Cognitive Reappraisal and Attachment
In this section we will explore how cognitive reappraisal techniques can be applied if you have identified that the attachment and connection tier of the hierarchy of needs is your client's primary concern.
The types of thought errors that you are likely to encounter with a client experiencing attachment related issues revolve around the belief that they are not loved or cared for by others, hyper-sensitivity to abandonment, maladaptive beliefs around others being trustworthy or well-intentioned and a tendency to feel alone. Clients justify these beliefs by adhering to evidence from both past and present experiences.
1. Past Memories:
Childhood memories which create the belief that the child is not loved or cared for by adult caregivers are the primary foundation for attachment-related challenges. Attachment theory, initially focused on infancy, extends its influence beyond that period, encompassing toddlerhood and early childhood. While the foundations of attachment are primarily formed during infancy, they continue to evolve and interact with a child's growing cognitive and emotional capacities beyond that age.
In my experience, when engaging in imagery work with clients who have encountered environments marked by inadequate attachment, a common pattern emerges: these individuals frequently recollect their earliest memories of abandonment, feeling alone or not cared for, from the age group of 3 to 6 years. This observation aligns well with the principle of cascading memories, as well as Erikson's psychosocial theory. Erikson's theory highlights the significance of the 'Initiative vs. Guilt' stage during these formative years, where children develop a sense of control and initiative over their environment. Poor attachment experiences during this phase can leave a lasting impact on a child's sense of security and control. Additionally, memories from this stage hold a unique blend of accessibility and richness due to the emergence of language skills, cognitive abilities, and moral awareness. This combination of factors makes memories from this time particularly poignant for clients. As a result, addressing memories within this age range through cognitive reappraisal allows for targeted and effective interventions, enhancing the potential for meaningful transformation. By revisiting memories from this age range and applying cognitive reappraisal techniques, we can help clients reframe early experiences and foster more secure attachment patterns that can cascade through a client's life. Let’s take a look at an imagery exercise to illustrate these principles in action.
Therapist: It sounds like you've been through a lot during your early years. I've noticed that there's a recurring theme of loneliness and not feeling cared for whenever we have talked about your past. Would you be open to exploring these feelings a bit today through an imagery exercise?
Sarah: Yes, sure, let's try it.
Therapist: Let's start by focusing on a particular memory. What's the earliest memory that stands out to you from your childhood?
Sarah: There's this memory from when I was around 5 years old. My mom was always distant, lost in her own world, and my dad wasn't in the picture. My siblings were dealing with their own stuff, and I often felt like a burden. I remember wanting to play with them or talk to them, but they would push me away and tell me to leave them alone. It felt like my presence was a burden to everyone. I was just not lovable.
Therapist: Now, imagine that you, the present-day grown-up Sarah, could travel to the past and be with the child Sarah as her mum is mentally absent and she's experiencing being pushed away by her siblings. But you're not there to push her away; you're there to show her the love and care she needed. Can you do that?
Sarah: No, I can't do it. I'm not sure why. It's like there's a wall between me and that little girl.
Therapist: Look deep within your heart. How do you feel towards that child? Do you feel love and compassion towards her?
Sarah: No, I feel angry towards her. I feel horrible saying this, because I normally love children. But I can't feel love for this child. I have such negative feelings towards her. I feel like if she was a bit less pathetic, her mum and siblings wouldn't push her away.
[Please note: during imagery work, when you come across clients who, like Sarah, struggle to extend love and compassion towards their younger selves, this should be considered as a sign of the severity of their self worth and attachment issues. With these clients, your first goal becomes to help them grow compassion towards their child self.]
Therapist: Sarah, please don't blame yourself for struggling to love that child. Your struggle to connect with your younger self is completely understandable, given the experiences you've had. Growing up, you didn't receive the modeling from the adults around you that this child version of yourself was deserving of love and care. This is exactly why we're engaging in this exercise – to bring healing and change to those deep-rooted beliefs. You could say that as you gradually grow love and compassion towards that child, you will also be growing love and compassion towards yourself. This may take some time, so don't feel like you have to achieve it overnight. And you're not doing this alone – I'm here to support you through it.
[Please note: It's common for clients to feel guilt when they struggle to love and care for their inner child. The purpose of the above statement from the therapist is to set the client's mind at ease that they are not judged and that they can let go of their guilt so that these thoughts could be explored freely.]
Sarah: Thank you. It's good to hear that.
