The effect of different attachment patterns on the counsellor

Attachment patterns evoke feelings in others and the nature of the different patterns will evoke a complementary response in the counsellor. No matter how difficult the issues discussed, when working with a securely attached person the counsellor is left feeling that the genetic interview went well, communication was easily established and it was relatively easy to attune to the patient and establish a two-way dialogue. This type of clinical experience is ful-filing and leads to a sense of professional satisfaction and the patient is appreciative of the care given. In contrast, insecure adults, having suffered some early assault on their capacity to develop relationships, bring their insecure representational models into the therapeutic relationship in vivid and immediate ways. The process of bringing relationship patterns alive in the consultation forms the basis of the counsellor's countertransference reactions (Slade, 1999).

Individuals with a dismissive style of dealing with life will minimise or ignore significant events and emotions. They may appear cold and distant, shutting out the counsellor, or they may be reactive and defensively brittle and appear to fight every idea discussed. Such an interview can feel barren, with no meaningful exchange. The counsellor is then left feeling that it was not possible to get through to the patient, as if a door had been closed. The seeming rejection of help can trigger feelings of frustration, hopelessness and professional impotence in the counsellor. One way of understanding this is that the patient is unconsciously forcing his early experiences (which can not be spoken) onto the counsellor, who then feels the anger and the sensation of being ignored, just as the patient had in childhood. This explains how there can be a recreation and a re-enactment in the present of an earlier interaction, as if the patient were saying, 'I can't tell you how things have been for me but I can make you do feel as I did?'

Another reaction in the clinician would be to try harder to engage the patient. That may result in the clinician becoming more forceful, creating a situation of escalating friction - a dynamic which may well be familiar to the patient. Alternatively, the frustration can lead to over-intrusion which invites further rebuff, leaving the counsellor hurt and possibly wanting to withdraw. The challenge here is how not to react by pushing harder in order to try 'and get through' and not to try and 'get inside'. Increasing the pressure on the patient will only result in an increased resistance. In contrast, asking a question about how previous difficulties have been coped with can sometimes result in the patient being more open and reflective. A long-standing pattern of having to manage alone is often revealed. Alternatively, commenting to the patient that it is difficult to know what to do with an upsetting or challenging situation can often free the resistance. This empathises with the difficulty and describes it, instead of reacting to it. These situations are very frustrating and the counsellor will find it helpful to understand the origins of the dismissive pattern. The patient's minimising style has arisen as a result of being unsupported as a child. Holding this idea in mind allows the counsellor to be more sympathetic and less reactive.

The other insecure pattern of attachment, the preoccupied, creates a completely different 'feel'. The consultation is coloured by the extremes of emotion, agitation, pre-occupation with the upset, a difficulty in calming down and an inability to tell a coherent story. In contrast to the rejection of comfort in a dismissive pattern, there is a hunger for comfort which is sometimes difficult to satisfy. The counsellor may feel overwhelmed or devoured by the patient's emotions and demands and may feel frustrated that no matter how much help or support is offered, it is not enough. The temptation is to fall into the trap of being impatient, which again the patient will have experienced before and thus will trigger further upset. The counsellor's natural response maybe to try and organise, but this is unhelpful. Empathising with the fact that the patient seems overwhelmed and that it is difficult to know how to soothe, can be containing for the patient. This intervention is addressing the process and the difficulty rather than the actual upset. Further, compassionately addressing how very upset the patient is and wondering what usually helps invites the individual to reflect on past experiences, to understand their usual reaction and to realise that the upset will pass.

Using a metaphor can also be a very simple and concise way of conveying an understanding. Expressions such as 'it seems as if the rug has been pulled from under you' or 'your world has been turned upside down' are immediately understood. A more direct approach is to ask a question which explores characteristic behaviour, 'I wonder what usually happens at home, how do you comfort one another or ask for comfort?' This is not only exploratory but also prescriptive, suggesting the need for comfort. The question also legitimises the patient asking for comfort.

It is extremely difficult to provide a secure base for reflection and to enter into the experience of patients who have an insecure attachment pattern and the attachment pattern of the counsellor plays an important part. Feelings flow from the counsellor to the patient as well as from the patient to the counsellor. With a secure pattern the counsellor creates an atmosphere of safety and connection. Making the consultation space a secure base is more difficult for a counsellor with an insecure attachment pattern and the counsellor is more vulnerable to being caught up in countertransference (Slade,

1999). However, on occasions, even counsellors with secure attachment patterns can fail to establish an emotional rapport.

The following example illustrates counsellors with secure attachment patterns being rejected by a couple with a dismissive pattern.

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