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Thursday Therapeutic Thought - Secure Attachment Style

Since Tuesday's assessment mentioned one type of attachment style, I thought I'd start a series of Thursday posts to flesh out all the styles a bit more. Inevitably, our characters will fit one of the four.

What is an attachment style, you might ask. Attachment, according to John Bowlby, is a "lasting psychological connection between human beings" (Bowlby, 1969, p. 194). This is developed from infancy, in direct proportion to how much care and comfort a child receives from their caregiver. Mary Ainsworth developed what is now called the "Strange Situation" and furthered Bowlby's theory of attachment.

Photo courtesy of About.com.

How the child responded to the parent when they returned became classified into an attachment style. She identified three, and researchers Main and Solomon (1986) added a fourth. Now, there are four classically accepted styles.

We'll look at the first style, Secure Attachment, today. The children in the Strange Situation would respond without significant distress when their caregiver left the room. When scared, they seek comfort from their parent, and any contact initiated by a parent is readily accepted by them. These children clearly prefer their parent to a stranger. Typically, parents of securely attached infants tend to play more with their children and react quicker to their child's needs. They generally are more responsive, as well.

If you feel the need to pigeon-hole one of the attachment styles as "good," this would be the one (see below for the names of the other attachment styles for why this could also be the case).
Research shows securely attached children tend to have long-term relationships as adults with partners they trust. They also typically have high self-esteem, enjoy deeply intimate relationships with others, seek out social support and relish their ability to share their feelings with other people.

Here's a breakdown, thanks to About.com.


Our core beliefs develop in direct proportion to how we attach. Now, this is not to say that people can't develop securely attached relationships as adults when they grew up with Ambivalent, Avoidant or Disorganized Attachment styles. (Don't those names just sound awful? So of course Secure Attachment sounds like the obvious winner.) But attachment styles of our characters are definitely overcomable (is that a word?). Anyway...

Our core beliefs revolve around two concepts: our thoughts about ourselves (self dimension) and our thoughts about others (other dimension). Each dimension centers around two questions.

For the self dimension, the questions are:

1) Am I worthy of being loved?
2) Am I competent to get the love I need?

For the other dimension, the questions are:

1) Are others reliable and trustworthy?
2) Are others accessible and willing to respond to me when I need them to be?

Based on your answers to these questions, you either have a positive or negative self dimension and a positive or negative other dimension. Remember this, as we will revisit this concept for the following few Thursdays.

Securely attached people have a positive self dimension. That is, they feel worth of love and competnent to get the love they need. In other words, they answer "yes" to both questions. They also have a positive other dimension. They believe others are reliable and trustworthy and accessible and willing to respond to them if they need them. Again, they would answer "yes" to both of the other dimension questions.

Think about how these questions essentially incorporate every expectation you would have about future relationships. It's like putting on a pair of sunglasses that tint everything about how you would look at a potential romantic relationship, how you see yourself, how you see others. VERY CRUCIAL for characterization!

So stay tuned as we take a deeper look into the Ambivalent Attachment style mentioned in Tuesday's post. I'll take you through the Strange Situation with an ambivalently attached infant and walk you through their core beliefs again using the four questions.

Till then!

Treatment Tuesday - Alcohol Dependence

Photo by Sheep"R"Us'

Today’s character therapy assessment comes courtesy of Eric. He’s writing in about his character Roberta*. Roberta is a homeless woman living out of her car on the streets of Denver with her two children. She’s a 24-year-old Hispanic who has been an alcoholic for the past six years or so. Her drink of choice is tequila, which she pretty much drinks every night until she passes out. She feels she is worthless, has a severe confidence problem, loves her children more than anything, but has just about lost all hope.

* Names have been changed to protect the fictional.

In the mental health field, there is quite a difference between substance abuse and substance dependence. Alcohol abuse would be drinking in situations where is it physically hazardous (i.e., driving), having recurrent legal problems for drinking (DUIs), and drinking so much that you fail to fulfill major role obligations at work, school or home. The person would also continue to use despite social/interpersonal problems that are exacerbated by the drinking.

Alcohol dependence is marked by much stronger characteristics, such as tolerance (needing increased amounts of alcohol to achieve the desired intoxication effect), withdrawal symptoms (i.e., sweating, increased heart rate, hand tremors, insomnia, nausea/vomiting, anxiety, fleeting hallucinations or illusions that can be visual, auditory or tactile, and physical motor agitation (i.e., restless, jittery legs).

It’ll be important to add these elements into your characterization of Roberta to make her a believable alcoholic. In addition, people with a substance dependence also take in larger amounts than intended, have a persistent desire and make unsuccessful efforts to cut back. A great deal of her time would be spent in activities necessary to obtain, use, or recover from the effects of the alcohol. Social, occupational or recreational activities would be given up or reduced because of her drinking, and the she would continue drinking despite knowledge that a physical or psychological problem is caused or exacerbated by the substance.

