Darren: Hello and welcome to Attach Together, the podcast where we explore attachment theory and what it really means in practice for counselors, psychotherapists and psychologists. The podcast is created by the team at Optima who deliver the level five and level seven diplomas in attachment-based psychotherapy. It's a space designed to help you deepen your understanding, reflect on your clinical work and stay connected to the heart of attachment-informed practice. I'm Darren, a counsellor and attachment-based psychotherapist working in private practice. Alongside hosting this podcast, I also teach on the level five courses at Optima. Before we begin, a quick note, our episodes now include a CPD certificate. like to access it, you can visit our website or check the show notes I'll share the website at the end of the episode. Joining me today is Gav McKee, counselor ⁓ attachment-based psychotherapist, also in private practice and also a tutor for level five at Optima. So today's topic ⁓ disorganized attachment. Gav, I find this one to be a huge topic So I am thrilled to have you Where do we even start? ⁓ Gav: Hi Darren. Yeah, well, thanks for inviting me I've listened to the past few podcasts you put out and they've been excellent. So I'm delighted to take this a bit further into disorganized attachment. Darren: Excellent. It's really great to have you here, Gav: Well, I just where do we start with disorganized attachment? ⁓ I think it's to say that it's a form of insecure attachment. But unlike the anxious, preoccupied or dismissing styles, which you've discussed in previous podcasts in this attachment style, the child has no consistent strategy for seeking safety or comfort from their caregivers. So there's no organized strategy. That's why we call it disorganized. And it's probably important to say when we're talking disorganized, we're talking about how it appears as the terminology for the child. It comes from the strange situation experiment developed by Mary Ainsworth, which looked at children, helped to understand what their attachment patterns are based on kind of behaviors within that experiment. researchers studying child in that strange situation noticed that some children had behaviors that didn't fit in with secure attachments. or ambivalent patterns. It was such things as freezing, being disorientated, a bit kind of like trance-like states, kind of contradictory approach, avoid behaviors, such as crawling towards the caregiver when they came in, but then suddenly freezing, turning away, approaching the caregiver with their head turned away, moving towards the caregiver, but stopping halfway and kind of collapsing. All these strange behaviors just didn't quite fit in. So they... identified this of disorganized attachment. Mary Main and Judith Solomon came up with definition. A ⁓ fourth from beyond what ⁓ Mary Ainsworth Darren: So we've been aware of this for quite some time now then, Gav. there's much that we're learning even now, isn't there? Gav: yeah, because this was quite closely linked into trauma, attachment trauma, and that's still, you know, a developing field. We've only talked about trauma in recent decades, so we're still very much learning all about it. And I guess with disorganized attachment, what we're talking here is fundamentally rooted in this kind of biological paradox that occurs when the infant's caregiver is simultaneously the source of safety, but also the source of fear. And it creates what we term Darren: Mm-hmm. Gav: fright without solution. This is where the child's survival instinct to approach for safety and to flee from danger are activated at the same time. And it leads to this collapse of any kind of organized behavior that we see in the other attachment styles. So yeah, it's really a developing area that we're leaning into. Darren: It's really hard for me to not feel quite overwhelmed for the child in the scenario that you paint. And I guess that might be how that would feel. Imagine having a caregiver who also is someone to be frightened of unpredictable. I guess we're not always just talking about children on the receiving end of abuse, are we? ⁓ could be any number of things that ⁓ have an impact. ⁓ Gav: Yeah. Yeah, definitely. And I think it's important to say that. mean, there are I say three different situations that kind of ⁓ to this. There's the frightening behavior of the caregiver, which is the kind of over abuse, anger, aggressiveness, the of things you might naturally think about. But there's also a frightened behavior from the caregiver. This is when the caregiver appears terrified, often by the child's own distress. And that kind of signals ⁓ to child there that there's some kind of mortal threat that this stronger, wiser adult can't handle themselves. And there's also a possible like dissociated behavior from the caregiver as well. When the caregiver kind of goes into maybe like in this trance like or kind of state, that kind of renders that secure base, which we're charged relies on, it's psychologically unavailable and that becomes an alarming. So I guess those kind of ⁓ from caregiver behavior. They kind of quite often occur because our caregiver themselves suffers from unresolved trauma or loss of their own. So the thing is when the child's needs or distress trigger