Always Hurting the Ones We Love

The social and political implications of aggression and destructiveness cannot be overstated. Interpersonal violence, in particular, is seen by many as having reached epidemic proportions in modern society.

In this paper, the author draws on attachment, trauma and neurobiological theory and research, as well as his own clinical experience in working with violent individuals and couples in both private practice and a forensic setting, to explicate why so many of us end up hurting the ones we profess to love. Attachment theory holds that the person’s implicitly encoded cognitive-affective representational models of early self-other relationships mediate all significant subsequent relationships, particularly those developed with intimate partners in adulthood. The oft noted and seemingly addictive propensity to repeatedly forge adult romantic relationships redolent of ties to early attachment figures, even when these were characterised by violence, abuse and trauma, suggests that such behaviour reflects neurobiological, as well as psychological, derivatives. The author presents two case vignettes of violent men from his forensic practice to illustrate theoretical and clinical issues. He also sets out how an attachment-informed psychodynamic approach can effectively be employed with couples whose relationships are characterised by a low level of intimate violence.

Keywords: intimate violence, attachment, aggression and destructiveness, separation and loss, neurobiology, trauma, dissociation, affect regulation, stalking, representational models, implicit-procedural memory, mentalisation, couple therapy.

"Always hurting the ones we love: understanding intimate violence from an attachment, trauma and neurobiological perspective" (Paul Renn)

Introduction

A violent act may be defined as an attack upon the body of another which is committed with the explicit intention of causing physical harm and injury (Mirrlees-Black, 1999). There is general agreement that interpersonal violence falls into two broad types of behaviour: predatory or psychopathic violence, which is held to be planned and emotionless, and in which the perpetrator seeks out a victim with whom he has no attachment relationship; and affective violence, which arises in reaction to the perception that one’s personal safety or sense of self is under threat, and which is preceded by heightened levels of emotional arousal (Gilligan, 2000; Mitchell, 1993; Panksepp, 2001; Perry et al., 1995; Siegel, et al., 1999). Despite these distinctions, both types of violence involve the experience of unbearable states of mind which cannot be regulated, reflected upon or symbolised (Cartwright, 2002).

intimate personal violence (IPV), as defined by the Home Office, relates to the experience of emotional, financial, physical and psychological abuse by partners or family members, and also to sexual assault and stalking. The Office for National Statistics estimated that 1.4 million women and 700,000 men had experienced intimate violence in the year ending March 2015. More recently, a new offence of coercive and controlling behaviour came into law. While the Crime Survey for England and Wales for the year ending March 2015 reveals that non-sexual partner abuse was the most common type of intimate violence among both men and women, it found that women were more likely than men to have experienced each type of partner abuse. For example, women were far more likely to be the victims of sexual violence and harassment than were men. Moreover, approximately one-third of female victims of partner abuse had been pregnant during the violent relationship (Home Office, 2014/15). In the light of these findings, it is clear that women experience an appalling level of intimate violence and abuse at the hands of their male partners (Dutton et al. 1994; Dutton, 1995).

Findings, then, confirm that the majority of violent assaults between adults occur within an existing intimate relationship and fall into the affective category (Meloy, 1992). Indeed, official statistics for England and Wales reveal that on average two women are killed by their current or former male partners or lovers each week, being most at risk in a context of the relationship breaking up (Hoare & Povey, 2008; Home Office, 2014/2015). However, research also reveals that intimate violence operates on a broad continuum of seriousness, with homicide lying at one extreme and pushing and shoving at the other. Moreover, an increasing body of research presents a picture of intimate violence that is reciprocal and bidirectional in nature (Bartholomew, Kwong & Hart, 2001; Hoare & Povey, 2008; Home Office, 2006/2007; Mirrlees-Black, 1999; Renn, 2008a, 2008b). This finding appears to obtain in both opposite-sex and same-sex relationships (Mohr, 2008). Commonly, the violence is infrequent, confined within the family and relatively “minor”. Whatever the form, violence and abuse are wholly unacceptable: the acts may differ in magnitude, but not in essence (Stein, 2007).

