Using Attachment Centred Therapy as a
means to assess and intervene with
addictive disorders and other
dysfunctional behaviours
Presented by:
Charley Shults, Psychotherapist
12 Harley Street
+44 1483 539 759
+44 75075 62864
[email protected]
A Basic Idea
If the AAI (Adult Attachment Interview) can be
used as an accurate instrument for assessing
attachment and the information processing
then it can be used also as an instrument for
attachment difficulties and information
processing errors
Attachment: a new paradigm
Has more explanatory power
Effects global changes in affect and behaviour
Gets everyone “off the hook”
Corrects the errors of information
programming that create the problems
• Empowers the client for lasting and ongoing
change and improvement and development
• Empowers “catch-up” development
Research Discrepancies
• Attachment styles are not transferred by the
mother to the child in an unbroken pattern
• Attachment styles are relatively stable across
the lifespan within the secure and insecure
• Attachment styles within the insecure
patterns can swing from A to B depending on
life changes
The George, Kaplan and Main
Interview (AAI)
Based on Carol George’s dissertation
Modified by Crittenden
Can modified to meet your needs
An idea for modification: describe your
relationship with your spouse; 5 words or
Methods of Classification
• Main and Goldwyn created the first
– A, B, C, D, U
• Dynamic Maturational Model (Crittenden)
– A, B, C, A/C, AC, plus additional subclassifications
In M&G danger disorganizes
In DMM danger organizes
DMM is a strengths model
M&G intergenerational transmission of
• DMM complex parent/child patterning
Methods of Classification (cont.)
• M&G has disorganized, unresolved, cannot
classify classifications
• DMM uses multiple classifications
• DMM expands Ainsworth’s ABC model from
the Strange Situation and allows it to develop
across the lifespan
• M&G assumes continuity across the lifespan
A Dynamic-Maturational Model
of Patterns of Attachment in Adulthood
Integrated True Information
Socially Facile/
False Positive Affect
Copyright P. Crittenden, 2006
True Negative Affect
Feigned Helpless
Integrated False Information
Omitted cognition & distorted affect
Omitted affect & distorted cognition
True Cognition
False Cognition
A Dynamic-Maturational Model
of Patterns of Attachment in Adulthood
Integrated True Information
Socially Facile/
False Positive Affect
Copyright P. Crittenden, 2006
True Negative Affect
Feigned Helpless
Integrated False Information
Omitted cognition & distorted affect
Omitted affect & distorted cognition
True Cognition
False Cognition
Patricia Crittenden
Family Relations Institute, Miami, FL
John Bowlby
Mary Ainsworth
Patricia Crittenden
Classification Categories
A: Avoidant; Dismissing;
B: Balanced; Secure; Free Autonomous
C: Coercive; Preoccupied; Ambivalent; Anxious
A/C: Fearful; Disorganized
AC: Psychopathy
Porges’ Polyvagal Theory
• Highest level: social interaction - in the
absence of danger
• Middle level: fight or flight - in the presence of
• Lowest level: freeze/submit – in the fear of
Porges’ Polyvagal Theory
• Social Interaction – does this correspond to
secure, B attachment?
• Fight or Flight – does this correspond to
preoccupied, C attachment?
• Freeze/Submit – does this correspond to
avoidant, A attachment?
Words are more than mere
concepts, they are the
tools that we use to grasp
and grapple with reality.
Split Brain Research
Time after time, the left hemisphere made up
explanations as if it knew why the response
was performed [by the right hemisphere]. For
example, if we instructed the right
hemisphere to wave, the patient would wave.
When we asked him why he was waving, he
said he thought he saw someone he knew.
