WORKING WITH DISORGANISED ATTACHMENT IN ADOLESCENTS & ADULTS: Skills and knowledge for providing therapeutic security to enhance client wellbeing.

The concept of attachment difference within Attachment Theory has offered a truly valuable framework to understand many of the serious mental health care risks associated with childhood difficulties. This attachment seminar extends this focus to addressing a relatively new set of adult differences identified as ‘attachment disorganisation’, something potentially influenced by ‘early and ongoing’ trauma and associated with adult personality disorders. In addition to clarifying current knowledge of ‘attachment disorganisation’ into adulthood, the seminar will also introduce more integrated approaches to treatment that include attachment and might also provide greater direction to our work.

The first half of the seminar will focus on updating current empirical understandings of ‘attachment difference’ and identifying manifestations of ‘disorganised attachment’ in adulthood. The aim is to provide a more realistic picture of adult disorganization that will enhance initial assessment and evaluation of ongoing clinical progress. Historically, the traditional adult identifications of maladaptive attachment—Unresolved/Disorganized/Cannot Classify Attachment (categories from the ground-breaking Adult Attachment Interview (AAI)) and Fearful-Avoidant Attachment (a continuum quadrant emerging from well validated self-report tools in Social Psychology)—have proven too broad to adequately inform clinical concerns; the two measures have also proven difficult to integrate. However, researchers have begun to identify greater specificity in the more disordered adult ‘disorganised attachment’ through the employment of new and expanded measures. Participants will be introduced to currently proposed specifics for ‘disorganised attachment’ in adulthood, drawing on important updated measures of attachment difference. Groups will consider these perspectives in light of their work with clients who are confronted by longer-term mental health challenges. ‘Disorganised attachment’ will also be considered in light of early and ongoing experiences of trauma, dissociation and personality disturbances.

The second part of the seminar focuses on clinical skills for addressing ‘disorganised attachment’. Focus on the clinical alliance and ongoing development of attachment will be addressed. Attachment Theory has greatly contributed to 

therapeutic relationship assist healing. The seminar will also clarify ‘what’ we may treat in therapy: ‘changing attachment’—a lifespan dynamic personality construct—, ‘resolving trauma’—a causal contributor to disorder—, ‘modifying dissociation’—a consequent symptom—and ‘enhancing’ reduced functional capacities typically associated with personality disorders’—especially emotion- and self-regulation. Attachment work will be situated within two integrated models for treatment [The Sequential Model of Emotional Processing (Pascual-Leone & Greenberg, 2007) and the recent Psychodynamic Diagnostic Manual 2nd Edition or PDM-2 (Lingiardi & McWilliams 2017)]. Case studies will be explored seeking to practically apply theoretical insights. Finally, attention will also be given to the practical considerations involved in working in a world of limited resources: How can we best respond to the need for longer-term work where clients may lack resources?

In summary, the seminar will explore how even disorganised attachments evolve across the lifespan, are not set in stone, and may be expected to demonstrate both continuity as well as change. This may serve as a beacon of hope for clients and therapists alike.