A Relational Perspective on Aggression and Destructiveness

While aggression and destructiveness are seen as biologically rooted, a relational perspective views such behaviour as secondary, arising in response to a perceived threat to the psychological self in an attachment matrix characterised by trauma and abuse, rather than innate, as in the death instinct (Black, 2001; Freud, 1920g; Klein, 1933; Schwartz, 2001). Indeed, Mitchell (1993) argues that we all experience enough danger and threat in childhood to harbour a fair amount of destructive aggression. Given this, he suggests that it is universal to hate and plan revenge on those we love when we feel endangered, betrayed, shamed and angry. However, experiencing aggressive and destructive thoughts, feelings, and fantasies in response to a stressful interpersonal situation is one thing; the violent enactment of this experience is quite another. Furthermore, while violence is viewed by many as having reached epidemic proportions in modern society (Gilligan, 2000), in more prosaic terms it may be seen as just one of many diverse forms of psychopathological reactions to trauma.

Just why an individual should ‘choose’ violence as the preferred way to express his or her personal psychopathology, rather than say somatisation, self-harm, eating disorder, alcohol/drug misuse, depression, psychosis, and so on, is an intriguing question. A consideration of this issue would need to examine socio/cultural/historical factors and socially constructed gendered aspects of the person’s experience, as co-constructed in the therapeutic relationship with each unique individual. This reflects the all-important hermeneutic and social constructivist aspects of the therapeutic process that tend to get lost in general theorising. In my view, the subjective meaning of such maladaptive behaviour is to be gained by attending to the subject’s phenomenological experience of unmourned loss and unresolved psychological trauma in a particular social and relational matrix (Renn, 2003, 2006, 2012). Indeed, I consider that an understanding of the person’s subjective experience, and of the therapeutic process, is facilitated by an approach that incorporates both empiricism and hermeneutics (Renn, 2010, 2012).

More specifically, I contend that intimate violence is rooted in the disruption of attachment processes and constitutes a disorganised, maladaptive reaction to a perceived threat or sense of endangerment to the self (Renn, 2003, 2006, 2012). From this perspective, attachment theory may be understood as a theory of trauma – the trauma of separation and loss in the face of overwhelming fear and helplessness (Bowlby, 1980). In this context, it is important to recognise that attachment needs are not outgrown with childhood but characterise intimate relationships across the life-cycle. With regard to intimate violence, Bowlby (1984) noted how appallingly slow psychotherapists have been in appreciating the prevalence and far-reaching consequences of violent behaviour between family members. Increasingly, however, an attachment perspective is being used to understand intimate violence.

From this perspective, the key to understanding violence is the evolutionary function of anger. Bowlby (1973) contended that “threats of separation and other forms of rejection, are seen as arousing, in a child or adult, both anxious and angry behaviour” (p. 253). Indeed, research findings indicate that angry protest is an instinctive biological response to separation from the preferred attachment figure whose physical presence and emotional availability afford the child safety, protection and psychobiological regulation. The adaptive function of angry protest is to increase the intensity of the communication to the lost person with the set goal of achieving reunion (Bowlby, 1973, 1988). Disturbance of attachment is the outcome of a series of deviations that take the child increasingly further from adaptive functioning. Thus, the child’s anger may become dysfunctional if the caregiver’s response is insensitive, lacks contingency or is actively unloving and abusive, thereby generating intense feelings of fear, shame, hate and rage, together with a felt sense of threat, anxiety and insecurity. Such individuals develop representational models of self and significant others imbued with implicit expectations of the other’s hostility and unavailability (Bowlby, 1969, 1973). These mental representations may be activated in later life in situations involving stress and a sense of threat to the self (Bowlby, 1969; Mikulincer et al., 2002; Renn, 2010, 2012, 2017a).

