Listen to Executive Director Nikki Preece and Clinical Director Kevin Randall discuss Fulshear’s Adult Attachment Model
Adult Attachment Model™
A couple of years ago during a group therapy session Kevin Randall, Fulshear’s Clinical Director, asked a group of our new clients how many years of therapy they had prior to coming to Fulshear. Within the six new clients in that room, they had a combined total of 64 years of therapy prior to coming to Fulshear. When asked what they knew about themselves prior to coming to Fulshear one of the clients said, “nothing good.” If after an average of 10 years of therapy we are at this place, then we needed to do something different. It was at this point that he and Nikki Preece, Executive Director, talked and determined that we need to provide something different from what had been done before. What was developed from that and many other conversations is the Fulshear Adult Attachment Model of treatment. The Adult Attachment Model includes:
Part 1: Adult Attachment Model
- What is Adult Attachment
- The Common Experience
- Broaden and Build
- Seek Don’t Find & Don’t Seek
- Activation of Secondary Attachment Strategies:
- Neutralization Loop
- “Success” of Secondary Strategy
Part 2: Adult Attachment Treatment
What is Adult Attachment?
Attachment is a word that you hear in passing. It isn’t really something that you stop and think too much about unless you are in an early childhood development class. There you will hear and read about Bowlby and Ainsworth, two great pioneers in the attachment field. You will probably watch or read about the “strange situation” which is a study that helped to explore different attachment styles of small children. But beyond that, attachment doesn’t impact much of the clinical that has been done. I think this was a surprise to Bowlby later in his life, that there wasn’t more of a clinical application to his work. There are thousands of studies on the subject of attachment, but it is far too rare that it receives adequate clinical attention.
But attachment is so much more than trying to figure out a child or parent’s attachment style. It has relevance to every one of the people we see in therapy as adolescents or young adults. It has relevance to their caregivers as well. And as you will see it is relevant to their diagnosis.
Attachment is at the heart of many of the disorders and issues that have brought clients and their families to Fulshear. Addiction, personality disorder, self-harm, even depression and anxiety have roots in attachment. Healthy attachment brings with it the opportunity for security and “safe base” or the safety from which to explore the world. Not surprisingly this is a concept that has application to both infants and adults. We will teach you how we view the diagnoses through the lens of attachment.
There is plenty of research on adult attachment, but there has been very little clinical application to adults. Fulshear’s Adult Attachment model is based off of research particularly the work of Mario Mikulincer and Phillip Shaver in their book Attachment In Adulthood; Structure, Dynamics, and Change (Guilford Press, 2007). We have been able to adapt & refine our model and you are now seeing an updated version based on our experiences. Through these experiences, it has become natural to picture the model while working with clients. It is natural to see every client through the lens of attachment. It opens the door for intervention and creativity when working with complex issues.
Adult Attachment: The Common Experience
- Daily Living/Threat: In the midst of our daily living we experience regular threats. These are moments small or great that will ignite our need to be relational. There are so many of these that occur throughout the day. It can be as simple as a glare from a peer or as large as an actual physical threat. It can be a thought, a dream, or a memory that momentarily and subconsciously sparks the need to seek proximity. Think about a small child who hears a loud, unexpected noise. They immediately seek the safety of their parent. Now think of an adult who has just been given bad news (the threat). It ignites the urge to reach out and connect. Each of these naturally ignites the biological urge to be relational.
- Filter of the Internal Working Model What we do with this urge depends very much on our internal working model. This is absolutely essential to understand. What we do with the threats that come our way depends on how we have come to view the world and ourselves. The internal working model consists of:
- How I see myself
- How I see others (are they available and responsive?)
- How I see the world around me
The internal working model is beginning to develop from pre-birth and is driven very much by our earliest experiences with our caregivers. If an infant cries what is the response? Are they fed when they are hungry? Are they comforted? Picture how that impacts their developing mind and belief about themselves, others and the world. What about an inconsolable child with parents who have responded but haven’t been able to comfort their child? Now consider the experiences that occur later in life. Bullying at school, abuse or other traumatic experiences can impact our beliefs which continue to shift over a lifetime of experience. In addition, our internal working model is also developed in part by adopting the internal working model of our care givers.
