Psychotherapy & Counselling -
|22nd October 2016|
Counsellor, Consultant, PsychotherapistHi, and thanks for checking out my site. This page will tell you about me and my work and how to get in touch if you want to schedule an appointment or find out more. The next page, "About Psychotherapy," will tell you about the techniques that I use including my own Attachment Centered Therapy. "Qualifications," the third page, is my vita, as it does seem appropriate to let you know what my training and experience has been. Finally comes "Frequently Asked Questions" which is information that I thought many of you might want to know. Again, thanks for checking out my site, and let me know if I can help you.
I am a member of the UKCP (UK Council for Psychotherapy) and certified by them as an Integrative Psychotherapist through the Metanoia Institute. Please see the qualifications page for a full listing of training, qualifications, and experience.
I providing counselling, consulting, and psychotherapy services for addictions, co-dependency, relationships, family of origin, issues of trauma, abuse or neglect, developmental and personality problems, lifestyle development, personal growth and development and other life issues.
My practice is in Manchester and London at 10 Harley Street by appointment only.
Please feel free to contact me if you would like more information or to arrange an appointment.
Healing the Broken Bond: how attachment difficulties cause problems and what to do about it
I am also writing a book about attachment difficulties and Attachment Centred Therapy. I am posting excerpts from the book below, so please feel free to read it and if you have questions or comments please let me know using the email link. Thanks.
This installment is Maslow's Hierarchy of Needs as Modified by me. As this section is very long I am presenting it in two parts. The first is below.
Please read below to find out more.
Areas of Specialization
Chemical DependencyI have worked in addiction treatment since 1988. I began my treatment experience working with chemical addictions, such as alcoholism, cocaine, marijuana, narcotics, prescription drugs and other drugs of addiction.
I have extensive training and experience in treating these problems, and I served on the board of directors of the Alabama Alcohol and Drug Abuse Association.
I have been certified as a Masters Level Addiction Professional, a Certified Criminal Justice Addictions Professional, and I was certified by the International Counseling and Reciprocity Consortium.
These certifications are not current, as I found that I just had too many certifications to keep up with them all, especially now that I am concentrating my work and training in Attachment.
Sexual Addiction CounsellingNext I moved into treating sexual addiction in 1992 when I entered private practice. I also treat relationship or romance addiction (sometimes referred to as "love addiction").
I have trained extensively with Dr. Patrick Carnes, acknowledged by many to be the leading researcher and writer in the field of sex and relationship addiction. I was a Certified Sex Addiction Therapist and a supervisor for counselors seeking certification.
I also served on the Advisory Board for Certified Sex Addiction Therapists, and am a past board member of the National Council on Sexual Addiction and Compulsivity (now known as the Society for the Advancement of Sexual Health).
Relationship, Couples and Marriage and Family CounsellingWe have long known that addiction is a family illness. Most people who develop problems with addictions come from families where addiction or co-addiction is present. In addition, the addiction has a grave impact on families where it is present.
It quickly became apparent to me that a knowledge of family dynamics and the best skills available for couples and family work were an important part of the recovery process. Many relationships survive the addiction only to fall apart during recovery.
I have trained with Dr. John Gottmann, the leading researcher in the U.S. in the field of marriage, relationship, and family counselling. I have worked with several systemic family therapy supervisors and participated in a systemic family therapy supervision group with Dr Don Brown in Birmingham Alabama for about 5 years. Thus my couples and family work is informed by Systemic Family Therapy.
In addition to doing therapy with addicts and their relations in recovery, I also provide marriage and family and couples counselling to others who do not have problems with addictions.
Co-dependency counsellingMany people who grow up in dysfunctional or addictive families become what we call "co-dependent". That is, they are excessively dependent on others for their own sense of self worth, or they compulsively caretake others, often getting into dysfunctional relationships that either they can't get out of, or if they do, they soon find another dysfunctional relationship to take it's place.
Because much of my work is done with people in later stage recovery when co-dependency issues begin to emerge, this field became a natural outgrowth of the other work that I do.
Eating DisordersWhile I do not deal with these problems primarily, I have seen many clients who have had these issues since addicts often have more than one addiction to deal with.
Attachment Centered TherapyThese days my work is centered on attachment. The reason for this is that I believe there is convincing evidence that almost all of the above problems stem from disruptions in attachment in childhood, and sometimes later years. For this reason I have undertaken to educate myself regarding attachment. To that end I have read hundreds of articles and books about attachment theory and research. I'm even working on a book of my own about it.
