Reflections on Attachment - The AFTA Clinical Research Conference

As reported in the Winter 2000-01 AFTA Newsletter

Joellyn L. Ross, Ph.D.

Couples therapy remains my greatest clinical challenge, even after nearly twenty years in practice. Helping couples to get re-connected is hard, especially when there are years of pent-up hurt and frustration. I am always open to new ideas, and have been actively involved in developing my skills via participation in a wonderful narratively-informed peer supervision group. I've been frustrated, however, trying to apply narrative thinking to my work with couples; I just can't get it to "click" for me with couples.

I wanted very much to attend AFTA's clinical research conference held last October because the subject was attachment, which has seemed to me an interesting and valuable rubric for studying relationships. Unfortunately, I was unable to attend, as celebrating my birthday in London beckoned stronger, I confess, than professional development. Fortunately, the Winter 2000—01 AFTA Newsletter had an excellent collection of articles which summarized and reviewed the conference, so I feel like I got the best of both worlds, vacation and conference.

I appreciated the breadth and balance of the articles, from Susan Johnson's excellent summary of her work about the importance of helping couples develop secure attachment and connectedness, to the critiques of attachment theory and its focus on the mother-child relationship, and of research into emotionally focused therapy, which primarily has been with Caucasian, heterosexual couples. Like many of those attending the conference, I too welcomed Hazan's work (well summarized by Volker Thomas), which looks beyond the sexual strategies theory based on evolutionary notions about human behavior to the human need for kindness and understanding in a mate. (I'm still puzzling, however, even after consulting my American Heritage Dictionary, over Hazan's use of the less familiar word "propinquity" rather than "proximity.")

Reading the articles about the conference inspired me to do some thinking and reading about emotionally focused couples therapy. Over the years, I have been an avid student of John Gottman's research on couples, and use many of his findings in my work. I have found it difficult, however, to apply his research to changing couples' relationships, specifically, how the individuals in couples feel towards one another. My experience has been that people can learn to communicate better and more skillfully, but still may remain emotionally unsatisfied in the relationship. Johnson's work directly addresses this problem.

I found that the articles inspired me to spend some time thinking about my couples work, and the theories which inform it. I warmed to the assignment to write my reflections on the articles about the Attachment conference because it gave me a reason to sit down and focus my attention on some new (to me) ideas. Living in the "trenches" of private practice, as I do, it is all too easy to get caught up in practice demands and ongoing battles with insurance companies, and to have little time to think.

A digression: In an earlier life, I was intent on becoming a journalist, Lois Lane as it were. Thus, I did a reporting internship at the Detroit Free Press in the summer of 1970, at a time when that newspaper's reporting staff was young and cocky and full of themselves. Every evening, an older man, a copy editor named Ralph, came in for his 6 p.m.— 2 a.m. shift. I'd say "Good evening" to him, and ask, "How are you?" To which—invariably—he would reply, "Dead, thank you." Ralph, although very competent and well-respected as a copy editor, was considered to be a "hack," someone over the hill, with no new ideas, out of touch with the excitement in the newsroom and with contemporary ideas. For us youngsters, becoming a hack was something to be dreaded, something to be avoided, always. I've carried that mindset with me into my work as a psychologist, inasmuch as I believe that if the day comes that I think I know it all and don't have anything else to learn, that's the day my licenses should be taken away from me. I still have the dread of becoming a hack. I fight against complacency by writing, participating in a peer supervision group, and by teaching at PENN Council for Relationships.

I conclude that all of us who work with couples need to be informed about all the different kinds of couples therapy, so that we can tailor our work to the needs of the couples before us. Some couples do need conflict resolution and basic communications skills, others benefit from help in getting away from their "scripts" so they can have in depth discussions about important issues they have been avoiding, usually for years. Others need help dealing with that which cannot be resolved (nearly 70 % of issues in marriage, according to Gottman).

My understanding of attachment theory-based couples therapy, as described by Johnson (who calls it Emotionally Focused Marital Therapy, or EFT), is that it seems related to Hendrix' Imago therapy, inasmuch as the interventions are particularly useful for helping people whose emotional expectations and responses are immature, the consequence of emotionally deprived upbringings; in other words, the narcissistically injured. Couples in which individuals have these problems can be the most difficult with whom to work, as sessions easily can deteriorate into affective free-for-alls, even with the strongest therapeutic structuring. I always have avoided emotionally-focused therapies as they seem to have little direction other than affective expression. Approaches such as Hendrix' are based on the belief that infantile needs must be honored and gratified—in rather infantile ways such as partners' "mirroring" each other—in order for partners to love and trust one another. I am not comfortable with this regressiveness.

Unlike Hendrix, whose work focuses on "healing the inner child" via exercises which encourage emotional expression and mutual soothing, Johnson's work is a sophisticated paring of behavioral techniques with emotional intelligence which is used to help individuals identify and express their needs in an effective manner which engages the spouse, rather than frightening or overwhelming the person. Johnson approaches people as adults with emotional needs which can be understood and expressed in a relatively mature manner. She does this by identifying the problematic interactional cycle, and using that to structure interventions. Within this structure, underlying needs are accessed, processed and expressed in more satisfying ways. I have long been aware that some couples "scare" each other, that their communications result in their feeling afraid about themselves and the stability of their relationship. I have not, however, had a particularly lucid method for exploring this fear, for identifying what may be causing it and finding ways of transforming the unexpressed needs behind it into something more fulfilling. Johnson's work provides some tools for dealing with these fears and helping couples to have relationships which are more secure.     

 There is a partial transcript at the end of her book, The Practice of Emotionally Focused Marital Therapy, in which the therapist takes a small incident of emotional disconnection translated into narcissistic injury, and skillfully uses it to help the couple move past their usual pursue/attack - withdraw/avoid pattern. There are numerous occasions in the transcript in which the therapist chooses not to explore the individuals' immaturities, but rather helps them to maintain more adult emotional positions and to learn to be more responsive to one another. It's wonderful reading, as it must have been a wonderful experience for this couple to learn to connect more positively.

I plan a careful reading of Johnson's book, and am likely to re-read the articles in the Newsletter. It will be an intellectual challenge to try to find connections between attachment and narrative. It's nice to be excited about some new ideas—my patients, hopefully, will be the beneficiaries.

  References

Gottman, John M.. (1999). The Marriage Clinic. NY: Norton.

Hendrix, H. (1988). Getting the Love You Want. NY: Henry Holt.

Johnson, Susan M. (1996). The Practice of Emotionally Focused Marital Therapy: Creating Connection. Philadelphia, PA: Brunner/Mazel (Taylor Francis).

Joellyn Ross, Ph.D., is a licensed psychologist in practice in Cherry Hill, NJ. She also is on the faculty of PENN Council for Relationships and is a member of the AFTA Newsletter's Editorial Board, for which she serves as staff photographer.