Abstract
Contemporary attachment theory also known as modern attachment theory is a psychological paradigm that seeks to elucidate the changes of long term and short term relational association among humans. The theory specializes on specific aspects of human response to specific occurrences in their lives rather than the general relationships. For instance, a young child will develop a strong attachment to the person who is taking care of them regularly. On the other hand self psychology theory is an advanced psychoanalytic theory whereby efforts to understand individuals from within subjective experience is made through abnormal self-examination basing renditions on the understanding the self as the cardinal agency of the human mind. The concepts of empathy, mirroring, idealizing the tripolar self, self object and twinship are essential in understanding self psychology. The application of this two theories to a post war African-American patient has been described in details herein.
Keywords: theory, patient, psychology, interpersonal relationship.
Benille a 45 year old African-American is admitted in hospital in Chicago. He suffered leg injuries during his service in his earlier years as a soldier in the Persian Gulf War. He was admitted to hospital in the year 1991 when the Persian Gulf War ended and himself together with a number of his friends with whom they served as cooks. They had been attacked by Saudi Arabia troupes as they were preparing food for the soldiers. The troops were short of ammunition and they did not want to use the little fire left on harmless cooks. In effect, they decided to use pangas to chop off their limbs. Bennile and his friend were only happy to escape that wrath when two soldiers came to their aid and shot their attackers. Bennile’s injuries were most severe and he could not escape being bedridden for a number of years.
Modern attachment theory
Attunement or misattunement
Attunement can be described as a way of adjusting or accustoming oneself to change. Misattunement is the failure or inability of a person to harmonise themselves to change.
Bennile’s attenuation
The realization of the fact that he had to be under someone’s care for over five years made him to attune to the new environment. He had to make major changes in his eating habits, friendships, and many other new basic life components. In his struggle for attunement, he tried to even harmonize his old way of life to the hospital environments.
The process of attunement for Bennile was smooth for the most part, although he struggled with some aspects such as making new friends. This was partly due to his background (Cicchetti & Toth, 1995. Having been raised poor in New Orleans, he had faced racism growing up. This made him develop trust issues with anyone he had not developed a habit of trusting before, which made him take a long time in making new friends in his new environment. He had had a drug problem growing up, mostly due to peer influence. Although he was clean when he joined the army many years before, the drug problem made his socialization skills weak. This made his attunement in the new environment a slow one. The slow attunement slowed down the recovery process over but slowly but surely he began attuning to his environment, although after a long period of time.
The case of this patient presents a clear case of misattunement because he could not bring himself to face the challenges that he faced in the new environment. The lack of accepting change also made the recovery process longer than it was necessary.
Secure verses insecure attachment
A secure attachment refers to the personal relationships developed in patients to care givers through the patients’ positive experiences with the care givers. Patients who have a secure relationship to those who take care of them have learnt to learn how to trust them. On the other hand an insecure attachment is where patients have negative and unpredictable experiences with their caregivers. Patients who have insecure attachment have learnt that caregivers are unreliable and they do not trust easily (Brisch, 2011).
For the case with the client, Benille, he displayed signs of secure attachment since his previous encounters with caregivers had been positive. From history, he had been through injuries and psychological issues prior to this encounter, and from examination, he exuded confidence that he had had positive experiences with medical professionals which made him trust that his psychological problems would easily be tackled. This positive outlook made thing easy while interacting with him.
Studies have shown that basic functions of the human brain of affect, attachment as well as memory possess a powerful implication for combined psychobiologic conceptualizations dealing with emotional dysfunction as well as its treatment. Particularly, data drawn from these areas of study show a high likelihood that indirect memory resulting from early attachment connection that has been communicated through the language of affect, possesses a long lasting neural structure capable of influencing emotional self-regulation as well as behavior that is connected to affiliation (Amini et al., 1996).
Clearly, the positive history the patient had with caregivers. This kind of affect was clearly seen in Benille and its application in his case showed that he tended to trust caregivers a lot and that gave hope of his quick recovery. As time progressed, the patient showed signs of trusting the caregiver’s advice which contributed significantly to his recovery. This then had a positive impact in the whole process as the patient was willing to try and cope with other stressful aspects such as the new environment because he seemed to trust the doctor’s advice strongly (Siegel, 2012).
Signs and symptoms which demonstrate problems in attachment
Attachment disorders are disorders of mood, social relationship and behavior that arise to primary care giving figures from normal attachments The cause of such a disorder can be neglect abrupt separation from the medical caregivers in the initial stages of admission, abuse, lack of nurses responsiveness to the patient effort in communication resulting in lacking of basic trust, frequent change or excess numbers of caregivers. There are two areas covered in diagnosis and checking for symptoms of attachment disorder. The first one is reactive attachment disorder (RAD), which is based on scientific enquiry. In a clinical setup, RAD is a condition where patients do not establish healthy and lasting bonds with caregivers. Attachment refers to the deep connection that is encoded to the brain of a patient between his or her caregiver. The second one is pseudoscientific and is found in clinical practice and publication but has no evidence base. This pseudoscientific type of disorder makes controversial claims relating to the attachment theory.
