{"id":43082,"date":"2024-04-11T10:13:40","date_gmt":"2024-04-11T14:13:40","guid":{"rendered":"https:\/\/www.goodtherapy.org\/blog\/?p=43082"},"modified":"2024-04-10T10:15:18","modified_gmt":"2024-04-10T14:15:18","slug":"what-am-i-missing-part-1-defining-the-problem-and-attachment-theory","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/what-am-i-missing-part-1-defining-the-problem-and-attachment-theory\/","title":{"rendered":"What am I missing? Part 1: Defining the Problem and Attachment Theory"},"content":{"rendered":"<p><b><span data-contrast=\"auto\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-43119 size-medium alignleft\" src=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/AdobeStock_673804581-300x200.jpeg\" alt=\"GoodTherapy | What am I missing? Part 1: Defining the Problem and Attachment Theory\" width=\"300\" height=\"200\" title=\"\" srcset=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/AdobeStock_673804581-300x200.jpeg 300w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/AdobeStock_673804581-800x533.jpeg 800w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/AdobeStock_673804581-1536x1024.jpeg 1536w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/AdobeStock_673804581-2048x1365.jpeg 2048w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>\u201cwhat am I missing; I keep relapsing and don\u2019t know why I have such a difficult time remaining clean and sober?\u201d<\/span><\/b><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><span data-contrast=\"auto\">How we treat <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/addictions-and-compulsions\">addiction in treatment<\/a> must change.\u00a0 The idea that we can provide information and teach an individual how to remain clean and sober is a fallacy.\u00a0 Most addicts and alcoholics are above average in intelligence and the question is <\/span><i><span data-contrast=\"auto\">\u201cDon\u2019t you think if they could be <\/span><\/i><b><i><span data-contrast=\"auto\">taught<\/span><\/i><\/b><i><span data-contrast=\"auto\"> how to stop destroying their life they would merely read a book and the problem would be eliminated?\u201d<\/span><\/i><span data-contrast=\"auto\">\u00a0 The answer is \u201cOf Course.\u201d Who would choose to drink, drug, or addictively act out knowing their life is over if they do?\u201d\u00a0 Nobody.\u00a0 Thus, people know and they still partake in these behaviors.\u00a0 <\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{}\">\u00a0<\/span><span data-contrast=\"auto\">Therefore, the answer is not merely education.\u00a0\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Facts:<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"1\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">9% of the U.S. population meets the criteria for <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/drug-and-substance-abuse\">substance use disorder<\/a> (SUDs) (Substance Abuse and Mental Health Services Administration 2010);<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"1\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Drug-related suicide attempts increased by 41% from 2004-2011 (Drug Abuse Warning Network (DAWN);<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"1\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Therapeutic alliance is one of the greatest predictors of positive treatment outcomes (Straussner, 2012).<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><b><i><span data-contrast=\"auto\">\u201cUntil an addict or alcoholic develops the capacity to establish mutually satisfying relationships, they will remain vulnerable to relapse and the continual substitution of one addiction for another (Phillip Flores)<\/span><\/i><\/b><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<h2><b><span data-contrast=\"auto\">What is Attachment Theory?<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/h2>\n<p><b><i><span data-contrast=\"auto\">\u201cMost of the psychopathology seen in the alcoholic is the result, not the cause of alcohol abuse.\u201d (Valiant, 1983).<\/span><\/i><\/b><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">If we don\u2019t begin treating the problem, which quite possibly stems from a lack of secure attachment modeled during childhood, as opposed to the solution, addictive behavior, we can count on continued treatment failure, often called resistance to treatment.\u00a0 Resistance to treatment seems to be a way of saying it\u2019s the patient\u2019s fault not ours.\u00a0 Therefore, we put the cart before the horse.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-43118 alignleft\" src=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/Attachment-Article-part-1-docx-300x216.png\" alt=\"\" width=\"413\" height=\"297\" title=\"\" srcset=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/Attachment-Article-part-1-docx-300x216.png 300w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/Attachment-Article-part-1-docx-800x575.png 800w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2024\/04\/Attachment-Article-part-1-docx.png 940w\" sizes=\"auto, (max-width: 413px) 100vw, 413px\" \/><\/p>\n<p><b><span data-contrast=\"auto\">The result of putting the cart before the horse is the following:<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">We admit a patient to treatment with distorted definitions of concepts learned as a child, i.e., honesty, hope, faith, courage, integrity, willingness, humility, brotherly love, discipline, perseverance, awareness, service<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">The patient learned these definitions from their caregiver or parent from the models presented to them as children.\u00a0\u00a0<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">How would the patient know these definitions are potentially dysfunctional if it is all they know?<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">How effective will step work be if the patient doesn\u2019t have a model or healthy definition of what the principles of the steps espouse?\u00a0\u00a0<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Attachment theory assumes that the experience of childhood relationships shapes adult attachment styles.\u00a0 These experiences create the road map or internal working model for how the individual will perceive himself and others relationally (Bowlby, 1973).\u00a0\u00a0<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The basic premise is that <\/span><i><span data-contrast=\"auto\">we only know what we know.<\/span><\/i><span data-contrast=\"auto\">\u00a0 For example, two men are sitting in the park discussing zoo animals.\u00a0 The one man asks the other if he has ever seen an elephant, to which the other man replies \u2018no, what does it look like?\u2019\u00a0 The man states, \u2018it is a large grey animal that has four hoofs, rough skin, floppy ears and trunk in the front\u2019.\u00a0 The other man states \u2018you mean like the tree trunk outside?