1. Attachment & Cognitive Therapy Patricia M. Crittenden, Ph.D. © Patricia M. Crittenden, 2005

2. Four Growing Points 1.Symptoms: diagnoses & treatment 1.Emphasis on “cognitive” rational & verbal processes 1.Model of psychological functioning & psychopathology 1.Evaluation of harmful effects of psychotherapy © Patricia M. Crittenden, 2005

3. Symptoms Distress = patient’s perspective Diagnosis = professional’s perspective Self-protective strategies Behaviors can serve many functions © Patricia M. Crittenden, 2005

4. Symptoms, con’t 50%+ failure rate 1 year post-CT Focus on symptom vs. reason for symptom Competence with danger vs. competence with safety Strengths approach vs. vulnerability © Patricia M. Crittenden, 2005

5. “Cognition” & Affect Cognition Temporal, causal contingencies Verbal generalizations about contingencies: core beliefs Affect Response to intensity of sensory stimulation Somatic & psychological feelings: images © Patricia M. Crittenden, 2005

6. “Cognitive” Memory Systems Procedural Memory –Reflexive, sensorimotor schema –Preconscious –Learned from experienced consequences –Re-active Semantic memory –Verbalized procedural contingencies –When/then & if/then and (distorted) absolute forms –Borrowed –Should & ought to do © Patricia M. Crittenden, 2005

7. “Affective” Memory Systems Imaged memory –Possibility of danger –Fight, flight, freeze –Bodily arousal and feeling anxious –Pro-active Connotative language –Brings images to mind –Elicits feeling in listener © Patricia M. Crittenden, 2005

8. Integrative Memory Systems Episodic memory –Cognitive-affective integration –Learned at about 3 years –Dependent upon a dialogue –Biased by what parents will talk about Reflective integration –Permits information to be corrected –Is slow –Done best under safe conditions © Patricia M. Crittenden, 2005

9. Memory Systems Temporal Order (Cognition)  Procedural  Semantic Intensity (Affect)  Imaged  Connotative Language  Episodic  Reflective Integration © Patricia M. Crittenden, 2005

10. Dispositional Representation Relation of self to context Each different DR disposes behavior differently Each highlights some aspect of the problem, but obscures some other © Patricia M. Crittenden, 2005

11. Arousal Scale 1. Anxiety Pain Sexual Desire Fear Anger Desire for comfort 2. Comfort 3. Depression Boredom Tiredness Sleep Unconsciousness © Patricia M. Crittenden, 2005

12. Transformations Sensory stimulation  Transformations of information  Dispositional representations  Enacted behavior © Patricia M. Crittenden, 2005

13. The only information that we have is information about the past whereas The only information that we need is information about the future. © Patricia M. Crittenden, 2005

14. Transformations of Information True Erroneous Omitted Distorted Falsified © Patricia M. Crittenden, 2005

15. Type of Transformation of Information False True Integration of Cognitive and Affective Information Affective Cognitive © Patricia M. Crittenden, 2005

16. Omits Affect Cognitively Distorts by Simplification Integrated True Cognition-True Affect Affectively Organized Cognitively Organized Omits Cognition Affectively Distorts by Simplification Type of Transformation of Information False True Integration of Cognitive and Affective Information Affective Cognitive © Patricia M. Crittenden, 2005

17. Adaptive in Safe Contexts, but Otherwise Maladaptive Omits Affect Cognitively Distorts by Simplification Adaptive in Dangerous Contexts, but Otherwise Maladaptive Integrated True Cognition-True Affect Affectively Organized Cognitively Organized I ncreasing Risk of Mental Health Problems Adaptive in Safe Contexts, but Otherwise Maladaptive Omits Cognition Affectively Distorts by Simplification Adaptive in Dangerous Contexts, but Otherwise Maladaptive Type of Transformation of Information False True Integration of Cognitive and Affective Information Affective Cognitive © Patricia M. Crittenden, 2005

18. Adaptive in Safe Contexts, but Otherwise Maladaptive Omits Affect Cognitively Distorts by Simplification Adaptive in Dangerous Contexts, but Otherwise Maladaptive AAnti@ Integrated False Cognition-False Affect Integrated True Cognition-True Affect Various Coercive C+ Strategies Various Compulsive A+ Strategies Type C Coercive/ Enmeshed (Anxious Ambivalent) Type A Defended/ Disengaged (Anxious Avoidant) Type A+/C+ Unintegrated Cognitive/Affect Type B Balanced/ Secure Type A+C+ Psychopathy Affectively Organized Cognitively Organized Reactive Reserved I ncreasing Risk of Mental Health Problems Adaptive in Safe Contexts, but Otherwise Maladaptive Omits Cognition Affectively Distorts by Simplification Adaptive in Dangerous Contexts, but Otherwise Maladaptive Type of Transformation of Information False True Integration of Cognitive and Affective Information Affective Cognitive © Patricia M. Crittenden, 2005

19. A Dynamic-Maturational Model of Patterns of Attachment in Adulthood False Affect Cognition (Type A) Affect (Type C) Integrated False Information (Type A+C+) Integrated True Information (Type B) True Cognition Compulsively Caregiving/ Compliant Delusional Idealization/ Externally Assembled Self Compulsively Promiscuous/ Self-Reliant Socially Facile/ Inhibited Comfortable B3 Reserved B1-2B4-5 Reactive A1-2 A3-4 A7-8 A5-6 C7-8 C5-6 C3-4 C1-2 Threatening/ Disarming Aggressive/ Feigned Helpless Punitive/ Seductive Menacing/ Paranoid AC Psychopathy A/C True Affect False Cognition © Patricia M. Crittenden, 2005

20. Treatment Outcomes There could be harmful effects Cognitive & affective strategies are psychological opposites They might need opposite treatments © Patricia M. Crittenden, 2005

21. Ideas from Attachment Theory The importance of understanding the self-protective function of symptoms. The strategic organization of all persons, patients included. The importance of affect. The structure of human psychological organization as consisting of two opposite processes and their integration - with patients rarely displaying integration. © Patricia M. Crittenden, 2005

22. Ideas from Attachment Theory The possibility that treatments may have different effects on people with similar symptoms, but opposite psychological organizations. The important of therapists knowing both the organization of each patient and also the effects on psychological functioning of each treatment technique that they employ. The importance of the therapist being, uniquely for each patient, a transitional attachment figure who helps to create enough safety and comfort for change to be explored. © Patricia M. Crittenden, 2005

23. This talk can be down-loaded from: www.patcrittenden.com © Patricia M. Crittenden, 2005