Attachment & Cognitive Therapy

Patricia M. Crittenden, Ph.D.

© Patricia M. Crittenden, 2005

 Four Growing Points
1. Symptoms: diagnoses & treatment

2. Emphasis on “cognitive” rational & verbal

processes

3. Model of psychological functioning &

psychopathology

4. Evaluation of harmful effects of psychotherapy

© Patricia M. Crittenden, 2005
 Symptoms
• Distress = patient’s perspective

• Diagnosis = professional’s perspective

• Self-protective strategies

• Behaviors can serve many functions

© Patricia M. Crittenden, 2005

 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
 “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

 “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

 “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

 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

 Memory Systems
Temporal Order Intensity
(Cognition) (Affect)
 
Procedural Imaged
 
Semantic Connotative Language


Episodic

Reflective Integration
© Patricia M. Crittenden, 2005
 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

 Arousal Scale
1. Anxiety
• Pain
• Sexual Desire
• Fear
• Anger
• Desire for comfort
2. Comfort
3. Depression
• Boredom
• Tiredness
• Sleep
• Unconsciousness
© Patricia M. Crittenden, 2005
 Transformations
Sensory stimulation

Transformations of information


Dispositional representations

Enacted behavior
© Patricia M. Crittenden, 2005
 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

 Transformations of
Information

• True
• Erroneous
• Omitted
• Distorted
• Falsified
© Patricia M. Crittenden, 2005
 True
Type of Transformation of Information

False
Cognitive Integration of Cognitive and Affective Information Affective

© Patricia M. Crittenden, 2005

 True Integrated
True Cognition-True
Cognitively Affect Affectively
Organized Organized
Type of Transformation of Information

Cognitively Distorts
Affectively Distorts
by Simplification
by Simplification

Omits Cognition
Omits Affect

False
Cognitive Integration of Cognitive and Affective Information Affective

© Patricia M. Crittenden, 2005

 True Integrated
True Cognition-True
Cognitively Affect Affectively
Organized Organized

Adaptive in Safe Adaptive in Safe

Contexts, but Contexts, but
Otherwise Maladaptive Otherwise Maladaptive
Type of Transformation of Information

Cognitively Distorts Affectively Distorts

by Simplification by Simplification

Omits Affect Omits Cognition

Adaptive in
Dangerous Adaptive in
Contexts, but Dangerous
Otherwise Maladaptive Contexts, but
Otherwise Maladaptive

Increasing Risk of Increasing Risk of

Mental Health Mental Health
Problems Problems

False
Cognitive Integration of Cognitive and Affective Information Affective

© Patricia M. Crittenden, 2005

 True Integrated
True Cognition-True
Cognitively Affect Affectively
Organized Organized
Type B
Balanced/
Secure

Reserved Reactive
Adaptive in Safe Adaptive in Safe
Contexts, but Contexts, but
Otherwise Maladaptive Otherwise Maladaptive

Affectively Distorts
Type of Transformation of Information

Type A Type C
Defended/ Type A+/C+ Coercive/ by Simplification
Cognitively Disengaged Unintegrated Enmeshed
Omits Cognition
Distorts (Anxious Avoidant) Cognitive/Affect (Anxious Ambivalent)
by Simplification
Omits Affect
Adaptive in
Various Compulsive Various Coercive Dangerous
C+ Strategies Contexts, but
A+ Strategies
Otherwise Maladaptive

Increasing Risk of Increasing Risk of

Adaptive in Mental Health Type A+C+ Mental Health
Dangerous Problems Psychopathy Problems
Contexts, but
Otherwise Maladaptive AAnti@ Integrated
False Cognition-False Affect
False
Cognitive Integration of Cognitive and Affective Information Affective

© Patricia M. Crittenden, 2005

 A Dynamic-Maturational Model
of Patterns of Attachment in Adulthood

True Cognition Integrated True Information

True Affect
(Type B)
B3
Comfortable
B1-2 B4-5
Reserved Reactive

A1-2 C1-2
Socially Facile/ Threatening/
Inhibited Disarming

Cognition A3-4 A/C C3-4 Affect

Compulsively Aggressive/
Caregiving/
(Type A) Compliant
Feigned Helpless
(Type C)
A5-6 C5-6
Compulsively
Promiscuous/ Punitive/
Self-Reliant A7-8 Seductive
Delusional
Idealization/
C7-8
Menacing/
Externally
Paranoid
Assembled
Self
AC
Psychopathy

Integrated False Information

False Affect (Type A+C+) False Cognition
© Patricia M. Crittenden, 2005
 Treatment Outcomes
• There could be harmful effects

• Cognitive & affective strategies are

psychological opposites

• They might need opposite treatments

© Patricia M. Crittenden, 2005

 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

 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

 This talk can be down-loaded from:

www.patcrittenden.com

© Patricia M. Crittenden, 2005