You are on page 1of 10

Clin Soc Work J (2009) 37:214223

DOI 10.1007/s10615-009-0217-1


Attachment Repair in Couples Therapy: A Prototype

for Treatment of Intimate Relationships
Marion F. Solomon

Published online: 24 July 2009

 Springer Science+Business Media, LLC 2009

Abstract This paper describes a prototype for the treatment of intimate relationships that takes into account how
to evaluate attachment styles in the couple relationship and
in psychotherapy, and how to integrate this understanding
into clinical practice. It is important for the couples therapist to understand attachment, its neurobiological underpinnings, and its origins in early development. Secure
attachment in an adult relationship may be challenged
if one or both partners have experienced disruption of
a primary attachment relationship. The goal of successful treatment is to restore the normative growth of intimacy, empathy, understanding, healthy dependency, and
Keywords Couples therapy  Attachment theory 

All couples encounter problems that are not fully understood. Many of the complaints presented to couples therapists as communication failures or conflicts over specific
issues are actually complaints about thwarted attachment
needs. When presenting problems remain the focus of
communication, unaddressed attachment failures can lead
to protest, fear, and sometimes hopeless withdrawal. It is
important to understand attachment, its neurobiological
underpinnings, and its origins in infant development.
Attachment theory provides the couples therapist with a
M. F. Solomon (&)
Lifespan Learning Institute, 1023 Westholme Ave, Los Angeles,
CA 90024, USA


clear set of goals, a focus and compass in the process of

change, and a language for the dilemmas and stuck places
in love relationships. In this paper, we look at how to
evaluate attachment styles in the couple relationship and
in psychotherapy, and how to integrate this understanding
into clinical practice.

Secure Attachment
Attachment theory outlines the basic human responses,
especially the needs and fears that structure long-term
bonds. The basis of attachment is that seeking and maintaining emotional contact with significant others are innate,
primary motivating principles across the life span. The
presence of an attachment figure provides a sense of
comfort and security, a safe haven that offers a buffer
against the effects of stress and uncertainty (Mikulincer
et al. 1993). Secure attachment complements self-confidence and autonomy (Feeney 2007). Secure dependence
and autonomy are two sides of the same coin, rather than
dichotomies, as often presented in the couple and family
literature. The more securely connected we are, the more
separate and individuated we can be. Health in this model
means maintaining a felt sense of interdependency, rather
than attempting to become self-sufficient and maintaining
impenetrable boundaries with others. Dependency, then, is
viewed as an innate part of being human, rather than as a
childhood trait we outgrow.
A sense of connection with an attachment figure is an
innate survival mechanism. It is the natural antidote to
anxiety and vulnerability that can arise in relationships.
Positive attachments create an optimal context for the
continuing development of a mature, flexible, and
resourceful personality. An attachment that has been tested

Clin Soc Work J (2009) 37:214223

in stressful situations and found to be safe offers a secure

base from which individuals can explore their universe and
adaptively respond to their environment. This promotes the
confidence necessary to risk, learn, and continually update
models of self, others, and the world, so that adjustment
to new contexts is facilitated. Safe connection with an
attachment figure strengthens the ability to stand back and
reflect on oneself and ones behavior, emotional responses,
and mental states (Fonagy and Target 1997).
Securely attached individuals are better able than are
insecure individuals to take emotional risks, reach out to
and provide support for others, and cope with conflict and
stress. Their relationships tend to be happier, more stable,
and more satisfying (Simpson et al. 1992; Simpson et al.
1996). They can better acknowledge and communicate
their needs and are less likely to be verbally aggressive or
withdraw during problem solving (Senchak and Leonard
1992). Research suggests that partnerships containing at
least one secure partner are more harmonious and have
fewer conflictual interactions than do relationships with
insecure partners (Shaver and Clark 1994). Secure attachment is characterized by a working model of self that is
worthy of love and care and that is confident, competent,
dependable, and trustworthy.
Attachment theory offers a comprehensive, new understanding of romantic love (Johnson 2008) and a map to key
pivotal emotionally hot events that seem to define relationships and in which individual identities are shaped.
These events include key moments of emotional disconnection (e.g., demand and withdraw or attack and defend;
Johnson 2003), which spark negative cycles that take over
the relationship, and key positive moments of bonding that
restore connection, create new positive emotions, and
provide an antidote to negative cycles. This theory also
helps us understand when strong emotional impasses prevent the renewal of connection and the restoration of trust
after an injury. These events, called attachment injuries,
occur when partners experience abandonment and betrayal
at times of intense need (Johnson et al. 2001; Makinen and
Johnson 2006).

