Abstract
Internal working models of attachment are conceptualized as internalizations of interpersonal dynamics involving attachment—schemata derived from secure therapeutic relationships if not established in childhood. The potential for developing internal working models in the absence of adequate attachment history is demonstrated by the case of a dismissing (avoidantly-attached) client with Dissociative Identity Disorder (DID) abandoned in early childhood. Using the Collective Heart model (Krakauer 2001)—which targets posttraumatic misattributions of power and quickly challenges the client’s perceived brokenness and helplessness—the client formed an intimate bond with a formerly unconscious inner guidance resource experienced as a maternal attachment figure long before a robust therapeutic relationship was established. Verbatim case material illustrates autohypnotic interventions potentiating this “Wise Mother’s” guidance of the client’s identity development and mastery of relational tasks by mining and augmenting fragmentary attachment experiences. Theoretical and clinical implications of the evolution and function of the Wise Mother are discussed.
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References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Barach, P. (1991). Multiple personality disorder as an attachment disorder. Dissociation, 4, 117–123. Retrieved from https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129.
Blizard, R. A. (2003). Disorganized attachment, development of dissociated self states, and a relational approach to treatment. Journal of Trauma & Dissociation, 4(3), 27–50. doi:10.1300/J229v04n03_03.
Bowlby, J. (1969). Attachment and loss: Volume 1. Attachment. London: Hogarth Press.
Bowlby, J. (1973). Separation: Anxiety and anger. New York: Basic Books.
Bowlby, J. (1980). Loss. New York: Basic Books.
Bowlby, J. (1982). Attachment and loss: Volume 1. Attachment (2nd ed.). London: Hogarth Press.
Caul, D. (1984). Group and videotape techniques for multiple personality disorder. Psychiatric Annals, 14, 43–50. Retrieved from http://www.psychiatricannalsonline.com/cmeInfo.asp.
Comstock, C. M. (1991). The inner self helper and concepts of inner guidance: historical antecedents, its role within dissociation, and clinical utilization. Dissociation, 4, 165–177. Retrieved from https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129.
Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., et al. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550–588. doi:10.1037/a0027447.
Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books.
Fraser, G. A. (1991). The dissociative table technique: a strategy for working with ego states in dissociative disorders and ego-state therapy. Dissociation, 4, 205–213. Retrieved from https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129.
Frederick, C. (2005). Selected topics in ego state therapy. International Journal of Clinical and Experimental Hypnosis, 53(4), 339–429. Retrieved from http://ijceh.com/.
Frederick, C., & McNeal, S. (1999). Inner strengths: Contemporary psychotherapy and hypnosis for ego-strengthening. Mahwah: Lawrence Erlbaum Associates.
Howell, E. F. (2003). Narcissism, a relational aspect of dissociation. Journal of Trauma & Dissociation, 4(3), 51–71. doi:10.1300/J229v04n03_04.
Howell, E. F. (2011). Understanding and treating dissociative identity disorder: A relational approach. New York: Taylor & Francis.
International Society for the Study of Trauma & Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. doi:10.1080/15299732.2011.537247.
Kluft, R. P. (1994). Treatment trajectories in multiple personality disorder. Dissociation, 7(1), 63–76. Retrieved from https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129.
Kluft, R. P. (2005). Diagnosing dissociative identity disorder. Psychiatric Annals, 35, 633–643. Retrieved from http://www.psychiatricannalsonline.com/cmeInfo.asp.
Krakauer, S. Y. (2001). Treating dissociative identity disorder: The power of the collective heart. Philadelphia: Brunner-Routledge.
Krakauer, S. Y. (2006). The two-part film technique: empowering dissociative clients to alter cognitive distortions and maladaptive behaviors. Journal of Trauma & Dissociation, 7(2), 39–57. doi:10.1300/J229v07n02_04.
Krakauer, S. Y. (2009). The therapeutic release of anger: Helen Watkins’ silent abreaction and subsequent elaborations of the anger rock. International Journal of Clinical and Experimental Hypnosis, 57(1), 47–63. Retrieved from http://ijceh.com/.
Liotti, G. (1992). Disorganized/disoriented attachment in the etiology of the dissociative disorders. Dissociation, 5, 196–204. Retrieved from https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129.
Liotti, G. (2004). Trauma, dissociation, and disorganized attachment: three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41(4), 472–486. doi:10.1037/0033-3204.41.4.472.
Liotti, G. (2006). A model of dissociation based on attachment theory and research. Journal of Trauma & Dissociation, 7(4), 55–73. doi:10.1300/J229v07n04_04.
Lyons-Ruth, K. (2003). Dissociation and the parent-infant dialogue: a longitudinal perspective from attachment research. Journal of the American Psychoanalytic Association, 51(3), 883–911. doi:10.1177/00030651030510031501.
Muller, R. T. (2009). Trauma and dismissing (avoidant) attachment: intervention strategies in individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 46(1), 68–81. doi:10.1037/a0015135.
Muller, R. T. (2010). Trauma and the avoidant client: Attachment-based strategies for healing. New York, NY: W. W. Norton.
Ogawa, J., Sroufe, L. A., Weinfield, N., Carlson, E., & Egeland, B. (1997). Development and the fragmented self: longitudinal study of dissociative symptomatology in a nonclinical sample. Development and Psychopathology, 9, 855–879. doi:10.1017/S0954579497001478.
Pearlman, L., & Courtois, C. (2005). Clinical applications of the attachment framework: relational treatment of complex trauma. Journal of Traumatic Stress, 18(5), 449–459. doi:10.1002/jts.20052.
Phillips, M., & Frederick, C. (1995). Healing the divided self: Clinical and Ericksonian hypnotherapy for post-traumatic and dissociative conditions. New York: W. W. Norton.
Schore, A. (2003). Affect dysregulation and the repair of the self. New York: W. W. Norton.
Schwartz, H. L. (2000). Dialogues with forgotten voices: Relational perspectives on child abuse trauma and treatment of dissociative disorders. New York: Basic Books.
Spiegel, H., & Spiegel, D. (2004). Trance & treatment: Clinical uses of hypnosis (2nd ed.). Washington, DC: American Psychiatric Publishing.
Watkins, H. H. (1980). The silent abreaction. International Journal of Clinical and Experimental Hypnosis, 2(2), 101–113. Retrieved from http://ijceh.com/.
Acknowledgments
The author wishes to express gratitude to the client who generously consented to publication of her case material, confirming that these clinical developments have been rendered faithfully despite biographical changes made to preserve her anonymity. The author also wishes to thank Ilana Krakauer and Joan Milkavich for their valuable suggestions in response to an earlier draft of this paper.
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Krakauer, S.Y. Must Internal Working Models be Internalized? A Case Illustrating an Alternative Pathway to Attachment. J Fam Viol 29, 247–258 (2014). https://doi.org/10.1007/s10896-014-9580-y
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DOI: https://doi.org/10.1007/s10896-014-9580-y