Attachment Disturbances in Adults: Treatment for Comprehensive Repair

by Daniel P. Brown, David S. Elliott

Winner of the 2018 International Society for the Study of Trauma and Dissociation (ISSTD) Pierre Janet Writing Award.
A comprehensive treatment approach for the repair and resolution of attachment disturbances in adults, for use in clinical settings. With contributions by Paula Morgan-Johnson, Paula Sacks, Caroline R. Baltzer, James Hickey, Andrea Cole, Jan Bloom, and Deirdre Fay.  Attachment Disturbances in Adults  is a landmark resource for (1) understanding attachment, its development, and the most clinically relevant findings from attachment research, and (2) using this understanding to inform systematic, comprehensive, and clinically effective and efficient treatment of attachment disturbances in adults.  It offers an innovative therapeutic model and set of methods for treating adult patients with dismissing, anxious-preoccupied, or disorganized attachment. In rich detail, it integrates historical and leading-edge attachment research into practical, effective treatment protocols for each type of insecure attachment. Case transcripts and many sample therapist phrasings illustrate how to apply the methods in practice. Part I, "Foundational Concepts," features a comprehensive overview of the field of attachment, including its history, seminal ideas, and existing knowledge about the development of attachment bonds and behaviors. Part II, "Assessment," addresses the assessment of attachment disturbances. It includes an overview of attachment assessment for the clinician and a trove of practical recommendations for assessing patients' attachment behavior and status both outside of and within the therapeutic relationship. In Part III, "Treatment," the authors not only review existing treatment approaches for attachment disorders in adults, but also introduce an unprecedented, powerful new treatment method. This method, the "Three Pillars" model, is built on three essential clinical ingredients: Used together, these interdependent pillars form a unified and profoundly effective method of treatment for attachment disturbances in adults―a must for any clinician. In Part IV, "Type-Specific Treatment," readers will learn specific variations of the three treatment pillars to maximize efficacy with each type of insecure attachment. Finally, Part V, "A Treatment Guide and Expected Outcomes," describes treatment in a step-by-step format and provides a success-assessment guide for the Three Pillars approach. This book is a comprehensive educational resource and a deeply practical clinical guide. It offers clinicians a complete set of tools for effective and efficient treatment of adult patients with attachment disturbances.

Genres: Psychology, Nonfiction, Mental Health, Relationships, Counselling, Self Help, Audiobook

752 pages, Hardcover

First published August 8, 2016

About the author

Daniel P. Brown was the director of the Center for Integrative Psychotherapy in Newton, Massachusetts, and an associate clinical professor of psychology at Harvard Medical School. Trained in Buddhist philosophy and languages at the University of Chicago and the University of Wisconsin-Madison, where he did his dissertation on mahamudra meditation texts, he maintained close relations with Tibetan teachers of the Gelug, Kagyu, and Nyingma lineages for more than thirty-five years as well as exploring the Theravada mindfulness traditions in Burma and Thailand. Dan was the author of fourteen books, including Transformations of Consciousness and he lived in San Francisco, California with his wife, Grethen Nelson.

source: publisher's site

Reviews

[Morgan Blackledge · Rating 5 out of 5]

The Ideal Parent Figure (IPF) Protocol was developed by hypnotherapist, psychologist and Buddhist meditation expert Daniel P. Brown.

IPF is a therapeutic technique to help repair attachment disturbances in adults by guiding practitioners to imagine their ideal parent.

😳

That’s right.

You read me correctly.

You basically pretend that you had good parents.

Ok ok.

If that sounds beyond the pale.

I feel you.

But wait.

Please.

Before you stop reading this.

Hear me out.

It’s actually RAD!

Super healing.

And based on AMAZING science and a SUPER interesting theoretical foundation.

But to properly understand it.

We need a little background.

Attachment Theory:

As many of you may be aware, attachment theory is a psychological theory of human relationship.

The most important tenet of attachment theory is that young children need to develop a loving relationship with at least one primary caregiver who is safe, curious and attuned to their emotions, attentive to their psychological as well as their material needs, fiercely protective (but not overly so) and genuinely excited (nay DELIGHTED) by them in order for SECURE attachment (optimal social and emotional development) to happen.

Five pillars of secure attachment:
1. A sense of felt safety
2. A sense of being seen and known (attunement)
3. The experience of felt comfort (soothing)
4. A sense of being valued (expressed delight)
5. A sense of support for being and becoming one’s unique best self.

So if you got all that stuff from mom and dad, than good for you.

But…

If you didn’t get all (or any) of that stuff from mom or dad.

Don’t trip.

It’s ok.

You’re totally ok.

But in order to feel truly at ease within your self and in relationships, you may need to do a little (or a lot) of work.

The good news is.

It’s really magical, wonderful, healing work.

But still.