The Disruption of Primary Attachments

Secure attachment, unfortunately, is not the universal
human condition, either in childhood or in adult relationships. Even if an attachment figure is physically present,
that person can be emotionally absent. Partners in these
insecure relationships have limited ways of coping with a
negative response to questionsverbalized or notthat
ask, Are you there for me, will you respond when I need
you? Do you value me and the connection with me?
(Fraley and Waller 1998). Without the perception of


emotional accessibility, a process of separation distress

results. In attachment terms, any response, even anger, is
preferable to no response (Johnson 2008).
When disruption occurs in the primary relationship, loss
of connection with the attachment figure can lead to
strategies intended to ward off anxiety or painful encounters. Anxious attachment results in clinging, pursuit, and
even aggressive attempts to obtain a response from the
loved one; avoidant attachment involves a suppression of
attachment and needs, and shutting down of emotion
(Ainsworth et al. 1978; Johnson, 2003). A fearful avoidant
attachment (Bartholomew and Horowitz 1991) features
clinging, alternating with detached avoidance when connection is immanent. Disorganized attachments occur when
the other is simultaneously the source of and solution to
pain and fear. In addition, Bowlby (1998) discussed anger
as an attempt to connect with an inaccessible attachment
figure, and distinguished between the anger of hope, in
which a viable response is expected from the other, and the
anger of despair, which becomes desperate and coercive.
Each of these insecure attachment strategies is wired into
the brain, often before the age of two.
The distinction between secure and anxious and avoidant attachment strategies was first identified in experimental separations and reunions with mothers and infants
(Ainsworth et al. 1978). Some infants were able to modulate their distress on separation, to connect with their
emotions and process them so as to give clear signals to the
mother, and to accept her calming and reassuring contact
when she returned. Then, confident of her responsiveness if
she were needed, they returned to exploration and play.
These infants were viewed as securely attached. Others
became extremely distressed on separation and clung to or
expressed anger to the mother on reunion. They were difficult to soothe and seemed to vacillate between one
reactive negative emotion and another. They were viewed
as anxiously attached. Another group showed signs of
significant physiological distress, but showed little emotion
at separation or reunion. They focused on tasks and
activities and were seen as avoidantly attached. These
styles are self-maintaining patterns of social interaction
and emotion regulation strategies (Shaver and Clark 1994,
p. 119). Although these habitual forms of engagement can
be modified by new healing relationships, they also can
mold current relationships and become self-perpetuating.

Why Early Attachments Linger

Those who experience early relationship trauma develop
coping methods that are likely to put a wall between them
and intimate others. Because early painful encounters are
frequently preverbal and are followed by defenses designed



to protect the vulnerable self of the developing child, clear

memory of early relationship trauma is lost through
repression or dissociation. What remains are the emotional
reactions to the painful moment; the unconscious repressed
emotion; and later, a faulty or incomplete narrative
designed to explain the surges of pain that suddenly arise in
adult relationships. Inevitably, the repressed affect around
painful events and defenses designed to protect the
wounded self are reenacted in the intimate relationship.
The relationship deteriorates into patterns of attack and
defense, or pursuit and withdrawal, becoming a collusive
jumble in which the partners cannot live, but from which
they cannot extricate themselves (Solomon 2003), pp. 325
326. When this happens, from the point of view of the
therapist, rather than a continuous coherent narrative, we
observe a precise narrative reenactment (Neborsky and
Solomon 2001, p. 165).
Relational patterns are imprinted parts of implicit memory, the effects of which are cumulative across the lifespan
(Kahn 1963). When emotions controlled by precortical
centers in the brain become imprinted, they can arise later
through limbic responses, without any thought or impulse
control. Over time, repetitive attunement failures become
fixed in memory, making change more difficult. Moreover,
prolonged failures of response can result in the development
of a primitive aggressive schematic pattern, with defensive
responses that can follow the person throughout a lifetime
of relationships (Neborsky and Solomon 2001). Hopeful
anticipation is often followed by disappointment, defense
against further painful encounters, and the pain of a deadlocked relationship (Solomon 2003, p. 326). The consequences of early attachment disruptions can cause deficits in
cognitive processing that include an inability to categorize
experience or to connect to autobiographical narratives of
experience, and that interfere with the development of a
capacity for empathic attunement toward others. Later, the
inability to perceive the emotional states of others leads to a
kind of psychic dyslexia in the ability to read facial
expressions, often resulting in misinterpretations of the
communications of others and coinciding with negative
expectations of the others intentions.
Too often, partners have protective defenses that lead to
disengagement and isolation. When this occurs, the very
person who is sought out for comfort is experienced as the
perpetuator of the painful experience. Even when the loved
one does respond, this response may not be completely
trusted and a heightened emotional sensitivity to relationship cues may remain. This response can be momentary or
it can develop into a habitual way of dealing with emotions
and engaging the partner. All in all, it is the proneness to
overreact to differences, the inability to accept anothers
views, and the inability to reengage after disrupted interactions that are so harmful to intimate relationships.


Clin Soc Work J (2009) 37:214223

Reworking Attachment Patterns

The reworking of attachment patterns offers important
opportunities for successful regaining or achieving of
intimacy. Research has found that, in a marriage in which
one of the partners has a secure attachment, an insecurely
attached partner may, within a period of 5 years, develop
an earned secure attachment. Main (2002) indicated that
reparative adult experiences enable those with attachment
traumas to increase their ability to cope with stress and
restore a sense of security. Healing through new relationships occurs frequently and makes a person who has
experienced trauma increase the ability to cope with stress
and negative affect. Schore (1994) indicated that a successful therapeutic relationship can function in an interactive affect-regulating context that optimizes the growth
of two minds.

