M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

M.E.T.A. Primary Attachment Psychotherapy

Attachment Theory

Attachment Theory

Attachment theory is being increasingly applied in psychotherapy, and is based on infant and interpersonal neurobiology, and caregiver/baby research.

Human infants are born ready to engage.

  1. We are born with about 20 reflexes inviting adults to attend, engage and bond, and are “hard-wired” to orient to facial features.
  2. Eyes focus best at 8 – 12 inches – the distance to our caregiver’s face when we are held.
  3. We recognize and orient toward the same voices heard in utero, and prefer voices to other sounds.
  4. We mimic facial expressions and mirror emotional states.
  5. The rhythm of engaging and disengaging teaches physiological and emotional soothing.
  6. Neglected or over-stimulated brains develop significantly fewer receptors for endogenous opiates (pain relief) and GABA (calming).
  7. Interaction (voice, touch, eye contact) is necessary for human survival–we die without contact.

The infant stage of attachment (0 – 6 months) centers on bonding and regulating, and as mobility develops, children must manage two conflicting drives:

  1. Curiosity and the need to explore.
  2. Security and the need to be safe.

The ideal dynamic for toddlers is called the Circle of Security.

  1. Child readily explores from secure base, and returns to base for soothing and protection if threat is perceived.
  2. When attachment system is switched “on”, exploring stops and child becomes preoccupied with seeking security.
  3. If soothing and protection are readily available, attachment system is switched “off” and exploration continues.
  4. Over time, child internalizes secure template about both people, and the world.
    1. I’m free to be me and follow my curiosity…
    2. I’ll be cared for if needed…
    3. I don’t have to worry…

Attachment Strategies were first identified by Mary Ainsworth using the Strange Situation.

  1. There are several versions, but the simplest includes these phases:
    1. Caregiver brings child into room full of toys.
    2. Child is given time to play and explore.
    3. Caregiver leaves room, leaving child alone with the toys.
    4. Stranger comes into room and attempts to engage child.
    5. Caregiver comes back and attempts to comfort child.

Roughly half the children followed a SECURE pattern:

  1. Balances proximity and access to caregiver, with drive to explore, learn and master.
  2. Engages in effective, interactive play.
  3. Protests when caregiver leaves; play and exploration stop; focuses on absent parent.
  4. Engages cautiously with stranger.
  5. Accepts comfort when caregiver returns.
  6. Settles down and resumes play.

Just over a quarter of the children followed an ANXIOUS/AMBIVALENT pattern:

  1. Clings to caregiver; engages in less initial exploring and play.
  2. Protests strongly when caregiver leaves, becoming visibly distressed.
  3. Engages stranger readily.
  4. Escalates protest when caregiver returns; difficult to console.
  5. Does not return to exploration.
  6. Termed Ambivalent, because child demands comfort and proximity but rejects caregiver when soothing is attempted.

A bit fewer than a quarter followed an AVOIDANT pattern:

  1. Initial play is less effective, organized and interactive.
  2. Protests mildly when caregiver leaves.
  3. Indifferent toward stranger.
  4. Little reaction upon caregiver return.
  5. Withdraws when caregiver attempts to comfort.
  6. Sometimes ignores caregiver altogether.

Both Anxious/Ambivalent and Avoidant children are in great internal distress.

  1. The Anxious/Ambivalent child escalates with protest behaviors, and is visibly upset.
  2. The Avoidant child attempts to shut down the attachment system internally with distancing maneuvers.
  3. However, measures of stress (heart rate, blood pressure, cortical steroid levels) show matching intensity of internal activation.

Roughly 5% lacked any coherent strategy, and were referred to as DISORGANIZED.


Security & Insecurity in Relationship

Attachment is a relational and life engagement template.

  1. Quality of internal platform creates relational (not just physiological) template.
  2. These templates are unconscious and inform us at the most primal level of all our interactions.
  3. Basic moving toward and away orientation related to how one engages with experience.
  4. Though the word “attachment” (and whether it is “secure” or not) relates to human relationship, it is not just about connections to other people, but about something inside of ourselves, a template that arises when life happens.

A sense of Self and inner security is learned.

  1. Attachment and sense of self are intertwined; “Who we are and who we become depends, in part, on whom we love” (Lewis).
  2. “Stability means finding people who regulate you well and staying near them” (Lewis).
  3. “Attachment determines the ultimate nature of a child’s mind” (Lewis).

What is the subjective experience of security and where does it come from?

