The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!

Abstract

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.     

Cognitive Alexithymia Mediates the Association Between Avoidant Attachment and Interpersonal Problems in Patients With Somatoform Disorder

Patients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.     

Daily Responsiveness,Expectations, and Self-disclosure: How the Average Levels and Within-person Variability of Three Relationship Components Mediate Personality–Relationship Transactions in Romantic Couples

The associations between couple members' personality and their relationship satisfaction can be conceptualized as reciprocal transactions. To better understand these transactions, we focused on both partners' interpersonal vulnerabilities (i.e. neuroticism, low self-esteem, and insecure attachment); daily emotional, cognitive, and behavioural relationship components (i.e. perceived responsiveness, positive expectations, and self-disclosure); and relationship satisfaction. Specifically, we examined whether the average levels and within-person variability of the relationship components mediated the transactions between interpersonal vulnerabilities and relationship satisfaction. Data came from 689 female–male couples aged 18 to 81 years who participated in three measurement occasions across 12 months, including a 14-day diary phase. We used mediated dyadic bivariate latent change score models to test the level–change and change–change transactions and mediations. The findings partly supported our hypotheses: Couple members with interpersonal vulnerabilities had lower average levels (but not higher within-person variability) of the relationship components, and less satisfied couple members had lower average levels and higher within-person variability of these components. The lower average levels but not the variability mediated between a lower level of relationship satisfaction and an increase in avoidant attachment. No other mediations were observed. We discuss the importance of studying daily relationship components for better understanding reciprocal transactions in couples. © 2020 European Association of Personality Psychology     

Attachment style impacts behavior and early oculomotor response to positive,but not negative,pictures

The present study investigated whether oculomotor behavior is influenced by attachment styles. The Relationship Scales Questionnaire was used to assess attachment styles of forty‐eight voluntary university students and to classify them into attachment groups (secure, preoccupied, fearful, and dismissing). Eye‐tracking was recorded while participants engaged in a 3‐seconds free visual exploration of stimuli presenting either a positive or a negative picture together with a neutral picture, all depicting social interactions. The task consisted in identifying whether the two pictures depicted the same emotion. Results showed that the processing of negative pictures was impermeable to attachment style, while the processing of positive pictures was significantly influenced by individual differences in insecure attachment. The groups highly avoidant regarding to attachment (dismissing and fearful) showed reduced accuracy, suggesting a higher threshold for recognizing positive emotions compared to the secure group. The groups with higher attachment anxiety (preoccupied and fearful) showed differences in automatic capture of attention, in particular an increased delay preceding the first fixation to a picture of positive emotional valence. Despite lenient statistical thresholds induced by the limited sample size of some groups (p < 0.05 uncorrected for multiple comparisons), the current findings suggest that the processing of positive emotions is affected by attachment styles. These results are discussed within a broader evolutionary framework.     

Mens sana in corpore sano: Psychotherapy with a cerebral palsy child aged nine months

This paper is the acount of the psychoanalytic understanding and treatment of a nine-month-old cerebral-palsy infant and her mother. When first seen, Abigail hung over her mother's arm, and would scream unceasingly if moved from this position. The mother-child relationship seemed to involve their sticking to each other without looking or losing contact. The mother's hidden hate, anger and resentment were communicated non-verbally and Abigail showed signs of finding it difficult or impossible to integrate experiences, given the amount of trauma she had suffered from an attempted abortion and the lack of enough experience of being loved to enable her to grow internally.

The process of assessing the internal world of the infant and her mother, and the thinking and planning of the psychotherapy that followed, are described. In order to promote the secure attachment of the mother-child dyad, and the emotional growth of both, the helping process focused on understanding both the baby's and mother's states in order to make sense of the child's inner world to the mother. Because of the acute pain this process involved for the mother, she was treated individually too, by a different therapist.     

The Effect of Attachment Insecurity in the Development of Eating Disturbances across Gender: The Role of Body Dissatisfaction

The present study examined the effects of insecure attachment on the development of negative body image as a contributing factor to the development of disturbed-eating patterns in male and female university students. Participants were nonclinical male (n = 100) and female (n = 381) university students. Administering self-report questionnaires, the authors assessed demographic information (gender, age), anthropometric data (Body Mass Index [BMI], age), romantic attachment (ECRS-R; R. C. Fraley, N. G. Waller, & K. A. Brennan, 2000), body dissatisfaction (BSQ), and disturbed eating (EAT-26). The authors found body dissatisfaction to fully mediate the relationship between attachment anxiety and disordered eating in women. Body dissatisfaction mediated anxious attachment and dieting in men. In addition, attachment avoidance had a direct impact on eating behaviors for both genders, without the mediation of any variables measured in this study. The findings of the present study suggest that the anxiety and avoidance dimensions of attachment insecurity affect eating behaviors differently, and the effects are different across genders. The authors discuss results in the context of therapeutic interventions design.     

