attachment & cognitive therapy patricia m. crittenden, ph.d. © patricia m. crittenden, 2005

Attachment & Cognitive Therapy

Patricia M. Crittenden, Ph.D.

© Patricia M. Crittenden, 2005

Four Growing Points

1. Symptoms: diagnoses & treatment

1. Emphasis on “cognitive” rational & verbal processes

1. Model of psychological functioning & psychopathology

1. Evaluation of harmful effects of psychotherapy


Symptoms

• Distress = patient’s perspective

• Diagnosis = professional’s perspective

• Self-protective strategies

• Behaviors can serve many functions


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


“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


“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


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


Memory SystemsTemporal Order

(Cognition)

Procedural

Semantic

Intensity(Affect)

Imaged

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


Arousal Scale1. Anxiety

• Pain • Sexual Desire• Fear• Anger• Desire for comfort

2. Comfort

3. Depression• Boredom • Tiredness• Sleep• Unconsciousness


Transformations

Sensory stimulation

Transformations of information

Dispositional representations

Enacted behavior


The only information that we have is information about the past

whereas

The only information that we need is information about the future.


Transformations of Information

• True

• Erroneous

• Omitted

• Distorted

• Falsified


Ty

pe

of

Tra

ns

form

ati

on

of

Info

rma

tio

n

False

True

Integration of Cognitive and Affective Information AffectiveCognitive


Omits Affect

Cognitively Distortsby Simplification

IntegratedTrue Cognition-True

Affect AffectivelyOrganized

CognitivelyOrganized

Omits Cognition

Affectively Distorts

by Simplification

Ty

pe

of

Tra

ns

form

ati

on

of

Info

rma

tio

n

False

True



Adaptive in SafeContexts, but

Otherwise Maladaptive

Omits Affect

Cognitively Distortsby Simplification

Adaptive in Dangerous

Contexts, but Otherwise

Maladaptive


Affect AffectivelyOrganized


Increasing Risk of Mental Health

Problems


Problems



Omits Cognition


by Simplification



Maladaptive

Ty

pe

of

Tra

ns

form

ati

on

of

Info

rma

tio

n

False

True





Omits Affect

Cognitively Distorts

by Simplification



MaladaptiveAAnti@ Integrated

False Cognition-False Affect


Affect

Various CoerciveC+ Strategies

Various CompulsiveA+ Strategies

Type CCoercive/

Enmeshed(Anxious Ambivalent)

Type ADefended/

Disengaged(Anxious Avoidant)

Type A+/C+Unintegrated

Cognitive/Affect

Type BBalanced/

Secure

Type A+C+Psychopathy

AffectivelyOrganized


ReactiveReserved


Problems


Problems



Omits Cognition


by Simplification



Maladaptive

Ty

pe

of

Tra

ns

form

ati

on

of

Info

rma

tio

n

False

True



A Dynamic-Maturational Model of Patterns of Attachment in Adulthood

False Affect

Cognition(Type A)

Affect(Type C)

Integrated False Information(Type A+C+)

Integrated True Information(Type B)

True Cognition

Compulsively Caregiving/Compliant

Delusional Idealization/Externally

Assembled Self

Compulsively Promiscuous/Self-Reliant

Socially Facile/Inhibited

ComfortableB3

ReservedB1-2 B4-5

Reactive

A1-2

A3-4

A7-8

A5-6

C7-8

C5-6

C3-4

C1-2Threatening/

Disarming

Aggressive/Feigned Helpless

Punitive/Seductive

Menacing/ParanoidAC

Psychopathy

A/C

True Affect

False Cognition© Patricia M. Crittenden, 2005

Treatment Outcomes

• There could be harmful effects

• Cognitive & affective strategies are psychological opposites

• They might need opposite treatments


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.


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.


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attachment & cognitive therapy patricia m. crittenden, ph.d. © patricia m. crittenden, 2005

Documents

images patricia

behavior patricia

vulnerability patricia

functions patricia

listener patricia

safe conditions patricia

true cognitiontrue affect

symptom competence