How important is attachment for effective therapy?

My answer to this question would be that it depends.

First of all attachment is just a part and parcel of life and it really is just everywhere in human relationships. My guess is that when a person has a secure attachment pattern in general then it is not very important in therapy because it is simply something that is given, it is probably invisibly on the background and there is never a reason to explicitly discuss it.

Attachment pattern becomes important when it is not secure because it then start affecting also the therapeutic relationship. I don't think it is something that needs to be encouraged or discouraged - it just happens anyway, in one way or another and this is precisely the manifestation of person's attachment pattern. Similarly, like with a securely attached person the attachment pattern manifests in a mutually positive and trusting relationships. Probably there are individual differences how precisely the attachment pattern (if it is not secure) manifests with each particular therapist but it will manifest somehow anyway. And then there is an option to work with it, or alternative is to avoid working it - it's the person's choice really, depending what they want to get out of their therapy.

Of course, in order to use the manifesting attachment pattern for productive work, the T must be up to the task as well and know how to do it - without fostering dependency in order to get something out of it for themselves but at the same time not hindering unrolling the process and accepting and tolerating all that is coming (within boundaries of course). Even if the T is great, it doesn't mean that this work is pleasant or flowers and butterflies. My experience is that this kind of work is very messy, often confusing and often very difficult for both parties involved.

All of this taps into my own experience and my own anger with my outcome. The severe PTSD I’ve experienced speaks for itself and still crops up long after I’ve been ‘out’. I’m still on the long road to recovery while she walked away consequence-free and on to the next person.

Though I could have written this myself, I might have re-phrased to “some/many” cases because I have to believe there are people with attachment issues who are helped by therapy. I also think there would be more industry backlash if more cases ended as catastrophically as mine.

I also believe some people are helped. But I dont see much evidence for that. I think mostly it's the therapists who are helped.

I dont think the industry is aware of the catastrophes, other than the really bad ones. I think therapists are mostly focused on themselves.

The irony of this attachment stuff is that a typical therapist probably has 20+ clients and out of necessity their investment in each relationship must be slight. Yet they encourage the client to throw everything into it. I think therapists generally view the relationship as disposable.

This is the crux of the problem. Many of us in therapy grew up feeling unimportant to our families of origin, so it’s particularly painful to relive these dynamics as adults.

i believe much of the industry tends to turns a blind eye to the 'catastrophes' and try to brush it off as client blaming to protect themselves instead of having the integrity to take ownership for failed or harmful therapies: the client was resistant to treatment, the client wasn't putting in the work, it was a bad therapist fit and the client needs to find a better T, yadda, yadda, yadda. when i read posts from the other side of the argument (by therapists on other forums) who may be doubting, or feeling burnt out by this broken system, there is a lot of propping up, ego boosting, and back patting going on by their colleagues and peers, rehashing all those client blaming reasons i mentioned already and also including: you have to take care of you and your needs first, you are only human, you shouldn't be working harder than the client, hand them a referal and the client will be fine, etc, etc. i rarely see anyone in these type of posts calling BS and questioning if the actions (reactions) of these T and the industry are actually leading to more harm to the clients who are seeking the services. the few that do try to take a stand, get shot down, ganged upon, or told they are in the wrong profession. personally, i find it appalling and disheartening. but what scares me the most, is when i see therapist discussing and talking about their own bad or harmful therapy experiences and their own difficulties of finding a good therapist to work with. to me, that speaks volumes, but no one seems to bat an eye.

ok, stepping down :

i honestly do not subscribe to the idea that one (specifically one who is coming from a background of attachment issues) can or necessarily needs to build a secure attachment to their T for therapy to be helpful to them. i don't think it is even possible because of the limitations of the therapeutic relationship: it's non-reciprocated, limited in availability of time, limited in availability of authentic care, and the dynamics of the relationship are not even practical or representative of many relationships out in the 'real' world. i do believe that some Ts can provide what i call a 'good enough' attachment where it is possible to gain enough trust and respect for a stable working relationship. that is a relationship where the T is respectful, transparent, honest, consistent and upholds personal integrity towards the client and they do not let their own needs get into the way of the relationship or the therapy.

