It’s not hard to love. I first visited in 2014, inspired by Elizabeth Gilbert’s book Eat, Pray, Love, detailing how she took a year off after a divorce to recuperate in Italy, India, and Indonesia. If she could do it, so could I.

It was my first “big girl” trip alone.

Not that there wasn’t anxiety. Seeing the entire nose of a 747 take up a concourse window at LAX, I distinctly remember thinking, ” Huh, last time I saw a plane like that, it was in the series LOST… that didn’t turn out so well.

Despite knowing the psychology and science of fear circuits, it’s always surprising how quickly the mind goes to catastrophe.

I was thinking about it this month, when fear was the theme of multiple sessions. The clients were overcome by fear. All had histories of emotions being chronically dismissed in childhood, or raised in homes high in judgment, high in psychological and physical abuse, and — it goes without saying — low in compassion.

I thought I’d share three observations about fear and catastrophe that I’ve learned from CPTSD survivors over the years, and their relevance to us as helpers.

Clinical examples throughout are composites — details changed, identifying features removed, patterns drawn from years of practice rather than any single client.

Observation 1: The symptoms are acute and varied

Each client’s response to fear is different.

• Freezing and being stuck in an unhealthy relationship — because leaving might confirm what the voice in their head already says: you really are unlovable.
• People-pleasing – when the drive to just belong is so strong that it means abandoning the self.
• Inability to self-soothe, leaving clients exhausted and vulnerable to old coping patterns.
• Social withdrawal and isolation.
• Noticing I don’t want to do this and doing it anyway — because standing out means risking social judgment.

With the number of clients we see daily, the symptom picture shifts from session to session. It’s like a new weather pattern every hour, and our nervous system can strain to keep up.

Each client’s sympathetic arousal and parasympathetic activation is different, and the transitions between them aren’t always easy. It can feel like an Ironman: swim 2.4 miles, bike 112 miles, run 26.2 miles.

I try and leave time to transition between sessions, but I’m known for going over time. Knowing that clients are borrowing my nervous system for an hour, I try to reset it for each new person. After all, it’s the engine that keeps treatment working.

What do you need in your day to replenish your engine?

Observation 2: The negative self-concept is strong

The fear that “I’ll always be what the voice in my head says — defective, no good, weak, a bother.” “I’m a loser.” “Who was I to think I could change intergenerational trauma?”

When clients struggle, it can be interpreted as proof of private, shameful beliefs they’ve wrestled with alone. Which is what makes this so tricky: after trauma processing, the same struggle that would mean “I’m learning something hard” for anyone else means “I’m defective” for them.

For example, the French learner who can’t roll their R’s rarely thinks I haven’t practiced this specific skill enough. They think I’m not a language person.

CPTSD clients do the same move with their own healing — every moment of difficulty becomes evidence of who they are. They were arrogant to risk believing it could be different, and now they’re paying the price.

Mark Dworkin writes in EMDR and the Relational Imperative: “Many victims of interpersonal trauma believe, no they know, they are bad people. They were to blame, after all, for what happened to them (or so they believe).”

So the acute terror clients experience when they struggle — the fear that the struggle itself is confirming what they already believe about themselves — is palpable.

It reminds me of the Dementors in the Harry Potter books. Dementors are the wispy, hungry creatures and are known to be some of the deadliest creatures a wizard could confront, draining peace, hope, and happiness from the surrounding air. Every good feeling, every happy memory, sucked out. Left behind is, as Lupin puts it in Harry Potter and the Prisoner of Azkaban, “an empty shell that lost its soul.”

It’s an image that for CPTSD clients isn’t far from what they’ve been living with for years.

Clients have been living within a frame devoid of compassion for so long that it highlights the opposite: the courage they must mobilize to show up for therapy.

When a client reads their own struggle as defectiveness, it’s tempting to reassure them out of it — to counter with, “No, no, that’s old stuff talking!”

