Final Exam Essay

Question 1

Types of adult attachment insecurity

Answer 1

Dismissing, Pre-occupied, Unresolved

Question 2

Overall therapeutic needs

Answer 2

• An affective as well as linguistic dialogue that accommodates as much of the patient’s subjective experience—feelings thoughts, desires—as possible
• A sensitivity to disruptions in the relationships and a readiness to initiate repairs
• A stance of acceptance combined with an expectation of a little more from the patient than he/she currently believes him/herself capable of
• A willingness to confront, set limits, and struggle with the patient

Question 3

Dismissing description

Answer 3

• Fall on a continuum with obsessives at one end and narcissists and schizoids at the other
• Enormous difficulty trusting others enough to be genuinely intimate with them, even though they may have stable long-term relationships
• Defensive overestimation of their own value requires that they remain remote from whatever feelings, thoughts, or desires might provoke them to seek support, connection, or care from others
• Reluctant to feel emotions that might spur them to connect deeply to others, and even more reluctant o express such emotions

Question 4

Dismissing subtypes

Answer 4

Devaluing, Idealizing, and Control

Question 5

Dismissing (Environment for each)

Answer 5

• Devaluing: Frequently the children of deprived and narcissistically devaluing parents, they have grown up in an emotional desert
• Idealizing: Grew up with overtly self-absorbed, covertly insecure parents; parents are only available when child tells them what they want to hear
• Control: Grew up with controlling, brusque, and fastidious parents who suppressed their own anger and appeared uncomfortable with close physical contact; parents with little tolerance for their children’s distress, messiness, or temper tantrums but unlike Idealizing or Devaluing parents, these parents respond with intrusive control rather than angry rejection or withdrawal

Question 6

How therapist engages with dismissing

Answer 6

• Only through making an emotional connection can we actually engage them in the kind of relationship that makes change possible
• Therapist must be keenly attuned to subtle affective cues, communicated through the body – for example watching the individual’s eyes which might display shame, sadness, moist from being moved, etc.
• Therapist must be attune to own feelings, often these mirror what the patient should be feeling; bringing this to patient’s attention can help them being to integrate their own dissociated feelings
• Therapy only works if the patient can attach to the therapist and use the secure base, central challenge is to enable the patient to allow the therapist to matter
• Must find balance between empathy and confrontation to navigate through emotional difficulties with client
• Controlling – key is to figure out the meaning of the little struggles, which are probably representations of rematches with controlling parents

Question 7

Pre-Occupied

Answer 7

• Polar opposite of dismissing patients
• Filled with self doubt and fearful of being too independent
• Trouble believing they can sometimes rely on themselves
• Diagnostic continuum with hysterics at one end and borderlines at the other; former appear overwhelmed and helpless, but superficially cooperative and sometimes seductive; latter appear angry, demanding, and chaotic; both are preoccupied with fear of abandonment

Question 8

Pre-Occupied subtypes and descriptions

Answer 8

• Helplessness:This is the Hysteric version - client appears hyperemotional and melodramatic; Connect with others through helplessness; make no secret of their neediness but do a poor job of satisfying their own needs or even knowing them
• Anger & Chaos: Life as ongoing crisis; emotions are painful and overwhelming in their intensity; feel chaotic inside and empty; in desperation they may approach, but in fear and anger they withdraw not unlike a dog with a wound, they approach their human for comfort but withdraw in fear when the human attempts to heal the wound; dependence and bottomless need

Question 9

Pre-occupied environment

Answer 9

• Early experiences of unpredictable attachment figures causes the individual to latch on and be demanding and to become hyper aware of internal and external cues to amplify their distress

Question 10

Therapist work with Pre-occupied

Answer 10

• Help such clients to strengthen their capacities for emotional balance, self-esteem, and trust
• Offer them a relationship that presents an alternative to their hyper-activating strategy; this implies a relationship where the client can come to rely on the therapist’s emotional availability and acceptance rather than feeling that they can obtain this quality of responsiveness only by defensively amplifying their affect

Question 11

Unresolved

Answer 11

• Typically borderline patients
• Multiple incoherent models of self, the other, and the relationship between them
• Lack resolution in regard to previous experiences

Question 12

Unresolved environment

Answer 12

• Grow up in disorganizing attachment relationships that were overwhelmingly painful and that provided no safe context within which to cope with this pain
• Chronically terrifying and or abusive parents

Question 13

Therapist work with unresolved

Answer 13

• The therapeutic relationship IS the therapy; promoting integration of various kinds is also very important to the work when working with a patient who dissociates
• Must be alert to passes in reasoning or discourse when patients touch on personal experiences of trauma and or loss
• Provide a different experience and a different model of relationship; that is, generate a new attachment relationship that is safe, reliable, and inclusive, and in which disruptions can be repaired
• Develop client’s resources, including those necessary to resolve past trauma