Academic journal article American Journal of Psychotherapy

The Talking Cure of Avoidant Personality Disorder: Remission through Earned-Secure Attachment

Academic journal article American Journal of Psychotherapy

The Talking Cure of Avoidant Personality Disorder: Remission through Earned-Secure Attachment

Article excerpt

INTRODUCTION

In many ways, attachment theory has preserved and rejuvenated psychotherapy in an age of biomedical psychiatry by supporting psychodynamic theories with robust behavioral, neurological, and endocrinological research (Fonagy, 2010; Kay, 2005; Roose et al., 2008). One important contribution to attachment theory and mental healthcare, in general, is the concept of earned security. Based on searches of PubMed, PsycINFO, MEDLINE and the Cochrane Library, there are no published clinical studies or case reports about earned-secure attachment in psychotherapy. To the author's knowledge, this is the first article describing a specific psychotherapy case that resulted in earned security.

Roisman et al. (2002) defined earned security as "the processes by which individuals overcome malevolent parenting experiences" (p. 1206). In their 23-year longitudinal study investigating earned-secure attachment, the study's authors described it as having "a history of insecure attachments that change over time and endure consistently harsh or ineffective parenting in their youth." (p. 1206) They determined that adults, fortunately, can overcome early negative experiences with caregivers, and the resultant psychopathology, by developing an earned-secure attachment style. Subsequent positive relationships, including psychotherapy, can rework early attachment relationships, changing attachment style from insecure to earned-secure.

A major characteristic of secure attachment is coherence: the ability to present a clear, consistent narrative of experiences with a linear and logical flow of ideas relying upon a consistent internal integration of thoughts, feelings, contexts and meanings. Pearson et al. (1994) were the first to differentiate earned-secure attachment from continuoussecure attachment, proposing that "earned security" applies to those with early insecure attachment styles that became secure by later relationships. Unlike those with continuous-secure attachments, who describe positive childhood experiences, those with earned security describe negative childhood experiences. However, unlike those with insecure attachments who incoherently describe their negative childhood experiences, those with earned security coherently describe their negative childhood experiences. This high coherency suggests current secure working models despite early negative relationships with caregivers. Mary Main, a prominent attachment researcher, identified those with earned security as speaking coherently and collaboratively about their histories (Wallin, 2007).

Collaboration is an important characteristic of secure attachment, including the ability to value relationships and the positive communications-often unconscious-among those who care for one another. Collaboration is, perhaps, the most important aspect of earned-secure attachment for psychotherapists to be mindful of in therapy. "At the most fundamental level, the intersubjective work of psychotherapy is not defined by what the therapist does for the patient, or says to the patient.... Rather, the key mechanism is how to be with the patient, especially during affectively stressful moments" (Schore & Schore, 2008, P. 9). It is often the unconscious nonverbal affective factors that are more important than the conscious verbal cognitive factors. With empathy, patience, and authenticity, the therapeutic relationship can be a corrective attachment experience.

In addition to coherence and collaboration, individuals who are earned-secure are capable of trying to understand and sometimes forgive caregivers, suggesting mentalization and self-reflection of their experiences. Mentalization is the ability to theorize about the mental state of one's self and others, including thoughts, feelings, intentions and explanations for behaviors (Gabbard, 2005, pp. 60, 86). Reflection includes the ability to deconstructing experiences (e.g. childhood traumas), including thoughts, feelings, contexts and meanings. …

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