I have trained with Dr. Patricia Crittenden, who was trained by Mary Ainsworth, who was trained by John Bowlby, the originator of Attachment Theory. Dr. Crittenden has created the Dynamic Maturational Method of attachment analysis. You may visit her website to learn more about this.
I use the Adult Attachment Interview as a way to get started in therapy. This assessment provides a dynamic and revealing way to quickly identify what went wrong and why, and also immediately begins to provide the healing necessary to fix it.
Healing the Broken Bond: how attachment difficulties lead to problems and what to do about itMaslow’s Hierarchy of Needs, as modified
First of all, I want to recognize the genius of Abraham Maslow. His way of seeing people was an alternative to either system in vogue at the time, and those two were the psychoanalytic tradition of Freud and others, and the ‘black box’ approach of the behaviourists. Briefly, in the psychoanalytic tradition the focus was on the feelings and transferences, dreams, free associations and etc that the client brought into the room. I was told or read somewhere that Freud, towards the end of his career, said that his aim was to help his clients become well adjusted to their neuroses. In other words, psychoanalytic insight was useful in understanding why we do the things that we do that we don’t like, but ineffective in helping to change them. In the behaviourist tradition, the belief and the focus was on changing the here and now by the stimulus/response effect observed and reported by Pavlov (you can read all about it on the internet) and before him, Birdwhistle, who got no credit for it, but never mind. If you want to see an amusing spoof on behaviourist theory then watch the movie, Raising Caine, starring John Lithgow.
Maslow’s vision was different. His view of human beings was that we are driven by our needs. In that sense, he was a harbinger of attachment theory. His ideas and the contrast between them and the previous two predominant theories of psychodynamics and behaviourism are described in Frank Goebbels’ book, The Third Force. Read it if you want to know more.
Maslow proposed 5 levels of need:
Safety and Security
Love and Belonging
Esteem of Self and Others
I understand that Maslow actually wanted to have a more spiritual title for the last level, but he was afraid that such a term would turn off the psychological establishment of the time (a new spiritual orthodoxy, but hey, when in Rome, etc.) so he borrowed a term that was already acceptable within the psychological community.
I have modified Maslow’s Hierarchy, so I will call it ‘Maslow’s Hierarchy Modified.’ I have made two additions to the Maslovian levels. In my modified form the hierarchy is:
Safety and Security
Love and Belonging
Esteem of Self and Others
The two additions are nurtural and self-transcendence. I have read Maslow and read about Maslow, and I believe that he would agree to these modifications. Regardless, it is what I am presenting here. For the two additions, I will include my arguments for why they need their own separate category, though we must remember that these needs are homogenous really, and so trying to separate them into distinct categories, while very useful, can also be misleading if we think of them as rungs on a ladder that we reach one at a time. Rather we must think of them as phases, or vibrations, much as the notes of a musical composition, that come in and out as the tapestry is woven. That said, here goes with each level.
Maslow’s idea was that our most basic need was to survive, hence the physical needs. We need air, water, food, rest, elimination, and shelter, pretty much in that order, though they can change depending on circumstances. When we are born, except for air, which we are pre-programmed to receive, we have to rely on our carers to provide: hence the initial connection with attachment theory. If we don’t get those needs met, at least in a minimal way, we die so, game over, no need to go any further.
Physical needs are individual only. That is, if I suffer from a want of those needs, you don’t no matter how closely you are attached to me. You may feel lots of other feelings in response to my plight, but you won’t suffer from the lack of the need being met itself. If you were put alone into a capsule and blasted into space, so long as your physical needs were met you would survive. Or you could be the only inhabitant of an island, as in Tom Hanks, wonderful movie, Castaway, or more latterly, The Life of Pi. But as these stories make clear, we are social creatures and we crave companionship. Pi had the Tiger, Tom Hanks had Wilson. This leads us to our next level of need, one of those that I have added: Nurturance.
Nurtural is a bit of a funny word and one that as far as I know I have made up, so perhaps there is a better word for it. What it refers to is the need for human contact. I have called that ‘nurtural.’ It is a combination of sexual and nurture. After our individual physical needs, this is the strongest. It is the basis of what many psychologists have labelled ‘traumatic bonding,’ and what more popular writers as in press and magazines have labelled ‘The Stockholm Syndrome.’ I am not going into that topic here, though you can read about the hostage taking in Stockholm that gave rise to the latter phrase by Googling it. I’m sure it’s an easy find. You may also find Patti Hearst’s account in Every Secret Thing a fascinating and instructive read.
I suspect this need is also what is at work with mass suicides such as the Jim Jones Guyana tragedy or the Branch Davidians of David Corresh. It will also be at work in suicide pacts. And it was definitely instrumental in launching the study of attachment.