Adult Attachment: Broaden and Build
- Seek and Find: Once the attachment system is triggered people will take one of three routes. The first option is that they may seek proximity and find it. We are looking for people that are available and responsive. Remember that if your internal working model is such that you believe that people will be responsive to you and that you are worth their time then you will likely choose to seek out an available attachment figure. For adults this can be a variety of people; parents, friends, a significant other. When you seek someone out and find that they are responsive and available it strengthens your beliefs. This is called the “broaden and build” cycle.
- Felt Security: Felt Security terminates the systems activation. “this sense of felt security is a psychological state with many implications. Feeling secure a person can devote attention to matters other than self-protection; being well cared for, he can appreciate the feeling of being loved and valued; in some circumstances, he can take risks, being confident that help is readily available.” (Mikulincer and Shaver, 2007 pg, 14).
This risk-taking is essential for our developmental progress. Without it our young adults won’t explore the world of college, employment or the social life. If they do explore these without that confidence in themselves or others they will struggle.
Adult Attachment: Seek Don’t Find & Don’t Seek
Those who are securely attached will continue to build on their experiences and strengthen their internal working model. Those that don’t Seek and Find do the following:
- Seek and Don’t Find: This means that they are seeking someone who is available and responsive and secure but aren’t able to find that. This can be because someone really isn’t available or responsive. It can also occur when a person interprets that others aren’t available and responsive because of their own belief or experiences, even if someone is ready and available. Another explanation is that a person who seeks and “doesn’t find” is not looking for someone who is available or responsible, but instead they are looking for someone to buy into their world view.
- Don’t Seek: Those that don’t seek have come to understand that it isn’t safe to seek others out. Instead they will go through it alone often using techniques of withdraw such as fantasy, substances, or self-injury to manage the threat and emotions they feel. They have been trained that nobody will see their world view, they haven’t experienced much security or their confidence in themselves or others has been significantly impacted through experience and they don’t see others as “safe.” They have learned that safety is closing off or blocking off their need for other people.
Adult Attachment: Activation of Secondary Attachment Strategies
A person who has experienced a threat has immediately had their emotions triggered. Those that can use healthy attachment strategies will work through the emotion through co-regulation. Those that “seek and don’t find” and those that “don’t seek” are now going to experience an increase in Emotional Distress. Since the primary attachment strategy of connection either wasn’t available or didn’t work then a person will begin to use secondary attachment strategies in order to neutralize the crisis, threat, or the emotion.
Watch this video below called the Still Face Experiment. In it, you will see a mother is directed to stop noticing her child. At first, you will see her connecting and the mother is available and responsive. The mother and baby are going through a cycle of broaden and build. Then notice the emotional distress when the mother stops being available and notice the baby’s response.
The primary strategy is proximity seeking. If that doesn’t work or the internal working model limits the desirability of that strategy, then the person moves into secondary attachment strategies. In this case the baby cried, screeched, reached for and did everything in her power to reach her attachment figure.
In adult care we see those behaviors occur differently. Often it is self-harm, suicidal threats and attempts, depression, anxious thoughts, angry confrontations, substance use and isolation to name a few. These are the behaviors that make up the list of diagnoses, and the misunderstanding of why this is occurring make up many misdirected therapeutic interventions. This is why the group we originally discussed had been to a collective 64 years of therapy and were still seeking help. Think of how many therapists have given a client a rubber band to put on their wrist and flick themselves instead of self-harming. Behavior or skills strategies are helpful to neutralize the crisis, threat, or the emotion but they don’t change the world view, confidence in others, or the ability to seek security. They miss the underlying component of attachment needs.
Many of our clients have been diagnosed with multiple disorders, including personality disorders. These disorders are often treated for the symptoms, but fail to address the underlying issues. They have been given skills and behavioral charts (which have their place and can be useful), but fear of the looming possibility of rejection is what is at the heart of these disorders. It is attachment based and needs to be treated as such!
In order to prevent attachment fears from becoming a reality and in order to manage the overwhelming emotions of that fear and the daily threats they experience, they adopt these strategies which are the symptoms of personality and other disorders. These are strategies that clients use to protect the last part of them that believes they are worthy of love and acceptance by either not allowing others in enough so that this lingering belief won’t be destroyed or by doing whatever they can to try and connect with others.