Therapist: Do you feel ready to continue?
Sarah: Yes, let's continue.
Therapist: You know, it's quite common for children to view adults as having everything figured out, almost as if they're perfect. But the truth is, adults have their own struggles and challenges too. Your mom might have been dealing with her own issues, maybe mental health concerns, that made it difficult for her to be as present as she should have been. And your siblings, they were also navigating their own difficulties. It's possible that they never learned how to be fully present and caring because of the family's difficult circumstances. The family was struggling as a whole. You interpreted their actions as a reflection of your own worth, but that's not accurate. The 5-year-old Sarah wasn't responsible for the actions or behaviors of the adults and siblings around her. You were just a child, seeking the love, care, and validation that any child needs.
I wanted to also tell you about a cycle that can form where the more a child feels pushed away, the more desperate they become to receive love and attention. As a result the child may start to act either overly reserved or overly clingy. The child's clingy or reserved behavior can then lead to the adult caregivers responding negatively, causing the child to feel even more unloved and rejected. Unfortunately this is a common cycle that can happen with neglected children. It is a possibility that these dynamics impacted you as a child as well.
So with all of this in mind, can you logically agree that there was nothing inherently wrong with little Sarah? That she was simply a child in a challenging environment, doing her best to navigate the circumstances around her?
Even if you find it challenging to emotionally love little Sarah right now, could you at least acknowledge, from a rational perspective, that she did deserve love and care, just like any other child?
Sarah: You have given me so much to think about. Logically, I can see your point. I wasn't bad or broken. I was just a normal child within an unhealthy environment.
Therapist: And how do you feel now, with all this new perspective?
Sarah: I feel sad for her. I mean, I still struggle to fully accept and love her. But I'm a bit more open to it. I feel like I'm not so angry with her anymore.
Therapist: That's a step in the right direction. It may take some time for your emotions to fully shift. That's totally okay. Emotions can take time to catch up with our thoughts and realisations.
2. Current Thought Errors:
When working with clients who are grappling with attachment issues, you'll often come across thought errors that revolve around their connections with others and the security they feel within relationships. These thought patterns might involve doubts about the authenticity and dependability of other people's care and affection for them. Or they may hold the belief that they are intrinsically unworthy of love and care.
The biggest "here and now" issue with this group of clients is a need for them to realise that although earlier in their life, their social connection issues came from outside sources (i.e. neglectful or abusive caregivers), their current struggles with relationships mostly stem from their own maladaptive beliefs, habits and behaviour. As a therapist hearing story after story where your client with attachment problems was treated terribly, ending up feeling abandoned, rejected or betrayed, you may start wondering: what is going on here? Is this person incredibly unlucky? How come they keep experiencing such a dark side of the society on a consistent basis? This line of questioning may continue for you until a point where you find yourself surprised that your own innocent behaviour was interpreted by your client as a sign of abandonment or abuse. Or where the client communicated with you in highly ineffective ways, leading to a myriads of misunderstandings within the therapeutic setting. This, usually, is the point where therapists stop and wonder: am I dealing with a personality disorder here??
The consistent patterns of abandonment, rejection and mistreatment experienced by clients with poor attachment are a result of three main mechamisms:
1) Scarring their realtionships through hyper-sensitivity and poor communication: Clients with attachment issues often grapple with poor emotion regulation, maladaptive coping strategies, and intense emotions like anger, clinginess and tendency to take offense easily. Moreover, they are often challenged with poor communication, an issues that likely stems from lacking positive communication models in their family of origin. These challenges can contribute to increased likelihood of experiencing rejection and abandonment by those around them due to frequent relationship breakdowns.
Cognitive reappraisal: One of the goals of the therapeutic journey is to explore with the client these problematic communication patterns with due sensitivity to their emotional landscape. Through cognitive reappraisal, the therapist delicately guides the client to a deeper understanding that certain communication patterns, might inadvertently distance others or harm their relationships. This realisation is not about making the client feel blamed or holding them accountable for their past actions; instead, it is to help them gain insight into the root causes of their relational challenges. If these therapeutic processes are done with due sensitivity and care, clients often find relief and renewed hope in uncovering the origins of the patterns they have found perplexing their whole lives.
Balancing Care and Honesty, therapists must navigate the fine line between gentleness and transparency. If we manage to communicate with sensitivity and honesty, clients can find their renewed understanding liberating, as it fosters a sense of agency and the potential for healthier connections.
