Psychotherapy with People who have Disorganised Attachment Patterns in a Psychodynamic and Attachment Theory Informed Setting

Abstract

The story of my work with a woman who has a dissociative disorder is presented from an attachment perspective. Someone with a disorganised/disoriented attachment status requires a different approach. Within an attachment and psychoanalytic psychotherapy approach I describe how by centring on issues of selfregulation (dissociative withdrawal) and interactive regulation, when the patient was in a highly helpless and frightened state, an enactment emerged that mirrored the interactions she had had with her parents. Within our growing mutual understanding of the mosaic of the transference–countertransference matrix a pattern was discernible: each time the therapist felt pressured to act she was caught in a repetition of earlier frightening and perverse relationships. Thinking and reflecting on these enactments enabled the patient to differentiate between past and present and helped her to verbalise her unmentalized feelings.