Male Perpetrators of Violence Against Women: An Attachment Theory Perspective

This paper proposes an attachment theory formulation of violent acts perpetrated by men against women, usually in the context of sexual relationships. It is proposed that relationship violence may be seen as an exaggerated response of a disorganized attachment system. It is related to a disorganized attachment pattern in infancy coupled with a history of abuse and an absent male parental figure. The author proposes a theory based on a psychoanalytic understanding of the development of the self, and highlights similarities between the clinical presentation of male perpetrators and those with borderline personality disorder.     

Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health

This article describes the interface between the fields of attachment and child trauma, their respective contributions to an understanding of infant mental health disturbances, and the clinical applications of an integration between attachment theory and trauma‐informed treatment and research. The organizing theme is that a dual attachment and trauma lens must be used in the assessment and treatment of infants and toddlers with mental health and relationship problems. The quality of attachment is an important factor in children's capacity to process and resolve traumatic experiences. At the same time, traumatic events often have a damaging effect on the quality of existing attachments by introducing unmanageable stress in the infant–parent relationship. It is argued that trauma in the first years of life needs to be assessed and treated in the context of the child's primary attachments. Reciprocally, the etiology of attachment disturbances should include an assessment of possible exposure to trauma in the child and in the parents. Current conceptualizations of attachment and trauma are reviewed from this perspective, and a clinical illustration is presented to highlight how a traumatic stressor can trigger behaviors reminiscent of disorganized attachment.     

Seeking Security in the Face of Fear: The Disorganized Dilemma

Attachment theory has been instrumental in identifying insecure disorganized attachment as a developmental pathway that leads to severe psychopathology in adults. Psychotherapy with these patients is challenging, offering a confusing pattern of relatedness, difficulties in mentalizing, problems expressing affect, utilizing dissociative defenses, and trying to gain an understanding of their subjectivity. This article provides a theoretical overview of disorganized attachment focusing on its etiology and how it presents throughout the life span. It reviews important therapeutic guidelines that help navigate the relationship with adults and presents a case study highlighting some clinical challenges.     

Head start is too late: integrating and applying infant observation studies, and attachment, trauma, and neurobiological research to groups with pregnant and new mothers

In this paper new knowledge generated from theoretical and empirical work in infant observation studies and attachment, trauma, and neurobiology research is integrated and applied to the development of a group for pregnant and new mothers. The purposes of this group were to (1) promote the establishment of a secure base for each baby through optimum self and dyadic affect regulation, the repair of ruptures, and the emergence of positive heightened affective moments; (2) to facilitate secure attachment between mother and infant by helping mothers mentalize the experiences of their babies; (3) to build affiliative bonds between group members and; at the very least, (4) to prevent insecure disorganized attachments. The group interactions also were thought to prevent new psychopathology from developing, as well as to minimize the intergenerational transmission of trauma. A discussion of how this group came out of gestation and birthed itself in a community setting is included.     

Undoing trauma: contemporary neuroscience. A Jungian clinical perspective

This paper uses insights from contemporary neuroscience and attachment theory to explore the profound dissociative defences associated with trauma. I discuss the effects of trauma on the emotional, intellectual and imaginative life of the individual and on the development of the self. Based on work with three patients with very different experiences of trauma, the paper offers clinical illustration of 'right brain to right brain' Jungian analysis. I argue that through repeated transference and countertransference experiences dissociative defences may be undone and change brought about.     

Links Between Disorganized Attachment Classification and Clinical Symptoms in School-Aged Children

Research examining the links between disorganized attachment and clinical symptoms largely has neglected middle childhood due to lack of available measurement tools. The few studies that have examined these links in other developmental phases have found higher clinical symptoms in disorganized individuals. Our study extended this research by using a recently-developed attachment interview measure ideally suited to evaluate disorganized attachment in middle childhood. We examined concurrent associations among disorganized attachment in 8–12 year old children and symptoms of psychopathology theoretically hypothesized for their links with disorganized attachment. Using child- and parent-reports, we measured symptoms of depression, social anxiety, shyness, inattention, and thought problems. During our two-session study, 97 children completed the Child Attachment Interview, and children and parents completed clinical questionnaires. Results suggested that disorganized attachment was associated with higher child reports of depressive symptoms and shyness, and with parent-reports of social anxiety, inattention, and thought problems, and that disorganized children are more likely to have symptoms that meet clinical criteria. Implications for the relation of attachment to psychopathology are discussed.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Double Binds,Unhealing Wounds: Discussion of “Airless Worlds: The Traumatic Sequelae of Identification with Parental Negation”

In his “Airless Worlds” paper, Steven Stern (this issue) is pinpointing and articulating what the author of this discussion has found to be one of the most challenging problems in working with certain psychotherapy patients – the relentlessly enduring obsession some traumatized people have with their traumatizing parent. In an agonized expression of disorganized attachment, these patients are held hostage by their unrelenting anger with and despair about the “negating” parent they have or had. Stern vividly describes how the negated, toxically objectified adult child, trapped in an externally derived identification, cannot mourn the tragedy of not having (or not having had) an affirming parent. The author extends Stern’s generative thinking to include reflections on the role of psycho-education in clinical work with this group; and further ways of helping these patients develop a durable experience of a self of their own.     