The way it was instrumental in the early days of attachment theory was by children dying at excessively high rates in institutions that were devoted to their care. You can read all about that and other aspects of the development of attachment theory in Robert Karen’s excellent book Becoming Attached.
But there are at least two discrepancies in the system. As Pat Crittenden says, look for the discrepancies. That is where the learning occurs. (My version of this, which I adopted a long time ago, is that confusion often precedes learning).
The first is that people will often sacrifice safety and security in the pursuit of reproductive goals. The second is based on empirical observation that really kick started attachment theory.
I suppose for the first example, I can use Romeo and Juliet, Shakespeare’s timeless classic of two young lovers who are willing to give their lives in the pursuit of romance, driven by the reproductive potential. We can also relate to the pop song, Running Bear and Little White Dove. You can Google it.
The importance of this observation is that whatever this need is, it is more fundamental than the safety and security need. For example, if you risk your life in order to have sex with someone, then you have clearly followed some stronger urge than the need for safety and security. You as an individual might die, but your genetic heritage will live on if you can just get to your lover and do the procreational act with him or her.
The second is more profound and consequential. This discrepancy was noted in the hugely high death rates of infants and children who had been institutionalized and had no contact with a consistent attachment figure. These death rates were as high as 70% within one year of entering an institution of ‘care’, such as an orphanage. 30% was not unusual. This was an enormously high death rate among infants and no one could explain it using the current theories of child rearing. These children were in institutions that were devoted to their care!!! These children had plenty of people to look after them, they had the best medical care and nutrition available at the time, and still they were dying at hugely disproportional rates compared to the normal population. You can read all about this and the research that led to the understanding of it in Robert Karen’s book, Becoming Attached. I recommend it if you want to understand how we got to this understanding of attachment. Not otherwise. As for how to treat it, he says that there are three things that contribute to a reversal of insecure attachment to secure attachment.
They are: 1. having an alternative attachment figure to whom you could relate in childhood. That’s done and dusted. If you had it, good for you, you don’t need to read any further. If you didn’t, then read on. 2. Having a partner who is securely attached and they can pull you up into security. I have to say, with my clients, this is a dodgy proposition, because it is equally at least, and more likely probably, that you will pull them down into attachment insecurity. I don’t intend to say more about this in this book, but it is a very important consideration, and unfortunately we don’t have any research that I am aware of on the question. This is a failing in our system, that such an important question has never been addressed. 3. The final one was getting therapy. But unfortunately, Karen’s book more or less ends there. He doesn’t give any guidelines on the kind of therapy that might be effective, nor how to find an effective therapist. Nevertheless, I recommend Karen’s book highly if you want to read about the evolution of attachment theory and also about some of the many indicators of attachment strategies. Back to the second discrepancy.
Basically the question was: why do children put into orphanages, children’s homes awaiting adoption, or medical facilities for long periods, die at alarmingly high rates? They had all of their physical needs met, they were safe from any kind of harm from predation or violence, and they had the best medical care available at the time, yet still they died in droves. So much so that new terms were invented to explain the phenomenon. These new terms helped to explain the discrepancy between theory and fact. Theory at the time said that we are mechanistic and that children are simply small adults waiting to grow up and be useful. Theory said that if the child had all the physical needs met, no discernible medical illnesses that cause death, and no external threats such as violence or predation, then the child should thrive. Unfortunate fact said otherwise. But the theorists prevailed.
The new terms were ‘hospitalism’ and ‘failure to thrive.’ These buzz words became the way of explaining what Was happening, though no mechanism or explanation for this result was found.
Instead it took someone going into these institutions and observing what was happening in order to bring about change. Perhaps his technique was pioneering the observation techniques that would later be used by Mary Ainsworth, John Gottman, Bandler and Grinder, and other pioneers of using what they observed (the facts) and learning from it (leading to a theory), rather than applying a theory to the facts and ignoring or distorting any facts that don’t fit the theory.
Three Phases of Attempting to Cope
The observation of these infants and children led to the identification of three phases, or stages, that children went through when separated from their carers – their attachment figures – their parents. The first phase was protest. The children, when they realized they were being left by their parents, protested mightily. When their protests did not good, the next phase they entered was despair. It was during this phase that they died. If you want to see despair develop, then watch ‘John,’ a film by the Robertsons. It shows John at around 18 months, put into care for less than two weeks, deteriorate socially and physically – he wouldn’t eat – to the point that one begins to despair of his existence. When his parents finally do come to take him home, he was changed from a lovingly engaged child into a child who is bitter and withdrawn. It is heartrending.
