The therapist-client relationship is not a one-way street guys. Changing attachment in therapy requires both parties to meet in the middle and build an alliance! Lots of things can affect this... including your therapist's own attachment style. Let's take a look.
So... in the last blog, we learned about the four attachment styles and how they affect our relationships and self-construct. Today, we're going to look at how attachment styles can change when working with your therapist, and exactly why attachment-focused hypnotherapy is so awesome.
The Therapeutic Alliance - Rocking it as a team
The therapeutic alliance provides the beginning of an attachment and describes the collaboration and bond between therapist and client during therapy, based on:
A therapist-client agreement on therapeutic goals
A therapist-client agreement on therapy tasking and interventions
Mutual regard between the therapist and client, thereby creating a meaningful and effective bond (Bordin, 1994).
This model describing the alliance may be a little outdated nowadays and there is ambiguity in differentiating alliance and straight-up conformity, perhaps making the relationship a site of negotiation rather than just a collaborative effort. By meeting in the middle, the relationship can develop positively and the client plays an active role within their own treatment plan, fostering autonomy.
> Basically speaking... we become an unstoppable team and come up with the best plan for you together. No one knows you better than you, I need you on board for you to get the best results!
The therapeutic alliance has been found to be a good predictor of successful therapeutic outcomes, created through a sense of reliability, protection, and support offered in the relationship between therapist and client. We are social beings, we need connection! Sensitive subjects are discussed in therapy, meaning that a secure therapist-client relationship may allow deeper exploration of experiences, thoughts, and feelings – mirroring the secure base* (Bowlby, 1979).
The 5 main ingredients to build a secure base for healthy attachment in childhood are:
a sense of safety
feeling seen and heard (attunement)
feeling comfort (soothing)
a sense of feeling valued
a sense of feeling supported
* For more details on the 'secure base, check out my last blog post >> HERE
When nurturing a secure relationship, therapists should always maintain unconditional positive regard (Rogers, 1959) to manage any distress and shame when discussing traumatic incidents and facilitate the client's understanding of the self and the reactions of others. This means the therapist is modelling empathy and the discussions undertaken in a caring way can allow mentalisation abilities to develop.
---> Mentalisation describes the automatic process of being able to understand our own, and others, mental states and make inferences regarding behaviours. This ability is often lacking in children who suffer maltreatment and it creates problems later, showing the need for a corrective experience to learn important skills.
Remember, your therapist has a history too and they have heard a lot of life stories... your experiences and behaviours are often normal responses to really abnormal situations, and it is our job to provide a non-judgemental space to allow you to share anything you want to share in a safe way. This is how we show unconditional positive regard. We've all got our baggage and therapy is a great place to really learn how to put it down, even if just for a while.
By acting as a secure base, the client feels safer to explore topics and issues. Your therapist also has a responsibility to act as a container within the session too, allowing the client to articulate negative emotions safely and without worry of damaging the relationship (Winnicott, 1969).
How attachment affects both the client AND the therapist....
As the therapist and client build the alliance, pre-existing attachment styles can influence the strength of the relationship, and over time, even disrupt therapeutic change!
Those clients with an avoidant attachment style show fewer improvements in therapy generally, becoming defensive if criticised and distancing, and fearful avoidants specifically, struggle with self-disclosure early in treatment and separation anxiety towards the closing of treatment. This is why building the alliance and fostering rapport should be prioritised no matter what the issue is, before shifting to self-regulation and autonomy.
--->> Don't forget though, this is a two-way relationship - therefore, the therapist will have an attachment style too! This isn't usually considered enough and self-reflective practice amongst therapists is always encouraged!
The therapist’s attachment style and their ability to occupy the caregiver role is an important consideration as the therapeutic relationship really is bidirectional. Remember, Avoidant attachers have learned to suppress their emotions (perhaps even from themselves) and prefer a logical approach to control things, whereas anxious attachers place a higher level of importance on relationships, often becoming neurotic when trying to maintain their own control. So how could that affect your therapist?
