Trauma and dismissing (avoidant) attachment: Intervention strategies in individual psychotherapy

Intrafamilial trauma is known to be associated with mental health-related challenges that place the individual at risk for the development of psychopathology. Yet, those trauma patients who are primarily dismissing (avoidant) of attachment also demonstrate significant defensiveness, along with a tendency to view themselves as independent, strong, and self-sufficient. Paradoxically, such patients present as highly help rejecting, despite concurrent expressions of need for treatment and high levels of symptomatic distress. Consequently, working with such individuals in psychotherapy can present a number of challenges. Prior theory and research has suggested that therapeutic change may be facilitated through direct activation of the attachment system and challenging defensive avoidance. Treatment strategies for working with this population are presented along with illustrative case examples. Such strategies include addressing the "I'm-no-victim" identity, using symptoms as motivators, noticing and using ambivalence, and, finally, asking activating questions around themes of caregiving and protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved).