Category Archives: Attachment

Attachment

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Attachments are the bonds we form with people, animals, places and things. The earliest bond we form is usually with our mothers. This or a bond with another person who becomes our primary caregiver becomes the template for all other bonds we make in our lives. We can launch into life with a solid sense of ourselves if we make secure bonds of affection that give us an experience of safety and security.

If however, we have early bonds that are not secure, but are unpredictable and chaotic, or harsh and punishing this tends to make us anxious and worried about affection and safety, or perhaps make us want to avoid affection. We tend to make later relationships in the same way.

Making attachments is what we do as mammals. So when dementia comes we continue to form and need relationships with others, with animals, places and things. Familiar people assume a greater importance for providing a feeling of safety and calm. All the better if these people are affectionate and warm (if that is what gives us a feeling of being safe).

It is important to remember that some people may not have ever formed a sense of being safe because of early difficult attachments. So they may react in their dementia from the old patterns, avoiding closeness or becoming anxious and insecure about your affection.

Attachments to animals and objects also remain important for some people. It may be a favourite chair, a worn old pullover, or a photo of their old dog or even her lead.

Thomas had been sitting quietly all afternoon in the lounge. He slept for a good part of it. Watched daytime TV for a time. Without notice he got up from the chair, walked to the laundry where he grasped the dog lead off the hook and said, “Come on then”. Out the back door, and into the park that backed onto his garden. Miriam, Thomas’ wife discovered him gone from the lounge about 20 minutes later. She realised what had happened, pulled on a jacket and boots, and followed him into the park. At first she couldn’t find him but listened and eventually she heard him calling out “Chlo..ee. Chlo..ee”. “There you are” Miriam said. “I can’t find her, the rascal. She went haring off into the bushes after a rabbit and I lost sight of her.” “Never mind love. She’ll come home when she’s ready. She always does”, said Miriam. Chloe was their Jack Russell terrier who had died 15 years ago. Thomas walked her in that park every day of her life and almost every day she went after rabbits, Thomas calling her and walking home with the lead in his hand. And for the last couple of years when the memory took him. Today Miriam walked alongside him and talked gently about Chloe until they were nearly home and talking about supper.

Who and what we are attached to remains important for us well beyond the moment. For some it may be people, for others objects or even places. Former towns or homes we have lived in. People we once knew. What is significant about them is the feeling we have about those places, objects, people, and animals.

It may be that an old relationship assumes a significance for a person with dementia in the present time. This can be very disturbing for a husband or wife to find their spouse talking fondly about a former husband or wife. This has noting to do with their affection for you. It has everything to do with their inability to stay in the present and the brain’s need to find meaningful connection in whatever way it can. If they can’t retain the present moment, old memories may be more easily accessible. So the brain follows the path of least effort and finds the old flame. Disturbing perhaps but it doesn’t mean they don’t love you. They just can’t hold onto you in their minds as easily as they can the long-term memories.

Psychotherapy at McCarthy Psychology Centre

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People who may benefit from therapy with Bernie McCarthy may present with the following conditions:

  • Anxiety (panic, agoraphobia, OCD, generalised worry, phobias, Post Traumatic Stress Disorder)
  • Depression
  • Medically unexplained symptoms (MUS) including chest pain, back pain, jaw pain, headaches and migraines, skin conditions including psoriasis and eczema, reflux and bowel disturbance
  • Eating disorders
  • Personality disorders
  • Fibromyalgia
  • Chronic fatigue
  • Transient cognitive disturbances such visual blurring, going blank, mental confusion
  • Relationship distress and life changes
  • Grief
  • Many of the above conditions will present with co-morbid depression/ anxiety.

For more information on the approach Bernie uses in therapy please click on the link here.

AGE

13years +

FEES

First session is a trial therapy of two hours – fee is $400.00 (out of pocket $275.50). Subsequent sessions 50-60 mins – fee is $215.00 (out of pocket $90.50).

Medicare rebates under Better Outcomes for Mental Health program

AVAILABLE:

Monday to Friday 9am to 6pm

CONTACT FOR APPOINTMENTS

For appointments call 0408 145 819.

