The first of the insecure attachment styles that we are going to discuss in adulthood is Preoccupied attachment.  The result of preoccupied caregiving is the child having an over-involvement and identification with the parents state of mind.  Parental responsiveness is inconsistent.  This could be for several reasons; perhaps the parents have demanding careers which take them away from the necessary attunement needed at a young age.  Perhaps the caregiver struggles with an addiction, or the mother and father are in a stressed relationship with regular arguments and fights.   These are just examples of ways that could create the dynamic of caregivers being only inconsistently available.  The child must learn what to do (or what not to do) in order to get its needs met.  Sometimes they learn to throw a temper tantrum as the only way of getting attention. 

Preoccupied parents have a chronic misattunement to the exploratory system in the child.  Exploration is a perceived threat, as it takes the child away from the needs of the parent.  The child is expected to regulate the parent’s state of mind, and thus becomes chronically hypervigilant to the state of mind of others.  As the anxious/resistant child grows into adulthood, now a preoccupied adult, there remains an inhibition in their exploratory behavior which interferes with healthy self development. On the AAI, Preoccupied parents were deeply absorbed in their own troubles and concerns about attachment.  The interviews were excessive, confused, angry, or passive.  They demonstrated a fear of abandonment, helplessness, and pervasive anxiety.  Their past emotions would overwhelm them in the present.   They would alternate between discussing childhood episodes to a current attachment grievance.  Quoting, imitating, childlike language, vague nonsense words, run-on sentences and fragments pervade the interview.  Intense fear, anger, or passivity in past and in current attachment relationships prevents coherence and collaborative discourse.  Their speech tends to be confused, tangential, lengthy, and discouraging of autonomy. 

If the preoccupied adult presents for treatment, having a consistent focus on the self experience is of utmost importance.  They grew up with an outside-in orientation, taking in what is happening around them as a way of survival and getting their needs met.  In therapy, we work toward developing an inside-out orientation, where one looks inward to find the answers and have them expressed outwardly.  The therapist should keep a consistent calming presence, even in the rise and fall of coherence in the patient.  Selectively attuning to exploratory words and behaviors allows the preoccupied person to begin to think of exploration as a possibility.  This is done within the Three Pillars system.  As an example, below I will type a script of a generic session one might have with a preoccupied adult within the IPF framework.

“You don’t have to worry about their state of mind, and if at any time you start worrying about that, imagine that they’re emotionally responsive to you, and they make a comment about your internal state and bring you back to yourself.  They notice all the subtle changes in your mood moment by moment.  What a relief to not have to worry about their state of mind, take in what that feels like.  They act in a way as to calm and comfort you, physically, you can feel the gentle touch that’s so reassuring, verbally they’re reassuring you that it’s all okay, everything is alright, and you respond to this in a way that dampens your anxiety, and you become more and more calm, take in that calming effect now. Everything is alright, it’s all ok.

And now notice the growing desire to explore in new ways and discover in new ways with the support of the parents. As with trying anything new, you mighty have anxiety, so imagine IPFs that are constantly attuned with touch and verbal reassurance constantly soothing, comforting.”

So the goals are as follows:

Correct for outside in orientation

Regulate child’s anxiety

IPFs who are attuned to a range of emotions

Encourage exploratory behavior with parents support

Preoccupied adults are most easily ruptured. If ruptures happen, step out of attachment language and go to 3rd pillar and collaborate.  Address that they wander off track, teach them turn taking, help them clarify what they’re saying.

In terms of metacognition, they’re deficient in mentalizing. The therapist can use their own experience at times to help the client contact their own experience.  “I imagine that was very scary…”

Memory is limited by what they experienced.  Imagination creates new possibilities.

When we play, as children, we are expressing ourselves. We have yet to cultivate the skill to articulate our nuanced selves to the world, yet it is crucial for the development of attachment security. In this exercise, Dr. Zack uses the concept of an "ideal play place" to co-create a number of secure scenarios in the play context. Patients report having an easier time exploring in their lives as adults as a result of this particular practice. Hobbies, interests, jobs, people... your one precious life in this one precious moment..... is you new ideal play place. Imagine that.