How People Change

The brain is mutable throughout our lifespan, forming new
synaptic connections and new neural and vascular circuitry
with every new incidence of learning and experience
(Neborsky 2003; Siegel 2003) Increases in complexity in
both the patients and the therapists continually developing unconscious right minds are seen as a major healing
factor (Schore 2003).
The importance of reworking defensive postures created
by early insecure attachment patterns cannot be overemphasized. In his book What Predicts Divorce, Gottman
(1994) addressed the role of disconnection in causing
unhappiness and marital failure. Gottmans (1994, 1999)
research indicates that it is not the number of arguments
partners have, nor their method of dealing with angry
feelings, nor even whether they successfully resolve disagreements, that makes a difference in defining success or
failure in a relationship. The defining factor is the ability to
sustain emotional engagement and to reconnect to each
other following arguments. Sometimes partners who fail in
these ways find they must choose between getting well or
staying married. Alternately, the willingness of one partner
to leave the relationship may be the only factor that
motivates the spouse to act differently. When denial,
repression, and withdrawal can no longer maintain an
unhappy stability and one partner suggests divorce, the
other (who has refused to go to counseling) may quickly
become the one who initiates treatment. In either of these
instances, genuine changes can be accomplished only
through a therapeutic reworking of unconscious early
attachment trauma.
Whatever went wrong in the childhood of each partner
will be tested in their intimate relationship. An earlier work

Clin Soc Work J (2009) 37:214223

presented a diagnostic schema for understanding the kinds

of imprinted patterns of relating, including a range of
disturbances and defenses that are seen in couples therapy
(Solomon 2001, pp. 138140). Those people who have a
resilient self can call on a variety of resources when they
are in stressful situations. In therapy, such people participate actively in the treatment, communicate needs and
distress, and are able to attune to the feelings communicated by a partner. At the other end of the continuum are
people who have developed anxious, avoidant, or disorganized insecure attachment patterns. They often begin
therapy with high levels of anxiety because of their fear
that unconscious emotions will break through.
Anxious attachment patterns manifest in pushpull
relationships in which the message is Dont come close
dont go away, which becomes apparent in therapy.
Because avoidant relationships are the result of early
expectations that others will not be available, a habitual
style of interacting develops that avoids stressful or disturbing emotional engagement with significant others. In
therapy, there is an avoidance of eye contact when entering
into dialog about unresolved issues, and physical as well as
emotional withdrawal can occur when emotionally laden
subjects come up. Those with a disorganized attachment
pattern protect a vulnerable self with defenses such as
aggressive distancing, emotional disconnection, repression,
projective and introjective identification, and explosive
discharge of affect. Disorganized attachments patterns are
usually the most disturbing for the individuals and create
the greatest distress in adult relationships. These patterns
also are reflected at times of confusion and emotional upset
in the therapeutic context (Solomon 2003, pp. 328329).

The Contribution of Neurobiology

In the past decade, we have begun to see new ways to
recognize and change locked-in, painful interactions
between partners and show how emotions and their regulationor lack thereofplay a role both in the dysregulation and the healing of these patterns. The answers rely
on understanding the interplay of the brain, mind, body,
and emotions in the dynamics of human relationships. The
neural circuitry underlying emotional bonds is now being
mapped out, as clinical psychologists, developmental
experts, and neuroscientists increasingly collaborate and
integrate the important knowledge that is rapidly becoming
available (Siegel et al. 2006). Research has shown that the
brain is a dynamic, connective, and socially seeking organ
(Siegel 1999). There is a neurological need for secure
attachment bonds that can provide a sense of safety and
emotional availability in times of distress and that remain
constant throughout the lifespan. Behavior, arousal, and


awareness are all organized simultaneously through an

interactive process that helps to solidify emotional bonding
and enables safe exploration of the environment.
In recent years, neuroscience has given us knowledge of
the brains plasticity and the transmitter circuits that can be
altered and redirected by our thoughts, feelings, beliefs,
relationships, and external life conditions (Doidge 2007).
Based upon knowledge of how the circuits in the brain
affect and are affected by past experiences, thereby coloring perceptions of current relationships, it is possible to
understand why people who meet, fall in love, and get
married can later come to see each other as the cause of
anxiety, distress, and danger. New situations reengage old
memory patterns. In milliseconds, subcortical processes
merge past and present emotional reactions. Feelings arise
that can influence the processes of reasoning and decision
Current research into the mind, brain, memory, and
cognition can inform the ways that clinical interventions
help intimate partners perceive and respond to each others
emotions and behaviors. These include helping the partners
distinguish feelings as they arise, connect emotions to
physiological reactions, and understand how protective
mechanisms developed out of necessity early in life may
have negative repercussions in current relationships. It is
important for partners to understand (a) how each developed unique patterns of attachment; (b) how early,
implicitly learned responses are recreated without conscious awareness in later relationships; and (c) how relational patterns are linked to the emotions and emotion
regulation, which in turn are linked to the physiology and
neurobiology that underlie behavior. If partners develop an
ability to view the other with what Siegel (1999) described
as mindsight (i.e., the ability to be with and see the other
person) and do not become critical of each others necessary survival traits, this understanding can be used to
create a climate for change.