that caregiver's traumatic memories, then they may react with sudden rage or fear, but just is really inexplicable to a child. And there's an interesting study by a researcher called Edtronic. And he looked at infants who were just eight weeks of age. with their mothers who were diagnosed with emotionally unstable personality disorder or borderline personality disorder. we saw like these tiny infants already showed signs of confusion, disorientation, distress and dissociation. And that's kind of really powerful research because these were just eight weeks old, these papers. ⁓ yeah, this really shows, really demonstrates ⁓ trauma can be cascaded, can be passed down through generations. So the unresolved trauma. Darren: 8 weeks, that's so young Gav: like a one generation profoundly impacts and shapes the attachment security of the next, often before they even, know, a conscious memory is formed within a child. Darren: Me and my partner have been fostering, or my husband, I should say, have been fostering for 14 years now. And I've got many reflections on children that I've either cared for or come across in other areas where what you're saying sounds really familiar at different ages ⁓ kind of confusion of not sure where to go. Now don't get me wrong, foster adds a whole extra layer of trauma on top of things, However, what am aware of is... the cause, you've made that sound so simple in a way, like, there's three main causes and it's either this or that or the other. But the Venn diagram, the lines that come out of what causes a parent to dissociate, is it a drug addiction? Is it that they're being abused themselves? And this, the whole thing just goes back and back and back. And I think that's why I find this subject so large, Gav, because we have those... you've laid out so perfectly those three areas, but what lies underneath those three areas, it just feels almost infinite to me. Gav: Yeah, yeah, I think you're right. And I think a key point here is that, you know, quite often it's the parents trying to do their best. You know, they want to care and they want to give love to that child, but they're just not able for all the kind of reasons you outlined, all the things they've been through, the way they've needed to cope with the things they've been through, just when they're unable to give what their child needs. So a lot of the time when we're working with clients who have been through these experiences, want to understand what the parents went through, what the caregivers went through, but quite often we're not. Darren: Yeah. Gav: Blaming with just more understanding and understanding how it impacts on the child and being honest with how it's impacted them. Darren: let's focus now on an adult who comes the room. What are the markers? What are we looking out for, that might indicate disorganised attachment? Gav: So disorganized attachment can kind of change ⁓ we go through ⁓ I think it's important to mention that. So, ⁓ example, in adolescence, the may move more into kind of an organized controlling pattern, first of all. And that's kind of controlling caregiving or more controlling punitive kind of pattern. ⁓ Because infancy, the child's dilemma is, you know, the person who I need for safety is also the person who frightens or overwhelms me. Darren: Mm-hmm. Mm-hmm. Gav: So the child develops cognitively and socially, they begin to solve this dilemma by taking control of the relationship dynamic. So instead of remaining disorientated, they come up with a strategy that if I manage the maybe the relationship will be safer. So we can see kind of a controlling caregiving pattern. where the child becomes prematurely responsible for the emotions of the caregiver. And it's really attempt to keep the caregiver regulated and stable, or they can move into more punitive controlling pattern where they become more dominant, critical and hostile of the caregiver. But it's all ways of trying to get control back or the control which I just didn't have before. Darren: Yeah. Yeah. And it's interesting because you say it's about trying to get the control back, but it's almost like they're being given the opportunity to gain control where other children just it wouldn't even occur to them. You know, they have a safe base. if you don't and if it's unreasonable and unpredictable and scary or disinterested, then yeah, it's almost like you're being given too much responsibility at that young age. in adulthood would know what to do with that, let alone a ⁓ or an adolescent. So I can understand the need to just take some control and feel in control of that. It makes total sense to me. Gav: Yeah, definitely. It's a kind of thought if I can control you, you can't hurt me or frighten me. Darren: So are we going to see that in our room Gav? our clients going to try and control us when they present to us? Gav: Well, when we move into adulthood, definition of terminology we use is unresolved for trauma or loss. So that's when we're looking at the adult attachment interview. That's the terminology we use from there. And that in those situations, there's often a breakdown of narrative coherence or overwhelming emotion comes up, but specifically related to the trauma or the loss that happens. Darren: Mm-hmm. Yep. Gav: So it's like that's all unresolved that hasn't