The neurobiology included in studying the signs and symptoms are brain development, stress response in patients, among others. They will be discussed in details in the case study. Given the background of the patient from the early years of his development right from being raised in a predominantly black community and having experienced racism growing up, the patient showed negative symptoms with association and trusting. As highlighted earlier, although the patient had shown negative outlook when it came to adjusting to the new environment, his separation from the initial caregivers did not seem to bother him much as this meant that it become relatively easy to handle him from the caregiver’s perspective.
Healthy and unhealthy coping skills
According to psychology, expending conscious effort in solving personal problems in effort to tolerate conflict or stress is commonly referred to as coping. Different type of stress/conflict will have different coping strategies. In psychology there are three categories of coping strategies they include appraisal-focused, problem focused and emotional focused strategies. Some of the conflict can only fit in one of the coping strategies and hence trying to apply other coping strategies in that conflict will be unhealthy. For instance, considering a patient who has mental problems that prevent proper attachment to the nurse the healthiest strategy for him is appraisal focused strategy. This strategy commonly occurs when the patient changes his thinking style by simply altering his values and goals. If the patient decides to find out information concerning the problem and trying to learn new methods of managing the problem, they will be using a problem-appraisal strategy, which will be unhealthy for them in this case.
The patient displayed emotional focused strategy for the most part under observation. He exhibited signs of breakdown whenever he was being talked to during his therapy sessions. His past especially tended to make him breakdown and exhibit emotional signs, something that made the sessions emotional. Whenever faced with a problem, the patient exhibited emotional breakdown on the extreme ends.
Self-Psychology
Tripolar self defined and explained
Being tripolar is possessing the personality of mixing three key emotional feelings at a glance. A tripolar personality jumps to the extremes of extreme happiness, joy, and anger. Tripolar personality is common in depression patients where they occasionally try to hide their depression by expressing happiness or joy. It is common to find mental patients and other psychology patients expressing their tripolar self.
For the case of the patient, these signs were missing, a clear indication that he could not be classified as tripolar. He however exhibited signs of anger whenever faced with a new challenge that he could not overcome. His coping mechanism was often emotional breakdown.
Cohesive verses non cohesive tripolar self
Cohesive self is a self that blends the aspects of the tripolar self in a smooth transition whereas non cohesive self means there is no flow of emotional feelings in tripolar self.
The client exhibited no signs of being tripolar, and his emotions were consistent as well as showed clear flow. This made managing the client’s emotional state relatively easy compared to other clients who had a similar history.
However, the client showed signs of disassociation with reality. This was exhibited by signs of depersonalization, amnesia as well as derealization. The patient sometimes seemed to forget some details of his ordeal and past painful experiences which is characteristic of an “out-of-body” experience. Sometimes, the patients showed signs of distorted reality, reduced awareness as well as detachment, possibly due to being resigned to his fate and feeling unfulfilled.
A patient may show that his egocentric desires are not met by the care giver in a number of ways. These includes aggressiveness to the caregiver, constant show of dissatisfaction to the services given, complaints among others.
For the case of this patient, he showed no aggression towards the caregivers, and this led to a smooth relationship with the caregivers. He mostly remained calm and did not complain much. He however seemed isolated due to being slow in making new friends.
The Patient however exhibited some symptoms that showed that his personal needs had not been met which included neglect of self-grooming. The patient had to be reminded time and again to take care of personal hygiene by grooming oneself, and this led to a situation where it became a routine. Despite showing signs of calmness, the lack of self-grooming portrayed inefficiencies in the patient’s ability to cope.
During one of the counselling sessions, the client indicated that he felt like he had not lived out his dream and that he felt “like a perfect example of failure and hopelessness.” This showed that he felt that he was not living out the life he had intended to live, and this caused him a lot of pain. The patient also confessed to having had sleepless nights wondering what would have been of him had he taken a different path in life. The client showed signs of lack of self-fulfillment.
Diversity Issues
The patient grew up is dire conditions that included being brought up in a poor setting. Moreover, the patient had a drug problem growing up in New Orleans, LA. Racism was rife when he was growing up and, having experienced racism issues, he seemed to have associated people of different races with not wanting the best for him.
Research has shown a strong relationship between early life experiences and adult behavior. Individuals who have experienced physical abuse show levels of increased hostile-intrusive behavior, high negative affect, as well as little tendency to open up about traumatic experiences. For instance, according to Lyons-Ruth and Block (1996), infants that have mothers who experienced violence or any form of abuse in their childhood displayed insecure attachment approaches compared to infants with mothers who had had good trauma-free childhood.
The patient’s childhood was full of trauma given the circumstances in which he grew up. This explains his reserved behavior and a tendency not to open up easily. The patient’s background highly affected his relationship with people of a different race other than that of his own – Black American. Race is a big determinant of how people relate with one another. The patient did not socialize well with other people around him and this created a lot of problems when trying to assimilate to the new environment. The poor background meant that the patient had experienced many traumatic experiences which caused him to exhibit signs of detachment from reality.
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