\u2019\u00a0 The man replies \u2018no, not a tree trunk\u2019.\u00a0 To which many asks \u2018You mean like the trunk of my car?\u2019\u00a0 The point is that the man will only know what an elephant looks like if he sees a picture or goes to the zoo.\u00a0 Similarly, if a child grows up with caregivers who are physically present although not emotionally present, thus, lacking a functional definition of emotional availability and <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/intimacy\">intimacy<\/a>, the child is more likely to have a stunted view of being emotionally present for others in their life.\u00a0 It is very possible that when this child becomes an adult, their innate need for secure attachment will not be met unless they see a model of what healthy attachment looks like.<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The basic principle of <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/types\/attachment-based-family-therapy\">Attachment Theory<\/a> is that those with secure attachment (stronger emotional relationship with caregiver) are better able to regulate emotions and have fewer relationship problems.\u00a0 However, <\/span><b><i><span data-contrast=\"auto\">disruptions in the attachment system (insecure attachment) can lead to vulnerabilities in the sense of self and others as well as relationship problems; thus, leading to shame, co-dependency, and a need to numb pain via addictive behavior.<\/span><\/i><\/b><span data-contrast=\"auto\">\u00a0 Therefore, if we don\u2019t address and model secure attachments to patients, they will stay stuck in the solution of continuously seeking to avoid and discharge pain through addictiveness.\u00a0 <\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{}\">\u00a0<\/span><span data-contrast=\"auto\"><span class=\"TextRun SCXW172759206 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"auto\"><span class=\"NormalTextRun SCXW172759206 BCX0\">Research <\/span><\/span>suggests that <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/relationships\">relationships influence<\/a> brain development and \u201crelationships have the capacity to rebuild certain parts of the brain that influence social and<a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/emotion\"> emotional lives<\/a>; clinicians can help clients to alter their attachment patterns with a secure clinical relationship.\u00a0 (Miehls, 2011, p. 82).\u00a0 <\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The bottom line in defining Attachment Theory is that the goal of treatment needs to be focused on changing the definition and model of what it means to feel included, loved, and secure.\u00a0 <\/span><i><span data-contrast=\"auto\">\u201cThe inability to establish healthy relationships is a major contributing factor to relapses and the return to substance use.\u201d\u00a0 (Flores, 2004).<\/span><\/i><span data-contrast=\"auto\">\u00a0 Thus, the answer to \u201csh*t what am I missing?\u201d is: Not having had a clear model of secure attachment because it was partially or completely missed during childhood.\u00a0 As Flores stated:<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><i><span data-contrast=\"auto\">\u201cTherapists must be able to challenge, soothe, care, love, and if necessary, fight with a patient if they are able to provide a full range of emotional experiences that can potentially come alive in an authentic relationship. (Flores, 2004, p. 259).<\/span><\/i><\/b><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><span data-ccp-props=\"{&quot;335551550&quot;:2,&quot;335551620&quot;:2}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">To sum up part one of this article, unless we provide a solid definition of concepts that we see as <\/span><i><span data-contrast=\"auto\">normal<\/span><\/i><span data-contrast=\"auto\"> (based on definitions that were modeled) albeit dysfunctional and damaging, the way we work the 12 steps will be flawed and based on dysfunctional definitions, lacking much change in behavior.\u00a0 Alternatively, we can utilize the 12 steps as a corrective experience by interpreting each step as follows:<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<h2><span data-ccp-props=\"{}\">\u00a0<\/span><span data-contrast=\"auto\">Interpreting the 12 Steps from an attachment perspective:<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Step 1:\u00a0\u00a0\u00a0\u00a0 The experience of <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/abandonment\">abandonment<\/a>;<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 2:\u00a0\u00a0\u00a0\u00a0 Permission to hope; integration to others;<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 3:\u00a0\u00a0\u00a0\u00a0 Taking a risk (vulnerability) to attach<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 4:\u00a0\u00a0\u00a0\u00a0 Taking a risk to attune with self<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 5:\u00a0\u00a0\u00a0\u00a0 Taking a risk to attach to another person<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 6-7:\u00a0 Correcting and repairing relationship with self<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 8-9:\u00a0 Correcting and repairing relationships with others<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 10:\u00a0\u00a0 Personal responsibility for securely attached relationships in my life<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 11:\u00a0\u00a0 Solidifying a secure attachment to my Higher Power<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Step 12:\u00a0\u00a0 Increasing my ability to model securely attached relationships to others<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>?what am I missing; I keep relapsing and don?t know why I have such a difficult time remaining clean and sober??? ?How we treat addiction in treatment must change.? The idea that we can provide information and teach an individual how to remain clean and sober is a fallacy.? Most addicts and alcoholics are above [&hellip;]<\/p>\n","protected":false},"author":3201,"featured_media":43120,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[1,1902,542,2095,628,622],"tags":[83,2219,1139,757],"class_list":["post-43082","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","category-addiction","category-featured-articles","category-find-therapist","category-general","category-types-of-therapy","tag-addiction","tag-attachment-theory","tag-drug-and-substance-abuse","tag-substance-abuse"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/43082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/3201"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=43082"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/43082\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media\/43120"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=43082"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=43082"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=43082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}