Techniques of Attachment-Oriented Couples Therapy

An attachment-oriented therapist views many extreme
emotional responses in distressed couples as primal panic
or secondary reactive emotions to this panic. This differs
from other perspectives whereby these responses might be
seen as signs of immaturity, a lack of communication skill,
a personality flaw, or a sign of enmeshment in the
couples relationship.
So, how is attachment repair approached in couples
therapy? The clinical interventions found to be effective
in the treatment of trauma survivors have direct application
in attachment-oriented couples therapy. In his treatment
of trauma, van der Kolk et al. (1996) emphasized the



importance of the interpersonal process, noting that successful treatment of trauma victims changes the survivors
relationships with others. To achieve these results in individual or couples therapy requires (a) the provision of a
safe milieu to contain emotional outbursts, (b) an opportunity to preserve cognitive awareness in the face of intense
feelings, (c) enhancement of the capacity to connect to
ones core, and (d) the challenge to face the fear of true
closeness with others. Foshas (2003) treatment model is
based on the ability to resonate empathically with anothers
body states and to empathically attune on an intuitive,
nonverbal level. When a person is feeling safe with
another, a safety zone is created in which core emotions
can emerge. If longing for connection, sadness around
disconnection, and fear of showing vulnerability are
received and accepted, an opening in the defensive armor
occurs. The help of a therapist may be needed to facilitate
repeated safe openings.
In applying these models to the couples forum, the
therapists goal is one of interactive repair through a
conjoint therapeutic experience that facilitates enhancement of emotional, physical, and sexual intimacy. The
therapist can, through empathic modeling and promotion of
direct emotional communication, encourage creation of a
growth-facilitating environment that can complete the
interrupted developmental process of each. Under such
conditions it is possible to help partners affect a transformative experience in which each reconnects with dissociated or repressed emotions, and develops the capacity to
empathically attune to each other. Helping to facilitate
mutually satisfying sexual contact (i.e., with its opportunities for warmth and holding, eye contact, smell, and
taste) can play a significant role in re-attuning partners to a
novel sense of personal well-being. This can occur if the
partners have a history of secure attachments or if they are
helped in therapy to overcome the residue effects of trauma
in their early attachment experiences (Solomon 2003).

The Ongoing Process of Treatment

The goal of ongoing treatment is to find ways to help the
partners overcome the defensive maneuvers imprinted in
their early attachment experiences, break the cycle of
mutual hurt, and begin to create the bonding events that
distinguish successful couples. After allowing sufficient
time for the partners to present their view of the problems,
the therapist shares observations that help each partner
understand the pattern of their interactions. It is then possible to focus on normal attachment needs and the lifelong
yearning for physical and emotional contact. The couple
can learn to understand how early wounds and protective
defenses have developed into a unique interactional


Clin Soc Work J (2009) 37:214223

repertoire, which is replayed in all subsequent relationships. Depending on the ability to retain the information
without resorting to defenses, treatment can focus on what
one partner believed he or she had found in the other to
induce relational commitment. The therapist clarifies that
people often choose their most intimate relationships with
an unconscious wish to heal the past. If the couple has
difficulty with these ideas, it is important to see this not as a
sign of their resistance alone, but also perhaps the therapists failure to convey the message in a way that can be
receptively incorporated. If the message elicits shame and
this is not repaired, it leads to humiliation, self blame, and/
or strategies to defend a vulnerable core.
If the couple responds by utilizing and giving examples
of the ways their past has played out in their current relationship, it becomes possible to accelerate the healing
process. We shall see in the case that follows how the
therapist is able to help partners communicate primary
needs and yearnings, and encourage discussion of internal
beliefs and attitudes about self and other. In this process,
shameful feelings and negative emotional responses are
attended to and reframed as a positive path to the emergence of core affect (Fosha 2003). This allows expressions
of vulnerability and hurt feelings to be discussed in the
sessions. The therapists role is to redefine intense emotionality as important expressions of attachment failure, so
they can be carefully observed and hopefully healed in the
current relationship.

From Disruption to Repair

The therapist uses the relationship as a healing milieu and
encourages the partners to narrate how they came together,
what made them choose each other, and what they are
yearning for now. Together they explore the similarities
and differences in their memories and view of the relationship. Further probing helps them consider how the
current relationship is reminiscent of their historical
interactions. In the process, the couple can gain clarity
about how the reenactment of their early traumatic events
has, in fact, been part of their striving toward a reparative
experience. Reinforcing their ability to take in and utilize
this information, the therapist explains that, in selecting a
partner, each one seeks an intimate connection with
someone who resembles a significant parental figure.
Together, they develop a unit that engages in a dance of
attachment (Johnson 2008). The therapist can help them
see that it is the desire for intimate connection that provokes attachment yearnings and fears, sometimes leading
to angry protests, emotional withdrawal, or despair.
Both partners can be helped to understand their own
unresolved yearnings and their wishes for reparenting by

