Utilizing Attachment Theory with Adult Patients: Disorganized-Unresolved

Toddlers classified by the Strange Situation [Ainsworth] as having a disorganized attachment pattern [Main] usually had caregivers classified as unresolved on the Adult Attachment Interview [Main]. The unresolved caregiver can appear to the infant frightened or frightening, with dissociation as a hallmark of their own unresolved trauma. The trauma may be event trauma (war, separation, abuse) or relational trauma (chronic misattuenement, humiliation, or emotional abandonment). Persons with PTSD, dissociative disorders, and personality disorders with dysregulation of affect all could suffer from unresolved traumas.

Trauma unresolved can be ‘frozen’ in time and unpredictably experienced as if occurring in the present moment. It causes discontinuities in memory because overwhelming affect at the time of the trauma caused the amygdala to ramp up emotional, sensory, procedural memory storage but decreased the activity of the hippocampus, vitiating the hippocampus’ ability to give context and language (event memory) to the trauma. Without words and context the trauma remains inaccessible in the treatment situation except through its procedural and affective expression via enactments between the patient and the therapist.

The treatment situation offers a safe, reliable, intersubjective (i.e. respecting the agency of both participants) context -- different from experience with early, unreliable caregivers -- in which ruptures can be repaired and trauma can eventually be resolved. Mentalization, a necessary step away from psychic equivalence and on the road to developing intersubjectivity, is fostered by sharing -- always with the aim to protect the patient from shame, injury, intrusion -- the contents of the therapist’s mind.

Wallin, D.J. (2007) Attachment in Psychotherapy Chapter 14. (Guilford Press, NY)