Darren: Hello and welcome to Attach Together, the podcast where we explore all things attachment theory for counselors, psychotherapists and psychologists. Created by the team at Optima, providers of the level five and level seven diplomas in attachment-based psychotherapy, this podcast is your space to deepen your understanding, reflect on your practice and stay connected to the heart of attachment-informed work. I'm Darren, a BACP accredited person-centred counsellor and an attachment-based psychotherapist in private practice. As well as hosting this podcast, I teach level five courses at Optima. also a foster carer, so I see attachment from many angles. Joining me today I have Uruj who is a BACP accredited psychotherapist, supervisor and level 5 and level 7 lecturer in attachment psychotherapy at Optima. Before training as an attachment based therapist she spent nearly a decade working as a genetic counsellor in the NHS supporting families navigating inherited and life limiting conditions. Her work now sits at the intersection of attachment, identity, intergenerational trauma, genetics and perinatal mental health. She works with individuals, couples and therapists and brings a culturally attuned lens shaped by her experience as a Pakistani Canadian now living in the UK. It's great to have you with me today Uruj, thanks for being here. This episode we're looking at anxious ambivalent which we also call preoccupied. What do we mean when we speak about someone as being preoccupied or having preoccupied traits?

Uruj Anjum: Thank you, Darren. I'm so glad to be here today and to speak about preoccupied attachment. So when we say preoccupied attachment the first thing that comes to my mind is that this is one of the insecure attachment styles. But I want for us to have a conversation about going beyond this label and to look underneath what you call the traits. And what I would say are the defenses of preoccupied attachment. I wonder Darren, when you hear preoccupied attachment, what sort of stereotypes come to your mind?

Darren: someone who seeks reassurance, who seeks closeness ⁓ and who actually maybe can feel like quite hard work to the that around. I mean that sounds very harsh ⁓ but that was definitely my understanding ⁓ anxious ambivalent style ⁓ training.

Uruj Anjum: Absolutely. And I think that's really great for us to speak about that here, because these stereotypes can then become a block in that therapeutic work in order to understand our clients at a deeper level. what describing there is really we need to look underneath, actually, is the nervous system. And early on, for someone that has a preoccupied attachment, that connection wasn't always guaranteed. So Darren, when we ⁓ can hear these stereotypes today. What that means is if we don't have that deeper understanding or training is it can potentially become a block to understanding our clients at a deeper level. And so when we're talking about preoccupied traits in adulthood or in our clients, this might look like things like overthinking, but overthinking their relational exchanges. So this could be texting, this could be phone calls, work emails. So really playing over and over in their mind, have they said the right thing or interpreting the responses that they're getting. They might become quite sensitive to shifts in tone. They'll be looking out for everybody around and seeing how people are responding to them. They may experience their emotions quite intensely. They might find it quite difficult to soothe. especially if there's a distance or a perceived distance within the relationship. And so what this does is this can create difficulties for for individuals to be on their own, to tolerate certain boundaries. And so when we look at this whole picture underneath all of this is a fear of abandonment. It's a real deep longing for secure connection, which is what Bowlby tells us. And so is what's going on beneath all of these stereotypes that you that you've brought here.

Darren: And it's interesting, it? So previous episode we were looking at ⁓ avoidant attachment. ⁓ And that underlying fear, it sits with What underneath them is not different. The way it enacts. ⁓

Uruj Anjum: Mmm.

Darren: is where the difference lies. That fear of rejected, of being forgotten, of being on their own. ⁓ the need to seek reassurance that they're okay ⁓ and they're not gonna be abandoned. And I can relate to that. I can have my moments where... I worry about what other people think of me, where I can overthink things and I'm seeking reassurance. I think that's important to acknowledge that many ⁓ will have similar against that fear of ⁓ being of ⁓ being much or not enough.

Uruj Anjum: And actually, Darren, what you're sharing here is what we know ⁓ individuals with a preoccupied attachment, we will see them sort of overrepresented in sort of the mental health areas, but also as clients and as practitioners. So that's very fascinating from both sides.

Darren: That is fascinating. And it makes complete sense to me why they are overrepresented within the therapy room, because these are exactly the kind of person that's going to move towards the work. They're going to be looking to find answers, to seek reassurance, to make changes, because they have a need for human interaction, closeness, understanding. I feel with a lot of these defences that we speak about, They bring an awful lot to the world. you know, it can be really helpful to have a friend that over thinks and is present for us ⁓ and ⁓ our ⁓ and is step ahead of our own feelings and emotions. That really does take a toll on the individual, doesn't it? I mean, that's quite heavy burden to place on yourself to be that person. ⁓ I notice a lot of burnout with these clients.