Clin Soc Work J (2009) 37:214223

the other. The result can lead to interdependency, rather

than a continued spiraling into mutual protective defensive
dance steps. Interdependency in intimate relationships is
the process by which each takes a turn as the benign
caretaker, particularly in stressful life conditions (Solomon
1994). As Kohut (1984) astutely noted, A good marriage
is one in which only one partner is crazy at any given time
(p. 210). An unhappy marriage is one in which only one
partner is allowed to regress, have needs taken care of, feel
emotions, and demand attention.
The therapist helps each partner acknowledge unresolved attachment needs, and process emotions with each
other present. In the process, partners become more exactly
aware of what occurs when needs feel unmet and of how
defenses emerge in a millisecond to protect the self from
unresolved pain. By helping in the process of holding the
painful emotion, instead of moving into numbing or acting
out defenses, there is a building of tolerance for core affect.
At that juncture, the defenses that keep them avoiding
emotion and each other can begin to diminish. The partners
begin to clarify similar and complementary needs, with the
therapist helping each to recognize and then empathize
with the others internal experience.
When the partners understand the active pattern of
vulnerability and defense, the therapist can begin to focus
on restructuring interactions. Intervention can include a
challenge to explore the here-and-now physiological and
emotional reactions of each mate and what these responses
represent. After reinforcing the idea that their very attempts
to protect themselves keep them locked in a distressed
pattern, the partners can see that, rather than creating a
nonthreatening relationship, the opposite has occurred and
is generating increasing alienation. Treatment, then, can
strengthen the emotional ties through suggestions that help
them to explore the experience of emotional engagement.
At this point, the partners may be able to access the
unacknowledged feelings that underlie their interactions.
With the therapist, they can begin to reframe their presenting problems in new terms. The therapeutic alliance
helps to provide a secure base from which hidden needs
and shameful feelings can emerge and be acknowledged.
This secure milieu offers a holding environment in which
frightening emotions, once experienced as too dangerous to
tolerate, are contained and detoxified. Modeling and identification with the therapist enhances the process of feeling,
dealing, and healing (Fosha 2003).

Case Example
The following case, an expanded version of which
appeared in Healing Trauma: Attachment, Mind, Body, and
Brain (Solomon 2003), illustrates an avoidant, disengaged


husband and a wife whose history indicated an ambivalent

attachment manifested by alternation between pursuit and
Beth and Phil are a couple in their late 50s whose two
daughters recently left home for college. The couple sought
marital therapy after Beth, who had always seen herself as
an ideal homemaker and caretaker, became very depressed
and sought individual treatment. After a year of psychotherapy and a series of unsuccessful attempts to get Phil to
listen and understand her needs, she decided that divorce
might be the answer to her longstanding unhappiness. This
motivated Phil to seek out marital therapy.
Phil had been a highly successful businessman until the
stock market plunge. He became semi-retired, but not by
his own choosing. The couple sold their large home and
purchased a smaller one, saying they needed less room for
just two. When their youngest daughter left for college,
Beth decided to open an art gallery. She was quite successful in her first endeavor, and opened a second gallery in
the resort community where the couple had a condo. After
a while, she found the business frustrating and was
unhappy about all the time they spent alone together in
their condo. Phil, on the other hand, wanted to go to the
condo every weekend because he was uncomfortable in
their new small home. When they came to couples therapy,
Beth was upset with Phil and expressed her unhappiness
repeatedly. Her upset was evident as she related her feelings, but Phil seemed mystified about what, if anything, to
do about it. His pattern of withdrawal was evident.
We began with a relational history, observing how they
present their own and listen to each others narratives. It is
important for the therapist to get a sense of how the partners particular cycle, in which each is both creator and
victim, has evolved.
Using a modified genogram, we discovered that both
Beth and Phil were youngest children in families that
had escaped Europe shortly before the Holocaust. Phils
father, a physician in his home country, did not have the
energy or the language skills to pass the US medical
boards, and worked at menial jobs for the rest of his life.
Phils withdrawal was a defensive response to his parents expectation that the family was supposed to stay
very closely attached because everyone else was a threat.
He became determined to succeed financially, and moved
three thousand miles from the rest of his family, while
the other three children stayed in the small town where
they grew up. Phil helped them all financially, but his
visits were rare. He described his family as wonderful
people, but always anxious, and found it difficult to
tolerate their unhappiness. His self-definition revolved
around his ability to maintain boundaries and avoid
the demands of his family. To get involved with their
emotions felt dangerous.



Beths family had moved from Europe to South America

in the 1930s. Although they avoided the direct trauma of
the Holocaust, they suffered through relatives who became
trapped. They helped more than a dozen family members
escape to the South American city where they lived. Beth
met Phil when she was on vacation in the US. Both
described it as a great love affair. After she and Phil
married, Beth went home twice yearly, for 3 weeks. She
described her parents as wonderful people who carried a
great sadness. Growing up, she saw it as her job to make
everyone feel good. Her self-concept was defined by how
well she kept her family together and happy. What
appeared altruistic was, in fact, self-serving, a process
described as the parentified child (Miller 1981).
Beth and Phil fit well together: the nurturing he needed,
she was inclined to give; what she needed, the creation of a
successful, close-knit family, she needed, he provided.
From their history, it was possible to draw some preliminary hypotheses regarding the insecurities and vulnerabilities underlying the position each partner took in the
relationship. As long as their life together worked well, the
traumas they carried from their family backgrounds, their
thwarted early attachment needs to define a self of their
own, and the resentments about unmet needs did not
emerge. It was only when the family dynamics changed,
their financial situation declined, and new pressures were
added, that underlying vulnerabilities began to destroy the
balance in their relationship.
When working with a distressed couple, it is important
for the therapist to encourage one partner, often the one
who appears more unavailable, to describe his or her
experience while staying connected with the other. When
Beth began to talk about her sadness, it was possible to
identify how Phil averted his face and his body from her.
Beths need for connection when she was most upset was
thwarted because he experienced it as a reflection of his
personal inadequacies or insensitivity; thus, his own pain
caused him to withdraw when he saw her sadness. The
following is an excerpt from a one-and-one-half hour session early in the couples therapy. A variety of interventions was used to form an alliance with the therapist, to
accelerate the couples ability to connect to their feelings,
and to connect the couples current relationship to past
Beth: Are you happy?
Phil: Yes, I am happy.
Beth: Well, then there is nothing to talk about.
Therapist: What are you feeling right now, Phil?
[Inquirypressure to feel]
Phil: Im frustrated. Nothing I do seems to help.
Therapist: What do you tell yourself about yourself and
your abilities?


