PLANTING Hope and the Art of Active Inquiry:

Case Conceptualization

Through the eyes of

Attachment in Couple and Family Therapy (AFT)

Dr. Martin Rovers PhDSaint Paul University

Attachment in Family Therapy (AFT) was developed by Martin Rovers and offers an integrative approach to individual, couple, and family therapy. AFT is built on the principles of Bowlby’s Attachment Theory and Bowen’s Family Systems Theory (Rovers, 2004, 2005), with an active touch of the Psychobiological Approach to Couple Therapy (PACT, Tatkin). Attachment in Family Therapy (AFT), which is seen as a short term (6-10 sessions) model, weaves family systems, emotional, behavioral, and cognitive approaches into therapy and healing.

Each person is inextricably interwoven within broader interactional systems, the most fundamental of which is the family. Bowlby attachment theory has increased awareness of the importance of early attachment experiences on interpersonal relationships throughout life. Bowen highlighted the emotional atmosphere of family of origin, including interpersonal relationships patterns. Attachment in Family Therapy (AFT) believes that family is the primary and the most powerful system to which a person belongs. When it comes to loving and being loved, people often tend to react in patterns reflective of the past, specifically attachment patterns absorbed in the family of origin. These attachment patterns have become interwoven into ways of thinking and being, thus providing an internal diagram or working model for being in a close relationship. AFT believes that our childhood experiences, especially within the family of origin, influences our adult relationships, especially romantic relationships. We each have a wound or two, born in the family of origin, which is playing out in the present adult relationships. Wounds are not our fault but they are now our responsibility. AFT works to name, claim, and tame the wounds within each of us and to recreate a more secure relationship bond through insight, emotional re-engagement, and touch, mostly done in the counselling (treatment) room. The AFT model helps people understand their role in their family of origin and present relationship system, by exploring how each of us has learned attachment behaviors which contribute to all their relationships.

C ase conceptualization begins with “thinking theory” (Bowen). Case conceptualization refers to the process in which we make sense of a client's presenting concerns in the context of a theoretical framework. Case conceptualization refers to how we explain or understand the client's presenting concerns and stories, personality characteristics, cognitions, feelings, and behaviors in light of a particular theory or integration of theories. Such understanding will lead to the formulation of your assessment, counseling goals, intervention strategies, and ethical framework. A solid case conceptualization enables you to speak

intelligently to your colleagues about your client(s) in a case presentation. The genogram is often used as one means to present the case more visually and with details.

The AFT psychotherapist employs an Active Inquiry approach to case conceptualization. The Aft therapist is “active” in the sense of pacing (affirm – affirm – nudge / shove - affirm), engaging and directing (choreographs) the therapeutic process with clinical intuition guided by theoretical understanding. We need to “Think Therapy” (Bowen), from the moment a new client calls us, and we begin our case conceptualization. Active inquiry moves beyond “meeting the client” or “following the client” and moves beyond reflecting content and reflecting feelings, to the place of making an (hypothetical) assessment and then actively directing the therapy to treatment and healing. The therapist has a task to do, called therapy, and it involves various tasks or steps, especially assessment and treatment, so get going!

The AFT Therapist can employ the PLANTING Hope model.

PLANTING HopeThere are eight components / stages in the AFT model, and can be seen as the PLANTING Hope model. Although listed as eight stages, they are really one approach, and the various components mingle throughout the counselling process. AFT therapy is more a seamless garment than any particular activity or steps. Thus these components describe more the interpersonal stances and therapeutic activities an AFT therapist would employ and often the AFT therapist would circle back around through the various components to achieve a level deeper.

Presence is the first component and the therapist endeavors to create and enhance the therapeutic alliance, by demonstrating acceptance and genuineness. Presence means to join with the client, or the couple, or all family members, to build rapport, to enhance the alliance, and to let everyone know the therapist is there for them. Therapy must be a secure base for clients to work from. Empathy is central. In couple and family therapy, de-escalating the conflict is also crucial by assisting the partners to disengage from their hostile cycle and inviting the partners to become co-creators of a new positive cycle. Becoming attuned to each other is essential, and balancing therapy work with both partners is fundamental. The AFT therapists observe the dance between partners or family members, allowing the negative dance to unfold for awhile, using the dance for assessment and treatment. Then, the AFT therapist actively directs the couple or family to a more secure place within therapy so deeper healing can happen. Presence to self (Safe and effective use of self), to the client(s), to the unfolding of life stages, and to spirituality are all important.