Once we begin to see these issues related to attachment we start to see them as something different. Not the monster that is painted by many professionals in the expression of a “borderline,” an “addict,” or “narcissist,” and not the weakness of an avoidant or dependent personality, but as women who have come to rely on powerful strategies to feel okay. They are not manipulators, they have just come to rely on these specific strategies as tools to manage powerful emotions.
Change comes through systemic work with family and peers, a thousand experiences of living out of positive beliefs about self and others, and healing trauma, all of which address our internal working model.
Secondary Attachment Strategies: Hyper-activation
Hyper-activating strategies are behaviors used to get an attachment figure perceived as unresponsive and unreliable to pay more attention and provide protection and support. (Mikulincer & Shaver, pg. 40) Remember that these strategies are used to gain a sense of security. Interestingly many of the strategies may seem contrary to this goal because they ultimately push others away. However, the behaviors tend to work sometimes. They are intermittently reinforced which is the most powerful reinforcement. If they worked once, then they may work again.
An example of this behavior may be when someone has experienced that threat, they need the connection but aren’t able to find it. That connection is important because it helps provide safety and support. Instead, a person may find someone they don’t know or just met and “hook up.” This allows for the threat to be neutralized and they have had a brief period of feeling safe and secure. Unfortunately, those moments tend to be fleeting and end up with increased feelings of shame and continue to contribute to negative beliefs about self, others, and the world around them. Shame is often the end result. Here are some behaviors that could be considered hyper-activating strategies:
- Excessive calling
- Excessive texting
- Emailing excessively
- Excessive social media activity
- Keeping score of how long it takes the other person to get back to you
- Sexually seductive or provocative behavior
- Making threats to leave
- Acting too busy for others
- Trying to make others jealous
- Excessive attention on outer appearance
- Seemingly shallow expression of emotions
- Needing reassurance to make decisions
- Suicidal threats
- Relationship hopping
- Social substance use
- Behaviors that make you feel like you are being pulled in by a rope
- Overdependence on a relationship partner for comfort
- Excessive demands for attention and care
- Strong desire for enmeshment
- Attempts to minimize cognitive, emotional, and physical distance from a partner
- Clinging or controlling behavior designed to guarantee attention and support
- Fear of rejection and abandonment
- Exaggeration of seriousness of psychological or physical threats
- Strong belief that they can’t cope
- Intensified expression of distress
- Strong protest if a person is unavailable or responsive
- Presents self in degrading or childish or excessively needy manner
- Overwhelming negative thoughts and emotions
- Damaged self-image
- Unpredictable or unreliable caregiving experienced as out-of-sync with needs or requests for help
- Overly soothed or caregiving that prevents development of self-regulation skills
- Messages from attachment figures that a person is weak, stupid, or helpless
- Outside abuse
These factors can be exacerbated by “temperamental deficits in self-regulation”. (Mikulincer and Shaver pg. 40
Secondary Attachment Strategies: Deactivation
Deactivating strategies involve behaviors that keep a person safe from needing others. The most difficult part about this is that there is still a biological urge to connect and yet they know within themselves that they others aren’t available, responsive, and secure. These are often some of the most difficult situations. These are often people who have been through years of therapy in adolescence and have been masterful at giving the therapist enough information to “get by” but not enough to make a difference. Others will be adamantly opposed to therapy and close meaningful relationships in order to protect themselves and sometimes to protect others
Below is a list of some specific behaviors that can be considered deactivating strategies:
- Fantasizing about sexual partners
- Excessive use of alcohol
- Drug use
- Living in a fantasy world (books, movies, video games)
- Surface level therapy sessions
- Strong negative reaction to emotional connection
- Failure to repair relationships
- A pattern of holding it all together and then major emotional explosions
- Makes themselves out to be more than they are. A sense of superiority
- Has a sense of entitlement
- Rebuffs the idea of being in need of others help financially or emotionally
- Seems to lack empathy
- Doesn’t enjoy relationships with others
- Seems to be solitary
- Lacks close friends
- Compulsive self-reliance
- Getting what is needed while maintaining distance, control & self-reliance
- Avoiding negative emotions
- Avoidance of interactions that require emotional involvement, intimacy, or self-disclosure
- Avoiding any discussion of personal weaknesses
- Inflated self-concept
- Poor emotional regulation
- Withholding commitment
In the past these young adults have experienced:
- “Consistent inattention, rejection or angry responses from an attachment figure.”
