Traumatic Attachment Induction Procedure (TAIP)

Jean came to a drug and alcohol unit in her 50s, seeking help after many years of alcoholism, and was assigned as a client to me (Monique). She reported drinking three bottles of wine a night and blacking out. I was becoming disheartened and began to doubt that she would ever give up drinking after many failed attempts at detoxing.  It was around this time that I learned about the traumatic attachment induction procedure (TAIP) and considered whether it could be helpful for Jean, who had talked about how she had been brought up to feel dependent on her mother who had died several years previously. This simple technique has a powerful effect on improving the psychotherapeutic experience and outcomes in adult clients who have suffered childhood abuse and neglect, by helping them become more aware of their traumatic attachment and understand the role it plays in destructive behaviour and fear of change.

Dialogue

The idea was first introduced to Jean by describing a test we could use that might be helpful. Then during another session, when Jean was talking about her mother, I said, ‘I think this is an ideal time to do this test.’ I invited her adult self into the room by saying: ‘You are 58, you have three children, you have achieved so much in your life. Imagine that your mother walks into this room now with you as a 58-year old woman. I am going to ask you to repeat something after me that you might say to your mother and just note how it feels in your body and where you feel it. In she comes, she sits on that chair, and I want you to say these words out loud to her: “Mum, I am 58 years old, and I don’t need you to care for me anymore like I did when I was a child.”’

The dialogue between us then went as follows:

Jean: I couldn’t, I couldn’t say that.
Monique: Why not?
Jean: Well, I wouldn’t say it, I wouldn’t because I need her, you know as a person not so much as a child, yeah, you know.
Monique: What do you need her for?
Jean: For everything, for moral support, for comfort, for listening, for back-up. 

Bearing in mind that her mother was no longer living, I was curious about Jean’s need for her. She explained that she had been devastated when her mother moved 100 miles away from her when Jean was 40 years old, and that she needed her to be close so her mother could fight her battles for her and give her advice. 

When she finally managed to say the words I had asked her to repeat, she reported a bodily sensation of feeling very empty, a feeling of ‘a big empty hole because I really do need her’. Jean later reflected that she now realised that for years it was that ‘big empty hole’ that she was trying to fill with alcohol.

Origins

While running a year-long group for sexually abused women in the Maudsley Hospital Traumatic Stress Service, I (Felicity) found that the best outcomes were seen in those who overcame their traumatic attachment by grieving the loss of their idealised but unavailable parent. A key part of this process was being able to say with conviction and without fear: ‘Mum, I do not need you anymore as I did as a child.’  When interviewed after six months, these same women were successfully getting on with their lives and reporting that their relationships with their actual mothers had markedly improved. We measured symptoms and levels of dissociation before and after psychotherapy and noted that both had returned to normal levels. This successful form of group therapy was then taken up by the South London and Maudsley NHS Foundation Trust and used for survivors of sexual abuse in childhood. 

These observations led to the development in 2005 of the TAIP, a procedure specifically designed to facilitate this process. Several therapists were trained at the Maudsley Hospital Traumatic Stress Service to use the TAIP with patients suffering from the effects of abuse, neglect and trauma, until my retirement from the NHS in 2011. Now training is available for its use by therapists in private practice. 

The aim of using the TAIP is to find out if, underlying many of the adult client’s difficulties in progressing in therapy, there is a hitherto implicit or unconscious younger child self who is strongly attached to an idealised caregiver from whom they still hope to finally get the care and love they yearn for by remaining needy and helpless. The TAIP brings this embodied experience to the client’s awareness, helping them to let go, make use of therapy and finally start to thrive. This article will describe the theory behind the TAIP and how it can be used in practice.

Roots of trauma

The human infant’s utter dependency on its primary caregiver in early development means that, should the caregiver become unavailable or threatening, they can neither fight nor flee but they can freeze and thereby disconnect. It is at this point that the infant brain adopts an alternative developmental mode referred to as traumatic attachment, with the potential to develop different mindsets that ensure its survival in a frightening world where others cannot be trusted. Some of the clients we meet in our therapy rooms may be those for whom the cost of these ways of feeling, thinking and behaving have outweighed their benefits – they suffer from the effects of addiction, prolonged grief, domestic and other forms of violence, borderline personality disorder and developmental or complex trauma. 

If we look at research carried out on infants who have suffered from abuse or neglect using the ‘strange situation’, a structured separation test originally developed by Ainsworth to observe how infants respond to a time-limited separation from their caregiver, there is often a dysregulated and disorganised attachment response towards their terrifying caregiver. These infants find themselves in a state of ‘fear without solution’ as their secure base, represented by their attachment figure, has also become the source of their terror.

When in a state of fear without solution the infant’s autonomic response to danger comes into play involving the fight, flight or freeze responses we share with other mammals. 

The fight-flight response, mediated by the sympathetic component of the autonomic nervous system, results in increased heart rate, blood pressure, respiration and muscle tone as well as hypervigilance. The thyroid system is stimulated as is the hypothalamic pituitary axis, releasing high levels of cortisol. As symbolic processing is not possible in such states, these traumatic experiences are stored in sensory, somatic, behavioural and affective states. The terrifying caregiver not only dysregulates the infant but, in addition, they do not attempt to repair the damage, so the child is left at the mercy of these states that interrupt normal development. 

However, if the fight-flight reaction is not possible a second reaction takes place, and the infant freezes as other mammals do in similar circumstances – in this way they conserve energy or feign death and thereby foster survival. Numbing of pain occurs through the release of endogenous opiates, and immobility is achieved through detachment dissociation. Cortisol levels are elevated and there is a decrease in blood pressure, metabolic activity and heart rate. Infants who are abused or neglected by a primary caregiver face a situation of fear without solution – this activates both responses and results in the human infant experiencing an inward flight from the source of danger. This process results in ‘structural dissociation’, a splitting of the self that takes place for the infant to survive. 

