The Integration of the Adult Attachment Interview (AAI) with the “Three Pillars” Practice and Development of the Ideal Parental Figures (IPFs)
Zack Bein, Psy,D,
Adult Attachment > Private: The Science of Relationships – Adult Attachment Theory – Level I – Self Paced Course > Intro to the “3 Pillar” Model of Attachment Repair Including Ideal Parent Figure (IPF) Imagery
“Three Pillars” Therapy with Ideal Parent Figure Imagery as the most efficient and effective means of attachment repair.
The Development of the Three Pillars Approach
To fully understand the theoretical underpinnings of the Three Pillars model
for healing insecure attachment in adults, one must go back to the pioneer of
attachment research, John Bowlby. According to Bowlby, the therapist provides a
“secure base” from which the patient can explore in psychotherapy the vast array
of their intrapsychic and external experiences (Bowlby, 1988). This position
has been widely accepted in the field. However, attachment research has yielded
the vital information that one’s formation of the “Internal Working Model,”
(IWM) as Bowlby (1988) termed it, is well established between 12 and 20 months
of age. The narrative portion of the brain in humans, however, does not become
fully developed until the beginning of the fourth year of life (Pillemer &
White, 1989). Therefore, it is perhaps unreasonable to assume that the adult
population presenting with consistent relational issues, rooted in their
insecure model of attachment, will be able to explain, describe, or even recall
the quality of the events when they were 12 months old. Since behavioral memory
is the primary memory system in the first years of life, these
attachment-related disturbances in adults are likely to be expressed by
repetition compulsion of unhealthy patterns in relationships and the perceived
inability to disengage with such behaviors. The IWM, it seems, it just out of
reach of the narrative and rational mind.
Building upon this knowledge, Brown and Elliot (2016) developed the Three
Pillars model. This model was intended to offer a comprehensive way to resolve
the structural core of attachment insecurity by restructuring and re-mapping
the internal working model of attachment in clients using imagined ideal parent
figures, guided by the five conditions that create secure attachment (Listed
Below). Often by this process alone, the client begins strengthening several
developmental capacities that were impeded by the insecure upbringing (Elliot,
2021). Two specific capacities that are often not nurtured in children with
insecure attachment styles are the development of metacognitive capacity
(2ndpillar) and enhancing collaborative abilities (3rd pillar). There are many
ways in which therapists can aid in the development of metacognition and
collaboration with patients. For the sake of this chapter, we will focus mainly
on the 1st pillar; the actual restructuring of the insecure IWM of attachment
through the co-creation of ideal parent figures who embody the five conditions
that promote secure attachment (Listed Below). In fact, by focusing on the
restructuring work, one is also promoting the development of metacognitive
capacity by encouraging patients to examine the mind states and behaviors of
the ideal parents and how those effect their own state of mind and behavior.
They also learn collaborative abilities as they work together with their ideal
parents and the therapist to create and maintain these conditions of security
via the secure imagery.
The Intersection Between the AAI and the Three Pillars
The Adult Attachment Interview (AAI) provides significant and clinically
valuable information to the “Three Pillars” practitioner. It has been
demonstrated clinically that safety and protection, attunement to behavior and
emotion, emotional soothing, expressing delight in the being of the child, and
encouraging the child’s own individual exploration, are five conditions that
promote secure attachment (Brown & Elliott, 2016). Several questions on the
AAI are designed to elucidate which, if any, of the conditions were met for the
client by one or both parents or primary caregivers. If it is clear that the
subject had a father that was neglectful (for example, not having any memories
of being held in a soothing way), then the development of the ideal father will
include an emphasis on physical presence, proximity, physical affection, and soothing
that feels safe. If the client grew up with a stifling mother, where the
child’s own exploration was ignored and replaced with the needs of the parent,
then the ideal mother will emphasize the encouragement of the client’s
individual exploration, the development of the their strongest and most unique
sense of self, with no agenda other than to support that development.
