This ad landed in my email this week.
I get a lot of emails and ignore most, but this one piqued my curiosity. The Telehealth Certification Institute was promoting a new training to adapt CBT for complex presentations, weaving it in with DBT and Schema Therapy.
I used CBT for case conceptualization as a graduate school intern. I remember half listening to my supervisor as she outlined transforming client history into a treatment plan. But I was numb and overwhelmed. I was fried after intake.
My client had been discharged 24 hours ago for a suicide attempt after losing a child.
We didn’t cover this type of case in class.
And wait — shouldn’t I have at least led with Sorry for your loss?
How was CBT supposed to help this?
The loss of a child was the worst kind of loss.
I was too overwhelmed to talk with my supervisor about how the session had impacted me. This was also my first case ever. I wrestled with “doing therapy right” by “keeping myself out” — ideas gleaned from class about how to create healing conditions.
So seeing CBT evolve to meet real-world demands was hopeful. It also validated what I felt that day on internship: that relational and attachment issues — including loss, despair, and grief — needed a different approach.
CBT may come from a different road than EMDR, but both hit the same wall when faced with the array of symptoms related to attachment wounds.
EMDR leaders Ann E. Potter and Debra Wesselmann, authors of EMDR and Attachment-Focused Trauma Therapy for Adults, recognize the “multiple consequences to clients’ internal and external lives.”
There’s so much behind that one line — substance abuse, DUIs, multiple depressive episodes, suicidality, fear, being burnt out on caretaking, hating emotions, and dissociation to manage sadness and despair.
Once you start looking, you see the impacts everywhere.
I felt empathy and solidarity with CBT’s position, reflected in that ad. It has been an all hands on deck moment for decades — designing, experimenting, and iterating toward better interventions.
As Plato said, necessity is the mother of invention.
AEDP — Accelerated Experiential Dynamic Psychotherapy
Developed by Diana Fosha, PhD, AEDP is a relationally-based, experiential model grounded in attachment theory, affective neuroscience, and infant research. Using relationship and shared experience, it creates conditions for transformation to healing states, not just symptom reduction.
One of the books I’m finally getting to is Tailoring Treatment to Attachment Patterns by Karen Pando-Mars and Diana Fosha, and it’s relevant to understanding attachment patterns in EMDR therapy as well as other modalities.
It’s worth picking up if you’ve found yourself irritated by a client presentation and couldn’t name why. Or if clients with a history of caregiver abandonment or neglect are on your caseload. Or if you’re trying to get a picture of why attachment is relevant to EMDR or other trauma processing modalities.
I’ve been sitting with my notes, and I wanted to share three things I’m taking away from it so far — three mindsets, attitudes, and skills for cultivating a secure base of treatment with clients who have an ambivalent/resistant attachment style.
1. Start with intention
Pando-Mars and Fosha write: “Start with the intention that we are two human beings and how we meet and what we do with our meeting is as important as the skills and interventions we subsequently provide.”
That stopped me. Effective therapy focuses on being with clients in a way that fosters secure attachment — providing a secure base for exploration. Understanding that we’re meeting to move from hyperactivation to exploration, and that my body and presence should foster that goal, isn’t always made transparent at the outset of therapy.
But wow, that’s clear.
2. Clinician reactivity is expected
The book validates clinician reactivities and how to work with them. Surprise, surprise, clients are human, and I loved the section on therapist reactions when working with someone with an insecure attachment style. I know we are beyond the “blank slate” era of psychotherapy (I hope), but I know many therapists who feel they’ve failed if their reactions reveal they can’t meet every moment with connection and care.
3. Meta-skills as a buffer
This is where it gets practical. The book unpacks clinician meta-skills designed to buffer against ruptures and detours — and to counter the inconsistent way of being that was reinforced in the client’s original caregiving relationship. One example: tracking the client’s window of tolerance while staying present to your own. Giving yourself that clear left-brain task while riding the client’s waves of anxiety adds resiliency to a “safe enough” working environment.
Structure, it turns out, is also a relational intervention.
There are other EMDR-focused modalities with similar aims — Potter and Wesselmann’s AFTT-A, and April Steele’s Imaginal Nurturing, for example. But I found this book gold in articulating the what, why, and how of working at the nexus of attachment and therapy.
If attachment wounds are showing up in your caseload right now — and if you’re reading this, they probably are — this is a read before your next complex case, not just an addition to your library. Its deep roots in attachment and neuroscience help bring the science into the clinical session in a way that grows your confidence.