The door opens.

“Hi Lisa”

“Hi,”

She yells up the stairs, “Mac, come on, your aunt’s here.” “MAC!!”

My nephew stares at his untied shoes as he comes down the stairs. The nine-year-old was swaying unevenly. I was in town visiting and thought we’d go to the zoo. I was excited since I don’t see him often.

But something was wrong.

In the car, he rested his head against the window, eyes closed.

“You okay?” I asked

“Don’t feel good”, he muttered. Never opening his eyes, his slight frame seemed small.

I pulled down the sun visor and tried to think, “Why didn’t she tell me he was sick?” I don’t understand; he should not be out.

The day was bright and warm, but feeling his cheeks, they were hot and clammy.

I pulled into the CVS. “I’ll be right back”

Returning from the store, his head still leaned against the window.

“Let’s bag the zoo”, I announced, “Did you eat today? The car clock read 11:34 am

A small head nodded ‘no’

I picked a local restaurant and ordered bowls of soup. His head rested on the table against his folded arms.

“Here, take this. I slid Children’s Tylenol across the table along with water.

“What’s that?” he asked, skeptical.

“Medicine, should help you feel better. You don’t take medicine when you’re sick?” I asked.

His head slowly nodded no.

I turned to stare out at the traffic.

I was angry and sad. My auntie part of me was angry, and my therapist part of me felt deeply sad. And I had to not criticize his mom’s caretaking.

I was mad about the consequences. His difficult feelings would fester. They wouldn’t transform. And for him, that would be more evidence that they didn’t matter. I could almost see the outcome start in his tone — ‘why should I give more than one-word answers?’

I’d seen similar dynamics with clients. They gave clipped, protected replies as they wrestled with vulnerability. Sometimes I could see the wheels turning, “Do I risk describing my authentic feelings?”

In therapy, we had to build a connection brick by brick.

Signal 1: Attachment is fundamental, like a hard drive, not a dongle

My hard drive powers my laptop. It’s the heart of organizing my life. But my most recent laptop has a C-port, not a USB port. To retrieve data from my retired laptop to my current one, I have to use a dongle, a small piece of hardware that enables connectivity.

What does tech have to do with EMDR therapy? I remember that after graduating from EMDR basic training, I didn’t fully understand the concept of attachment. I treated the concept as a dongle: only reaching for it when something was visibly stuck. For example, attachment wounds were the theme behind statements such as “my parents were great, I was a bad kid.” While working on a memory of Dad’s business being raided by the FBI.

Attachment wounds were behind a client flooded with the critical voice of a perfectionistic dad and self-hatred for being a bad kid. Because it’s easier to blame oneself than to accept imperfect parents.

As a new EMDR-trained therapist, attachment was just “something to consider”. Now, I understand it differently. It’s the humming hard drive through which everything else, like sadness, grief, and loneliness, moves.

As an EMDR consultant, I often have the chance to review session transcripts. I can recognize patterns of avoidant attachment in processing. It sounds like a cognitive, intellectual stance — without feeling the emotion. It sounds like a person suffering alone who doesn’t know how to use the therapist to help with hard parts.

Clients try to do what they do alone.

Anabel Gonzalez in EMDR and Emotional Processing explained that statements such as “I don’t want to feel this way,” “I shouldn’t feel this way,” “I am strong, this isn’t going to affect me” — or if asked what they notice in Phase 4, repeatedly replying “I don’t know,” “I don’t notice anything” — can signal overregulation of emotion.

Signal 2: Understanding the mechanism of defensive exclusion can strengthen the therapeutic alliance

Bowlby’s concept of defensive exclusion refers to the strategies children use when caregivers are chronically unavailable and unresponsive.

Kids have to exclude from awareness experiences and sensations that are overwhelming and can’t be managed alone. For example, emotional suppression. The difficulty for EMDR therapists, though, is that if it’s suppressed, like a turtle pulling its head back into its shell, it’s unavailable to be integrated and processed in Phase 4. Pando-Mars and Fosha add that “blocking awareness and shutting down experience protects the integrity of the self or protects the relationship with others” (p. 111).

Repeated “I don’t know” or “I don’t want to feel this way” suggests the mechanism of defensive exclusion may be at play. Fosha describes the conditions for ideal therapeutic growth, what we try to create in the room, as “feel and deal”. She describes the avoidant strategy, by contrast, as “deal and not feel” (p. 195).

Signal 3: Undoing aloneness can build resiliency

A third signal worth highlighting is how alone the avoidant client remains — even in the therapy room.

Diana Fosha, PhD, coined the concept ‘undoing aloneness’ as a core tenet of Accelerated Experiential Dynamic Psychotherapy. It refers to the fact that an element of trauma is a person bearing the unbearable alone. And that aloneness can be felt by the therapist.

“I could be a blowup doll”

That’s how one colleague described being with a client with a dismissive/avoidant attachment strategy. They could exit the room, leave a life-sized doll in their chair, and they weren’t sure if the client would notice.

The deactivating strategy utilized to manage hurt and rejection from caregivers who weren’t available to coregulate can show up as detachment. So even in my office, especially early on, clients may spend much of the session talking to the opposite wall or window rather than with me. They are doing life alone right in the room.

After some time, I might gently invite an experiment: Can we try some eye contact? Can you look at me for part of this?

My shoulder or foot? It may help you feel not so alone.

It may also kindle their sensitivity to use other people to bear distress. I remind them they can always disconnect. But we’re practicing small doses of connection during the hour.

Although they have a low bandwidth for connection, it isn’t absent. It can be stretched slowly over time, so they have some choice between processing alone and with another — exactly what a secure attachment in session is built from.

EMDR works with traumatic memories. But clients arrive having spent years — sometimes decades — managing symptoms and sensory overload in the only ways available to them. Attachment patterns and strategies are well-documented, developed early, and continue to influence relationships, including those with us.

The good news is that we are not problem-solving alone. Colleagues have been translating research into clinical practice while remaining sensitive to the specific needs of clients with insecure attachment styles. Pando-Mars and Fosha’s work is one example. Gonzalez is another. Their work helps us better understand and navigate fragile territory.

We are not alone as EMDR clinicians. And neither, eventually, are our clients.

Hit reply with what you notice about avoidant attachment and how you work with it — I read every response

References

Gonzalez, A. (2020). EMDR and emotional processing: Working with severely dysregulated patients.

Pando-Mars, K., & Fosha, D. (2025). Tailoring treatment to attachment patterns. pp. 111, 195.

Bowlby, J. (1980). Loss: Sadness and depression. Attachment and loss (Vol. 3). Basic Books. [Referenced via Pando-Mars & Fosha, 2025.]