Ya gotta do it (the work) to get the benefits.

An important tenant of attachment theory is the internal working model.

Attachment theory assumes that infants and children develop implicit mental representations, or internal working models (IWM) based on the quality of loving care that they receive, that informs their sense of self, and guides their behavior and expectations in relationships for the remainder of their lives.

It’s important to know that IWM’s are not explicit thoughts.

They are deeply held beliefs, that primarily function on the level of feeling and instinct.

But if you did translate the IWM into language, an IWM for secure attachment might go something like this:

1. I’m fundamentally worthy of love.
2. The world is a safe place to explore.
3. My care givers will be there for me when I need them.

For those us us who did not always receive “good enough” parenting.

Or only had inconsistent support.

Or conditional love.

Or maybe had self absorbed, mentally ill, addicted, or otherwise emotionally unavailable parents, or caregivers.

Than your IWM probably doesn’t sound (or rather feel) like that one up there.

That’s the bad news.

But…

BIG BUT…

The good news is.

Our IWM is always updating.

And as adults, we can give ourselves the loving support we missed out on as kids.

Or we can do it in therapy.

And we can walk away from the deal with a totally rewritten IWM.

We can become securely attached.

In attachment theory, they refer to that as.

EARNED SECURE ATTACHMENT (ESA).

And as it turns out.

It actually has some major benefits over plain old secure attachment.

For one.

People with ESA actually make the best care givers in many ways.

In the same way that working on your own car might make you a better mechanic.

Awesome teachers, therpaist etc.

Anyway.

This 753 page MONSTER of a book is a DEEP DEEP DEEP DIVE into the attachment literature.

Its WAY more detail than the average reader will need or want.

Frankly, it’s more detail that move mental health professionals will need or want.

But if you’re interested in getting a SERIOUS handle on attachment theory.

I know of no better single source.

It’s also a manual for the Ideal Parent Figure (IPF) Protocol.

Remember that nonsense about pretending you had good parents way back at the beginning of this review?

The IPF is a powerful way to reprogram you IWM via intensive, guided visualization designed to give you the experience of having that ideal parental experience we may need in order to undo some of the FUNKY junk in our past.

And it is PROFOUNDLY healing.

Gurl!!!!

Get ready to cry like a baby.

An important tenant (lots of tenants here in this review) of attachment therapy generally, and the IPF protocol specifically is:

Metacognitive Awareness.

Metacognitive skills – often referred to as 'thinking about thinking' include planning, mental scripting, positive self-talk, self-questioning, self-monitoring and a range of other learning and study strategies.

The IPF protocol improves metacognition as a way of helping people monitor their own (and other peoples) inner states.

Again.

This is one reason people with ESA are such super helpful healers.

The last tenant of the IPF protocol.

And probably the last tenant of this review, is:

Collaborative Abilities.

Part of secure attachment has to do with getting, and staying collaborative with our partners, co-workers, kids, clients, all that.

#OkKaren!

Anyway, engaging and enhancing collaborative skills is like a super important part of the IPF protocol.

And it’s like the third pillar of comprehensive attachment treatment (more generally speaking).

What’s that?

I’m glad you asked.

The Three Pillars Model of Comprehensive Attachment Treatment:

1. The First Pillar: Creating a New, Positive Internal Working Model (IWM) of Attachment.
2. The Second Pillar: Developing a Range of Metacognitive Skills.
3. The Third Pillar: Enhancing Collaborative Abilities.

I simply can’t do justice to the IPF protocol in this review.

But suffice it to say, this book is a MONSTER MASTERPIECE.

I’m a different human before and after.

I feel an ease of being that after doing (even a little) of this work.

And I’m FOR SURE a better therapist after reading this.

Simply wonderful.

Fucking life affirming AF!!!

5/5 SUPER STARS ⭐️

[Michael · Rating 5 out of 5]

In this very well organized, readable and comprehensive textbook, Daniel Brown (a psychologist on faculty at Harvard) presents us with a remarkable contribution to the field of psychotherapy. For those in the field, we are often challenged with barriers to the resolution of interpersonal challenges and traumatic experiences based on the very early life experience of patients. These challenges can be remarkably resistant to most interventions including the spectrum of evidence based therapies and the original psychodynamic approaches. Brown has studied the emerging literature on early attachment and uses his in depth understanding of attachment disruption and his previously honed skills in hypnosis and use of imagery to deliver for us an intervention that he has supported with substantial data for the correction of attachment disturbance. This is a novel and fresh approach that has real face validity as it uses the basic principles of what we have learned about the development of attachment, emotion regulation and self organization. Brown summarizes the latest research on attachment and goes on to summarize historical approaches to psychotherapy based on our understanding of attachment, which has been evolving over the past few decades. He then goes a step further to include research on metacognitive development and the work of Fonagy and others on mentalization based approaches to personality disorders, blending the work in seemlessly with his own. As such Brown gives us an approach that clearly includes the best of previous approaches combined with the power of his own very novel contribution. These techniques promise to move us forward considerably in helping the most treatment resistant of our patients. Brown provides powerful and fascinating case examples of his work and his well organized approach makes it very easy to follow his thinking and his clearly articulated treatment framework. I warn you that this textbook is formidable, weighing in at 650 pages with a further 100 pages of references, but it is extremely well organized and some may choose to skip over some of the sections on attachment research. That being said much of the research is presented in a very readable format and I found it very interesting, but admit that it became somewhat exhaustive towards the end of the research section. The sections that review historical treatments were excellent, and his sections of treatment of avoidant, ambivalent and disorganized attachment are the high points of the book. A monumental contribution to the field.

