A secure base
Reading notes
## Caring for children
* Healthy, happy, and self-reliant people came from stable homes which both parents gave a lot of time and attention to them
* The relationship between child and attached figure
* If all goes well — joy and security, confident and competent, thrives socially and emotionally
* If threatened — jealousy, anxiety, and anger
* If broken — grief and depression
* A secure base — a place a person can return to knowing for sure that he will be welcomed and nourished physically and emotionally, comforted if distressed, reassured if frightened — created when a parent is available and ready to respond when called upon
* Girls who grown up with physical abuse would grow up to be perpetually anxious about abandonment, expect physical violence to be natural, and expect nothing in the way of love or support from anyone
## Violence in the family
* Abusive mothers:
* Prone to periods of intense anxiety with outbursts of violent anger (which puzzles her and feels intense shame)
* Impulsive and immature
* Has exceptionally strong dependency needs but extremely distrustful and unable or unwilling to make close relationships
* Socially isolated
* Treat children as though they were much older than they are
* Experienced long or repeated separation and/or being repeatedly threatened with abandonment in childhood
* Yearn for care but expect rejection only and mistrust any offer of love and care
* Grow up terrified that if she did anything wrong her mother would leave — later in life, this anger and terror is triggered by unrelated events then redirected toward a different target, often the child who cannot retaliate
* ———
* Physical assault is a manifest sign of repeated episodes of angry verbal and physical rejection — prolonged hostile rejection and neglect
* Abused children:
* Depressed, passive, inhibited, dependent and anxious, angry and aggressive
* Frozen watchfulness, hyper alert for what might happen, unusual sensitivity to needs of their parents
* Difficulty making relationships
* Shows unhealthy avoidance or a mix of approach and avoidance behavior in social settings
* Assault other children or assault or threaten to assault adults
* Malicious behavior with the sole intent of making the victim show distress
* Attacks were sudden and especially toward an adult who a child is becoming attached
* Unsympathetic to age-mates in distress; instead of expressing concern and make move to comfort, they react with fear, distress, and anger, then behave hostilely toward the crying age-mate (treat others like how they were treated)
* Unpredictable behavior — one moment a child is hugging the therapist, the next he’s kicking her
* ———
* Abusive men:
* Unwarranted violent behavior, akin to madness
* Received harsh and unsympathetic treatment in childhood
* Parents constantly engaged in violent quarrels
* Angry and despair abut the love he never got
* Jealous of wife’s attention to baby
* Coercive techniques
* A form of imprisonment — lock wife inside of house or take all of her money
* Lock wife out of house then beg her to come back
* Battering
* ———
* ———
* Battered wives: from disturbed and rejected homes and has tendency to marry the first man they met (often also from violent homes)
* Abusive relationship lasts because each partner is deeply anxiously attached to the other and developed a strategy to control the other to keep them from departing
## On knowing what you are not supposed to know and feeling what you are not supposed to feel
* When children observe scenes their parent do not want them to observe, the children are aware and conform to parent’s wish by not process this information — they stop being aware of they have observed the scene, formed a impression, or had a experience. Sometimes parents would further press the children to shut of — such children develop a chronic distrust of other people, inhibition of their curiosity, distrust of their own sense, and a tendency to find everything unreal
* Feelings are not processed — sorrow and crying is condemned as inappropriate and child is jeered at instead of comforted
* A child is required to act as parent while the parent becomes a child — placing a heavy burden on the child and the child is expected to be grateful and appear to be happy at all times — “I was terribly lonely as a child but I was never allowed to know it”
* Threatening to abandon a child as a mean of control — the child develops acute and chronic anxiety because he feels he was deliberately abandoned as a punishment
* This causes major disorder of personality such as narcissism or false sense of self, and worst case psychosis and multiple personalities
* If feelings and actions ensured from feelings were not processed, the personality will be prone to the already established unhealthy pattern —
* Yearning for love and care inaccessible
* Anger directed at inappropriate targets
* Anxiety aroused by inappropriate situations
* Hostile behavior expected from inappropriate sources
* ———
* The goal of therapy is to
* Find a link between current feeling and a situation that aroused them, then find the true target of the feeling
* Once the why is found, then the person can reappraise his response and take action to restructure his thought pattern