been integrated. So they can move on maybe away from their caregivers. So this controlling behavior, you might not see that, but they still are wary of relationships. And I think in the therapy room, we can see lots of different ways they can interact with a therapist and different presenting issues that they come into therapy with as well. Okay, I guess there's three kind of key areas that we might see someone with disorganized or now unresolved attachment in the therapy room. quite often come in with relationship difficulties. an intense push-pull dynamic which they have within relationships. A kind of a fear of intimacy, but also a fear of abandonment. It might attraction to unpredictable or unsafe partners like that repetition compulsion can happen a lot. or they can have sudden emotional shutdowns in relationships. But it's quite often some kind of relationship issue might bring them therapy. The area might be emotional regulation. So ⁓ quite people with unresolved attachment have overwhelming emotions, like really intense emotions and then potentially followed by numbness afterwards, ⁓ really and downs, emotional flooding. could be dissociation or difficulty even identifying emotions, but it's just really intense. emotional dysregulation happening. And the third might be self-concept. So real deep shame. feeling defective in some way, kind of a fragmented sense of self and instability. And a lot of these ⁓ presenting are quite similar, we see, to complex PTSD. ⁓ And people will come in and they've been diagnosed with complex PTSD or personality disorders such as Darren: Yes. Yes. Gav: borderline personality, emotionally unstable personality disorder, or maybe even dissociative disorders such as DID, dissociative identity disorder. All these things kind of can be wrapped up and associated kind of with early attachment trauma. Darren: So this attachment style really is associated with some of the complicated diagnoses then, isn't it? This is not straightforward we're in the room. Gav: No, I think it needs to be quite slow work as well. The first stage, I think, with working with clients with unresolved attachment is giving stability and safety. So you really want to make sure they kind of think the therapy and the therapist can feel them as being somewhere safe and secure, that they can come back and take a long time. Darren: Now, so how would that be achieved? What should do to calm someone into the room? Mm-hmm. Gav: ⁓ So if we're thinking about the root cause ⁓ of this attachment style, you can almost think like a child in the midst of winter when cold outside and there's a fire there. So they to the fire because they need it for safety and security and for warmth. And sometimes that fire can gently warm them and that's nice. But sometimes for whatever reason, might suddenly flare up and can burn them. Darren: Mm-hmm. Gav: So there's no way to really predict what's gonna be. So a child learns something confusing. The thing that keeps me safe also hurts me. The place, you I need to go for comfort and safety is a place I might also get burnt. So over time that child's body itself, a nervous system begins to react to the fire in a conflicted way. They move towards it, cautiously. They might hover close enough to feel the warmth, but never fully relax. They might step forward for comfort, then suddenly jump back and show if a burn is gonna come. Darren: Mm-hmm. Mm-hmm. Gav: So that uncertainty becomes a template for adult relationships. And so the healing task, I think, in therapy ⁓ relationships work is really slowly discovering something new for that person. The new thing is that ⁓ all fires burn. Some can be steady, predictable and warm without burning me. And when the nervous system starts to experience that consistency over time, it can begin to learn that closeness doesn't have to hurt. Darren: Mm-hmm. So actually as therapists, a consistent, warm, supportive, reliable place, that's where start. We start by being the calm of fire. Gav: Yeah, it's largely down into the relationship, giving them some consistency, know, helping with emotional regulation, helping them stay grounded in the moment, helping them feel it's safe to be there. Darren: Mm-hmm. And when we say helping with emotional regulation, would that be somatic work, body work? What would we be looking at there, Gav? Gav: Yeah, quite often I think of emotional regulation as a top-down bottom-up approach to that. So the bottom-up is the somatics, as you say. It's focusing on the body. That's where we store these unconscious emotions. We feel them in the body. So it's, you know, calming the breath, the body, relaxing, you focusing on the parts that carry the emotions and the tension. And at the same time, getting your thinking brain back online, because quite often when emotions hijack us, Darren: Mm-hmm. Gav: the thinking part of the brain just goes offline. So again, the thinking brain back on is just, it might be some of the symbols saying I'm being triggered right now, I'm safe here. And where we wanna get people to is the here and now, the present. That's what grounding is all about and mindfulness, it's being here and now because if we're in the past, we're feeling depressed, know, about missing all the kind of mourning whats happened in the past and if we're