Unexpressed anger in childhood, then, becomes split off into a dissociated representational system of the personality characterised by pathological mourning and profound emotional detachment (Bowlby, 1973, 1979; Liotti, 1992, 1999). Child abuse and cumulative developmental trauma violate the child’s sense of trust, identity and agency. In the absence of any resolution via subsequent positive attachment relationships, this may have a pernicious and seminal influence on adult psychopathology: all too often the violated child becomes the violent adult (Bowlby, 1944, 1988; Dutton et al., 1994; Renn, 2003, 2007; West & George, 1999). In this sense, violence may be seen as representing the extreme of behaviours that are all too human (Stein, 2007). Representational models deriving from implicitly encoded developmental trauma provide the templates for psychopathology in later life, which may include violent, destructive and self-destructive forms of behaviour (Renn, 2012; Schore, 1994). Such mental models interfere with the ability to consider the other’s perspective and feelings, and predispose the individual to expect hostile intent in ambiguous social situations (Bartholomew et al., 2001; Bowlby, 1988; Cortina & Liotti, 2007; Fonagy et al., 2004). Indeed, Fonagy and his colleagues (2004) argue that brutalisation in the context of attachment relationships generates intense shame. When this is coupled with a history of neglect and a consequent weakness in mentalisation, it becomes “a likely trigger for violence against the self or others, because of the intensity of the humiliation experienced when the trauma cannot be processed and attenuated via mentalisation” (p. 12). From this perspective, the alien, dissociated part of the self is used as a survival strategy “to contain the image of the aggressor and the unthinkable affect generated by their abusive actions . . .” (p. 13).

From a relational perspective, then, intimate violence involves disturbance of attachment processes, and is understood as the distorted and exaggerated version of attachment behaviour that is potentially functional (Bowlby, 1973, 1979; de Zulueta, 1993; Fonagy et al., 1997). While a disorganised attachment state of mind does not inevitably lead to the enactment of affective violence in intimate relationships, in line with Lyons-Ruth & Jacobvitz (2008), I would argue that it constitutes a potent risk factor.

The Links Between Attachment and Stalking Behaviour

Stalking or harassment, a prevalent crime in the UK and USA, may be understood in terms of attachment pathology deriving from acute separation anxiety and fear of abandonment in early life. In such cases, the insecurely attached person is ineluctably drawn to follow and seek proximity to the real or fantasised attachment figure onto whom such relational dynamics have been displaced or redirected in order to assuage overwhelming feelings of loss, shame and isolation (Hoare & Povey, 2008; Home Office, 2006/2007; Meloy, 1992; Povey & Allen, 2003). The following case example illustrates the attachment dynamics involved in stalking behaviour.

Clinical Illustration

“Hardeep” embarked on a campaign of violence and harassment when his partner, “Jaswinder”, ended their relationship. His violent behaviour in relation to Jaswinder had brought him before the courts on several occasions and culminated in his breaking into her home one night armed with a knife and assaulting her when she phoned the police.

Hardeep was 25 at the time of the assault, and is the second oldest of six children. He was born and raised in India, but the family moved to the UK when he was aged 14. Prior to leaving India, Hardeep’s favourite uncle died, as did his father soon after the family had settled in Britain. Hardeep’s mother was an anxious, fearful woman who related to him in an overly protective way. This took the form of a morbid preoccupation with his physical health, diet and personal safety, fearing, for no apparent rational reason, that he would die. Because of this fear, Hardeep’s mother discouraged him from leading an independent life outside the family home; instead, she kept him firmly tied to her, seemingly as a means of quelling her fear and anxiety. It would seem that she had inverted the relationship with her son, unwittingly using him as her attachment figure.

This merged, sub contingent style of relating intensified following her husband’s death. In her grief, she increasingly turned to Hardeep for comfort and emotional support, and he became her confidante and constant companion. Although he resented this imposed role, he felt trapped in it by a sense of duty and obligation, fuelled by guilt and shame whenever he tried to step outside of this role. Thus, he was unable to express the anger and frustration he felt towards his mother for what he saw as her failure to “give me my freedom”.

Hardeep’s relationship with Jaswinder was his first intimate, sexual involvement with a woman. He continued to live with his mother throughout their intense, turbulent two-year relationship, and was unable to accept that Jaswinder wanted to lead an independent life whilst they were together, or that she eventually wanted to end their relationship because of his coercive and controlling behaviour. He spoke of feeling lonely, distressed, frightened and angry because of her wish to leave him, and of responding by becoming ever-more dependent upon her. Hardeep denied the reality of the loss and, instead, perceived his affiliation with Jaswinder and her parents as “close”, despite all evidence to the contrary. He made frequent intrusive telephone calls to Jaswinder, visited her and her parents’ respective homes uninvited and unannounced, and kept Jaswinder under regular surveillance, frequently following her every movement. He resorted to violence in an attempt to frighten her and thereby bring her under his power and control. Prior to this situation, Hardeep was a conscientious, passive and law abiding citizen who worked in the family business and saved assiduously to fulfil his mother’s wish to go on holiday together to India.