Split Brain Research
When we instructed the right hemisphere to
laugh, he told us that we were funny guys. The
spoken explanations were based on the
response produced rather than knowledge of
why the responses were produced. ...the
patient was attributing explanations to
situations as if he had introspective insight
into the cause of the behaviour when in fact
he did not. (LeDoux, The Emotional Brain)
Differences from Bowlby
The attachment system is “always on”
There are three levels of attachment needs
These levels or needs are cumulative
Thus if one level of need is not satisfied, it is
carried forward as a deficit to the next level,
and so on
• When attachment needs are met, those are
carried forward as strengths to the next level
Always On
• Bowlby uses the analogy of a radar system
guiding a missile to it’s target
• But radar is useless if it is not on before the
threat approaches
• More like driving a car: accelerator, brakes,
• Becomes active when needed, inactive when
not needed, but it is always on
3 Attachment Needs
• Survival
– Have sustenance needs met
– Avoid predators
– Avoid environmental dangers
• Freedom
– Explore the environment
– Learn the skills necessary to enable continued survival
• Reproduction
– Find a partner
– Produce offspring
Attachment Needs
• Ensure survival of offspring
– Provide sustenance
– Protect from predators
• Freedom
– Allow exploration while protecting
– Teach about the environment
• Reproduction
– Nurture offspring’s offspring
In an infant’s world
• Wolves in the closet
• Monsters under the bed
• “Not only will I not save you from the wolves, if
you keep on like that, I’m going to throw you to
the wolves” (the best strategy here is to not
protest, lie low)
• “Oh all right! I’ll come there now just because I’m
tired of hearing you howl!” (the best strategy
here is to escalate until your protector comes)
Attachment complications
Dispositional representations (DRs)
Case example: couple A
• She is anxious in the relationship
• He is avoidant in the relationship
• Vacation
– For him: he has ‘filled the tank’
– For her: she can get all she wants whenever she
• He is anxious with caregivers
• She is avoidant with caregivers
Case example: Couple A (cont.)
‘Oh yes, he is with me the
way I am with my mom,
and I can’t stand it when
he is that way with me.’
Grice’s Maxims
• Relevance – does the information being
presented relate to the subject being discussed?
• Quality – is there evidence to support the
information and conclusions being presented?
• Quantity – is there enough information without
being too much: The Goldilocks Principle?
• Manner – is the information being presented in a
manner that is coherent and makes sense?
Discourse Markers
Discourse Markers
• Used to identify the pattern of attachment
• Multiple markers
• No single marker or set of markers can be
• All must be considered
• By correcting the errors, a coherent narrative
can be achieved
‘A’ pattern information errors
• distort information by deleting negative
emotions and information
• Maintain when possible a false positive affect
• As the numbers get higher (more pathological)
cognition begins to be more distorted
• Violates relevance by leaving out important
• Violates quantity by not giving enough
‘C’ pattern information errors
• Process information based on feelings rather than facts
• Ignores information contrary to emotional conclusions
• As the numbers get higher (more pathological) feelings
become more distorted also
• Violates relevance by giving irrelevant information
• Violates manner by using poor temporal order
• Violates quality by giving information without evidence
to support it, or by outright lying
A/C pattern information errors
• A combination of A and C
• May be one with one caregiver and another
with another
• May have a different relationship with the
‘AC’ pattern information errors
• Distort both facts and feelings
• Use intentional deception to mislead others
• This includes giving information in such a way
as to lead the listener to reach false
• A very well developed and “balanced” strategy
in that both cognition and emotion are
deceptive to self and others
The Interview
NOT the place to confront denial
1.5 hours usually
Needs to be done in one go
CANNOT be done in writing
Must be transcribed by a trained
transcriptionist (unless you want to do it
• Requires a commitment of time and money
– For training for the therapist
– For the client as well
• Needs to have a sufficient and significant
length of time for processing and application
• Must be titrated carefully: it can overwhelm
the client
• Requires a commitment of time and money
– For training for the therapist
– For the client as well
• Needs to have a sufficient and significant length
of time for processing and application
• Gets very deep very quickly
• Used correctly it is a way of reprogramming the
mind and correcting errors of information
processing when integrated with other
Advantages (cont.)
• Because it is changing how information is
processed it is:
– Global: it leads to improvement in all areas of
– Lasting: these changes are permanent and give
the clients the tools that they need to deal with
life situations
How I use the AAI
• Introduction of attachment concepts and how
they apply to the clients presenting
• Explanation of ACT and the AAI process
• Administration of the AAI: recorded, then
transcribed, then the transcribed interview is
“coded” using discourse markers
How I use the AAI (cont.)
