Attachment and the Defence Against Intimacy

Understanding and Working with Avoidant Attachment, Self-Hatred, and Shame

Linda Cundy

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429825972
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This book combines attachment theory and research with clinical experience to provide practitioners with tools for engaging with individuals who are indifferent, avoidant, highly defensive, and who struggle to make and maintain intimate connections with others. Composed of four papers presented at a Wimbledon Guild conference in 2017, this text examines the origins of avoidant attachment patterns in early life, describes research tools that offer a more refined understanding of this insecure attachment pattern, explores the internal object worlds of "dismissing" adults, and considers the impact on couple relationships when one or both partners avoid intimacy or dependency.

Each chapter contains case studies with children and families, adolescents, adults and couples that acknowledge the challenges of engaging with these "shut down" individuals, with authors sharing what they have learned from their patients about what is needed for effective psychotherapy. It is an accessible book full of clinical richness and insight and will be invaluable to practitioners who are interested in deepening their understanding and clinical skills from an attachment perspective.

CHAPTER ONE

Avoiding avoidance: neglecting emotional neglect and deactivated relationship styles

Graham Music

In work with children and young people we are more likely to encounter cut-off and avoidant attachment patterns than in private adult psychotherapy where very avoidant people less commonly present for help. This is the point of an avoidant attachment pattern; it gives rise to a profound belief that you have to stand on your own two feet, that seeking help is a form of weakness, that strong emotions should be avoided, particularly upsetting negative ones. For more avoidant personalities, early adaptation to their families of origin would have meant deactivating their attachment needs, because displaying their dependency and neediness would have led them to be rejected by their primary carers. Part of my personal history was being sent to boarding school at the age of nine, where I, alongside many other boys my age, had to “just get on with life”, where there was no space for moping, missing parental care, or feeling understood, or for upset or fragile emotions. Many of us developed tough defences, forms of exoskeletons that aided survival, but left the needy, often desperate, aspects of our personality deeply buried, to be avoided at all costs. The psychoanalyst Herbert Rosenfeld (1987) described a form of narcissistic defence in which the needy, dependent parts of the self are attacked and denigrated or, alternatively, projected into others and attacked there. This is in part why it is so common for an adult with a needy, ambivalently-attached way of relating to be in a relationship with someone, often a man, with a primarily avoidant style. The archetypal British “stiff upper lip” personality style is a classic example of this avoidant way of being, and of course many of the British upper classes had this reinforced by also being sent away to boarding school very early on. Indeed, some even believe that this is one of the reasons why politicians seem so deaf to young children’s emotional needs (Duffell, 2000; Schaverien, 2015).

This client group can challenge conventional therapeutic technique – and challenge us personally. They evoke a range of countertransference feelings that are hard to admit to, but are the most vital clues to how we should approach the work. These include boredom, deadness, and cut off, dulled down states in which thoughts can become wooden and bodily feelings flat. I will suggest that it is easy with such patients to be unwittingly drawn into enactments (Aron, 2001) and a form of role-responsiveness (Sandler, 1993) whereby there can be two dulled people in the room and little real therapy is done.

Work with such children requires an understanding of how normal developmental trajectories might have been stymied by the lack of good experiences and how such stalled trajectories can be re-started. As Alvarez says, these children are not withdrawn but rather can be thought of as “undrawn” (Alvarez, 1992) and require a particular kind of “reclamation” or “live company” to come alive and grow a mind.

For this, a developmentally informed psychoanalytic approach (Hurry, 1998) is needed, allied with astute observational skills. Such work also requires helping patients to experience and bear positive as well as the negative emotional states that are the usual fare in psychoanalytic work (Music, 2009).

We also need to be prepared to speak with authenticity and spontaneity, as many in both the British Independent (Coltart, 1992; Klauber, 1987; Symington, 1983) and relational (Altman et al., 2002; Aron, 2001; Bromberg, 1998) traditions have asserted. This avoids the dangers of over-using interpretations with such children defensively, to make one believe that one is doing something called therapy when one is in fact going through the motions.

Work with this group is also helped by facilitating interoception, the awareness of body sensations (Farb et al., 2015), as too many avoidant children are cut off from the kind of body awareness that allows them to read and respond to their own signals.

A big therapeutic challenge is to remain psychologically alive and curious with children who so easily slip out of our minds. Such children and adults can be experienced as deadened, inhibited, passive, and overly self-contained. They often have little ability to reflect on emotions (their own and others’), their narrative capacity is limited, and they experience little pleasure. Indeed, they rarely inspire hope, affection, or enjoyment in those around them.

In sessions, I can find my mind wandering off. In fact, my cognitive countertransference is rarely alive with fantasies and reveries useful to the work. Rather it is my somatic countertransference that gives me the important clues – my listlessness and lack of presence, my boredom and dullness. Winnicott (1994) exhorted us to be alive to and bear our “hate in the countertransference”. With these patients we might add the need to be alert to “boredom in the countertransference”.

