Psychotherapy & Counselling -
|1st June 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.
The second installment, History of the AAI, is posted below.
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 itMary Main System
Mary Main’s theory was that the attachment strategy of the mother would be ‘transmitted’ to the child by some transmission mechanism that has yet to be explained, much in the way that genetic predispositions would be or perhaps more pertinently anti-bodies through mother’s milk. There was a seminal study that ‘proved’ this was so. Children’s attachment strategy was studied using the Strange Situation and they were assigned a classification, and their mothers were given the AAI and their results examined. The trouble was that in order to ‘prove’ this theory, the discourse markers for the adult attachment coding had to be made to fit the classification of the child. They were so made and they did so fit.
You don’t have to be scientifically trained too well to see the problem with this approach. It is the tail wagging the dog. In order to achieve the expected outcome the coding system had to be jiggered accordingly.
This assumption – notice that I have changed the term from theory to assumption – worked well enough so long as the distinction was only between secure and insecure, but beyond that, it broke down.
There had been another study done by Everett Waters and colleagues that showed the stability of the attachment classifications over time. Those who were measured to be secure on the SSP (Strange Situation Procedure) when assessed two decades later using the AAI were overwhelmingly likely to still be secure. This was thought at the time to lend great credibility to the concept of attachment, and it does as far as it goes. But it doesn’t go very far. The corresponding finding of this study was that those who started out as insecure on the SSP were overwhelmingly still insecure on the AAI. But then things got more interesting. First, for those who did change between secure and insecure, the trend was definitely to become more insecure. Second, among the insecure categories, of A vs C, there was a great deal more movement than from secure to insecure. And third, the thing that brought about the change was almost always a seriously threatening life event of the caregivers, such as death of a parent or divorce, mental illness of a parent, and so on. Of course this observation must be somewhat speculative because the evidence is correlational and it would take more sophisticated studies to determine what precisely causes a shift in attachment strategy.
Back to the Mary Main approach, as this coding and classifying system developed, their system, which has come to be known in some circles as the ABC+D system, had room for only the very low-numbered As, A1&2, and the low-numbered Cs, C1&2. Now, try to stay with me, and I shall try to not get lost myself, as it gets very complicated from here. Also, I am just going to call this the Mary Main system, because it is her baby more than anyone’s, and I could be particular about the ‘correct’ designations, but I figure most of you are a lot like me and would like to just keep it as simple as possible. So to call it ‘the Mary Main system’ is easy to understand and remember, so I will use it.
The first thing that one would encounter, if one were to select an arbitrary classification scheme, is that, the more diversity in the objects being classified the more quickly the system will breakdown. In other words it will work very well on the initial objects on which the assumption was formed, but the further it is tested the less robust it will be. And this is exactly what happened. Except, nobody noticed.
Actually, that’s not true, some people did notice, but they were in the minority. And I noticed when I read this original study purporting to show the transmission of A to A to A and so on intergenerationally. It flew in the face of my life experience and my clinical experience that the mother would transmit her attachment strategy to her child, just as she had received the ‘transmission’ from her mother. Thus an A grandmother produces an A mother who has an A child, and so on for the Bs and Cs. Again, because security begets security, this held up fine enough for the Bs, but for the As and Cs it was a whole different story. And here is where it really went haywire.
First of all for some reason it was thought necessary to come up with whole new labels for the adult categories. Why? Don’t ask me. So the letters chosen were D, E, and F. I know what you are thinking, D equals A, E equals B, and F equals C, only for adults, not children, right? Wrong. See, you are trying to make it make sense, like one of those exam questions that ask you to match the order of things. Unfortunately, for some reason, D did replace A, and the D was dubbed ‘Depressed’, which is fair enough as the avoidant As are often quite depressed, sometimes deeply so, and typically unexpressed. But the E actually skips a place and equates with C, and the moniker for E is ‘Enmeshed’, which again is fairly true to form as Cs often do promote enmeshment, where you don’t know where your own boundaries end and someone else’s begin. Then the F gets moved back to correspond with the B, and stands for ‘Free, Autonomous’, a good enough label for the secure, balanced, individual. (For convenience sake I will now shift back to A, B, and C, as I find it just too absurdly complicated to try to use D, E, and F, and constantly remind you – and myself – that D is actually A and E is actually B except it’s not cause it’s in the wrong place and is actually C which is not F because F had to go back to take E’s place! Whew! From now on it’s just A, B, and C, okay? And if attachment strategies are going to be deemed to remain durable over time then doesn’t it make sense to keep the labels durable over time?)