Avoidant therapists may lack sensitivity in care, providing less empathetic understanding and Anxious therapists may confuse boundaries and be unable to be a container for client emotions. These patterns are subconsciously noticed by clients who then report poorer working alliances. Choose your therapist wisely! If you don't feel good vibes, find someone else... that's not to say your therapist should embody Mary Poppins, but generally, you want someone who feels on your wavelength.
Funnily enough..... Much like in romantic attachments, anxious patients are more comfortable with avoidant therapists and vice versa! (I'll show you why in just a minute) Yet, while this may seem complimentary as the two styles play a game of balancing logic and emotions... it also..... confirms existing beliefs (that damn confirmation bias we all love!), preventing therapeutic change while increasing both transference and countertransference, potentially impacting the relationship as well as the outcome (Mohr et al, 2005).
So... here is where it can get really tricky...
The therapist’s response to a client’s attachment style can also influence treatment choices!
- Clients with an anxious attachment style may be viewed by a therapist with an anxious attachment style as requiring more room for emotional expression - as this is what they both prioritise during the session - meaning they potentially forsake really important cognitive work!
- Clients with an avoidant attachment style may evoke a more logical approach in therapists with an avoidant attachment style, and both may tend to shy away from discussions on feelings, which neglects important emotional processing that is usually a really integral part of therapy (Black et al., 2005).
You can see why the anxious-avoidant relationship can appear complimentary now right? Both parties require the skills the other has! But, to really foster a secure attachment, neither style gets it quite right. We need balance and we can only achieve that when we've got a secure template.
- A securely attached therapist can adapt and challenge the client accordingly and provide a template of healthy attachment behaviours, encouraging avoidant clients to begin to label and experience their emotions, and anxious clients to use mentalisation skills to manage their emotions. By modelling a secure attachment style which is flexible and helps the client understand attachment behaviours and where they are coming from, the therapist provides a template which could influence future connections (Levy et al., 2011).
So, how important is this?
Well, specifically in adults with PTSD caused by interpersonal trauma (typically by way of a betrayal within a close relationship), secure attachment styles increase significantly during therapy and are maintained at least six months after discharge (Muller & Rosenkranz, 2009). Furthermore, attachment security is associated with symptom reduction and positive changes to both avoidant and anxious behaviours, suggesting that attachment security should be a fundamental component of therapy! Meaning clients feel more socially connected, more emotionally regulated and less suspicious about their relationships. Plus, they have healthier constructs of the self and the other models, coming to understand things from both an objective and subjective viewpoint (again, check out last week's blog!).
Is the therapeutic alliance enough though? Enough to change a whole attachment system built and maintained over the life course? Well, yes, it can be. But, it also can not be, it really depends on how much the client wants to change, how good/secure the therapist is and how well the relationship works! Plus a whole stack of other variables of course... nothing is ever cut and dry really is it. We are humans after all.... And this is where Hypnotherapy can be really useful in comparison to other psychotherapies and can act as a corrective attachment experience.
--->> You know like when you're in a deep and meaningful (3am?) chat with someone and you're in sync and bouncing off one another?
This is called attunement within a relationship, resulting in a feeling of kinship, like you're just on the same page, in alignment, whatever you want to call it. The unspoken communication between the parties, or between a mother and child for that matter, occurs naturally between humans and synchronous behaviours develop - matching tone, pace, breathing etc. We call this a mental state of 'therapist-client coupling'. It really is a two-way relationship!
Well, when you're in that nice hypnotised mindset - we could call it 'trance' but I prefer 'absorbed in inner processes/experiences', although it's not quite as catchy - there is increased attunement and some reality distortion which can amplify the mental synchronisation of both parties (Zelinka et al., 2014). ---> This makes for a pretty profound experience sometimes and when I say it is a genuine privilege to work with my clients, this may be why. Because it is often profound for me too! I think most hypnotherapists would agree!
So.... this brings me to the benefits of hypnotherapy when changing attachment
Linguistically, Hypnotherapy can facilitate changes in attachment styles (Zelinka, Cojan & Desseiles, 2014) through hypnotic communication. - Think language patterns and the type of language your hypnotherapist uses, there is a reason for it and the effects are well-studied!