Distinguishing Between the Facilitating and the Self-Serving Charismatic Group Leader

Winnicott informed us about the components of the facilitating environment. Kohut warned us to differentiate between the charismatic leader, who looks for enfeebled followers to further his own grandiose ambitions, and the idealizable leader whose actions are based on a sense of values. Findings from attachment theory and neurobiology indicate how specific developmental issues make for a perfect fit between the self-serving charismatic leader and those who have been deprived of attuned interactive regulation and secure attachment in early childhood. This article attempts to integrate the above ideas for application to group dynamics in therapeutic, supervisory, training, and institutional groups.     

Insecure Attachment and Subclinical Depression,Anxiety, and Stress: A Three-Dimensional Model of Personality Self-Regulation As a Mediator

Although the effects of insecure attachment on vulnerability, incidence, and developing mental disorders have been confirmed by many studies, the mechanism of this effect is still unknown. Therefore, the main aim of this study was to investigate the mediating and moderating role of the three-dimensional model of personality self-regulation in the relationship between insecure attachment and subclinical depression, anxiety, and stress. Four hundred Iranian students at Shiraz University were recruited and completed the following scales: the Revised Adult Attachment, Depression Anxiety Stress, Integrative Self-Knowledge, Mindful Attention Awareness, Self-Control, and Self-Compassion. Results showed that there was a moderate correlation among all the variables under study in the expected directions. Multiple mediating models analyses indicated that regarding the relationship between insecure attachment and depression, the components of integrative self-knowledge, self-control, and self-compassion functioned as mediators. However, regarding the relationship between insecure attachment and anxiety and stress, the components of integrative self-knowledge, mindfulness, and self-compassion relatively functioned as mediators. Further, our results showed that only mindfulness and self-compassion were identified as moderators in the relationship between insecure attachment and depression. It is concluded that insecure attachment may cause psychological damage due to deficiency in the components of the three-dimensional model of personality self-regulation, and that mindfulness and self-compassion may play a protective role in the relationship between insecure attachment and depression.     

Attachment security differs by later autism spectrum disorder: A prospective study

Although difficulties with social relationships are key to autism spectrum disorder (ASD), no previous study has examined infant attachment security prior to ASD diagnosis. We prospectively assessed attachment security at 15 months in high‐risk infants with later ASD (high‐risk/ASD, n = 16), high‐risk infants without later ASD (high‐risk/no‐ASD, n = 40), and low‐risk infants without later ASD (low‐risk/no‐ASD, n = 39) using the Strange Situation Procedure. High‐risk/ASD infants were disproportionately more likely to be classified as insecure (versus secure) and more likely to be classified as insecure‐resistant (versus secure or avoidant) than high‐risk/no‐ASD and low‐risk/no‐ASD infants. High‐risk infants with insecure‐resistant attachments were over nine times more likely to receive an ASD diagnosis than high‐risk infants with secure attachments. Insecure‐resistant attachment in high‐risk infants suggests a propensity toward negative affect with the parent in conditions of stress. Insecure‐resistant attachment may prove useful as a potential early index of propensity toward ASD diagnosis in high‐risk siblings, while insecure‐resistant attachment in the context of emergent autism may contribute to difficulties experienced by children with ASD and their families.     

催产素对不安全依恋者人际适应性的影响

催产素被誉为“爱的荷尔蒙”, 与依恋有着密切关系。以往研究已证明不同来源的催产素对不安全依恋者的人际适应性会产生不同的影响, 主要表现为内源性催产素水平越低, 不安全依恋者的人际适应性越差; 外源性催产素增强了依恋回避个体的人际适应性, 但降低了高依恋焦虑个体的人际适应性; A、G等位基因与不安全依恋者的人际适应性有关。此外还借助依恋理论和社会显著假说解释了上述影响, 不安全依恋者的防御性排斥、环境因素和个体差异调节了催产素的效应。未来应比较催产素受体基因与不安全依恋者人际适应性关系的差异, 催产素影响不安全依恋者人际适应性的性别差异问题, 并在人际互动过程中研究催产素对不安全依恋者人际适应性的影响, 以增强催产素研究的生态效度。