Implanting hope (see attached: Moving up the Continuum of Hope) is also an important aspect of presence. Hope is “a belief and a feeling that a desired outcome is possible.” (Ward & Wampler, 2010) Treatment outcomes become more possible as the therapist implants hope and positive outcome possibilities with clients. The AFT therapist prayer is: Am here with you, and together, we can do good work.

In component two, Listening, the therapy focus is having clients, partners, and family members tell stories of their life and their relationship issues. In this stage, the questions the therapist needs to ask themselves are: What am I hearing? What is the body language saying; the eyes; the touch? What am I thinking / sensing might be some of the counselling issues? What is my developing hypothesis about wounds and healing? What theoretical approach might work best with this client(s)? Through the telling of stories, the therapist seeks to enhance or ‘soften’ the blaming, and ‘engage’ the wounds in every client. The therapist reframes the stories in terms up underlying attachment needs and childhood wounds for each client. Validation of client(s) stories is crucial, while heightening particular emotions or words to deepen the emotional response within the client.

Listening has two approaches:1) Listening to each client tell stories and reflecting content and feeling for awhile, as well

as deepening emotion. 2) In couple and family therapy, the AFT therapist actively directing the conversation

between the partners / family members where each talks and hears the other(s). One technique here is effective communication between clients by introducing inter-person communication which encourages each person to talk nicely and to actively listen to others. (see Communication attachment) The goal here is to have people hear each other while holding tight to their emotional reactivity. We need to hear the other, in all love: we do not have to agree!

a. Joe, what are you hearing Mary saying about her concerns regarding this relationship?

b. Mary, can you tell Joe what do you hear him saying about how he feels about you?

3) Another technique is the internalized other question used as a means to assess how well clients really hear or know the other, and the needs and wants of the other. This is a measure of emotional connection, empathy, knowledge, com-passion, courage to engage. a. Mary, what do you think Joe really want from you?b. Joe, knowing Mary as you do, how do you think she is feeling right now?

When possible, taping the therapy session and allowing clients to take these tapes home for review also facilitates clients seeing and hearing each other.

A Couple or Family Journal is also helpful, wherein all members can write issues, concerns or solutions to other(s), or to be used in couple or family communication when one person really wants to remember and note what other(s) are saying to them.

Component three is assessing the stories of the client(s) and wondering what might be the issues, the needs of each person, and attachment style of each. Assessing starts with the first phone call: who made the call; what is the tone; who sits where in the room; who begins the conversation. Activities such as the genogram / adult attachment interview (see attached) are implemented to enhance each person’ knowledge and awareness of the their past story on the present relationship as well as generational patterns and influences of their family of origin, individual attachment style, and attachment wounds that are carried into their adult relationship (Rovers, 2004). More

objective tests like the Experiences of Close Relationship Test can also be employed to allow people to become more aware of self, or how past and present attachment stories beginning to link and connect. It is through these activities that the AFT therapist develops an assessment as to the couple / family issues; to the wounds of each person; and to the contribution of each person to the couple or family troubles. Assessment is about delineating the interactional cycles within the family system, often called the “dance of wounds” (Rovers). Once wounds are assessed, even hypothetically, the AFT therapist engages in Active Inquiry to name and explore if the assessment accurately describes the client(s). Ultimately, the client needs to name and claim their own wound.

Component four addresses the naming and claiming of each person’s attachment wounds, unmet childhood needs, maladaptive schemas, or other unfinished business, and see if each person can articulate their contribution to the couple or family problem. (see attached naming my wound and healing word ). This stage is about creating awareness within each couple and family member of their own, and other’s wounds. Often a more Active Inquiry approach is used here as the AFT therapist hypothesizing possible wound words for each person, heard through their narrative stories, and determining how much buy in each person can give to their own wound words. There is a noticeable more active engagement in the therapy process. One technique is to ask wound questions: 1) As best as you know yourself right now, what would you say your wound is? 2) What words might describe your wound. 3) have you notice what you are thinking or felling when you are most angry / withdrawn about the relationship? The AFT therapists often teaches family systems concepts within the counselling session, like: we each have a wound; family of origin dynamics; genograms; negative and positive cycles: it takes two to tango; my contribution to the problem is … ; know my wound and know my partner’s wound better: who is big enough to go first; the couple bubble: 27 second hug: reading the Wired for Love book.