During the AAI, the subject is asked to give five words or phrases that
describe the early child relationship between them and mother, and then with
father. If the subject states that their mother was absent and neglectful, and
they have memories to support that assertion, then take those negative words
that they used to describe the relationship and use their positive opposites in
the development of the Ideal Parent Figures. As an example, if the client
describes the father as, “absent,” and, “neglectful,” then the clinician takes
note that the ideal father must be present and attentive, the
positive opposites. If the client gives ‘glowing’ words or
phrases like, “very loving,” “caring,” and “supportive,” and then does not have
adequate memories to support that assertion, then the clinician should be aware
of the possibility that idealization may be occurring and it is likely not an accurate
depiction.
The interview is then transcribed and scored by a reliable scorer through
the AAI Institute. The coder scores the transcript and provides the referring
clinician with the report. Verbal feedback only is given to the patient during
the next session. The raw data and report are not to be shown to the client for
ethical reasons and to preserve the integrity of the test. Probable childhood
experiences, probable states of mind with regard to attachment, and probable
attachment classifications are verbally discussed with the client. Using the
evidence from the interview, the therapist and client will collaborate (3rd
pillar) to co-create the imaginal imagery of the client’s own unique ideal
parent figures.
Restructuring the IWM of attachment using the co-creation of secure
imagery informed by the Adult Attachment Interview
Before even asking the client to imagine an ideal figure, it is helpful go
over the five conditions that create secure attachment (Brown & Elliott,
2016, pp. 288-292).
1. Safety and protection
2. Attunement to behavior and emotion
3. Emotional soothing
4. Expressing delight in the very being of the child
5. Encouraging the individual exploration of the child
Reviewing each of the conditions in detail, giving concrete examples of what
each of those conditions might look and feel like in a parent, can bring to
life these five conditions for the patient who otherwise may have never
experienced them. As one begins to talk about the ideal “figures,” this is a
part of the treatment that can have a great deal of variability in responses.
For some clients, they are eager and excited to imagine these figures. They are
probably visual learners and creatively inclined. Then, there are those who are
less visually inclined, who come into the process with a preconceived notion
that they will not be able to imagine a figure. These clients require more
assistance in the beginning. It may behelpful to ask the client to think of a
person in their life—a teacher, mentor, benefactor —whom when they think of
them, they experience a sense of warmth or safety. Encourage them to use the
figure of that person, but realize that it is not actually them, and to
embellish upon the image of the figure to make it even more safe and secure.
As long as the client has some sense of what their ideal parent figures look
like, and can they can imagine them in their mind, then begin the 1st IPF
imagery session. The intention is to plant the seeds of the five conditions of
secure attachment, so that the client can begin to practice imagining scenes in
which the ideal parents are creating those five conditions around them. There
is first a period of settling in. This is done right away to get the client
“out of their head” and the narrative memory and “into the body.” As stated
earlier, our IWM is well established prior to the
development of narrative memory. Easing clients out of the world of thinking
and into the felt sense of the body is crucial for this process. Clients are
asked to imagine that they grew up in a family different than their family of
origin, with a set of parents completely and ideally suited to meet all of
their attachment needs. They begin by simply imagining themselves as a young
child, quite innocent and carefree and curious. They are asked to place their
attention back in the body of that child, like they are back being that child
again. The client is encouraged to invite the ideal parent figures into the
imagined scene; at first keeping them at some distance away, and looking them
up and down with great curiosity as themselves as a young child. “What is it
about these figures that makes you feel instantly secure? Imagine all the
things they could be saying. Imagine how they would move, their tone of voice,
the way that they look at you, it makes you feel instantly safe. There’s
nothing threatening about them. They are only a place of total safety and
protection.” The client is encouraged to embody that feeling of safety.
The next four conditions are then introduced. The client is asked to shift
the scene to imagine that the ideal parents are completely attuned to their
behavior and their inner state of mind. “They would never divide their
attention, or be too busy. They can tell, just by looking at you, what you are
feeling. And they can track you, moment by moment, and shift and change as your
mood shifts and changes. Really take that attunement in. Notice the effect is
has on your body and mind.”