Uruj Anjum: Absolutely, because what you're describing there is these traits or these defences are part of a protective mechanism. It's protected them in childhood or in the way that they were raised to feel safe.

Darren: don't we look at that a bit more? What what is it about a childhood that could lead to someone ⁓ Anxious ambivalent in childhood, which we would then refer to it as preoccupied in adulthood How does someone develop? being preoccupied. ⁓

Uruj Anjum: So this develops an environment, Darren where caregiving was inconsistent. And what that means is it wasn't necessarily abusive or neglectful, but it was unpredictable. So sometimes the child will have had really attuned and compassionate caregiving ⁓ to be delighted in. ⁓ on other times, there would be emotional unavailability from the or that they would be overwhelmed with their own preoccupations. And so through that process, a child might learn that they need to stay alert, that they need to check, parent am I getting today? This idea that I need to work really hard to seen or to be heard. And also this is where sometimes other defenses may come into the room, ⁓ like or caregiving ⁓ or that the child can ⁓ seek proximity. from their caregivers.

Darren: ⁓ an example shared that has stayed with me forever. Imagine being a and ⁓ having a full food, all your favourite foods, it's all there, it all makes you feel great, it's amazing. The next time you go that fridge it's empty and there's no food there. The next time you go the food's all back there again and it's amazing, it's good. ⁓ What you're then likely to is hang around that fridge and try and make sure ⁓ that you maybe checking it often is the food still in there has anyone taken it because it feels great to have all the food in the fridge and it feels really horrid when there is no food in the fridge so you're going to keep checking you're going to seek reassurance that the food is still there and that you can be nourished and that's been a metaphor that has stayed with me for a really well until this day ⁓ when speaking about preoccupied clients. It's checking the fridge. Is the food still going to be there? Because I love having the food and I love having it when I need it. But I can't rely on it being there. So I need to seek the reassurance. I need to keep checking it. And if that sounds like a silly example to you, hey, how about this one? How many times do you check for your passport before you go on holiday? You know you need your passport. Someone only has to say to me in the car, my husband will say on the way, you did pack the passports, didn't you? And I will literally have to stop the car. the side of the road, get out and check my bag. Despite the fact I know I put the passports in there, I just need to reassure myself that they are still there and when I get to the airport and I need them, they're gonna be there for me. ⁓ And of these metaphors ⁓ really to life for me ⁓ what speaking about and how this ⁓ attachment develops in childhood.

Uruj Anjum: Absolutely. I really love that fridge example. I might borrow that from you when I'm teaching next, because you're essentially on the spot there, because what's happening there, as has told us, is that attachment alarm system is being activated. It's because you know ⁓ when you that love and attunement, how that is and how lovely it feels. And so when you get it, there's this anxiety around when am I going to get it next? When am I going to get that full fridge again? And it's that uncertainty and that waiting that can be really difficult to know when that is. And so that gives rise to all of these different very clever and intelligent defenses to make sure that you can access it.

Darren: And so when we're in the room, our aim here, Uruj? When we, okay, we've identified ⁓ we have a preoccupied client in the room. ⁓ You they're seeking reassurance. They feel like they're a lot for others to deal with. What's our aim? what's the work that need to do?

Uruj Anjum: So the work here, Darren, is slow things down, to slow the emotion down actually. ⁓ if a client is dysregulated, they use that thinking part of their brain and we can't mentalise together or to think about why did not respond to your text until maybe two days later, what was going on for them, for example. ⁓ So when can slow down our clients, especially our preoccupied clients, ⁓ And we can appreciate that we need to bring them more from their right brain, which is their emotion center, to their left brain, which is their thinking center. And so we want to help and support our preoccupied clients to develop more thinking around what they're experiencing because the emotion's already being flooded. And so we want to contain and regulate the emotional side and to think, to help our clients think about the other people in their lives or to see a different perspective. and to be able to hold and contain things even in between sessions because it can be very hard challenging for someone that's preoccupied ⁓ ⁓ uncertainty.

