Phobias of attachment-related inner states in the psychotherapy of adult survivor of childhood complex trauma

Liotti, G. (2013), Phobias of Attachment-Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma. Journal of Clinical Psychology, vol. 69 (11), pp. 1136-1147


The clinical case described in this paper illustrates the relevance of taking into account the dynamics of disorganized attachment in the assessment of attachment-related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized  patients. These opposite phobias typically coexist in the same patient, appear both as phobias of inner states (affect phobias) and of relational experiences, and are linked to dissociated representations of self-with-other. Theory and research on attachment disorganization provide a clinician friendly conceptual framework for capturing both the intra-psychic (e.g., intrusive and non-integrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment-related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are extensively dealt with in the paper

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