The client is then asked to imagine that something has happened, something
small, and they have become upset. They are encouraged to imagine the fear or
anxiety that comes when they get upset, and to actually experience it as the
child in the imagery. But then, right away, before they start to suffer, the
ideal parents come right into the scene. They see the client-as-child. “They
see exactly what is wrong; why you are upset. That deep level of attunement
allows them to know exactly what is upsetting you, and then they know just what
to do and how to be to make whatever you’re upset about go away, even if just a
little bit at first.” The client is asked to imagine all the things the ideal
parents could be saying and doing, and especially their ways of being,
to make some of what they are upset about dissipate. “Imagine that one or both
ideal parents can give this child easy and natural, safe, and totally
appropriate physical affection – such as a hand on the back, or a soft kiss on
the top of the head — and feel that that physical closeness and contact as good
and safe. But notice too, that just as easily as they give you physical
affection, they give you space when you need it. That is completely fine with
them. Imagine that. When you want physical affection, they are there and they
do it. When you have had enough, before you even have to ask, they have given
you space. Really take that attunement in.”
The client is asked to continue to shift the scene to imagine how these
parents are totally delighted in the very being of the client (expressed
delight). “There is nothing you have to do, there is nobody you have to be, no
job you need to have. It is just your very being, just your being as a child is
more than enough for them. It gives them great joy, and they are not subtle
about it. They are gently reminding you of your worth and that you are the very
center of their life. You can really feel it in your body. You can really tell
that there is nowhere they would rather be than just holding this space, being
together with you.”
And finally, the client is asked to imagine that they are getting a bit
older, and discovering new things, and these ideal parents are their biggest
support and their biggest cheerleaders. “They have no agenda for you. Rather,
they support you to be most fully you, your most unique and distinct self, you
really being you. and that is what they support. They have no agenda for you
other than to support you on your path, and they are dedicated to doing so.”
Finally, the clinician might ask the client to look forward. “As you get
older, imagine that you had these ideal parents, every step of the way, at
every single developmental milestone. They were there, to hold you when you
were scared, to support you when you were tired, to soothe you when you were
upset, and to consistently remind you of your essential worth and importance.
You can come to depend on the fact that your needs will be met every step of
the way. And because these ideal parents were there to meet your needs and keep
you safe, you come to deeply believe that the world is a safe place that can
meet your needs. Really imagine that.”
The client is asked to let the scene go and bring their attention back to
the body and breath. This is the first cue that the session is coming to an
end. A slow transition back and out of the imaginal framework is helpful. A
gentle count backward from 5 to 1, reminding them that when the countdown is
complete, they will be fully present.
It is important to leave 5 to 10 minutes to debrief after the imagery, to
get an idea from the client what happened, assessing their ability to track
their own experience throughout the imagery. Perhaps there will be a question
or clarification. There may be a variety of responses to the first session of
planting the seeds of the five conditions that create secure attachment. Either
the client becomes elated and feels like they are in the making of a
breakthrough because they felt and imagined these safe and secure conditions,
or the client can become sad, grieving the fact that their birth parents did
not provide these five conditions. When this occurs, it is totally normalized.
The clinician could let the client know that the sadness, or grief, is not
uncommon as one imagines these secure conditions. But, that at the end of the
sadness is healing. And sadness is okay. The clinician might encourage them to
simply acknowledge the sadness and see it, because it needs to be seen. The
client’s experience of sadness and grief can be included in the context of
ideal parents and the five conditions, such that the IPFs notice and respond
with loving, soothing care. In this way the client has the experience of
‘negative’ emotions being welcomed, of being helped to feel and regulate them.
Touch the sadness but live in the security. Secure attachment allows us to be
able to hold both.