Clin Soc Work J (2009) 37:214223

Phil: [Holds back tears] I cant solve this problem. I

cant even figure out whats wrong.
Therapist: You look so very sad when you say that, Phil.
Are there other feelings that go with your look?
[Pressure to feel]
Phil: [Begins to cry] Its not sadness; its hurt and anger.
Everything I do is wrong. So I try not to do anything, and
thats wrong, too. Beth says she wants me to be close.
But she really doesnt. She wants something amorphousI dont understand it. I just want a nice life. I
worked hard all my life.
Beth: You just want to do what you want. You dont go
where I want or do the things Im interested in.
Phil: Everything you want to do is here in town. You
know I want to get away to the beach.
Beth: You just sit there all weekend, waiting for me to
entertain you. I spent my life doing that. I am tired and
Phil: I just want to get away and have some peace. I
dont need you to be there to entertain me.
Beth: If you think that Im just talking about entertaining
you, than you dont understand anything Im saying to
you about what I need.
Phil: What are you saying to me about what you need?
Beth: Ive been telling you how I feel. You have to
figure out what to do. I cant do that for you. Ive been
doing my best, but if you cant do it, well maybe this
relationship is not for me for the rest of my life. I have to
think about what I want, with or without you.
Phil: [Winces and begins to turn away].
At this point, a connecting intervention from the therapist to link the couples current relationship with their past
was appropriate. Beth did not recognize that the cause of
her depression was not only Phils emotional unavailability, but also the burden of sadness she and her parents had
carried, which she had not been able to resolve. She had
learned early on how to take care of others in distress, but
had never found an outlet to safely express her own deep
well of sadness. Both Phil and Beth had re-created the
issues that dominated their families of origin, in which
sadness, loss, and grief were supposed to be handled by
children who do their best. Beth spent a lifetime as a
caretaker, while Phil tried to pull his family out of poverty
and despair by getting away and making enough money to
help everyone. Beth had learned in her family that when
someone is emotional, she could make it better, but now
she was feeling a lot of painful emotion and wanted Phil, to
make it better by reaching out and holding her, instead
of pulling away.
When Beth tried to express her emotions, Phil thought
she was asking him to read her mind. He did not know how
to do this and did not understand her needs. His self-image

Clin Soc Work J (2009) 37:214223

involved taking on a difficult task and overcoming the

odds, and it was frustrating to feel he had failed. In situations in which early attachment injury resurfaces, threatening what remains of the relational bond, the therapist
must help the couple stay in touch with the emotions
related to their injured feelings, and help them articulate
the impact of their present issues. The session continued
with the following excerpt.
Therapist: Beth, when you relate your needs and they are
not understood, what happens inside you? [Inquiry]
Beth: I think Ill have to spend the rest of my life feeling
alone. And it makes me angry.
Therapist: [Asks Beth to look at Phil and tell him
directly that what she wants is for him to reach out to her
when she tells him of her pain; Modeling new behavior]
And when he turns away, you get angry at him for
leaving you alone with your feelings. [Interpretation of
anger at abandonment]
Beth: [Turns to Phil and takes both of his hands] I need
you to put your arms around me and hold me and let me
cry for as long as I want to cry.
Phil: Its hard to stay with you when youre telling me
how sad I make you.
Beth: Do you think I blame you for my sadness?
Phil: Well, youre always telling me Im doing it wrong.
So I know Im making you sad. I dont know what to do
to fix it, so I feel terrible.
Beth: You think my sadness is about you.NoNo
Phil: [Puts his arm on her shoulder tentatively]
Therapist: You look almost afraid to reach out fully and
take Beth in your arms, Phil. Do you think she will turn
away or push you away? [Interpretation of fear, with
implied possibility of new behavior]
Phil: I dont know why I am afraid, but I am. [Puts both
arms around Beth and pulls her close, as she cries
Therapist: You look as though you are holding back
tears yourself, Phil.
Phil: [Cries softly as they hold each other]
By normalizing what was said as common unconscious
feelings, both Phil and Beth had a chance to explore the
impasses of their relationship. The approach illustrated in
this example is successful when the partners can avoid the
cycle of shame and blame, look at the underlying painful
feelings, and choose to feel them rather than defend against
them. The therapist, curious about which failures caused
regressive feelings to arise, has an opportunity to help the
partners translate feelings such as anger and fear into
deeper, underlying attachment needs that have been
thwarted. If emotions are allowed to emerge freely and are
explored in terms of the way the current situation recreates
painful experiences of the past, it is possible to see that


defenses that were an optimal response when the person

was a very young child are continuing now even though
they no longer are effective for the adult. Often, an
extraordinary sense of relief comes with knowing that these
feelings are transference from past figures and not a direct
response to the relationship. At this point, one or both
partners may become curious enough about themselves to
accept a needed referral to individual therapy. Beths
psychotherapy precipitated Phils call for marital therapy.
As they were finishing conjoint therapy, Phil asked for a
referral to individual psychotherapy for himself.