[Razi · Rating 5 out of 5]

Attachment Disturbances: Treatment for Comprehensive Repair by Daniel P. Brown, David S. Elliott et al is a remarkable book that offers a groundbreaking perspective on understanding and treating attachment disturbances. With a deep understanding of attachment theory and extensive clinical experience, Brown et al present a comprehensive framework for repairing attachment disruptions that can have long-lasting effects on an individual's emotional well-being.

One of the standout features of this book is the authors' ability to present complex psychological concepts in a clear and accessible manner. They effortlessly guide readers through the intricacies of attachment theory, ensuring that even those new to the subject can grasp its fundamental principles. This accessibility makes the book invaluable not only for mental health professionals but also for individuals seeking to understand their own attachment patterns.

The authors provide a simple but comprehensive treatment framework calling it the Three Pillars Aproach:

1) The Ideal Parental Figure (IPF) Protocol. Therapist becomes the ideal parent and creates different positive mental models for each fragment of the personality assigning them the IPF roles.
2) Fostering a Range of Metacognitive Skills (developing a framework of thoughts about the way the patient thinks, its limitations and detatched observation of the patient's internalised mental models)
3) Fostering Collaborative Nonverbal and Verbal Behaviours (collaboration as an antidote to loneliness)

The authors' approach to attachment disturbances is both compassionate and evidence-based. Drawing from a wide range of therapeutic modalities, including psychodynamic, cognitive-behavioral, and somatic approaches, the authors offer a comprehensive treatment model that addresses the multifaceted nature of attachment disruptions. By emphasizing the importance of integrating these different therapeutic approaches, Brown et al provide a holistic and nuanced understanding of attachment repair.

Furthermore, the book is filled with numerous case studies that illustrate the practical application of Brown et al's treatment model. These real-life examples not only serve to enhance the reader's comprehension but also evoke a sense of empathy and connection. Readers will find themselves relating to the struggles of the individuals portrayed and gaining insight into their own attachment patterns.

What sets Attachment Disturbances apart from other books on attachment theory is its emphasis on the reparative process. Brown et al emphasize the possibility of comprehensive repair, challenging the notion that attachment disruptions are irreversible. They provide practical tools and interventions that therapists can employ to help individuals heal and develop secure attachments. This positive and empowering approach instills hope and fosters resilience in both therapists and clients.

Another notable aspect of the book is its inclusion of a detailed exploration of the neurobiology of attachment. Brown et al skillfully weave together the psychological and neurobiological aspects of attachment, shedding light on the intricate interplay between brain and behavior. This integration of research from multiple disciplines strengthens the credibility of the book and enhances its practical relevance.

If there is one minor drawback to this otherwise exceptional book, it is the level of detail that may overwhelm readers seeking a more concise overview of attachment disturbances. However, given the depth and breadth of knowledge provided, this can be seen as a minor quibble rather than a significant flaw.

In conclusion, Attachment Disturbances: Treatment for Comprehensive Repair is an indispensable resource for mental health professionals, researchers, and anyone seeking to understand and heal attachment disruptions. The authors' expertise, compassionate approach, and evidence-based insights make this book a must-read. By offering a comprehensive treatment model and practical tools for attachment repair, Brown et al provide hope and guidance to both therapists and individuals on the path to healing.

[holly · Rating 5 out of 5]

4.5* only because I haven't read it in full, only the parts that are relevant.

but I love psychology and find this to be a very comprehensive and insightful approach to all facets of attachment theory. some very interesting, practical guides to securing attachment. ily bowlby and ainsworth <3

[Degas A Wright · Rating 5 out of 5]

Very Comprehensive!

The authors presented a comprehensive well written book on attachment disturbances. The case studies illustrated the methods in an effective manner.

[Amanda]

Oof. This book is DENSE. It's a lot to read any of the chapters straight through, but it's a useful reference book.

[Elizabeth]

Really great work, not for recreational reading at the moment. I'll look at it again in the winter.