during my healing work, i have been fortunate enough to build a secure attachment with my husband, but it took a lot of consistent and stable work between us both, day in and day out over many many months. this is something that my ex-T could never realistically provide for me. also, since he was not around me everyday like my husband was, T had very little understanding of what my life experiences, both internal and external, present and past, was like for me and my husband had the ability to become quite attuned to me because of this. unfortunately, not everyone with attachment disorders have this option or a partner willing to do that kind of intensive support and work and that is why i can see the appeal of trying to build that kind of attachment with a T. it sounds 'reasonable'...i believed the dream that ex-T was trying to sell me at first, telling me it was possible to connect and attach to him, that it was necessary for the therapeutic alliance and for therapy to work, but unfortunately, i found out the hard and way that it wasn't realistic in therapy even though i spent many painful and frustrating years fighting for it, believing in it, and holding onto endless hope that my T would eventually fulfill that cold emptiness inside of me by being fully connected and attached to me. in the end, i realised he sold me a dream that was never attainable. i was desperate and fell for it.

Even though I sometimes feel like a bright spot, I utterly agree with this . When things get to this point, it can even be fatal to the client. The scenario in which the T fetishizes or glamorizes being a hardcore trauma T but doesn't have much real experience is real. The T then learns on the traumatized client's watch, realizes it is all going to take years, and bails out/ refers out five years into the therapeutic relationship is a nightmare for the client.

I sometimes feel like a bright spot bc I have improved. I have control over losing time/ dissociation- which is an enormous change. And yet the weekly anguish and terror, my chronic swing between trust and distrust on my T, the complete control he exerts on the environment and my resulting fear of him I have to put on manual override in order to progress- it is exhausting and leaches psychic energy from living real life. My T has come through big for me and also made some mistakes ( like writing about my case on Reddit) ; I have come through big for my T and also made some mistakes and begged for forgiveness ( like lapsing back to taking Ambien and going to sleep rather than deal with a tense session). while there is caring, there is risk. I am very bound by my own sharing of family secrets to this one human; he is not bound to me in the same way and the reciprocity that normally cements a relationship isn't there.

I have issue with the idea of "attachment issues." I assume most human beings experience crazy infatuation, obsession and hurts as evidenced by the literature of pop songs, movies and well...literature. What's the metric for determining that someone's crazy love significantly is crazier than the next?

Then many therapists convince clients they possess the special spell that will alleviate our agonies and lift our woes. Many appear larger-than-life clairvoyant. For an hour or two or three weekly they beam their beneficence our way, then withdraw it. The attention is seductive; the withdrawal mimics the cruelest of lovers.

I didn't fetishize my therapists, but I've been on some wild infatuation rides.

I wince when I read self-recrimination around attachment issues. Love was never considered rational.I wish those who feel their attachments somehow are defective can let themselves off the hook.

Discussion of attachment among humans is not solely about romantic love.

There is vast body of theory and empirical research about attachment, summarized here:

Attachment theory - Wikipedia

I'm well aware of the -- theory.

Experientially, I've yet to encounter a human who doesn't have great insecurities and irrationality at times relating to other humans. I also see other irrational trends: neediness, sometimes a large need to perform or for recognition, and sometimes a large need for superiority or dominance, among other things.

I wince when I see psych professionals tap a client's insecurities and make her feel defective about what I feel is simple humanness.

I agree. I find attachment theory interesting and useful to a certain extent, but I don't like the judgmental terminology and conceptualization in it. Imposing that some people are set to be insecure, almost like some sort of fate, which is hard to change. Like you said, everyone has insecurities, usually many. I also think there are many silver linings in the so-called insecure attachments styles - for example, I have avoidant tendencies (nothing extreme) and I would not want it any other way. It's protected me from so many unhealthy engagements and I find it's great being comfortable on my own, having simple interpersonal needs etc. Similarly, I think some people with the anxious/preoccupied style can be wonderful attentive company and have great empathy, because they are so interested in others and merging with others.