in the future, we'll have anxiety about what might be coming, there's a threat coming. If we're in the present, that's Darren: ⁓ yeah. Gav: usually the safest place to be. So we want to get them comfortable to be in the therapy room in the hearing now and in control of their emotions. Darren: There can quite a different energy in room. And when I've worked with clients, I find myself needing to not book a ⁓ client in straight away afterwards. It's quite useful me to have a bit time for me do that bit of grounding. ⁓ at the end of the session as well. So that's just my personal experience and that's really important for me. So it's interesting how what describe for the client is exactly what I then need to put in for myself working with such a client. So that that top down, body up really kind works for me. Gav: Yeah, that's good. And let's say it's a relationship. The therapy is a relationship between two people and you need to be just as grounded to offer that to the client, to offer them effectively your nervous system to help ground them. Because we might see lots of different things happening in the therapy room. We talked about what the presenting issue might be. But what we might see clients as well in therapy is that kind of approach avoid pattern as well. ⁓ know, they might close to you. Darren: Mm-hmm. Mm-hmm. Gav: then kind of rejecting as well shortly afterwards. They might test our reliability and our availability. They might be thinking, I gonna be rejected if I get too close? Are they gonna be angry with me if I tell them exactly what's happening? might challenge us as therapists. They might withdraw or provoke reactions. All of these things are happening unconsciously in the clients because of what they've been through. But aware of that, so emotional flooding is one thing that might happen, you know, and we need to ground them, but they might also be. And we're certainly testing the relationship a bit as well. Darren: Absolutely. ⁓ I guess, Gav, before we sign off on this conversation, ⁓ the bit I'm keen to do is acknowledge that change can happen. So when we're talking about clients who are unresolved, does that mean we can reach a point where they are ⁓ resolved for of a better way of phrasing it? You know, what can we see if we accept it's work and we're reliable and we offer the... conditions to help change. What might we see? Gav: Yeah, I believe so. I believe that's what we're aiming for is to resolve the trauma that he's been through. So it's not, it's a bit like, you know, I always think it's a bit like a physical wound. You're always going to have a scar there, but you don't want it to be so raw that you're having to protect it and it hurts all the time anytime it gets touched. And to do that, it's the integration and resolution of that trauma. So the integration to be able to eventually process what's happened, think about it. in terms of like what we call mentalizing, that we can think about it and feel the emotions at the same time, but we're moving outside of our window of tolerance, sort of still being regulated. So feeling, thinking at the same time is where we want to kind of help them get to. And then we can sort of start processing it, but the first stage is safety, stabilization. Then we can start thinking about, okay, can we start processing some of this trauma which has happened? And that might not necessarily be a narrative talking through it. It might just be feeling. know, the body sensations and sitting with those and let those follow through and, you know, be integrated. I think working slowly with the clients and being mindful of what they're going through and ⁓ trauma informed, understanding how trauma is impacting the body as well as the mind is really important. Darren: But there really is hope for everyone. So anyone listening to this now and they feel like maybe themselves would fall under this category. There's definite scope for change and optimism, isn't there? ⁓ think it's really important just acknowledge reassure for everybody listening. Gav: Definitely, yeah, and we know the brain has plasticity. So we know it can evolve and it can adapt and that's what we're aiming for here. We're aiming to give them ⁓ a experience, a new way of relating to themselves so as their brain structure can, you new can be made and they can feel safer within themselves and safer within the world. Darren: Yeah. yes, its big important work, isn't it? This is, yes, not trivial subject. And I'm we could have spoken about this hours, but I'm gonna have to move us on. Is there a key Gav? Is there any ⁓ one point for those are listening, we're considering disorganizing unresolved attachment What's the key message here? Gav: I think a key takeaway is to work slowly with these clients. Say to be trauma informed to understand ⁓ what they've been through and how their bodies reacting to that. Go slowly with the clients. Safety first, I think. Don't rush too fast into the work. The importance is that a client can feel safe and held within the ⁓ therapeutic relationship. So I'd say safety first. Darren: Yeah. Gav: and then think about all the other work you might normally do with afterwards, but go slow. Darren: So that's a great place for us to just pause that subject. ⁓ Thank you so Gav and I will be back