How to Address Attachment Challenges in Trauma Treatment

Published by ninakeeler on

First things first, let’s first talk about attachment.  What is attachment?  In the 1970’s, founders of the term, “attachment theory,” Dr. John Bowlby and Dr. Mary Annisworht referred to it as the way we learn to have relationships between the ages of 0-3 years old. There are two categories of attachment: secure and insecure. Within secure you have the Secure attachment style and within insecure you have anxious-ambivalent, avoidant, and disorganized attachment styles.  Attachment refers to the relationship the child has towards the caregiver and bond refers to the relationship the caregiver has towards the child. 

I believe that attachment styles transfer into how we have different types of relationships.  A person’s attachment style is usually most evident when they are under stress.  I also believe that a person’s attachment style can be affected by trauma. Therefore, as trauma treatment professionals, we need to be aware of attachment theory and how it might play out in our therapy sessions. 

Usually, our clients come to see us under stress.  Therefore, it is important to understand that you are more than likely getting a good look at a client’s attachment style when they are with you in therapy. 

For example, a client who has a secure attachment style will have good boundaries within the therapeutic relationship.  They will also typically be willing to try new thing in between sessions and look forward to reporting back in with you on progress and barriers.  The client with anxious ambivalent-attachment might be overly concerned with your approval of them in the therapy session.  They constantly predict what you are thinking about them and what they think you want to hear from them.  The client with avoidant attachment often struggles to let you support them when they are stressed.  In sessions, they may come off as closed off or angry.  Lastly, the disorganized attachment style will likely struggle to stay in session.  They will struggle with feeling safe, constantly check your motives, and seem to be looking for the negative in everything.  

As I give these descriptions you can see how a client’s attachment style can consume a lot of the therapy session.  Being able to address the client’s attachment style is important in keeping treatment from derailing. 

In this week’s vlog I share, in detail, some things to consider when addressing attachment challenges in trauma treatment.

1. Provide the client with psychoeducation about attachment theory

2. Assist client in identifying when their attachment style is showing up in sessions. 

3. Speak directly to the client’s attachment challenges in session. 

Attachment challenges can easily show up in trauma treatment and if they are not correctly identified, it can become a sore spot between you and your client.  If you feel the therapeutic relationship is struggling, it is worth considering whether or not working from an attachment-based perspective might be helpful.

Categories: Training


Nicola Illsley · July 13, 2019 at 3:37 pm

Loved this vlog – really helpful. I had just watched the recent one on pacing and found this one which I hadn’t seen. I know a bit about attachment but struggle to identify which style a client might be showing in session. I have a client who will not do any work outside of sessions on regulation or stabilisation and who regularly experiences disocciated states. She likes to have some control in sessions and in my last session told me that the previous two sessions she hadn’t felt heard. She was talking about a time in her life when she was 17 and the family moved to another part of the country – she felt very uprooted. She had begun to make friends and to find herself after an upbringing by a mum who seemed uninterested in her and being abused by her grandfather when she was 5 – 8. I listened to some things she was telling me and then asked if we could go back to earlier in the session when she had talked about how frozen she is in the mornings before she has to get up… I wanted her to try something different and see if she could make an inroad into changing how she feels in the mornings. The last session i had with her, she said she was very scared that I would be upset or offended or wouldn’t want to work with her anymore but she needed to tell me that she hadn’t felt heard. The ‘move’ when she was younger was what she wanted to explore and not some ‘yoga’ move before she gets out of bed. Even though she is worried about me turning away from her, she is trying to be the one in control in the sessions. What kind of attachment would you say that was? Is she trying to control the sessions because it’s a way of making sure she doesn’t lose me? Sorry this is turning into a long rant! I feel frustrated that she won’t try anything outside of sessions and won’t even try things inside sessions now. I am wondering whether she wants to stay unwell so that she can continue to come and see me… is that possible?

    ninakeeler · August 7, 2019 at 6:08 pm

    Hey Nicole, sorry for the delayed response. I am so happy that you enjoyed this vlog. I also appreciate you wanting to best help your client, but due to the public nature of this vlog I will refrain from sharing any thoughts related to her. I would love to talk with you more related to this client if you want to setup a consult. If that is something you would like to do feel free to contact me through the contacts me page.

    In the meantime, there are a number of attachment assessments that will help clients identify their attachment style if that might be helpful. One that comes up is the Adult Attachment Interview. Another is Diane Poole Heller’s Attachment Styles Test…you can google it and find a link.

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