* Discover what the relevant scenes and experience are, and find out how these senses continue to influence him
* False Self (Donald Winnicott
* True self is based on spontaneous authentic experience and a feeling of being alive, having a real self with little to no contradiction
* False self is created by defensive facade, cause individual to lack spontaneity and feeling dead and empty behind inconsistent and incompetent appearance of being real
* When a good-enough-parent is missing, a child places other people’s expectation over their own feeling (this is when the contradiction occurs), they build a false set of relationships and performs being real, but it’s just concealing the barren emptiness behind an independent seeing facade
* A false self is marked by changed behavior, repressed feeling, needs, desires, and thoughts — examples:
* If I make more money, I will be successful
* If I am pretty, then I will be likable
* If I work hard, then I will provide more value
* If I drink more wine, I will be happier
* ———
* It’s important to value real feelings and desires, no one else’s needs should proceed our own
* ———
## The role of attachment in personality development
* Principal features of effective personality functioning and mental health is marked by the capacity to make intimate emotional bonds with other individuals
* Emotional bond:
* care seeking
* Caretaking
* Exploring environment — when a person is secure, they are more likely to explore away from the attached figure
* ———
* Secured children has better capacity to engage in social interaction and experience pleasure during it
* Attachment is a working model of self and attachment figures that are build in the mind during childhood and is the central feature of personality functioning throughout life
* Pattern 1, secure — they are confident that if they need help they would receive it after asking parents
* Pattern 2, anxious resistant — uncertain if they would receive help — prone to separation anxiety, clinging, anxious about exploring the world
* Pattern 3, anxious avoidant — no confident about receiving help and expected to be rebuffed — attempt to live life without love and support of others, try to be emotionally self-sufficient, may later be diagnosed as narcissistic or having a false self, vulnerable to mental ill-health, vulnerable to breakdowns
* ———
* Once attachment is developed, they are taken for granted and operated at a unconscious level
* A insecurely attached mother can still have a securely attached child, characteristics of such mothers:
* Can fluently and coherently tells childhood story — positive aspect of childhood is acknowledged and well integrated with negative ones
* Reflected a lot on heir unhappy experience and how they have affected them in the long term, and why their parents treated her the way they did
* Came to term with their experience
* Since they reprocessed negative experience to come to term with them, she is just as capable of responding her child’s attachment behavior as a mother who had a happy childhood
* ———
## Attachment, communication, and the therapeutic process
* Goal of attachment-based therapy is build a relationship with the patient and help them gain new understanding of themselves as the experience the new therapeutic relationship
* Tasks of attachment-based therapy
* Provide patient with a secure base to explore unhappy and painful aspects of his life (past and present) —a trusted companion for support, encouragement, sympathy, and occasionally guidance, so he can process what otherwise could be impossible
* Encourage patient to think about the ways that he engages in relationships with significant figures in his current life — expectation for self and others, unconscious biases when he selects a person for intimate relationship but creates a situation that ends badly for them
* Examine the relationship between therapist and patient, so patient can view perceptions, constructions and expectation for the childhood attached figure
* Table the patient to get to know his metal model of self and others, how it came to be, and if it’s still a accurate reflection of his current word, and what kind of action would be caused by this model; therefore, the patient can think about alternatives that’s most suitable to lead his current life better instead of being a unknowing slave to the model — able to think, feel, and act in new ways
* ———
* Traits of a good therapist:
* Reliable, attentive, sympathetically responsive to his patient, and empathetic (able to to see and feel through the patient’s eyes) — accept and respects the patient, cares about the patient’s welfare
* Not there to provide the patient with all the care and affection he has always wanted but never had
* The only purpose of exploring the past is to gain insight into current feeling and actions, so they are free to restructure, therapy is inclined towards self-healing
* Not passive — attentive, sensitively response and recognize that there are times the therapist should take initiative instead of the patient