straight after this break. Welcome back, we're at the point where ⁓ pose a dilemma and me and Gav chew the fat for a small ⁓ of time. ⁓ Gav, today's dilemma, it actually relates to the we had before the break. A ⁓ client in your counseling room ⁓ and the session, they dissociate. How would you ⁓ approach Gav: Yeah, well, I think the first thing is to recognize that they've dissociated, that they've gone, they might go into a bit of like a trance-like state or, you know, they just don't seem to be currently in the here and now in the therapy room. You know, they've gone somewhere else to, so to recognize that is the first important step. Then afterwards, I think we need to bring them back to the present. If they dissociated, they've gone somewhere else within their mind. happened which potentially has triggered them, which, you know, dissociation is a... a defense effectively to stop us feeling or getting too overwhelmed. And it's an adaptive strategy, which, you know, is a useful strategy to have when you're in a really unsafe environment. But we want to bring them back to the here and now to ground them, to let them know that it's safe in the therapy So yeah, just bringing them slowly back to the present and doing all the techniques we spoke about before about grounding you know, bottom up, top down, and let them feel safe back in the therapy room. Have you experienced this yourself with clients? Darren: ⁓ Yes, I have actually. And I remember the first time it happened, ⁓ scared. My reaction was, what's going on and what do I do? I've just felt very ill-equipped for it, if I'm honest. ⁓ So I immediately called supervisor straight after the session ⁓ and very soon after attended some CBD training and was just more cautious for a while. But the that I was definitely given was... as you mentioned the break, to be in the moment and just to try and bring the client back to the moment here and do that through safety. And dare I say, just through conversation and humor, those bits you know, we kind of think of therapy as needing to be like a big subject and ⁓ we and we explore big things, which obviously we do and that's really important. But sometimes it can be just as useful to discuss what song you were listening to on the radio on the way here or what you plan to eat for dinner tonight. Because if it can just ground you and bring you back and then, you know, we can move on from that. And actually I was encouraged to not be shy about speaking to the client about what's happened really exploring that for them. ⁓ you've mentioned, like it's a protective strategy. ⁓ how in the past has it helped, but how in the past maybe it's helped a bit less. just to be very gentle and slow in the approach. Gav: that's great, Darren. Like it sounds like you've done a really fantastic job with the client you're thinking about there. And I think you're right. Yeah. Humor, ⁓ know, just bringing it to the everyday conversations can really bring someone back to the here and now, which is absolutely fantastic. And if you can, being able to bring it up, if it feels safe and it feels appropriate, obviously, to discuss what's happened, this increasing awareness and helping people gain more control, more awareness, someone has more, you know, we can understand what's happening within ourselves. Darren: Yeah. Okay, I'm gonna finish on that sentence seems like a beautiful place to stop. So thank you for looking into that topic for us. Before you go, I'm gonna acknowledge the fact that I mentioned at the beginning that both Gav and I teach on the Optima courses, but actually, full disclosure, we also studied together for our own level fives for attachment-based psychotherapy. I'm just wondering, you did that course, how found it ⁓ and it changed anything for you since? Where are at with your level five attachment in psychotherapy? ⁓ Gav: Yeah, we did the course together and it was like, I find it just a fantastic course, really insightful. We had a really good time on the course. I think for me, I came into the course knowing there was something about attachment I needed to know more of, to be able to work with the clients I was working with. A lot of the things I could see came back to early childhood and I didn't feel like I really had the skills or the knowledge or framework to kind of work with. What the course gave me was that kind of framework, that to see clients. ⁓ presenting issues through an attachment lens, just made things just so much clearer and gave me a way of working with clients. So it really kind of changed fundamentally how I work with clients. It gave much more structure, much more, I guess, certainty about like what I was doing with clients before. I felt like I was fumbling around a little bit. Now I've got clarity. I've got a framework which really supports me in my work. So yeah, it's completely changed my practice. Darren: Mm-hmm. I definitely feel the same. think my work has changed hugely since completing qualification. And I guess if you're listening you're also like, this sounds quite appealing. Maybe you'd like to find out more about our Level 5 and Level 7 diplomas in attachment based psychotherapy. You can find full details at OptimaHealthServices.co.uk. A huge thank to and for you for listening. see you next time on Attached Together.