In the next session, one would begin with a check-in. The clinician should
look for signs that the client can do several things: that, when asked, they
can imagine their ideal parental figures. It is made clear that it is not vital
that they decide on every detail of the ideal parent figure’s face, as the imagined
caregivers will likely change and become refined over time as the client
becomes more aware of what their needs are and the ideal parents are able to
respond to those needs. But it is encouraged that their imagery is clear and
detailed. More important than having the figures decided in their mind is the
experience with the ideal parents, the felt sense of the
five conditions that create secure attachment. Ideally, the client will be able
to imagine their ideal parental figures in a variety of sense modalities,
especially feeling them and the effects of the five conditions viscerally. It
is also helpful for the client to be able to imagine them the IPFs working
together (collaborating, 3rd pillar) to achieve those five conditions. The
client would be able to imagine this visually and feel the conditions
viscerally. This, of course, might not happen in only the 2nd session. The
client may have some trouble still with settling on the figures, especially
clients who have an avoidant or dismissing attachment pattern. The clinician
can normalize that this is a process; that they will continue to shape and
refine their ideal figures and that is totally permissible. Again, normalizing,
acknowledging and dignifying the difficulty, praising them for their effort in
imagining these experiences that were not available to them as children. And
one might take this opportunity to add that some sadness, some grief, is part
of the process. As one begins to imagine attunement and expressed delight,
there is often a sense of grief that this was not necessarily our experience as
children. This is, of course, harder with the dismissing client who has
idealized one or both parents. But, because of the AAI, the therapist will know
this and approach the topic more lightly. The therapist should not approach the
sadness and grief as an obstacle, but rather emphasize the necessity of
allowing these emotions to flow through them, to resolve them in real time,
with the help and collaboration of their ideal parent figures, so the sadness and
lack of resolution can no longer have an effect on their behavior or the
partners they choose. Effectively, restructuring what one imagines as possible
for themselves (the Internal Working Model).
The AAI transcript and coding provide the therapist with information about
the client’s particular experiences that were problematic for the development
of attachment security. The therapist takes note of this information, and lets
it inform the application of the IPF imagery process. As always, the session begins
with a period of settling into the body (see Elliott, 2021, for the
developmental principles underlying this step). Then, for example, with a
client who has had little sense of safety with caregivers as
a child, the therapist is going to want to emphasizes how the ideal parent is
completely non-threatening and supportive of feelings of safety. The client is
encouraged to imagine all the ways the parents could be, all the things they
could say, all the things they could do, all the ways they could be with them,
that would make them feel just a little safer, even just a little at first,
including in the body. And then leave some space for the client to imagine, and
then simply check in. “So what are you experiencing?” If the response is
aligned with the idea of safety and the client is imagining things the parent
might say and do, then the therapist could emphasize that. “Yes, really feel
what that’s like to know at a deep level that you are completely protected.” If
they simply cannot imagine anything that would give them safety in their body,
the therapist will continue to normalize the difficulty, and have them notice
that the ideal parents see how difficult it is. “And they see that as the most
normal and natural thing in the world. And if you need all of the time in the
world to get comfortable with these ideal parents, that is totally fine with
them.” Have the client really take that in. And continue to check-in with what
they are imagining, and, collaboratively, the client and therapist build the
visualization with the goal of achieving those five conditions of secure
attachment in their mind and in their body.
As the client gets more practice and can more easily cultivate and
spontaneously engage with the ideal parents, one can then move into “activations.”
The client brings up a time from the week when they were uncomfortably
activated in some way, such as feeling afraid or alone. After recalling that
experience, they are encouraged to really be aware of that experience in their
mind and in their body, to get curious about it like a detective, and to report
to the therapist their experience is in the moment. The therapist might ask,
“What is going on in the body? What story is the mind telling? And what’s the
feeling?”
“I have tightness in my throat, the story is that I’m unlovable, and I’m
sad.” It is crucial that the therapist embody and maintain the presence of the
ideal parent during this exploration; always safe, accepting, and warm. The
therapist then asks the client to go back in their memories, back as far as
they can, and look for a memory or a time or a scene of a circumstance where
there was some aspect of this activation; some aspect of this feeling. “I’m in
my room playing with Legos and I want to be with my parents but I don’t know
where they are.” The therapist then asks the client to bring the ideal parents
right into the scene. They see the client-as-child, they see what’s wrong, and
know instantly what to do and how to be to soothe them, even if just a little
bit at first. And the therapist can ask, “What are you experiencing?” and
collaboratively create a new and different experience, replacing the neglect of
birth mother with the total attunement and collaboration of the ideal parents.