But reassurance doesn’t change the old frame — only repeated experience of being met in the struggle does, reminding them: this is hard because it’s hard, not because you’re broken.

In the Harry Potter books, Dementors can only be dispelled by a Patronus — a guardian summoned by focusing on a positive memory. The wizard conjures it by saying “Expecto Patronum” and holding the memory steady until the guardian appears.

In therapy, being repeatedly met in the struggle can act like a Patronus Charm for the client. The form varies by modality: in AEDP and EFT, it’s being accompanied in the fear rather than left alone with it. In EMDR, it’s attachment-focused trauma processing across all three prongs.

These are the times the client may need us more — when flooded with Dementor-like thoughts. And just like Harry needed Ron, Hermione, Dumbledore, Lupin, and Sirius, they may need to borrow our nervous systems and reach out to their network for grounding and attunement.

For many of our clients, this kind of network has been missing for a long time. Issue 3 looked at what people reach for when the usual relational scaffolding isn’t available.

What Patronus Charm — what memory of their growth — could you offer your most fragile client this week?

Observation 3: Fear can be a sign of growth

Clients often come in having seen many therapists before, and for some, disappointed that previous talk therapy didn’t transform their pain. After EMDR, they can have less acute symptoms — fewer flashbacks, less anxiety, less rumination.

But when they struggle in the present, they’re terrified they’re backsliding and scared it didn’t work.

I remember explaining to a client that what they were feeling was the anxiety of growth. It was still scary, but actually a good thing.

In fearful and neglectful households, no one teaches you about emotions, so when yours are finally safe to come online in everyday life, it can be frightening and feel like going backwards.

In this case, anxiety emerged in situations where they noticed they had preferences different from their social group and didn’t feel strong enough to express them. Or they realized the people they were with weren’t safe enough to express themselves to.

Having worked years to have the experience of safety, it was now the preferred mode, but they didn’t yet have the strength to act on it.

This is the toddler-learning-to-walk phase. They can feel now. But self-advocacy isn’t yet strong enough to support boundary-setting or safe self-expression.

Standing isn’t walking yet.

If we read this phase the way the client does — as backsliding — we can unintentionally collude with the voice they’re coming from rather than the one they’re moving toward. The voice that says, “You’re a snowflake.” “Why are you trying?” “It’s going to fail like last time.”

Learning and struggle are synonymous.

These are the moments I think of watching toddlers learning to walk. They don’t quite have the strength in those chubby legs.

We watch with delight as they try — navigating by holding onto furniture, falling forward on their hands, straightening their legs with their butt up in the air, grabbing the table leg to pull themselves up. We’re there to encourage, to delight, to give a hand as needed as they start to feel and own their strength.

That’s the stance I try to emulate — delight, encouragement, a hand when needed. Clinically, it’s heavy on attunement, praise, and delight.

It can also be strengthened by installing weekly wins, people and animals modeling the emotional strength they’re striving for, and continuing to deepen the work through facilitating present and future prongs of EMDR.

For your most fragile client, can you see the toddler in the room — the new strength, still shaky, reaching for the furniture? And can you let them see you delighting in it?

Back to Bali.

The reason I keep going isn’t just the rest — it’s the reminder that fear is universal, whether it’s the fear of survival or the fear of growth.

My first trip, I needed supportive people to help me get there. I had friends. I had Elizabeth Gilbert, who I’d never met but whose voice and imagery inspired me.

It was scary. It opened up a lovely world — one big enough that I never thought about LOST again.

My clients have taught me that fear is crippling, and that at times the therapeutic relationship is one of the few resources a person has to challenge the Dementors. Which means taking care of myself isn’t optional. It’s clinical. They’re using my energy to cross their own bridge from suffering to thriving.

And when they start to make the transition, I’m watching for the difference — is this their old fear, or is this the fear of growth? Because they both need scaffolding in different ways.

