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Unread July 2nd, 2006, 09:18 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Re: attachment therapy/disorders/theory

I haven't seen much regarding CBT with individuals diagnosed as having attachment disorders. To a large extent, this is because "attachment disorders" aren't DSM diagnoses and most CBT practitioners stick to the established diagnostic categories rather than inventing new diagnoses. If you have questions about certain DSM diagnoses which your psychodynamic colleagues assume are attachment disorders, post them here and we may be able to recommend some articles or books.

I suspect that many of those who talk about "attachment disorders" are actually hypothesizing that attachment problems are the "deeper" issues that are "behind" certain DSM diagnoses and are assuming that if they treat the "deeper" issues, the "surface" problems will go away. CBT typically assumes that it is better (i.e. faster, more economical, and more effective) to treat the "surface" problems directly and to go after "deep" issues only when necessary.

This doesn't mean that we consider attachment to be unimportant. In fact, Beck discusses John Bowlby's work on attachment quite a bit and quite a few CBT interventions can be useful if there actually is an attachment problem.

Our typical approach would be first to identify specific examples of situations in which the hypothesized attachment problems are manifested. We would work with the individual to develop an understanding or the chain of events leading to the problem situation, the individual's thoughts, feelings, and actions in the situation, and the outcome. Usually this information is sufficient for us to develop an individualized conceptualization which provides a framework for choosing promising interventions. We might well use some very traditional interventions such as modifying dysfunctional thoughts and beliefs, using in-vivo exposure to desensitize the individual to situations and emotions they have been avoiding, and teaching improved coping skills. We also might use less widely-know interventions that are useful in dealing with family of origin problems and in dealing with the effects of traumatic experiences.

If you post an example or two of the type of problem you have questions about, that would help us be more specific in our responses.
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