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Trauma and Attachment

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'This monograph contains a rich variety of material that is not usually included in traditional writings on trauma. In addition to the theoretical and clinical perspectives, poetry and storytelling join in to weave a vivid tapestry of multifaceted approaches to trauma. Whilst remaining true to its theoretical base (which, of course, is Bowlby's attachment theory), the monograph succeeds in locating its subject matter in wider perspectives, thus enabling the reader to appreciate the complexity of contributing factors. It is not easy to compile a single publication out of a conference; yet, this monograph achieves its objective by offering a coherent treatment of trauma that also includes some up-to-date approaches and innovations. The papers are written with authority, clarity and sensitivity and will provide the reader with a most beneficial elaboration of trauma from an attachment theory perspective.'- Renos K. Papadopoulos

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CHAPTER 1: TRAUMA AND ATTACHMENT INTRODUCTION TO THE MONOGRAPH OF THE 13th JOHN BOWLBY MEMORIAL CONFERENCE 2006

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Sarah Benamer and Kate White

The planning of the John Bowlby Memorial Conference is a pleasure to be a part of. It is an organic process through which we as conference organisers share our clinical work, theoretical understanding, our questions about what might be missing in the literature, and what may contribute to a deeper appreciation of our clients and ourselves. The 2006 conference, part of a series that includes “Unmasking race, culture, and attachment in the psychoanalytic space” and “Shattered states-disorganized attachment and its repair”, evolved out of our response to clients who have sought our help in their bid to survive vivid experiences of trauma in all its various forms, whether endured first hand or transmitted intergenerationally. This monograph continues that journey of exploration.

As this suggests, we live in troubled times. Perhaps this has always been so, but this moment in history seems a particularly poignant one for therapists to reflect on how we may understand trauma and find meaning in the desolation, individually and in the wider sphere, as community members who may be able to contribute something very particular to the debate.Underpinning our endeavour to promote social inclusion at The John Bowby Centre, is the understanding that trauma and the potential disruption of our attachment bonds are at the heart of human experience. This monograph explores our questions about the relational and interpersonal aspects of the links between attachment and trauma as they emerge in clinical practice, together with ways in which trauma is experienced emotionally and physically in the body and how this might be expressed interpersonally in the therapeutic encounter. This is discussed through personal and clinical narratives of leading researchers, clinicians, and writers.

 

CHAPTER 2: ATTACHMENT THEORY AND THE JOHN BOWLBY MEMORIAL LECTURE 2006: A SHORT HISTORY 5

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Bernice Laschinger

The theme of this year's Bowlby Conference links directly with the inspirational core of Bowlby's thinking. His early T experience of children displaced through war or institutionalization led him to the conviction that the heart of traumatic experience lay in parental loss and prolonged separation from caregivers. These observations laid the foundations of attachment theory. Later, however, in trying to account for the continuity of these experiences into adulthood, Bowlby came to the understanding that the complexities of the traumatic impact on the child's development could only be fully understood in the context of its relationship with parents. The essential significance of traumatic experience lay in the “unravelling of the relationship between self and nurturing other, the very fabric of psychic life”.

In the 1970s and 1980s, the increased awareness of the extent of childhood physical and sexual abuse formed the background to deepened understanding of trauma within attachment research. Abused children were not only threatened by the loss of their secure base, but were also faced with a more profound conflict when their attachment figures became sources of danger. Since then, the core insights of attachment theory have been incorporated into othercognitive, social-psychiatric, and neurobiological approaches to trauma. In this integration, the work of this year's Bowlby Memorial Lecturer, Bessel van der Kolk, has been ground-breaking. While demonstrating the limitations of current formulations of post traumatic stress in terms of single catastrophic events, his work opens windows on the devastating emotional and physiological consequences of cumulative relational trauma on human development.

 

CHAPTER 3: TRUTH AND RECONCILIATION?

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Gillian Slovo

Between 1994 and 1995, I lived in Cape Town, researching B what was to become my family memoir. This was the first occasion in over thirty years that I had spent any protracted time in South Africa (for almost thirty I had not been able to go back). It was a wonderful year to be there. The best. South Africa's democratic election was held in April of 1994, and, despite the fears of violence in the run-up, and even, possibly, civil war, the election had gone as smoothly and also as movingly as any election the world had witnessed.

The African National Congress (ANC) was now in power. Nelson Mandela was South Africa's first democratically elected president. His, and his party's aim, was to turn a country from the “skunk” of the world, into a model whose watchwords were equality, justice, and reconciliation.

Welcome to the new South Africa.

And here is a story from that time (although it isn't fiction).

It was in January 1995, nine months after the election, that I was pushing a trolley round a Sea Point supermarket. As I moved into the dried fruits section, I overheard four Sea Point ladies (and I use this term knowingly, so as to conjure up for you what kind of womenthey were). They were complaining about the recent changes to what was then South Africa's equivalent of Radio 4's Today programme. They didn't like the local focus (for local, read black) of the news. They didn't like the way it was biased. And, “What's worse,” one of them said, to the accompaniment of the others' nods, “I can't even understand them half the time. I mean, the bulletins are read by an American woman, and a you-know-what.”