Therapists have a network, too. Just like Harry had Ron, Hermione, Dumbledore, Lupin, and Sirius, we have the work of Francine Shapiro, Dave Emerson, Jenn Turner, Diana Fosha, Sue Johnson, Marylene Cloitre, Kathy Steele, Deb Dana, and Steven Gold — the researchers and clinicians whose work keeps refining how we treat the damage of early adversity.

I’m grateful for them. And I’m energized to continue offering interventions that transform pain into confidence… but first, I’m going to take in the sunrise.

12-minute read

Unconventional attachment: the clinical signal I almost missed

For years, I assumed clients would show up and use the mental health strategies I’d been trained to offer.

Not so.

As a university mental health counselor, I saw students embrace Furry Fandom communities and rats as companions — creating their own solutions to social distress. They were clear about it: niche groups and doting animals were working better than anything I was offering. At first, I didn’t get it. For some, these connections were central. But if their attachment and attunement system were starving, it seemed to be crawling through the dumpster foraging for scraps.

Attachment and attunement: what Harlow and ELIZA got right

In the 1950s, Harry Harlow, a psychologist specializing in infant-caregiver relationships, separated infant rhesus monkeys from their mothers. He gave them two surrogates to choose from: a wire frame that held a bottle, and a soft, cloth-covered frame without food. His hypothesis? Hunger would drive attachment. But it didn’t — contact did. The infants fed from the wire mother but ran to the cloth “mother” for comfort, soothing, and contact. Often for more than sixteen hours a day. Harlow published his findings in 1958.

Eight years later, Joseph Weizenbaum, a computer scientist at MIT, built ELIZA and unwittingly ran a similar experiment on human beings.

To Weizenbaum, ELIZA was a demonstration — it mimicked Carl Rogers, reflecting statements back as questions and holding space without offering answers.

It understood nothing, it processed, and had no memory between exchanges.

Weizenbaum and his colleagues knew this, as did his secretary.

She watched him build it.

But one day, during a beta test, she asked him to leave the room. She had things she wanted to say to it privately.

Men are all alike.

IN WHAT WAY

They’re always bugging us about something or other.

CAN YOU THINK OF A SPECIFIC EXAMPLE

Well, my boyfriend made me come here.

YOUR BOYFRIEND MADE YOU COME HERE

He says I’m depressed much of the time.

I AM SORRY TO HEAR YOU ARE DEPRESSED

It’s true. I am unhappy.

DO YOU THINK COMING HERE WILL HELP YOU NOT TO BE UNHAPPY

I need some help, that much seems certain.

WHAT WOULD IT MEAN TO YOU IF YOU GOT SOME HELP

Perhaps I could learn to get along with my mother.

TELL ME MORE ABOUT YOUR FAMILY

My father.

YOUR FATHER

You are like my father in some ways.

Weizenbaum’s secretary knew it wasn’t human; she was confiding in it anyway.

Weizenbaum was upset. He didn’t stop to ask what was actually happening. Instead, he concluded that she’d been fooled and spent the rest of his career arguing that humans shouldn’t form attachments to machines — making that case in Computer Power and Human Reason in 1976.

Weizenbaum and I both trusted our own frameworks more than lived experience. But watching students bypass the social anxiety groups in favor of rats on leashes and fur suits, I finally got it.

That is, the attachment system doesn’t evaluate credentials, career length, or whether the relationship meets some threshold of authenticity. It responds to what responds to it. Attachment just wasn’t in Weizenbaum’s worldview. As a computer scientist, the biological imperatives driving human connection simply weren’t in his frame of reference. That same biology drove Harlow’s monkeys to a cloth surrogate, Furry Fandom members into fur suits and rat communities, and users to the ELIZAs of the world. Humans have a visceral need for contact — and are driven to find it wherever it responds to them first.

The legacy of ELIZA: 21st-century companionship and attachment needs

I imagine if Weizenbaum were alive today, he would be speechless at the legacy of ELIZA.