Changing the Patterns in an Intimate Relationship

It is often helpful to utilize an educational component in
couples therapy. The therapist first delineates conflictual
patterns and negative interactions. At that point, the therapist can help the couple examine the unconscious reflex to
protect against perceived and experienced wounds. When
the partners learn that each constructed an insufficient
image of how intimate attachments can work, the way is
opened for co-construction of a new narrative that will
work for both in their relationship.
Although individuals vary in their ability to understand
current developmental and brain research, it is important
for them to understand the ways in which early experiential
failures may be affecting their current relationship. It is
helpful for partners to understand that because traumatic
experiences are processed in the nonverbal right hemisphere, their earlier relationship trauma is, in fact, present,
but is beyond their awareness. This trauma is now denying
them access to an integrated biographical narrative, and is
instead part of their current unsatisfying narrative reenactment. The therapist helps the couple with self-reflection
through a series of inquiries into their narratives, adding
gentle pressure to explore feelings by query and by noting
physical responses and facial expressions.
In this attempt to guide attention toward the current
unconscious process, it is important that the therapy proceed with a spirit of inquiry, without blame or shame or
stigma. In this way, the therapist helps to lead the couple to
self-reflection about anxiety and defenses that have kept
core feelings out of awareness. By reconnecting to the
feelings that have kept them cut off from themselves and
cut off from each other, partners can restart their own
growth process and reengage with each other. By constantly teaching them what internal elements of their
behavior and emotions are hurting the other partner in the
relationship, the therapist reminds the partners of the
unfinished work that needs to be addressed. This process
provides opportunities to repair the structures of the self of



Clin Soc Work J (2009) 37:214223

Over a relatively short period of time of conjoint treatment, feelings that were previously experienced as intolerable, overwhelming, or dangerous are held and contained
in the therapeutic milieu. Partners increase the ability to
tolerate the intolerable, and develop the courage to face
what was once believed to be too unbearable to experience.
As they learn to respond behaviorally to one another in
ways that are different from those in past encounters, they
experience a new empowerment and increased selfawareness. Self-esteem is bolstered by the journey into the
abyss and the courageous encounter with inner sadness,
fear, rage, shame, and guilt.
The result of the therapy can be what Main (2002) called
earned secure attachment. When partners stances
toward attachment and defensive system are reorganized
and they have the opportunity to expand their intimate
relating, the ability to feel anger, grief, fear, and pain
unleashes the ability to feel love, joy, courage, and

process on childhood traumas can reinforce externalization

and can lead to projection and victimization. One of the
partners may have been victimized during childhood;
however, it is that persons responsibility to deal with his or
her feelings in the present. The therapists responsibility is
to help the partners uncover their feelings, express those
feelings, and learn to establish healthy boundaries.
We know that couples therapy been successful in
repairing insecure attachment when the partners not only
rediscover each other, but also discover for the first time
the needs and longings that brought them together in the
first place. The goal of successful treatment of those who
experienced trauma in their relationships is to recreate a
narrative in which the person is not a victim, but the author
of a new narrative in which he or she is in control of events
in his or her life. Ultimately, the goal is to restore the
normative growth of intimacy, empathy, understanding,
healthy dependency, and connection.



The bonds of love in an adult relationship represent an

accumulation of the loving attachments each individual has
developed early in life. However, if the primary attachment
relationship of one or both partners was disrupted during
childhood, emotional defense mechanisms likely will have
formed that inhibit their ability to connect. Couples therapy, then, is called on to explore the possibility of resurrecting in an adult love relationship the pre-traumatized
capacity to feel love, joy, and compassion.
Couples therapy helps the partners to become aware of
their own and their partners relational imprints. It helps
them to move beyond what otherwise will become an
endless cycle of shame and blame, and shows them they
can choose to stop acting defensively with each other. The
therapeutic process is directed toward building the level of
responsiveness associated with the emotional accessibility
and emotional engagement of a secure parent. Partners are
helped to understand their dependence on one another in
order to meet their needs for secure attachment, and are
encouraged to express emotions when attachment needs are
thwarted. When they begin to establish a stable, more
secure attachment bond in this relationship, the structures
of the core self are strengthened. Paradoxically, they have
less of a need to rely on the other as an external source of
Only if they are successful in this process of selfexamination, and are willing to tolerate the difficulties
inherent in breaking old patterns, will a couple be able to
establish their relationship on firm and lasting grounds.
One caveat: too much emphasis within the therapeutic


Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978).