The effect on the psyche and the nervous system is profound. The client is
beginning to learn that the secure base does not exist out in the world
somewhere, but it is within themselves. Often times, just not feeling alone in
the memory can be quite soothing.
To further illustrate how the AAI can be used in conjunction with the Three
Pillar method, a case illustration will be given. For anonymity, he has been
named Patient 1.
Patient 1
Patient 1 is a 38-year-old Hispanic male who presented with relational
difficulties, most specifically and especially with his girlfriend and mother.
He had a history of psychotherapy, mostly Cognitive-Behavioral Therapy (CBT),
as he described. He was still having trouble disengaging with unhealthy
patterns and unhealthy people. As he described it, he had many tools and
strategies, but his ability to employ those strategies was directly related to
his level of regulation or dysregulation at that given moment. He had heard
about the Three Pillars and especially that Ideal Parent Figure therapy could
help with that base level of dysregulation, and was interested to give it a
try.
The AAI
Among the early questions on the AAI, the subject is asked to give five
words or phrases or adjectives that would describe the relationship between
themselves and the mother, and then the father. These five words or phrases are
then used as the subject of further inquiry. Patient 1 set a very “high bar”
for himself. He began by providing ‘glowing’ words and phrases to describe the
relationship with actual mother. As he lists them, the interviewer writes them
down. Each word is brought to the subject’s attention, and they are asked to
provide an actual memory, a concrete and authentic recollection of a time,
moment, scene from childhood that would illustrate why they chose the phrase.
For example, when I asked Patient 1 why he chose “very loving,” he paused in
silence for about twenty seconds, and then said, “I don’t know,” with a big
smile on his face. He was encouraged to think a little longer, normalizing that
it is a difficult question for many. He eventually provided a very general
memory, stating that she was “always caring.” I again asked for a specific
memory from as far back as he could remember of how the relationship was very
loving and always caring. For “always caring,” Patient 1 described how his
mother would pick him up from school with some regularity and he could trust
that she would be there. When queried about how the ride home usually went, Patient
1 stated that they would usually just talk about the mother.
Next, he was asked to give five words or phrases that describe the
relationship between himself and his father when he was a child. He seemed to
be much quicker to respond this time, and the words were quite different.
“Tyrant.” “Liar.” “Needed me to be like him.” One can see rather quickly that
there is a drastic difference between Patient 1’s early relationship to his
mother to that of his father. He was then asked to provide evidence for his
words or phrases, by providing a detailed memory, scene, experience, from
childhood that would illustrate why he chose those words. This time, he almost
seemed eager to answer the questions. When I had asked him the same questions
about his mother, he seemed to struggle a bit. He was not as eager to answer.
But for his father, when asked to give evidence for why he said, “Tyrant,” he
provided a detailed memory of a time when he had made a pact with his dad, that
if he just pointed out when his father was enraged, then he would stop being
rageful in that moment. Then, some days after, his father got angry and Patient
1 told him, “Dad, you’re doing it.” And it made no difference. He did not abide
by the agreement.
Using the AAI Results in Conjunction with the Three Pillars
The amount of information gathered by the third AAI question and its inquiry
was astounding. In that short time, Patient 1 provided very positive and
general words to describe his relationship with his mother. Yet, when asked to
provide evidence for the words he chose, he either did not have any evidence or
the evidence he presented contradicted his initial word or phrase in some way.
This notifies us that there is likely a dismissing strategy in place, namely
idealizing. Idealization scores are raised when the subject gives positive
words to describe the relationship and then does not have adequate evidence to
support the positive picture that they paint (Brown & Elliott, 2016). The
clinician must see this as a defensive posture against having to actually and
authentically explore the relationship with mother. This is something that the
Three Pillars/IPF practitioner sees as very important and useful. There is
idealization with his mother, and “love” and “care” seems to be confused with
his duty to her and the self-seeking needs of the mother, needing to talk about
her on the way home from school. Firstly, understand that this is a loss for Patient
1. The house of cards cannot hold up to the AAI questions. There is evidence
that his mother was overinvolved and that he confused that for secure
attachment. There is also evidence that his father was an angry, rejecting, and
untrustworthy man, with whom Patient 1 is consciously and significantly angry.
