The Role of Attachment in Shaping Core Beliefs and Interactions in Therapy: A Case Study

Abstract

Lawrence Tan Kok Kah

This paper explores a case study (which is , in reality, a composite of several real cases to protect client confidentiality) through the lens of Brennan, Clark & Shaver’s (1998) work on the dimensional model of attachment and Marmarosh, Markin & Spiegel’s (2013) work on attachment styles of individuals playing out in group work [1,2]. It is especially interesting to retrospectively re-look at the case, explore new possibilities and hypothesise different outcomes as a result. X is a 32/ Male/ Chinese referred to me by the hospital psychiatrist one year ago for the management of generalized anxiety disorder and major depressive disorder. X was first presented to the hospital in 2013 for the management of his benzodiazepine use and was placed on a long-term therapeutic and monitored dose of dizapam by the psychiatrist subsequently. In my intake interview with X, he disclosed that his mother was both verbally and physically abusive towards him when he was a young child while his father was often absent in his life. X elaborated that his father was a fairly successful businessman at that time and would often attempt to compensate for his absence by showering him with expensive gifts and being extra permissive with him whenever he was around. X mentioned that while he appreciated the presence of his father, he also felt resentful towards him deep inside. X was angry with his father for not protecting him and allowing the “atrocities” to continue (father stayed out of the situation between X and his mother). A part of him believed that the “niceness” of his father had a selfish motive underneath; so that he would not have to feel so guilty about being absent. X remembered mother being frustrated all the time and nothing he did would please her. His grades and subsequent careers he ventured into were never good enough for her and the focus was often on his shortcomings rather than his strength. X added that he grew up believing that the world is harsh and critical and people would either put him down and reject him or be nice to him because they had a secondary agenda. As a result, X often talked about his disdain for people around him and how they are likely to “reject and abandon him” after that have completely sucked the life out of him. As a result, he lived his adult life “as if” this was always going to happen to him, demonstrated by his tendencies to be, outwardly giving and accommodating in his relationships, often to the point of subjugating his needs, being hypersensitive to signs of rejection and lack of reciprocation to his giving and resentful over his partners not “playing their part” when he expected them to meet his emotional needs. He reported a pervasive pattern of being perceived as overly-clingy, calculative and hard to please by a number of partners he used to be in a romantic relationship with. He also talks about how this has reinforced his world view that people are generally cold, unappreciative and impossible to satisfy, just like his mother. If they were to be nice to him for any given periods, it must be because they wanted “something” from him and once he “fell into their trap”, they would eventually “betray” and “leave him high and dry”, just like his father. According to X, his anxiety and depression became unmanageable when his last girlfriend left him 3 years ago. X says that he became increasingly insecure and suspicious about people around him and these fears eventually transcended into other areas of his life, which resulted in him becoming increasingly isolated, lonely and depressed. He oscillates between talking about the yearning for connection and feeling fed up with not getting what he wants and swinging onto the other extreme of isolating himself and “running away” when people in his life attempted to get close to him because “they are going to hurt him anyway”.

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