Anxiously Attached

Understanding and Working with Preoccupied Attachment

Linda Cundy

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781782205197
• eBook ISBN: 9780429910883
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Anxiously attached individuals feel chronically insecure and their relationships are often intense, angry, and enmeshed. In the spectrum of anxious attachment, some people tip into states of acute rumination following specific life events, while an extreme manifestation may be thought of as "borderline borderline" - inescapable brooding, raging, and inability to separate. Preoccupied clients can be difficult to work with, and these therapies often feel stuck or end badly. Anxiously Attached contains four papers presented at a conference in February 2016. They address the origins of anxious attachment in specific features of parent-infant relationships, findings from research about developmental aspects, typical features, concerns, and defences in adults, and how these may be presented in psychotherapy. Enmeshed dynamics in adult relationships, including the therapeutic relationship, are also highlighted, where threat of separation and loss activate intense attachment seeking. The aim is to increase understanding of preoccupied clients from an attachment perspective, to recognise the nature of their anxieties and resistances, and propose specific skills for therapeutic work.

Chapter One
Fear of abandonment and angry protest: understanding and working with anxiously attached clients

Linda Cundy

Our attachment patterns lay the foundations of unconscious beliefs about ourselves, and expectations we hold of other people and relationships. These belief systems are played out in the therapeutic relationship, influencing transference and countertransference, attitudes to boundaries, and how the therapy is used. This presentation focuses on individual therapy with adults, outlining what preoccupied attachment looks like in general and in the consulting room, highlighting difficulties that commonly arise in therapy, and proposing aims and a specific focus for therapeutic work with preoccupied clients.

Of course, in trying to better understand our clients, we may also recognise ourselves in the descriptions that follow. It is a natural progression, a creative use of talents, for a compulsive caregiver to train in and practise counselling or psychotherapy. If you do identify as “anxiously attached”, then I hope your own therapy has enabled you to stand back and observe the processes I describe without being overwhelmed by feelings too often. Therapeutic work with clients who are insecure and tormented by memories that continually fuel anger and helplessness quite frequently gets stuck or even ends badly. Certainly, I find these the most challenging clients, the ones I take to supervision most often. However, when practitioners can identify the core difficulties and dynamics and adjust their interventions accordingly, there is real cause for hope—as many here today may testify.

More than half of patients in my private practice struggle with this particular pattern of attachment, and I suspect that they are over-represented in mental health services, voluntary sector counselling services, and the Improving Access to Psychological Therapies (IAPT) scheme, compared to those with an avoidant/dismissive pattern of relating. This is regardless of the fact that twenty-five per cent of the population in Britain is estimated to be dismissing, compared to just eleven to fifteen per cent enmeshed/preoccupied (the figure varies according to research project). However, findings from the Adult Attachment Interview (AAI) suggest that a further ten per cent show evidence of being unresolved in respect of trauma or loss. The interview transcripts from this latter group indicate a basic attachment pattern that could be secure, dismissing, or preoccupied but their language breaks down in response to particular questions, indicating unintegrated thoughts and defences against them. So individuals may combine preoccupied and unresolved qualities.

Where a mother–infant dyad is predominantly anxious–ambivalent but the child is exposed to repeated traumatic experiences such as parents fighting, domestic violence, physical or sexual abuse, then he is likely to develop particular patterns of relating to other people and to himself. This sets a trajectory towards the preoccupied/unresolved subcategory that we may know by another name. Peter Hobson and colleagues undertook research using the AAI to explore how early experiences affect and potentially disrupt the ability to think. All interviewees were women diagnosed either with chronic depression or borderline personality disorder. What they discovered was that all of those with a borderline personality disorder diagnosis “were enmeshed/preoccupied in their thinking about their early relationships” (Hobson, 2004, p. 158). Additionally, ten out of these twelve women were “confused, fearful and overwhelmed in relation to past experiences with significant figures. Therefore the women whose relationships were in turmoil and who often showed very troubled relationships with themselves (for example, cutting themselves or being self-destructive in other ways) … seemed haunted by something they could not resolve” (ibid.).

Unresolved trauma is not the focus of this presentation, but it may help us to understand our preoccupied clients when they appear almost borderline in response to a life crisis. They have very limited resources to help them process difficult events and are perhaps more easily traumatised than secure or dismissing individuals.

First, we need to recognise preoccupied patterns of attachment and appreciate something of the internal and interpersonal dynamics. For the sake of clarity, I will use the masculine pronoun when describing anxiously attached individuals and the feminine pronoun in relation to therapists.

Features of preoccupied attachment in adults

People are complex. With our evolutionary capacity to adapt to new environments, we can adjust ourselves in relation to other people. We may find ourselves feeling secure around a certain colleague but more dismissing, preoccupied, or even disorganised around others. We affect them in turn, bringing out different aspects of each other’s interpersonal repertoires. This capacity to adjust ourselves in relation to the influences of others is essential in parenting and may be a vital component of therapeutic skill. Noticing how we are “used” by each client and our countertransference responses to subtle levels of communication form a core of technique in many therapeutic approaches. But when we are under sufficient duress, our core attachment patterns and defences emerge. As Steve Farnfield said, “all people have an underlying strategy”.