An important element of this is educating clients with attachment problems about healthier communication styles. The exploration of healthier communication strategies is a large topic that extends beyond the scope of this module. We will be exploring communication strategies in upcoming modules or you may like to refer to the chapters on communication within the Mind Wellbeing Workbook. These resources provide practical tools to help clients with attachment issues cultivate and sustain healthier communication habits.
2) Not perceiving or detecting genuine love/care: Individuals with attachment issues often struggle to perceive genuine love and care when they receive these. The idea that individuals with attachment issues might struggle to perceive or fully accept genuine love and care is well-established in the literature on attachment theory. This concept ties into their tendency to interpret situations through the lens of their past experiences and attachment patterns. People with attachment difficulties might have developed defensive mechanisms that make it hard for them to trust or believe in positive interactions. As a result, they might be more attuned to cues of rejection or mistrust and they may find it challenging to embrace positive feelings or connections. For example, when interacting with others, they may dismiss or not notice any signs that the other person cares for them or wants their company, but only notice the times when the other person is preoccupied with other things or fails to respond favorably.
3) Attraction to Abusive or Uncaring Partners: An additional element is that individuals with attachment issues often do become vulnerable to real abuse or mistreatment. This is due to the fact that they tend to get attracted to abusive or uncaring relationships, while rejecting genuinely kind or caring people. This further increases the likelihood of broken relationships or hurt and a reinforcement of their beliefs in relationships being insecure.
The phenomenon of individuals with attachment issues being attracted to abusive or uncaring partners is well-documented within psychology and relationship research. This pattern likely stems from the fact that these individuals are attracted to relationships that feel familiar and "normal" as they replicate the unhealthy dynamics of their early attachment experiences. Moreover, relationships with partners who treat them poorly might validate their negative beliefs about themselves, as they may feel they deserve such treatment.
So, here we can observe a paradoxical situation where people with attachment problems often find it easier to see love and care in abusive or uncaring people rather than in those who genuinely care about them. It's important to note that these patterns do not imply that individuals with attachment issues intentionally seek out harm. Rather, it often reflects deeply ingrained emotional patterns and a lack of healthy relationship models.
Cognitive reappraisal: An important task for cognitive reappraisal is to help these clients re-evaluate their relationships and their inner "detectors", so that they can understand:
a) which instances of relationship breakdown were due to their own hypersensitivity and poor communication;
b) which instances were due to not noticing or detecting genuine love; and
c) which instances were due to them simply choosing an uncaring or abusive partner.
A task of therapy, then, is to go through a journey of discovery with these clients, to assist them to find these distinctions.
Understanding the Paradox
The phenomenon of perceiving care in abusive or uncaring individuals while struggling to recognise it in genuinely kind ones is rooted in a complex interplay of psychological factors. Below are a few factors explored in the literature which may help us understand this perplexing dynamic, along with suggested intervention strategies using cognitive appraisal:
1. Attachment Blueprint: As we explored earlier, early attachment experiences serve as the foundation for understanding relationships throughout life, and a blueprint for how relationships should look like. Their early attachment experiences might have been characterised by inconsistency, neglect, or even abuse. These negative experiences, while painful, become ingrained in their understanding of relationships. As a result, they may be more comfortable or accustomed to relationships that mirror their past.
Cognitive reappraisal: When therapists observe these tendencies in their clients, it presents an opportunity to bring this pattern to the client's attention. By gently exploring their past attachment experiences and their influence on present relationship choices, therapists can help clients assess and challenge these deeply ingrained patterns. This process can shed light on the origins of their preferences and offer them the chance to redefine healthy relationship dynamics.
2. Low Self-Worth: Deep-seated feelings of unworthiness often plague individuals with attachment problems. As a result, they might struggle to believe that someone genuinely caring and kind would be interested in them. This disbelief can push them towards relationships that align with their self-perception and poor self image.
As we delve into the self worth aspect of attachment problems, it might be worth revisiting an idea that we previously discussed. You may remember that in Module 1 we suggested that while everyone with attachment issues tends to grapple with self-image problems, the inverse is not necessarily true. Meaning that it is possible for individuals with secure and healthy attachment styles to grapple with self image issues. Here it may be worth spending a bit of time exploring the distinctions and nuanced differences between the self worth/self image issues experienced by people with attachment problems and those without attachment problems. These differences can be summarised as follows:
Developmental Origins: Attachment-related self-image issues are likely onset earlier in life, influenced by the quality of attachment experienced with primary caregivers during infancy and childhood. Self-image issues not related to attachment, on the other hand, are likely to be created later in life. As explored in the previous module, they are frequently rooted in middle childhood experiences. At other times, they can be developed as a result of pressures or traumas experienced in adolescence or adulthood.
