More Ranting About Attachment Therapy

I apologize for needing to rant again about so-called attachment therapy methods. I'm working through some very tough stuff with my therapist, and I need to do some venting. I have already told her how I feel, but I feel the need to write it out here again too.

The whole idea of helping clients with childhood trauma-based attachment issues by encouraging the idea of a "corrective emotional experience" between therapist and client is rife with difficulties. In fact, that therapy orientation, while it may be needed for a client, does not usually work because the therapist is not willing/able to manage the intense pain and needs that arise when the therapist encourages the client to bring forth those painful feelings and needs, and the Pandora's Box opens.

Therapists need to realize that adults with severe attachment issues have a huge cavern of painful experiences that they've probably worked as hard as possible to bury because they hurt too much to think about and feel. If the therapist encourages such opening up, clients will experience a flood of strong pain and need that they felt as a child for someone to love, cherish, and protect them. At that point, therapists suddenly realize they can't manage or meet those painful needs, and it sets up serious problems in the therapeutic relationship.

Once Pandora'x box is open, if clients can't manage the barrage of memories and pain that therapy brings up, they begin needing contact with their t between sessions to maintain equalilbrium or manage crises. And therein lies the problem. Therapists resent clients infringing on their time.

Why don't t's realize this is going to happen before they encourage their clients to let down their walls, trust, and open up their pain in sessions? Don't they know this situation is going to arise if they rip the scab off of the wounds of someone with severe attachment issues?

Outside the session, if the client should have a severe flashback, anxiety attack, or dissociative episode, it can be jarring to reach out to their t (via phone call or email) for support...only to find that the caring, attentive, supportive t they see in the office has disappeared. In their place is someone who resents having clients at their work place infringe on their time.

If the t responds to the client's attempts at contact/support, it is often a bare bones reply, and carries with it an air of hesitancy that the client can easily pick up on. This is a deeply disconnecting, painful experience for a client who has trusted enough to open up Pandora's box, with the expectation that if support is needed, the t will be there for them, unlike those in their past who were not.

For the client with severe attachment issues, these kinds of therapy ruptures prevent them from ever being able to truly achieve a secure, safe enough attachment to the t to continue the painful work of healing. Then the therapist wonders "Why is my client not feeling supported/securely attached?" It is because when they need support, the t is not there. Just Like It Has Always Been.

I think my anger results from my therapist's reassurance early on in our work that by means of a secure attachment and corrective emotional experience with her in therapy, I could get relief from the pain of my childhood and heal my attachment wounds. This has not happened.
Although I have felt small moments of caring and connection, it has not been enough to internalize a secure attachment with her. The impasse of client needs/therapist availability keeps undoing any progress we've made toward secure attachment.

I think one of the biggest mistakes therapists make is assuming that clients with severe attachment issues can be helped using the "typical 60-minute, in the office, no other contact method" that is common in therapy and that works for many other clients. True healing often requires the therapist to relax some of their strict boundaries and extend a little more contact and connection to their clients who suffer from these issues. If they are not willing or able to exert themselves a bit more to help clients like this, they should not take them as patients to begin with. They are not equipped to help them.

Not all of us have the ability to process and manage the kind of emotional pain therapy brings up without at least a bit more support between sessions. If t's do not want to make themselves available during times when the client truly needs assistance with grounding and contact, then I believe those t's should not encourage their clients to get in touch with deep-seated needs and pain from childhood. I think it is wrong.

I believe t's do care, and do have good intentions. But they do not understand what it feels like to experience Pandora's box opening and the cascade of pain and need that threatens to drown us when it is opened up. They don't know what it is like trying to contain distress of that kind at the end of the therapy hour with the snap of our fingers. It just doesn't happen that way.

