The Attachment Paradox

19 05 2021

I recently wrote an article for Psychotherapy Excellence (PESI); the largest psychotherapy learning hub in Europe. They’ve asked me to write a few articles on Attachment for them in the past, and this time I approached them with the topic of the Attachment Paradox in mind. The article is as follows:

We are social animals, and the social wellbeing of our clients is a crucial aspect of therapy. Over recent years, attachment theory and the neuroscience that supports it have meant that most therapists no longer approach their clients as an island of complex neuroses, but as part of a larger system or systems. As we explore these systems and relationships, we can start to uncover deep wounds, and then begin to facilitate their healing.

Our clients will often speak about experiences that have been painful or traumatising, and which may have led to the unconscious development of certain maladaptive coping strategies and behaviours, and ways of relating to self and others. These experiences may have taken place within our clients’ relationships with parents, loved ones, family, friends, and colleagues. Or they may have been connected to the jobs they do, the money they have, the lives they have constructed, the beliefs they hold, the intergenerational family systems and genetic legacies they were born into – or to themselves and their constituent parts.

Attachment theory can be a helpful guide to framing some of these relationship experiences and their consequences, however it is often presented in a way that can feel confusing or even blaming to clients.

A particularly common problem is how to help clients understand the perfectly natural and predictable cycle of escalation that occurs in bids for connection when a secure attachment relationship feels like it may be under threat – for instance, when there has been a life event which renders an attachment figure suddenly emotionally unreliable.

During these times, a previously secure relationship, or securely attached individual, can quickly fall into anxious patterns. A cycle of escalation occurs, as the anxious and threatened party seeks closeness and reassurance during the time of threat. As seen in Dr Edward Tronick’s Still Face experiment (available on YouTube), this cycle of escalation typically follows the following process:

  1. Reach (the seeker makes a bid for connection)
  2. Protest (when this bid is unmet by the giver, there may be a sad or angry protest attempt)
  3. Despair (as this continues, the seeker falls into a state of despair; often marked by some kind of meltdown or tantrum)
  4. Detach (ultimately, the seeker turns away and shuts down, going into a state of withdrawal and collapse)

This pattern of pursuit can seem suffocating, needy, or neurotic, and can be quickly matched by a similar pattern of withdrawing and distancing by the other party.

These cycles can seem paradoxical at first, and I often find that clients are reassured when I explain the simple ‘attachment paradox’ to them; that a secure attachment can tolerate distance, whereas an anxious one cannot. This is often a lightbulb moment, as they understand the shift in inter-dependence. They recognise how they were once able to travel separately or have their own individuated friends and interests, whereas now they feel stuck in a pursue and withdraw cycle of enmeshed hyper-vigilance or anxious co-dependence.

These pursue and withdraw cycles, and the painful distance they create, are often what brings clients to therapy, however they are perfectly understandable and reversible. As we identify and understand them, we can quickly de-escalate these maladaptive cycles and then promote new healthy patterns of connection and repair. We can move our clients away from patterns of forced connection and sympathetic arousal, and back into a state of relaxed and connected flow.

An easy way to check for secure attachment is to ask the question, “ARE you there for me?”

  • Accessible (can I get to my attachment figure when I need them?)
  • Responsive (do they respond to my bids for connection?)
  • Emotionally Engaged (are they able to understand my emotional needs in these moments and create a shared sense of safety?)

If we can create this emotional safety, then both parties will know and trust that they exist in the other’s mind. This implicit sense of being held in mind is what Winnicott described as the ‘internal holding environment’; something that evolves out of the literal maternal holding environment throughout childhood, as the child develops an internal working model of relationships.

In a secure relationship we can have our independence, knowing that our partners won’t forget about us or withdraw their love in our absence. In an anxious relationship, we cannot be so sure. ‘O what a joy it is to hide,’ wrote Winnicott, ‘And what a disaster to never be found.’

It can be found here on the PESI website.

If you would like to explore this – or any other issue – in therapy, then please do not hesitate to Contact Me.





How To Change Your Drinking: A Harm Reduction Guide to Alcohol

16 12 2011

My review of “How To Change Your Drinking: A Harm Reduction Guide to Alcohol” by Kenneth Anderson:

How to change your drinking front cover

Substance misuse is one of the most common and widely discussed topics within the mental health community, as both clients and professionals debate the most effective ways to deal with addictions and their causes.

In the past, treatment might typically have involved a focus on abstinence as the ultimate goal, through zero-tolerance groups such as Alcoholics Anonymous, or a 12-step program, where clients would be rewarded only for complete sobriety and nothing less.

