Healing Trauma, page 49
When there are long ingrained defenses against traumatic attachment failures, anything can become a source of stress and pain. A look not given, a message not understood, a yearning for closeness not met, become magnified into a recreation of emotions around early trauma. Feelings related to dependency needs and deep unfulfilled yearnings are replaced by rageful feelings and blaming attacks. Defenses reemerge to protect both the vulnerable core self and the object of one’s multifaceted loving and hateful feelings. In the treatment setting, when emotion suddenly intensifies, it is a signal that the partners are dealing with an unacknowledged wound in the here-and-now of the session.
The reason it is necessary to focus on here-and-now affect is that the great fear of many people is that their feelings are wrong, or even dangerous. “If you see the effect of my disappointment in you, my crying, clinging tightly, protesting, raging, or showing despair or depression, you will be disgusted and withdraw from me completely.” Conversely, with overwhelming emotions, “I can drown you out, so I will not be hurt.” Such reactions are not unusual for adults who have experienced early attachment traumas. These negative emotional responses, if not attended to and restructured, will undermine any chance of repair of a couple’s relationship. Emotions are vital in organizing key responses to significant others and operate as an internal compass that helps to focus people on their primary needs and goals. Many emotional states emerge in conjoint sessions with couples. Often they are expressed not in words, but in body reactions and facial expressions. Partners may need help in accessing and acknowledging them as they are experienced in the conjoint session. In the process of containing and exploring together such emotions, the therapist can help to clarify internal schemas about the nature of self and other, and cocreate new narratives, thus beginning the process of change.
Techniques of Attachment-Oriented Couples Therapy
Conjoint therapy is designed to help each partner to reconnect with his or her own and each other’s needs and emotions. The treatment includes a differential diagnosis of the unique history of trauma and patterns of attachment that each partner brings to the relationship.
Whatever went wrong in the childhood of each partner will be tested in an intimate relationship that includes not only the partner, but in-laws, children, and other family members. If the early childhood trauma was significant, then the individual will frequently invoke defenses to alleviate the relationship difficulty, and then the normative growth of intimacy, empathy, understanding, healthy dependency, and connection that occurs over time will not unfold. Instead, stalemate and stagnation prevail, and conflict and alienation dominate the partners’ life together.
Because early painful encounters are frequently preverbal and are followed by defenses designed to protect the vulnerable self of the developing child, clear memory of traumatic events is lost through repression or dissociation, or never having been visually or verbally represented. What remains are the emotional reactions to the painful moment, the unconscious repressed or unrepresented emotion, and later, a faulty or incomplete narrative designed to explain the surges of pain that suddenly arise in relationships. As Freud (1911/1959) noted, we are destined to repeat that which we do not remember. Inevitably, the repressed or unrepresented affect around painful events and defenses designed to protect the wounded self is reenacted in the intimate relationship. “Rather than a continuous coherent narrative, we observe a precise narrative reenactment” (Neborsky & Solomon, 2001). In the worst cases, husbands and wives can become each other’s worst nightmare through projective and introjective identification (Dicks, 1967; Scharff & Scharff, 1987). The relationship deteriorates into patterns of attack and defense, becoming a collusive jumble in which they cannot live, but from which they cannot extricate themselves.
Listening to the way that the partners present their issues, what is reported of the history of each, who begins, how each reacts to the other’s report of the relationship, what physical and emotional responses are demonstrated, helps the therapist determine whether this is a relationship permeated by traumatic attachments, and suggests various ways to approach the pain. Repair of disrupted attachments is more easily accomplished when a severe traumatic incident was not foreshadowed by a history of earlier “small-T” traumas, such as repeated humiliations of a child who has been made a scapegoat in the family or among peers at school (Shapiro, 2001). When large-T traumas such as rape, violence, and natural disasters have been preceded by this more insidious kind of small-t trauma, states of high alert to danger and rigid patterns of interaction are imprinted in the circuits of the brain (See individual chapters in this volume by Schore, Siegel, & van der Kolk). The temperament of the child, the degree of the trauma, and the capacity of the caregivers to respond, determine the self-organization that forms.
Once a relational pattern is imprinted it becomes part of implicit memory, “the effects become cumulative” (Kahn, 1963). Repetitive attunement failures become fixed, making change more difficult. Moreover, prolonged failure of response can result in development of a primitive aggressive schematic pattern with defensive responses that can follow the person throughout a lifetime of relationships (Neborsky & Solomon, 2001). Hopeful anticipation is often followed by disappointment, defense against further painful encounters, and the pain of a deadlocked relationship.