I also do not believe that attachment styles exist as distinct categories or are stable, I think it is a fluid spectrum like many other things in the psyche and mental health. Sometimes it is also said that people with one type of "insecure" attachment can experience the other extreme when they are triggered by some situation or interpersonal combination - this is something I experienced myself in the past in a romantic relationship with someone who was much more avoidant than me. It became extremely intoxicating and obsessive for both of us, like a one-of-a-kind, unique experience in life. Neither of us ever imagined before that we had a capacity for such interpersonal obsession and it was definitely not healthy. Eventually I ended it and what was interesting is that it did turn into a pattern for several years afterward, albeit much milder. Like I was seeking that obsession and looking for people everywhere to experience with again. But it never worked and mostly caused frustration. Eventually, it subsided and now I actually feel more balanced and secure interpersonally than ever, having experienced those extremes. I can imagine that therapy can achieve similar for some people, I just don't like the idea very much because of its imbalanced, unnatural structure and potential for manipulation.

For me, it was the mutual, equal obsession that opened me up to aspects of my psyche and relationship needs that achieved it - I really doubt a one-sided "affair" could result in the same because that only takes the lid off some deep-seated feelings and needs but never satisfies them. For me, going through these things in normal life, actually "acting out" repeatedly (something not recommended in therapy) satiated the deeper cravings quite effectively. Mere talking and feeling things would have never lead there. It was a painful and very frustrating process but seems to have resolved things inside and I am much more aware of and open to my interpersonal needs and limitations now.

For me, it is much more realistic to picture attachment style as a continuum, a line where one end is extreme interpersonal avoidance and the other end is extreme preoccupation/relationship anxiety. Most people are somewhere in between and also fluctuate over the course of life. It is also very much influenced by the specific encounter - for example, I know full well now that a so-called secure or preoccupied person could have never brought out that obsession for me, it was triggered by wanting to engage deeply with someone more avoidant than me, who also decided to try something unprecedented and unusual for him at the time. I can very easily imagine, before that experience, in my much less aware youth, I could have been triggered somewhat similarly in therapy due to its inherent limitations and deprivations. But I am glad it happened in real life and not in therapy for me.

Xynesthesia

I’ve fluctuated a bit with attachment styles throughout my life and the style has been highly dependent on my maturity, power dynamics in the relationship and level of personal safety and security.

For me, therapy brought out childhood attachment patterns which didn’t at all represent how I currently attach in relationships. More so, therapy brought out an attachment style representative of how I respond when I’m under stress, emotionally deprived and feeling unsafe.

I do not think attachment is necessary for work to be done in therapy.

I see numerous urges inflecting and contaminating human relationships. I see people ascribe to others others unconscious roles: their gurus, their supervisors, their persecutors, their subordinates, their students, their competitors, their audience, their admirers, etc.

I think these roles won't always be obvious or perhaps absent entirely because the therapist-client transaction is so specific . I see attachment as often in flux and only one factor in relationships.

Completely agree with this and as a result it's also easy to take the crumbs that Ts offer and blow them out of proportion and think the T really cares and that therapy is really working! That's why IMO it's hard to know if therapy is materially helping to improve people's lives or if it's just helping people build up illusions about their relationship with their Ts because their lived lives are too painful to face. So in a sense the relationship with the T and the illusions that follow act as a distraction from what's really going on in the client's life! I think if you come from a family dynamic where you were the scapegoat or had parents with personality disorders/alcoholics, you are especially vulnerable to the psychological manipulation aka transference. You tend to have poor boundaries for one. The fact that some "authority figure" is letting you monologue and has told you it's all going to be about you and your needs is very enticing. It's like any other abusive relationship. It's a bait and switch!

Also many inside industry critics have written about the research that shows that the effectiveness of therapy is no more than a placebo effect.

Can point to any particular references showing that, please?

Indeed.
Is Psychotherapy a Placebo? | Psychology Today
Does placebo effect inflate the effectiveness of psychotherapy?
http://www.sageofasheville.com/pub_d...CHOTHERAPY.pdf
The placebo is psychotherapy | Behavioral and Brain Sciences | Cambridge Core

A placebo effect is still an effect. See: acupuncture.

Believing in fairies keeps tinkerbell alive, dumbo and his feather keeps him flying, and there is always santa clause too

My thoughts too.

If it helps, it helps. It didn’t help me but I don’t doubt that others are helped.

