Attachment Injury Resolution Model in Emotionally Focused Therapy
Emotionally focused couple therapy (EFT) is an empirically validated therapy (Wiebe and Johnson 2016) for increasing relationship satisfaction and creating secure bonds in distressed couple relationships. As an attachment-based, systemic, humanistic-experiential therapy, it places emotion in the forefront as the target and agent of change, making it particularly relevant for repairing interpersonal injuries. Johnson et al. (2001) first presented the construct of “attachment injury” to describe a particular type of interpersonal injury and delineated a model for resolving such injuries.
Johnson developed a model of forgiveness and resolution to address relationship traumas such as infidelity and other moments of betrayal or abandonment, defining an attachment injury (AI) as a specific relational incident where one partner violates the expectation that she/he will offer comfort and caring at a particular moment of urgent need. Attachment injuries emerge in therapy “in an alive and intensely emotional manner, much like a traumatic flashback, and overwhelm the injured partner” (Johnson et al. 2001, p. 145), redefining the safety and trustworthiness of the relationship and blocking relationship repair. From the moment of injury, the specific event continues to be the standard by which one partner measures the dependability of the offending partner (Zuccarini et al. 2013).
Prominent Associated Figures
The theoretical framework of the EFT AIRM includes attachment theory as a theory of romantic love, the empirically validated EFT theory of change, the empirical study of hurt and social pain, and the reparative responses created through the AIRM.
Romantic love as an attachment process. Attachment theory holds that the human need for affectional bonds extends throughout the life span. The attachment view of romantic love (see Attachment Theory, Johnson, this volume) – that partners develop emotional bonds of interdependence – is a core concept for understanding the power of a single event to rupture a relationship and redefine its security.
According to attachment theory, events in which one partner responds or fails to respond in times of danger and extreme distress are found to influence the quality of an attachment relationship disproportionately (Simpson and Rholes 1994). It is not the content of the event but rather the life-and-death sense of threat experienced during the event – in the absence of the other partner’s comforting response – that gives it the power to rupture an attachment bond.
The EFT theory of change: Working with emotion to shape security. EFT consists of three stages (see Emotionally Focused Couple Therapy, Johnson & Wiebe, this volume). Stage 1 (Steps 1 to 4 of EFT) culminates in de-escalating the negative interaction cycle between partners, and sets the stage for attachment injury resolution. The second stage of EFT is one of reprocessing underlying emotions to reshape the couple’s relationship. When there has been an attachment injury a couple will reach an impasse in therapy and because of the disproportionate impact of the injury, will be unable to move beyond de-escalation. The AIRM provides an empirically validated 8-step model to use in Stage 2 for resolving attachment injuries and rebuilding trust. In the third stage of EFT partners integrate and consolidate their newly shaped attachment bond.
Stage 1 – de-escalation of the couple’s negative interaction pattern – precedes the Stage 2 AIRM forgiveness and resolution process. When the injured partner is the critical pursuer, the AIRM process is followed after withdrawer re-engagement. Without de-escalation and withdrawer re-engagement, the depth of this process could not be tolerated without triggering reactivity.
Rationale for a model of forgiveness and resolution. The attachment meaning of an injurious event – that in a moment of urgent need one’s expected source of comfort is unavailable or unresponsive – shatters trust, making the relationship unsafe and catapulting it into ongoing distress. To rebuild trust in a relationship and resolve the injury, the hurt surrounding the injurious event needs to be explored and reprocessed. The AIRM is a blueprint for clinicians (Zuccarini et al. 2013) to do this.
Hurt or social pain is distinguished from other emotions as a complex blend of sadness, anger, and fear of rejection or abandonment. It is conceptualized as an experience that devalues the relationship and the injured person (Vangelisti 2007). With the AIRM, partners can transform the hurtful impact of an AI. Injured partners are helped to experience the emotional depth of the hurt and to disclose it in an increasingly vulnerable manner, and offending partners are supported to respond with emotionally engaged empathy and remorse (Zuccarini et al. 2013). In this vulnerable reaching and responding process, the hurt is reprocessed, forgiveness occurs, and trust is restored.