Component five is about treatment interventions that help the partners reconnect with each other. Indeed, for the AFT therapist, treatment begins at the time of the first phone call. All the activities in the previous stages are part of the treatment plan: inter-partner communication, internalized other question, AAI, etc. Some of the work of this stage is attending to emotional connectedness by softening the pursers’ anger in order for the withdrawers to address their shame, or to develop health coping strategies. Therapy will look at behavioural changes explicit to emotional regulation.The therapist may introduce the importance of inter-partner touch. Inter- partner touch can represent eye contact, holding hands and/or a 20-30 minute hug to enhance the couple’s connection (Rovers, 2015).

Component six is inter-person connection and touch. Attachment is all about connecting with significant others in our lives, beginning, hopefully, with our parents, and other caregivers, and the whole family of origin. How we have learned to connect within the family of origin will guide and direct how we connect with other significant people throughout our life. Connection is about eye contact, words, looks, touch, hugs, and intimacy. It is about how we come together and how we separate from with significant others, and how we stay in touch while apart. It is physical connection, emotional connection, and even spiritual connection.

Component seven is naming the healing word. Since we each have a wound or two, each wound word needs a healing word. Naming the healing is crucial cognitively and emotionally.

My wound word, “not good enough” need a healing word “I am good”: my abandonment childhood experience needs a healing word of “I am loved”. Wounds are born in us through the harmful words, looks, touches and presence of significant others in my family of origin, so cognitively and emotionally speaking, I need to develop and name my healing word as a mantra for the life-long healing. Healing word questions are: 1) What words or gestures would the child within you want to hear right now? 2) What word or gesture might soothe your fears or anger and make this relationship safe for you?

Component eight is growth and soothing. Therapy is much more about caring than curing. It is about finding ways each person can soothe and attend to the needs, emotions, and wounds of the other(s), through emotional attentiveness, touch, and / or enabling the partners and family members to reach the stage of forgiveness and reconciliation. Partners and family members begin to learn to be each other`s secure base (PACT). Mindfulness is most helpful as I continue to reflect upon, pray, and feel my healing words over the years, gradually re-wiring my brain and emotional pathways to hear, believe, and react to relationship threats in a new and more compassionate manner.

Attachment in Family Therapy (AFT) is a more comprehensive approach to individual, couple and family counselling as AFT incorporates more holistic combination of emotional, cognitive and behavioral approaches to treatment and healing.

The rationale for AFT is multi-facet:1) AFT attempts to understand how each person is inextricably interwoven within broader

interactional systems, especially the family of origin. What we learn within our family of origin will be the attachment `driver` for the rest of our lives. We each have “working models” to explain the way attachment and relationship is learned, and AFT works to clarify our attachment styles / patterns and other wounds.

2) AFT seeks to heal relationships at all levels, in the “here and now” AND “there and then”

3) AFT seeks to give a therapeutic secure base for people who think as much as they feel and who want to know the why of their present relationship wounds. This is especially true for men who tend to want to know why for their feelings.

4) AFT is an approach to therapy when client(s) can come in alone, without partners / family. It is an approach to individual therapy through family systems lens.

5) AFT provides therapist with a meta-perspective on healthy adult coping in terms of healing descriptors for everyday living.

6) The use of genogram is a strong visual aid to help clients see and externalize the issues within relationships.

7) AFT is very client friendly and the approach to therapy is collaborative: clients are called upon to do their part in the work of making love and relationships more secure and soothing.

Moving Up the Continuum of Hope

Hope is the “a belief and a feeling that a desired outcome is possible.”

Four properties of hope are: Evidence, Options, Action, and Connection

The evidence property suggests that the desired outcome is likely to occurThe option property suggests that hope is dependent upon believing and feeling that a person has options and the ability to choose. The action property is the belief and hope that one is able and willing to reach the desired outcome. The connection property is the idea that connecting with the other person / God / or partner provides a sense of hope. Increased connection leads to increased hope.