- Threats or punishment for proximity-seeking behaviors.
- Violent or abusive behaviors by attachment figures.
- Explicit or implicit demands for greater self-reliance.
- Inhibition of expressions of need or of expressions of vulnerability. (Mikulincer and Shaver, pg. 40)
Adult Attachment: Neutralization Loop
The Neutralization Loop is what happens when these young adults can’t achieve a resolution. They go back and forth between strategies until they reach a resolution or get burnt out. Many struggling young women are simply stuck in the loop. Without intervention the loop continues until the threat, crisis, or emotion is neutralized. This can be done through any of the strategies listed above. For example, a person who is using hyperactivating strategies can continue to feel emotionally dysregulated and express that emotion through yelling, throwing, stomping or door slamming. All of these would be strategies to get someone perceived as unreliable or unresponsive to respond. If those didn’t work she would become more emotionally dysregulated and increase the intensity of those responses. Finally, she may threaten suicide or engage in self-injury behaviors which force a nurturing response in others.
This is where inexperienced parents & clinicians will reinforce secondary strategies i.e. bandaging self harm. These young ladies will keep going until something helps them neutralize the threat, crisis, or emotion. This is the part where parents & clinicians will have to sit through hours to weeks of relational discomfort as these young women who engage in deactivation will punish, reject, or push away.
Adult Attachment: “Success” of Secondary Strategy
Success of a Secondary Strategy is when a young woman resolves or neutralizes the crisis, emotion or threat but does not find long term success and does NOT feel security.
This success also reinforces the belief or view of the world of Internal Working Model – it broadens and builds secondary strategies in a negative way. In the example above where the young woman would become angry, throw, stomp, yell and slam doors in an attempt to get an attachment figure to respond she eventually threatens self-harm or suicide and forces a nurturing response from others. This response neutralizes the threat but unfortunately reinforces the idea that her needs are only met if she responds at that level. Her negative belief about self, others and the world is perpetuated, though the immediate crisis has subsided. This is why adult treatment is so much more difficult because they have this cycle so much more ingrained.
Adult Attachment: Three Areas of Intervention
The aim of therapy from the perspective of attachment theory is to provide a corrective relational experience that will modify the client’s internal working model and the implicit rules and patterns that guide all of her close relationships.
In order to accomplish this we see three areas of intervention within adult attachment. The first is in the internal working model, the second is intervening with emotional distress, and the third is intervening in the secondary strategies. The goal is to help clients move from using secondary strategies to successfully working within the broaden and build cycle and when they don’t that they quickly and effectively repair the relationship and get back on track.
Response to Internal Working Model
This model focuses on three mental filters our mind uses to interpret the world. These include:
- The way I see myself
- The way I see others
- The way I see the world
If these areas are unclear, undefined or negatively defined the attachment system can be constantly activated. The person will then be preoccupied with threats and the need for protection.
Our internal working model is powerfully influenced by our “core”. By this we mean your core issues or beliefs. Your core issues are what you believe about yourself in a negative way, such as beliefs of powerlessness, unworthiness, and of being unlovable. When it comes down to it the core issue is really a fear of rejection. This belief drives our ability to approach others or seek them out when needed. It tells us that we are not worthy to seek others out. “Why would they want to talk with someone as stupid as me?”
Part of this model is coming to realize what everyone has inside of them which is their core meaning. Instead of focusing on diagnosis and behavior exclusively we want people to know who they are when they are experiencing joy, success, and love. Our core meaning is specific to each person but usually contains truths spoken that have been buried for years. It is a statement that conveys purpose and is based on some experience of the past. Helping young women understand this core meaning and then have a thousand experiences of living out of that meaning is part of what we want to accomplish at Fulshear.
How to intervene with the Internal Working Model
We need to stop addressing the content of a problem and focus on the process. As one of our clients said, “The more attuned, available and responsive someone is to me, the more able I am to solve my own damn problems!” Here are some ways to help:
- Become attuned to their core issue. Be aware of what is driving the emotional response (or lack of response)
- Help them discover their core meaning. Encourage discovery of times when they have acted out of their core meaning.
- Help them identify their power or influence to act—not to be acted upon.
- Challenge the ideas of powerlessness, victimization, passivity, weaknesses, unworthiness. Show them how and expect them to be influencers of their environment.