Porges’ Polyvagal Theory provides and explanation of what happens in this phase. We will discuss Porges’ theory in more detail later.
The third phase is accommodation/adaptation. The children became adapted to their environment. They became socially promiscuous and sometimes sexually promiscuous as well (we must wonder if some adult had taken advantage of their social promiscuity to inappropriately sexualize these children, or whether the sexualisation had happened independently). They became more interested in what the parents had brought for them when they came to visit rather than the parents themselves. In short, they displayed the characteristics of addictive disorders.
There is more evidence for the power of this nurtural enemy. In popular culture the movies Sleeping with the Enemy and Enemy Mine portray this phenomenon very well. In real life we have examples such as the Nazi collaborators in France and other countries.
We can also use the examples of soldiers in war and prisoners in prison who find nurturing, comfort, and sometimes sexual engagement with their comrades. Think of the Spartans. I don’t want to go further into this phenomenon except to say that it seems to be universal, not only among humans but in other species as well, and to include inter-special relationships.
The essence of this need is that it depends on one other person with whom a pair-bond can be formed. Sometimes this bond can go beyond pairing and include 3 or 4 or even more numbers. But I think beyond 4 is rare. 4 itself is unlikely, 3 can happen and sometimes does, but one on one is by far the most likely. And this person becomes, even if only temporarily, our attachment figure. When you watch ‘John,’ if you do, you will see the child’s despair despite loving caregivers in the face of the fact that there is no one individual to whom he can attach.
This need is distinguished from the physical needs because if you don’t get this need met you won’t die, especially as one gets older and better able to cope. In fact some individuals organize their strategy around never getting these needs met. This occurs when they ‘learn’ through not getting their needs met that they can’t rely on others to help them meet their needs, and so they become compulsively self-reliant or promiscuous on the A side, or obsessed with seduction and punishment on the C side.
For those not so high in numbers on the scale, I expect it is the basis of statements such as ‘I’ll die if s/he leaves me,’ ‘I can’t live without him/her,’ etc. See the Porges’ section for the discussion of ‘neuroception.’
I won’t say more at this time, because I fear I risk violating Grice’s Maxim of quantity by saying too much. At the same time, I hope I have told you enough to convince you of the validity of this separate level of need or at the very least the need to investigate it more.
I think that it is certainly relevant to our discussion, because it impacts directly on much of what will be said later regarding the force of this drive that leads people to engage in what are self-destructive and self-harming acts. It also can lead to harm to others.
As for quality, I hope that I have provided you with information that substantiates my claim, plus my assurance that there is more where that came from, I think. I have also attempted to give you some leads for investigating further so that you can make up your own mind.
And as to manner – well, if I have done a good job so far then I suppose that you will read on, and if I haven’t, you won’t.
Safety and Security
In the traditional Maslovian model Safety and Security comes after Physical, because what does it matter if all the physical and – presuming I am right – nurtural needs are met if a tiger kills you and eats you, or an enemy kills or captures you, or you die in a natural disaster. So, once we have our physical needs met, we are ready to fight our enemies for survival. And the best way to do that is to form alliances with others for our mutual protection.
There are many examples of this. Do you live in a community with ‘neighbourhood watch’ programs? That is about safety and security. The policeman on the street is paid by us to provide safety and security. Of course, the most important aspect of safety and security is found in connecting with that one significant other. But as soon as we do that, we begin to make babies, and those babies require protection. That creates what we call families, and when those families band together in tribes then we further increase our safety and security. While two of us may be able to support and protect each other to a very important degree, it is still better if we belong to a larger group. Especially if one of us is busy caring for the children, the result of the nurtural connection in the previous level.
At this level of safety and security, we don’t have to like one another, or have any identity of interest, other than facing mutual threats. You help me to meet my threat, and I help you to meet yours. If we band together, we are as a group stronger than the sum of our individual parts, and thus we are social enemies.
Yet often we face mutual threats. ‘The enemy of my enemy is my friend’, as the saying goes. Thus if we are faced with an invading army or band of warriors from another tribe we can band together and cooperate in order to protect ourselves from them. We may even become aggressors ourselves. If we are able to take our enemies’ supplies then that can help us to survive the winter, and so help our offspring survive.
We can go on about tribal warfare, but I don’t suppose it would serve any purpose. There are countless examples of this phenomenon in both literature and history. The book and TV series Band of Brothers are a good example of this, and there are many others.
Safety and Security are right up Bowlby’s alley. After all, that is what he preached, and I am here in the choir loft eager to say ‘Amen brother!’ And speaking of brotherhood that brings us to the next level of need.
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