 

CHAPTER 4: SURVIVING THE CARE SYSTEM: A STORY OF ABANDONMENT AND RECONNECTION

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Chris Purnell

When I was invited to speak at this conference on “Attachment and Trauma” about my own experiences of surviving in the care system, my initial thought was that I do not have anything sufficiently traumatic to talk about. What on earth was I going to say that would be sufficiently interesting or significant to address a conference?

When I thought about it further I realized that my initial response was reminiscent of years ago-when I used to tell people that I spent thirteen of the first sixteen years of my life in institutional care, the usual response was, that must have been awful for you, to which I would counter, well it wasn't as bad for me as it was for some of the kids that I grew up with.

Of course, I realized later on that this was complete nonsense. It was just as bad for me as it was for any of my peers. My distancing of myself from anything that suggested a traumatic experience was simply part of the strategy that I developed to survive in the system. In attachment terms, it might be understood as an avoidant or dismissing strategy. Many of the kids that I grew up with adopted it; it's the way that we managed to survive long-term in the institutional care system.

 

CHAPTER 5: THE JOHN BOWLBY MEMORIAL LECTURE 2006. DEVELOPMENTAL TRAUMA DISORDER: A NEW, RATIONAL DIAGNOSIS FOR CHILDREN WITH COMPLEX TRAUMA HISTORIES

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Bessel van der Kolk

Childhood trauma, including abuse and neglect, is probably the single most important public health challenge in the USA, a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year, more than three million children are reported to authorities for abuse or neglect in the USA; about one million of those cases are substantiated (US Department of Health and Human Services, Administration on Children, Youth and Families, 2003). Many thousands more undergo traumatic medical and surgical procedures and are victims of accidents and of community violence (Spinazzola et al., 2005, p. 433). However, most trauma begins at home; the vast majority of people (about 80%) responsible for child maltreatment are children's own parents.

Inquiry into developmental milestones and family medical history is routine in medical and psychiatric examinations. In contrast, social taboos prevent obtaining information about childhood trauma, abuse, neglect, and other exposures to violence. Research has shown that traumatic childhood experiences not only are extremely common, but also have a profound impact on many different areas of functioning. For example, children exposed toalcoholic parents or domestic violence rarely have secure childhoods; their symptomatology tends to be pervasive and multi-faceted and is likely to include depression, various medical illnesses, and a variety of impulsive and self-destructive behaviours. Approaching each of these problems piecemeal, rather than as expressions of a vast system of internal disorganization, runs the risk of losing sight of the forest in favour of one tree.

 

CHAPTER 6: DEVELOPMENTAL TRAUMA IN ADULTS: A RESPONSE TO BESSEL VAN DER KOLK

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Felicity de Zulueta

Following Bessel van der Kolk's excellent presentation on developmental trauma in children and the resulting implica-F tions in relation to their treatment, I shall look at the implications of his presentation in relation to adult patients with a history of child abuse.

It is through an understanding of attachment disorders that we can most easily make sense of findings relating to simple and complex or developmental post traumatic stress disorder (PTSD). The implications of attachment research in terms of the assessment and treatment of psychological trauma are covered in my recent paper (Zulueta, 2006a) where I underline how PTSD impacts both on the individual and on the immediate family system and can be transmitted down the generations.

After an initial review of current research in the field of attachment, I emphasize the importance of integrating techniques that enable clients to modulate their emotions as part of the therapeutic process. These approaches are essential in the treatment of clients whose lack of affect modulation results from their early traumati-zation or neglect, or subsequent traumatization in adult life. These techniques influence mainly the right hemisphere through thevagus nerve; i.e., yoga breathing, the energy therapies and art and dance therapy. Eye movement desensitization and reprocessing (EMDR) and sensori-motor therapy also have an important part to play in integrating the mind and body of the traumatized individual, for whom, as van der Kolk says, the “body holds the score” (Siegel, 2001).

 

CHAPTER 7: THE HUNGRY SELF: WORKING WITH ATTACHMENT TRAUMA AND DISSOCIATION IN SURVIVORS OF CHILDHOOD ABUSE

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Sue Richardson

This paper explores some features of attachment-based work with people with dissociative conditions. It describes work T with a very wounded and vulnerable part of the self within a client, “Sally”. It concludes that the capacity for repair does not rest on the severity and chronicity of abuse or developmental dependency on the abusers, but rather on establishing a secure therapeutic base from which a relational bridge (Blizard, 2003) can be built and some communication established across dissociative barriers.

Sally suffered serious attachment trauma, including emotional and sexual abuse from early childhood. She has had considerable difficulty in forming supportive companionable relationships and her relational experience has been of dominance and submission (Heard & Lake, 1997). She is also in poor physical health, much of which arises from long-term anorexia.