Darren: when we say about down the work... ⁓ that sometimes that can mean doing what feels like the opposite to our training as therapists, which is ⁓ sit and listen and hold and contain our clients. Because it means interjecting. We're just simply listening ⁓ and reflecting. Actually, we are interjecting saying, well, OK, this is a lot of information coming my way. ⁓ I wonder if can just slow this down a bit. And ⁓ that feels almost at odds sometimes, it? To interrupt our clients and ask them to slow down because ⁓ often say about moving towards the work ⁓ and isn't a case of moving away from it. Actually it's a case of digging deeper each time because so much information can come our way. I don't if this has been your experience but mine is I can just feel ⁓ like almost a complete tsunami coming at me of information and emotions and opinions and and that reassurance that I'm in agreement and sometimes I say well I'm not sure what it is I'm even agreeing to here ⁓ let's slow this down as you say and I think slowing down can take more than one form can't it Uruj?

Uruj Anjum: Absolutely. There's so many layers to this, And, you know, in our work, it is about, you know, as a tutor ⁓ support students to deepen that level of clinical practice, ⁓ to to places where they can do that deeper work to safely slow our clients down. Another aspect of preoccupied clients that I've noticed over the years ⁓ is may bring everyone else into the session.

Darren: Mmm.

Uruj Anjum: but themselves and that might be a great defense. And so there's something about in that slowing down of refocusing actually onto our clients and to say, the work we're doing here together? Because I'm hearing about all the work you're doing with all of these different relationships around you that might look like compulsive caregiving, that might look like, you know, all these worries and concerns for other family members, for friends. And so that's an important part to consider as well, is to always coming back to our client and to think about what they need this space.

Darren: guess when we consider ourselves as the secure base for this client, it's offering them ⁓ than... we would offer to maybe someone who has a secure attachment because actually it's about containing the full amount of emotions and sensations that they're holding. And although we speak about being preoccupied, I find actually sometimes these clients aren't really engaging their brain. Being preoccupied almost sounds like, oh, okay, I'm thinking about this and I've got something else on my mind. Actually I'm not sure often there's there's much thinking going on at all. I think it's overwhelm of ⁓ and reaction rather ⁓ a thought process as to what's happening in their lives. ⁓

Uruj Anjum: . Absolutely. I'd like to add here, you might find that in this type of work, there's often ⁓ a supervisor, I'll get supervisee saying, ⁓ ⁓ like we've circled around and we've come back to the same thing or we were back to where we started or I feel stuck. And there's something about in that preoccupation is rehashing, going over ⁓ things ⁓ and over in hopes to make sense of them and actually for us to be aware.

Darren: ⁓ Yes, yes.

Uruj Anjum: of why that's happening. If we can understand about why that's going on for our clients, we can then as therapists and as supervisors, you know, support the change or the shift that they're wanting to achieve.

Darren: it's really powerful stuff, it? And the good thing is about a pre-occupied client ⁓ is that they will turn and they seek counseling. However, sometimes they almost ⁓ more from than we're able offer. communication between sessions is more likely and we've really got to hold our boundaries with this client group, haven't we?

Uruj Anjum: Absolutely, that's one of the main focuses of supervision is boundary containment. To do meaningful work, we've got to keep our clients and ourselves safe. ⁓ it is hard and we have to find ways to navigate, you know, our preoccupied clients asking, what would you do? What are you doing on the weekend? ⁓ you've, ⁓ know, where are you going on holiday? Do you have children? Do you have a family? ⁓ these questions, they'll just very naturally ask you. ⁓ They've got, they want to know more about you. They want to know what you would do, what you would say. It's part of that reassurance seeking. It's part of that process of them to make sense of what they would do.

Darren: you where my mind's just gone to is preoccupied therapist, the therapist who ⁓ has those traits. guess I've had thought a late in the conversation.

Uruj Anjum: Mm.

Darren: you're happy to back for another episode but it'd be amazing to dig deeper into one if that sounds good to you. ⁓

Uruj Anjum: I'd love to because we said before, ⁓ see this overrepresented in our ⁓ of work. So of course, there's going to be preoccupied as well ⁓ who have earned their security through their work, through their personal professional development, ⁓ but can still, you know, the transference and counter transference and triggers, we're all human. ⁓ And things can come up for us as well. ⁓ And a really fascinating lens in supervision to consider the attachment ⁓ of your supervisee, my own attachment, how all of these layers sort of work together. So I'd love to come back and explore that a bit more.

