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Attachment

Attachment Theory and Chronic Illness

What we need from our close connections.

Key points

  • Our earliest relationships with caregivers influence how we manage difficult emotions, including those associated with chronic illness.
  • Secure attachment, which includes the provision of holding and containment of emotion and appropriate space, builds positive coping abilities.
  • One can achieve secure attachment in adult relationships, particularly in psychotherapy.
Katie Willard Virant
Source: Katie Willard Virant

A Brief Overview of Attachment Theory

Our earliest experiences with caregivers serve as inner templates for life-long beliefs about self, relationships, and the world-at-large.

We can trace back how we currently manage stress and trauma (including the stress and trauma of chronic illness) to what we learned in these relationships.

When a child is securely attached to her caregivers–when caregivers are present, dependable, and safe–she knows that her distress will be comforted. Eventually, she internalizes the support received from these early relationships, retaining both an ability to self-soothe and use other relationships as she regulates her emotions.

Attachment theory posits that a healthy connection facilitates independence. That is, a child securely attached to his caregiver views that caregiver as a “secure base.” The child feels safe enough to explore the environment, as she knows she can return to the “secure base” whenever she needs comfort, connection, and replenishment.

Chronic Illness and the Attachment Process

Chronic illness increases stress both for the patient and her close connections. Anger, grief, anxiety, and sorrow are an understandable part of living with chronic illness. How does the person living with chronic illness manage these emotions?

Does she try to deny them, believing that expressing–or even feeling–them will sever her connection with loved ones? Does she anxiously cling to attachment figures, expressing distress that seems never to be soothed? Or is she able to respond effectively to her painful feelings, gaining comfort from her connections and inner resources?

Take a moment and think about how you handle your illness-related emotions. Do you let yourself feel them? Do you communicate them? What responses do you receive from your family and friends that make you feel more and less comforted?

Now move back in time. What was it like when you were a child and experienced painful feelings? What did you learn from your parents from those interactions? Perhaps your father got angry, and your mother got tearful when you felt difficult emotions. Maybe they turned away altogether, unable to bare your feelings. Perhaps they could accept sadness but not anger, or vice versa.

Be curious as you explore your memories, seeking to make connections between what you learned as a child and the ways you currently respond to your emotions.

Healing Attachment Wounds

Our past is not our destiny. If you grew up with insecure attachment, you can mourn what you didn’t have and create a new inner template to more effectively manage the painful feelings that occur with chronic illness. Forming this updated template will require deep experience with holding, containment, and the provision of space (Odegard, 2005).

“Holding” is a term that describes acknowledgment and tolerance of one’s feelings. A child who falls and scrapes his knee runs to his father, who takes him in his arms and says, “Oh, that really hurt.” A woman calls her best friend and says, “This new medicine is making me feel so fatigued.” The friend says, “I’m sorry. That really stinks.” These are examples of holding, as the feelings presented are accepted as legitimate and deserving of empathy.

“Containment” describes the active process of transforming distress into a tolerable form (Odegard, 2005). When we contain someone’s feelings, we absorb their communication of those feelings, translate what we are seeing, and give back our translation in a way that helps the person feel understood.

When a child is angry at bedtime, for example, a parent contains the feelings when she says, “I wonder what your feelings are telling you? Maybe you’re angry because we must stop playing and pick up the toys right now.” Similarly, a man says to his spouse, “I notice that you get really anxious when you have a medical appointment. I can imagine seeing the doctor would bring up a lot of feelings for you. Do you want to talk about it?” These are examples of containing.

The feelings presented are seen as communicating something that can be put into words and understood; the containing individual is able to help the individual make big feelings more manageable.

“Providing space” refers to providing a space where an individual may explore or play on her own terms without judgment or interference from others (Odegard, 2005). A parent who provides this space conveys that he trusts his child to have her own feelings, thoughts, and experiences. He is comfortable rather than threatened by her autonomy and agency.

As adults with chronic illnesses, we treasure friends who do not jump in to offer unsolicited advice or criticism about our disease management. Their non-judgmental stance conveys the message that they believe in our ability to cope and that they can hear our pain without jumping in to try to solve it.

You may be thinking, “I’d like to find some of this holding, containment, and space. Where do I get it?” If you didn’t experience secure attachment in childhood, you might feel at a deficit in relationships, as if you didn’t get the user’s manual. You can get that user’s manual through psychotherapy, where you’ll be provided with holding, containment, and space.

In having that powerful experience–even as an adult–you’ll develop the tools to engage in meaningful relationships. These secure attachments will enhance your ability to cope with chronic illness and respond compassionately to the emotions it raises.

References

Johnson, S. (2003). Introduction to attachment: A therapist’s guide to primary relationships and their renewal. In S. Johnson & V.E. Whiffen (Eds.), Attachment Processes in Couple and Family Therapy. Guilford Press.

Ødegård, W. (2005). Chronic Illness as a Challenge to the Attachment Process. Clinical Child Psychology and Psychiatry, 10(1), 13–22.

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