Attachment and Trauma: The Fragmented Self
Dianna Scholtes
Advances in the fields of trauma and attachment have demonstrated their intertwining nature,
their respective influences on infancy, development, psychological health and development
and associated clinical therapies. This paper presents an overview of psychoanalytic ideas of
attachment and trauma, specifically interpersonal trauma. It explains key concepts and
explores the historical, social and clinical contexts of how the models developed and evolved.
It looks at the effectiveness and strengths of the attachment model with reference to trauma
and its application to psychotherapy, specifically the role of the therapeutic alliance. It
presents the psychological impact of attachment trauma and the notion of the fragmented self. It
further evaluates professional limitations and challenges associated with working within
this therapeutic environment.
Attachment and Trauma 2
Attachment and Trauma: The Fragmented Self
There has been considerable erudition in the last two decades concerning the effect of
trauma and attachment on development (Hoehn, 2011). Without doubt, relics of attachment
trauma in childhood frequently affects individuals in elusive and moderately direct ways
which compromise functioning (Terr, 1990). The significance of the impact of attachment
and trauma is highlighted within this paper through exploration of the significance of trauma
within the caregiving system. The paper begins by providing an overview of both attachment
and trauma theory, specifically interpersonal trauma. It discusses important historical, social
and clinical concepts.
Research reveals that infants require a relationship with a parent/caregiver that is nurturing,
secure and safe and fosters development. The absence or disruption of such a relationship can
traumatise an individual, consequently making them incapable of connecting appropriately with
others. The destructive and disabling effect of traumatic experiences stemming from parental
neglect, abuse and/or violence can propel an individual into fractured versions of themselves,
forcing them to cope with the arduous task of adaptation (Gaffney,
2006; Herman, 1992). The following section provides a definition of attachment and provides a
review of the history of attachment theory, describing how the affectional bond affects
individuals from birth through to death.
The term ‘attachment’ is applied in describing the affective bond that cultivates between
an infant and their parent/caregiver (Goldberg, 2000). This bond is said to provide
the foundation for an infant’s development in which they learn to regulate emotions and
affective responses and form relationships with others (James, 1994; Schore, 2003). Fonagy
(2005) believes that such bonds have a huge impact on psychological health and
development, and that deficits in this area are responsible for most psychiatric disorders. Due
to the importance of security and distress in attachment processes parents/caregivers therefore
Attachment and Trauma 3
play a central role in the development and maintenance of an infant’s affect regulation
(Simpson & Rholes, 1994).
The history of attachment begins with Sigmund Freud - a man whose theories were
grounded in self and relational psychology, ego, object-relations and drive. Freud’s (1920)
psychoanalytic theory suggests that there are various stages of psychosexual development
which place an emphasis on attachment in infants. Freud believed that during the ‘oral stage,’
the main focus of attention is breastfeeding and providing the infant’s comfort needs. He
purported that the quality of nurturing received throughout this stage influenced the infant’s
resilience and trust in the world (McInerney & McInerney, 1998). John Bowlby (1979), who
furthered Freud’s findings stated that, “Freud not only insisted on the obvious fact that the
roots of our emotional life lie in infancy and early childhood, but also sought to explore in a
systematic way the connection between events of early years and the structure and function of
later personality” (p.1).
Bowlby formulated the basic principles of attachment theory which draw heavily on
ethological concepts. Bowlby built on these ethological concepts and developmental
psychology and made his official assertion of attachment theory in three seminal papers
which highlight the characteristics and development processes of bonds during early life
stages through to death. Bowlby’s theory is one of both normal socio-emotional development
and psychopathology, explaining that attachment processes are crucial to psychological well-
being and psychopathology (Egeland, 2004). Thus, this notion shifted psychodynamic
clinician’s to focus on early development as the root of all (Schore, 1997).
Bowlby (1979) believed that the initial attachments formed between the infant-
parent/caregiver have implications for one’s social development and underpin an individual’s
‘inner working model’ (IWM), which influences relationships across the lifespan. When an
attuned response is provided to the infant by a parent/caregiver the infant acquires a ‘felt
Attachment and Trauma 4
security’ thereby adapting an IWM encompassing mental representations in which an
individual understands themselves, their world and others (Bretherton, 1992; Schore, 2000).
