Sexually Compulsive Behavior as a
Manifestation of Disorganized Attachment
and Facilitating Capacity for Intimacy
SASH Conference
October 1st, 2010
Mark Schwartz, Sc.D.
Castlewood Treatment Center for Eating Disorders
800 Holland Road
636-386-6611
www.castlewoodtc.com
[email protected]
Attachment Trauma
The psychologic distress underlying the craving is the result of
an inability to metabolize negative emotions utilizing the
attachment system (Fosha, 2003; Neborsky, 2003). Successful
therapy restores secure attachment which allows for intimate
relationships to utilize for self-soothing. Injury to the
attachment system is the result of difficulties between the
caregiver and child that results in segregated systems of
attachment and dissociated self-systems. The result is a variant
of narcissism or a false-self personality organization as a means
of avoiding the need for attachment.
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Dissociation
( Liotta, 2000)
• Early dyadic processes lead to a “primary breakdown” or lack
of integration of a coherent sense of self, i.e. Unintegrated
internal working models.
• Disorganized attachment is the initial step in the development
trajectory that leaves an individual vulnerable to developing
dissociation in response to trauma.
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Disorganized Attachment
• Drawing close to the other is thus accompanied by the
expectation of re-experiencing the anxiety of unpredictable
availability, the fear that allowing oneself to ask for and
obtain care may mean giving up one’s identity and
independence.
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Ogawa Research
• 126 children with disorganized attachment followed until age
19. Prediction of Dissociative Disorder from maternal
unavailability and disorganized attachment in the first 24
months of life was more predictive than trauma. Trauma
history did not add to the prediction, of dissociation after
disorganized attachment.
• Specifically maternal Dissociative symptoms, disrupted
maternal affective communication, maternal lack of
involvement at 12 months, significantly contributed 5 other
measures non > 19.
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“Trauma related to structural dissociation then, is a
deficiency in the cohesiveness and flexibility o the
personality structure. The lack of cohesion and integration
of the personality manifests itself most clearly in the
alteration between the vivid re-experiencing of the
traumatic event and avoidance of reminders of the
traumatic experience.”
(van der Hart et al., 2006)
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Adult Attachment
1. Describe your relationship with your parents as a young child (i.e., derogation,
relevance violation, loving).
2. 5 adjectives to describe your relationship with mother/father as young child (i.e.,
idealization, dysfunctional).
3. Your first remembered separation from parent.
4. Ever frightened or worried as a child?
5. Did you tell your parents?
6. Any close relatives or loved one die?
7. How did you respond?
8. Do you think loss has had an affect on your personality?
9. What is your relationship like with your parents now?
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Parts
• In response to life experiences, parts can become extreme and destructive,
obscuring the leadership of the Self.
• People who have undergone severe trauma typically have more discrete,
polarized parts.
• Sub-personalities or aspects of our personality that interact internally in
patterns that are similar to the ways that people interact in human systems.
• We all have parts: think of your playful part, your organized part, shy part,
etc.
• All parts are valuable and have good intentions. Even though the
behaviors might appear to be destructive, they are intended to protect the
individual.
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Reenactment
As a child I would lock myself in the bathroom and play with dolls the way I had
been touched. One would be in bed, the other would fondle him or her. I couldn’t
understand why I did this or where it came from. I was ashamed of this awareness,
but couldn’t help acting it out, I thought the shame belonged inside me, that the
awareness was created solely from me.
During teenage years, I turned to boys to duplicate some of those feelings – of being
cared for or loved. I knew I was fooling myself, I felt the emptiness I was left with
after my liasons with boys, but was all I had. I was desperate to feel loved. My need
for affection was so great, I couldn’t say no to many people and I rarely did.
Do you want to know why I had my tubes tied at age 18? Because whenever I
thought of myself around my child, a mental image would always appear. The
image was clear, and I believed in its certainty. I saw myself not being able to
control the thing that lived in me from you. I saw myself fondling sexually my own
infant.
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“If ego states are split off, projected, rejected, indulged or
otherwise unassimilated, they become black holes that
absorb fear and create the defensive posture of the isolated
self – unable to make satisfying contact with one’s self or
others. When split-off ego states are made conscious,
accepted and tolerated or integrated, the self can be at one,
and compassion can be released.”
(Epstein, 1995)
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Qualities of Self
Calmness
Curiosity
Joy
Gratitude
Clarity
Compassion
Confidence
Courage
Connectedness
Humor
Equanimity
Perspective
Peace
Kindness
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False Self
Winnicott
“Parents who are intensively over-involved with their infant
cause the child to develop a false self based upon compliance.
Care-giver doesn’t validate the child’s developing self, thus
leading to alienation from the core self. Parenting practices
that constitute lack of attunement to the child’s needs,
empathetic failure, lack of validation, threats of harm or
coercion and enforced compliance, all cause the true self to go
underground.”
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Creation of The Punitive False Self
• Parent ignores the emotional attunement with the emerging
self in order to mold them into objects.
