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

Figure 1

Figure 2

Figure 3

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

Reading one’s own

and

another’s mind

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

Two-dimensional, four-category model of adult attachment

(Bartholomew, Henderson & Dutton, 2001)

The dynamics of the secure attachment system

(Bartholomew, Henderson & Dutton, 2001)

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.

IPI

David E. Scharff, M. D.Jill Savege Scharff, M. D.

© 2005