Therapeutic Lines of Hope:1) I tell you what: why don’t we do 6 sessions, and I have every confidence things will

become more clear to you by that time. 2) Tell me about the time you did that well?3) I have hope that the difficulties in a relationships helps clear the air and has potential for

growth.4) When we give our clients something and it works …..5) I know that life looks a whole lot differently when we get over this hump. 6) Let’s just work with part of this issue, for now.

Ward, D.B, and Wampler, K.S. (2010) Moving up the Continuum of Hope: Developing a Theory of Hope and Understanding its Influence in Couple Therapy: Journal of Marital and family Therapy: 36(2) 212-228

Communication

Inter-person Communication: Five and Five

3 Sins of CommunicationBut replace with And

You replace with IAlways /never replace with Often / rarely

I Statements

Listener Receive/Attend Ponder Mirror the Message

What I heard you

say....Mirror Back

Talker : Start Here Prepare Secure a istener Deliver message

I Statements

I Statements

Listener Receive/Attend Ponder Mirror the Message

What I heard

you say....

Mirror Back

Talker : Start Here Prepare Secure a istener Deliver message

5 mins per topic

The Genogram and the Adult Attachment Interview

Goals: 1) Seeking to know the client(s)2) Listening and assessing for wound words, attachment style, and unfinished business from

childhood spoken in the stories.3) Helping client(s) know their own wound as well as the wound of their partner.4) Wonder about possible treatment plans and the client healing word.

(to both partners) I want to get a better picture of you both and your family of origin, and I want to do a genogram and ask you some questions about how your childhood experiences may have affected your adult personality and present attachment style. I firmly believe that our past lessons on love and relationships play out in your present relationship. In doing this, you and I can get a better picture of what and why issues are dancing between you both right now. Is this OK?

(to partner 1)Your name, age, Where do you fit amongst your siblings: oldest to youngest; gender of each

Your father’s name, ageCan you give me three NICE words to describe your Father!Three NOT-SO-NICE words!I’d like you to try to describe (3-5 words) your relationship with your father as a young child, starting from as far back as you can remember. (encourage age 5 or earlier, but age 5-12 ok)

Your mother’s name, age …Can you give me three NICE words to describe your Mother!Three NOT-SO-NICE words!I’d like you to try to describe (3-5 words) your relationship with your mother as a young child, starting from as far back as you can remember. (encourage age 5 or earlier, but age 5-12 ok)

How would you describe your father and mother’s relationship.

Which parent did you feel closest to and why? Who was your favorite parent? Who was dad’s favorite kid! Mom’s favorite kid!

When you were upset as a child (hurt, ill, sad, scared) what would you do? To whom did you turn for comfort and soothing?a. When you were upset emotionally when you were little what would you do?  Can you think of a specific time that happened?

What is the first time you remember being separated from you parents? a. How did you respond? Do you remember how your parents responded?b. Are there any other separations that stand out in your mind?

Did you ever feel rejected as a young child? (even if they now know it wasn’t rejection, but at the time of being a young child felt rejected) a. How old were you when you first felt this way, and what did you do?b. Why do you think your parent did those things - do you think he/she realized he/she was rejecting you?c. Were you ever frightened or worried as a child?

Were your parents ever threatening with you in any way- maybe for discipline or jokingly? a. For example, some have said that their parents would threaten to leave them or send them away from home

Did you experience the loss of a parent or other close loved one while you were a young child- for example, a sibling, or a close family member?

Did you lose any other important persons during your childhood?

Other than any difficult experiences you’ve already described, have you had any other experiences which you would regard as potentially traumatic?

If you had three wishes for your child twenty years from now, what would they be? I’m thinking partly of the kind of future you would like to see for your child.

Is there any particular thing which you feel you learned above all from your own childhood experiences? I’m thinking here of something you feel you might have gained from the kind of childhood you had.

We have just talked about what you think you may have learned from your own childhood experiences. I’d like to end by asking you what would you hope you child might have learned from his/her experiences of being parented by you?

Your brothers and sisters names, age, gender, a few words about each….

Inter-partner Communication: (to partner 2) What are you hearing your partner say about their family of origin? Can you tell your partner what are you learning about your partner that might be new?Is there anything else you think I should know about your partner’s family of origin that (s)he did not include? Other questions…. Internalized Other Question: (to partner 1)What do you think your partner thinks or feels about your family of origin?Internalized Other Question: (to partner 2)What do you think your partner thinks or feels about your family of origin?

