12 min read | March 1, 2026
Andy gave a thumbs up and rolled off the side of the boat.
I watched him go, rocking with the swells off the coast of Maui.
Popping up from the water, Andy shouted, “There are sharks down here!”
“That’s where they live,” said the divemaster, not looking up from the air gauge.
We knew it from the travel guides. But now we knew it.
That’s how I felt the first time the EMDR research on child-onset versus adult-onset trauma actually landed. I wasn’t deliberately skipping attachment questions — I was focused on the protocol and expected processes to work as they had in basic training. Like Andy, the reality of my client’s history and their coping would soon come into focus.
A Brutal — and Valuable — Lesson
Years ago, prepping a middle-aged client who wanted to reduce anger outbursts in the classroom, I checked all the boxes on my EMDR worksheet.
- Thirty-plus trauma experiences in adolescence ✔
- Unremarkable DES score ✔ (I now use a more accurate assessment)
- All thirty-plus experiences between the ages of nine and ten? — noted
I saw a straightforward candidate, not a fragile one, and I was excited to offer relief after years of suffering. Then, during Phase 4 Desensitization, their face went red, and their body began to shake.
Too much was erupting.
They didn’t have the capacity to hold it — an abreaction.
I helped reorient them by having them notice objects in the office and by guiding breathwork. I had been so locked into the protocol that I’d missed clues in plain sight, such as the clustering of adversity between the ages of nine and ten.
I wouldn’t have blamed them if they ran out. Instead, between sips of water, they said, simply: “Let’s not do that again.”
Learning the extent to which history matters was a brutal lesson for me that day. But it did teach me to listen differently to clients who grew up alongside untreated mental illness, domestic violence, intergenerational trauma, or who were the sole gender queer person in their world. History wasn’t just history for history’s sake — just like France isn’t just croissants and the Eiffel Tower. It was a living system I had barely learned to read.
The Narrative Tells the Story: What Early Relationships Reveal — and How to Use It
Which brings me to the question posed last issue:
When you were growing up, and you got upset about something, what typically happened?
It was a way to reveal how a client copes and whether they use others to manage stress and regulate their emotions.
The question was a variation of one from the Adult Attachment Interview, or AAI. Developed by Mary Main, the AAI is a semi-structured interview of 18–20 questions that identifies four adult attachment classifications — Autonomous, Dismissing, Preoccupied, and Unresolved. When used as a clinical tool, it reflects the nature of a client’s early experiences with caregivers, the client’s mental representation of those caregivers, their emotional stance towards each caregiver, and the extent to which loss, trauma, or other circumstances impacted a client’s personality structure. (Steele & Baradon, 2004)
What they say about their childhood will tell you something, but how they say it will tell you more. Wherever you’re starting from — whether attachment is new territory or familiar ground — knowing it and feeling it land in the room are two different things.
Coherence is a major tell. The way a client’s language holds (or doesn’t hold) their memories can reflect how their brain learned to manage emotion in their earliest relationships. And a few questions borrowed from the AAI help form a working hypothesis about two things that matter enormously: how a client organizes their experience of early relationships, and how they’re likely to show up in the therapeutic relationship itself. If I had known to ask them that day, I might have had an easier afternoon.
That working hypothesis identifies something specific — the memory networks that shaped how this person learned to be in relationship, and what that means for how they’ll use you and the therapy process itself. Consider what it feels like in practice. Will they join you in a genuine alliance, leaning into the safe and supportive relationship you offer? Or because of their history, will it feel like too much?
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And how will we feel? We’re human, and it can hurt when a client can’t fully lean in, especially when being a safe person is part of our professional identity.
Take a client with a Dismissing attachment classification. They’ve learned to minimize attachment needs and go it alone — and they’re expert at it. They may appear calm or unruffled while internally underreporting how much they’re actually struggling.
Early in treatment, gently naming the pattern — operating alone as a response to early adversity makes perfect sense — can open something in a client who has never had it reflected back to them. From there, you might introduce the option of using the therapeutic relationship itself as part of the work, not just as the backdrop. In practice, one way that might look is being mindful of sharing the space together — occasional eye contact, taking in one another’s presence — rather than being in the room but talking to the window.
With that opportunity, a client’s nervous system may be open to using another person’s authentic connection to tackle trauma symptoms. For EMDR specifically, that matters enormously — because the therapeutic relationship is the foundation that makes processing the energy of adversity possible. That kind of understanding has an additional benefit. It helps the client combat the urge to quietly drop out after three sessions.
Listening for What’s Alive in Memory Networks: A Focus on EMDR Preparation
To clarify, I am not suggesting you administer the AAI.
That would be untenable as full administration and coding requires specialized training — we’re talking 40 hours of training and years of supervised practice to classify transcripts with confidence. That is not what this is about.
What I am suggesting is to borrow from its spirit, a recommendation from seasoned trainers such as Dr. Andrew Leeds. A handful of questions, asked with genuine curiosity, can offer you a qualitative sense of which experiences remain emotionally alive in a client’s memory networks. One question opens this door particularly well.
“Why do you think your parents behaved the way they did?”