• Working through the AAI with the client,
education the client further about attachment
• Relating the patterns within the AAI to the
clients present patterns of behaviour – this
includes their mental and emotional
processing of information
• Improving or creating coping skills using other
How I use the AAI (cont.)
2 hour sessions typical
Work may be completed in months
More likely will take years
Behavioural and Affective indicators of
progress are assessed periodically
Other therapies
• REBT – Rational Emotive Behaviour Therapy
created by Dr. Albert Ellis, the original and in
my opinion still the best CBT
• NLP – Ericksonian languaging patterns;
reframing; elicitation of highest purpose;
sometimes hypnotherapy; “parts” therapy
• Gottman’s (and Notarius and Markman’s)
marriage and family therapy techniques
Other therapies (cont.)
Maslow’s hierarchy of needs/affective therapy
Meditation and breathwork
Time Line Therapy®
The Pattern in addiction
• Idealizing with regard to one parent (usually the
opposite sex parent)
• Demonizing with regard to the other parent
• Fails to see the dynamic played out between the
two parents
• More importantly fails to see how the deception
inherent in this dynamic leads to errors of
information processing adopted in childhood as a
means of coping with a dysfunctional relationship
Case examples: Laura
• Laura: 45 y.o., lawyer, married for 12 yrs., both
sexually anorexic, sexually abused by uncle
from ages 2-6 approximately
• Met a climbing guide while trekking in the
• Got “psychic” messages that they were
“meant to be together”
• Long distance relationship
Case examples: Laura (cont.)
• “Psychic Stalking” – in one year spent
$300,000 on “psychics”
• Created multiple false facebook identities in
order to stalk & manipulate
• Eric, the object of her obsession, was revealed
to be a sex addict not in recovery
• Paul, a former high school friend, was also
encountered as a mountain guide and she had
a fling with him
Case example: Laura (cont.)
• Why do you think you felt closer to him than
• L: because I had an emotional connection. I
trusted him, I felt special, I felt adored. We
had something that felt real
• okay.
• Then became infatuated with a junior lawyer
at her firm
• All of these 3 men:
– Were younger
– Were in much less responsible positions
– Earned much less
• Laura has become the predator!!!
Case example: Henry
• my father lost all his money basically because
he spent this three, four years in this no man’s
land between staying with my mother and
going with the secretary so they lost the
business, lost the money,
Dismissing discourse
• DMM model:
– ‘A’s dismiss self
– ‘C’s dismiss others
– Looks to the function of the discourse
• ABCD model:
– Dismissing discourse gets classified as ‘A’ or ‘DS’
• Sexual acting out
• Only started in the last 5 yrs. After the deaths
of father and sister
• 12 step program
• “I must work with myself to minimize negative
Larry (cont.)
• Text from daughter A to say that daughter B
had ‘passed out’ and was taken to hospital
• 1 a.m.
• Larry thought ‘nothing can be done she is in
hospital and triaged – go back to sleep’
• Wife – a C – upset wanting something to be
done (even though they could not influence
the outcome)
Larry (cont.)
• Wife was upset, wanted to call hospitals to
locate daughter
• Larry was coming from A4 position, ‘whatever
can be done is being done’
• Therefore no problem to be fixed
• Cognitive distortion (A5-6) the wife’s and his
own emotional needs were ignored
• Emotions related to daughter’s potential
death were ignored
Larry’s AAI
• Well what if you needed comfort? What would
you do?
• {9 sec} And we’re talking up to 12 or some…
something like that. I’d probably read.
• Yeah.
• You know or something. Uhh, uh no I don’t you
• Don’t remember needing comfort?
• {..} I don't remember. {…} Yeah.
Larry’s AAI (cont.)
• Ok. Umm can you recall how your parents would
touch you in childhood whether it would be gentle as
in a caress or harshly as in punishment?
