Sexually Compulsive Behavior as a Manifestation of Disorganized Attachment

and Facilitating Capacity for Intimacy

SASH ConferenceOctober 1st, 2010

Mark Schwartz, Sc.D. Castlewood Treatment Center for Eating Disorders

800 Holland Road636-386-6611

www.castlewoodtc.commfs96@aol.com

2

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.

3

Dissociation

• 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.

( Liotta, 2000)

4

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.

5

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.

6

“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)

7

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?

8

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.

9

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.

10

“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)

11

Qualities of Self

Calmness Joy

Curiosity Gratitude

Clarity Humor

Compassion Equanimity

Confidence Perspective

Courage Peace

Connectedness Kindness

12

False Self

“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.”

Winnicott

13

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.

14

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.

15

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.

16

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.

17

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

18

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).

19

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.

20

Target Symptoms For “Earned Secure Attachment”

1. Turning towards other people for self-soothing and intimacy.

2. Establishing a coherent narrative regarding one’s life.

3. Establishing metacognitional thinking in relation to family of origin.

4. Minimize idealization and family loyalties.

5. Establishing clarity with regards to self and self in relation to significant others

6. Resolution of significant losses in one’s life.

21

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

22

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.

“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.

26

Stuckpoints

1. How am I avoiding remembering?

2. How am I avoiding feelings?

3. How am I avoiding talking about it?

4. How am I minimizing?

5. How am I avoiding focusing on enjoying parts of life?

6. How am I avoiding noticing triggers that cause me to hurt self?

7. How am I avoiding dealing with current life stresses?

8. How am I still protecting those who hurt me?

9. How am I avoiding being close to others?

10. What secrets have I not yet discussed?

11. How am I fighting my therapist and working my program?