Populations in Focus
The AIRM is relevant for couples in distressed relationships for whom the nature of their relationship is linked to one or more attachment injuries in which there was a pivotal injurious event that redefined the relationship and shattered trust.
Strategies and Techniques Used in Model
Therapist interventions used in EFT include intrapsychic experiential interventions in combination with interpersonal systemic interventions. Exploring and deepening attachment related fears and needs and facilitating emotionally engaged disclosures and responses between partners are central to successful outcomes in EFT and particularly to the resolution of attachment injuries. Zuccarini et al. (2013) identified particular interventions associated with the resolution of attachment injuries to include empathic reflection and validation, evocative responding, reflecting and tracking process patterns and emotions, heightening softer primary emotions, and structuring enactments.
The first four steps of the AIRM de-escalate the cycle related to the injury, preparing the terrain for more explicit processing of the emotional injury. AIRM Steps 5 and 6 are the core of the interpersonal forgiveness and resolution process, wherein new cycles of emotional engagement related to the injury are created. Finally, in AIRM Steps 7 and 8 the newly restored bond is consolidated. The case example below illustrates this process with an injured partner who was a withdrawer in the relationship.
Research About the Model
Naaman et al. (2005) published the first report linking the hypothesized model to outcome. In a case study comparing one couple who successfully resolved their attachment injury with a couple who did not, they found that the resolver couple “went through the steps of the AIRM in the expected order… [whereas the nonresolved couple] deviated significantly from the expected sequence” (Greenman and Johnson 2013, p. 54). The resolver couple also showed “increasing depth of emotional experience in both partners and increasingly more affiliative responses to each other” (p. 54).
The first outcome study (Makinen and Johnson 2006) validated the effectiveness of the model as a map for the forgiveness change process. It was conducted with 24 couples who experienced an attachment injury. Sixty-three percent resolved the injury, forgave the injuring partner, and reshaped the attachment bond. A 3-year follow-up study (Halchuk et al. 2010) showed that increase in relationship satisfaction and forgiveness in the resolver couples was maintained.
In 2013, Zuccarini et al. examined the process of change following the steps outlined in the 2006 study. They delineated the specific therapist interventions and client processes that promoted successful attachment injury resolution and further validated the change process identified in the earlier studies.
Case Example of Resolving an Attachment Injury with the AIRM
A 5-year-old incident emerges in Stage 2 with Dom and Sofia, illustrating that a seemingly small incident can have as devastating an impact and be as sharp an attachment threat as a recently discovered incident of infidelity. Dom and Sofia, a couple in their mid-forties, have two adolescent children. They entered therapy with a well-entrenched cycle of Sofia pursuing with escalating criticism and hostility and Dom “going cold” and disappearing into his work. Silence would hang heavy between them for days, until Sofia would explode, insisting they “talk about what’s happening.” Their talks – which eventually brought them closer for a while – were filled with accusations from Sofia and admissions and apologies from Dom for being such a “poor recreational partner” and for disappearing into work. Shortly thereafter the pattern would recur.
After several months of therapy they successfully de-escalate their negative interactive pattern. Dom becomes increasingly engaged and able to share his fears of disappointing Sofia. In EFT Step 5, therapist Casey helps Dom to deepen and disclose his core fear of eventually losing her. Sofia is touched: “I had no idea you had any fears at all!” she says in amazement. “No idea you still want to be close to me!” (EFT Step 6).
While Dom is emotionally engaged with his attachment fears and longings, Casey inquires what he needs from Sofia to remain open and engaged (inviting EFT Step 7, withdrawer re-engagement). An injurious memory from the past resurfaces and stops Dom in his tracks. His face goes blank, he drops his head and stares at his shoes. Haltingly he utters, “She wants a strong, active husband, not me. Ever since Disney – it’s been clear – I’m a bother to her.” Sofia is incredulous that he is talking about Disney, 5 years after their trip, and initially becomes defensive about revisiting the event.