As far as alcohol treatment would go (since you mentioned she would need to go to a facility for detoxifcation and treatment), I would definitely Google this. When I worked at a private psychiatric hospital, I’m pretty sure I remember the Registered Nurse on duty in the Alcohol and Drug unit telling me that alcohol is one substance where you need to be medically monitored while you detox. Something about how the body gets so adjusted to having the substance that without medical intervention, the body could go into shock and the person might die. (Since I’m not a medical professional…you might want to check with a doctor.)

Okay. On to Roberta’s emotional state. You mentioned that she feels worthless and has a severe confidence problem. Feelings of worthlessness usually originate from the family of origin. This is why I asked questions about Roberta’s dad and mother. (Thanks for filling in the blanks I asked in my additional email of questions!)

There are four classic attachment styles identified by John Bowlby. Roberta exemplifies the Ambivalent Attachment style. I recommend you (and anyone else) get the book, Attachments: Why You Love, Feel and Act the Way You Do by Dr. Tim Clinton and Dr. Gary Sibcy. This is a book written from the Christian perspective about attachments. Fascinating for character development. The following is from that book.

Roberta would likely believe/think the following:

1) She is not worthy of love.
2) She is not capable of getting the love she needs without being angry and clingy (although you didn’t specifically mention anger or clinginess…you might want to think about writing these in)
3) Others are capable of meeting her needs but might not do so because of her flaws. (which shows the confidence issue)
4) Others are trustworthy and reliable but might abandon her because of her worthlessness (which speaks directly to the heart of Roberta’s internal dialogue…her mom left, her dad ultimately left by drinking and driving, and her first husband left, as well).

Now we’re stepping into more generalizations, but people with this type of attachment style, therapists have seem some commonalities, such as:

• fear of making decisions,
• rarely expressing disagreement with others
• obsessed with the fear of being left alone (could apply with her children…scared they might get taken away from her, maybe?)
• feelings helpless when alone
• desperately seeking new relationships when others end (which could initially be a needy relationship with Frank when she meets him?)
• perpetually seeking advice
• frequently subordinating themselves to others
• often working below their ability level
• accepting unpleasant tasks to please others
• having a tendency to express distress through medically “unexplainable” physical symptoms rather than admitting to an emotional pain (i.e., headaches while doing something stressful rather than just owning up to the fact that the activity is stressful)
The one fact that might be problematic in this list is the subordinating quality. Hispanic women are not known for this. Even Hollywood portrays Hispanic women as strong and reliable (Jennifer Lopez, Gloria Estefan, Salma Hayek, Eva Longoria Parker, etc.). So consider how you might make this element more culturally acceptable if you decide to include it.

Alright! That’ll do it for today. If you’ve kept with me this long, you’re to be commended. Eric, I hope this helps!

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

Thursday Therapeutic Thought - Reaction Formation

Nice to be back with everyone on the blogosphere! I've missed this writing community.

Without further ado, I want to keep today's Thought focused on Reaction Formation. This is a fascinating defense mechanism from the psychoanalytic theory (Freud)...but one that we use all the time in writing! So I thought I'd clue you in on it.

To break it down, a defense mechanism is a psychological strategy the mind employs to cope with reality. Freud used a bunch of different words to explain this process more fully (id, ego, superego), but for our purposes, the above definition will do. There are over twenty identified defense mechanisms in four levels, Level One being severely pathological and Level Four being more mature and geared toward success.

Reaction Formation is in Level Three, which means it's usually considered neurotic, but is fairly common in adults. Reaction Formation is when a person converts unconscious wishes or impulses that are perceived to be dangerous or anxiety-producing into their opposites. A person could behave in a completely opposite way of how they really want or feel (i.e. a woman fakes indifference to men and gives off an independent vibe when all she really wants is to be loved and cherished). A person could also believe the opposite of something simply because the true belief causes anxiety (i.e. a man believes that all women are gold diggers because to believe only his ex-fiance was is too painful).

Photo by Katie Freeland

Hopefully your brain is already working on this, but I'll give a few more examples to solidify my Thought. I'll use some movies to do so. Take Maid in Manhattan. Jennifer Lopez's character takes on the opposite persona of what she is because the thought of telling Ralph Fiennes' character that she's actually a maid trying on expensive clothes belonging to another woman is too anxiety-producing. Reaction Formation. Take Twilight (Edward = sigh). Edward tells Bella that he's the bad guy and that she should stay away from him, but what he really wants is to get to know her much more intimately, to learn why he can't read her mind and why she smells so much better to him than other humans. Reaction Formation.