Mary Ainsworth (1970) believed that these IWM arbitrate the infant’s capacity to
utilise the parent/caregiver as a ‘secure base’ in which the infant could explore new situations and
environments and know instinctively that the parent/caregiver would be available. Her
experimental procedure known as the ‘Strange Situation’ provided empirical evidence for
Bowlby’s theory of attachment which suggested that successful interaction between an infant and
their parent/caregiver has implications for later development of self-regulatory and social skills
(Bowlby, 1958, 1969, 1982). Ainsworth characterised three main attachment styles:
‘secure’; ‘insecure avoidant’; and ‘insecure ambivalent’. A fourth attachment style was
identified by Main and Solomon (1990) known as ‘disorganised’. All of these attachment
styles are said to be established by the end of the infant’s first year of life and are likely to
remain constant over the life course (Bretherton, 1992).
Attachment theory therefore provides a deeper understanding of the development of
psychotherapy and psychopathology. In the clinical context, research has observed that a high
number of individuals diagnosed with disorders of personality or mental health concerns are
insecurely attached; whilst those that have a disorganised attachment are strongly correlated with
later psychopathology (Goodwin, 2003).
Since its inception, attachment theory has “become the most powerful contemporary
account of social and emotional development available to science” (Steele, 2002, p. 518),
which is a prominent factor in the intervention, assessment and treatment of infants/children
and adults in any clinical setting. A number of evidence-based early intervention programs
for children are congruent or stem from Bowlby’s attachment theory: The Circle of Security
Child Parent Psychotherapy (Hoffman, Marvin, Cooper & Powell, 2006); Attachment and
Attachment and Trauma 5
Biobehavioral Catch-up (Dozier, Dozier & Manni, 2002); and Video Feedback Intervention to
promote positive parenting (Juffer, Bakermans-Kranenburg, van Ijzendoorn, 2007).
The expansion of research on attachment has further enhanced theoretical knowledge
and clinical applications of the theory, indicating that the attachment system continues
throughout life, undergoing crucial developmental changes. Hazan and Zeifman (1999), like
Freud (1920), purport that the affectional bond between the parent-child relationship and
adult relationships bears the same primary behavioural and emotional dynamics: security
seeking; separation; and proximity. Therefore, if the dictum that an affectional bond is a
primary defence against trauma generated psychotherapy what about the child who
experiences antithesis? The following section of the paper focuses on trauma, providing a
definition and an overview of the history.
The Australian Psychological Society (APS, 2014) depicts ‘trauma’ as a fear provoking or
stressful event which may cause psychological distress. The history of trauma is one that has seen
clinical and theoretical literature in psychoanalysis focus on manifestations of trauma. These
manifestations have been highlighted by the likes of Sigmund Freud, JeanMartin Charcot, Pierre
Janet, Josef Breuer, Jacques Lacan, Alfred Binet and Morton Prince, to name a few (Leys, 2000).
Trauma, for psychoanalysts like Khan (1963) implies a broader reaction to internal or
external impingements which generates varying levels of subjective distress. Khan’s
perception of trauma emphasises the psychological importance of occurrences that seldom enter
consciousness. Seemingly, the oxymoron of unrecognised trauma arises from the
infantile cognition of the child, thus limiting representational opportunities. Bromberg (1994)
however focusses on dissociation in relation to trauma. He conceptualises helplessness as an
occurrence in which the self of the individual is shattered.
Attachment and Trauma 6
Trauma, in recent years has resurged due to acts of terrorism, violence, natural
disasters and war. This interest has incited research and seen the development of clinical
procedures and diagnostic tools in relation to the impact of trauma on individuals and their
psychological functioning. Together with a heightened understanding of child abuse and
reporting protocols, researchers and clinicians have begun to examine the notion of
‘interpersonal trauma’ (Sanderson, 2009).