As a result, instead of healing, the client experiences endless cycles of yearning/longing, needing, emotional hunger...that ends in disappointment because the t cannot/will not interact outside the therapy hour. All good and well...I understand that t's don't want to work outside their paid therapy hour. I would not want to work for clients who weren't paying me either. But t's have a big responsibility toward the well-being of their clients. If they can't be flexible enough to step outside their comfort zone a little bit when the client truly needs it, then don't go opening up Pandora's box in the first place!


That is why I am holding firm to my decision NOT to do any further therapy work that uncovers childhood rejection/abandonment/trauma issues. I deal with things better as an adult when I leave those issues alone in therapy. If therapy can't fix those wounds, then quit ripping off the scab!

I want to make it clear that I am not saying that t's should spend lots of time outside sessions, or outside work hours, answering emails and talking clients through crises. I am talking about only those times when the client is having a major problem coping. I don't expect my t to answer 4-5 emails per week. I don't expect her to talk to me on the phone for 30 minutes every couple of weeks because I can't cope. I don't call her at home or in the evenings. I feel that the level of support I am asking for is reasonable, considering my issues. Something like this:

Week 1 - no contact needed
Week 2 - 1 or 2 email contacts needed
Week 3 - 1 email contact needed
Week 4 - no contact needed
Week 5 - no contact needed
Week 6 - 5-minute phone call needed
Week 7 - 1 or 2 email contacts needed

When I say "1 or 2 email contacts needed," I am not talking about 1 or 2 email chains that contain multiple replies. I am talking about me sending 1 email message, and her replying once.

Is that too extreme/dependent/needy for me to be, even though I have depression, C-PTSD, GAD, possible DDNOS/DID, a husband with multiple serious health issues who has been on disability for 10 years and may now have cancer, my mother-in-law just died, I'm the primary caregiver who works full-time, we have no kids or grandkids, or support network, to speak of, and my own parents live out of state and are not emotionally supportive?

I know I've been in therapy for many years, and that is not ideal. But I am not just sitting around feeling sorry for myself and wanting my t to take care of me. I have worked hard to address my issues. I try to take as much responsibility for my healing as I can on my own. But I NEED more support from my t, and I don't understand why it seems so difficult for her to realize.

Or am I just totally off-base in my thinking?

PS - I apologize if I sound like I am speaking for all patients who have attachment issues. I am sharing MY experience in therapy. I know some of you have managed to heal from your attachment issues in therapy with your therapists. Likely, there are those of you who have not felt the need to have regular support outside sessions. I feel like I'm too needy and that brings me shame... I would LIKE to be strong and NOT need more support. But I am speaking my truth. I can't help it. This really is my truth.

Interesting points.

Would it be possible to see your t more times per week for a limited time, say a month or two? Maybe an intense period would help. When my t and i had our big rift, i saw or talked to him every day, one day i even saw him twice. As you say, you have been with her for a long time, so while this might not work for a new therapy pair, it might for you?

I agree that these things might be necessary. Also I know that there are therapists who understand and accommodate those needs. They might be rare but I personally have met with two such therapists and I'm currently still seeing one of them.

Why many or most therapists don't understand it? I don't know. Maybe because most of their patients have been well enough not to need outside contact in such a way and this it has never occurred to them that there are patients who need it?

Also, most probably these therapists are afraid that their patients become "overly dependent" on them and thus it might feel safer for them to keep their patients at arms length. I would call it lack of experience and lack of personal therapy work (because understanding one's need to keep his patients at arm's length is perfect topic for someone's own therapy).

Anyway, I personally would not see such a therapist.

I'm sorry you aren't getting what you need. That sounds incredibly painful. For what it's worth, I don't think what you describe sounds unreasonable in terms of needing outside contact. I know exactly what you mean about the pain of getting in touch with feelings that were buried a long time ago for very good reasons. I also struggle with feeling shame for being needy (which is just having normal needs!) and for wanting to manage my emotions on my own but sometimes not being able to. It has been helpful to have my T to fall back on in those moments. Even a tiny bit of accessing our connection is often enough to pull me back from a total meltdown now. One thing that has been helpful about her allowing outside contact without any particular rules about frequency is that it lets me "see" the full extent of my need, and it's often smaller and more manageable than it felt like when it was all bottled up inside.