  1. “When someone loves you, the way they say your name is different. You know that your name is safe in their mouth.” (Billy, age 4. The Hendrick’s Institute, FB).
  2. As Diana Fosha says, “For a child to be securely attached, she must exist in the heart as well as the mind of Other.”
  3. A sense of inner “safeness” (inner stability) comes from secure attachment experiences over time.
    1. Mom’s heart beat…
    2. Having had a good enough experience of safe base…
    3. Having been regulated by an external source…
    4. An attuned and present caregiver…
    5. Experienced safe haven enough when danger arose…
    6. Having been protected and cherished.

Insecure attachment strategies become habituated trance states.

  1. As with other states, individuals differ in how often they draw from strategies, and how identified they are with them.
  2. For some, attachment strategies are relatively superficial and fluid.
  3. For others, attachment strategies significantly interrupt daily living.
  4. As with other neural networks, attachment strategies can be updated through deliberate, mindful intervention and corrective experiences.

Insecure Attachment templates can be updated through:

  1. Focused limbic re-engagement (as in Hakomi loving presence and Hakomi corrective emotional experiences) around historical attachment wounding.
  2. Mindful, sustained, present moment and inter-personal eye contact therapy.
  3. Intentional corrective therapeutic relationship over time, regardless of methods.





M.E.T.A. Primary Attachment Psychotherapy

Foundational Assumptions

Therapy depends on client needs, capacities and readiness for change. From an attachment lens, treatment is most effective when present-oriented, holographic, limbic resonance-based, and directed at the deep, unconscious bonding templates and behavioral consequences within the client. Attachment related interventions are usually based on in-the-moment events and dynamics. Interventions themselves can also be used to intentionally shift the work from a problem-solving, historically-driven framework, to a right here, right now engagement process, and based on the following assumptions:

Attachment templates are malleable and contextual.

1. Change happens within ever changing environments.
2. Attachment tendencies are not fixed traits but responsive states.
3. We develop tendencies around our relationship to relationship and to the world.

Attachment interventions seek to clinically support security and mitigate insecurity of Self and Self-in-Relationship through experiential re-patterning

1. Attachment related habits are recurring experiences of Self and Self-in-relationship.
2. These habits are most effectively evolved through new recurring experiences connected with awareness and intentionality.

Relationship is the centerpiece of therapeutic work, and the therapeutic relationship is the foundation of clinically supported change.

1. “relationships are our natural habitat” (Cozolino, 2006)
2. The client/therapist relationship impacts and reflects client attachment systems.
3. The therapeutic relationship (based on safeness, proximity and intimacy) is itself a change-oriented intervention, as well as a primary and necessary condition for an effective therapeutic alliance geared toward goal directed therapeutic change.
4. Therapists need to proactively create a therapeutic bubble, rapport and safety by being kind, gentle, accepting and holding a respectful therapeutic attitude, and intentionally creating an attuned limbic state of Compassion, Caring, Connection, Contact, Curiosity.
6. This requires adapting, adjusting and contributing to relationship maintenance.
7. The therapist needs to be “in charge” of the general process and the client “in charge” of the therapist.

CONTACT is a state of being in therapist and client in which both feel a sense of connection, emotional and energetic attunement.

  1. Attunement can offer a corrective container based in intentional and natural inter-personal processes that mitigate insecure attachment styles and support secure attachment experiences.
  2. CONTACT underlies M.E.T.A. work–to provide “a safe and empathic relationship” which can “establish an emotional and neurobiological context conducive to the work of neural reorganization.” (Cozolino, 2002)

Ongoing assessment and customized responsiveness is needed in attachment work.

1. M.E.T.A. is an eclectic framework that employs mindfulness and direct experience in a customized way within an intentional relationship.
2. There is an emphasis on inner and outer attunement (mindfulness/core consciousness) and present moment, subjective experience.

The inter-personal nature of attuned therapy intentionally includes non-verbal, somatic elements.

1. Interpersonal processes over time and in the moment can directly support secretion of particular neurotransmitters and change the brain’s relationship patterns.
2. Empathy and intuition are deliberately increased through postural mirroring, facial mirroring, synchronizing breath.
3. Intra-psychic processes of self-study can unfold when relationship is solid.

The META treatment parabola has three attachment related treatment trajectories.

1. A Housekeeping option to allow therapeutic deepening via Hakomi, R-CS, trauma, or other clinical processes or approaches
2. A Stand-Alone option with its own Contact, Accessing, Processing/Transformation, Integration/Completion phases (inspired by R-CS and CIMBS–complex integration of multiple brain systems)
3. An Arc option in which the long term therapeutic relationship itself is explored and recognized as the attachment intervention

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