A Clinical Case of an Avoidant Attachment

Whereas there is considerable information on attachment theory and its research, the description of a case of avoidant attachment and its detailed clinical process is rare. The nature of these patients’ insistence on independence and self-sufficiency, their lack of admission of distress often linked to dissociation, and their dismissiveness of others, minimize the need to seek treatment. Nonetheless, such patients often are experiencing chronic duress and require assistance because of their incapacity to moderate and stabilize their emotional states. I describe a patient who came to treatment because of his panic attacks. His long-standing belief in his self-reliance and autonomy, a coping mechanism that evolved very early in his life, was an important therapeutic consideration. Early maladaptive interactions between his primary caregiver and him led to an internalized model of avoidant relationships. Because of such extreme insensitivities and misattunements on his mother's part, he developed a reliance on self-regulation. This stratagem masked a need for interactive regulation from a caregiving other when he was stressed. This feature of our therapeutic work was an important focus. Those who demonstrate an avoidant/dismissive interaction are difficult to deal with therapeutically and the theoretical and clinical implications of this attachment are explored. In a lengthy analytic treatment, different psychoanalytic ideas were offered to the patient. Nonetheless, this case highlights the usefulness of attachment theory and its attendant therapeutic interventions.