Interpersonal Process: A Therapist’s Framework for Healing Attachment

Someone recently asked me why they needed to know about the interpersonal process. There seemed to be a misunderstanding that the interpersonal process is only focused on building rapport, when stronger rapport is, in fact, a byproduct of the interpersonal process. If you have similar questions about how or why this framework could strengthen your practice, read on.

Interpersonal Process as a Framework

It is important to know that the interpersonal process is not a new theory or technique. Instead, it is a framework that can be integrated with any modality you want to use. You lay your favorite theory or technique upon this framework. This makes the interpersonal process not only versatile, but the cornerstone of any practice in which it’s used. Your modality can change based on individual needs, but the framework stays consistent.

Keep in mind that the interpersonal process comprises three core components: process dimension, corrective emotional experience, and client response specificity. Of these three, process dimension is what this article will focus on.

The Cognitive Domain: A Crucial Component of Process Dimension

Tyber and McCluer identify three domains that make up the process dimension: the cognitive domain, interpersonal domain, and familial/contextual domain. While interpersonal domain addresses how a person experiences attachment brokenness, and the familial/contextual domain is where this brokenness is reinforced, the cognitive domain is at the origin of an person’s attachment brokenness.

The cognitive domain addresses the practical application of much of the attachment research that has been done. Under the cognitive domain, we identify the origin of the attachment style a person had or has with their primary caregiver. As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Therapists use these subcategories of the cognitive domain to identify attachment brokenness that occurred in response to real life experiences. To understand the importance of healing attachment brokenness using the interpersonal process framework, let us first look at how we treat attachment brokenness in children.

The Experiential Approach in Action: Play Therapy, Theraplay, and the Neurodeck

Becoming a registered play therapist requires candidates to spend 15 hours in training that specifically address attachment and how to build, repair, and strengthen a child’s ability to attach to a primary caregiver. But what is the common theme between attachment play therapy, theraplay, and the Brain Booster Neurodeck? Simply put, the common thread in these three modalities is an experiential approach. Healthy attachment is developed through experience, not reframing.

As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Play Therapy

In play therapy, clinicians provide experiences that support healthy, safe touch through activities such as foil hand prints, lotion on hands or feet, holding hands during activities, or working together on a task. All these activities encourage safe touch and eye contact. Eye contact in particular is important for our limbic systems to communicate and bond, as we learn from clinicians such as Curt Thompson or Louis Cozolino. Communication between our limbic systems is nonverbal; hence, the importance of eye contact.

Theraplay

Theraplay is also quite experiential; in fact, it may be the most experiential of all the methods listed. Attachment brokenness is healed through re-experiencing the attachment-building interactions that were not provided (or were insufficiently provided) during the first years of life, such as eye contact made when a baby is fed and swaddled. In some cases, the child needs to be cuddled or rocked as they would have been as an infant, a process that is exceptionally experiential. It may also be that a traumatic event broke an initially secure attachment, in which case Theraplay is utilized to re-establish the previously secure attachment style.

The Neurodeck

The Neurodeck comprises activities that build the brain from the bottom up. It begins with activities that assist with sensory integration, utilizing many of the same type of activities used in other attachment play therapy techniques. These experiential approaches harness messy play and movement. For example, they may use the lotion activity mentioned above or swing a child in a blanket to mimic the rocking movements experienced in utero. As a clinician moves through the deck, the activities become increasingly relational. This is the attachment component of the Neurodeck approach.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics.

The deck specifically states that certain activities should be completed in a one-on-one context before they are used them in a group setting. The one-on-one context is important in establishing safety before engaging in group work. Attachment work is rooted in laying a foundation for understanding safe and unsafe characteristics in relationships through a one-on-one dynamic. This dynamic then informs the safety of other relationships, especially relationships in a group setting. Each phase in the protocol is experiential and progressive.

Addressing Attachment in Adults

It is evident how attachment work in children is achieved through experiential modalities. The same can be said for attachment work with adults. The cognitive domain mentioned above is at the root of an person’s attachment brokenness, while the interpersonal domain is where attachment brokenness is experienced, and the familial/contextual domain is where the brokenness is reinforced. Through our work as therapists, we provide an experiential repair for broken attachment that is evaluated through interpersonal skills. A person’s maladaptive interpersonal skills provide a wealth of information about what happened in the cognitive and familial domains, as well as crucial information for effective treatment planning.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics. Are they interacting in healthy ways that allow people to draw near to them and create a desire for others to be in a healthy relationship with them, or are they fracturing relationships unknowingly because they lack the awareness or skills to build healthy relationships? Sharing our experience of an person’s behaviors or words can help them develop self-awareness and contemplate whether they are communicating what they intend. This approach can also help with reality testing.

Strengths of Interpersonal Process

One strength of the interpersonal process framework is the way it helps build flexibility and other-focused awareness, which allows for healthy attachments and navigating unhealthy relationships more confidently and constructively. By highlighting awareness of how a person’s communication might be perceived by others, we broaden their understanding of themselves and of others. Maintaining a broader range of interpersonal understanding ideally increases a person’s window of tolerance in their relationships and creates a desire to repair a broken healthy attachment or confidently sever an unhealthy attachment. The individual becomes better equipped to advocate for positive change in their life through a strengthened commitment to repair healthy relationships or by valuing themselves enough to part ways with unhealthy relationships without behaving destructively.

The Effective Interpersonal Process Clinician

A provider who effectively uses interpersonal process reflects truths to people that help them feel heard and known so they may heal. Those on the receiving end of these truths may not always like what they hear. However, when they work with an empathic and skilled therapist, people can hear and understand their therapist’s reflections, even if they do not like what is said.

At the appropriate level of reflection, people learn to trust their therapist. Feeling known and understood improves rapport. In this context, rapport is equivalent to attachment. A grounded relationship with an effective interpersonal process therapist is emotionally supportive so people may engage in difficult, effective therapy that greatly improves treatment outcomes.

Reference:

Teyber, E., & McCluer, F. H. (2010). Interpersonal process in therapy: An integrative model (6th ed). Belmont, CA: Brooks/Cole.

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