“Before there is a self, there is

relationship”L. Alan Sroufe

Assessments of early experience and current contexts together always predict psychopathology better than either alone.

Early experience does not directly or solely cause later problems, yet has a special role through framing of subsequent experience.

Foundations add to current contexts in predicting pathology and that troubled children having positive early foundations are more likely to recover than troubled children who do not. The

Obversely, children with histories of anxious attachment who are functioning well in middle childhood are more likely to have problems in adolescence or adulthood than are other well-functioning children.

Attachment and EDWe become who we see reflected in themirrors of our parents’ eyes…?

Developmental perspective

ED controversy - Temperament, genetic predisposition vs. blaming mothers

Mike Rechtien, MAPrimary TherapistCastlewood Treatment Center, St. Louis, MO

Our clientsSomething unusual:

• Sensory integration difficulties• Emotional dysregulation• Highly sensitive/reactive• Excessive caretaking or• Overly controlling

Crystal BallWhat actually happened?Memory is falliblePoisonous pedagogy (A. Miller) as

good parentingThe perspective of the childWe can predict attachment of

unborn child with 80% accuracy Correlation of Strange Situation

behaviors with narratives of adults

AttunementConnection between CNSsMirror neurons 1 second delayIntertwinedMentalizing/Reflective Function –

Allen/FonagyContingent Communication - SeigelSafe Haven – Bowlby

1. the ability to reflect on one's internal emotional experience

2. make sense of it and at the same

time…3. reflect on the mind of another

The hallmark of secure attachment is:

“Mentalizing” (Fonagy, 2001, 2002)

1. Secure - high coherence, evidence for what they say, succinct but complete, relevant to the topic of conversation, clear and orderly

2. Dismissing – idealized, or derogatory about attachment (avoidant)

3. Preoccupied – angrily, passively or fearfully (ambivalent)

4. Unresolved in relation to loss or abuse (disorganized)

The Adult Attachment Interview~ semi-structured interview

Mary Main ~ surprising the unconsciousHer interest was in the coherence of the narrative. Rather than focusing on the individual’s story, she looked at the structure of the story – what the person allows themselves to know, feel, and remember in telling the story. Breaks in the story, disruptions, inconsistencies, contradictions, lapses, irrelevancies, and shifts are important, relevant and diagnostic, as they are

linguistic efforts to manage that which is not regulated in experience or memory.

The Adult Attachment Interview

Anne Rifkin (2005)

Disorganized (U/d) adult subjects exhibited performance issues on frontal lobe tasks, especially working memory tasks.

Suggests that too much stress is placed on working memory when a speaker attempts to simultaneously recall and discuss a frightening experience.

U/d subjects are scored so due to lapses in the monitoring of discourse or reason.

1. Quality – truthfulness (internal consistency)

2. Quantity – succinct but complete3. Relation – relevant to the discourse4. Manner – clear and orderly

The Adult Attachment Interview~ Grice’s maxims

HypothesisMaybe ED is more about attachment than food.Clients relationship with food is a lot like their relationships with people.In times of stress it substitutes for people.

Social Anxiety treatment doesn’t take.Behavioral therapies don’t work in the long run.

What if the client’s relationship with food is a re-enactment of early attachment disruptions with a transitional object that can be controlled and is always accessible?

#1 predictor of infant’s security of attachment

The parent’s coherence of narrative on the AAI

Shows capacity of the adult to make sense of the mind of self and capacity to detect child’s behavior and see implicated mind (behind the behavior) and respond in a timely and effective manner

Disorganized

PreoccupiedBulimic

Attachment relationships are defined by emotional vulnerability

Child’s experience of parental behaviors:Rejection – child goes to parent with tender

emotions and is turned awayNeglect – parent physically available but emotionally unavailableInvolving/Role Reversal – child’s attachment

is used for the parent’s gainLoving – an active dedication to the development of the child as an individual

AAI scale definitions

Castlewood clientsU/d – Disorganized in attachment, unresolved concerning loss or trauma

E – Preoccupied in attachment

Ds – Dismissive of attachment

CC – Cannot Classify - Uses opposing (E and Ds) attachment strategies

F- Secure (almost nonexistent)

Castlewood clientsAAIs of complex trauma clients look a lot like AAIs of our “perfect family” clients.

Attachment trauma – small “t” trauma?

Disruption of attunement that contributes to sensory integration issues

ED as a disorder of intimacy vs. a disorder of eating

Study patterns of attachment and design treatments accordingly

Securely Attached Adult Values attachment and regards attachment

experiences as influential Acknowledge need for others Freely explore thoughts and feelings Remember childhood events clearly At ease with their own imperfections Don’t idealize family or have involving

anger And produce secure infants!!

J. Allen, 2001

Infant not capable of emotion regulation (i.e. need assistance from the caregiver)

Early attachment development overlaps with SIGNIFICANT neurological development

Research has shown a high correlation between caregiver’s attachment strategy and infant attachment strategy (80%)

Attachment is central to the capacity to regulate emotions

Need for Attachment

When a caregiver reads the verbal and non-verbal cues of the child and reflects them back, the child sees him or herself through their interaction with the attachment figure.

It is through this attunement and contingent communication process that the seeds of the developing self are planted and realized.

Internal Working Models

Fonagy (2001, 2002)

“During infancy and childhood, working models are thought to be somewhat flexible and responsive to changes in the environment.

However, as the child grows older, working models become established and the child is more likely to assimilate new experiences into the existing model.”

Internal Working Models

Leveridge, Stoltenberg, and Beeseley (2005)

Thoroughly resolve Loss and Trauma - state dependent memory work (IFS, EMDR, Hypnotherapy), cognitive processing, narrative work, expressive work

Contextualizing attachment environment and its importance – “T squared” Neglect, Rejection, Involving Behavior, Role Reversal, witnessing terrifying events

Reduce Idealization to deal with self blame

Treatment – “earning” security

Reduce family enmeshment and expose family secrets, legacy burdens

Expose preoccupied anger seen through projection and criticism

Establishing a coherent narrative regarding one’s life

Self agency – action as opposed to reaction

Treatment – “earning” security

“Before there is a self, there is

relationship”L. Alan Sroufe

“and it is from that relationship that the self emerges”