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Unread June 26th, 2006, 05:33 PM
scouserbod scouserbod is offline
Join Date: Jun 2006
Location: u.k
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Question attachment therapy/disorders/theory

hi all
new member and first timer
i work with young people and my colleagues are mostly psychodynamic in practice. a lot of discussions about young people we see revolve around a persons early attachments to caregivers. because they come into our service with problems either with their own parents or adoptive/foster carers the therapy focuses on attachments(or lack of them). what is/are the role/ theory of cbt with people who are "diagnosed" with attachment disorders? are there any articles/books from a cbt perspective ?
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Unread July 2nd, 2006, 09:18 PM
James Pretzer James Pretzer is offline
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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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Unread October 28th, 2006, 06:18 AM
alexandra_k alexandra_k is offline
Join Date: Jan 2006
Posts: 106
Default Re: attachment therapy/disorders/theory

Yeah, I'd be interested to know what kinds of problems you are talking about too. Do you mean such things as oppositional defiance (in the sense of, violence, swearing, etc. Impulse control problems, emotion regulation problems, self harm, etc.

Might be that you are talking about childhood versions of what might eventually be considered to be... Personality disorders. In which case... Attachment theory can be fairly useful. Especially if you are looking at how the child is adjusting to foster care or adoptive parents or similar.

There are behaviourist techniques that can be fairly helpful. Helpful for oppositional defiant type behaviours. First thing you need to work out is what the function of their unwanted behaviour is. Once you have figured out the function (attention, expression etc) then you can set about teaching alternative (more appropriate) ways that they can get those needs met and you can shape their behaviour gradually to what is desired... Same goes for self harm and things like that.

Marsha Linehan has adapted CBT into what she calls 'dialectical behaviour therapy' or DBT. She is looking at self harm, suicidal behaviours, emotional dysregulation, and inadequate interpersonal skills mostly. I was reading a special edition of a journal the other day and they were looking at mechanisms that might be responsible for the success of both psychodynamic / attachment therapies and CBT and schema therapies etc for treating those kinds of behaviours.

The mechanism... Was thought to be mentalization. Teaching people how to observe and describe their intentions, thoughts, feelings, desires etc. The observe, describe, participate mindfulness techniques of Linehan with the mentalization stuff that has been written about in the psychodynamic literature. In particular I was reading that what might be going wrong in BPD was that there was a failure to mentalize appropriately when the attachment (emotion) system was active.

But yeah, examples of the particular kinds of symptoms you are interested in would help.
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Unread December 18th, 2006, 10:14 PM
James Pretzer James Pretzer is offline
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Default CBT and attachment theory

The December, 2006 edition of the Journal of Consulting and Clinical Psychology includes a special section on Attachment Theory and Psychotherapy. One article is particularly interesting. McBride, et al. looked at attachment as a moderator of treatment outcome in a comparison Interpersonal Psychotherapy (IPT) and CBT as treatments for depression. They found that participants higher in "attachment avoidance" did better in CBT than in IPT. Very interesting.

McBride, C., Atkinson, L., Quilty, L. C., & Bagby, R. M. (2006). Attachment as Moderator of Treatment Outcome in Major Depression: A Randomized Control Trial of Interpersonal Psychotherapy Versus Cognitive Behavior Therapy, Journal of Consulting and Clinical Psychology, 74, pp. 1041-1054.
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