The anger comes out in his speech in the interview, and it comes out in the
five words he chooses for dad.
As IPF practitioners, the above information is crucial. Because Patient 1’s
mother was overinvolved and role reversing at times, his ideal mother will
emphasize the 4th and 5th conditions that create secure attachment. “Notice how
your ideal mother has no agenda for you. Feel the spaciousness in that. She
wants you to be your strongest, most unique self. She would never put herself
before you, for any reason at all. And notice how easy it is for her to give
you space. You don’t even have to ask, because as soon as you start to feel
crowded, she can attune to that and sense it and adjust and move away. Imagine
that.”
Patient 1 also sees his father as a predator. He is scared of his father.
Additionally, through the AAI results, it was found that he does indeed have
unresolved physical abuse from dad. This is something to be taken very
seriously, mindfully, and gently. “Start by simply imagining yourself as a
young boy, quite innocent and carefree and curious… And then imagine that that
boy, you, the boy you are, that you grew up in a family different than your
family of origin, with a set of parents completely ideally suited to meet each
and every one of your attachment needs. Begin by simply inviting your ideal
dad’s figure to be known, to enter the scene, always keeping him some distance
away.” After pausing for a moment, “Imagine everything about this figure is
completely nonthreatening. And in fact, notice that he sees that this is
difficult for you. He totally understands. He really sees you. Experience what
that’s like in your body, to be seen this way, and have it safe and soothing.
Notice also that you don’t have to figure it out right away. Your ideal dad
knows this is difficult, and if it takes you all of eternity to get comfortable
with him, that is completely fine with him.”
Thus, through many months of co-creation of secure imagery using Patient 1’s
ideal parent figures, he has taken his tyrannical and untrustworthy father’s
behavior and co-created an imaginal ideal father figure that is completely
non-threatening, totally attuned, safe, spacious, and encouraging. Today, he
has a relationship with both ideal mom and ideal dad, and they him. Even if he
is not directly imagining them, he experiences that they are available and with
him, because they have now integrated and become part of his most unique and
secure self. By using present time activations in session to go back to earlier
memories at the root of the activation, having the ideal parents come right
into the memory and see the child and soothe the child in exactly the right
way, one can literally re-map or restructure their “internal working model” of
attachment and of life in general. This is the movement from a worldview which
proclaims that, despite all of one’s best efforts, one’s needs will not be met;
to one that proclaims this world is more than enough to meet one’s needs. And
not only that, but that the client is more than enough as they are. This is the
movement from sickness to health, from illness to wellness, from insecurity to
security.
The world is becoming more and more global, and in-person weekly office
visits with a therapist have become more difficult, timely, and expensive.
Therefore, the “therapist as a good enough attachment figure,” or TAGAF, model
has become even more tenuous. The Three Pillar model is unique and forward
thinking, in that it equips clients and patients with a secure base that lives
inside their own hearts and minds. Eventually, just imagining the presence of
the ideal parent figures helps clients at once feel not alone, that they have a
team of support that is reliable and safe. Having that secure base within you,
available at all times, is often enough to allow one to feel safe enough to
pursue their most authentic and unique lives, no longer limited by their
insecure working model of the world. At last, the world is seen to the client
as a safe place that can meet their needs.
By beginning treatment with the administration and scoring of the Adult
Attachment Interview (AAI), the Three Pillar practitioner begins with a real
advantage. It is possible to infer from Probable Childhood Experience domains
which, if any, of the five conditions that promote secure attachment were
promoted to the client from their birth mother and father. If certain
conditions were lacking, then the clinician should ensure that the ideal parent
emphasize those conditions. If certain conditions were overemphasized, then the
clinician likewise knows to have those conditions be tapered or tame in the
ideal parents. And finally, by using positive opposites of the five words and phrases
that clients use to describe childhood relationships with their birth parents
as asked in the AAI, the client can begin to define their ideal parent figures.
Equipped with these imagined ideal parent figures and a skilled therapist to
aid in the co-imagining of the felt sense of secure
behaviors, the client is able to reappraise and eventually restructure their
Internal Working Model of attachment.