Hardeep’s case supports research indicating that sub optimal representational models persist into adulthood, albeit in a non-linear way. These mental models co-exist with more appropriately adaptive ones, reflecting the view that attachment is an open system (Bowlby, 1973, 1979). This, in turn, is consistent with findings which show that the brain retains plasticity across the life cycle, with new neural connections being consequential on novel environmental challenges and demands (Cozolino, 2002, 2006; Edelman, 1987; Renn, 2017a). Liotti (1992) posits a connection between disorganised attachment, dissociation and the construction of a multiple, incoherent representational model in respect of the primary attachment figure. An incompatible model in respect of one and the same person generates oscillating beliefs and expectations. At times of intense emotional stress the earlier, less conscious model tends to become dominant (Bowlby, 1984, 1988). In later life the confused, unstable representational model imbued with dysregulated rage, shame and hate deriving from childhood fear of abandonment and dread of loneliness may be activated under circumstances of separation and loss. These affective states cannot be mentalised and thus may result in extreme behaviour, including violence (Fonagy et al., 2004).

This attachment paradigm, in conjunction with a neurobiological perspective, may be used to understand Hardeep’s stalking and violent behaviour in the context of Jaswinder ending their relationship. The clinical evidence, combined with Hardeep’s recent forensic history, indicates that he had developed an unresolved/disorganised state of mind in respect of loss and trauma. As a consequence, his capacity to mourn loss and regulate negative affective states of anger, shame and rage when under stress was deficient. Abandonment by Jaswinder was experienced in traumatic terms, activating a multiple, incoherent representational model characterised by confusion and fear. This, in turn, caused him to seek proximity to Jaswinder in a clinging, tearful and dependent way. When she failed to respond to his pleas and provide the comfort, security and support he needed to alleviate his stress and deactivate his attachment system, his coping strategies and mental defences were overwhelmed by negative affect and an unregulated cascade of stress-related neurochemicals. These, in turn, suppressed the hippocampus and enhanced amygdala activity, leading to the re-emergence of trauma-related childhood memories, conceptualised, psychologically, as a dissociated archaic representational model.

Lacking the capacity to represent, mentalise and organise feeling states of fear, shame, hate and rage, Hardeep acted out his emotional distress in an escalating pattern of stalking that culminated in a violent assault on Jaswinder. By his own admission, this maladaptive behaviour was, in part, a frantic attempt to control Jaswinder to ensure her continuing emotional and physical availability, thereby protecting him against disturbing feelings of loss, shame, and fear of self-annihilation. Her understandable reluctance to respond to him kept Hardeep in a protracted state of psychobiological stress, thus his fear and attachment behavioural systems remained in a state of chronic activation. Being unable to self-soothe and self-comfort, he desperately sought proximity to Jaswinder, since she had become his main attachment figure.

As a result of this unhappy situation, Hardeep was faced with an exquisitely painful and irresolvable problem: as Jaswinder was his primary attachment figure it was to her that he instinctively turned for comfort at times of stress to deactivate the physical, emotional, and neurobiological reaction that he was experiencing. However, her understandable rejecting and abandoning behaviour was the unwitting cause of his distress. Lacking a coherent strategy to deal with separation and loss, and thus the capacity to mentalise, regulate and process his traumatic state of mind, Hardeep’s behaviour became increasingly obsessive and disorganised. He denied the loss and distorted his perception of the relationship, rationalising his controlling, stalking and violent behaviour, which he cast in terms of protecting Jaswinder from others and from the excesses of her own self-destructive behaviour.

