1. Attachment and Trauma in Object Relations Family & Couple Therapy Family Therapy Institute of Firenze April, 2005 David E. Scharff, M. D. Jill Savege Scharff, M. D. International Psychotherapy Institute

2. Affect Development and Therapy (Schore) Early right brain development Entrainment Importance of affect match and mis- match in family & couple relationship

6. Attachment Theory (Bowlby, Ainsworth) Types: Secure Insecure - Resistant Insecure - Ambivalent Disorganized/Disoriented (Traumatic)

7. Attachment Theory (Bowlby, Ainsworth) Adult attachment (Main) Attachment in couples Matching different attachment styles Separations and reunions Therapist and separation

8. Fonagy, Jurist, Gergely & Target 2003 Transformation of Attachment Theory to Theory of Growth of Mind –Mentalizing –Reflective Function –Interpersonal Interpretive Mechanisms –Regulation of Affect –Development of the Self

9. Evolutionary Function of Attachment Bowlby: Survival in the wild Fonagy et al: Building a mind that knows itself and others

10. Social Origin of Affect Regulation From Co-Regulation to Self-Regulation Developmental Schema of Affect Regulation –Co-Regulation: Marking, contingency, coupling Marking as contingent and the same 0-3 months –Shift in infant’s preference at 3 months: Now wants Non-Contingent “Nearly the same, but clearly not the same” response from mother –Mother down regulates negative affect

11. 1 st & 2 nd Order Affects Tompkins, Ekman Universal Primary Emotions: Happiness, sadness, anger, fear, disgust, surprise –Recognizable from facial expressions, vocal signs Secondary Affects –More complex, subtle –Shame, Pleasure, Envy, etc.

12. Genetics vs. Social Environment Previous Studies: Most variance due to genetic endowment Fonagy’s argument: Studies have use wrong environment. –The right environment is the early mental interaction that grows a mind to filter and give meaning to experience –Risk or protection for expression of genes –Example: Suomi’s ADD monkeys

13. Reflective Function in Childhood A control system Psychic Equivalence Pretend Mode Playfulness and Alternate Views to Child’s Own Mind Trauma constricts playfulness and increases prevalence of psychic equivalence

14. Playing with Pretend Mode Sensitization Building Representations State Regulation Communication Mentalizing –Cognitive advances at Oedipal phase

15. Agency of the Self Physical – Somatization of Affect Social Teleological – about 1 year Intentional – 18-24 months Represenational/Autobiographical – 3-4 years

16. Playing with Reality Marking and Affect Mirroring Marking of Non-Consequentiality Decoupling from Reality Empathy and Pretend Play Importance of “False Belief” Pretend Mode in Psychotherapy

17. Reading one’s own and another’s mind

18. Complex Attachments in Couples (Fisher & Crandell 2001) Secure & Secure Secure & Insecure: Preoccupied Man & Secure Woman Preoccupied Woman & Secure Man Dismissive & Dismissive Preoccupied & Preoccupied Good Relationship At Risk Low Risk At Risk

19. Two-dimensional, four-category model of adult attachment (Bartholomew, Henderson & Dutton, 2001)

20. The dynamics of the secure attachment system (Bartholomew, Henderson & Dutton, 2001)

21. Attachment & Psychoanalytic Therapy Verbal Exchange is also Exchange of Affect Marking “Not for real” in pretend mode Attunement...

22. Attachment & Psychoanalytic Therapy (continued) Emotional regulation Sensitive pointing to internal states Establishment of 2 nd order representations Adaptation & transformation of affect through externalization

23. Attachment & Couple Therapy Reading of one’s own and partner’s mind Regulation of affective states Transforming 1 st Order into 2 nd Order Affects Changing the dynamics of mirroring: –From escalations of augmenting the “same” into down-regulation of “nearly the same, but clearly not the same.”...

24. Attachment & Couple Therapy (continued) Moving through Holding to Containment Using playfulness to move from psychic equivalence to pretend mode Increase Non-Consequentiality, De-Coupling Move from expressions in the body to increase couple’s reflective function...

25. Attachment & Couple Therapy (continued) Improve the Couple’s holding and containment to improve shared mentalizing

26. Attachment & Abuse Bartholomew, Henderson & Dutton 2001 Risk of Being Abused Secure Dismissing Preoccupied Fearful No Abuse Leaves Abusive Partner At Risk Lower Risk (unless also Preoccupied)

27. Attachment & Abuse Bartholomew, Henderson & Dutton 2001 Risk of Perpetrating Abuse Secure Dismissive Preoccupied Fearful Low Risk Likely to Leave Potential Violence/Abuse Not Demanding ? Low Risk

28. Attachment & Abuse Bartholomew, Henderson & Dutton 2001 Research Findings on Abusive Couples Preoccupied Men & Preoccupied Women (most common pattern) Preoccupied Men & Fearful Women (a stereotype of abuse) Fearful Men & Preoccupied Women (mutual abuse; more female perpetrators)

29. References Clulow, C. (2001). Adult Attachment and Couple Psychotherapy. New York and London: Brunner/Routledge. Fonagy, P., Gergely, G., Jurist, E., Target, M. (2003) Affect Regulation, Metalization, and the Development of the Self. New York: Other Press. Scharff, D. E. and Scharff, J. S. (1991). Object Relations Couple Therapy. Northvale, NJ: Jason Aronson. Scharff, J. S. and Scharff, D. E. (1998). Object Relations Individual Therapy. Northvale, NJ: Jason Aronson. Scharff, D. E. and Scharff, J. S. (eds.) (In Preparation) Treating Relationships: Advances in Object Relations Couple and Family Therapy.

30. IPI David E. Scharff, M. D. Jill Savege Scharff, M. D. © 2005