Therapists often find themselves stymied when working with such deadlocked relationships. They should be viewed as possible diagnostic indicators of early trauma in which fight, flight, or freeze responses were evoked. In such cases, the persistent expectation of impending danger results in a constant need for reassurance, which, if not met, is translated into a sign of betrayal. In a deadly cycle, the initial breach spirals into a battlefield characterized by hyper-alertness for further signs of betrayal, which becomes the norm for the relationship (Johnson, 2001). To vulnerable participants, the relationship always feels tentative, and there is a tendency to test the love to alleviate the constant doubts, even when things are going well. At the same time, any sign that needs might be ignored or denied is met with avoidance, numbness, and criticism, often along with self-doubt and self-blame. The internal message, “I am defective, destructive, and unlovable,” is repeatedly confirmed.
In addition, early trauma causes deficits in perceiving and processing ability that may include the capacity to categorize experience, connect to autobiographical narratives of experience, or develop a capacity for empathic attunement toward others. Later, this inability to perceive the emotional states of others, a kind of psychic dyslexia in ability to read facial expressions, leads to a misinterpretation of the communication of others and coincides with negative expectations of others’ intentions. There is a failure in contingent communication1 (Siegel, 1999) which interferes with resolution of problems. In his book What Predicts Divorce, Gottman (1994) discussed the complex causes of marital failure.
Gottman’s research (1994, 1999) indicated that it is not the number of arguments that partners have, nor the method of dealing with angry feelings, nor even whether they successfully resolve disagreements, that make a difference in defining success or failure in a relationship. The important defining factor is the ability to sustain emotional engagement and to reconnect to each other following arguments.
It is the proneness to overreact to differences, the inability to accept another’s views, and inability to reengage after disrupted interactions that are so harmful to intimate relationships. Such failure seems to follow people who have experienced trauma and traumatic attachments. From their early experience, they have learned that it is not safe to depend on others, and when disagreements erupt, they become defensive. In stressful situations they utilize various coping strategies, including walling themselves off from another to avoid emotional engagement, hiding a true self while showing a façade that seems more acceptable, or acting out angrily when they experience disruptions with significant others. These are methods of self-protection developed over time during repeated painful encounters with important figures in their lives.
These protective defenses should not be viewed simply as indications of pathological development, but as the best possible course at the time when an intolerable attachment failure left them no other course. Although it was useful at an earlier time, it has become an impediment in current relationships. To understand the way we learn to attach and protect a vulnerable self in traumatic situations, it is necessary to turn to those who have researched attachment (Bowlby, 1998; Ainsworth, Blehar, Waters, & Wall, 1978; Main, 1999; Tronick, 1989 Sroufe, 1996; Siegel, 1999). The different defensive maneuvers that are likely to effect intimate relationships throughout the lifespan are reenactments of protective measures developed in early life painful encounters.
Assessing Degree of Relational Disruption
All couples encounter problems at times. Differential diagnosis of the core relational issue and the degree of early trauma is a priority. While secure attachment provides a base of trust in relationships with others, and a sense of efficacy in coping with the environment, those who have experienced traumatic attachments develop coping methods that are likely to put a wall between themselves and intimate others.
Anxious/preoccupied attachment patterns manifest in push-pull relationships in which the message is “Don’t come close—don’t go away.” Avoidant/dismissive relationships are the result of early experiences leading to an expectation that others will not be available. The effect is likely to be development of habitual styles of interacting that avoid stressful or disturbing emotional engagement with significant others. There is an avoidance of eye contact when entering into dialogue about unresolved issues.
Disorganized attachment patterns are usually the most disturbing for the individuals and create the greatest distress in adult relationships which are usually chaotic, alternating between disruption and reconnection. They often originate when trauma follows trauma, and there is no way to overcome the pain, terror, or danger.
It is important to differentiate those who are likely to respond to marital therapy from those whose pathological defenses make the likelihood of change problematic. Because of unconscious processes that the partners have no way of understanding, the choice of a loved one includes the probability of recreating earlier traumatic experience. This occurs because, through repetition, a response is shaped in which the internal working model of each partner can trigger the other’s most painful and repressed emotional reactions (Neborsky & Solomon, 2001). This produces a counter-reaction in the mate and eventually shapes each other’s responses such that their behavior becomes a reminder of the original wounds. The question is, “Can the imprints of intimate relationships be changed?” If so, what can the marital therapist offer?
An earlier work presented a diagnostic schema for understanding the kinds of imprinted patterns of relating, including a range of disturbances and defenses that are seen in couples’ therapy (Solomon et al., 2001 pp. 138–140). The range includes people who have developed the capacity for secure attachments and are in the high functional-adaptive range (Solomon et al., 2001, p. 140). While they may have relationship problems, the issues are not due to unconscious acting out, the outgrowth of old family traumas, or painful attachments. These people have a resilient self and call on a variety of resources when they are in stressful situations. In therapy, such people participate actively in the treatment, communicate needs and distress, and are able to attune to the feelings communicated by a partner.
