Robert T. Muller - Trauma and the Avoidant Client: Attachment-Based Strategies for Healing

I dont want to pretend , I dont want to take part in the grand social conspiracy that makes widows tell strangers on the bus that it was his time, or makes parents of buried children say, Well, were just happy we had her for as long as we did, or that in any other way makes any of us pretend that were not furious about the double-edged broadsword of life and death. (Scott Peck, All-American Boy, 1995, p. 91)

T his book begins with a few simple questions. How do you engage the client who pretends, the client who denies and minimizes the effects of her own cruel past? How do you help the vulnerable individual who cannot admit to her own vulnerabilities? How do you work with the trauma survivor who is not so sure that she wants to be helped?

For the clinician who is seeking a therapeutic connection, who is attempting to engage the client, there is no question that such a person is hard to treat. In fact, it may be tempting instead to write off individuals such as these as treatment resistant or to refer them to others. Perhaps this, in part, is why the development of specific intervention strategies for this clinical population has been rather slow moving. Although there is much written about the frustrations of working with such clients, there is far less that can actually be used as a practical guide to treatment.

Earlier in my career, when I was still on faculty at the University of Massachusetts, I attended a talk delivered by a colleague at a meeting of the Society for Family Therapy and Research. Higgins (1994a) described her findings on a group of resilient adults who had managed to overcome the effects of their traumatic histories. I was so intrigued by this talk that the topic of resilience among trauma survivors came to shape my earlier academic interests. A positive sense of the human spirit can be inspiring. However, as I did more and more clinical work with adults who had experienced intrafamilial trauma and as I received training in attachment theory and assessment, I came to realize that the story is actually much more complicated than I had previously thought: A good many trauma survivors pretend to be doing a lot better than they really are. They pretend for years on end. They pretend for others, and they pretend for themselves. And, the individual who pretends to be okay (but who is otherwise in need of help) is in fact hard to treat.

This book is about the psychotherapy of trauma. Attachment-related traumatic experiences, intrafamilial abuse or neglect, and traumatic losses are the primary traumatic stressors considered. In each of the cases presented, an important trust has been violated. Thus, fundamental to this work is the development of a strong therapeutic alliance to ultimately help the client regain a sense of trust in others. The treatment approach is attachment oriented and psychodynamic. It uses the therapeutic relationship as a means of understanding the individuals relational difficulties and compensatory mechanisms. The client is encouraged to take interpersonal risks, to express feelings he would normally keep buried, to mourn losses, to face his vulnerabilities. A lot of personal digging is asked of the clinician as well. One of the more dense chapters (Chapter 6) focuses on therapist countertransference. Treatment choices in this work are often mediated by the clinicians own attachment history and pattern of vulnerability.