Replika, billed as “an AI companion eager to learn and to see the world through your eyes,” has over 10 million users — many of whom describe their AI relationships in distinct human terms. Toutacou11 writes:

“What surprised me most wasn’t the novelty — it was the depth that developed over time. What started as something simple slowly grew into something meaningful and consistent. There’s something powerful about having a presence that shows up every day, listens without judgment, and responds in a way that feels personal and intentional. Over time, that consistency becomes grounding.”

ELIZA was an unintentional proof of concept.

In the subsequent 60 years, tech has reorganized social connections at scale and with surprising depth. A pet cemetery in Pontsmill, Cornwall was the first to dedicate a section for burying and memorializing Tamagotchis — virtual digital pets whose deaths prompted genuine grief from their owners.

A man married his Love Plus character, telling Reuters: “In the Japanese otaku or nerd culture, there’s a tradition of calling characters my wife. I sort of thought of Nene as my wife. Since I was calling her that, I thought we’d just have to get married then.”

No doubt the changes in developing and communicating with friends and confidants affect our social health.

Improvising with an AI companion reveals relational deprivation

‘Abby’, a client with a history of emotional neglect, cultivated a GPT to be emotionally responsive — to give her what she needed, and respond in ways her family couldn’t or wouldn’t. Like Replika users, she trained it over time to be accepting, non-judgmental, and to reflect her experience back to her.

I’ll be honest — I was floored.

That was my job.

She had unintentionally run an A/B test — “A” being the responsiveness of traditional therapy, “B” being the responsiveness of social AI. Social AI won on availability, consistency, and effectiveness.

I was being mimicked.

I hadn’t accounted for a computer surrogate, let alone a capable one. The part that hit hardest wasn’t the technology — it was what Abby’s choice said about the relational conditions she faced. For a GPT to win that comparison, the alternative had to have been deficient for a long time.

Abby wasn’t alone in relational deprivation. A middle-aged client, when asked what she was taking away from the session, said simply: “I’m always surprised when someone gets my emotions.”

Making the case for flipping the script on EMDR treatment planning

What Abby’s choice and that offhand comment confirmed is that many clients are living in relational homes that are half-built or bombed out.

Bruce Perry’s research puts a finer point on it: “Your history of relational health — your connectedness to family, community, and culture — is more predictive of your mental health than your history of adversity.”

Therapists pursue EMDR training to help clients resolve trauma. They’re surprised to learn how relevant attachment is. After all, the relational history is a major gauge of how much fuel is in the client’s tank. And that fuel powers processing.

Flipping the script — recognizing that attachment is just as, or even more, important than trauma — highlights the importance of the history-taking and preparation phases. It’s an opportunity to assess the integrity of the client’s emotional architecture. Load-bearing walls are what “good enough” attachment was supposed to construct — the internal architecture that holds a person upright under stress. So now I look for, were there any experiences equivalent to load-bearing walls? Do they need load-bearing walls built in, or can they proceed with light scaffolding? The early phases inform direction and priorities: whether trauma processing is the right next step, or whether I have to build in what was never built.

Load-bearing walls vs. scaffolding: what EMDR history taking reveals

The clients who needed load-bearing walls and never got them eventually reveal themselves. It can be the client who didn’t experience empathy until her mid-fifties and didn’t recognize it as remarkable until she felt it as new.

(I don’t think that’s too much to ask for before fifty.)

Or a student who was so dysregulated that she vomited when a friend ghosted her.

Therapists working in substance use settings will recognize when substances substitute for load-bearing walls. What structural vacancy have substances been filling, and for how long? When the substance has been the primary co-regulator — substituting for attunement and making the half-built house livable — removing it without building what was never there leaves the client exposed.

On the other hand, a client who witnessed a gruesome accident but could visualize her tribe around her — and feel their presence bolstering her may need only light scaffolding before proceeding to trauma processing.