Bowlby (1973) viewed interpersonal trauma as an acute negative effect connected to
experiences of abuse and neglect. Such an event is regarded as interpersonal in nature and
correlates with a particular form of attachment, usually an avoidant, ambivalent or
disorganised attachment which is viewed as dysfunctional (Ainsworth & Bell, 1970; Main, et. al.,
1990). Allen (2001) suggests that interpersonal attachment trauma possesses more
pervasive effects than any other form of trauma. His theory reverberates ‘betrayal trauma’
proposed by Pamela Freyd (1996), a form of trauma which transpires within relational
environments where a caregiver violates the essential role expectations of protection and care
essentially severing affectional bonds.
The concept of interpersonal trauma evolved with a principal focus on the importance
of the mothering relationship with the developing child. Freud (1920) and Garland (1998)
purported that the mother provided a protective function for the child from damaging and
painful stimuli thus, Bowlby’s theory of attachment interconnects with interpersonal trauma
and allows us to spotlight what is damaging and what is protective in the developing child.
Researchers have identified several damaging disorders associated with interpersonal trauma
which include disorders of personality, schizophrenia, disorders of anxiety, dissociative
disorders, post-traumatic stress disorder, depressive disorders, self-harm, and dependency
(Sanderson, 2009).
Attachment and Trauma 7
Research suggests that serious attachment disruptions and trauma-related experiences often
coexist in the lives of infants. Both are viewed as threats to one’s survival. As
previously discussed trauma enfeebles attachments affecting individuals behaviourally,
biologically, socially and psychologically, as well as influencing an individual’s self-concept and
future relations (Badenoch, 2008). The overwhelming fear, anxiety and helplessness of
interpersonal attachment trauma stimulates post-traumatic stress reactions which have the ability
to fragment the self and alter personality (Sanderson, 2008).
Schore (1994) suggests that infants categorised as having a disorganised attachment
have difficulty in affect regulation, whilst Fonagy (1995) considered securely attached infants to
show mastery in affect regulation. Curnow (2007) asserts that anything which interrupts
the affectional bond may be experienced as trauma and generate disruptive behaviours. This
is in line with continuous research emphasising that traumatic events in childhood query
fundamental human relationships, contravening attachments and fragmenting the structure of
the psychological structures of self (Janoff-Bulman, 1985; Kohut, 1966).
In light of the literature presented it is essential to note that there are significant
contrasts amongst ‘secure attachment’ and ‘trauma attachment’. Secure attachment is
founded on love and enriches an individual’s development; whereas trauma attachment is
founded on terror and is potentially detrimental. Whilst infants perceive these relationships as a
necessity for survival, the dynamics of each scenario impact the development of the
individual very differently (James, 1994).
Therefore, exposure to trauma during infancy is believed to be a key causal dynamic in
the ontogenesis of psychopathology. Thus, a secure connection with a parent/caregiver is the
basis for cognitive and social development. When this connection fails the traumatised individual
loses their basic sense of self, eroding the structure of personality and often
developing a fragmented sense of identity (Herman, 1998; Kohut, 1966).
Attachment and Trauma 8
In clinical practice then, from an attachment trauma viewpoint, the symptoms and
behaviours of the client are recognised as unprocessed traumatic occurrences which have been
reproduced in implicit-procedural memories, as typified in a disordered, insecure IWM. These
unconscious memories shape the individual’s experience and appear in the
interpersonal structure, being communicated through narrative and expressional forms to the
therapist (Renn, 2012).
An important objective in psychotherapy in relation to attachment is the re-evaluation of
ineffective, antiquated IWM of self. Bromberg (1994) and Hughes (2011) purport that it is
essential to create a safe environment or ‘secure base’ to allow this re-evaluation of self to
occur. This core tenant of attachment theory is crucial in treating disorders of attachment
trauma, allowing clients to be open to new learning and exploration of self, in an attempt to
release affective elements of the client’s unresolved trauma. In treating clients with
attachment trauma several studies have identified that the therapeutic relationship itself is
fundamental in creating change. It is perhaps the most crucial evidence-based feature of the
therapeutic approach (Hughes, 2011).
Research demonstrates that the quality of the therapeutic relationship underpins effective
therapy, and is the foundation in which healing occurs. For such a relationship with clients with
attachment trauma allows for co-creation of dissociated experiences, encouraging identification of
mental states and influencing behaviours within several interpersonal contexts. According to
Renn (2012), this produces in the client a logical, safe and agentic self as antiquated IWM are
modified into new interpersonal models.
