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Nicolai, N.J. (2017). Psychotherapy with People Who Have Disorganised Attachment Patterns in a Psychodynamic and Attachment Theory Informed Setting. Att: New Dir. in Psychother. Relat. Psychoanal., 11(1):35-50.

(2017). Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 11(1):35-50

Psychotherapy with People Who Have Disorganised Attachment Patterns in a Psychodynamic and Attachment Theory Informed Setting

Nelleke J. Nicolai, M.D.

The story of my work with a woman who has a dissociative disorder is presented from an attachment perspective. Someone with a disorganised/disoriented attachment status requires a different approach. Within an attachment and psychoanalytic psychotherapy approach I describe how by centring on issues of self-regulation (dissociative withdrawal) and interactive regulation, when the patient was in a highly helpless and frightened state, an enactment emerged that mirrored the interactions she had had with her parents. Within our growing mutual understanding of the mosaic of the transference-countertransference matrix a pattern was discernible: each time the therapist felt pressured to act she was caught in a repetition of earlier frightening and perverse relationships. Thinking and reflecting on these enactments enabled the patient to differentiate between past and present and helped her to verbalise her unmentalized feelings.

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