Clearly, there is also spectrum of intensity when we look at this genre of anxious attachment. Some individuals manage to contain their anxieties most of the time, even appearing rather dismissing in their relationships with others—until there is a crisis that shatters these defences and reveals a core of preoccupation. Brooding and anger reveal a different defensive strategy aimed at preventing abandonment. I make sense of this by imagining an infant with a rather tantalising but inconsistent mother. The original pattern of attachment between them is ambivalent, and the child tries repeatedly to recapture and hold onto mother’s love and attention. But eventually he gives up, accepting that he cannot rely on her for containment, comfort, or reassurance—he must learn to provide these for himself. And so he does, until a later relationship breaks down and he is confronted with the original yearning, love-hunger, and desperate need that he once felt for his mother.

Another possible scenario is the dyad where mother is loving and attentive but her anxiety is too invasive. Perhaps the child, once he has developed certain cognitive capacities, dis6covers methods for protecting himself and his integrity from her intrusions. But again, these more developmentally mature strategies can be shattered by loss or threat of it in later life, triggering a regressive return to the core attachment pattern. This often takes his family, his circle of friends, and the person himself by surprise—they do not recognise the person “he has become”. Winnicott wrote about people who dread breaking down because they suffered the agony of ego disintegration early in life and thus developed desperate defences to protect themselves from returning to this terrifying disintegrated state (Winnicott, 1974). The people I am thinking of here have already experienced the terror of abandonment created by inconsistent caregiving, and have then constructed different layers of defence against a repeat of the original situation. Under certain circumstances, when current relationships echo the first anxiety-provoking attachment, secondary defence mechanisms (avoidance and dismissal of intimate relating) break down to expose the original raw anxieties and the clinging, demanding, primitive strategies to hold on to the other who is needed as protector.

At the other end of the spectrum, there is the “borderline borderline” presentation, where there is so little capacity to tolerate anxiety that dysregulation frequently threatens. We may not see the active attacks on the self (or others) that feature in borderline personality disorder, but we do see other more covert methods to undermine the self, as well as aggression towards others.

The unifying factors among this spectrum of self-experience are the core anxiety of being abandoned and patterns of defence aimed at preventing separation; all else stems from this. From childhood on, attachment-eliciting behaviours are resorted to in order to attract the care and attention of others and hold on to them once their attention has been captured. Coercive helplessness, angry protest, and even illness are found to be effective in preventing desertion. A further feature is the difficulty accessing space to think and reflect. As children, they “learned [to] emphasize affect and disregard, or defend against, cognition” (Crittenden, 2000, p. 382). This denies them a useful resource in life.

While the core anxiety and range of defensive strategies form a general pattern, each individual evolves in a specific relational environment and context, and every person’s situation is influenced in subtle or not so subtle ways by a unique constellation of fantasies. In detailing the features of preoccupied attachment, I risk stereotyping. I prefer to think in terms of an archetype, a “pure form” containing an essence that we can recognise in different manifestations. For this reason, I introduce you to Archie. Archie is an archetype of anxious attachment whose qualities are distilled from many patients I have worked with (and people I have known personally).

Archie’s internal world is filled with anxious fretting and grievance. To other people, his anger and distress seem disproportionate to the events he protests against. He is easily offended. His relationships are enmeshed and rather too claustrophobic for some friends, who find his need for their time and attention too demanding. When they pull back from him a little—perhaps not responding immediately to a phone call or text message—Archie panics. He is hypervigilant to signs of rejection. He may persist in his attempts to make contact, perhaps escalating the intensity of his communications, or he may withdraw angrily and contact another friend, engaging her with complaints about the offending person in long tirades. The implicit message is “don’t you withdraw from me too, or I’ll say bad things about you to others in our social group”.

Archie can also be very caring. He likes to be helpful, though at times his generosity can feel intrusive and seems to imply an obligation to those being helped. He feels resentful when they appear to forget all he has done for them—“you would have thought they’d invite me after all I’ve done for them, wouldn’t you?” Woe betides you if you do not agree with him on this point! Archie needs people whose minds are the same as his, and he struggles with different perspectives.

Along with compulsive caregiving, another strategy for getting his needs met is helplessness. After falling out with his friend, Archie is so upset that he collides his bicycle with a parked vehicle and breaks his arm in the resulting fall. He ensures that his cast is visible when meeting people in the street, but refuses any help offered by the friend whose unkind behaviour preceded the accident. As he clearly cannot manage to shop, cook, or get around with a broken arm, other people step in to help, and they may be required to take sides in what is turning into a feud.

Although Archie has fallen out with an old friend, that relationship dominates his thoughts and actions. His mind is so full of repetitive brooding, and he is so prone to intense emotions, that he has little internal space for reflection. He is more inclined to impulsive action than conscious choice. He continually fuels the conflict, punishing the person who has let him down. And what is curious here is the particular quality of his anger. Despite rejecting any advances his now ex-friend makes towards him, Archie keeps the grievance alive in his mind. This implies that he is not ready to bury the relationship. It is not yet the anger of despair or mourning. The two are bound together in a drama where bitterness has replaced love—but the attachment is just as alive, and perhaps more intense.