Now...how many books have you read where the entire plot hinged on a reaction formation? Seriously? Usually, this would be in the characters inner journey. The key to reaction formation is that it can work effectively only in the short term, because eventually is will break down. So it's a built-in plot tool for a writer to use. The character will have to give up the reaction formation in due time (hopefully by the end of the book...otherwise, we won't see the character's inner journey to completion).

Q4U: Think about your own works. Do you or have you used reaction formation for your characters? Did you resolve their reaction formation by the end of the book by having them once again embrace the truth?

Treatment Tuesday - Borderline Personality Disorder

Photo by photobunny. No one was harmed for this photo.

This week’s assessment comes from Sarah. Here’s her quick character sketch:

At six, Janice* lost her mother. She lived with her abusive father and her brother who molested her for five years. She became angry, belligerent and tough; ran away at 16, lived on the streets and turned to drugs. Placed in a mental hospital at 23, she resented the controls placed on her and fights the system until a series of events and an encounter with a Christian causes her to let her guard down. Her life slowly begins to change.

* Names have been changed to protect the fictional.

Sarah had a few questions she wanted me to consider:

• How do I pull the reader to become a part of Janice's world and to feel what she feels? I want them to feel the powerlessness she feels.
• Is her character believable?
• How do I show her reactions to the other patients and staff in such a way that the reader gets inside her head and understands from her point of view?

I believe the first and third questions stem from the second question, which is where I’ll start. To me, believable and realistic are synonymous. To make Janice realistic, you need to know some common consequences of early abuse in life that you might want to incorporate into your book.

1) Dissociation – at times, the human mind splits off from itself to protect itself while experiencing trauma. This is a diagnosis in and of itself called Dissociative Identity Disorder (formerly Multiple Personality Disorder). 2) PTSD – see last week’s assessment here. 3) Drug/Alcohol abuse – as a way of self-medicating through the pain, guilt, shame, etc. 4) Self-harm – a little different than self-harming through drug abuse. This is cutting behaviors where the client will cut (usually on their upper thighs, forearms) as a way to override the emotional pain. They would rather experience physical pain than the torturous pain of their memories and thoughts. 5) Suicidality. Sometimes the depression drowns and the emotions overwhelm to the point life is too difficult to continue. Know ahead of time just how dark you want to let her struggle get.

Just a few options you have to think about.

But since I like to work within a diagnostic framework, the one diagnosis that keeps coming to mind for Janice is Borderline Personality Disorder. As you may or may not know, a personality disorder is pervasive – encompassing every aspect of a person’s life. Think of it as putting on a pair of sunglasses that tint everything you see. You mentioned Janice was angry and belligerent, which definitely would qualify. And since she grew up with no mother, a woman-hating father (your term from our ongoing emails) and an incestuous brother, she likely would have an unstable sense of self or self-image. But the other symptoms you might want to layer in your book, to really flesh out this diagnosis (if you want to, that is). ☺

She would need to exhibit impulsiveness in at least two areas of life (definitely her drug use would fit here). Other areas might be her sex life, reckless driving or binge eating. She would try to avoid real or imagined abandonment (even more so because of her mother), and she would be frantic about this. As mentioned in the above, if you choose to give her suicidal or self-harm behavior, this would be a big-ticket symptom for this diagnosis. A chronic feeling of emptiness is also common.

One other big-ticket symptom to include would be a pattern of unstable and intense interpersonal relationships that alternate between extreme idealization and devaluation. Think Glenn Close in Fatal Attraction, loving Dan Gallagher one minute, hating him the next. It is for this very symptom that I want to caution you about the “encounter with a Christian.”

If your novel will lose credibility anywhere, this would be the likely place. One of the most frustrating things about treating a person with Borderline is their pattern of undermining their own treatment. Usually, this happens in therapy just as a goal is about to be realized. For example, after a discussion about how well the client is doing, they would severely regress back into old behaviors. At the moment when the reader is thinking the Christian is just about to get through to Janice and change her life, Janice would probably regress in real life. So I’d make the Christian go through a few different scenes with Janice before she actually reaches her. Otherwise, readers could write off your book as unrealistic and not suspending belief enough.

Another thing to consider including in your book is some inanimate object/possession, or perhaps a pet, that Janice feels close to, comfortable with, and secure when she is around it. Often time, people with Borderline feel more sheltered with something like this rather than a person.

That’s all for now! From the sounds of it, though, you were at least half-way to a Borderline diagnosis on your own. So hopefully this helps you think through some additional layering you can add to your novel should you choose to go this route fully.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

Thursday Therapeutic Thought - Relationships

I was reading the other day about psychotherapist Don Jackson and his contributions to family therapy. His work was mainly in the 1960s during the time of Ozzie and Harriet, which ran from 1952 to 1966 on ABC.