So what I'm saying is that I think what you describe seems reasonable (pretty moderate, actually), and there are therapists out there who will do it. I'm just sorry that you keep bumping up against your T's limits in a way that feels traumatizing. My T has said that if I need more than she feels like she can give me, we would consider a higher level of care (like intensive outpatient). She would never tell me to just stop needing things when she knows I try my hardest to self-regulate and to get support from other people too.

I think the contact you have set out above is very reasonable. Totally agree with you that you can't just cram feelings back into a Pandora's box, once that box is open.

I think I am more "demanding" in the sense that I ask for more contact with my T. During a few crisis times we've had phone calls every day (just about 5 mins each time). During difficult times but not crisis, quite a few texts in a week. Average times maybe one text in a week or one every two weeks (that's with meeting now once every two weeks as well). Have had some times with no contact for 2 weeks.

I really think I get the hurt and frustration you are talking about - the things we allow T to hear/see/know are so enormous and so huge in our lives, but then for T it's a 50 minute slot, part of their job, one of many... I am really struggling with this at the moment.

I go between struggling, feeling very emotional, sometimes self destructive for all these reasons, and being able to see the huge progress I've made in my life, all the things that are so much better than before, and the fact that I do often (but not right now) experience the feeling of calm and stability that goes with the secure attachment.

The awful feelings are so awful aren't they? For me when I'm in them it's hard to remember that I ever felt differently. I get so frustrated and I think that my T must be bored/frustrated with me too, because he is just hearing the same old same old from me. But T says he finds it easier to "zoom out" and see the overall progress. Kind of like a looping pattern that is going down and up but the overall trend is upwards.

I did attachment therapy for 18 months. And, the schedule you suggested would not have worked for me. I needed way more than that. If you asked me at the time I started therapy I would have said I needed none of that. I believe it is impossible to plan what is needed in advance, except for a having a therapist that says they have done their work and they are solid, so that whatever your needs are they can handle. That is where trust has to come in. There were times I needed my therapist at 3 in the morning, but I knew she would not be available, (this was her way of taking care of herself). She agreed to get back to me as soon as she could. If it was an emergency or I just wanted a response, then it was my responsibility to let her know by email or phone, so that when she accessed them she knew I needed to be a priority. As far as other emails and phone calls, she would respond if and when she could. Lucky for me there was never a time that she could not respond.

Most therapist can only take one or two clients on at a time that have these needs. In addition, it would be difficult if they had a growing family or they were the go to person in an extended family. I was lucky.

I have a standby therapist that does not do attachment therapy, but is very generous in answering most all my emails, especially if I am having self-doubt for a moment or two. She does more than what you requested in your post. I go from zero emails a month to sending as many as six a day. It's still my way of purging, though the attachment piece is good. The last time I saw her, we talked about the struggles so many on PC have with there therapist not allowing, not responding, or sending one sentence replies when a more substantial responses is being hinted at. She is 75, has just learned to text, but I have no plans to text with her. She said she was glad I was able to send emails anytime I needed to get something out and away from me. And, that I should rest assured that she reads all. She also responds to more than half. I asked her once about what happens if I need the attachment piece again, "If you feel you need that then you will get an attachment therapist." She is willing to read to me if I want it(never have), sit next to me to look at things, etc, but she is just a plain old psychodynamic therapist and will not pretend to do attachment therapy.

I have come a decision that no matter what kind of therapist I employ, if they are not okay with me emailing anytime I need or want then that therapist is not for me.

*You have been with your therapist for a long time and I can understand your reluctance to give her up. But, is there a possibility of hiring a separate therapist to do the attachment piece. People hire a second therapist to do EMDR, so maybe it can be done for the attachment piece.

