MENTAL HEALTH & ADDICTION
One of the core theories of a psychodynamic style of psychotherapy is that of analyzing past patterns which play out today. This may include themes of trust or distrust, individuation or family, identity or confusion. We repeatedly witness in treatment the core dilemma of attachment issues. Whether this involves a limited ability to attach with a peer or a clinician, the past is continuing to repeat itself. This article will review some of the more common examples.
Attachment and Attunement
Initial healthy attachment is developed through a loving and attentive bond with a primary caregiver. A caregiver may include a birth parent, close older sibling or actively involved extended family. As a child is growing and developing, the presence of a stable and loving guiding force helps that child experience love. Ultimately the child will be able to carry love and give it forward over one’s life. The opposite is also true. The absence of this sense of love and attachment can stifle the future capacity for such traits.
A child has needs for many things, including a sense of safety. This includes a desire for new experiences and mastery of basic sensory building blocks such as touch. This child also needs to experience something called ‘attunement’. Attunement involves someone closely paying attention to them. This last trait may be the most fundamental for secure attachment to develop.
Attunement happens when a caregiver is present with the child, interested in the activity at hand, and genuinely curious. The caregiver is demonstrating empathy for this child. The child feels valuable. Through this experience, the child is able to give such things to others later in life. The ability to attend to another, to be curious about another’s life and to show compassion. These all extend from having received such gifts first.
Attachment Amidst Addiction
There seems to be something very human and fundamental about the desire to attach. Even for those who have severe struggles with attachment patterns, they often are looking to attach in some way. We see this often at CeDAR, especially in regards to the current and past relationships of our patients. The intrinsic energy to keep a relationship going can be stronger than anyone’s advice or logic.
While emphasizing the importance of attachment and connection, potentially toxic attachments clearly hurt someone’s chances at recovery. Examples of such toxic attachments might include an abusive domestic relationship, an enmeshed family member, or a close friend who is also addicted to drugs. Many experts in recovery would argue that the need to change one’s attachments is imperative for legitimate life change. But what if someone only has a few attachments? That person will cling to those relationships, even if it means risking everything.
Toxic attachments very likely replicate attachment patterns of the past. For instance, staying in a marriage with an alcoholic partner is very similar to growing up with an alcoholic parent. Both those people are struggling with emotional distance caused by the addiction. They may be passed-out, inattentive or even rarely at home. People live according to what is familiar to them, and this includes choices around relationships.
It is common for people in early recovery to seek new and intense romantic relationships. This represents a continued yearning to attach, and has the risk of causing destruction. Prematurely finding a new love can also serve as a distraction from reflective recovery. Instead of working on oneself, the person starts to slide back into the past. Some relationships in early recovery work out successfully and are healthy and supportive, but this seems to be the exception rather than the norm.
For most of our patients, we recommend exercising caution in this territory. Each individual needs to build insight around issues and patterns with attachment before seeking new ones. In this way, they are able to make different choices over time, discovering the capacity to change.
Corrective Attachment within Treatment
Although the content and skills of psychotherapy carry good value for patients, the nature of therapeutic attachment may be the most beneficial healing ingredient. Simply having a therapist who is attentive and curious about someone’s life can offer tremendous value to someone who may have experienced limited attachment and attunement over their life. We call this a ‘corrective experience.’ It offers the patient something new in place of typical life events.
So much about psychotherapy is helping a patient become ‘a patient.’ This involves addressing areas of distrust and resistance to a therapeutic process. The therapist is trying to help the patient build a good attachment to the therapist. Once that starts to happen, the therapist might comment about what this attachment feels like, how it compares to other attachments in the person’s life, and ways to apply these principles to build on the person’s important relationships.
Many people resist this process and some never fully build a good therapeutic relationship. We try to explore this, although the very nature of the exploration may seem suspect to the person as the attachment and trust really aren’t there. The best we can do in these scenarios is to be patient and consistent.
This can be especially problematic for patients who always describe their prior therapists as not being a good ‘fit.’ If everyone fails such a fitness test, perhaps the attachment dilemma is more with the client. For anyone who has struggled with this, a middle-ground approach seems useful. In other words, it makes sense to explore the quality of fit with a small handful of therapists, but you would eventually need to make things work with one of them. Using a ‘good enough’ mentality can be comforting to some people.
Patterns repeat themselves in life, especially with regard to relationships. For anyone who is seeking counseling or therapy for issues involving today’s relationships, we need to start the process by exploring basic patterns of attachment and links to the past. Repeated self-defeating choices usually are rooted in some deeper psychological themes such as an attachment disorder. If we can help someone understand how attachment looked in their life and show them a different experience through safe and helpful therapeutic attachment, they can change.