Fear of Attachment, Ruptured Adult Relationships, and Therapeutic Impasse

When patients enter therapy following ruptures with an idealised other—whether therapist, lover, or spiritual teacher—their fear of being retraumatised and betrayed creates difficulties in attaching to the new therapist. Initially, the patient will appear distant and unrelated, making it hard for the therapist to find her bearings without clear affective clues. This can lead to momentary or longer lasting impasses. The concept of disorganised attachment is useful as a model for picturing the bind the patient feels of wanting to depend on someone, while being simultaneously frightened of being injured. A therapeutic sequence is described from seeming unrelatedness in the therapeutic relationship, to a more actively negative phase, where the trauma just prior to the onset of therapy is re-enacted, to a final phase where the therapeutic relationship can be more fully established, and the therapist seen in three dimensional depth. The therapist is challenged to bear, and elaborate, the patient's disappointment, criticism, and rejection, in the context of the recent ruptured relationship. There is an eventual shift in the patient from a state of psychic equivalence, where the patient's unhappiness with the therapeutic relationship is believed to be simply a reflection of failings in the therapist, to a growing capacity to play with reality, and realise a more full and complex picture of the therapist and the therapeutic relationship, and the relational world.