Darren: Excellent, thank you Uruj Yeah, if what we've said today is felt personal to you, maybe keep a lookout for that episode that will come out later this series. Thank you so much for that bit of conversation. We've got a quick break now. When we come back, we'll have a look at our dilemma. is still with me now ⁓ I'd like us to ⁓ a look at this week's dilemma. This a bit of a classic one and I'm we all know what I mean when I say the phrase door knob confession. That client who will leave a big important subject piece of insight.

Uruj Anjum: Mm-hmm.

Darren: until the very end of their session. What's your thoughts on Doorknob Confessions Uruj? What do we do as therapists with that?

Uruj Anjum: ⁓ I've. got so many thoughts, Darren. But before I share mine, I wonder, what do you think that the client is sort of fearing to not bring it up sooner? What do you think is behind it?

Darren: Okay, so I do think sometimes it takes a while to build up the courage to do something. And I think that we need to...

Uruj Anjum: Mmm.

Darren: ⁓ acknowledge the fact that we're relationship building and it takes time to build trust in the rapport. ⁓ I think about a door knob confession, ⁓ assuming that a lot of that is already there and there's something extra at play and I guess the fear that I notice would be the fear the session ending. ⁓

Uruj Anjum: Mm-hmm. Mm-hmm. Absolutely. So when I hear, you know, doorknob confessions ⁓ a preoccupied client, I'm thinking immediately around, is this a test of the relationship? You know, do you care about me enough ⁓ extend the session because I've brought something really important, something difficult for me to have brought sooner? It's, as you is it a difficulty in regulating their system, their response that, okay, session is coming towards an end? Or is it a bit of protest around, know, you're leaving me here and I still, have so much more to say. There's this like insatiable need with of our preoccupied clients of them more from us, which is what we've discussed. And so it's really important here to, from an attachment lens, to appreciate those layers when we respond or when we... then work with our client who's done that. And you've got like two minutes to go and you've got your next client booked in and you do have to end the session.

Darren: What do we actually do at the point of a doorknob confession?

Uruj Anjum: What we do is we maintain that boundary for our clients. It's really important if we are acting and serving as that secure base, having those clear contained boundaries are really important for creating that safety. Because if we blur those lines, if we make exceptions, it can be confusing for our clients as well. To that consistency. ⁓ I think that boundary setting is really key, but how do we do that? And so it will be different depending on if you've got literally a few minutes, then I would sort of wrap up a session to acknowledge that they've shared this and I tell them that, you know, this sounds really important and why don't we start with this next time? I'll hold it for you. As opposed to if they've done that, maybe say there's five or 10 more minutes still towards the end of session. If there's a bit more time, ⁓ might ask them, ⁓ you know, wonder made this feel so urgent towards the end of session or I wonder how we can address ⁓ with the time that we have, know, or to pause that here and bring it next time. But I would always acknowledge what they've shared and keep that boundary really firm. I know there might be an internal pull or tug ⁓ to give an extra five minutes an extra 10 minutes because it feels really big. actually if we put that clinical hat on we've got to maintain those boundaries and consistency especially for our clients.

Darren: I have to say, having been on the receiving end of... sessions that went on longer than they were planned to and sometimes they'd go on for 20 minutes longer and I had no concept when you're the client you're sitting in the room you're just you're so in your own world that you're just working with the stuff you really are relying on the therapist to manage that space and it made going to therapy really much harder for me because I almost felt like

Uruj Anjum: You

Darren: I had to keep an eye on things myself and I also just simply didn't know how long I was going to be there for. So the practicalities of well what time do I pick and what can I plan for afterwards and for the rest of the day. So yeah having been on the other side of that lack of boundaries it really means so much to me to maintain those now for both sides and as a therapist we know Sometimes we have another client coming in in just 10 minutes time. We don't have long between those sessions. So it's essential for more than one reason to hold those boundaries.

Uruj Anjum: Absolutely.

Darren: Thank you so much for taking a deep dive into our preoccupied styles ⁓ and for at that dilemma at the end today. It's been fantastic to have you. don't forget, you've promised now you'll back. Thank you so much.

Uruj Anjum: You're welcome. Thanks for having me. It's been really great to have this conversation and this discussion. And I can't wait to come back and look at it from a supervisor's point of view.

Darren: Excellent. Thanks for joining us today on Attached Together. We'll see you next time.