Crittenden

Attachment & Cognitive Therapy
Patricia M. Crittenden, Ph.D.
Patricia M. Crittenden, 2005
Four Growing Points

1. Symptoms: diagnoses & treatment
2. Emphasis on cognitive rational & verbal
processes
3. Model of psychological functioning &
psychopathology
4. Evaluation of harmful effects of psychotherapy
Symptoms
Distress = patients perspective
Diagnosis = professionals perspective
Self-protective strategies
Behaviors can serve many functions
Symptoms, cont
50%+ failure rate 1 year post-CT
Focus on symptom vs. reason for
symptom
Competence with danger vs. competence
with safety
Strengths approach vs. vulnerability
Cognition & Affect

Cognition
Temporal, causal contingencies
Verbal generalizations about contingencies: core
beliefs
Affect
Response to intensity of sensory stimulation
Somatic & psychological feelings: images
Cognitive Memory Systems

Procedural Memory
Reflexive, sensorimotor schema

Preconscious
Learned from experienced consequences
Re-active
Semantic memory
Verbalized procedural contingencies

When/then & if/then and (distorted) absolute forms
Borrowed
Should & ought to do
Affective Memory Systems

Imaged memory
Possibility of danger
Fight, flight, freeze
Bodily arousal and feeling anxious
Pro-active
Connotative language
Brings images to mind
Elicits feeling in listener
Integrative Memory Systems

Episodic memory
Cognitive-affective integration
Learned at about 3 years
Dependent upon a dialogue
Biased by what parents will talk about
Reflective integration
Permits information to be corrected
Is slow
Done best under safe conditions
Memory Systems
Temporal Order
(Cognition)
Procedural
Semantic
Intensity
(Affect)
Imaged
Connotative Language
Episodic
Reflective Integration
Dispositional Representation
Relation of self to context
Each different DR disposes behavior
differently
Each highlights some aspect of the
problem, but obscures some other
Arousal Scale
1. Anxiety
Pain
Sexual Desire
Fear
Anger
Desire for comfort
2. Comfort
3. Depression
Boredom
Tiredness
Sleep
Unconsciousness
Transformations
Sensory stimulation
Transformations of information
Dispositional representations
Enacted behavior
The only information that we have

is information about the past
whereas
The only information that we need

is information about the future.
Transformations of
Information
True
Erroneous
Omitted
Distorted
Falsified
Type of Transformation of Information
True
False
Cognitive
Integration of Cognitive and Affective Information
Affective
True
Cognitively
Organized
Integrated
True Cognition-True
Affect
Affectively
Organized
Cognitively Distorts
by Simplification
Affectively Distorts
by Simplification
Omits Cognition
Omits Affect
False
Cognitive
Affective
True
Cognitively
Organized
Integrated
True Cognition-True
Affect
Affectively
Organized
Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Adaptive in Safe
Contexts, but
by Simplification
Cognitively Distorts
by Simplification
Omits Cognition
Omits Affect
Adaptive in
Dangerous
Contexts, but
Adaptive in
Dangerous
Contexts, but
Increasing Risk of
Increasing Risk of
Mental Health
Problems
Mental Health
Problems
False
Cognitive
Affective
True
Integrated
True Cognition-True
Affect
Cognitively
Organized
Type B
Affectively
Organized
Balanced/
Secure
Reserved
Reactive
Adaptive in Safe
Contexts, but
Type A
Cognitively
Distorts
by Simplification
Type A /C
+
Defended/
Disengaged
(Anxious Avoidant)
Unintegrated
Cognitive/Affect
Type C
Coercive/
Enmeshed
(Anxious Ambivalent)
Omits Affect
Various Coercive
C+ Strategies
Various Compulsive
A+ Strategies
Increasing Risk of
Adaptive in
Dangerous
Contexts, but
Mental Health
Problems
Type A+C+
Psychopathy
Adaptive in Safe
Contexts, but
by Simplification
Omits Cognition
Adaptive in
Dangerous
Contexts, but
Increasing Risk of
Mental Health
Problems
AAnti@ Integrated
False Cognition-False Affect
False
Cognitive
Affective
A Dynamic-Maturational Model
of Patterns of Attachment in Adulthood
True Cognition
Integrated True Information

(Type B)
True Affect
B3
B1-2
Comfortable
Reserved
B4-5
Reactive
A1-2
C1-2
Threatening/
Disarming
Socially Facile/
Inhibited
Cognition
(Type A)
A3Compulsively
4
Caregiving/
A/C
Compliant
C3-4
Aggressive/
Feigned Helpless
A5-6
Affect
(Type C)
C5-6
Compulsively
Promiscuous/
Self-Reliant
Punitive/
Seductive
A7-8
C7-8
Delusional
Idealization/
Menacing/
Externally
Paranoid
Assembled
Self
Psychopathy
AC
False Affect
Integrated False Information

(Type A+C+)
False Cognition
Treatment Outcomes
There could be harmful effects
Cognitive & affective strategies are
psychological opposites
They might need opposite treatments
Ideas from Attachment Theory

The importance of understanding the self-protective
function of symptoms.
The strategic organization of all persons, patients
included.
The importance of affect.
The structure of human psychological organization as
consisting of two opposite processes and their
integration - with patients rarely displaying integration.
Ideas from Attachment Theory

The possibility that treatments may have different effects
on people with similar symptoms, but opposite
psychological organizations.
The important of therapists knowing both the
organization of each patient and also the effects on
psychological functioning of each treatment technique
that they employ.
The importance of the therapist being, uniquely for each
patient, a transitional attachment figure who helps to
create enough safety and comfort for change to be
explored.
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Attachment & Cognitive Therapy

Patricia M. Crittenden, Ph.D.

Patricia M. Crittenden, 2005

Four Growing Points

Cognition & Affect

Cognitive Memory Systems

Reflexive, sensorimotor schema

Verbalized procedural contingencies

Patricia M. Crittenden, 2005

Affective Memory Systems

Integrative Memory Systems

Patricia M. Crittenden, 2005

The only information that we have

The only information that we need

Type of Transformation of Information

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Type of Transformation of Information

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Type of Transformation of Information

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Type of Transformation of Information

Patricia M. Crittenden, 2005

Integration of Cognitive and Affective Information

Integrated True Information

Integrated False Information

Patricia M. Crittenden, 2005

Ideas from Attachment Theory

Ideas from Attachment Theory

This talk can be down-loaded from:

Patricia M. Crittenden, 2005

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