Photo by nickwheeleroz

Ozzie Nelson and his real-life wife, Harriet, epitomized the nuclear American family of the 1950s: bread-winning husband and housekeeping wife. This was the way things were done. Husband came home at five o'clock after a hard day at work to a home-cooked meal, hot on the table. Wife spent her day cleaning and doing laundry and taking care of the children and volunteering. According to Jackson, this is a complementary relationship. Both Ozzie and Harriet were different, but they fit together. One is assertive, the other is submissive. One is emotional, one is logical. (It's important to note that these are not evaluative terms, but just descriptive. And don't assume that one person's position causes the other's. After all, it takes both a sadist AND a masochist to create a sadomasochist relationship!)

Photo by Mrs eNil

The mid-60s was a time of great change in the nuclear American family. Women, spurred on by the civil rights movement, made a movement of their own to join the workforce. Suddenly, women were bringing home paychecks, too, and men came home to dirty laundry and no dinner.
Marriages leaned toward symmetrical relationships where the behaviors of one are mirrored in the other. Both husband and wife have careers and share in household chores and childrearing. Nichols and Schwartz consider the two-paycheck family to be the "most profound change in family life in the second half of the twentieth century" (p. 39).

I think it important to note that research shows neither relationship style is more "functional" than the other, although writing that probably goes against your modern twenty-first century sensibilities!

So how does this affect our writing? We should think about which camp our heroines and heros come from. Think about the possibilities if you had a heroine, expecting the complimentary relationship style of her parents, to meet a hero who presumes his wife is going to work? What are the underlying relational expectations of your main characters (especially relevant if you're writing romance)?

Treatment Tuesday - Posttraumatic Stress Disorder

First off, I'm a guest blogger over at Seekerville today, so stop in and say hello!

Today’s assessment comes courtesy of Heidi. Her heroine got pregnant when she was 17 and had the baby, but her parents forced her to give the baby up for adoption. She is married, but not to the baby’s father, and has lived over twenty years since the incident mentioned above, which has molded her into the person she is today. She blames her parents for the adoption and doesn’t consider herself at fault (premarital sex and all).

Heidi wants to know the following:

1) If someone has PTSD and they are triggered, would they have “panic attacks” or something that would send them to the hospital for a few days? My character has depression more than PTSD, but I need her to end up in the hospital for a night or two to be monitored—what can she have?
2) What would happen if someone with PTSD tried to regulate their medicine, either by not taking it or taking less or none from time to time?

Great questions to get us started, and I like that you already have a working diagnosis! That can and should serve as the framework for the character.

PTSD—or posttraumatic stress disorder—is an anxiety disorder with a fairly high prevalence (about 8% of adults). It is characterized by reexperiencing an extremely traumatic event accompanied by increased arousal (exaggerated startle response, irritability/angry outbursts, hypervigilance, etc). Yes, if she is triggered, a panic attack would be something she could experience. You’d want to incorporate many of the following symptoms into your portrayal of a panic attack to make it very realistic:

1) Pounding heart, increased heart rate
2) Sweating
3) Shaking or trembling
4) Sensations of shortness of breath/being smothered/choking
5) Chest pain/discomfort
6) Nausea/abdominal distress
7) Faint, lightheaded, dizzy, unsteady
8) Fear of losing control or going crazy or dying
9) Parathesias (numbness or tingling sensations)
10) Chills and hot flushes
11) Derealization (feelings of unreality) and depersonalization (feelings of being detached from oneself)

While any and all of these symptoms would be uncomfortable, scary, and upsetting, likely most people would not end up in a hospital because of a panic attack. (There will always be exceptions, however.) My suggestion is to have her pass out from hyperventilation and she could hit her head on something and then that would require monitoring at a hospital.

People with PTSD also avoid anything associated with their trauma. So Heidi’s character would likely avoid talking about adoption, wouldn’t want to be in a hospital (where I assume she was forced to give the baby up) or an adoption agency. So I’d add a few of these telling type scenes to really up the tension factor when she does have to go to hospital. The reader will know this is a big deal.

But since Heidi mentioned her heroine is also depressed, I would be remiss in pointing out an option that would definitely land her in a hospital for evaluation: suicidal ideation. In California, if a person is deemed by a health care professional to be a risk to themselves or others, they can be checked into a mental hospital for observation for 24-72 hours. You might not want to go this dark route, though.

As for your second question about medications, I’m afraid I can’t help you. I’m a therapist, not a psychiatrist (who can prescribe and advise patients on medication). I would refer a patient who was self-regulating her medications back to the doctor who prescribed the medication. Maybe a medical doctor could help you with the physiological reactions you could incorporate into your book. Sorry I can’t be of more help there, but hopefully I’ve given you some other things to chew on.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.