They make meaningful links between their current partner and figures from the past. They are open to the help offered by the therapists. A variety of treatments can be used to help people with relatively secure attachments. When such people enter therapy, and they do occasionally, they are gratifying to work with.
Current research has found that a marriage in which one of the partners has a secure attachment, an insecurely attached partner may, develop an “earned secure attachment” (Main, 2002; Davila, Burge, & Hammen, 1997; Kirkpatrick & Davis, 1994; Hazan & Shaver, 1987, 1994).
People who have what Kohut (1984) called “self disorders” seem to overlap with the feelings of avoidant, ambivalent, or disorganized insecure attachment. They often begin therapy with high levels of anxiety because of their fear that unconscious emotions will break through and interfere even more in their life problems. In treatment, they demonstrate moderately high resistance, psychic isolation of the self, and fantasies about destruction of self and others. They protect a vulnerable self with defenses such as aggressive distancing, emotional disconnection, repression, projective and introjective identification, and explosive discharge of affect. They have a proneness to emptiness and depression when the loved one separates, even momentarily, and need others to shore up a fragile sense of self, bind others to themselves through dependency and/or fear, and often set up rejection by others through unconscious aggressive acts. In their relationships there is a constant battle for control, and sometimes there is a tendency toward compulsive caretaking to compensate for inordinate feelings of dependency and neediness.
When the stress of their lives together brings such partners into couples’ therapy, one or both may demonstrate resistance to the treatment. They may activate repressive defenses immediately, denying that there is any problem, or project problems onto one another, or find that a busy schedule requires them to cancel sessions. In the sessions, they may demonstrate regressive defenses, mood disorders, acting out and externalization of problems. Symptoms arise that may cause significant personal distress, and the functioning of relationships may be severely impaired. In fact, it may be so sufficiently severe that it sabotages the therapy until the deep pain caused by the imminent relational destruction motivates the partners to change.
Sometimes partners find that they must choose between getting well or staying married. Alternately, the willingness of one partner to leave the relationship may be the only factor that motivates the spouse to act differently. In either of these instances, genuine changes can be accomplished only through a therapeutic reworking of unconscious early attachment trauma. This may require individual treatment in addition to the conjoint sessions.
Where partners’ personality style falls into the most disturbed end of the spectrum, identified as borderline-narcissistic patterns, (Solomon, 2001), we are likely to find collusive relationships with others who have complementary defenses. Partners form unconscious love bonds that help them ward off painful or frightening emotions and may draw other family members into dysfunctional dynamics. They may have a variety of presenting issues, but the underlying dynamics are similar. These include faulty boundaries, intense separation anxiety, and stormy encounters with others. Relationships are marked by impaired attunement, and often physical and/or emotional abuse. In treatment of such people, we find a history of early attachment trauma, primitive dissociation, high somatization, a fragile self, and high resistance to change.
When pathological disorders caused by very early attachment trauma of both partners are being played out in the couples’ relationship, the result can be a destructive deadlock. Change in one partner may mean the end of the marriage. The fear of separation and divorce may result in an attempt to undermine the emotional growth of the partner who has changed. Conjoint therapy rarely succeeds in changing the unconscious interactional pattern of such people. Their defenses are designed to protect the vulnerable selves of both. Therefore, unless methods are found to inspire couples’ movement past their resistance to confront the emotional demons, treatment efforts will be futile.
Generally, two people with a history of avoidant modes of relating are unlikely to maintain lasting bonds. Partners who find the behavior intolerable often decide to leave those with entrenched defenses, thus adding to relational distrust. Some very successful people who put their energy into business success to compensate for lack of relational success, maintain relationships in which both partners are unhappy, but choose not to terminate for reasons other than lack of emotional intimacy. The couples that are most likely to try to resolve and improve their emotional and sexual relationship are a combination of an avoidant and an ambivalent partnership. An example of this will be found in the case discussed later in this chapter.
The Effect of Reparative Experiences
New evidence (Main, 2002) indicates that reparative adult experiences enable those with attachment traumas to increase their ability to cope with stress and restore a sense of security. Healing through new relationships occurs frequently, and makes a person who has experienced trauma increase the ability to cope with stress and negative affect. Religious or 12-step experiences, therapeutic experiences, and intimate relationships all offer possibilities for repair.
Among promising new therapeutic models, Neborsky’s “Accelerated Analysis” (Personal communication) focuses on accessing unconscious emotions in the here-and-now between patient and therapist; then connecting with defensive maneuvers with attachment figures in the past. Fosha’s treatment model is based on a psychotherapist’s ability to resonate empathically with a patient’s body states and to empathically attune on an intuitive, nonverbal level. The goal is to bypass defenses and process core emotions (Fosha, 2000).
