Clinical Use of Attachment Theory

A gifted therapist whom I supervise serendipitously provided a clinical example illustrating the usefulness of Attachment Theory. The therapist had just begun treatment with a nineteen year old female patient who stated in their very first meeting, ‘I had four previous therapists and they all irritated me by asking questions. Don’t ask me questions, just give me a task and then observe what I do and give me information on what you observe.’ She added, “when people irritate me, I do something to irritate them back.’ For the therapist it felt there was an unmistakable need of the patient to be in control.

Controlling behavior in Attachment Theory brings to mind the observation in six year olds who had a history of disorganized attachment at one year, disorganized, perhaps, because their attachment figures were frightened or frightening. These six year old children exhibit controlling caregiving or controlling punitive behavior. What might have led to the above patient’s need to control the therapy situation? Had her parents been too controlling (frightening) or had they been unable to ‘take control’ [regulate] of the situation (frightened) causing the patient to prematurely need to ‘stepup’ and take things into her own hands?

Both, said the therapist: The parents had frightened the patient as a little girl by beating her, and they had failed to attend to her emotional life. The patient says there is nothing she wants except death, but the patient must kill others before she kills herself. The patient recognizes that either action (suicide or homicide) will serve to indict the parents. Perhaps it is her parents she will kill. The parents confirm that it is their daughter who is now in control for they tip toe around her so as not to set her off. [It has become a life-death struggle for a child to save herself when faced with a dangerous onslaught against her developing self and her developing agency.]

The patent predicts whether her day will turn out poorly or well based on whether the calendar date is odd or even. [I muse that OCD symptoms give a sense of control, control about the future.] The patient cannot sleep before an exam or a doctor’s appointment or a trip. [Perhaps she must remain vigilant to predict what is coming. Predicting a beating or what she needed to do next would be important to a small child whose parents are frightening and frightened.]