The augmentation of the client’s capacity to progressively systematise and assimilate
their fragmented self involves the healing of trauma misattunement in the client-therapist
relationship. Therefore, the therapist’s facilitating behaviours amalgamate with the client’s
creating a sense of safety in which the attachment relationship develops. This relationship
Attachment and Trauma 9
allows facilitation of a collaborative exploration of the client’s self-states, aiding the client to
develop an integrated sense of identity (Renn, 2012; Gingrich, 2013).
This paper has highlighted that attachment trauma creates impairments to one’s ability to
adapt and make meaningful connections with others. It illustrates that treating attachment trauma
requires knowledge and understanding of the dynamics of both attachment and trauma in order to
successfully integrate the concepts and develop a coherent treatment and
therapeutic experience (James, 1994).
Several evidence-based approaches to treatment of attachment trauma include: Childparent
Psychotherapy (Lieberman & van Horne, 2008), Patient-child Interaction Therapy (Eyberg,
1998), Trauma Focussed Cognitive Behavioural Therapy (Cohen, Mannarino & Deblinger,
2006), Sensorimotor Psychotherapy (Ogden, Minton & Pain, 2006), Dyadic
Development Psychotherapy (Hughes, 2003) to name a few.
Within all of these therapeutic practices it is imperative to note that numerous professional
challenges are implicated in working with individuals suffering from attachment trauma. These
challenges affect therapists across several dimensions. Therefore, it is
fundamental that therapists are equipped with sound knowledge and understanding of
attachment and interpersonal trauma and the psychological impact on both the client and
therapist. This involves focussed training in the dynamics and characteristics of trauma in relation
to attachment (Sanderson, 2009).
Considerable research has highlighted that therapists can become affected when treating
clients within this setting (McCann & Pearlman, 1989; Figley, 1995). This includes
being susceptible to an array of challenges and professional issues. Thus, it is important that
the therapist possess a developed sense of self-awareness. Self-awareness allows the therapist
to be mindful of the power and control dynamics of the therapeutic relationship in order to
minimise re-enactment. It also aids in noticing threats to the therapists well-being associated
Attachment and Trauma 10
with poor self-care, compassion fatigue, burn-out, vicarious trauma and/or secondary
traumatic stress (Sanderson, 2009; Figley, 1995).
Therapists in this setting are also likely to demonstrate a desire to want to ‘rescue’
their client. Such a process is counter-productive to the therapeutic process and is indicative
of transference and/or counter-transference (Sanderson, 2006). Thus, professional support
networks, training and peer and clinical supervision are critical to ensure the health and well-
being of the therapist to counteract working with clients in this therapeutic setting.
Attachment and trauma theory have undoubtedly modernised research highlighting
their interconnecting roles in psychological health, infancy and development. It is apparent in the
literature that attachment is the foundation for many trauma-centred therapies. More often than not
individuals presume that infants are not significantly affected by traumatic
occurrences. They believe that if the infant is too young to understand what is transpiring, then they
will not be affected by the event, or that the infant’s resilience will allow them to recover without
difficulty (Hughes, 2003).
The information presented throughout this paper has illustrated that this is not the
case. It has highlighted the notion that early attachments and the parent-child relationship are vital to
an infant’s capacity to acquire and develop emotional, cognitive and social skills. For an infant’s
first important relationships directly influence their developing brain forming a template for
attachment relationships into adulthood.
In summary, this paper has presented the key concepts of both attachment and trauma
theory with reference to their historical, social and clinical concepts. It has highlighted a form of
trauma known as interpersonal trauma and its connection with attachment, as well as
presenting the psychological impact and notion of the fragmented self. The paper evaluated
the strengths of attachment in treating trauma by highlighting the need to provide the client
with a safe and secure base.
