Positive experiences of a therapist cannot possibly disconfirm and dissolve some attachment-based, symptom-generating schemas. In such cases, reparative attachment work would necessarily fail to create transformational change of the schema. Methods other than reparative attachment are then necessary, not optional.
The case in Chapter 4 of Ted, who had, with unconscious purposefulness, made his life a shambles in order to rebuke his father, provides our first example. His presenting symptom of pervasive underachieving was maintained, it was found, by an emotional implicit schema that became verbalized in the following way.
The most important thing to me is to get Dad to see that he failed at being a father to me.
I hate to admit it, but that’s so important to me that I’m willing to keep my own life a mess, and get nowhere, to get him to see how badly he screwed up by tearing me down all the time.
That the content of this schema consists thoroughly of attachment learnings and memory of attachment experiences is clear. However, this particular schema does not consist of terms of attachment, so Ted’s experience of the therapist’s empathic attunement and
acceptance could not disconfirm this material, and therefore reparative attachment work was not appropriate. To see in detail why this is so, one considers each way in which the client could have an experience of the therapist that might possibly be relevant either to disconfirming the schema’s component constructs or fulfilling needs or solutions specified in the schema.
If Ted deeply recognized and felt that he was utterly safe from being torn down by the therapist as he was by his father, and even that the therapist strongly wanted to protect Ted from being torn down by anyone, would this knowledge either disconfirm his need for accountability and justice from his father or somehow end that need by satisfying it? No, it would not.
If Ted experienced the therapist’s (instead of Dad’s) genuine, empathetic understanding that he had been horribly hurt and harmed by his father and that his father was therefore a complete failure as a father, would this experience either disconfirm his need for accountability and justice from his father or somehow end that need by satisfying it? No, it would not.
With reparative attachment ruled out, the therapist used a different method for guiding Ted into experiencing the needed contradictory knowledge.
A second example is the brief but deep work conducted by psychologist Sara K. Bridges to address the marital sexual aversion of a mid-30s woman called Carol, the mother of an 11-year-old daughter, Dana (Neimeyer & Bridges, 2003, pp. 291–292).
Carol had no idea why she always felt so avoidant of sex with her husband despite their emotional closeness, other than to say that she
“just didn’t like to have sex very much.” Using Coherence Therapy, Carol’s symptom-necessitating schema was soon retrieved and found to be built upon the raw data of perceptual and emotional memory of much suffering due to her parents’ flagrantly erotic behavior during her childhood.
In a quiet tone, with her legs crossed and her head in her hands, Carol then recalled a time when she was about 15 years old when her mother walked into the bathroom and found her masturbating. Far from being angry, her mother was so pleased that she not only told Carol’s father but also called several friends and told them about this “beautiful good news.”
Carol identified her decision to shut out sexual feelings from that very point. Discussing this series of memories and associated feelings, she also realized that enjoying sex with her husband subjectively meant being like her mother, and closer to risking mortifying her own daughter, Dana, in the same way.
At the end of that session, Carol left carrying an index card with the following sentences expressing the emotional truth of her newly conscious compelling purpose for avoiding sexuality. Reading these words would create integration experiences each time.
I hate to admit it, but experiencing sexual pleasure with my husband makes me more like my mother. So, even though it is hurting my marriage, I will continue to avoid sexual contact, because it is better to sacrifice pleasure and intimacy than to risk doing to Dana what my mother did to me.
Before that therapy session, Carol (non-consciously) expected that for her to engage in any marital sexuality would cause her own daughter the same sorts of harm and suffering as were inflicted on her by her parents’ eroticism, making it urgent for her to avoid feeling or being sexual with her husband.
Was Carol’s sex-avoiding schema amenable to reparative attachment work? To answer that question, we use the reparative attachment decision process. Clearly her schema was forged in the crucible of her attachment relationships with her parents, but are the constructs in this schema terms of attachment, i.e., primary rather than secondary (other attachment-related) learnings? In our view the answer is yes, they are primary, which is apparent as follows. Her mother’s terms of attachment, as learned by Carol, could be verbalized approximately as, “Be erotic like me, out in the open where I and my friends can delight in it. This is what most strongly gets my attention and fondness and connects you to me. There must be no boundaries hiding your sexual behavior from me.” The essence of these terms of attachment is: Sexuality must have no boundaries of privacy between us. That implicit construct defined Carol’s
understanding of how sexuality operates in a family. Inhabiting that problem-defining construct, Carol was implicitly expecting her sexuality to violate her daughter’s boundaries.
The last question in the decision process is this: Is it conceivable that Carol’s experience of her therapist’s empathy, sensitivity, validation, safety, and so on could disconfirm those terms of attachment? Only if the answer were a clear yes could reparative attachment be a suitable approach for working with Carol. There is no reliable form of such disconfirmation that we can envision, though there is the following possibility that is an uncertain maybe: Carol’s female therapist, upon learning the makeup of Carol’s symptom-necessitating schema and recognizing the involvement of the terms of attachment described above, could have begun to express sensitive, overt recognition and respect for the fundamental privacy of Carol’s sex life in relation to herself, the therapist. This might have created for Carol a secure attachment experience in the sexual area, in sharp contrast to her experience of her mother. For example, the therapist might have said, “Naturally, you’re here to address a sexual problem so you are telling me about your sex life, but I just want to say—in case there is any part of you that might be wondering, from a certain angle, about our interaction—that I’m feeling no need of my own to hear about your sex life, and I deeply regard your sex life as your private domain. And only with your permission and wish for me to hear about it will we talk about it, because otherwise I feel it is your private domain.” That would be followed at some later point by asking, “How is it for you to see and understand that I’m so different from your mom in this way?”
