A Model of Group Psychotherapy Based on Extended Attachment Theory: a Preliminary Report

by Una McCluskey, PhD

This article introduces the reader to a model of group psychotherapy that is being developed within the field of extended attachment theory. Bowlby’s original work on attachment (1969, 1973, 1979, 1980, 1982) which was developed by Ainsworth (1969, 1974, 1978) and numerous subsequent researchers, see Cassidy and Shaver (1999) was extended by Dorothy Heard and Brian Lake (1986, 1997, 2003) to include a further four instinctive biologically-based goal-corrected systems and a fifth non-goal-corrected system which together with the original instinctive systems of care-seeking and care-giving operate as a single process to maintain wellbeing.

These additional systems consist of three interpersonal goal-corrected systems, (i) exploratory interest-sharing with peers, (ii) sexuality and (iii) self-defence, one intra-personally goal-corrected system whereby one creates an external supportive/unsupportive environment (personal home and life style) and finally there is the system which consists of the internal supportive/non-supportive environment (our internalised experience of the self relating to attachment figures over a lifetime).  While this system is certainly self-organising it is non goal-corrected in the manner that the other systems are.

These seven systems function as a single dynamic interpersonal process whose main function is to restore wellbeing after an individual has experienced a threat to his of her wellbeing.  Heard, Lake and McCluskey (in press) refer to this process as: ‘the dynamics sustaining attachment and exploratory interest sharing’. For those interested in a fuller account of extended attachment theory and its application to adolescence and adults please see the forthcoming book.

While it is clearly more difficult to think coherently about seven separate systems interacting together than it is to think of two systems, we feel that in order to understand adolescent and adult motivation and behaviour one needs to think outside the care-seeking, care-giving paradigm. This paper will concentrate only on the model of group psychotherapy being developed for professional care-givers. It will provide the reader with a preliminary introduction to the work of these groups.  A fuller account is currently in press.

These groups are part of a process of training and research that is being carried out in order to be able to (i) create a new model for working with clients using ‘extended attachment theory’ as a guide,  (ii) a way of supporting professional care-givers in their role and (iii) to provide an evidence-based training programme for those interested in learning to facilitate this model of group psychotherapy with professional peers and clients.

The theoretical roots and research underlying this model of practice draw heavily on the work of Trevarthen (1978, 1979 (a), 2001), Stern (1987), the Brethertons (1990), the Grossmanns (1985, 1988, 1991 (a), 1991 (b), 2006, Tronick (1989), Blakemore and Frith (2006) and Siegel (1999, 2003).  All of these researchers have focused on early interaction and the importance of affect identification, attunement and regulation for the developing biological, social and subjective self.  My own interest in this field was sparked by watching the perturbation studies by Lynne Murray which concentrated on the effect on an infant of a break in inter-subjective relating when they lost contact with their care-giver with whom they were having an enjoyable, mutually regulated interaction in which both were finding satisfaction (see Murray. 1986). On witnessing the break in real time contact both mother and baby were clearly distressed, the mother expressing her distress verbally and the infant expressing their distress, powerfully, non-verbally. Clearly, loosing contact with the person the baby felt connected with and who was supporting their vitality and ongoing being and sense of self was clearly upsetting, the inner experience of which could only be conjectured.

Witnessing the videos of these interactions between these six week old infants and their mothers I was interested in whether one could see when adults felt ‘let down’, ‘dropped’ or not properly engaged and related to by their therapist. I went on to establish a research study to investigate the phenomenon of affect attunement in adult psychotherapy (see McCluskey, U, Roger, D and Nash, P 1997, a preliminary study of the role of attunement in adult psychotherapy, human relations, 50, 1261-1273).

One of the major ideas to come out of this research (1997, 1999, 2001, 2005) was that the offer to help in adult life triggered the dynamics of attachment in adult care-seekers. It then becomes absolutely essential that the professional care-giver is able to tune in to the various ways that adult care-seekers disguise their care-seeking needs. If a care-giver is unable to identify the ways in which insecure care-seekers become defensive when the dynamics of attachment are aroused then they will be unable to interact with them in such a way that the care-seekers can relax and explore and express their problems and emotions fully. What tends to happen in the context of defensive care-seekers is that care-givers can become defensive themselves and both parties end up distressed leading to various degrees of failure in the consultation process.