Remember as we go through this that these labels are strictly for convenience, and are chosen because they have some relevance to the strategy being described. But they lack quantity, in that they convey very little information that is useful. It is a bit like the title of a book: it can give you some idea of what is inside, but is no comparison to reading the book itself. So too these AAI labels try to capture something of the essence of the category, but can in no way accurately portray it, and in some cases if taken literally can be quite misleading as to how someone functions, which means that they can also lack quality. But nevertheless labels are handy for discussing concepts as long as we remember that the map is not the territory.
Back to the story. Have I confused you yet? If not, just wait, the best is yet to come. Because the coding system beyond the Bs and the low numbered As and Cs – what can be described as the ‘non-clinical’ population – was inadequate, as subjects began to be encountered in the A+ range (which is A3-8) the C+ range (which is C3-8) the AC category (psychopathy) and the A/C range (which is some mixed combination of A and C) then the Mary Main system created two more categories which are brilliant in their conceptualization: they are ‘Disorganized’ and ‘Cannot Classify.’
Imagine that, a child, or adult who is organized around being disorganized? It’s kind of like my desk. If you saw it, you might say that it is disorganized. But to me, it is organized, just not in the way that you would organize it. The point is that people have a way of organizing information so that it is useful to them. While this may appear disorganized to someone else, the point is that it works to some extent for the person. In the context in which the behaviour arose, it made sense and was the best that person could do. So disorganized became a pretty big target to hit. It would be hard to miss, conceptually: we can’t make the information about this person fit into our current organized scheme so we will create a special ‘disorganized’ category that we can fit it into and so keep our classification system organized.
Even better is the ‘Cannot Classify’ classification. Here the researchers encountered, I presume, discordant information that, even with the ‘Disorganized’ catch-all, they could not classify. So the obvious and solipsistic thing to do was to create the ‘Cannot Classify’ classification. I can’t really spoof it any further than that. Suffice to say that Moliere or Gilbert and Sullivan could do very well with it, I expect, as the capacity for spinning absurdity onto absurdity was their speciality. Of course, one would be hard put to do better than the academics and researchers themselves.
So why, you may ask, did they not put them into those categories that I mentioned earlier, the A+, C+, AC, A/C categories? Because they don’t have them!!! They are not included in the Mary Main system, apparently. I should make clear at this point that I have not studied with Mary Main, though I would like to, but just haven’t had the time or money for such a lavish undertaking. What I am reporting here as the Mary Main approach I have learned about through my AAI training and my reading in professional and other literature. According to Pat Crittenden, the first part of the DMM (Dynamic Maturational Model) training is based on the Mary Main model, but with a few modifications. So not having had the Mary Main training I cannot speak from personal experience about that system. But if this is true, what I consider to be the bulk, and virtually all of my clients would not be found in the Mary Main classification system except as ‘disorganized’ or ‘cannot classify’ . Such broad, undifferentiated classifications tell neither me nor the client very much about their functioning, not in any useful conceptual way. It reminds me of the New Yorker cartoon of the ‘patient’ lying on the psychoanalyst’s sofa, and the psychoanalyst had written on his pad, ‘Just plain nuts.’ It’s about as useful a system as that, really.
That’s not a very good system, is it, one that allows you to understand the most common forms of attachment strategies – the ones that you will rarely encounter seeking psychotherapy or needing social services – but not the ones that you encounter day in and day out in one’s clientele (and in one’s personal life, truth be told!)
I would like to add before closing this section that a great debt is owed to Mary Main and her colleagues for all of the wonderful and inventive work that they have done. To give credit, the conceptualization of an assessment instrument based on an interview that can be coded and classified in some objective, reliable, and valid way is quite a brilliant stroke of genius in its own right. So kudos for that. I just can’t help poking a bit of fun at academia when they screw it up so badly. This is just my opinion, you understand, and we all make mistakes from time to time. When one invests a great deal of time and energy, academic prestige and funding from grants and etc., it becomes very hard to admit that a wrong turn has been taken and it is time to rethink the model. Not only is it difficult to admit one’s own mistake – or indeed even to see it sometimes – but it also makes sense to ostracize anyone who challenges the existing vested interests. I think that is what happened to Pat Crittenden.
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