Repeat Genogram / Adult Attachment Interview for Partner 2

Naming my Wound Word and the Healing Word:

Attachment Theory: Healing1) Avoidant and Preoccupied and fearful Towards Secure

Bowen Theory (balancing life’s two forces / needs);1) Connection / togetherness / intimacy Learning Individuation2) Independent / autonomous / individuated Learning connection / togetherness

Young Schema Therapy Healing1) Abandonment / Instability Building connection2) Mistrust / abuse Courage, compassion3) Emotional Deprivation Compassion, empathy

4) Defectiveness / Shame Self-revelation, humility5) Social Isolation / Alienation Celebrating my difference6) Dependence / Incompetence Team player, humility7) Vulnerability to harm or Illness Self-care, vigilance8) Enmeshment / Underdeveloped Self Loyal, team player9) Failure Modesty, perseverance10) Entitlement / Grandiosity Enthusiastic, assertiveness11) Insufficient Self-Control / Self Discipline Spontaneity, take initiative12) Subjugation Empathy, reliant13) Self-Sacrifice Generous, service14) Approval Seeking / Recognition Seeking Sensitive to others needs15) Negativity / Pessimism Sensitive, concerned16) Emotional Inhibition Self-control, tactful17) Unrelenting Standards / Hyper criticalness Responsibility, principles18) Punitiveness Accountability, justice

Erikson Stages of Growth Healing1) Trust verses Mistrust Building trust2) Autonomy verses shame and doubt Practicing Autonomy3) Initiative verses guilt Taking Initiatives4) Industry verses inferiority Creating5) Identity verses role confusion Telling others who you are6) Intimacy verses isolation Daring to love7) Generativity verses stagnation Daring to create8) Ego integrity verses despair Doing a Life review

Wound Healing1) Helpless potent2) Lost purpose3) Worthless valued4) Inadequate adequate5) Alone connected6) Insignificant significant7) Loss/ empty fullness8) Hopeless optimistic / hopeful9) Bad Good

AFT Therapy ScriptMartin Rovers

Case of Joe (J) and Mary (M)

Therapist. (joining) Welcome. What would you like to talk about today?

M. (anger in her voice) You tell him! Go ahead … tell him how you never touch me … not for 10 years.

J, (half looks at her; puzzled look; silence)

M. (a touch less anger … hints of hurt) I feel so unwanted. You never tell me anything. Never come and hold my hand. …. (pause) Do you love me at all?

J. (looking straight ahead) I am here aren’t I?

T. (listening; assessing Mary’s preoccupied attachment style; curious if Joe can hear her and engage; inter-person communication) Joe, what are you hearing Mary say to you?

J. (pause, slow) She is always angry with me. She thinks I do nothing.

T. (active inquiry; directing Joe; inter-partner communication) Joe, just what do you hear…. Not what you think … slowly, what did you hear Mary say?

J. (cautiously) Well, she is saying I don`t touch her. But…..

T. (active inquiry; can Joe hear her) Sorry to interrupt Joe, and I will get to your side of the story soon … and right now, can you slow and tell Mary what you are hearing. … something about not touching her, and she feels unwanted?

J. OK. Mary is saying that I do not touch her enough, (slowing more) and that she feels I do not love her, but what….

T. (active inquiry; interrupting Joe; stick with one treatment goal at a time; reflecting Mary’s feeling; inter-personal communication) exactly Joe, well done. Mary feels you do not love her because you do not touch her enough. Can you hear that Joe. I am not asking you if you agree, just if you can hear her.

J. I hear her.

T. (active inquiry; assess if withdrawer can re-engage) Joe, can you tell her …

J. (turning to Mary) You know I love you.

M. (more anger) No, I do not know that. Why is it that…..

T. (active inquiry; interrupting Mary; stick with one treatment goal; help Mary do some inter-partner communication) Sorry Mary… I want to hear Joe more. I hear you saying that you love Mary. Is that true?

J. Yes that is true; I love you Mary … I am sorry if I do not say that enough. I am not a person of many words.

M. I don’t believe you.

T. (reflecting emotion; actively push Joe for more engagement: assess if he can do it) I hear you Mary, and that this is hard to believe, AND can you slow and just hear Joe right now. Joe please say it again.