Depth and Scope of Impact: The depth of self-image and self-worth problems can differ significantly between individuals with attachment-related issues and those with self-image problems unrelated to attachment. For individuals with attachment problems, the self-worth issues can be deeply ingrained, pervasive and profound, often affecting their overall sense of identity and ability to form healthy relationships. On the other hand, self-image issues not tied to attachment may be more context-specific, potentially leading to fluctuating feelings of self-worth based on different situations. They are often centered around aspects of oneself that are not directly linked to their bonds with close connections and loved ones, but are related to external factors, societal influences, or personal attributes and capabilities.
Cognitive reappraisal: An effective approach to cognitive reappraisal here involves guiding the client to realise that the way their self-worth was defined within their family of origin is not a testament to their genuine worth as a person. Instead, the neglect, lack of empathy, or abuse that they experienced while growing up was a result of the dysfunction or stressful factors present within their family dynamics. As a result, these clients can begin developing an alternative explanation for the patterns of harsh criticism, disapproval, neglect or maltreatment they experienced, leading to a paradigm shift within their sense of self-worth.
3. Loss of Trust in Kindness: Perhaps the most powerful testament to the depth of these individuals' low self-worth and self-resentment is that, if attachment problems are severe enough, when the individual experiences genuine care and kindness, they are more inclined to perceive the caring person as flawed or insincere than to entertain the idea that they themselves might be deserving of such care. At times this tendency can result in them perceiving the caring person as having something inherently wrong with them. For example, they may believe that the kind person must be too lonely or unpopular to be able to find other company. Or they may perceive their kindness as a vulnerability or weakness. At other times, they may lose trust in the kind person, thinking that they must be insincere or manipulative. Within the therapeutic setting, they may believe that the therapist is only displaying kindness because they are getting paid for the sessions or because they are professionally obligated to do so. As you can imagine, navigating this tendency can be a significant challenge for the therapeutic alliance and this can account for much of the difficulties therapists face when trying to assist individuals with borderline personality or other personality disorders.
Cognitive reappraisal: Cultivating cognitive reappraisal around this issue entails several objectives aimed at dismantling the patterns of mistrust and negative labeling that individuals with attachment problems might exhibit:
Awareness Raising: As therapists, it's crucial to recognise when clients consistently label individuals who have shown them care or kindness in negative ways. By gently pinpointing this inclination, or bringing it to the client’s awareness, therapists can prompt clients to reflect on their own cognitive biases and how these biases might affect their perceptions of relationships.
Questioning Patterns: At times a deliberate line of inquiry may be necessary for the therapist to understand unhelpful patterns that may be impacting the client. When clients with attachment problems complain about consistent pattern of abuse, mistrust or hurt in their lives, therapists can quiz the client to see if there have been any exception to the rule, where the client experienced being treated well or with kindness? If so, how did the client perceive the individuals who treated them well? Did they trust or respect the kind individual? Did they enjoy their company? This line of inquiry can help detect any negativity that the client may have felt in relation with the kind or caring individuals that have crossed their path. The therapist can then help challenge any cognitive biases.
Exploring the Intentions of Others: People with attachment problems may face difficulties in accurately interpreting the intentions and behaviors of others due to potential challenges in emotional and social intelligence. Therapists can play a crucial role in gently probing clients' negative interpretations, helping them confront and reevaluate their perceptions. By highlighting instances where their assumptions might not align with the actual intentions of both caring and non-caring individuals, therapists guide clients to distinguish between past triggers and present reality. This process can empowers clients with a sense of confidence and control as they become more skilled at predicting the behavior of others.
Engaging in Therapeutic Dialogue: If the therapeutic relationship encounters moments of strain or disconnection due to clients’ tendency to replicate their attachment-related dynamics, such as miscommunication or mistrust, therapists can use these moments as opportunities for open and honest dialogue. Conversations centered on the client's feelings of doubt can be pivotal in building faith in the sincerity of the therapeutic connection. This open dialogue can potentially salvage the therapeutic bond during difficult moments and contribute to the healing process. These discussions also serve as a reflection of the therapist's commitment to maintaining a safe and open environment for communication, fostering a sense of trust that might have been absent in the client's earlier experiences.