Spirituality,Self‐Representations,and Attachment to Parents: A Longitudinal Study of Roman Catholic College Seminarians

The author used an attachment theory framework to explore relationships between early attachment to parents and seminarians' later self‐representations and relationship with God. Attachment to mother was a key variable in predicting seminarians' level of self‐esteem and internalized shame as well as the quality of their relationship with God. This study suggests that a secure relationship with God may, over time, have a moderating effect on low self‐esteem. Furthermore, an individual's style of early attachment to mother may influence the quality of later spiritual experiences in relation to God. Implications for counseling are discussed from the perspective of attachment theory.     

Die Bindungstheorie als Basis psychotherapeutischer Interventionen in der Terminalphase

Recent attachment research has shown that every person develops, already in early childhood, special attachment strategies activated in cases whenever the person cannot cope on his own with dangers. These strategies are classified into four categories: “secure”, “insecure-avoidant”, “insecure-ambivalent/enmasked” and “disoriented/disorganized” attachment patterns. The death of a next person represents a situation of a unique and final separation causing psychical disturbances for the patient himself and his relatives. It is, therefore, an especially effective trigger for the activation of the attachment system. This article aims on relating attachment theory to an attachment-oriented therapy, that would open, particularly in the field of palliative medicine, possibilities of application which have been neglected. Case studies illustrate how these insights may be applied during the psychotheraputic care for patients and their relatives. As dying patients generally are brought by their family to the clinic, physicians have a particularly favourable situation to observe the attachment patterns in the family and integrate these informations into their treatment strategy: for example in case of “avoidant” attachment patterns, to bring cautiously the denied emotions into the communication and to support hopes for the fulfilment of needs for affection and protection; or in case of so-called “ambivalent/entangled” attachment patterns to help to disentangle too close relationships; or in case of “disorganized” attachment patterns to support emotional regulation and help to clear the relationships. It is obvious that this approach based on attachment theory and offering alleviations during the process of dying, is not only on a palliative board relevant, but may be applied with success in the medical care of dying patients and their relatives.     

Broadening the Contours of Attachment Experience and Implicit Relational Knowledge: Reply to Commentaries by Dr. Kaplan and Dr. Nahum

Replies to Dr. Kaplan and Dr. Nahum (this issue) focus on the complexly layered aspects of both attachment dimensions and clinical engagement. Attachment is looked at in the context of multiple self states. Thus, despite the predominant annihilation anxiety that accompanies disorganized attachment, there may also be self experiences of shame and humiliation generated by dependency needs. In response to the Boston Change Process Study Group, the paper proposes the idea that there is “something more” than implicit relational knowledge— something that is not subsumed under that theoretical paradigm. In keeping with the theme of multiple self states, “dissociation” and “enactment” are believed to be useful concepts in providing a path for transformative relational experience.     

A threshold approach to understanding the origins of attachment disorganization

Disorganized attachment in infancy is known to predict a wide range of maladaptive outcomes, but its origins are poorly understood. Parental lack of resolution concerning loss or trauma has been proposed to result in atypical parenting behaviors, which in turn have a disorganizing effect on the parent-child relationship. The authors review the evidence for this transmission pathway, considering other factors (e.g., social environment, child characteristics) that might enrich understanding of the antecedents of disorganization. A threshold approach is proposed to explain (a) why different parental behaviors are linked to disorganization depending on prevailing social conditions and (b) why certain children appear more vulnerable to forming a disorganized attachment relationship.     

The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence

The paper suggests a way of understanding borderline personality disorder in terms of the failure of a secure base. We begin with an account of optimal self-development in a secure attachment context, highlighting the importance of the caregiver's ability to help the small child think about his own and others' minds. This optimal self-development is crucial in developing the child's capacity for mentalization, which can enhance his resilience in the face of later trauma. We discuss the impact of attachment trauma in later development, arguing that the extent of this impact depends on how well early attachment relationships facilitated the capacity for mentalization. We identify some of the consequences for the representations of the internal world of a failure of mentalization that may follow trauma in individuals made vulnerable by genetic predisposition or disorganized early attachment. We link these features to the clinical presentation associated with borderline personality organization. Finally, some of the necessary characteristics of successful psychotherapeutic treatment of borderline personality disorder are briefly considered.     

Formulation and Treatment of Chronic Suicidality in Patients with Developmental Trauma

Although the psychodynamic literature has examined some of the links between developmental trauma and suicidal thinking and behavior, much of this scholarship focuses on the management of chronic suicidality in the treatment of patients with borderline personality disorder. In this paper, we examine the relationship between complex trauma and the broad spectrum of chronic self-destructive thoughts and behaviors commonly seen in clinical practice. We incorporate perspectives from psychodynamic theory with an emphasis on attachment theory in our understanding of the underlying mechanisms involved. We describe how we use this developmental understanding to address chronic suicidality in ongoing clinical treatment beyond management and safety planning, by providing psychoeducational, cognitive, behavioral and affect-focused strategies that serve to enhance the treatment alliance.     