J. (looking straight ahead) I love you Mary.

T. (actively push for some inter-partner connection) Can you look at her eyes and say that.

J. (looks at Mary) I love you.

M. (angry resistant) How can I believe you. (pause, softly crying) Why …… where have you been … how can I know you are real?

T. (reflecting Mary’s hurt feelings: staying on my treatment goal; inter-partner communication) Mary, I hear your hurt and the pain that Joe has not been able to touch you and tell that he loves you. We can look at that later, but right now, can you hear him?

M. I hear you Joe … I don’t know if I can believe you, but I hear you.

J. (more tenderly) Thank you Mary for hearing me. I do love you.

M. (smiling) That is nice to know. I love you too.

T. (celebrating a little hope; summarizing; teaching therapy) OK Mary and Joe … good for you guys. I do see the love, AND I see the years of pain and neglect, and we will have to better understand that too. Our work here reminds me of a good book: Love and War in Intimate Relationships. Partners usually have both love and war playing in their relationship. But for this moment, celebrate this moment of beginning to speak nicely to each other and really hear what my partner wants from me. Good work! I have hope for our work together.

AFT Case Study: The History of Sally Q

As a powerful tool used in family therapy, the genogram highlights fundamental information that is often hidden from the clients’ own awareness –an undoubtedly powerful and enlightening experience. In the case of Sally Q, the genogram truly became a catalyst for transformation and understanding. Through the mapping of familial wounds, clarity was discovered, coupled with confusion. Sally Q viewed two very distinctive patterns of behavior in her familial history and thus, contrasting behaviours impacting her development. It is her avoidant tendencies that have aided in developing an overall securely attached, individuated, and grounded family member.

Genogram Analysis: A Struggle Between SidesThe genogram of Sally Q documents a history of attachment wounds and mental illness previously considered by her to be minor and non-impactful on development. However, through the use of the genogram, transmission of wounds amid generations indicates more clearly how Sally Q became the woman she is today. Most notably, while there has always been known angst towards her mother, there is now greater understanding and empathy due to her awareness of her mother’s difficult upbringing.

Originally, Sally did not include her biological maternal grandfather on her genogram, as she deemed him unimportant and unimpactful. Sally had never met her biological maternal grandfather but does know that when her mother was a child, he told his family he was going to the grocery store one afternoon and never returned. As a result, Sally’s mother then returned home to a very stressed, anxious, and withholding mother. She was faced with coming to terms with her father leaving, having a mother who was now most concerned with finding work to insure survival, and being responsible to care of her sister who at the time began to exhibit symptoms of schizophrenia. Sally’s mother also struggled with issues related to abandonment. Although Sally was not yet alive, this event would ultimately impact her greatly.

Recounting her life experiences with her parents, it became clear to Sally that her mother certainly struggled with many mental health related issues (See Appendix B). Sally’s mother also behaved in a manner consistent with preoccupied/anxious attachment styles. She acted in a very clingy manner and needed control over various situations, yet became overwhelmed easily. As a result, Sally tended to have a distant and hostile relationship with her mother. She avoided using her mother as a secure base and tended to rely on her father as a primary caregiver (See Appendix B). The genogram maps a very securely attached paternal family history and a hostile and preoccupied maternal family history (See Appendix A).

Close Relationship Test Results: Surprisingly SecureAfter having completed the Close Relationship Test (CRT), Sally’s relationship style is

somewhat of a surprise given the hostility documented on her genogram (See Appendix C). Specifically, it was assumed beforehand that Sally would have more preoccupied traits given her mother’s inconsistent availability. However, Sally is rated to be rather low on both the anxiety and avoidance scales, suggesting a secure attachment. Although Sally’s mother presents as preoccupied, her father may take credit for her generally secure nature, as it became clear that Sally relied on him as a secure base to build and broaden her own experiences. Sally’s father’s

consistent availability, love, and soothing effects allowed for Sally to individuate while balancing intimacy.

Sally’s securely attached nature is most evident in her romantic relationship with her partner. Based on the CRT results, Sally is able to both seek intimacy, while acting as an individual. Sally can both seek comfort from her partner and provide comfort for his needs. Her autonomy is couple with a need for connection. This secure nature is most evident when she is not in the presence of her mother’s anxious attachment behaviours.

