Part of what has been so challenging in therapy lately is that I have not been able to find words to really describe what I’m experiencing. It all feels so emotionally familiar, but also foreign and new at the same time.
My therapist always says that sometimes when we’re experiencing something new, it is hard to put words to it because we’ve never spoken about it before. This is particularly true when you are trying to speak the unspeakable.
In response to a recent blog post, a reader left a comment suggesting the book “Trauma and the Avoidant Client: Attachment-Based Strategies for Healing” by Robert T. Muller. I did a quick Google search and came upon the book, as well as an article titled “Trauma and Dismissing (Avoidant) Attachment: Intervention Strategies in Individual Psychotherapy” by the same author.
I had to read it a few times before my brain could settle down enough to make sense of everything I was reading. I have often been told I have an anxious-preoccupied attachment style or, more recently, a disorganized attachment style. I’ve done a lot of reading about those two styles to try and understand both myself and the work I should be doing.
So I was very surprised by how much I could relate to this article about individuals with a dismissive attachment style. It turns out this is fairly common in patients with intrafamilial trauma. Since these clients are by definition avoidant, it is a challenge to do research and develop treatment strategies for them. But Muller was able to tackle this important issue and what he came up with resonated with me in a very powerful way.
Dismissing attachment is characterized by the avoidance of feelings, memories, or longings that might drive away the attachment figure…the function of this avoidance is to disable feelings and ideas that threaten the real or perceived relationship…the patient shifts attention away from memories of potentially painful relationship episodes with caregivers, thereby avoiding possible threat to his or her characterization of the relationship
I feel like this really addresses the difficulty I have been experiencing recently. There have been moments where I am literally rendered speechless, or I feel compelled to quickly change topics, when my therapist and I are attempting to delve into attachment issues in session. I couldn’t understand why I would completely decompensate or outright switch when I started having an emotional reaction to our relational issues. It somehow seemed to be about her, but I didn’t quite understand how or why that would be happening because I couldn’t access the full emotions.
The article explains this a bit:
Deactivation, a central defensive characteristic of dismissing attachment, has as its goal to shift the individual’s attention away from those feelings, situations, or memories that arouse the attachment system. It enables the person to diminish, minimize, or devalue the importance of attachment stimuli…such inhibition occurs only when stimuli are attachment related, suggesting that such individuals’ regulatory skills are specific to attachment-related material, as opposed to material that arouses strong affect in general.
Unless the attachment system is activated in treatment, attachment as a topic of discussion will likely remain closed or, as is often the case with brighter, analytic individuals, the underlying affective meaning of a given issue will remain closed, rendering it impossible to reappraise or restructure mental representations of self or other.
Furthermore, I tend to get incredibly frustrated and angry with my therapist when she tries to address these strong triggers. I don’t understand why she won’t engage with me or fight for me when I’m feeling so distressed or lost.
But then I read about how Muller recommends approaching dismissive clients:
I propose a general treatment approach that runs counter to the defensive strategy favored by such patients, that is, an approach that is activating of the attachment system, one that turns the patient’s attention toward attachment-related experiences and challenges defensive avoidance. Without such challenge, the psychotherapist runs the risk of colluding with avoidant coping patterns that may evade distress in the short run yet turn out to be ineffective over time…Previous trauma theorists have described the countertransference that emerges with such patients as the tendency to engage in a mutual avoidance , which provides relief for both the therapist and patient.
The challenge facing the therapist is to make active attempts to turn his or her attention toward trauma-related material; to listen for it, notice it, ask about it, and facilitate rather than avoid such painful topics. If not, the risk is that of replicating the rejecting response of the parent who reacts to the child’s abuse revelations by discounting or minimizing their importance.
He talks about this more specifically later on:
It is important that gentle but consistent pressure be kept up to help the individual stay focused. The clinician resists the temptation to rescue the patient from the anxiety surrounding difficult attachment-related material. When the patient responds with “I don’t know; I never thought about that before” and then stares at the clinician or searches uncomfortably for a distraction, instead of rescuing the individual with another question, the clinician asks the person to take his or her time, and think about it right now, even if it is the first time she or he has ever thought about it. This is then followed by a period of attentive, engaged silence. Such an approach undermines deactivation and is therefore experienced as quite challenging.
Oh my god.
I cannot even begin to explain how absolutely SPOT ON this describes the way my therapist works. She never saves me in the moments I am anxious and wanting to desperately escape from the profound pain of the attachment wounds. She very often pushes me to stay present with a thought or emotion, even if it’s very painful and especially if it’s something I’ve never been able to talk about previously.
As far as “attentive, engaged silence”? Holy shit, that’s like half my sessions! Okay, maybe not half, but it feels like a lot of time. I get so hurt and frustrated because it really feels like she’s abandoning me in those moments! This article, however, allows me to understand that she is not abandoning me at all. She’s actually working extra hard to stay with me during the moments when I am working extra hard to abandon myself.
She tends to ask these prompting questions that feel so invasive and challenging. I always tell her I think she’s trying to “set me up” so that I fail and then look stupid. Or I make fun of her or push back at her because I’m so scared of being hurt or rejected that I suppose I want to push her away before she can hurt or abandon me. But sometimes she perceives that as me “not caring” or dismissing her and she gets upset. This is one of the major reasons we end up in these embattled dynamics that feel impossible to navigate. So I was particularly struck by this statement from Muller’s article:
Such patients can respond to questioning about trauma-related feelings by rejecting them outright, minimizing or laughing off therapist observations, or using defenses such as intellectualization to dampen the intensity of therapist comments. There is a sense of failure and shame for having fallen apart or self-directed anger for being so needy, along with a desire to figure out how to protect themselves from falling apart in the future…In response, the clinician may react to such rejection or minimization with a variety of emotions (e.g., frustration, irritation, hurt, or disappointment), with different therapist responses depending on the clinician’s own personal history and attachment pattern.
Which is such a wonderful representation of what happens with my therapist and I during these moments. Because I do respond in ways that are rejecting, minimizing, or intellectualizing. And she does become hurt or frustrated when I do so. We are both only human after all.
I went to session on Friday with the intention to talk about this article. I didn’t quote it, I just used my own words to summarize what I felt Muller was saying and how I thought it was related to us and our work. It was amazing to finally have this language for something that I otherwise cannot speak about or even understand.
She was very excited about it and shared my opinion that it was a great representation of our work together. I explained how much it helped me to understand my reactions and this really specific attachment trigger that I experience. She asked if it also helped me understand some of her choices and behaviors, which is does. She invited me to bring the article (and the book) into session in the future if I want so that we can keep talking about this.
I have to admit that I have recently felt like our relationship was on a trajectory that just didn’t have a good ending. I was scared. I couldn’t figure out how to even talk about it, let alone problem solve.
So the timing of encountering this article was absolutely perfect (and thank you to the person who suggested the book!). I feel so much more calm and relaxed. It’s like I can breathe again in therapy. I know this isn’t a permanent solution and there will be more challenges, but I am so utterly relieved to have finally found language for something that previously felt unspeakable.
As Muller states in his closing sentence:
The challenge in treatment, then, is in helping such patients find a way to tell a story too painful to speak, but too compelling to ignore.