Attachment and Trauma 11
It further evaluated the strength and crucial importance of the therapeutic relationship in
treating attachment trauma. Conversely, limitations in contemporary practice were
evaluated with a central focus on the well-being of the therapist, highlighting the challenging
nature of working within this therapeutic environment. To conclude, it is of fundamental
importance that appropriate evidence-based treatments are utilised by trained professional staff in
the treatment of individuals with attachment trauma disorders and that self-reflection and care are
just as imperative as the therapeutic alliance.
Attachment and Trauma 12
References
Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated
by the behavior of one-year-olds in a strange situation. Child development, 4(1), 49-
67.
Allen, J. G. (2001). Traumatic relationships and serious mental disorders. Chichester, UK:
John Wiley & Sons.
APS (2014). Understanding and managing psychological trauma. Retrieved from
http://www.psychology.org.au/publications/tip_sheets/trauma/.
Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal
neurobiology. NY: W. W. Norton.
Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of
Psychoanalysis, 39, 350-371.
Bowlby, J. (1969). Attachment. Attachment and loss: Vol. 1. Attachment. New York: Basic
Books.
Bowlby, J. (1973). Attachment. Attachment and loss: Vol. 2. Separation: Anxiety and anger.
New York: Basic Books.
Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock
Publications.
Bowlby, J. (1982). Attachment (2nd ed.). New York: Basic Books.
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth.
Developmental Psychology, 28, 759- 775. Retrieved from
http://www.psychology.sunysb.edu/attachment/online/inge_origins.pdf.
Bromberg, P .M. (1994). “Speak! That I may see you”; some reflections on dissociation,
reality, and psychoanalytic listening. Psychoanalytic Dialogues, 4(4), 517-547.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief
Attachment and Trauma 13
in children and adolescents. New York: The Guilford Press.
Curnow, R. (2007). Trauma a psychoanalytic perspective. Retrieved from:
http://www.aipsych.org.au/articles/aip_trauma_psychoanalytical.pdf.
Dozier, M., Dozier, D., & Manni, M. (2002). Attachment and biobehavioral catch-up: The
abc’s of helping infants in foster care with early adversity. Zero to Three, 22, 9-13.
Egeland, B. (2004). Attachment-based intervention and prevention programs for young
children. In R. E. Tremblay, R. G. Barr & R. D. Peters, (Eds.), Encyclopedia on Early
Childhood Development, 1-7.
Eyeberg, S. M. (1998). Parent-child interaction therapy: Integration of traditional and
behavioral concerns. Child & Family Behavior Therapy, 10, 33-46.
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder
in those who treat the traumatized. New York: Brunner/Mazel.
Fonagy, P. (2005). Attachment, trauma and psychoanalysis: Where psychoanalysis meets
neuroscience. Keynote lecture presented at the IPA 44th Congress on Trauma: New
Developments in Psychoanalysis, Rio de Janeiro, July 28th..
Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., & Traget, M. (1995).
Attachment, the reflective self, and borderline states: The predictive specificity of the
Adult Attachment Interview and pathological emotional development. In S. Goldberg,
R. Muir & Kerr, J. (Eds.), Attachment theory: Social, developmental, and clinical
perspectives, pp. 233-278. Hillsdale, NJ: Analytic Press.
Freud, S. (1920). A general introduction to psychoanalysis. New York: Boni and Liveright. Freyd,
J. J. (1996). Betrayal trauma: The logic of forgetting child abuse. Cambridge, MA:
Harvard University Press.
Gaffney, D. A. (2006). The aftermath of disaster: Children in crisis. Journal of Clinical
Psychology, 62 (8), 1001-1016.
Attachment and Trauma 14
Garland, C. (1998). Understanding trauma: A psychoanalytic approach. New York:
Routledge.
Gingrich, H. D. (2013). Restoring the shattered self: A Christian’s counselor’s guide to
complex trauma. Downers Grove, IL: Intervarsity Press.
Goldberg, S. (2000). Attachment and development. NY: Oxford University Press.
Goodwin, I. (2003). The relevance of attachment theory to the philosophy, organization, and
practice of adult mental health care. Clinical Psychology Review, 23, 35-56.
Hazan, C., & Zeifman, D. (1999). Pair-bonds as attachments: Evaluating the evidence. In J.
