Academic journal article Journal of Cognitive Psychotherapy

Patterns of Attachments and the Assessment of Interpersonal Schemata: Understanding and Changing Difficult Patient-Therapist Relationships in Cognitive Psychotherapy

Academic journal article Journal of Cognitive Psychotherapy

Patterns of Attachments and the Assessment of Interpersonal Schemata: Understanding and Changing Difficult Patient-Therapist Relationships in Cognitive Psychotherapy

Article excerpt

The results of empirical studies of attachment behavior in children provide the cognitive psychotherapist with powerful conceptual tools that may be profitably used in some puzzling instances of patient's behavior within the therapeutic relationship. Some patients ask energetically for the therapist's reassurance and at the same time resist the therapist's comforting responses. Others seem compelled to avoid any expression of personal vulnerability as soon as they perceive the therapist's empathic availability to listen to their painful emotional experiences. Other patients utter their requests for help in a most confused, mutable and contradictory way. When the therapist deals with such kinds of therapeutic relationship, the knowledge of the representational models of self and the attachment figure that may be inferred from abnormal patterns of attachment (anxious-resistant, avoidant and disorganized/disoriented attachments) guides the assessment and change of the patient's interpersonal schemata in a most profitable way.

In this paper, I shall describe how, by using attachment theory (Bowlby,1982), some specific difficulties in the patient-therapist relationship may become a useful starting point for the assessment of the patient's interpersonal schemata. In accordance with Safran's use of the term (Safran, 1990), I mean by "interpersonal schema" a generalized representation of self-other relationships within a given meaning domain.

It is almost a truism to state that both the patient and the psychotherapist perceive their relationship, at the very basic level, as one in which the patient needs help for his/her problems, and the therapist is, hopefully, both able and willing to provide the specific kind of help which is required. To be in the situation of asking for help means to experience feelings of vulnerability. The interpersonal schema related to the meaning domain whose emotional-behavioral boundaries are feeling vulnerable and asking for care plays, therefore, a key role in the therapeutic relationship. This interpersonal schema originates, very likely, within the child's first attachment relationships. Attachment is defined as the tendency to seek for the proximity and care of a specific person whenever one is vulnerable or distressed. Attachment behavior is displayed with full intensity during infancy and childhood (Bowlby, 1977,1982,1988). Research on attachment behavior in infants and children (Bowlby, 1982; Bretherton & Waters, 1985; Greenberg, Cicchetti, & Cummings, 1990), therefore, may provide the psychotherapist with very useful information concerning some cognitive, emotional and developmental processes that are likely to be implied in the shaping of the therapeutic relationship.

Developmental psychologists have identified three major patterns of abnormal, or insecure, attachment: avoidant, anxious-resistant or ambivalent, and disorganized-disoriented.

AVOIDANCE OF THE ATTACHMENT FIGURE

Active visual, physical and communicative avoidance is surprisingly prevalent in children reunited with their attachment figures following stressful and prolonged separations (Bowlby, 1982). In rejected or neglected children avoidance of the attachment figure appears also following very brief separations, such as the ones implied in Ainsworth's "Strange Situation" (Ainsworth, Blehar, Waters, & Wall, 1978; Main & Weston,1982). About 20% of one-year olds whose attachment behavior has been observed in the "Strange Situation" show a pattern of attachment identified by their avoidance of the attachment figure during the episodes of reunion after a brief separation. Careful observation of this avoidant behavior provides hints that it is related to an active inhibition of the behavioral system that normally motivates children to approach their attachment figures after a separation (Main & Weston, 1982).

Mothers of avoidant children often have a rejecting or neglecting attitude toward their offspring. …

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