At the beginning of therapy, the wounded, vulnerable part of Sally was in a double bind, caught between the longing for care and the fear of approaching a care-giver. Sally regarded the emotional and physical hunger of this part of the self as dangerous and intolerable. In turn, the hungry self had become a separate,dissociated self, of whose needs and responses Sally was persistently dismissive.

 

CHAPTER 8: THE SHADOW OF MURDER: LOVE AND HATE IN TIMES OF VIOLENCE

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Rachel Wingfield

I am going to start with a clip from Fahrenheit 9/11, a documen-I tary film, which includes coverage of the war in Iraq (Moore, 2004).

It will, I hope, give you just a little bit of a sense of the atmosphere, the psychic reality, inhabited by refugees from war and political violence; the processes by which ordinary people might become killers, as well as raising the question of how we adapt to living in a climate where this kind of violence and murder is commonplace.

The writer, Bertolt Brecht, captured his own experiences of living and surviving in this climate; he tells us:

I ate my food between massacres
The shadow of murder lay upon my sleep.
And when I loved, I loved with indifference. (Brecht, 1947)

One of the important aspects of this conference is the explicit links we are making between different forms of trauma across the range of relational contexts, including war, cultural dislocation, both political and so-called interpersonal violence. Making these links remains a radical development, pioneered only in very recentyears in Judith Herman’s ground-breaking book, Trauma and Recovery (Herman, 1992). In this book Herman highlights that there is a need to:

 

CHAPTER 9: HOW DO WE HELP OURSELVES

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Valerie Sinason

Introduction

[As people came back from their final break of the conference, Valerie had Vusi Mahlesela’s haunting “When you come back” playing in the auditorium. Written to inspire Mandela’s return from prison, the piece starts in enormous sadness and moves into deep celebration. It was played both as an example of music chosen by Valerie to help herself and as a link to Gillian Slovo’s moving talk on South Africa at the start of the conference.]

Here to welcome you in was music from Vusi Mahlesela which helps me and inspires me, linking me with my yearly work in Cape Town and here. Music was an important expression of emotional and political resolve, longing and pain in South Africa, and is one of the ways many of us help ourselves. Some of us, like Brett Kahr and John Southgate, take it further by being professional musicians!

I would also like to say something I promised to say to the small group I facilitated. This has been a powerful and demanding conference and if anyone has had enough and would like to helpthemselves by saying “no” to any more input, please do leave now! Some of us find it very hard to help ourselves to regulate work input and politely go beyond our tolerance level!

 

CHAPTER 10: TRAUMA AND ATTACHMENT READING LIST

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Books

Bizos, G. (1998). No One to Blame? In Pursuit of Justice in South Africa. Cape Town: David Philip/Mayibuye Books.

Bloom, S. (1997). Creating Sanctuary: Toward the Evolution of Sane Societies. London: Routledge.

Bromberg, P. M. (2001). Standing in the Spaces: Essays on Clinical Process, Trauma and Dissociation. New York: Analytic Press.

Cozolino, L. (2002).The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. London: Norton.

Dangor, A. (2004). Bitter Fruit. London: Atlantic Books.

Davies, J. M., & Frawley, M. G. (1994). Treating the Adult Survivor of Childhood Sexual Abuse: A Psychoanalytic Perspective. New York: Basic Books.

De Kock, E. (1998). A Long Night’s Damage: Working for the Apartheid State. Saxonwold, South Africa: Contra Press.

De Zulueta, F. (2006). From Pain to Violence, The Roots of Human Destructiveness. Chichester: Wiley.

Etherington, K. (Ed.) (2003). Trauma, the Body and Transformation: A Narrative Inquiry. London: Jessica Kingsley.

Foa, E. B. Keane, T.M., & Friedman, M. J. (2004). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford.

 

CHAPTER 11: INTRODUCTION TO THE CENTRE FOR ATTACHMENT-BASED PSYCHOANALYTIC PSYCHOTHERAPY

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The Centre for Attachment-based Psychoanalytic Psychotherapy (CAPP) is an organization committed to the development of this particular approach to psychotherapy. It provides a four-year training for psychotherapists and a consultation and referral service.

Attachment-based psychoanalytic psychotherapy has developed on the basis of the growing understanding of the importance of attachment relationship to human growth and development throughout life. This approach to psychotherapy, developing from the relational tradition of psychoanalysis, draws upon psychoanalytic insights and the rapidly growing field of attachment theory.

Understanding psychotherapy within the context of attachment relationships leads to an approach to psychotherapy as a co-operative venture between therapist and client. The aim is to develop a sufficiently secure base to enable the exploration of loss and trauma in the course of development. The therapy is designed to create a safe space in which the client can reflect upon their lived experience, their experience of relationships in the present, and their experience of their relationship with the therapist.Mourning is vital to the acknowledgement and understanding of the effects of abandonment, loss, abuse, whether emotional, sexual, or physical. The support of an authentic process of mourning forms a central part of the therapeutic work. This is crucial to the development of a sense of self, and the capacity to form and sustain intimate relationships. Both a strong sense of self and good attachment relationships are essential to managing stressful experiences.

 

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