Proactive Communication: It is beneficial to be proactive with clients with attachment issues, recognising the potential for them to distance themselves due to past dynamics, and establishing a foundation of open communication from the outset. This means that early on in the therapeutic relationship, it is beneficial to explicitly invite clients to voice their concerns and feelings of hurt, if these ever arise in the therapeutic relationship. By emphasising that the therapeutic relationship can be transparent and open around such matters, we can address these challenges head-on and mitigate potential misunderstandings. We can also demonstrate a departure from the negative relational patterns clients might have experienced in the past.
4. Repetition Compulsion: Some theories suggest that individuals unconsciously seek out relationships that replicate their past in an attempt to "rewrite" or heal their early attachment wounds. In the case of individuals with attachment problems, this often results in a tendency to engage in relationships with uncaring or abusive individuals in an emotionally driven attempt to finally receive the approval and affection of individuals who are reminiscent of their early caregivers. In some ways, individuals with attachment problems feel a compulsion towards receiving the care and affection of uncaring or callus people, as these are the types of individuals who made them feel unworthy in the first place. At times, I have found that this compulsion is so strong that even after they have become aware of its futility during the process of therapy, they still find it difficult to give up on this life long desire. In these cases, assisting clients to overcome this compulsive desire becomes a gradual and consistent goal of therapy for an extended period of time.
Cognitive reappraisal: The cognitive reappraisal process in this context aims to help clients recognise the futility of seeking care and affection from uncaring or callous individuals. An analogy that can be beneficial is to compare this situation to expecting apples from an orange tree. Just as you wouldn't get apples from an orange tree, seeking genuine care and affection from individuals who are emotionally disconnected and callous is unlikely to yield the desired results.
Psychoeducation about the mindset of uncaring and callous individuals can shed light on why their actions and behavior may not align with the client's expectations. It's important to emphasise that their lack of care is not a personal rejection but a reflection of their own emotional state and limitations at that given time. Clients can benefit from understanding that these individuals are often disconnected from their own emotions and empathy for various reasons, making it challenging for them to provide the care and affection the client seeks.
The goal of this cognitive reappraisal task is to help clients let go of the compulsion to seek care from those who cannot provide it and redirect their focus toward healthier, more fulfilling relationships. By understanding the limitations of these uncaring individuals, clients can work toward building relationships that genuinely meet their emotional needs and move beyond the repetition compulsion.
5. Need for Exaggerated Claims of Affection: Individuals with attachment problems can experience a heightened sensitivity to cues of rejection, and a reduced ability to perceive affection or praise. This tendency may mean that they require more pronounced or exaggerated claims of affection or praise to register in their awareness. Abusive or manipulative individuals can exploit this vulnerability by displaying intense and overstated claims of affection or praise as a means of control or manipulation. These exaggerated expressions can stand out more to those with attachment issues, and capture their attention more readily than the subtle yet genuine expressions of care found in healthier relationships.
Cognitive reappraisal: When therapists observe these tendencies in their clients, it presents an opportunity to bring this pattern to the client's attention.
6. Fear of Intimacy: Individuals with attachment issues might have an underlying fear of intimacy due to their early attachment experiences. Forming genuine connections can feel threatening to them, as it opens them up to the possibility of rejection and abandonment. As a result, they might gravitate toward relationships where intimacy is superficial, artificial, limited or absent.
Cognitive reappraisal: When therapists observe these tendencies in their clients, it presents an opportunity to bring this pattern to the client's attention.
7. Distraction Mechanism: Poor emotion regulation can result in distraction seeking behavior as individuals with attachment issues attempt to sooth their unresolved emotional pain and attachment wounds. Being with abusive or uncaring partners can often present much drama and chaos which can feel attractive to individuals with attachment issues, as it can momentarily divert their attention from emotional pain.
Cognitive reappraisal: When therapists observe these tendencies in their clients, it presents an opportunity to bring this pattern to the client's attention.
As you can imagine, the intricacies of treatment for people with attachment related issues are multilayered and there are many complexities. However, with a systematic approach that takes into consideration communication strategies and increased awareness of maladaptive attachment dynamics, we can increase the chances of success in therapeutic outcomes. A further element that is necessary in the treatment of these clients is the establishment of emotion regulation and mindfulness techniques. These will be covered in later sections.