Intergenerational Transmission of Violence: Shattered Subjectivity and Relational Freedom

This article considers a relational perspective regarding the intergenerational transmission of the trauma of violence. The psychoanalytic literature suggests that parents often transmit the trauma of violence to their children in the form of projected nameless dread and unmentalized states that interfere with the children's emotional needs and support. The offspring absorbs the trauma, which manifests itself in the form of disorganized attachment and in turn leads to the development of a predisposition toward cocoon-like dissociative states. This study considers two clinical cases that examine the interpersonal dynamics of dissociative processes. The therapist's reverie about his ancestors' survival of depersonalizing violence and Winnicott's concept of the survival and the use of the object help the therapist find his or her identity and gain the relational freedom needed to overcome the dissociative state, thereby becoming an alive subject who is able to help the child patient.     

恋爱受挫对自我—他人工作模型的影响

摘 要 该研究使用内隐联想测验（IAT）考察了成人依恋的主要表现形式恋爱关系中,恋爱受挫对被试自我—他人工作模型的影响。结果表明：（1）虽然实验组与控制组在依恋焦虑、依恋回避得分上均无显著差异,但IAT结果发现,组别、依恋类型在IAT效应（自我积极—他人消极模型指标）上的主效应显著,其交互作用也显著。除了回避型被试,安全型和焦虑型实验组的IAT效应显著高于控制组。（2）控制组中,焦虑型被试相容部分反应时显著大于不相容部分,回避型被试则相容部分反应时显著小于不相容部分,安全型被试无显著差异。     

Dissociation,the true self and the notion of the frozen baby

Abstract

The widespread ‘trauma talk’ that is prevalent in the social sciences, has, in recent years, become increasingly commonplace in psychoanalytic writings, especially in attachment theory and relational psychoanalysis. This paper examines dissociation, a key concept in ‘trauma theory’, in conjunction with the Winnicottian term ‘true self’, in the context of a particular discursive and theoretical combination of the two. This discursive formation is named ‘the frozen baby discourse’, and it is presented and analysed. A critique is offered of the way ‘true self’, understood as a humanistic concept, is often used together with dissociation, in order to create a theoretical construct that is far removed from Winnicottian theory. This paper begins by exploring definitional issues, both around dissociation and ‘true self’. It is subsequently argued that this contemporary usage of ‘true self’ in combination with dissociation has important implications for psychoanalytic practice.     

Attachment Theory,Psychoanalysis, Personality Development,and Psychopathology

Blatt and Levy place attachment theory and research in a broad theoretical matrix by considering the relationship of attachment patterns to personality development and to different types of psychopathology in adults. Thus Blatt and Levy construct conceptual bridges between the two configurations of personality development and psychopathology that Blatt and colleagues have developed over the past quarter century (e.g., Behrends and Blatt, 1985; Blatt, 1974, 1995; Blatt and Behrends, 1987; Blatt and Blass, 1990, 1996; Blatt and Shichman, 1983) and attachment theory and research. Blatt and Levy identify a polarity that is central to attachment theory and research, the polarity of attachment and separation, and they note that this polarity has also been central in much of classic psychoanalytic theory (e.g., Freud, 1930; Loewald, 1962). This polarity is expressed in attachment theory and research in the differences between avoidant and anxious-preoccupied insecure attachment patterns as well in the distinction between two types of disorganized attachment, helpless-withdrawn and negative intrusive, identified by Lyons-Ruth (1999, 2001).

This polarity of attachment and separation, or relatedness and self-definition is also fundamental to personality development that occurs in the hierarchical dialectic transaction of two basic developmental lines—interpersonal relatedness and self-definition (Blatt and Blass, 1990, 1996). This polarity is also inherent in the conception of two fundamental configurations of psychopathology—anaclitic psychopathology, the dependent (or infantile) and hysterical personality disorders—that are preoccupied with issues of interpersonal relatedness, and introjective psychopathology, the paranoid, obsessive-compulsive and depressive personality disorders, in which issues of self-definition and self-worth are dominant (Blatt, 1974, 1995; Blatt and Shichman, 1983). Thus, the identification of this fundamental polarity provides the basis for establishing links between attachment patterns, personality development, and adult psychopathology. Blatt and Levy also attempt to integrate psychoanalytic concepts of the representational world (e.g., Sandler and Rosenblatt, 1965)—the development of concepts of self and significant others—with the internal working models (IWMs) of attachment relationships. This integration enabled Blatt and Levy to bring a fuller developmental perspective to the IWMs of attachment theory and to note that, based on differences in the content and structural organization of the IWMs or mental representation of self and significant others, several developmental levels can be identified in both avoidant and anxious preoccupied attachment. These developmental levels within each attachment style also identifies less and more adaptive forms of both types of insecure attachment. Thus, the integration of the psychoanalytic concepts of mental representation with concepts of the IWM of attachment theory and research enables Blatt and Levy to create a fuller developmental perspective in the study of insecure attachment patterns.