I would like to suggest an emotionally focused therapist ( Sue Johnson). There also may be other methods for working through attachment issues when a corrective experience is needed/wanted, but I am not familiar with them.

peaches100, you are not too needy; you need what you need and you are definitely not asking for too much. Shame is a big problem for many, but hopefully if you can get the attachment piece the shame will disappear over time.

Continue to speak your truth!

That's all too familiar. I only needed, for the most part, one 5 minute conversation in the middle of the week rather than multiple emails, but he wouldn't do it. He works psychoanalytically, so to him, attending to my need would be 'rescuing' me and prevent me from "doing the work". He encouraged the attachment, but then when I got there, it felt like I was being retraumatized after Pandora's Box was opened. I tried over and over to get him to understand my therapeutic needs, but he would always say everything was transference. I was attached to him as if it was life or death by that point.

It's irresponsible for a T to take on a client with these difficulties and not offer support outside of the 50 minute per week session, so I disagree with you that they don't have the responsibility. It is unprofessional to do otherwise, and they shouldn't be taking on trauma clients if they don't accept responsibility for the side effects of the treatments they deliver.

My T invited me to come 3 times a week, but like many people, I couldn't afford it. When he first took me on, he knew about my issues. He knew about my financial situation. The truth is, he doesn't care about me at all. All he cared about was having a paying client to fill a slot.

When my condition caused my medical expenses to escalate leaving me with no money for therapy, I had to end abruptly since I couldn't even pay for one more session, needing the money for medical copays that month. After bawling my eyes out at our last session, he just sat there and looked it me then at the end, said to let him know when i come back. That was after 5 years. I don't think I'll ever recover from this.

Hi Peaches,

I agree that T's doing certain types of therapy need to be more open and available to their clients. I'm confused as to if your T has clearly stated that she is not that available or if you feel she is not. If she has said she is not as available (actually more available) than what you listed, I would agree that she is doing a disservice to those clients that need this level of interaction. I know I need the level of interaction you list or more and that is with seeing my T 2x week. For me, I think this form of therapy has been helpful but not without its pains, ruptures, and limitations.

Feel free to vent away,
Elio

Peaches, you described the situation extremely well. I know where you're coming from. Please feel free to vent when you need to. I've found it extremely helpful to vent here, too.

I don't think you're asking too much. I'm sorry your therapist isn't willing to work this out with you to get the support you need. It might seem like you can omit work on these more triggering issues, but I have a feeling it will just make things worse to suppress. Is it possible to consult with another therapist about this, with a view to changing ts? I don't think these kind of unresolved issues go away.

You definitely speak ( eloquently) for me too. I am put together and productive, and I use my capacity to compartmentalize horrible things from the past away from my "here& now" t go on. My T wants to rip off the bandage and integrate everything. Ummmm- ouch it hurts after sessions when I try to please him and give the stories he wants. The side effect is, while I usually trust and adore my T, at those times I feel summarily dismissed from session and ignored between, and I start to view him as the talented Mr Riipley. Your opening post? Agree with every word.

me too!

at one time, i would have sworn that was my post...almost word for word, and that was my experience of therapy for many years. when it felt like i could no longer take the frustration anymore of the limitations after my T reassured me year after year that we could work through my attachment issues based solely on the extremely limited and lacking relationship with him, i finally gained the courage to vent similar to what you wrote and share that directly with him. needless to say, he really did not take it well and felt slightly attacked or unappreciated, but i could no longer hold on to the empty hope that he repeatedly dangled in my face session after session, year after year.

this is why i so strongly believe that the system is failing those of us with severe childhood trauma and developmental trauma issues. there are too many stories like yours and mine out there of clients not getting the proper healing that they are seeking in psychotherapy and/or even becoming more traumatised because of the experince.

hugs to you peaches... please know you are not alone.

I honestly feel the same way.

