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The Role of Brief Therapy in Attachment Disorders

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The Role of Brief Therapy in Attachment Disorders provides a comprehensive summary of the range of approaches that exist within the brief therapy world, including Cognitive Analytic Therapy, Cognitive Behavioural Therapy, Eye Movement Desensitisation and Reprocessing, Ericksonian Therapy, Neurolinguistic Psychotherapy, Provocative Therapy, Rational Emotive Behaviour Therapy, and Self Relations Therapy. Historically, many of the founders of these therapies commenced their psychotherapy careers as psychodynamic or systemic therapists, and have changed their allegiance to briefer therapies, viewing these as more respectful and offering greater potential for assisting the client to change through an outcome-oriented approach.

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CHAPTER ONE: The purpose of the book

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The purpose of the book

Within the brief therapy field, there is a plethora of books on the “how to” of each approach, most of which are effective at demonstrating the approach. Many of the therapists who are recognized within the brief therapy field originated from psychodynamic or systemic schools, having moved across to what they identify as briefer, more respectful, outcome-orientated approaches. Only a few of the publications in this arena are underpinned by theory, research, and evidence-based practice, yet the therapies appear to work.

With the increasing understanding of neuroscience and developmental theory, there is now the opportunity to make the links between these therapies and those that are grounded in a more psychodynamic approach, specifically for attachment disorder and related problems. By adding to the understanding that exists in the field, and supporting this through grounded research, brief therapy may then take its place as a therapy equal to those that have been long recognized in the psychodynamic world.

 

CHAPTER TWO: The inner world of the client through the brief therapies

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The inner world of the client
through the brief therapies

Introduction

This chapter integrates the current understanding within the brief therapies of core belief structures, sense of self, and internal processes, and links these to the theories of object relations and the later development of attachment disorder.

One of the challenges that the brief therapies face is the ability to demonstrate effectiveness of therapy in relation to outcomes, and, where brief therapies have evolved from the more traditional approaches, to gain recognition, respect, and credibility with the longer-term psychodynamic and analytic approaches.

In reviewing some of the underpinning theories of psychody-namic and analytic approaches, my intention is to present alternative and briefer therapeutic interventions to specifically respond to attachment-based problems.

Most brief therapies aim to affect the subjective relationship that a client has to their current reality. In considering the underlying principle of object relations theory that later informed the development of attachment theory, it is clear that Klein (1928) worked to alter the subjectivity of relationship to the internal object, viewing the client as a “subjective agent within a subjective world of relationship, conflict and change” (Gomez, 1997, p. 34). This resonance with the subjectivity of relationship, which is an inherent component of many of the brief therapies, is also found in the work of other, later object relations and attachment therapists, such as Winnicott, Fairbairn, and Bowlby.

 

CHAPTER THREE: Attachment theory and recent developments in neuroscience

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Attachment theory and recent
developments in neuroscience

As the previous chapter and research included within it have argued, the sample of brief outcome-orientated therapists interviewed were working with the attachment relationship. They were also describing some of the concepts that are present within attachment theory and its predecessor, object relations theory. Whether these concepts are common across all therapists is open to debate and feeds into the Dodo verdict (Stiles, Shapiro, & Elliott, 1986): that all therapies have equivalently positive outcomes. It may well be that as the understanding of neuro-science develops, it will be possible to measure the effect that empathy, alliance, and collaborative involvement (Stiles, Barkham, Twigg, Mellor-Clark, & Cooper, 2006) has on determining the outcome of therapy. However, as there is little known about the direct impact of the therapy process on repairing neurological deficit regarding attachment processes, my aim is to add to the debate from the perspective of the brief therapies.

 

CHAPTER FOUR: Creating potential for repair and growth in the brief therapies

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Creating potential for repair and
growth in the brief therapies

The recent advances in neuroscience have enabled an understanding of the potential for repair and growth of neural synapses in psychotherapy work. Yet, it is clear that we are only just beginning to scratch the surface of what can be done within the therapy context. Many of the brief therapies include elements of neuroscience, and certainly some of them are able to provide empirical evidence of their effectiveness in working with a range of psychological disorders.