- Demonstrate consistency, availability, and responsiveness throughout the relationship.
Response to Emotional Distress
“It isn’t pleasure that addicts are seeking; rather, they are attempting to regulate their emotional states and escape, even momentarily, from the constant feelings of deprivation, shame, and inadequacy that dominate their emotional lives.” (Khantzian’s theory of self-medication) Whether it is addiction or other behaviors when we are in emotional distress we want to find a way to seek some sort of comfort and relief.
One of the things that makes this so difficult is that when we reach a certain point emotional regulation is especially difficult. Many therapy philosophies teach that we should be able to self-regulate and this is a good message and these are great skills to have. Unfortunately we can’t always self-regulate. Part of the intervention here is to move beyond self-regulation to co-regulation. This means that close attachment figures will need to be included in the therapy work.
How to intervene with Emotional Distress Model
- Use co-regulation skills. Be mindful of your own feelings and reactions. If you are distressed, you can’t help others co-regulate.
- Encourage self-regulation skills if possible.
- Sit with them through painful emotions. Don’t rescue. Let it be.
- Practice de-escalation strategies.
- Help them understand how emotions make sense and what they are telling us. Be mindful of primary emotions.
- Provide physical and emotional safety and protection and support.
- Validate the emotions. They feel the way they do for a reason.
- Don’t get caught in content.
Response to Secondary Strategies
How to Intervene with Hyper-activating Strategies:
- Give some to get some. Do the dance and then teach.
- Help them understand how to connect in relationships in healthy ways. .
- Set firm but not rigid boundaries.
- Teach them how to get needs met in appropriate ways.
- Be cautious not to engage in the hyper-activating behaviors (Don’t wrestle for glass).
- Don’t reinforce the hyper-activating strategy by connecting over it. Get to the core-issue and core meaning.
How to Intervene with Deactivating Strategies:
- Sit with them through the dark of their pain without judgment or expectation.
- Up regulate in order to help them feel in the relationship.
- Be absolutely consistent.
- Develop a strong relationship.
- Expect rejection. Don’t give up. Remember the core issue and the core meaning.
- Provide opportunities and identify times when they have acted out of core meaning.
- Persuade them to be healthily dependent on you, your team, and Fulshear.
- Expect breaks in the relationship. Demonstrate repair regardless of who is at fault.
Becoming Available, Responsive and Providing Security
Available is defined as “Sufficient power or effectiveness; Readiness for use.” Answer these questions to become more “available” to your young adult daughter:
- In what ways can you offer yourself in service?
- How can you do it and accomplish daily, regular tasks?
- What needs to be done to allow yourself to feel as though you have sufficient power?
- How do you demonstrate to the young adult daughter that you can be effective in meeting her needs?
We interpret being responsive as being receptive to your daughter’s needs and acting with an understanding of her Core Issues and Core Meaning. Ask yourself:
- How do you move beyond hurt or fear of daughter’s rejection, or anger?
- What about your daughter’s Core needs to be understood?
- How do you demonstrate responsiveness to your daughter?
Young adults with attachment seek security through freedom from danger or risk. They especially want freedom from physical or emotional danger. This freedom comes when parents and clinicians provide consistency, boundaries, and protection without rescuing. Use these questions to help you provide more security for your daughter:
- How can you provide security when your daughter is causing emotional unsafety?
- How do you ensure that if you are providing protection and support, that you aren’t rescuing?
- What types of “emotional danger” are there?
- What would cause your daughter to feel emotional or physically unsafe?
- What principles do we as a family espouse that we all agree on that will allow us to be consistent?
- How do you balance boundaries with responsiveness?
When a child is struggling and reaching out to a parent the “parenting system” is triggered to respond instead of the attachment system. The parenting system being activated in the case of young adults is often inappropriate. When clients are trying to reach out and they trigger the parenting system they find something in the response of being parented that temporarily soothes them.
However, the real growth comes when instead of the parenting system being activated the parent’s attachment system activates. This allows the client to experience unconditional regard even though there may be difficult issues or events occurring. Parents must learn to adjust this parenting system and identify the attachment system.
Whatever your family is struggling with, if you can view it from the attachment model you will find creative ways to address the three areas of intervention – mostly you will have a renewed sense of hope for you and your young adult child.