• Infant’s needs met with inconsistent and unreliable
attunement, develops a self as unworthy of attention and
incapable of influencing others who care.
• Parent intrusively over involved creating false self based upon
compliance and externally imposed standards.
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In I.F.S., the more unburdening of these
“legacy” and personal burdens, the more
space for Self to re-enter. Decreasing
compartmentalization leads to an increase
in metacognitive capacities and
establishment of a coherent, cohesive
narrative.
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Multiplicity
Internal Family Systems presumes an innate multiplicity,
i.e. the unfolding of parts is natural, whether under
normative, optimal or abysmal life circumstances. The
degree of access and smooth interplay of parts vs. the
compartmentalization and degree of polarization of parts,
relates back to the kind and degree of burdening, i.e. how
much has to be “exiled” and the amount of “protection” it
takes to keep it so.
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Self Healing
Therapist is no longer “healer” but more
“mid-wife,” facilitating the birth of that
which already exists inside the client,
waiting to be born.
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Every deep desire, every powerful emotion, gives a trail
into the unconscious. Usually there is only one-way
traffic: outbound, toward the world of sensation and
action. But we can follow the trail to its source by going
against the current. With this desire to go against desire,
to buck the demands of biological conditioning, the
journey of self-realization begins in earnest.
Meditation in Action
Eknath Easwaran
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Compassionate Witnessing
This occurs when the Self of the client is able to witness
the stories of parts from a compassionate position. Ask the
client to identify an activated part (usually associated with
extreme behaviors, thoughts, or feelings). Ask the client
where in the body the part (position of Self) indicates that
another part is blended with the Self. Ask the blended part
to please step aside and let the Self work with the activated
part (this may include asking more than one part to step
aside).
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Burdens
The concept of “burdens” is brilliant in its widespread
application. It sidesteps the need to compare, contrast, count
symptoms to diagnose, and postulates instead more of a “no
one escapes unscathed” framework. Thus, “burdens” can
encompass beliefs, feelings, and energetic residue of events
and experiences that overwhelmed the internal and/or external
accessible resources of the organism and its attachment
environment at the time, thereby creating constraint.
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Target Symptoms For “Earned Secure Attachment”
1.
2.
3.
4.
5.
6.
Turning towards other people for self-soothing and
intimacy.
Establishing a coherent narrative regarding one’s
life.
Establishing metacognitional thinking in relation to
family of origin.
Minimize idealization and family loyalties.
Establishing clarity with regards to self and self in
relation to significant others
Resolution of significant losses in one’s life.
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Secure Attachment I
• Because their caretakers have been routinely available to them,
sensitive to their signals, and response with some degree of reliability
(though by no means is perfect care required), these infants develop a
confidence that supportive care is available to them.
•They expect that when a need arises, help will be available. If they do
become threatened or distressed, the caregiver will help them regain
equilibrium.
•Such confident expectations are precisely what is meant by attachment
security.
L.Alan Stroufe, 2000
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Metacognitional
Metacognition means treatment of one’s mental contents
as “objects” on which to reflect, or in other words
“thinking about one’s thinking.” Distinct skills
contribute to its characterization, such as the ability to
reflect on one’s mental states, elaborating a theory of the
other’s mind, decentralizing, and the sense of mastery
and personal efficacy.
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“SELF-EMPATHY” - The internalizing
(evoking) of the attentive, validating, caring
relationship to oneself. This involves
helping the client articulate her experience
and bring it into her own internal relational
context.
INTER-PSYCHIC INTIMACY
(between the couple)
vs.
INTRA-PSYCHIC INTIMACY
(within the individual)
Table I.I
1.
Facilitating a coherent and reflective narrative.
2.
Neutralizing idealization and loyalties to family system.
3
Facilitating metacognition.
4.
Facilitating self-compassion.
5.
Utilizing an attuned relationship with therapist as a home base for exploration of developmental change.
6.
Asking others for self-soothing under stress.
7.
Re-examine detailed beliefs about self and others.
8.
Relinquishing defense of dissociation and re-associating affect, sensation, and knowledge.
9.
Not inhibit or minimize internal experiences and learn to tolerate, express attachment and related emotions.
10.
Resolution of internal relational exchanges between parts of self.
11.
Internalize self-parenting, is forgiving of mistakes, listens to disowned parts of self.
12.
Sets and teaches healthy boundaries.
13.
Resolution of significant losses in one’s life.
14.
Deconstruct the attachment pattern of the past and construct new ones.
15.
Integrate traumatic attachments, losses and re-enactments.
16.
Establishing appropriate entitlements related to having needs, expressing needs, and meeting needs.
Stuckpoints
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
How am I avoiding remembering?
How am I avoiding feelings?
How am I avoiding talking about it?
How am I minimizing?
How am I avoiding focusing on enjoying parts of life?
How am I avoiding noticing triggers that cause me to hurt
self?
How am I avoiding dealing with current life stresses?
How am I still protecting those who hurt me?
How am I avoiding being close to others?
What secrets have I not yet discussed?
How am I fighting my therapist and working my program?
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