Hardeep’s terrified reaction to the loss of Jaswinder may be seen as the re-emergence of implicitly encoded, context-dependent childhood emotional memories associated with early unresolved loss and trauma; in Winnicottian terms, the breakdown that has already happened, but which has not yet been ‘remembered’ (Winnicott, 1974). In this relational context, Hardeep’s anger, stalking and violence may be understood as motivated by fear and an urgent need to protect the self from being re-traumatised. His violence and desperate attempts to maintain proximity to Jaswinder may, therefore, be viewed as a pathological form of attachment behaviour – as de Zulueta (1993) aptly puts it, as “attachment gone wrong”.

Hardeep’s lived experience reflects findings indicating that vulnerability to adult post-traumatic stress is vitally affected by early traumatic experiences that have been indelibly imprinted in implicit-procedural memory (LeDoux et al., 1989; Perry et al., 1995; Renn, 2012, 2017a; Schore, 1994, 2001; van der Kolk & Fisler, 1995; Wilkinson, 2010). Indeed, implicit effects of past experiences are thought to profoundly shape our emotional reactions, preferences and dispositions – key elements of personality (Grigsby & Hartlaub, 1994; Schacter, 1987, 1996). Moreover, research shows that the dysregulation of fear-states in early life results in a permanent sensitivity to even mild stress in adulthood, with the individual being unable to terminate a stress response in time to prevent an excessive reaction (Perry et al., 1995; Schore, 2001). Perry and his colleagues found that traumatic early life events predispose certain individuals to later psychiatric disturbance when they are re-challenged with a matching event, or experience a recurrence of the original stressor (Perry et al., 1995). These findings reflect a trauma-induced deficit in the brain’s right orbitofrontal systems and concomitant difficulty in inhibiting responses related to orbitofrontal dysfunction. As a result of such dysfunction, affective information implicitly processed in the right brain is inefficiently transmitted to the left hemisphere for semantic processing. Thus, the individual is more likely to behave impulsively and aggressively in situations of stress and arousal (Bradley, 2003; Schore, 1994, 2001). The way in which the individual subjectively interprets traumatic and abusive experiences is, needless to say, central to the modulation of affective arousal and to the development of symptoms and disorders (Herman & van der Kolk, 1987; van der Kolk & Fisler, 1995). The case vignette of “Michael” may further help to bring these clinical issues to life.

Clinical Illustration

"Michael" killed his estranged wife "Anna" hitting her head repeatedly with a claw hammer in an explosive rage after confronting her about "the accusations she was making about me to the children". He was 49 at the time and had been married to Anna for 20 years. The couple had four children aged between 10 and 18 years.

Michael’s parents separated when he was aged 4. He soon lost contact with his father and paternal grandparents after his mother re-married. He became estranged from his mother when she and his stepfather became preoccupied with running a small business, and he developed a substitute attachment with his maternal grandmother since she was now chiefly responsible for his upbringing. Michael had nothing in common with his stepfather and their relationship was distant and strained. His relationships with his parents deteriorated further when his half-sister was born because he felt they favoured her over him. This situation seemed to reinforce Michael’s sense of rejection and foster a nascent misogynistic attitude. At about that time a friend of his grandfather’s sexually abused him. He frequently ran away from home and suffered from persistent enuresis. He had six months of therapy with a child psychiatrist at that time.

In early adulthood, Michael became engaged to Clare, who precipitately broke off the engagement. On subsequently meeting Clare by chance in the street they argued and Michael stabbed her in the chest with a hacksaw blade. He was convicted of grievous bodily harm (GBH) and imprisoned. On his release a spate of offending behaviour occurred, culminating in a four-year sentence of imprisonment for offences of robbery, possession of a firearm, and GBH with intent.

Michael’s criminal activity ceased following his marriage to Anna. In the four years prior to his killing her tension mounted in the marriage. He was working long, unsocial hours and Anna suspected him of having an extra-marital affair. They led increasingly separate lives, rarely having sex and frequently arguing. Their problems were exacerbated by Anna’s excessive drinking and his controlling behaviour. Michael’s grandmother and mother both died during this time causing him intense distress. He was reluctant to share the money he inherited with Anna because he suspected that she would use it to “leave me”.