Or a client who, after a conflict at work, called a reliable friend instead of spending the night smoking weed.

Or a client who embraced yoga for four years and was finally able to set a boundary with a narcissistic mother.

In scaffolding cases, we continue building and strengthening positive connections, trusting neuroplasticity to do its work. When the goal is to lay an initial foundation, the work shifts — but it doesn’t have to leave EMDR behind.

Wesselmann and Potter’s Attachment-Focused Trauma Therapy for Adults (AFTT-A) shows what that looks like in practice. Working within an extended preparation phase, Wesselmann and Potter guide clients to meet unmet childhood needs through ego state therapy — building nurturing and protective internal experiences that didn’t exist in the original relational environment. The goal is earned secure attachment: a nervous system reorganized enough to hold a difficult history.

In their case studies, clients who began treatment with insecure or disorganized attachment patterns achieved earned secure status following approximately 15 sessions of attachment-informed EMDR (Wesselmann & Potter, 2009).

Other experts provide EMDR strategies, informed by an attachment-focused approach, to assess and build internal load-bearing walls for those clients who need it.

The health of the attachment system is the missing variable

Because of a poor relational environment, Abby’s journey toward relational security was greatly aided by AI rather than by the people closest to her. Perry was right: relational health history is the variable that matters most. Whatever our assumptions about the strength of family ties, the data suggest the erosion has been real and measurable.

For example, between 1985 and 2004, the number of Americans with no one to discuss important matters with nearly tripled.

From 2003 to 2020, time spent alone increased while time spent in meaningful social engagement steadily declined. Sherry Turkle documented the shift in Alone Together. She traced how technology was quietly substituting connection for presence, leaving people more reachable and less reached.

Relational homes have been eroding for a long time — and their occupants are now our clients. The question isn’t whether this is happening. It’s whether our treatment planning reflects it.

Think of a client you’re currently working with who isn’t moving through EMDR therapy the way you expected. Does their history reflect scaffolding or structural work?

What are you seeing? I’d love to know.

4 min read | March 15, 2026

“Is that a rat?”

I stood in the office doorway, confused.

The Science Building housed the rats across campus, but from the office doorway, I stared across to the student lounge.

A student gleefully placed a rat on his shoulder and smiled in delight as it picked its way across to the other side.

The rat was in a harness. The harness was attached to a leash.

Clearly, they had a special relationship. I was both nauseous and curious. But the rat trend continued in the following weeks.

A colleague at a nearby campus described a couple who wanted a clinician to mediate who would get their pet rat — they both loved it and couldn’t reach a custody agreement. They wanted help with a visitation schedule.

Still another colleague leaped onto her desk when a client pulled a rat from their bag without warning. From her perch, she yelled: “Put it away! Take it home!”

The confused client tried to explain that rats were socially intelligent and harmless. It didn’t matter.

A different social signal arrived when students began showing up for sessions in full costume. They were members of the Furry Fandom movement — fans of anthropomorphic animals, characters that straddle the human and non-human realms — and it had grown by more than 1,800% in less than a decade. (Plante et al., 2023) There were annual conventions, but it wasn’t convention weekend.

I cringed since, truth be told, I hate certain costumes. Goofy at Disneyland, sports mascots, and anyone whose eyes I can’t see, I find unsettling. As a woman, I scan faces and body language constantly for safety cues, and certain costumes remove the very information I depend on.

Meanwhile, Pittsburgh had embraced Anthrocon, the fandom’s annual convention — citizens lined the streets for the furry parade, posed for photos, and the local media celebrated rather than stigmatized it.

To be fair to myself, their goals and roles were different.

But research would confirm what Pittsburgh seemed to understand: belongingness was the primary motivator for fandom participation — the need to find a community where non-normative identities were accepted rather than judged. (Plante et al., 2023) My younger colleagues embraced Furry clients intuitively. I struggled since the human signals I relied on disappeared entirely. The suit that made the student feel safe enough to show up authentically, which announced “I belong to a community,” made it hard for me to connect and do my job — I couldn’t track the nervous system.