In subsequent research McCluskey (2005) identified five typical care-seeking approaches that were used by adults and five typical care-giving responses which yielded twenty-five patterns of interaction. Of these, three patterns are effective and six are ineffective.  The effective pattern I have called goal-corrected empathic attunement (GCEA). What is clear from this research is that the way in which the care-giver interacts with the care-seeker in relation to affect identification and regulation is crucial to the assuagement of care-seeking. If care-seeking remains unassuaged exploration is inhibited (Heard 1982). What was also clear from this research is that there are two aspects to care-giving which are responsive to the needs of the care-seeker.  One offers protection and support and the other offers support for ongoing exploration.  Care-givers who are more likely to be insecure are less able to identify these different signals from care-seekers.

Following on from the basic research I started to run a series of training workshops for professionals on the different patterns of effective and ineffective care-giving.  These workshops were carried out using split screen photography so that you could see both people interacting in real time and monitor the vitality affects in each person as they either succeeded or failed to reach the goals of care-seeking and care-giving.  The training was bedded within the context of experiential groups where I introduced the membership to the seven systems comprising extended attachment theory. The training also focused on discriminating between affect attunement and empathic attunement. Affect attunement while hugely important for communicating with pre-verbal infants is insufficient as a way of communicating to an adult that one understands them.  Moreover it can be felt as highly destructive when not followed by an empathic response. Affect attunement by its very nature gives rise to an expectation of an empathic response.  When this does not happen one can be left feeling exposed, shamed, hurt and isolated. In this situation it can have the effect of shutting down exploration.  While empathy on the other hand generally promotes a sense of wellbeing and competence. These workshops evolved into two-day training events for professionals who wished to explore for themselves the way the different motivational systems within the self interacted together as hypothesised.

What these two-day workshops taught me was that it was certainly possible for professional care-givers to engage positively, coherently and meaningfully with a structure that offered them the possibility of exploring their own patterns of care-seeking, care-giving, affectional or defensive sexuality, exploratory or defensive interest-sharing, whether they felt supported or undermined by their current lifestyle and lastly how supportive or unsupportive they found their internalised experience of attachment relationships from the past.  However, two-days was clearly not enough for people to do this work properly and in January 2006 I offered the first in a series of pilot courses aimed at professional care-givers which would give them an opportunity to explore ‘the dynamics of attachment and exploratory interest sharing with peers’ in their own lives and begin to form the nucleus of a research and training project in developing a new model for attachment based work with adults.  It is this work that I will now go on to describe.

Since January 2006 I have set up eleven ongoing monthly courses for professional care-givers.  In all 125 people have taken or are taking part. Membership has included psychiatrists, GP’s, paediatricians, clinical psychologists, social workers, occupational therapists, art therapists, solicitors, psychoanalytic psychotherapists, nursing administrators, academics, marital and sexual counsellors, student counsellors, play therapists, mental health nurses and clergy.

All the participants were asked to give preliminary consent at the beginning of the course for the groups to be videod and transcribed for research purposes. Upon completion of the course they verify or withdraw their consent.  Most participants have given permission for the material to be used for research and training purposes.

Each month the course focuses on a particular motivational system. During the experiential group individuals are encouraged to explore what triggers that system in the here and now and how they express it; whether they feel they reach the goal of that system and what their experience inside themselves is when they fail to reach the goal. In addition, they are encouraged to explore what they know about the aetiology of this phenomenon.   For example in the week that we explore care-seeking we will look at what activates care-seeking currently in one’s personal and work life, how people express their care-seeking needs and whether or not they are met.  The group may then go on to explore their experience of care-seeking as children and how their parents responded or failed to respond. All the work in the group is conducted in a supportive, companionable manner.  People are encouraged to join with each other on resonance and to allow the difference in their experience to pop-up spontaneously.  Group members are not encouraged to remain in silence but to try and access their experience, bring it into the group and make contact with each other.  Through working in this way group members begin to get the experience of what it is like to hold something within oneself and to share it with someone else, or maybe even two or three.

As mentioned in a previous article (McCluskey 2002), one can conceptualise group process as a series of transient dyadic encounters.  It is these dyadic encounters and the meeting with other people through eye contact when one is in touch with the affective core of the self that is part of the essential process of self-acceptance, integration and expansion of consciousness.  Over the course of nine months group members will explore not only what they know about what activates their care-seeking but what activates their care-giving and how their care-giving is received and responded to.  They will also explore their memories of when they first experienced their care-giving being triggered and the context in which that happened.  For example, the instinctive care-giving system may have been aroused in childhood in relation to a wounded animal or becoming conscious that ones mother was overburdened, stressed or unwell.  In many cases group members discover that the older system we have for survival, i.e. our danger/fear system which triggers fight, flight and freeze (La Doux) was also triggered at the same time as care-giving or care-seeking.  They may become aware that their care-giving system is partly infiltrated by care-seeking and that this may account for a sense of exhaustion or burn-out in their professional work.