This has slowly changed over the past decade, though, through the realization that complete abstinence simply wasn’t a realistic or achievable goal for some, and that such a harsh insistence on withdrawal simply wasn’t working. In fact, it is estimated that 60 to 95 percent of clients who enter 12-step programs either drop out or otherwise fail to maintain abstinence from alcohol, and the NIAAA’s statistics suggest that only 7 percent of people who suffer from an alcohol use disorder will typically seek treatment within any given year.

As a result the treatment focus has shifted from simple cold turkey toward an overall emphasis on healthier and safer habits, and lowering risks. This has seen an emerging popularity for modalities such as motivational interviewing, where both the pros and cons of sustaining the negative behaviors are acknowledged. The client is then free to decide how, and at what pace, to proceed.

The HAMS group takes a similar “baby steps” approach. HAMS — the acronym stands for Harm reduction, Alcohol abstinence, and Moderation Support — describes itself as “a free of charge, lay-led support and informational group for people who want to change their drinking for the better.” Founder and CEO Kenneth Anderson is himself a former problem drinker.

In this book, How To Change Your Drinking: A Harm Reduction Guide To Alcohol, Anderson presents a comprehensive summary of the harm reduction approach to drug and alcohol problems, suggesting it could “either be used as a self-help manual for people working on their own or by people who are participating in a harm reduction support group.”

The book begins by introducing the underlying theories of harm reduction, and is written in a nonjudgmental tone that will be reassuring to most readers:

Some folks today want to say that everything fun is an addiction and that everyone had better spend their lives in 12 step meetings talking about their ‘Higher Power’ and holding hands and saying the Lord’s Prayer instead of ever doing anything fun. We beg to differ with these people. Prohibition does not work because there is nothing essentially evil, sinful, or diseased about having fun. There is nothing evil, sinful or diseased about drinking alcohol moderately, and for that matter there is nothing sinful, evil or diseased about engaging in recreational intoxication either.

There is not some specific magical quantity which we can say is too much alcohol – free individuals have the right to make up their own minds about how much they believe is too much for them personally. Occasional intoxication is not a symptom of a disease; it is a choice.

It is this focus on individual choice and empowerment which personifies this book and differentiates it from much of the rest of the substance misuse canon. Instead of focusing on problematic labels or clinical diagnosis as a means of demanding perfect abstinence, the author leads the reader on a step-by-step journey toward deciding what their own goals should be, and offers advice and support on the healthiest ways to achieve and maintain them. There is even a short section titled “Ken’s Story,” where Anderson talks about his own previous drinking problems and near-death experiences in AA. Those led to his resolution to “find a better way” and start the HAMS network.

The opening chapters might seem familiar to many mental health professionals, as Anderson suggests that each reader completes a Cost Benefit Analysis exercise, similar to those used in motivational interviewing techniques:

Miller and Rollnick (2002) say, ‘Often individuals considering changing a problem behavior will concentrate on all the negative aspects of the behavior. ‘I know how bad my drinking is for me,’ they say. In fact, they can often produce a litany of reasons why what they are doing is bad for them. Clinician and client are often baffled by the fact that even with all these negatives, change does not occur. The reality is that if the behavior were not in some way beneficial to the client, he or she would not be doing it. Until the client acknowledges the ‘good things’ about the behavior, they cannot prepare to combat temptation once they make an attempt to change. The decisional balance helps facilitate this process.

It is clear that Anderson has done his research in this field, and even though much of the book features personal stories and experiences, these are all presented within a scientifically supported framework, using clinically proven techniques and offering further resources where appropriate. Later in the book, Anderson explains Prochaska’s “stages of change” model, leading the reader through each stage and explaining the range of thoughts and behaviors that might accompany this process. He offers readers a large quantity of materials to help them along this journey, too, ranging from goal-setting and risk-ranking worksheets, to consumption charts and graphs, to the chemical breakdown of different alcoholic beverages and how they are processed within the body.

The book also addresses the addict’s friends and family. Anderson features chapters on specific topics such as spousal goals, alcoholism’s effects on children, and a study of drinking patterns as affected by ethnic identity and religious affiliation.

There is a wealth of knowledge in this book, but the clear, concise and easy-to-read style ensures that it never becomes overwhelming or difficult to follow. Anderson describes things in layman’s terms and it is doubtless this open, reassuring style which attracts so many of the HAMSters to the harm reduction approach.

As a comprehensive manual to changing drinking behaviors, readers will be hard-pressed to find a better book than this. If you’re looking for support, advice, scientific facts, or recovery tools, you’ll find them all here, clearly laid out for both mental health professionals and clients alike.

4 out of 5 stars.

It is worth noting that alcohol misuse has been a major issue in the British media since I wrote this review; with suggestions of major changes in government policy and the introduction of ‘drunk tanks’ and ‘booze buses’. I have a lot more to say on this topic, and it is one that is close to my heart as I do a lot of work for a substance misuse agency within the NHS in North London; but that’ll have to wait for another time.