Many have not suffered terrible abuse or obvious trauma, such as being beaten, sexually abused, or witnessing violence. These children are marked out not by what happened to them, but rather by what did not happen to them – in other words, neglect. They have lacked the good experiences that foster healthy emotional development.

An example from a typical clinical day illustrates something of the response often evoked in such work. One morning my second patient is a very neglected and cut-off boy I call Josh. We do not have very much information about Josh’s early life but we know he was adopted from a South American orphanage at the age of nearly three. Reports suggest that his early environment provided at best for his basic physical needs but not his emotional development. We do not know at what age he entered the orphanage or anything about his biological parents.

When the receptionist informs me of Josh’s arrival I feel a deadening thud inside as I slowly reach for the phone. I walk down the corridor lethargically, nearly dragging my feet. My breathing is shallow and, indeed, so is my mind. I feel a kind of dread and am certainly not looking forward to the session. I barely remember what happened last time, but know it was very much like the session before. My main intention is to try to keep myself psychologically present. In the waiting room Josh is sitting where he sits every time, reading from the same set of comics. He looks up in the same way he always does, and I feel dulled down in the face of his predictability as he languidly gets up and follows me to the therapy room. There is a robotic feel to all this. My reactions to Josh are, I think, typical of what often happens in the presence of children who have been emotionally neglected.

This is in stark contrast to my previous patient, who I call Tommy. He is not the kind of child this chapter describes, and was overtly abused and traumatised rather than neglected. The contrast in countertransference responses between abused children like Tommy and neglected ones such as Josh is very telling. There is rarely a dull moment in therapy with Tommy. The previous week I left the session with bruised shins, a battered therapy room and my psyche similarly battered. Six-year-old Tommy cannot be still for even a few seconds. He is a real handful not only for me, but also for his teachers, his social worker, and especially his adoptive parents. Yet with Tommy, as opposed to neglected children such as Josh, I feel alive and interested. When the receptionist tells me of his arrival my heart begins to beat fast, partly from anxious sympathetic nervous system arousal, but also from a modicum of eager anticipation. Something about Tommy evokes warm feelings in those who know him, a warmth one rarely experiences in response to dulled down, more neglected children.

Troy: a case example

I describe a boy of nearly three, who I call Troy, to illustrate typical issues in working with children who have developed a very avoidant way of being, in this case linked with extreme early neglect. Troy was placed for adoption with a childless couple who had already adopted a boy a year older than Troy, who I call Alf. They had their hands full with Alf, who almost definitely had an ambivalent attachment style, was clingy, demanding, and needed constant attention. With Alf, these parents were constantly active and involved and, even if it was hard work, they had the gratification of being in no doubt how much they were needed.

With Troy things were different. They did not warm to him, and he seemed to be in his own world much of the time. He did puzzles and played with sand but did not play symbolically and, more importantly, did not seem to need people. He could ask for things such as toys or food, but seem unbothered about who he was with. He would fall over or cut himself but seek no comfort, would run off in the supermarket and not look back to his parents, and when reunited after a separation showed no pleasure, reacting to his parents just as he did to strangers. In other words, this was an extreme variant of an avoidant attachment style in which he had had to deny the emotional need of others.

Troy’s history makes some sense of this. He was born into a single parent family with a depressed, learning-disabled mother who barely interacted with him. He was left in a pram on his own. He was clothed and fed and was maybe fortunate that the case was picked up by social workers as the warning signs were not obvious. He was taken into care as a one-year-old when neighbours alerted services that his mother had left him alone on several evenings. He was placed with an experienced foster carer who was looking after several children. She was efficient, the home was kept extremely clean, and again everyone was fed, clothed and changed. Troy was described as “easy to manage” and “well-adjusted”. He did not protest that he was barely interacted with – Why would he? He knew nothing better and this was what he expected from life. He was left to his own devices for much of the time. Indeed, when the prospective adopters first saw him he was in a buggy with a bottle in his mouth and apparently such “prop-feeding” was normal. He had already had thousands of hours of learning not to expect very much from adults.

In my first meeting, the parents conveyed many worries. Alf always required one parent’s attention in the session, while Troy wandered around the room. It was probably twenty-five minutes before I realised that I, a child psychotherapist trained to be in touch with children’s minds and feelings, was barely paying him any attention, and nor was anyone else. He had slipped out of our minds. Even when there was awareness of his physical needs, any idea of him as a human being with thoughts or an emotional world seemed to get lost.