I’ve had some success with acupuncture and self-help books. Since neither of these are “medical treatments”, could also be considered placebos.

Whatever works.

I have no problem if someone believes therapy helped them. I have a problem with the profession pretending like it is something it is not.

Well said.

And don't forget the cost. Rates are $180-over $200/50 minutes in my city and nearly all therapists are out of network. Even if they cut the rate by half, it's not worth it imo. Most people could probably get the same placebo effect by just reading self-help books or joining support groups.

I'm sorry, but my experience is different. I have a relationship with my therapist. It's real, even if I have to pay for it. Even for him, it's a real relationship, even though it's professional. I most definitely could not get the same thing from reading a self-help book. That relationship is the only reason I'm alive. My situation may not be the norm for people who seek out therapy, but I get something out of it regardless.

I don't think reading self-help books (or any psych literature, or engaging in a forum like this) is the same but I personally get much much more out of actively engaging in my everyday life and "ordinary" relationships. Plus a decent lifestyle, i.e. a balanced and non-restricted diet, some form of regular exercise, good relaxation and sleep habits, not allowing extreme stress and toxic people much, etc etc. I do believe that if someone lives a very isolated life, has basic survival and self-preservation problems, constant relationship troubles, no or little rewarding and fulfilling occupation etc etc - then therapy and the relationship with a decent T can make a big difference, perhaps even be life-saving, when it helps to snap someone out of a deep hole. But that's when the so-called attachment issues (the original topic of this thread) can also become potentially destructive, when a client does not have satisfying, enriching normal life attachments, and wants to substitute with a T. I think what a client gets out of therapy (or does not) is also a spectrum, just like most mental illnesses. Including that the same client may find therapy very useful at a particular stage of life, totally useless in another period, and everything in-between.

I do very much agree with stopdog though that therapists and the profession at large often exaggerates and claims many things it is not, and that can be not only misleading and overselling but also damaging for some. The "healing power" of the relationship with the T can be one of those things IMO. Not suggesting at all it is some generic BS but I am quite confident in my opinion that it is more often oversold by the profession than not. And many Ts do not encourage clients to focus more on developing good relationships in their everyday life. There are some exceptions of course - I had a T like that myself and heard of others as well (including on this forum). I think it takes good character, self-control, discipline and generosity from a T to habitually make it clear therapy has many limitations, is not meant to be forever and is not a healthy substitute of normal life, when they can quite easily manipulate and keep many clients for years and even decades due to attachment and other things that could really be found elsewhere as well.

I think attachment is not necessary for effective therapy but it is quite necessary to live a balanced, fulfilling life - we are simply a social species. The form and extent of it varies widely between individuals of course. And if someone (who originally struggled with the interpersonal world) can truly and effectively learn how to have better everyday relationships via therapy and initial attachment to a T, then it is great. I guess then we can say, in retrospect, that it was important. But as an anticipation and without extending it, I think it can be dangerous for some people.

As for the placebo effect - I believe that taking something that was mostly placebo (an OTC "supplement") at one point of my life when I was in a severe depressive episode had made a gigantic difference. Just enough to finally start being more proactive in resolving my issues and living a better life. I thought that stuff worked wonders for me back then, but whenever I tried it again later (when I was much healthier in general and would just have wanted some boost), it never gave me anything at all. I never tried therapy during my darkest, deepest periods of my life - perhaps I would have experienced similar. There is also the thing that if someone is very fragile and vulnerable to start with, anything can potentially have an influence, whether placebo, a listening and validating pair of ears, or some true biochemical effect. Obviously this is also what underlies the potential adverse effects of therapy (and exaggerates premises) on people in a very vulnerable state.

Do you happen to know any newer references? I have my reservations about an analysis made in year 1983 or 1985. I would also have similar reservations about any meta-analysis from the same year that would claim that therapy is super helpful.

My understanding is that the clinical fields of psychotherapy and the academic field of psychotherapy research do not have much overlap. Which effectively means that most psychotherapy research results do not make much sense in clinical context. And thus, claiming anything about it, be it that it's super helpful or that it is no better than placebo, similarly does not make much sense. One's conclusions are only as good as one's data permits and if the data is crap, then so are the conclusions.