These are not particularly likable qualities, but we must remember that, for Archie, these strategies developed in childhood and were adopted because they worked for him; they were effective in ensuring the attentions of his specific attachment figures.

The anxious stance … is encouraged by (1) unreliable care, which is sometimes affectionate and at other times neglectful; (2) intrusive care that is more related to the caregiver’s own needs and anxieties than to the needs of the attached individual; (3) care that discourages the acquisition of self-regulation skills and, directly or indirectly, punishes a person for attempting to function independently; (4) comments that emphasize a person’s helplessness, incompetence, or weakness when trying to operate autonomously; and (5) traumatic or abusive experiences endured when one is separated from attachment figures.

(Mikulincer, Shaver, Cassidy, & Berant, 2009, p. 297)

This kind of early environment discourages children from developing skills that would enable them to function autonomously. Anxious and inconsistent mothering makes children afraid to explore the world. They grow up needing other people to help them manage many aspects of their lives, and yet they also expect other people to be inconsistent and let them down. If we cannot guarantee that there is somebody always by our side as we negotiate life, we can at least ensure that there is always someone occupying every corner of our internal world. Archie is never alone as long as he rages against his one-time best friend.

“With exploration comes self-confidence and relative autonomy … [this helps] the individual to make realistic judgments of his own strengths and limitations so that he will know when it is appropriate … to ask for help” (Parkes, 1982, p. 298). Archie never had the opportunity to internalise a secure base so was never able to take advantage of opportunities and challenges that might have helped him find better solutions to his dilemmas. He was not able to develop the resilience to recover from a narcissistic wound. He has never been able to stand back and see events from a different point of view, let alone consider whether he has misread his friend’s intentions.

Having failed to firmly internalise secure experiences and “good objects”, he lacks the internal resources for self-soothing, self-containment, or self-encouragement. Unable to gauge when it is appropriate to ask for help, Archie continues to make unreasonable demands of other people. But even when relational feeding is offered, he has difficulty taking it in, holding on to it, digesting and being nourished by it. These “secure attachment experiences” do not help him establish a secure base inside himself. Rather than internalising the care and attention he receives, he remains focused on what is missing.

The needs of Archie and others who are preoccupied seem insatiable, especially when their relationships are threatened. This can take the form of sibling rivalry when there is competition for limited resources, and an inconsistent attachment figure will certainly fuel these fears of deprivation when she must share herself between two or more children. Intense envy of the other who appears to be favoured, or who is “greedy” enough to get the lion’s share of love and affection, can dominate sibling relationships throughout entire lives. Several of my clients appear haunted by envy of—and by—siblings that can be traced back to early childhood. In all cases, the mother’s own limited resources and inconsistency are at the root of competition for her favours. I have also noted that, for some of these preoccupied patients, identifying a sibling as the “bad object” onto whom all resentment and blame are directed has effectively protected the mother from being contaminated by such destructive feelings. She has been kept pure, perfect, and longed-for in the minds of these individuals.

Archie, however, happens to be an only child and his feelings for his parents are much more ambivalent. Despite his rage against them for all their perceived failures, he still longs for their love, and much of his behaviour is intended to communicate his needs to them. But Archie’s parents died many years ago. Like the friend who let him down, his parents are kept alive and kicking in his mind. In particular, he appears to have a complicated relationship with his (internal) mother. In reality, there were many times he can recall of intimacy, fun, and love with her when he was young, but she suffered from frequent bouts of depression, during which she took to her bed. Her small son tried to cheer her up and look after her, but sometimes this seemed to anger her, so she would shout at him and lock her door. It is not surprising that he developed quite different images of her—the loving, doting mother who made him feel special, the anxious, needy, depressed mother who over-compensated by being sentimental and infantilising her son, and the angry, rejecting mother who completely withdrew from him, leaving him terrified of what might happen. These multiple models are reminiscent of those held by toddlers in the Strange Situation Test who approach a parent for reassurance while effectively backing away from the same parent as if he or she is the source of the danger. For Archie, there was just enough consistency, not quite enough trauma to set the scene for psychopathology.

Preoccupied attachment is associated with … childhood experience of intrusive or role-reversing parenting in which the child’s attention is persistently focused on a parent who is described as incompetent, ill, overconcerned, or unduly critical of the child. Such parent—child relationships appear to be highly involving, int...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE EDITOR AND CONTRIBUTORS
• INTRODUCTION
• CHAPTER ONE Fear of abandonment and angry protest: understanding and working with anxiously attached clients
• CHAPTER TWO Softening a mother's need to reject her baby's urgent attachment cries for help
• CHAPTER THREE The Adult Attachment Interview: information processing and the distinguishing features of preoccupied attachment—Or: What has attachment theory ever done for us?
• CHAPTER FOUR Don't ever threaten to leave me—and if I threaten, you'd better not believe it
• INDEX