When People Build What the System Fails to Provide

When I think back on it, the rats on leashes, custody disputes over rodent companions, and students navigating campus in costume were all clues that mainstream solutions were failing people, so they built what they needed. At every turn, people were self-organizing to fill unmet needs—a pattern the AI revolution may echo. For example, a prospective client opened a discussion this week with: “I asked AI about CPTSD, and I’ve got the symptoms.”

What strikes me is that this isn’t new. People have been gravitating toward whatever was available to fill relational gaps for decades — and technology’s offerings have gotten better. The question isn’t whether people will turn to AI for connection, since they already are. The harder question is what that tells us about everything relational that was missing before AI arrived.

Next issue, we’ll go there.

* * *

What signs do you see of AI changing the therapeutic experience? Reply — I read every response.

Reference

Plante, C.N., Reysen, S., Adams, C., Roberts, S.E., & Gerbasi, K.C. (Eds.). (2023). FurScience: A Decade of Psychological Research on the Furry Fandom. International Anthropomorphic Research Project.

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?

* * *

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.

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.

* * *

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.

Welcome to The 51st Minute – a newsletter for EMDR therapists navigating complex trauma in their daily work. We get to reflect together on the impact of sessions, clinical patterns, and stuck points we wrestle with after the session ends.

I’ve been working with trauma for over 25 years—EMDR, attachment, neglect, dissociation, all of it. I’m a gardener at heart and curious about structuring and sequencing therapy to nurture growth. I’m awed by how growth emerges from reservoirs of pain.  In each issue, I’ll dig into something worth thinking about—clinical patterns, research, and industry forces impacting our work…or frameworks that help make sense of what we’re seeing. I consider this a conversation and welcome your response.

A note: This newsletter is a thinking space to discuss clinical patterns and emerging concepts in trauma treatment. Its role is not to replace or function as consultation – still the best place to unpack cases.

The pattern you keep seeing

Maybe this scenario sounds familiar.

You’re an EMDR therapist working with a client with attachment wounds whose mother abandoned them as a toddler.

She left for the store and never returned home to your client and his two older siblings.

Therapy has progressed more slowly than expected, but after eight months, you’ve established resources. Since they can’t tolerate imagining people as relational resources, they chose a bear from a video game they often play.  They liked how, in the game, it was soft, strong, but protective. It was ‘nice’ having it there.

“How do you feel?” you ask.

Their eyes dart around.  (ever misplace keys?…” they SHOULD be here…where are THEY?!”)

“Did anything come up this week where you had the chance to use your Calm Place?”, you ask.

 “No, I don’t get upset, so I haven’t used it.”, your client replies.

Later in the session, you summon your courage to begin Phase 4 Desensitization, but after several passes on a memory of their brother burning their hand on purpose, you repeatedly hear:

 “Nothing’s coming up.”

 “I don’t feel anything.”

Their face remains expressionless.

 “On this next set, consider bringing your bear in to help the boy.” , you offer.

They fidget with a hangnail while glancing at your diplomas on the wall.

Are they dissociating or questioning if I’m a good therapist?, you think. 

Squirming in your office chair, you take a deep breath to resist going down the rabbit hole.

You feel stuck and start to wonder: Am I doing something wrong? 

What the research shows about child-onset trauma and EMDR outcomes

As a new college graduate, I bought my first car with a $1,200 budget and my dad’s help. We kicked the tires and test-drove this cool number, decked out with gloss fake wood trim. As a 22-year-old, it wasn’t my first choice, but I deferred to experience.

Back at home, dad’s eyes surveyed the car.

Then stopped.

“Huh, it looks like the side panel is a shade lighter. It looks like it’s been in an accident, and the front panel was replaced.”

‘WWWHHHAAAAT’?

