Attachment & Cognitive Therapy

Patricia M. Crittenden, Ph.D.

Patricia M. Crittenden, 2005

Four Growing Points

1. Symptoms: diagnoses & treatment
2. Emphasis on cognitive rational & verbal
processes
3. Model of psychological functioning &
psychopathology
4. Evaluation of harmful effects of psychotherapy
Patricia M. Crittenden, 2005

Symptoms
Distress = patients perspective
Diagnosis = professionals perspective
Self-protective strategies
Behaviors can serve many functions
Patricia M. Crittenden, 2005

Symptoms, cont
50%+ failure rate 1 year post-CT
Focus on symptom vs. reason for
symptom
Competence with danger vs. competence
with safety
Strengths approach vs. vulnerability
Patricia M. Crittenden, 2005

Cognition & Affect

Cognition
Temporal, causal contingencies
Verbal generalizations about contingencies: core
beliefs
Affect
Response to intensity of sensory stimulation
Somatic & psychological feelings: images
Patricia M. Crittenden, 2005

Cognitive Memory Systems

Procedural Memory

Reflexive, sensorimotor schema

Preconscious
Learned from experienced consequences
Re-active

Semantic memory

Verbalized procedural contingencies

When/then & if/then and (distorted) absolute forms
Borrowed
Should & ought to do

Patricia M. Crittenden, 2005

Affective Memory Systems

Imaged memory
Possibility of danger
Fight, flight, freeze
Bodily arousal and feeling anxious
Pro-active

Connotative language
Brings images to mind
Elicits feeling in listener
Patricia M. Crittenden, 2005

Integrative Memory Systems

Episodic memory
Cognitive-affective integration
Learned at about 3 years
Dependent upon a dialogue
Biased by what parents will talk about

Reflective integration
Permits information to be corrected
Is slow
Done best under safe conditions
Patricia M. Crittenden, 2005

Memory Systems
Temporal Order
(Cognition)

Procedural

Semantic

Intensity
(Affect)

Imaged

Connotative Language

Episodic

Reflective Integration
Patricia M. Crittenden, 2005

Dispositional Representation
Relation of self to context
Each different DR disposes behavior
differently
Each highlights some aspect of the
problem, but obscures some other
Patricia M. Crittenden, 2005

Arousal Scale
1. Anxiety

Pain
Sexual Desire
Fear
Anger
Desire for comfort

2. Comfort
3. Depression

Patricia M. Crittenden, 2005

Boredom
Tiredness
Sleep
Unconsciousness

Transformations
Sensory stimulation

Transformations of information

Dispositional representations

Enacted behavior
Patricia M. Crittenden, 2005

The only information that we have

is information about the past
whereas

The only information that we need

is information about the future.
Patricia M. Crittenden, 2005

Transformations of
Information
True
Erroneous
Omitted
Distorted
Falsified
Patricia M. Crittenden, 2005

Type of Transformation of Information

True

False
Cognitive

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Affective

True

Type of Transformation of Information

Cognitively
Organized

Integrated
True Cognition-True
Affect

Affectively
Organized

Cognitively Distorts
by Simplification

Affectively Distorts
by Simplification
Omits Cognition

Omits Affect

False
Cognitive

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Affective

True

Type of Transformation of Information

Cognitively
Organized

Integrated
True Cognition-True
Affect

Affectively
Organized

Adaptive in Safe
Contexts, but
Otherwise Maladaptive

Adaptive in Safe
Contexts, but
Otherwise Maladaptive

Affectively Distorts
by Simplification

Cognitively Distorts
by Simplification

Omits Cognition

Omits Affect
Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive

Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive
Increasing Risk of

Increasing Risk of

Mental Health
Problems

Mental Health
Problems

False
Cognitive

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Affective

True

Integrated
True Cognition-True
Affect

Cognitively
Organized

Type B

Affectively
Organized

Balanced/
Secure

Reserved

Reactive

Type of Transformation of Information

Adaptive in Safe
Contexts, but
Otherwise Maladaptive

Type A
Cognitively
Distorts
by Simplification

Type A /C
+

Defended/
Disengaged
(Anxious Avoidant)

Unintegrated
Cognitive/Affect

Type C
Coercive/
Enmeshed
(Anxious Ambivalent)

Omits Affect

Various Coercive
C+ Strategies

Various Compulsive
A+ Strategies

Increasing Risk of
Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive

Mental Health
Problems

Type A+C+
Psychopathy

Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Affectively Distorts
by Simplification
Omits Cognition

Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive

Increasing Risk of
Mental Health
Problems

AAnti@ Integrated
False Cognition-False Affect

False
Cognitive

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Affective

A Dynamic-Maturational Model
of Patterns of Attachment in Adulthood
True Cognition

Integrated True Information

(Type B)

True Affect

B3

B1-2

Comfortable

Reserved

B4-5
Reactive

A1-2

C1-2
Threatening/
Disarming

Socially Facile/
Inhibited

Cognition
(Type A)

A3Compulsively
4
Caregiving/

A/C

Compliant

C3-4
Aggressive/
Feigned Helpless

A5-6

Affect
(Type C)

C5-6

Compulsively
Promiscuous/
Self-Reliant

Punitive/
Seductive

A7-8

C7-8

Delusional
Idealization/
Menacing/
Externally
Paranoid
Assembled
Self
Psychopathy

AC

False Affect
Patricia M. Crittenden, 2005

Integrated False Information

(Type A+C+)

False Cognition

Treatment Outcomes
There could be harmful effects
Cognitive & affective strategies are
psychological opposites
They might need opposite treatments

Patricia M. Crittenden, 2005

Ideas from Attachment Theory

The importance of understanding the self-protective
function of symptoms.
The strategic organization of all persons, patients
included.
The importance of affect.
The structure of human psychological organization as
consisting of two opposite processes and their
integration - with patients rarely displaying integration.
Patricia M. Crittenden, 2005

Ideas from Attachment Theory

The possibility that treatments may have different effects
on people with similar symptoms, but opposite
psychological organizations.
The important of therapists knowing both the
organization of each patient and also the effects on
psychological functioning of each treatment technique
that they employ.
The importance of the therapist being, uniquely for each
patient, a transitional attachment figure who helps to
create enough safety and comfort for change to be
explored.
Patricia M. Crittenden, 2005

This talk can be down-loaded from:

www.patcrittenden.com

Patricia M. Crittenden, 2005