Group members will then go on to explore the context in which they first discovered and/or expressed their sexuality, the kind of sexual atmosphere they grew up in.  Whether it was abusive, fearful, supportive or enjoyable and how they use their sexuality affectionately or defensively in the here and now to maintain wellbeing.

In the fifth session the group will explore their system for personal self-defence.  The final two sessions will be devoted to current lifestyle and, finally members’ experience of their own internal worlds.  It is difficult to do justice to the work the members are doing in these groups in such a short space of time and the vitality expressed and experienced by those taking part.

The following are some brief figures and quotes from the first cohort of 44 professional care-givers.  They are provided in order for the reader to get some sense of what people say they have got from the groups.  Much more detailed information arising from the research will be provided in later publications

Reported changes by members having attended six two-hour monthly group sessions

CATEGORIES	N	%
Those who identified specific changes	31	70%
Those who were positive about the group but did not identify changes	6	14%
Those who were disappointed that they had not contributed more because they felt that they would have got more from the group	2	5%
Those who were unsure about what they got from the group	1	2%
Those who made no mention of a change and who did not make positive comments	4	9%
TOTAL:	44	100%

If one looks at the above chart one can see that out of 44 responses, 37 (84%) were positive about the experience and 31 (70%) could actually identify specific changes that they had made in their lives

It’s a new way of working for me, it’s so powerful, I haven’t worked in this way before.  Thoughts and memories and life experience comes up, and the emotion is there, never so overwhelming that I can’t go away feeling intact with myself.  So I feel I have become more confident and accepting of myself here.

                                                                                                             Female group member

I was thinking back on other groups I’ve been in, but there’s something that’s happened here for me where there’s been connections with people that has normalised me.

                                                                                              Female group member

There’s something quite pure about the process of the group, something quite organic about how it happened and heaps of stuff have come up for me.  I think the important thing that shifted here, is that it has really made me look at relationships that I have and how I am in them and my place in the world, how I make some of the choices I make, and even within my work, how I operate within the organisation I’m in, and wondering why I’m in that organisation.

                                                                                               Female group member

Being here, and being part of this group, has been very important to me.  I’ve always thought that it was really important that I was challenged, because I have lots of strong opinions.  Something struck me as I was driving down today about how this group has worked, which is around the absence of challenge.  This has allowed me to realise that when I seek a challenge from people it’s been about proving something about myself or to myself, which is quite a pain really.  It is the absence of direct challenge that has made it challenging to be here at times.  It’s been challenging to put out bits of my own story and [being asked to find] the emotional bit that goes along with that.

                                                                                            Male group member

I think what sort of got it for me was last night travelling back from North East and as we were driving out of the city we went past a play area.  It was about 8.00pm at night, nice and warm and there were kids playing on the swings, slides and roundabouts and there was a guy sat there.  Before this group started I would have been sitting there thinking ‘what’s he doing, what is this about?’ and really having loads of negative stuff.  That didn’t enter my mind at all last night. I’ve really changed a lot and you have helped me with that.  The group’s helped me with that.  There are good people in this world and most of us are quite good and I think if I was on a plane tomorrow and it was hijacked or crashed we’d help each other.  People are relatively, intrinsically good.  I’ve literally halved what I am doing in my forensic work.  I’ve gone from 30 to 12 hours and got another job working with very different people.  I won’t be now sitting with offenders day in day out every minute and I wouldn’t have done that.  I wouldn’t have thought of doing that if I hadn’t come here.  I would have carried on thinking that ‘yeah, the world’s going to die, we are all going to get greenhoused to death’.

                                                                                              Male group member

Of the 44 people who took part in the first series of courses, two people were less positive about them, one more strongly than the other. For this latter person, she felt that her different perspective on life was seen as problematic for others. She felt she didn’t get as much as she would have liked out of the group.  The second series of courses which started in October 2006 on the whole are lasting for nine months rather than six and work to a three-hour time structure.

There is a lot of detailed analysis yet to be carried out on the transcripts.  In the meantime work is underway with colleagues to develop a second stage to the research which will aim to assess the impact of this work, not only on the lives of professional care-givers but also whether it has application in their professional work.

We are currently coming to the end of the second series of courses.  They will finish in June 2007.  In the meantime the first international conference on using extended attachment theory as a guide to working with adolescents and adults will take place in Cork at the end of May this year.  This will form the first step of a training programme for those interested in exploring ‘extended attachment theory and exploratory interest-sharing with peers’ and its application for working with adolescents and adults.

Una McCluskey, PhD, is a Senior Research Fellow at the University of York and a Freelance Consultant. . Contact u.mccluskey@ntlworld.com

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