuel the cycle ESCALATION, e.g. polarisation of actions, beliefs and feelings

DEVELOPMENT of ATTACHMENT STRATEGIES

Attachment system triggered by

DANGER ! !

Each parent’s response to child’s fear, distress, comfort seeking .......

shapes the child’s attachment pattern to that parent

ATTACHMENT STRATEGIES AS A CONTINUUM: Styles of protective & defensive processes

DISMISSING/DE-ACTIVATING PRE-OCCUPIED

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 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

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.

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

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

ATTACHMENT NEEDS - MUTUAL

needs PARENT (care-giving & seeking)

attachment needs

CHILD (care –seeking & giving) Parents meet child’s needs but also child meets parents’ needs

Secure Attachment

“…what sustains our relationship is, I’m 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. It’s 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

“ 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)

‘ Attachment Injury’

  A betrayal of trust/abandonment at a crucial moment of need Like a form of relationship trauma – defines relationship as insecure (you weren’t 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)

Attachment Injury & Resolution

     Help articulate ‘injury’ and impact….

I promised myself: Never again!!

Acknowledgement of hurt partner’s 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)

Internal Working Models

Beliefs and expectations about  One’s own and other people’s 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?

COUPLE THERAPY

Trauma responses and attachment injury 28 Abuser Abused?

30 8 32 Sam abused by MGF 4 60 36 Jim 30 Father died when Jim was 12

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 person’s 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’

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

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

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

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

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

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.....

Exploring Attachment Narratives Through the Family Genogram

The relationship between the grand –parents

- 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 mother’s parents vs father’s 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?

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