Casey recognizes the AIRM is needed to help the couple move forward. Using EFT interventions described above, Casey processes the injury and choreographs the forgiveness and resolution process. In AIRM Step 1 Dom repaints the scene of the injury. “We booked a family trip to Disney just before I was placed on a waiting list for a heart procedure and I said, ‘I guess we’ll have to put the trip on hold,’ and she just shrugged and said, ‘Well I’d better learn to do things without you!’ She was angry. She just pushed me away.” Casey validates Dom’s pain.
Sofia interrupts (AIRM Step 2), “How could I have done it differently? The pressure was on me! Our kids and nephews were counting on us. And now it’s all about how much I hurt you?” Casey supports Sofia in her defensive reactions, validating that she cannot hear Dom’s pain at feeling rejected – only his anger at her for going to Disney without him.
Dom experiences and discloses his core pain of feeling rejected by Sofia (AIRM Step 3). “I just keep going back to the moment you brushed me away. You literally pushed me away, like you didn’t need me in this family anymore and you went off without me!”
Sofia begins to grasp the significance of the event (AIRM Step 4). She begins to understand that what felt like blame and guilt levied at her for going to Disney was Dom’s painful sense that she was rejecting him. When Casey inquires how Sofia could brush Dom off like she did, she tearfully discloses, “You were in a precarious medical condition and I had no idea you’d understand all the obligations tugging at me. I couldn’t burden you with this. I just froze – terrified you might die – and carried on as though I’d already lost you.”
After hearing Sofia’s description of how this happened, Dom (AIRM Step 5) deepens his emotional expressions and tells a clear, coherent statement of the painful impact of the event. Sofia listens wide-eyed – never having seen Dom so vulnerable and open. Tears brimming in his eyes, Dom discloses, “I needed you that day and I felt in one moment when you brushed past me that I became useless and insignificant to you. I wouldn’t have tried to stop you from going on the trip – but you didn’t even seem to like me anymore or want me in your life!”
Sofia rolls her chair in close to Dom with both hands on his knees, tears streaming down her face (AIRM Step 6), clearly moved by his pain. Her face mirrors his anguish as she says, “I had no idea – five years ago! My heart aches to see how my brushing you off that day hurt you so much!” She feels how important she is to him, and expresses deep remorse and regret for turning away from him in that moment. “I totally need you in my life. I want you to know how much I need you and like you. I am so sorry!”
Dom could now receive her empathy and remorse (AIRM Step 7). With Casey’s prompting he asks to have his needs, sparked by this attachment injury, met. “I worry that there are so many ways I’m not quite the partner you want – and now with all my medical concerns I need to know you still want me – to be a full partner in this relationship. That you still need me – as I am.”
Sofia replies (AIRM Step 8): “I want you to feel safe and loved – to know I need and want you! You are everything to me! I want you to feel completely safe with me. I want to care for you every way I can!” Casey validates how Dom and Sofia are beginning to create a new attachment bond, redefining their relationship as one of safety and shared support.
This AIRM was Dom’s withdrawer re-engagement change event. Following this change event, Casey processes Sofia’s blamer softening where Sofia is helped to reach from a vulnerable position of attachment fears to ask Dom for what she needs to be soothed and comforted, thereby reshaping secure connection between partners. Finally, Stage 3 of EFT marks the integration of the new positive interactive cycle across pragmatic concerns and the consolidation of the new relationship bond.
The attachment injury resolution model (AIRM) operationalizes forgiveness and resolution as an interpersonal process, wherein the depth of emotional experiencing and affiliative, vulnerable disclosures and emotionally engaged responses are reparative. The AIRM moves partners beyond forgiveness into rebuilding trust and intimacy.
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