Whether work along those lines would have been a sufficiently strong, relevant disconfirmation to achieve dissolution of the terms of attachment binding Carol is too uncertain to predict; and even if it had done so, it is also uncertain whether that shift would have brought about a dissolution of the construct that was directly maintaining Carol’s aversion to marital sex—her expectation that her own sexuality would harm her daughter, as she was harmed by her mother’s sexuality. Thus, we do not see any clear, decisive
disconfirmation of that master construct developing within the client–
therapist interaction, so the result of the decision process in this case is, for us, a ruling-out of reparative attachment work. The contradictory knowledge that would successfully disconfirm Carol’s expectations would have to be found outside of the client’s experiences of the therapist. How the schema was dissolved was described by Neimeyer and Bridges (2003, p. 292) in this way:
In the next session, Carol reported that the statement [on her index card] began to seem almost silly to her during the week, and although she knew it would take time and practice, finding a new way to understand her sexuality as her own and not her mother’s was a freeing experience for her and also for her relationship with her husband. Once held as a conscious rather than unconscious position, the previously prevailing view soon lost much of its power, permitting the client to relinquish it as her governing emotional reality.
In that account are two markers of transformational change. One is her reporting that “to understand her sexuality as her own and not her mother’s was a freeing experience.” That is a description of contradictory knowledge—my sexuality is not the same as my mother’s—that came into Carol’s awareness in response to her overt statement task on the index card, which maintained her awareness of her retrieved presupposition that her sexuality was identical to Mom’s. (Emergence of contradictory knowledge in that manner is the fruit of the brain’s mismatch detection activity, as described in Chapter 4.) The other marker is the report that emotional truths on the card that had felt deadly serious to Carol when first retrieved into direct awareness a week earlier now felt “almost silly” to her. That indicates that the disconfirming knowledge had successfully created a juxtaposition experience and dissolved the terms-of-attachment construct of identical sexualities and the associated expectation that her sexuality would harm her daughter.
The examples of Ted and Carol illustrate the class of clinical cases in which a retrieved schema is not disconfirmable through reparative attachment work, so utilizing other sources of disconfirmation is necessary. Another type of situation in which reparative attachment work is infeasible warrants mentioning here. It occurs with adult clients who seem to be good candidates for reparative attachment
therapy—in that they have a full-blown history of insecure attachment, feel the emotional woundedness that that entails, and have opened up without resistance to experiencing deep areas of emotional distress and vulnerability in their sessions (indicating the presence of adequate emotional safety, trust, and empathy in the client–therapist relationship)—but they find the prospect of having attachment needs met through interactions with a therapist to be utterly unsuitable, unreal, non-credible and impossible. As one such client, “Tomás,” a man of 45, honestly put it to his older male therapist, “Look, you’re a professional practitioner who offers expert services that I’m paying you for. We might do five or 50 more sessions, but then you won’t be in my life any more. So, when you ask me how it is to be feeling so understood and seen and validated by you after never getting any of that from my mother or father, no, it doesn’t fill those empty slots that should have been filled by them doing it right. That’s just not how this could work for me. Maybe it could work with someone who’s in my life for real.” Of course, it is possible that responses such as Tomás’s might be a rationalized expression of unconscious resistance to the emotional dependency that accompanies allowing an attachment relationship to develop. However, we have observed this response from clients with whom such resistance was not a very plausible explanation, given their openness to deep, painful emotional work in prior sessions. Rather, it seems more likely to us that these are individuals who have a well-developed and authentic adult identity, and that reparative attachment can take place in therapy most readily for adults who lack a firm state of adult identity and are based largely in a child identity or ego state, which allows the therapist to be a plausible attachment figure.
Tomás’s example drives home to us that the fully adequate presence of the non-specific common factors in the client–therapist relationship (trust, empathy, alliance, shared therapeutic goals, etc.) and the full, emotional engagement of the client in the work do not mean that the client necessarily experiences the therapist as an attachment figure or is having an experience of secure attachment. A therapy client can experience secure attachment with the therapist
only if he or she experiences the therapist as an attachment figure.
However, trusting a health care professional enough to cooperate with treatment, including putting oneself in a vulnerable position, is not, in itself, an attachment relationship. Thus, the common factors may be fully present without an attachment relationship or secure attachment experience being present. In other words, the common factors are a necessary but not sufficient condition for an attachment relationship and secure attachment to occur, because for that, conditions in addition to the common factors are required.
Further, as we have discussed in this chapter, if an attachment relationship and secure attachment are present, this does not necessarily mean that reparative attachment work is taking place, because reparative attachment requires, in addition to secure attachment, the fulfillment of the therapeutic reconsolidation process, with the client’s experience of secure attachment serving to disconfirm his or her insecure attachment expectations in juxtaposition experiences.
In this way, the therapeutic reconsolidation process helps us to clarify the relationship between the presence of the non-specific common factors, the occurrence of secure attachment experiences, and the carrying out of reparative attachment work in therapy.