Many clients have asked me “how do you use attachment theory in counselling?”. This post provides an overview of what attachment oriented therapy process looks like.
In attachment oriented counselling (AOC) as I practice it, clients tell stories to make sense of their lives. I use the insights of attachment theory to help clients create stories about their “self” and their “self” in relation to others across time. In the process they develop. Developing involves unlearning some things and learning other things in a way that facilitates a shift from one level or quality of understanding and awareness to another.
One of the primary insights of attachment theory is that people develop best when they feel really safe and when they have the assistance of a caring and able person to help them. In AOC I hope to become a caring and able person in relation to the client – a reparative attachment figure of sorts, a safe haven to assist with the risks associated with developing.
For these reasons, the first step in AOC is to create a sense of safety. For the most part a sense of safety is a result of interacting in the very ways that are known to produce a secure attachment. In essence, this means communicating (both verbally and nonverbally) in ways which are engaged, responsive, receptive, attuned and contingent.
My experience has been that when I communicate in these ways well enough and for long enough, clients come to feel safe enough to just be themselves. They reveal themselves. In time as they do so, we begin to see patterns – patterns of behavior, of thought, and of relating. Seeing patterns is part of the art of this method, in part because it is as much about seeing what isn’t there as it is about seeing what is there. Patterns are often to be found in the interactive dynamics between the client and the counsellor, but also by tracking the characters, events, and themes in the client’s story.
Generally speaking the process unfolds more or less as follows. First we talk to get comfortable with each other. Then we talk to understand the “problem(s)” as presently conceived, and the story as known already. Then we look for patterns in the existing story. Then we talk about the patterns that we think we see. Sometimes we even talk about talking about the patterns. Eventually we talk about changing the patterns and developing the story.
One of the ways we do this talking is with words. There is vast healing potential in words. They have the potential to afford us distance from our experiences. When we use words, we are putting experience into symbolic form. Words are symbols. They are things that stand for other things. Symbols offer a degree of separation between an experience itself and the representation of that experience. This bit of separation can give a person distance from the experience to usefully reflect on it. When it comes down to it, a person’s story is essentially the making sense of representations of experiences of self and others across time.
When an experience is represented in symbolic form it can be picked up, looked at from multiple perspectives and put back down again in altered form as needed. Some symbols can be tossed out in favor of other ones, if we decide they don’t do a good enough job of representing the thing they are meant to symbolize. Symbols can be examined and manipulated
As we use words to symbolize experience, we acquire the capacity to reflect on the symbols and, by extension, on the experience. In so doing, we position ourselves to determine how we represent our experiences to ourselves and to others and we actively author ourselves into being.
In AOC one of the primary ways I do this is to increasingly facilitate a mindful and curiously investigative stance toward experience. With these two stances toward experience, the client is afforded experiential breadth and interpretive depth in relation to their experiences. The more we do this over time, the more we become active agents in how we know, experience, and present ourselves and the more we become able to author ourselves into being.
As we talk with words in AOC, we also talk without them. I listen really closely to the client’s body, face and breathing to see if any of the word-talking we are doing about patterns or experiences is overwhelming to the point that the client is becoming hyper-activated or hypo-activated. If this appears to be the case it is often not possible for the client to have a mindful or interpretive stance toward experience because s/he may well be too embedded in or too dissociated from the experience to usefully reflect on it.
When this is the case, we slow right down or even stop discussing content of the experience altogether. We start talking much more without words. What I tend to do in such moments is to use my affect, tone, body, eyes, breath and a likely a few carefully chosen words to say, in effect, “I understand, you’re not alone, we can handle this together, and we’ll get through it; we’ll do what we need to do so you are as safe as possible”.
There is often vast potential for healing and development in these moments, but it has to be handled really carefully to avoid traumatizing or re-traumatizing a person. In my experience it is often critical in moments like these to keep the focus on the present rather than on the overwhelming past or the feared future. Focusing on the present can include discussing current day resources, sources of safety and even just what “is” in that moment as perceived through a persons senses. Often some sort of relaxation or grounding technique can help to bring a person back to a comfortable level of arousal. When we get through rough spots in a person’s story effectively in this way and then later use words to develop understanding of what happened we are helping a person learn to regulate affect, that is, to be aware of and to monitor their level of arousal with more clarity and to influence it more efficiently.
When a person’s level of arousal is back within tolerable limits, we may revisit those parts of the story which had been overwhelming. We may explore a smaller, more manageable part of the story than before, or we may explore it for a shorter time. The goal is to facilitate a different stance in relation to the previously overwhelming experience, to help the person have enough distance to reflect meaningfully on the experience without becoming the experience.
Often I use my understanding of the person’s attachment history and style as we work on developing a coherent self narrative in this way. If a person characteristically tends to become flooded by emotion at the expense of being able to think, I attempt to engage the person’s left hemisphere cortical capacities to work through the difficult parts of the story toward developing new awareness. Over time I hope to help the person be able to think through and make sense of the experience and to incorporate this new understanding into their story.
If, on the other hand, a person characteristically tends to disavow the emotional content of experience and to think at the expense of feeling, I try to engage their right hemisphere cortical capacities to feel, sense and intuit things to work through the difficult parts of the story. In time I hope to help the person be able to tolerate the emotional and somatic dimensions of the experience and to make room for and sense of this in their story.
As time goes on, the client and I continue to develop the story and the capacity to reflect on it meaningfully, in part by adding in new story lines, themes, characters, and details as needed, but perhaps more importantly, by progressing from one level to the next of awareness about the self and the self in relation to others. Along with more developed understanding and awareness also comes a greater capacity to tell the story coherently, and importantly, a greater capacity to experience oneself and to act on the basis of the more developed understanding and awareness.
As this process progresses I keep track of my client’s story with and for them. If I’ve done this well, I have made myself a safe, familiar and helpful co-holder of the story, giving the client a sense of feeling felt and being known across time.
I believe that over time in these ways a client comes to increasingly internalize a felt sense of security. As this felt sense of security increases, so too does a client’s capacity for autonomous exploration, intimate connection, interactive and self-regulation of affect, and meaningful reflection on experience.