The dynamic within hypnotherapy sessions allows a (typically) relaxed client (though this is not a prerequisite) to listen to the therapist’s voice in a way that may appear to merge with their own internal dialogue.... and this one-way dialogue could resemble parental styles of communication (Banyai, 1998). Babies and children that are spoken to gently and consistently by their caregivers feel seen and heard, creating that oh-so-important attunement! (This doesn't mean your hypnotherapist is talking to you like a baby, that would be weird).
By using communication that conveys attention, responsivity, sensitivity and availability in a benevolent manner, thought to be key ingredients in building a secure attachment between caregiver and seeker (Mikulincer & Shaver, 2010), the hypnotherapist may implicitly impact relational schema - the web of knowledge the client has about relationships - independent of the explicit content of the dialogue. This means that regardless of the language the therapist uses, simply the way the message is conveyed can subconsciously and positively affect how the client feels about relationships generally.
This experience of being seen, heard and understood may be achieved simply by ratifying the client’s hypnotic experience using biofeedback, for example, the therapist can notice any physical changes and feed them back to the client. Let me show you...
> Think about how it works in infancy... Parent to child - "Your tummy is rumbling, I think someone must be hungry!" = Child receives attention and response.
> In Hypnotherapy this might sound like... Therapist to client - "Your breathing is becoming slower now and you are beginning to relax".
Through this relational attunement (Banyai, 1998), the client is aware of attentiveness, implicitly conveying communication that represents a secure attachment and could act in a grounding manner. Moreover, as attachment forms during a preverbal stage of development, working with implicit memory is advantageous (Liotti, 2007) and resembles early interactions which facilitate security...
“Implicit memory refers to a change in behaviour or performance that occurs as a result of prior experience without conscious recollection of that prior experience” (Glisky, 2017, p. 1)
Image credit: Dave Cornell, HelpfulProfessor.com
The use of hypnotic language and tone alone to positively influence attachment is difficult to evidence because of the unique experience between the client and therapist in each session - we all have individual differences and unique life experiences you know! So, speculation and assumption should be avoided in evidence-based practice, however, it appears that combining hypnosis with psychodynamic models of therapy may be beneficial when working with insecure attachment origins (Seligman, 2017).
--->> Now, I'm not going to go into psychodynamic theory too much here, but basically, Sigmund Freud explained all human behaviour as coming from childhood experiences, you've probably heard of the term "root cause" right? This is the basic idea. Freud is a story for another time... I am not a massive fan but some of his ideas were OK (and some were so wacky that they prompted other psychologists to develop theories just to prove him wrong, meaning he played a role in progressing the psychological field regardless - Cheers Sigmund lol). This was Freud for reference:
Using an integrative approach within hypnotherapy can be really effective for this reason... for example, I've just described using Attachment theory, psychodynamic theory and hypnosis as a psychological tool! See how it all comes together?!
So, well done if you've made it to the end of this article! The main takeaway points today are:
The collaboration/negotiation between client and therapist is hugely important to the therapy being successful.
The therapist should ensure they have addressed their own attachment style so they can provide a template of a healthy attachment.
If you really want to change your attachment style, you're going to have to face your discomfort and pre-existing beliefs. For avoidance we need to learn about the importance of feeling emotions and moving through them in a safe way, for anxiety, we need to relax the system to allow perspective to change to a more objective viewpoint.
The therapist-client relationship should be safe, secure and non-judgmental to allow for exploration of the issues, just like how children use parents as a secure base to explore the world.
Hypnotherapy may replicate the type of communication children experience from their parents, allowing the client to feel sensitively responded to. This can alter implicit memories and increase attunement.
I hope you have learned a little about how we begin to change attachment styles in therapy today. This is not the end of the story though!
Interestingly, the same brain region is responsible for social interaction and hypnotic phenomena (Zelinka et al., 2014), perhaps suggesting hypnotherapy could effectively mediate sociocognitive mechanisms within the brain to improve attachment (Wolf et al., 2022). So... next week we're going to dive deeper into basic neuroscience and I'll do my best to explain the cognitive and biological processes involved in both hypnosis and attachment!
I hope you all have a fantastic weekend,
Big Love x x
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