The couple tried but failed to reconcile their differences. Michael was hospitalised with depression after a suicide attempt. Within two weeks of being discharged, Anna accused him of raping her and he was arrested and remanded in custody for three months. During his time on remand, Anna filed for divorce. Four days after his release he went to see Anna and killed her when she refused to talk to him, attempted to phone the police and flee from the house. Afterwards, Michael explained that “all my anger and frustration suddenly burst out”. The police were called and found Michael sitting in his car outside the family home. He was convicted of manslaughter and sentenced to seven years’ imprisonment

Michael spoke of loving Anna and of not wanting them to separate and divorce. However, he felt that she had provoked him by alleging rape, by tarnishing his name with their children, by withdrawing sexually from him, and by planning to divorce him, leaving him feeling shamed and humiliated in hers and the children’s eyes. Michael seemed emotionally detached and unable to empathise with Anna, but he was deeply distressed by “the grief I’ve caused my children”, when he had wanted to give them the “perfect childhood I didn’t have”.

Michael’s formative experiences would seem to have consisted of both cumulative developmental trauma deriving from interaction with unresponsive caregivers, and dramatic trauma in the form of loss, abandonment, broken attachments, and sexual abuse. These experiences are likely to have impacted negatively on his neurological development. In the absence of appropriate help to process these experiences, it would seem that he developed a disorganised pattern of attachment and concomitant difficulty in regulating emotional states associated with rejection and abandonment. In childhood, he expressed his anger and distress by running away from home and bed-wetting, whereas in adulthood it was enacted in violent crime.

Michael’s secure-enough attachment to Anna enabled him to contain his fear and anxiety and his offending behaviour ceased. However, it appears that he was defending against unresolved childhood trauma by controlling Anna and idealising the relationships with his children. Whilst Anna was emotionally available to him such defences and coping strategies kept his fear and anxiety within manageable proportions. However, perceiving that Anna was intent on leaving him activated Michael’s multiple, incoherent representational model, together with an uncontrolled release of stress-related neurochemicals and the re-emergence of dissociated traumatic childhood experiences. Lacking a coherent strategy to deal with separation and loss, Michael’s behaviour became increasingly disorganised. His coping strategies, mental defences, and capacity to mentalise and regulate emotional and bodily states were overwhelmed, resulting in an explosive murderous rage. His attack on Clare when she had rejected and abandoned him may also be seen as indicating that loss activated an incoherent representational model deriving from dissociated childhood trauma and disorganised attachment to his early caregivers.

Thinking about Michael’s early experiences in the context of neuroscience research, van der Kolk & Fisler (1995) found that childhood trauma results in more pervasive biological dysregulation than adult trauma. Significantly, their research shows that people who have a history of childhood trauma experience greater difficulty in regulating internal states than those first traumatised in adulthood. Genetic variables notwithstanding, infant and trauma research may help to elucidate the question as to why individuals respond differently to the same, or qualitatively similar, traumatic incident. Researchers have demonstrated that securely attached children develop the capacity to stay attentive and responsive to the environment and use error-correcting information to reflect on their experience and construct a coherent narrative (Main et al., 1985; Main, 1991; Solomon, George & De Jong, 1995). Thus, the stressful experience remains available for processing via the systems of explicit memory. Secure/autonomous individuals may, therefore, possess the resilience and mental resources to process information more readily in the aftermath of a traumatic event without developing full-blown post-traumatic stress disorder than unresolved/disorganised subjects whose ability to regulate states of arousal was compromised during early development.

This contention is supported by findings showing that children subjected to misattuned, insensitive and over-arousing caregiving may typically inhibit responsivity and enter prolonged and severe states of withdrawal (Beebe, Jaffe & Lachmann, 1992) as an ‘emotional regulation strategy’ (Schore, 1994). It would seem reasonable to hypothesise, therefore, that an individual with an unresolved state of mind with respect to childhood trauma, and concomitant incapacity to regulate psychobiological states in moments of stress may be more vulnerable to subsequent trauma and its sequelae than an individual with a secure/autonomous state of mind.