Patterns of attachment: A psychological study of the strange
situation. Hillsdale, NJ: Erlbaum.
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles
among young adults: A test of a four-category model. Journal of
Personality and Social Psychology, 61, 226244.
Bowlby, J. (1998). A secure base: Parentchild attachment and
healthy human development. New York: Basic Books.
Doidge, N. (2007). The brain that changes itself. New York: Viking
Feeney, B. C. (2007). The dependency paradox in close relationships:
Accepting dependence promotes independence. Journal of
Personality and Social Psychology, 92, 268285.
Fonagy, P., & Target, M. (1997). Attachment and reflective function:
Their role in self-organization. Development and Psychopathology, 9, 679700.
Fosha, D. (2003). Dyadic regulation and experiential work with
emotion and relatedness in trauma and disorganized attachment.
In M. F. Solomon & D. J. Siegel (Eds.), Healing trauma:
Attachment, mind, body, and brain (pp. 221281). New York:
W. W. Norton.
Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A
test of the typological model. In J. A. Simpson & W. S. Rholes
(Eds.), Attachment theory and close relationships (pp. 77114).
New York: Guilford Press.
Gottman, J. (1999). The marriage clinic: A scientifically based
marital therapy. New York: WW Norton & Company.
Gottman, J. M. (1994). The relationship between marital process and
marital outcomes. New York: Basic Books.
Johnson, S. M. (2003). Introduction to attachment: A therapists guide
to primary relationships and their renewal. In S. M. Johnson &
V. E. Whiffen (Eds.), Attachment processes in couple and family
therapy (pp. 517). New York: The Gilford Press.
Johnson, S. M. (2008). Hold me tight: Seven conversations for a
lifetime of love. New York: Little Brown.
Johnson, S. M., Makinen, J., & Millikin, J. (2001). Attachment
injuries in couples relationships: A new perspective on impasses

Clin Soc Work J (2009) 37:214223

in couples therapy. Journal of Marital and Family Therapy, 27,
Kahn, M. (1963). Cumulative trauma. Psychoanalytic Study of the
Child, 18, 286306.
Kohut, H. (1984). In A. Goldberg, & P. E. Stepansky (Eds.), How
does analysis cure? Chicago: University of Chicago Press.
Main, M. (2002). The history of attachment. Paper presented at
Attachment from Early Childhood Through the Lifespan, Los
Angeles, CA.
Makinen, J., & Johnson, S. M. (2006). Resolving attachment injuries
in couples using EFT: Steps towards forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74, 1055
Mikulincer, M., Florian, V., & Weller, A. (1993). Attachment styles,
coping strategies, and posttraumatic psychological distress: The
impact of the Gulf War in Israel. Journal of Personality and
Social Psychology, 64, 817826.
Miller, A. (1981). The drama of the gifted child. New York: Basic
Neborsky, R. (2003). A clinical model for the comprehensive
treatment of trauma using an affective experiencing-attachment
theory approach. In M. F. Solomon & D. J. Siegel (Eds.),
Healing trauma: Attachment, mind, body, and brain (pp. 282
321). New York: W. W. Norton.
Neborsky, R., & Solomon, M. F. (2001). Attachment bonds and
intimacy: Can the primary imprint of love change? In M. F.
Solomon, R. J. Neborsky, & L. McCullough (Eds.), Short-term
therapy for long-term change (pp. 155185). New York: W.W.
Schore, A. N. (1994). Affect regulation and the origin of the self: The
neurobiology of emotional development. Hillsdale, NJ: Lawrence
Schore, A. N. (2003). Affect regulation and the repair of the self. New
York: W. W. Norton.
Senchak, M., & Leonard, K. (1992). Attachment style and marital
adjustment among newlywed couples. Journal of Social and
Personal Relationships, 9, 5164.
Shaver, P. R., & Clark, C. L. (1994). The psychodynamics of adult
romantic attachment. In J. M. Masling & R. F. Bornstein (Eds.),
Empirical perspectives on object relations theories (pp. 105
156). Washington, DC: American Psychological Association.
Siegel, D. J. (1999). The developing mind: Toward a neurobiology of
interpersonal experience. New York: Guilford Press.

Siegel, D. J. (2003). An interpersonal neurobiology of psychotherapy:
The developing mind and the resolution of trauma. In M. F.
Solomon & D. J. Siegel (Eds.), Healing trauma: Attachment,
mind, body, and brain (pp. 156). New York: W. W. Norton.
Siegel, D. J., Porges, S., Tronick, E., van der Hart, O., van der Kolk,
B., Schore, A. N., et al. (2006). The embodied mind: Integration
of the body brain, and mind in clinical practice. Los Angeles,
CA: Lifespan Learning Institute.
Simpson, J. A., Rholes, W. S., & Nelligan, J. S. (1992). Support
seeking and support giving within couples in an anxietyprovoking situation. Journal of Personality and Social Psychology, 62, 434446.
Simpson, J. A., Rholes, W. S., & Phillips, D. (1996). Conflict in close
relationships: An attachment perspective. Journal of Personality
and Social Psychology, 71, 899914.
Solomon, M. F. (1994). Lean on me: The power of positive
dependency in intimate relationships. New York: Simon &
Solomon, M. F. (2001). Breaking the deadlock of marital collusion. In
M. F. Solomon, R. J. Neborsky, & L. McCullough (Eds.), Shortterm therapy for long-term change (pp. 130154). New York:
W.W. Norton.
Solomon, M. F. (2003). Connection, disruption, repair: Treating the
effects of attachment trauma. In M. F. Solomon & D. J. Siegel
(Eds.), Healing trauma: Attachment, mind, body, and brain (pp.
322346). New York: W. W. Norton.
van der Kolk, B. A., McFarlane, A., & Weisaeth, L. (Eds.). (1996).
Traumatic stress: The effects of overwhelming experience on
mind, body, and society. New York: Guilford Press.

Author Biography
Marion F. Solomon is the Director of Clinical Training, Lifespan
Learning Institute; Senior Extension Faculty, Department of Humanities, Sciences and Social Sciences at UCLA. Author of Narcissism
and Intimacy and Lean on Me; Co-editor of Healing Trauma,
Countertransference in Couples Therapy, and The Healing Power of