 

 

Attachment and caregiving

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Caregiving in dementia can be conceived as being a secure base or safe haven for the person with dementia.

old lady and carer

This requires an atunement of the caregiver with the needs and wants of the person with dementia much the same way a mother is attuned to the cues for food, comfort and safety that an infant gives to the mother.

Separations and reunions are the moments when this need for a safe haven becomes most keenly felt. When a caregiver leaves or walks back into the room the person with dementia is most likely to feel the sense of anxiety or relief/anger that can be evident with infants in Ainsworth’s Strange Situation.

What does it require of you to be a secure base for the people you care for? What can you do to be more a source of security and safety for the people you care for?

What do you do currently that causes people to feel safe and secure in themselves, not just physically but emotionally?

Aged Care at Christmas – New Year

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Living in an aged care residence at this time of year brings home the realities of life. Too many of our residents do not have any visitors and the aloneness they feel can be crushing. Many feel abandoned by their families. Many have unhappy visits from family members that they find difficult to transact pleasantly despite their hopes for a “happy family” experience. And it should be said, some of our residents do indeed have pleasant and fulfilling experiences of being with family who come and take them home for a day or two to share in their lives and celebrations.

This time of year brings home the stark reality of the lack of satisfying and nourishing attachments for many of our elders who have been dislocated and isolated from their families, some for years. This creates a deadening effect for some as they defend against the pain of not being loved in their old age. For others they rail against it and become angry and upset with those nearest to them – the care staff and fellow residents, pushing away the very people who are there to care for them.

We need infinite patience and a caring mind to see the opportunity in this period of the year. This is an opportunity to see the aloneness and isolation and break it down with a quiet (perhaps brief but regular) warm visit and friendly conversation that establishes or sustains the rapport you have with the elder.

If the person has cognitive impairment they will likely be living with a constant threat of isolation and aloneness and a sense of struggling to make good sense of what is happening and feel competent to handle it. We can step in and provide a support to their desire for competence by helping them finish the sentence, patiently listening, or even just sitting quietly for a few moments and smiling and not blaming them for their angry outburst but trying to find an explanation. Its not complex but it seems to be difficult to do these simple things consistently.

So there it is. My wish for 2012 is that you find at least one moment this year to give another person comfort in their isolation and aloneness and support in their desire to feel competent once again.

best wishes

Bernie

Attachment in care

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Attachment is the bond of affection and care that characterises most of our close relationships as human beings and can be seen in many animals.

John Bowlby, the British psychoanalyst who is regarded as the father of attachment theory suggested that attachment is a phenomenon that is active throughout the life cycle from infancy to old age.

Attachment figures are the caregivers who provide a safe haven and secure base from which infants and then we as adults move out to form our own lives and establish intimate attachment relationships. As adults we also internalise the capacity to form secure attachments so that the attachment figure does not have to be in the room with us but we can still feel loved and safe.

Some people however do not internalise secure attachments. Rather they internalise insecure, anxious attachments or avoid attachments altogether in their lives.

Ainsworth who is regarded as the mother of attachment theory, identified three styles of attachment that I have just referred to: Secure, Anxious/ ambivalent and Avoidant. These continue into adulthood and are present in parenting or caregiving styles of parents and others involved in close relationships with others.

Caregiving is an attachment experience in which we act as attachment figures to people who are dependent on us to provide food, affection and safety. This is particularly true for people living with cognitive impairment who are unable to process life experience in the way they previous have done and who engage with the world of social relationships in a way that is reminiscent of their previous attachment styles.

So we see dependent behaviour, asking for mother or father, wanting to go home, asking what they can do next, calling out, sexualising contact, and being clingy as attachment behaviour of proximity seeking, a behaviour that is a hallmark sign of attachment.

However, such proximity seeking is not the only sign that an attachment is active. We also see angry outbursts, pushing the attachment figure away, attacking, as the reaction to an attachment need not being  met by the desired caregiver. Then if the attachment figure does not respond for long enough the person gives up and disengages. This is often the reaction we see by people living with dementia who are left for long periods without stimulation or not interacted with, not spoken to, not noticed, or simply ignored by passing staff.

Attachment behaviour in dementia is a common experience and the explanation for much ‘disturbed’ or ‘challenging’ behaviour.

Where have you noticed attachment behaviour in the people you care for?