Even though it doesn't fix the system, I am so glad you all understand this predicament. The anguish is very hard to describe, and it hurts that this person designated to be a trusted guide then encourages such pain while not understanding the suffering that results nor taking any responsibility for it. I had horrible childhood trauma yes, but it was very well walled off by defenses I didn't even know I employed . I do think facing the facts and making it all real is important, but it just may not be survivable with the rip off the band aid and don't- call- me- in- the- morning theory of the frame/ boundaries in which psychologists believe with religious fervor .

yes, this exactly! very well said...

although i believe that there are some very good trauma researchers and some therapist that are starting to understand this predicament, they still don't quite have the knowledge or agreement, and sometimes i wonder if it is also somewhat a lack of patience and courage, to how is the best way to help solve these challenging truama issues for clients like us.

I was told by my ex therapist that many therapist will not offer unregulated outside contact because they are afraid of getting sued, so they maintain the strict teachings of what they were taught; do not bend the frame. It is true that therapist have been sued for providing nonstandard forms of care; emails, walks outside the office, sharing a meal inside or outside the office, etc, which leaves many therapist to protect their livelihood in whatever way they think is necessary — to hell with what the client thinks they need. More importantly, I think there are a fair amount of therapist wanting to give more, yet they hold back in fear. At least from reading here on PC, many therapist themselves go into the profession because of unmet needs from childhood like many of us, so how could they not know the anguish we go through? Or has their training delivered them into deep denial of what the pain was like and what it is to be human?

That is a very good point. One reason I just submit to the rules, and suffer on my own is bc I do realize what would be enough? 50 minutes, 100 minutes, their whole day? Trauma is a never-ending story, until it gets integrated, so I do see how T's would be overthrown by client anguish if they tried to staunch it, especially if they have to care for their own. I can see how they might fear what looks like neediness too, but with Trauma clients, I do believe in our strength. It is just tested badly by the exact medicine that is supposed to help. It is a high stakes situation, in which despair and the relationship have a conversation. I just don't think my T sees any of that. He is 1000 percent intensive and kind of brilliant in session, and then he is all done with me, but he sees himself as on my team, trustworthy and there for me. It's confusing bc I don't see it that way. always. I see it as he asks for so very much, and then doesn't take responsibility in the Little Prince children book way that you are responsible when you set out to elicit trust.

this is clearly a sad reality of the attitude in mental health care and if this fear driven attitude is what has become of humanity, then we clearly are doomed...not only as truama clients but as a society as a whole

How are you doing now, Peaches? Did expressing yourself here, and the replies, help any? One of the things you wrote:

I think I have needed social support, not just psychological help if that makes any sense. Psychological help, yes, for the trauma and results of trauma but if, as you pointed out:

In my experience, too, the therapy often doesn't really help us "recover". And I have found that after ripping off the scab the therapist's issues can then additionally "infect" me. So, yeah, leave a scab on there if the therapy can't really deal with those wounds.

Like another poster suggested I wonder a little about the possibilities of EMDR and related therapies for just the trauma piece, not the relationship building/repair.

Probably, with adults, it may be too much for many therapists to deal with the unresolved, intense longings? But then, as you asked, why don't they know that? Maybe eventually they will hear us?

Going forward, I also wonder about a supportive COMMUNITY of others who have had similar experiences. Unfortunately I have not found anything like that in real life. But the online communities have been definitely better than nothing for me.

I agree. Some of us go through unreasonably intense, unrelenting emotional pain from week to week that ends up being retraumatizing. While I wouldn't expect therapy to be easy or painless, there is nothing healing about that.

There's a type of therapy that seems to address these shortcomings. People have been posting about it here. It's called "schema therapy."

Have you tried it, Rayne? There's one person here who has posted that they have tried it and found it to be effective. I looked in my area several years ago and couldn't find anybody that was certified.

It would be good to hear from some others who have experience with schema therapy, too.

No, never heard of it until this forum. Was doing psychoanalytic therapy for a number of years before realizing it is more traumatic than not. Currently not in therapy though not by choice.