As Schore put it when describing the formation of traumatic attachment, these children (and later adults) will resort to dissociation to maintain their attachment to their desperately needed caregiver:‘They will develop an idealised attachment to their parent by dissociating off their terrifying memories of being abused. The resulting working models are those of an idealised attachment relation and that of a dysregulated self in interaction with a mis-attuning and frightening other’.These internal working models are internal representations of how the attachment figure is likely to respond to the child’s attachment behaviour. 

Thus, the different dissociated states of the child in relation to the terrifying caregiver will develop around the fulcrum of the idealised attachment to that same caregiver. The result is the creation of ‘self-states’ or different representations of themselves in relation to their caregiver.  These are found in those who suffer from fairly common disorders such as addiction or prolonged grief, or from disorders with higher levels of dissociation resulting in a lack of self-continuity in relation to the other, such as borderline personality disorder and other dissociative disorders.  All these individuals suffer to a varying degree from an inability to regulate their emotions, to empathise and mentalise.

Strange situation

The TAIP is based on a simplified version of Ainsworth’s strange situation by creating an imaginary separation between the client and their abusive caregiver. It reveals either their idealised or their dysregulated internal working models in relation to their abusive or neglectful caregiver whom they are invited to imagine sitting in the same room as them.  

An attuned and trusting relationship must first be established between therapist and client before the TAIP is introduced.  At the appropriate moment the therapist explains how helpful this intervention can be in making sense of the client’s problems. This usually takes place when the client is ready to explore in depth their relationship with their primary caregiver.  

When the client says they feel ready to carry out the TAIP the therapist will start by asking the client to remind them of their age and achievements, to make sure that the adult self is ready to carry out the procedure. The client is then invited to imagine that their mother, or other primary caregiver, is sitting in the room. The therapist then asks the client to say the following words: ‘Mum, I don’t need you anymore, as I did when I was a child’(or words to that effect), while noticing what bodily sensations come up during this imaginary exercise. 

The value of the TAIP experience lies in the fact that the adult self of a traumatically attached individual finds that what they initially thought would be quite easy – telling an imaginary mother or father that they no longer need them as they did as a child – turns out to be very difficult or seemingly impossible because of the fear it elicits. 

Making sense of this discovery is what follows in the session and is achieved with the attuned support of the therapist. If a traumatic attachment is present it means that a child self is also present within the client, and repeating these specific words usually evokes an extreme fear response, as was elicited in infants with a disorganised attachment in the strange situation test. This fear response makes the heart beat faster, and there isa tightening sensation of the stomach and chest. Often speaking becomes difficult as the client feels afraid to say the specific words. 

With the gentle encouragement of the therapist the client’s adult self finally repeats their choice of words to their caregiver and the client’s body responds as it did all those years ago when interacting with the frightening parent– ‘the body holds the score’. The elementary self-system in the brain stem and limbic system is activated when faced with the threat of annihilation, which results in an overwhelming sense of terror. To individuals who are traumatically attached to their parent, proclaiming their independence can feel at that moment as devastating as it does for a child who is abandoned by a parent on whom they depend for survival. 

However, it is important to point out that when the TAIP is used for the first time this interaction does not last more than one or two minutes. At this point the therapist will gently invite the client to share what they are feeling and thinking and to report any bodily sensations.  

Acknowledging their bodily manifestations can help the client understand the connection between their traumatic attachment and the felt emotions in the body, which may have led in the past to the client trying to overcome these distressing emotions through self-medication, leading to addiction or other symptoms of dissociation. In the process of sharing their very powerful emotions and bodily feelings with their attuned therapist clients become increasingly aware, both cognitively and somatically, of the presence of their extremely needy or terrified younger self. In doing so, the adult and child selves can begin to come together and begin a path to healing the dissociation that is at the root of the problem. The therapeutic journey will then involve letting go and mourning their idealised parent as clients come torecognise that they can now survive and develop as competent adults.

Unresolved grief

Over the next 12 sessions, Jean was able to mourn the loss of her mother, overcoming her unresolved grief. The integration of her dissociated self, triggered by the experience of the TAIP, meant that her addiction could finally end.  I recently heard that nearly 10 years later she is still not drinking alcohol.  

The use of the TAIP in this case revealed that Jean’s previous inability to make use of therapy was the result of the unconscious traumatically attached internal working model of her child self.  Her recovery from her addiction and from her unresolved grief illustrates just how effective the TAIP can be for clients who suffer from an apparent resistance to therapeutic change.

Wider applications

The TAIP has also proved to be a powerful tool in revealing and healing some of the psychopathology underpinning borderline personality disorders and dysfunctional violent behaviour in individuals with a history of childhood abuse and neglect.  

It has the additional merit of making people aware of their traumatic attachments in a very concrete way through their yearning and/or fear response. It has also become increasingly evident to us that it facilitates the integration of the childhood self-state and thereby heals the underlying structural dissociation – in so doing, the TAIP promotes healing of the self and wellbeing. Perhaps most importantly it provides us with an alternative explanation for clients labelled as ‘resistant’ to therapy, or the therapy as having failed. 

Authors: Monique Notice & Dr Felicity de Zulueta

(c) This article was first published in Therapy Today October 2024 edition, the journal of the British Association of Counselling and Psychotherapy (BACP) 

The TAIP process is covered in depth in the book "Healing The Fractured Mind" 

The book can be purchased here