• Umm {….} well I’ll start with my father. Umm I don't
really remember him touching……me. The only thing I
remember is that we’d have a game with my sister, the
three of us. My sister, me and my father where he
would sit on the couch and we would uh have a ra…
we’d have a contest uhh to see who could kiss him the
most times. So I’d be on one cheek. She’d be on the
other cheek.
Larry’s AAI (cont.)
• Mm-hm.
• He’d have a beard. I mean not a beard but you
know like rough skin.
• Mm-hm.
• Um and we’d have a race to see ok we’ll you’d
literally go like (kissing noises) you know see and
someone would win. Of course then we’d be
completely chap lipped for the next day (Hm.)
but... That’s pretty much all I can remember in
(Ok.) terms of um {..} physical contact.
Seductive Parenting
Mothers with first born sons
Sexualized touching: bum, genitals, kissing
Interrupts the child’s activities in order for the
mother to seek affection
• Disparaging to daughters
• Lack of an appropriate sexual/romantic
(“Development of the Person”, Sroufe, et al)
Larry’s AAI (cont.)
• And how about Mom?
• Umm with .. Mom … the times I remember her
touching me umm well there’s….… well .. the
bed time ritual. She you know… I remember her
caressing my face. I remember kk you know uhuhh kissing me. I remember she’d have a thing
where she’d kiss my fore… you know like kiss me
here, here, here, here. Umm, umm …. that’s
really where I remember most in terms of the
physical affection.
Larry’s AAI (cont.)
• Um there was one umm uhh sexual memory
which I remember umm which is that uh I
remember a time when my… uh, uh the way I
discovered masturbation was I remember a
time when I was in the bath. Uh I don’t
remember how old I was but again it must
have been post uh, uh five or older because
we’re in this house in New York ‘cause I can
visualize it.
Larry’s AAI (cont.)
• I remember her bathing me umm which
obviously I was already past five. That’s a
second story now that I think about it um (ha)
but uh and I remember her umm ww uhh ..
washing or whatever my penis and, and I what
I remember is saying, “Oh that feels good. Do
it again.”
Larry’s AAI (cont.)
• Um I don't remember what her response was
or anything but then what I recall is then
when I would be bathing myself…
• Mm-hm.
• Way before preadolescence…
• Mm-hm.
• …umm I would and way before I’d you know
have an orga… you know have a ejaculation.
Larry’s AAI (cont.)
• when you were young did you ever feel rejected
by your parents even though they might not
have meant it or even been aware of it?
• Umm {..} there was one time because I
remember uh… well with my father rejected is
the wrong word. Umm {…} you know where he
umm {..} didn’t uhh {..} approve or whatever uhh
www (Mm-hm.) one thing which was remember
at one point I tried knitting and I remember umm
{….} knitting in front of him.
• Mm-hm.
Larry’s AAI (cont.)
• I think to show him what I was doing or
something like this and him being like ‘no’ you
know ve… eh very……’you don’t do that.’
• How old were you then?
• (sigh) {….} Probably like nine.
• Nine. Ok.
Larry’s AAI (cont.)
• Something like that. Again I go more by the
grades. I’m trying to put which of the grade I…
• Um so you said rejected wasn’t the right word.
• He was… I don't know that it… rejected sounds
permanent, more permanent. I don’t think I’ve
ever had a sense of…
• Ok. What did you, what did you think it was?
What… how would you describe it?
• Umm…
Larry’s AAI (cont.)
The feeling.
{..} I think it was umm {5 sec} disappointment.
For me and anger at my mom.
That she let me do this.
Oh really?
Yeah, yeah.
Larry’s First separation
• Sister 2.5 yrs younger
• Mom & dad go on a trip to Europe for “a
month or two.”
• Mom was pregnant with his sister
• How old was client? 2 yrs? Approximately.
37 y.o. SWF, lesbian/bi
Very butch, very attractive
A series of limerent relationships
In a committed relationship with a woman for
six years; they plan to marry
• Had cheated on her partner several times with
Cat 2
• First sexual intercourse at 15 w/a much older
married male (old enough to be her father!)
