attachment and trauma in object relations family & couple therapy family therapy institute of...
TRANSCRIPT
Attachment and Trauma in Object Relations
Family & Couple Therapy
Family Therapy Institute of FirenzeApril, 2005
David E. Scharff, M. D.Jill Savege Scharff, M. D.
International Psychotherapy Institute
Affect Development and Therapy (Schore)
• Early right brain development• Entrainment• Importance of affect match and mis-
match in family & couple relationship
Attachment Theory (Bowlby, Ainsworth)
• Types:
Secure
Insecure - Resistant
Insecure - Ambivalent
Disorganized/Disoriented (Traumatic)
Attachment Theory (Bowlby, Ainsworth)
• Adult attachment (Main)
• Attachment in couplesMatching different attachment styles
Separations and reunions
Therapist and separation
Fonagy, Jurist, Gergely & Target2003
• Transformation of Attachment Theory to Theory of Growth of Mind– Mentalizing– Reflective Function– Interpersonal Interpretive Mechanisms– Regulation of Affect– Development of the Self
Evolutionary Function of Attachment
• Bowlby: Survival in the wild
• Fonagy et al: Building a mind that knows itself and others
Social Origin of Affect Regulation
• From Co-Regulation to Self-Regulation• Developmental Schema of Affect
Regulation– Co-Regulation: Marking, contingency, coupling
Marking as contingent and the same 0-3 months– Shift in infant’s preference at 3 months: Now wants Non-Contingent “Nearly the same,
but clearly not the same” response from mother– Mother down regulates negative affect
1st & 2nd Order Affects
• Tompkins, Ekman• Universal Primary Emotions: Happiness,
sadness, anger, fear, disgust, surprise– Recognizable from facial expressions, vocal
signs
• Secondary Affects– More complex, subtle – Shame, Pleasure, Envy, etc.
Genetics vs. Social Environment
• Previous Studies: Most variance due to genetic endowment
• Fonagy’s argument: Studies have use wrong environment. – The right environment is the early mental
interaction that grows a mind to filter and give meaning to experience
– Risk or protection for expression of genes– Example: Suomi’s ADD monkeys
Reflective Function in Childhood
• A control system• Psychic Equivalence• Pretend Mode• Playfulness and Alternate Views to
Child’s Own Mind• Trauma constricts playfulness and
increases prevalence of psychic equivalence
Playing with Pretend Mode
• Sensitization• Building Representations• State Regulation• Communication• Mentalizing
– Cognitive advances at Oedipal phase
Agency of the Self
• Physical – Somatization of Affect• Social• Teleological – about 1 year• Intentional – 18-24 months• Represenational/Autobiographical – 3-4
years
Playing with Reality
• Marking and Affect Mirroring• Marking of Non-Consequentiality• Decoupling from Reality• Empathy and Pretend Play• Importance of “False Belief”• Pretend Mode in Psychotherapy
Complex Attachments in Couples(Fisher & Crandell 2001)
• Secure & Secure
• Secure & Insecure:
Preoccupied Man & Secure Woman
Preoccupied Woman & Secure Man
• Dismissive & Dismissive
• Preoccupied & Preoccupied
• Good
Relationship
• At Risk
• Low Risk
• Low Risk
• At Risk
Attachment & Psychoanalytic Therapy
• Verbal Exchange is also Exchange of Affect
• Marking
• “Not for real” in pretend mode
• Attunement . . .
Attachment & Psychoanalytic Therapy (continued)
• Emotional regulation
• Sensitive pointing to internal states
• Establishment of 2nd order representations
• Adaptation & transformation of affect through externalization
Attachment & Couple Therapy
• Reading of one’s own and partner’s mind
• Regulation of affective states
• Transforming 1st Order into 2nd Order Affects
• Changing the dynamics of mirroring:– From escalations of augmenting the “same”
into down-regulation of “nearly the same, but clearly not the same.” . . .
Attachment & Couple Therapy (continued)
• Moving through Holding to Containment
• Using playfulness to move from psychic equivalence to pretend mode
• Increase Non-Consequentiality, De-Coupling
• Move from expressions in the body to increase couple’s reflective function . . .
Attachment & Couple Therapy(continued)
• Improve the Couple’s holding and containment to improve shared mentalizing
Attachment & AbuseBartholomew, Henderson & Dutton 2001
Risk of Being Abused
• Secure • Dismissing • Preoccupied • Fearful
• No Abuse• Leaves Abusive
Partner• At Risk• Lower Risk (unless
also Preoccupied)
Attachment & AbuseBartholomew, Henderson & Dutton 2001
Risk of Perpetrating Abuse
• Secure
• Dismissive
• Preoccupied
• Fearful
• Low Risk
• Likely to Leave
• Potential Violence/Abuse
• Not Demanding? Low Risk
Attachment & AbuseBartholomew, Henderson & Dutton 2001
Research Findings on Abusive Couples
• Preoccupied Men & Preoccupied Women (most common pattern)
• Preoccupied Men & Fearful Women (a stereotype of abuse)
• Fearful Men & Preoccupied Women (mutual abuse; more female perpetrators)
References
Clulow, C. (2001). Adult Attachment and Couple Psychotherapy. New York and London: Brunner/Routledge.
Fonagy, P., Gergely, G., Jurist, E., Target, M. (2003) Affect Regulation, Metalization, and the Development of the Self. New York: Other Press.
Scharff, D. E. and Scharff, J. S. (1991). Object Relations Couple Therapy. Northvale, NJ: Jason Aronson.
Scharff, J. S. and Scharff, D. E. (1998). Object Relations Individual Therapy. Northvale, NJ: Jason Aronson.
Scharff, D. E. and Scharff, J. S. (eds.) (In Preparation) Treating Relationships: Advances in Object Relations Couple and Family Therapy.