In this chapter, I summarize the main brief therapies and review the potential of neurological growth and repair that exists within each of them.

The chapter concludes with a contribution from Betty Alice Erickson, Milton Erickson’s daughter. Betty Alice is a licensed Professional Counsellor, Marriage and Family Therapist, and works in private practice in Texas. She has authored numerous books and articles on Ericksonian therapy, and in this chapter, she summarizes Erickson’s work with children with anxiety disorders.

 

CHAPTER FIVE: Outcome orientation as a model of psychotherapy

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Outcome orientation as a model
of psychotherapy

Goal orientation and outcome focus is a common component of each of the brief therapies described in this book. Each therapy approaches goals and outcomes differently, and some approaches will focus only on the outcome without referring to past related issues. This chapter reviews the outcome process of each brief therapy, and then considers stress and arousal responses in regulated and dysregulated individuals. The use of sensory motor stimuli and associated and dissociated states is discussed, leading to an understanding of motivational patterns and goal orientation.

Outcome processes in brief therapy

Cognitive analytic therapy acknowledges and works with past, present, and future states, with the aim being to create more effective ways of responding behaviourally and emotionally in the future.

Cognitive behavioural therapy operates in the here and now to gain insight into the relationship between thoughts, feelings, and behaviour. The approach includes clear strategies, goals, and timescales for developing psychological and/or behavioural skills. Goal orientation is in the immediate future.

 

CHAPTER SIX: The therapist’s role in brief therapy

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The therapist’s role in
brief therapy

Gerhardt (2004) proposes that, in early development, we learn to modulate our own states by monitoring the states of others to ensure that we can maintain the relationship that is essential for our survival. This is done through observing visual cues, such as facial expression, which leads to attachment and social learning. When we observe someone else’s behaviour, the same neurons become activated in our own neurology. Gerhardt (ibid.) refers to Davidson and Fox’s work (1982) when she says that “babies who see happy behaviour have activated left frontal brains and babies who witness sad behaviour have activated right frontal brains” (p. 31).

Schore provides a more comprehensive description of this process, stating that

only in a right hemispheric-dominant receptive state in which a “private self” is communicating with another “private self” can a self–self object system of spontaneous affective transference– countertransference communications be developed. [2003a, p. 51]

 

CHAPTER SEVEN: Conclusions

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Conclusions

Within this book, I have reviewed each of the brief therapies, that is, existing modalities of therapy that are usually delivered in twenty sessions or less, and have included a significant evidence base for the modalities as they relate to attachment disorder. I have not been exhaustive in my inclusions and, at the same time, recognize and appreciate that I am not a natural researcher, therefore any omissions or oversights are not deliberate. I have concluded this book with a summary review of existing psychotherapy research into this area, and recommendations for ongoing clinical practice.

Research evidence base

There is a significant evidence base for the role of brief therapies in working with attachment disorder. Attachment disorder can appear in a number of guises within therapy and can manifest wherever individuals consider themselves in relation to the other in a relationship. Shaver, Belsky, and Brennan (2007) have used the Adult Assessment Interview to study the state of mind with respect to attachment and have identified a number of domains where attachment related problems may manifest. These include: idealizing of the mother or father figure in light of conflicting evidence; downplaying the importance of attachment relationships; lack of memory for specific examples of attachment experiences; passivity of speech; metacognitive monitoring; irrational discourse; lack of coherence of mind with episodic gaps in semantic memory; defences; unresolved mourning or trauma; fear of loss of one’s own child; anger to each parent. Many of these domains also occur in fear and phobia related disorders, relationship difficulties, depression, anxiety, and borderline personality disorder. It would, therefore, be difficult to clearly determine if an individual has attachment disorder; rather, it is the degree that they can successfully relate to others that may be the desired outcome in therapy.

 

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