* When patient talk about everything except his thoughts and feelings about people — necessary to draw his attention to his avoidance of this area, and the mistrust of the therapist — ask for more details or raise questions about situations of childhood that the patient has and think about how this fits into what the patient has been describing and how they fit into problems the patient is suffering from
* A problem can be the patient describes what a terrible time he had but there’s no progress made — possible the patient is worried the therapist does not believe what he says — a therapist can help patient understand he believes
* A problem can also be a story can be told and retold in cynical way with no show of feeling — this is not right — the therapist need to help uncover the feelings, they can express all possible feelings verbally, then the patient would feel safe to do so — “all the grief and the tears she had always felt but never dare express) — failure to express emotion is mainly due to unconscious fear that the emotion would lead to a dreaded outcome (anger that leads to punishment, a tearful appeal for comfort and help lead to rejection and humiliation) — these patients often assume therapist will be intolerant to anger and tears
* ———
* Issue with therapy
* Issue: patient might problem in a way to avoid rejection, criticism, or humiliation (i.e. not completely honest); some are aware of this and some are not. Therapist should be able to catch signs of distrust and evasion — avoidance patients has a tendency to be emotionally self-contained and insulated against intimate contact with other people, even when they start therapy they keep the therapist at a distance — and will talk about anything BUT emotionally charged relationships (past or present), or say that they have nothing to talk about (i.e. might look very honest and open but really they are not because they are not talking about something that really bothers them. To treat a deeply distrustful person, therapist should hav prolonged, quiet, and friendly patience — these type of patients have been subjected to prolonged rejection as a child when they asked for comfort or help, and are terrified to receive something similar again.
* Issue: patient worries that therapist try to trap him so that the situation benefits the therapist — these type of patient were subject to being a caretaker for their parents as a child OR patient treat therapist like a parent and direct negative emotion; in these cases therapist should help patient understand that present resentment/fear/anxiety stems from past mistreatment at the hands of others and treatment, continue to hold battle is not productive, and the unhappy past can never be changed
* Issue: false idealization of therapist to be a perfect parent they never had
* ———
* Attachment model is not here to blame the parents (i.e how they threat their parent is a major cause of mental ill-health; therapist should avoid moral judgment and encourage the patient to consider how and why the parent might have acted the way they did — this way patient can gain understanding of how things have developed and move on to forgiveness and reconciliation. Also to gain insight into how and why family life has developed and now to help improve it
* Example pathogenic situations (help to inform origin of anxiety, anger, and guilt)
* Systematic threats to not love a child used as a mean of control
* What: not provide affection or comfort when child is upset, frightened, or distressed; not provide help or encouragement in other times
* Result: patient intensely anxious to please and guilt prone
* Threats to abandon a child
* What: physically disappear or make up story about how child will be removed from home
* Result: separation anxiety
* Threats to commit suicide
* What: threats to commit suicide or other appalling things in distress situation, either to another parent or directed at the child; then after situation is done they claim they never had said such things
* Result: terror
* Disclaimer and disconfirmations
* What: parent disconfirm what a child has seen or heard
* Result: patient is uncertain whether something had happened and end up being guilty about making things up (therapist should weight evidence and ask probing questions, and unless there’s evidence or the patient is a pathological liar, accept patient’s story as a reasonable approximation to the truth. The reverse of empathy is to question the patient constantly.
* Others examples:
* Child is unwanted
* Child is the wrong sex for their family
* Child is made as the family scapegoat (family tragedy is always attributed to him)
* Parent use guilt-inducing techniques to control a child (you did xyz so now my stomach and heart hurts)
* Parent make the child her attachment figure by discouraging exploration and from believing he will never make it on his own
* Child is a target of serious physical abuse from parent or step parent
* ———
* ———
* In order for therapy to be effective — patient not only talks about memories, ideas, dreams, hopes, and desires, but also express his feelings (help a cynical and frozen person to discover the depth of her feeling and express them freely).
* The most important thing between two people is emotional communication — how each feels toward the other — therapy should help enable this by uncovering and restructuring unhealthy mental model that prevents this from happening in the patient’s life