Perhaps most interesting to note is the CRT results indicating Sally’s slightly greater preference for avoidance over anxious attachment behaviours. During times of significant stress, Sally appears to withdraw and self-soothe rather than seek out others, likely due to the unpredictable nature of her mother’s care during childhood. Sally credits this avoidant behavior to the anxiety her mother would provoke in those surrounding her. In an effort to regulate affect, Sally would withdraw from the overbearing and anxious mother in order to relieve her experience of anxiety –a occurrence suggesting that a solely secure attachment style is improbable and idealistic.

The Attachment Style of Sally Q: Securely InsecureSally Q appears to have a secure attachment tendency. She has individuated from her

family, lives outside of the childhood home, and has a committed relationship with her partner. While she is satisfied being with her partner, she can be equally satisfied on her own, as her identity does not rely on her romantic partnership status. Furthermore, Sally can go to her partner in times of need and be able to experience relief from stress or threat. As a romantic partnership, Sally and Mark are able to recognize each other’s emotional states and act accordingly.

The anxious attachment behaviours of Sally’s mother were very difficult for Sally to endure as a child. However, Sally’s father provided consistency, modelled secure behaviors, and thus, deactivated many of Sally’s avoidant behaviours. Similarly, Sally’s current partner embodies much similar secure behavior, further grounding her sense of self and notably calmer disposition. While Sally views herself as a securely attached individual –and her CRT scores indicate this as well—she is aware that her mother’s anxious presence draws out her primitive avoidant tendencies, begging the question: is Sally’s secure attachment style only as good as her surrounding secure bases?

Sally Q’s unique familial history and childhood upbringing suggests a need to develop connectedness and intimacy toward her mother. Due to the fact that Sally tends to withdraw from her anxious mother, therapy for Sally would focus on understanding through empathy building and a notable movement toward connectedness. Sally can function very well when individuated from her mother, but tends to withdraw when surrounded by her mother’s familiar anxiety. Therapeutic work focused on the development of connectedness will aim to allow Sally’s secure attachment behaviours to become more prevalent and consistent.

Appendix A

Genogram of Sally Q

Appendix B

Adult Attachment Interview Excerpts

Question 3. 3: Now, I’d like you to choose 5 words or adjective that reflect your relationship with your mother starting from as far back as you can remember in early childhood-early as you can go but say age 5-12 is fine.

Answer: I would have to say: unpredictable, mean, crazy, sad, and also loving.

1. a. Now let me go through some more questions about your description of your childhood relationship with your mother. You say your relationship was unpredictable, mean, crazy, sad, and also loving. Can you think of a memory or incident that would illustrate why you chose these words to describe the relationship?

Answer: Well that would be difficult to really explain. There are a few instances I can remember where all those words could describe her all at once. Some examples that stand out to me would be when she would force my sister and I to have our hair cut like boys. We would be called boys at school and would tell our mom this but she insisted we have the haircuts. It made little sense. I would say she was mean and crazy here. Mean for making us go through the bullying and crazy for a decision made without reason. She was unpredictable with her love. There was a time when she asked me to stop telling her I love her since she felt it was said too often. Then the next day rescinded that decision because she apparently missed hearing the words. She seemed sad in life though. Not outwardly, but her eyes always seemed sad. As crazy, sad, unpredictable, and mean as she was, she did love all the kids in her own way seen in brief glimpses. She would just be devastated if we became distant to her or she felt we were moving closer to our dad. That would cause a lot of problems too.

b. Repeat the above with father.

Answer: My dad was/is the anchor of sanity. I would describe him as strong, loving, honourable, caring, smart, fair... that’s more than five words haha. But I could keep going. He was always there for us. Always gave us life lessons and wanted us to learn about many different subjects. I remember getting a bad grade in school when I was 8 or 9 and I cried on his shoulder. He just gave me a huge hug and said that this was an opportunity to learn and improve. He always found the good in the bad and never ever was stressed about anything. He could get through any adversity with a laugh and not a care in the world. I think the kids were his world.

4. 4. Which parent did you feel closest to and why? Why isn’t there this feeling with the other parent?

Obviously my dad for everything stated above. My mom, although there is love there, she wasn’t consistent. It would be too much of a gamble to rely on her. I suppose she needed to look after herself before I could rely on her.