I decided to begin to engage in dyadic work (Hughes, 2007) with Troy and whichever parent could bring him. I also did some modelling for them by staying close to him and watching what he did and talking aloud about this. Any hint of a more interactive gesture that I saw, such as Troy reaching out or looking quizzical, I hammed up and amplified. I broke my usual pattern and became more directive, suggesting that each parent took time alone at home with Troy every day, since it was apparent that when they were all together Alf commandeered their attention and Troy, who seemed to need little, was indeed given little.

The model I had in my mind, which I often refer to in similar cases, comes from Selma Fraiberg’s (1974) work with blind babies and sighted mothers. Fraiberg helped these mothers draw their infants into an interpersonal world by pointing out the infants’ barely noticeable reactions: their faces might not have lit up in response to their mothers’ voices but a little toe wiggle here and hand gesture there were taken as signs that the mothers were important to their infants. This encouraged the mothers to interact more vigorously and the babies in turn responded, becoming livelier and, importantly, more fulfilling to look after.

This is just what happened with Troy’s parents, who within a few weeks were coming into sessions with stories of little changes he was making. I was moved and indeed close to tears one session when I played with him, observing and talking about what he was doing; I caught a fleeting gesture in which he momentarily pointed at an object and looked at me. This was an example of what we call “protodeclarative pointing”, in which a child points something out knowing that this thing, in this case a picture, would be in the other person’s mind too, that two people can share an appreciation of this third object, and know they are sharing it. This let me know that he was not on course to be on the autistic spectrum; we had in that moment shared what autistic children never do, a genuinely intersubjective moment when we both knew what was in the other’s mind and could enjoy and appreciate this.

His mother watched me interact with him and slowly got interested in him, and he responded to this. In a session a few weeks later he was tapping the table and she said: “Oh look at that tapping, you are anxious aren’t you”. This felt miraculous. She had noted and ascribed emotional meaning to an action that a few weeks before would have gone unnoticed. This is how infants develop a sense both of being held in mind and getting to know their own thoughts and feelings. Slowly this flat and cut-off boy became more lively, interested, and fun-loving.

After a few months, Troy began to play peekaboo, and would shriek with delight when found, wanting more and more attention. After a while, another moment signified a change. He stumbled in the room and tripped up and hit his head, but this time instead of just getting up as if nothing had happened he looked up at his mother and his hands for a second seemed to reach out to her. This was the beginning of normal secure attachment behaviour, an expression of his need for her. Mother was deeply touched by this.

Another sign of this was when I introduced Troy, in the presence of his mother, to a gifted clinical psychologist who was to do play therapy alongside our family work. In the room, he cuddled into his mother for safety, showing the first signs we had seen of appropriate attachment behaviour in the face of stranger anxiety. Only a few months before he would have carried on as if nothing significant had happened. In fact, he responded very well to the play therapy as well as to the family work and it was important that the parents could see the effects of what they were doing.

Within a few more months Troy was remarkably transformed, so much so that his parents even worried that he was getting rather rowdy! He had begun to scream to demand attention, was being a rival with his brother, made a huge noise if he felt he was being ignored and was most definitely a lively little boy who knew he had needs and was extremely ready to express them.

At the point of referral, the parents were in a crisis and had decided that they probably were not going to keep Troy. Indeed, his would-be mother admitted at a review at the end of the treatment that in those early days she had thought every day about giving him up. Maybe one child was enough, they had reasoned, and anyway it was probably not fair on Alf who needed lots of attention. The truth was probably that they did not feel sufficient warmth for Troy, nor could they enjoy parenting him. By the end they felt warmth, and he felt warmth; indeed, I did too.

Troy was typical of many avoided and neglected children in not evoking warmth or affection in those around him. We need to feel we are needed if we are to parent well or offer other forms of help to a child, and these children often act as if they don’t need us or anyone, making us feel useless. By the end of the therapy, not only Troy, but also his parents and Alf all seemed very different. I think the parents felt affection, love, and passion for Troy, and would have fought to keep him. The work with Troy was easier than in many cases as he was so young and retained much developmental potential. Nonetheless his story was all too typical and could easily have ended disastrously, with a string of foster placements and Troy growing into a cold, cut-off young person.

Psychoanalytic thinking

In thinking about avoidance we can build on helpful psychoanalytic ideas about “cut off” and un-psychologically minded patients. In adult psychoanalysis, Bollas (1987) uses the concept “normotic” to describe patients he sees as psychologically “...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright page
• Table of Contents
• Acknowledgements
• About the Editor and Contributors
• Introduction
• CHAPTER ONE Avoiding avoidance: neglecting emotional neglect and deactivated relationship styles
• CHAPTER TWO Not trying to avoid the bridge: avoidant attachment from research to clinical practice
• CHAPTER THREE Avoidant people in relationships: why would they bother? How do partners fare?
• CHAPTER FOUR Masters in the art of defence: shame and defences against intimacy
• Index