[Lisa Gray · Rating 3 out of 5]

Read for a therapist book club. Basically a textbook. Great info but unless you are going to get extensive training in the AAI and their method, it won’t do you much good.

[Tobias Johnson · Rating 4 out of 5]

First off, I learned that attachment theory is powerful stuff. It predicts a bunch of life outcomes that everyone would care about.

Basically, your attachment style really does matter. But it's much more fluid than that sentence implies.

You don't have a single attachment style, you express an attachment style contextually.

An attachment style is not a personality trait.

But also, you can't read this book without noticing what a HODGE PODGE Attachment Theory is

The popular “anxious” attachment has also been called: anxious-insecure, ambivalent/resistant, anxious-preoccupied, hyperactivating…

All names for one style of attachment!!

I hate this about psychology in general. Everyone whines about the replication crisis but there's an even deeper infection in the psychological sciences that nobody talks about.

That problem is the MESS of terminology.

Every psychologist thinks they're at the liberty to make up a new term, either because 1. They are chasing clout and a new term = new discovery, and 2. They haven't looked into previous literature deeply enough and so aren't aware that their new discovery is not all that new.

It means that the Jangle Fallacy is almost impossible to avoid: Are we still talking about anxious attachment if you're talking about resistant attachment and I'm talking about preoccupied attachment?

In physics, momentum is momentum and no one uses other terms for it.

Why do we tolerate such a mess in psychology?

Anyway, I loved this book. It's a textbook, but I couldn't put it down.

I learned how we form attachments in early childhood, how they transform our adult relationships and personalities, and what can be predicted from these lifelong processes.

Who wouldn't find that fascinating?

It's essential human life stuff.

The theory itself is not directly practical, but it makes relationships more fun to think about.

The end of the book, which focuses on healing attachment style, is much more practical.

I feel so privileged to be able to learn freely about the frameworks in psychology that I believe are useful rather than follow some stupid curriculum that a random academic came up with.

To sum it up, this book felt enlightening.

I finished reading having gained a useful, empirically-validated framework to think about attachment issues.

But I think I will hold this framework lightly. Generalising experimental findings to the insanely complex idiosyncrasies of a human relationship in day-to-day life seems like a mission that is bound to fail.

[Sophie · Rating 5 out of 5]

Brilliant book that takes away the misconceptions about attachment (there are too many social media videos or pop science books that illustrate only one side of attachment).

A baby’s brain is plastic and constantly taking in the information given to it — just like the beginning of a foundational model in artificial intelligence. The book shows how parents — the way they respond to the baby is absolutely vital for ensuring secure attachment when the baby becomes an adult.

The book greatly illustrates how insecure attachment is a fundamental issue in our world. Our foundational model is broken and hence we’ve become broken human beings - resorting to different forms of addictions and coping mechanisms.

I hope that more parents will find and read this book, and heal themselves before having a child, so that we can all bring healthier, securely attached children to the world.

[Crystal Marie · Rating 5 out of 5]

This book covers attachment theory extensively. What blew my mind especially was that the Three Pillars model has been used as a standalone method for those clients who struggle with traditional trauma treatment , for example EMDR, and that it was proven to be successful in alleviating dissociative & trauma-related symptoms, cPTSD, depression, and Disorganized attachment.

[Amanda · Rating 3 out of 5]

This was LOOOONG. I felt like a child’s attachment style was formed in real time during the making of this book. That’s how long it felt. But I will admit to enjoying parts of it and I can use several treatment options in my practice.

[Jamie Roach · Rating 4 out of 5]

Great and vast resource covering the scope of attachment science.

[Elvira · Rating 5 out of 5]

Heavy complex content but thorough and accessible if you have the time to finish it.

[Cindy · Rating 4 out of 5]

Very comprehensive. Super valuable contribution to the field.

[Andrei Gheorghe · Rating 5 out of 5]

Ah, the forbidden fruit book, no therapist will ever encourage you to read it :)

It has pretty much everything, from scientific methods to evaluate people on the attachment scale to techniques for using visualization to repair attachment or to improve mentalization and self-awareness. A great framework to deconstruct self-esteem and the self. A lot of intro to psychology and history of psychotherapy.

Of course it's best to find a therapist to guide you through the practice, it's probably also good not to read it before. I still think reading it opens the path to self-healing.

[Justin Souter · Rating 5 out of 5]

This is very very good. Difficult and challenging reading at times, and at ~600 pages a lot to get through and process. As relevant to one's own development needs and areas to work upon, as it is applicable to others and their healing. Highly recommended and I hope to be returning to this source materials many times in future.

[Annie PhD · Rating 5 out of 5]

Excellent resource and academic book. I first heard of this book from my studies, and while I do not work in a clinical setting, this is a great book for anyone interested in understanding attachment.