• Other sexual encounters of a similar nature
• Preferred females for romantic partners but
cheated on them with men
• A recent flirtation w/a male work colleague
led her to seek therapy
• Despair over her continued acting out
First memory
• what’s the earliest memory that you have as a
• C: Erm? It’s sitting in my back garden with my
• Your?
• C: Tortoise.
• Tortoise. Okay. You still have your tortoise?
• C: Apparently it ran away – ironically okay I
mean they don’t run very fast, but it ran away
First memory
• When did it run away?
• C: It might have been my mum telling me it ran
away when probably it died. It’s no I mean – so it
was in childhood?
• C: Oh yeah yeah I was err, there is a picture of
me actually with my tortoise – erm, I, I was very
very small. I don’t know how old I was? Maybe
five or something?
• Yeah – I saw a story in the paper about some
guy who had one that was seventy years old or
something like that – anyway.
First memory
• C: Yeah, I have no idea how old mine was
• Alright. Erm, when do you – what else do you
remember about that event?
• C: Erm? The tortoise event?
• Yes – sitting in the back garden you said?
• C: Err it was sunny mm but nothing else.
• Okay. Anybody else there?
• C: No okay just me.
First memory
• Erm? Why do you think you have that
• C: Erm, possibly because of the photos.
That’s a possibility okay. Erm, but it’s – it’s,
it’s err a happy moment mm that’s the only
other thing I can think of, I’m with – with a pet
and the sun is shining and I’m in the garden
yes it’s a nice –
• So what happened when you went to bed as
a child Cat?
• C: Erm? . . . . (4) nothing I guess. I mean err
parents would tuck us in. I don’t remember
mum being there, I remember dad being there
more, to say goodnight. Erm I remember
being absolutely petrified at night times and
that was – err I didn’t like the darkness.
• can you recall how your parents would touch
you, whether it would be tender, caressing or
harsh, punishing?
• The one thing I do remember from my dad is
that he used to tuck us into bed at night and
give me a cuddle and that was – nice and
tender and you know – perfect.
• Do you think that you may have been abused
• C: Erm? . . . . . . . . (8) (sighs) . . . (3) there’s
only one time (upset) and I am upset because
I have only ever told one person this before
okay erm, there, there was one time with my
dad – erm and he you know I told you that he
used to erm put us to bed and kiss us
Cat, dysfluence (cont.)
Erm – I know that erm he used to kiss me for a
little bit longer than he should have done, on
several occasions, and that’s it. There was
nothing more. It didn’t go any further than
that. But it upsets me to talk about that
because I have had such a good relationship
with my dad but that happened and I don’t
really know what to think about it.
• Where was he kissing you?
• C: Just on my lips on your lips but it wasn’t a
peck on the cheek or a peck on the lips like a
parent should do it was – it was longer than
• A lingering kiss?
• C: Yeah.
• And how old were you then?
• C: I was really tiny. I was – (cannot hear) tiny
erm – it, it would have been before the age of
ten, before puberty anyway. Yeah. Mm I
didn’t think anything of it at the time but you
know – you don’t - you don’t have that kind of
link when you are that age yeah.
• So thinking back on it?
• C: Thinking back on that – I try not to think about it,
because it conflicts with the relationship I had, but I
know it’s important because it happened.
• Why do you think he stopped doing that – I mean I
presume he stopped did he?
• C: Yeah, he did yeah. I don’t know you know, I can
only remember it, I remember one particular time it
happening and that was it – just that – but I am sure it
– maybe it happened a few times mm. But yeah.
Development of the Person, Sroufe et al
The Haunted Self, van der Hart et al
The Polyvagal Theory, Porges
The Emotional Brain, LeDoux
In Search of Memory, Kandel
Assessing Adult Attachment, Crittenden
Raising Parents, Crittenden
Bibliography for clients
• Becoming Attached, Karen
• How to Break Your Addiction to a Person,
• We Can Work it Out, Notarius and Markman
• The Seven Principles for Making Marriage
Work, Gottman
• Raising an Emotionally Intelligent Child,

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