Another Case Example
Another example of this was my client S whose presentation tricked me into believing that she was a classic attachment deficit client. From the first session I had with her, her main complaint was a deep seated sense of loneliness. She struggled to maintain healthy relationships (another symptom to look for when it comes to attachment related conditions). She had a history of poor connection with her mother, and her father had left the family without leaving a trace since she had been very young. She often spoke of her deep longing for her father to have been a part of her life and her belief that if he hadn't left them, life would have been so different. Her relationship with her mother was also very detached and distant. So my treatment with S was focused on the area of attachment and connection. However, her progress was slow and she was not responding to treatment as I had hoped. What was I missing this time?
Sure enough, once again I needed to have moved lower down the triangle. Digging a bit deeper into her childhood history, the answer was there staring me in the face. S grew up in a war zone and in the midst of poverty and deprivation. She lived far from any conflict zone, so no war related threats to her safety. But she suffered the impact of war in the form of severe poverty, hunger and deprivation. Often they had no food to eat, clothes for warmth or other essential needs. She recalled a deep seated anxiety over bare essentials for survival. Worrying about connection and affection was not on top of her priority list. She longed for her dad's presence because she believed that if he had been there, he would have provided for the family and they would have no longer suffered from poverty. When I dug deeper I realised that as an adult her sense of loneliness echoed exactly the same needs. She longed for a partner that would be supportive enough to make sure she would never sink to the depths of poverty again. Underlying her needs for attachment and human connection there was often a need for security around primary needs.
As you can see, S's needs as an adult mimicked her needs as a child. And of course warm connections with primary caregivers, and a sense of achievement and self esteem were also missing from her childhood. But before they could have been addressed, the more basic tier of the triangle needed to have been satisfied first.
Both clients in these two examples began responding better to treatment and an improvement to their symptoms after the change of direction in their treatment. We will cover treatment strategies for clients like R and S in the next two modules.