Cassidy & P. R. Shaver (Eds.), Handbook of attachment theory and research, 336-
354. New York: Guilford.
Herman, J. L. (1992). Trauma and recovery: The aftermath of violence. New York: Basic
Books.
Herman, J. L. (1998). Trauma and recovery. New York: Basic Books.
Hoehn, E. (2011). The importance of an attachment security, Brisbane North Interagency
Forum - Attachment issues in young children and adolescents. Royal Children's
Hospital, 25 August.
Hoffman, K., Marvin, R., Cooper, G., & Powell, B. (2006). Changing toddlers’ and
preschoolers’ attachment classifications: The Circle of Security Intervention. Journal of
Consulting and Clinical Psychology, 74, 1017-1026.
Hughes, D. (2003). Psychological intervention for the spectrum of attachment disorders
and intrafamilial trauma. Attachment & Human Development, 5, 271-279.
Hughes, D. A. (2011). Attachment-focuses family therapy workbook. New York: W. W.
Norton.
James, B. (1994). Handbook for treatment of attachment-trauma problems in children. New
York: The Free Press.
Attachment and Trauma 15
Janoff-Bulman, R. (1985). The aftermath of victimization: Rebuilding shattered assumptions.
Trauma and its wake: The study and treatment of post-traumatic stress disorder. NY:
Brunner/Mazel.
Juffer, F., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Promoting
positive parenting: An attachment based intervention. New York: Taylor and Francis.
Khan, M. M. R. (1963). The concept of cumulative trauma. Psychoanalytic Study of the
Child, 18, 286-306.
Kohut, H. (1966). Forms and transformations of narcissism. In C. Strozier. (Ed.), Self
psychology and the humanities. New York: Norton.
Lieberman, A. F., & Van Horn, P. (2008). Psychotherapy with infants and young children.
New York: The Guilford Press.
Leys, R. (2000). Trauma: A genealogy. Chicago: The University of Chicago Press.
Main, M., & Solomon, J. (1990). Procedures for identifying infants as
disorganized/disorientated infants during the Ainsworth Strange Situation. In M.
Greenberg, D. Chiccetti, M. Cunmings (Eds.), Attachment in the preschool years.
Chicago: University of Chicago Press.
McCann, I. L., & Pearlman, L. A. (1989).Vicarious traumatization: A framework for
understanding the psychological effects of working with victims. Journal of
Traumatic Stress, 3, 131-149.
McInerney, D. M., & McInerney, V. (1998). Educational Psychology: Constructing
Learning (2nd ed.). Frenchs Forest, NSW: Prentice Hall Australia.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach
to Psychotherapy. New York: W. W. Norton.
Renn, P. (2012). The silent past and the invisible present: Memory, trauma and
representation in psychotherapy. New York: Taylor & Francis.
Attachment and Trauma 16
Sanderson, C. (2006). Counselling adult survivors of child sexual abuse. London: Jessica
Kingsley Publishers.
Sanderson, C. (2008). Counselling survivors of domestic abuse. London: Jessica Kingsley
Publishers.
Sanderson, C. (2009). Introduction to counselling survivors of interpersonal trauma. London:
Jessica Kingsley Publishers.
Schore, A. N., (1994). Affect regulation and the origin of the self: The neurobiology of
emotional development. Mahweh, NJ: Erlbaum.
Schore, A. N. (1997). A century after Freud’s project: It’s a rapprochement of between
psychoanalysis and neurobiology at hand? Journal of the American Psychoanalytic
Association, 45, 841-867.
Schore, A. N. (2000). Forward to the reissue of attachment and loss, volume 1: Attachment
by John Bowlby. New York: Basic Books.
Schore, A. N. (2003). Affect regulation and the repair of the self. New York: W. W. Norton.
Simpson, J. A., & Rholes, W. S. (1994). Stress and secure base relationships in
adulthood. In. K. Bartholomew & D. Perlman (Eds.), Advances in personal
relationships. London, UK: Kingsley.
Steele, W. (2002). Trauma informed care. Retrieved from:
http://assets1.mytrainsite.com/500051/ticsingle.pdf.
Terr, L. (1990). Too scared to cry: Psychic trauma in childhood. New York: Basic Books.