On Disorganized Attachment

It is very difficult to hold a client with a disorganized attachment state of mind, further dysregulated by trauma, in the embrace of a non-residential, therapy setting.

The transference is unbearable, dangerous even, and the countertransference takes the therapist to places they would often rather not go. Containment is an issue, contact between the sessions is an issue, the pain is voiceless, the holding inadequate to the task. Frequently, the therapy fails … the client/patient can be deemed just ‘too ill’. Sometimes, the therapist ends it. Sometimes, the client flees - the ultimate flight being suicide.

These clients who cannot regulate their own affect and whose affect is extreme and unbearable frequently seek to supplement their therapies with ‘extras’ of one kind or another. They are right to do so. They are doing their best to construct a lifeline that they can hang on to when the storm comes. Sometimes, the lifeline holds. And sometimes, it breaks. When it breaks, that client arrives - if they live - in the next therapist's room and the task of understanding, or trying to understand, repairing, or trying to repair begins again.

In my experience, it is hard for therapists to help the client discover for themselves what worked and what did not work about the previous, unusually constructed, lifeline. It has, by definition, been built in the ‘not therapy’ places. The therapy is all filled up with an unbearable transference and so is useless for preserving life. The scrutiny of the therapist, the desire to see, the desire to understand is unbearable. So, by definition, the lifeline will be constructed where the therapist was not looking, is not thinking about: ‘in the cracks’.

I am quite a sophisticated client. I am a therapist with twenty years' experience. I have been shocked at how the thinking of therapists runs out or closes down in the places where they know what is right - from their training, from their experience, from the regulations, even hearsay. It has