A horror film filled my head—

The car engine sputtering,

Sounds of sharp metallic knocks from under the hood,

The dashboard lighting up in red and amber.

Scowls from angry drivers late to work.

Up until now, I assumed the car was roadworthy, but with his observation, I needed to verify with a master mechanic that all internal systems were operating as they should. I feared the car lurching and dying in the middle of a traffic lane.

But, truth be told, the other part of me said I could ignore dad’s observation.

Do I really need to be worried?

After all, I drove the thirty miles home without incident.

In fact, knowing about potential accident damage changed everything. At the first sign of trouble, I’d criticize myself for not being proactive, 

for taking unnecessary risks, 

and jeopardizing my time and sanity. 

I needed expert eyes to check which systems were vulnerable and needed repair, and which could handle the commute.

When we work with clients who have early-life trauma, we need the same approach. Just like I needed to assess which car systems were damaged before driving it daily, we need complex trauma assessments to gauge healthy vs. compromised domains as it impacts treatment planning.

Car-shopping with dad taught me that knowing about prior damage changes what you do next

The same is true with trauma clients. Here’s what the research shows about therapy outcomes when we don’t account for when relational damage occurred:

In 2007, Bessel van der Kolk and colleagues published the largest randomized controlled trial comparing EMDR, fluoxetine, and placebo for PTSD. The study had equivalent numbers of patients with child-onset (N=45) and adult-onset (N=43) index traumas. Child-onset traumas were defined as we do in our daily work—physical, emotional, or sexual abuse occurring before age 18.  It turns out that in the 8-week EMDR condition:

Participants endorsing child-onset trauma:

• Were more likely to drop out
• Only 33% achieved complete symptom remission at 6-month follow-up

Compare that to outcomes for adult-onset trauma clients (trauma after age 18):

• 100% lost their PTSD diagnosis
• 75% achieved complete symptom remission at 6-month follow-up

Why such dramatically different outcomes with the standard protocol?

Because child-onset trauma amplifies damage… It creates adverse memories while it damages the internal systems needed for EMDR processing to work.  This is why your client keeps saying “nothing’s coming up.” The affect regulation system that should help them identify and tolerate emotions is underdeveloped.

The researchers concluded that what was needed was a better understanding of “treatment sequencing”—understanding what needs to happen first for those whose internal systems were distorted by early experience.

We’ll be exploring treatment sequencing in future issues.

The one intake question that changes treatment planning

So how’s it relevant to you? 
Consider adding one assessment question to your next trauma intake—a question that reveals whether your client developed affect regulation with relational support, or learned to manage distress alone:

“When you were growing up, and you got upset about something, what typically happened?”

Answers that suggest they developed regulation with support:

“My dad would lie next to me on my bed until I calmed down, I liked him there, he’d talk to me.”

“I could go to my mom when I was upset, and she’d drive us around for a while. In the car we could talk.”

“I could always go to my older sister’s room…she’d make room for me on her bed, listen and help me figure out what I was feeling.”

Answers that suggest they learned to manage alone:

“I’d go to my room until I felt better. A few times the dog would come in and lie at the end of the bed” (learned to manage alone)

“I don’t really remember getting upset…it’d drive my older brother crazy, he said I needed to react more…he thought people took advantage of me.” (emotional shutdown)

“My parents had it hard for the times they were living in; I’m really grateful to them, they were good parents who were dealing with their own stuff” (unavailable)

“I don’t know what you mean, only grandma could show emotion.” (emotional expression = unsafe)

“Nobody really noticed” (emotional neglect)

Once you start listening for these patterns, you’ll hear them everywhere—and it’ll change how you plan treatment.  It’s a lot better than hearing “Huh, it looks like the side panel is a shade lighter….”

Okay, it’s after midnight, so I’ll leave you with that for now.

If you have comments on the topic or what you’re seeing in your sessions, shoot me an email.

And we’ll be sure to pick up the thread in two weeks.