This is one of the most revealing questions in the AAI — a client’s answer tells you not only about their parents, but about the state of the memory networks those relationships left behind. The table below highlights possible responses you may recognize from your work.
| Classification | What You Might Hear | What to Listen For |
|---|---|---|
| Autonomous | “She had her own trauma she never dealt with. It took me a long time to understand that, but I don’t think it was really about me.” | Balanced perspective. Can hold the parent as a full, flawed person. Affect is present but regulated. Past feels like the past — which suggests the network has been integrated, at least partially. |
| Dismissing | “He did his best. That’s just how things were back then. I turned out fine.” | Brief, tidy, emotionally flat. Reflection closes quickly. The network may be intact but walled off — affect is stored but inaccessible. This client may struggle to connect to the emotional components EMDR requires. |
| Preoccupied | “Why did she do that? I still don’t know. I’ve asked myself that my whole life. Even last week when she called, she just — she never changes, she always makes it about her…” | Still tangled. Past bleeds into present. The network is unintegrated and easily activated — this client may have difficulty staying within the window of tolerance during processing. |
| Unresolved | “My dad was… he wasn’t well. He died when I was nine. I think about it sometimes and I just — I don’t know, it’s hard to…” (long pause, loss of narrative thread) | Disorientation around loss or trauma. The story briefly stops making sense — and then the client catches themselves and moves on as if it didn’t happen. This is a memory network that has never been safely approached. |
The classifications are useful for starting to see patterns, and advanced training delves deeper into the clinical applications of attachment theory.
A published case illustrates what this looks like in practice. Steele and Baradon (2004) describe a father whose AAI illustrates the gap between rich content and restricted access. His responses were emotionally vivid — specific memories, affect-laden language, even genuine remorse over lost relationships. And yet, in the same breath, he consistently minimized the meaning of what he was describing, as if the memory and its emotional weight occupied two independent rooms. In AAI terms, that pattern — and specifically that gap between what is remembered and what is felt — suggests the internal architecture is there, but access seems to be restricted. In EMDR terms, an opportunity for ‘+’ signs to link up.
Did the examples prompt you to recognize someone from your caseload?
What It Sounds Like in the Room
Here’s what listening for narrative quality might look like in practice. Consider two clients responding to the same question.
Therapist: “Why do you think your mother behaved the way she did when you were growing up?”
Client A: “I mean… she had a hard life, I guess. Her own mother was pretty cold. I used to think she just didn’t love me, but I think now she just didn’t know how. It wasn’t really about me.”
This client can hold two things at once — their childhood pain and a contextualized understanding of their mother. The affect is present but not overwhelming. The memory network has some integration.
Now consider a different response to the same question:
Client B: “Why did she behave like that? I have no idea. She just… she was fine, honestly. She worked hard. I didn’t have any complaints.”
The question asked for reflection. The response offered was clipped. That gap — between what the question invites and what the client can give — is telling, suggesting that the memory network is there but access is blocked; it doesn’t have the same level of integration. That gap is worth sitting with. What a client can’t reach may carry more emotional weight than they can articulate or show.
A Related Instrument Worth Knowing
The Adult Attachment Projective Picture System
The Adult Attachment Projective Picture System, or AAP, was developed by Carol George — one of the original co-developers of the AAI — and the late Malcolm West.
Where the AAI works through language and life narrative, the AAP takes a projective approach. The clinician presents a series of eight drawings depicting attachment-relevant scenes — a child alone, figures in distress, moments of separation and reunion — and asks the client to describe what is happening. There are no right answers and no structured questions to navigate. The client simply responds to what they see, and in doing so, reveals how their attachment system organizes under pressure. What gets told, what gets avoided, and where the narrative breaks down are rich sources of clinical information.
The AAP yields the same four adult attachment classifications as the AAI and goes a step further by assessing defensive processes that other attachment measures don’t capture — specifically, the ways clients unconsciously exclude threatening attachment-related material from awareness. For therapists interested in understanding defensive structure before processing begins, consider it as an alternative. The added value comes from being ready for psychological defenses that can interfere with accessing the maladaptive memory network and processing associated memories. (Leeds, A.M. (2009). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants. Springer Publishing Company.)
Like the AAI, the AAP requires training and certification to administer and code reliably. Carol George continues to offer training periodically throughout the year. If this is a direction you want to explore, her website, attachmentprojective.com, is the place to start.
(Reference: George, C., & West, M. (2012). The Adult Attachment Projective Picture System: Attachment Theory and Assessment in Adults. Guilford Press.)
Final Thoughts
Clients don’t always know what information matters and how it informs treatment — and even when they do, they don’t always have access to it. When a client describes, “I had a good childhood. My parents were good people, and we got along well,” they are telling you the truth as they understand it. It’s also how they answered in talk therapy. EMDR preparation can help socialize them to a different process.
Attachment assessments like the AAI and the AAP function as X-rays. Where standard intake questions capture what the client can consciously report, these tools reveal the underlying structure — what has been integrated and what is still very much alive in the memory networks. Knowledge that can inform treatment planning.
The data shapes which resources you build in Phase 2, which RDIs you reach for to construct a stable platform for processing, and how you orient the client to the therapeutic relationship itself. A client whose Dismissing organization has taught them to always go it alone will require a different relational foundation than one whose Preoccupied system taught them the opposite.
The tools give you an internal map, so it’s less likely you’ll find yourself sitting across from a trembling, red-faced client and hoping they’ll stay.
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If you use attachment questions, I’d love to know your go-tos. What’s your top question — and what do you like about what it reveals? I’d love to hear your response.
References
Steele, M., & Baradon, T. (2004). Clinical use of the Adult Attachment Interview in parent–infant psychotherapy. Infant Mental Health Journal, 25(4), 284–299.
George, C., & West, M. (2012). The Adult Attachment Projective Picture System: Attachment Theory and Assessment in Adults. Guilford Press.
Leeds, A.M. (2009). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors and Consultants. Springer Publishing Company.