Attachment theory, then, holds that the person’s cognitive-affective representational models of early self-other relationships mediate all subsequent relationships, particularly those with intimate partners in adulthood (Eagle, 2017; Holmes, 2017). A neurobiological perspective adds another level in understanding the seemingly addictive quality that characterises so many traumatic and abusive intimate relationships (Mitchell, 2000; van der Kolk, 1989, 1994). From this perspective, trauma-related childhood memories such as Michael’s are encoded and stored in the systems of implicit-procedural memory and may re-emerge in stress-inducing social contexts in adulthood such as separation and loss that cue the retrieval of these indelibly imprinted emotional memories (LeDoux et al., 1989; LeDoux, 1994, 1996; Pally, 2000, 2005; Schacter, 1996; Renn, 2017a, 2017b; Schore, 1994; van der Kolk & Fisler, 1995).

Couple Therapy and the Links Between Adult Attachment States of Mind and Intimate Violence

The decision whether or not to work therapeutically with a couple whose intimate relationship is characterised by violence and abuse should be informed by an assessment of risk, by relevant research findings, and by the couple’s particular needs and socio-cultural context. The detrimental emotional impact on any children of the family should also be assessed, as research shows that witnessing violence in the home is a significant risk factor for the development of disorganised attachment in children (Lyons-Ruth & Jacobvitz, 2008). Moreover, experiencing domestic violence in childhood was found to be the best predictor, for both males and females, of becoming a victim of violence in adult couple relationships (Wekerle & Wolfe, 1999).

I think it good practice to see the couple together for an initial meeting followed by a separate interview of both partners. This may facilitate disclosure of violence and emotional abuse. It also provides the opportunity to take each partner’s attachment and relationship history, explore their experiences of abuse and psychological trauma, and assess the general emotional and sexual quality of the relationship and their respective adult attachment state of mind, as reflected in their discrete discourse style. In cases where the couple discloses a low level of violence and abuse, and both partners indicate their desire to freely participate in couples therapy with the initial goal of eliminating all forms of abuse, it makes good clinical sense to work on the relationship conjointly, not least because the woman is much more likely to be physically injured in a violent exchange (Bograd & Mederos, 1999). Couples work, however, is strongly contraindicated in cases in which the woman is caught up in a battering relationship characterised by frequent and severe violence and unstable, dysfunctional attachment dynamics. In my view, the woman needs help to physically and emotionally separate from her battering partner, and the man should be worked with individually with the goal of resolving the attachment trauma that is likely to be motivating his violent behaviour.

How, then, can attachment theory and research help us to understand the contradictory relationship between violence and abuse, on the one hand, and love and intimacy, on the other hand? To paraphrase Oscar Wilde, why do so many people hurt the ones they love?

Adult attachment can be represented by two underlying dimensions reflecting the degree to which an individual feels discomfort in intimate relationships or fears abandonment from the partner: discomfort with closeness and anxiety over abandonment (Feeney, Noller & Hanrahan, 1994; Mikulincer & Shaver, 2007; Roberts & Noller, 1998; Simpson, 1990). Adults with a dismissing attachment state of mind report more discomfort with emotional intimacy and interdependence, whereas those with a preoccupied attachment state of mind report higher levels of anxiety over abandonment and fear of rejection. Researchers have presented evidence showing that couple violence is related to the regulation of intimacy and the maintenance of proximity within the relationship (Bond & Bond, 2004; Downey et al., 1997; Dutton et al., 1994; Roberts & Noller, 1998). These findings are consonant with the contention that the main purpose of defence in attachment theory is affect regulation, and that the means of achieving this are behavioural and intrapsychic mechanisms conceptualised as distance regulations (Dozier et al., 2001; Sroufe & Waters, 1977).

Whereas a secure partner may provide a buffering effect for the behaviour of an insecure individual, the pairing of two insecure individuals may prove a highly volatile combination, especially if one partner is fearful of abandonment and the other is uncomfortable with intimacy. This not uncommon combination of couples with these particular adult attachment styles or states of mind may be especially fraught and combustible because of the conflicting needs for intimacy involved. In particular, a person who is anxious over abandonment may find the withdrawal and emotional distance of a partner who is uncomfortable with closeness extremely anxiety-provoking (Cohn et al., 1992; Roberts & Noller, 1998). The dismissing partner’s distancing behaviour activates the preoccupied partner’s archaic representational model, together with fearful affect and the expectation of abandonment. As the preoccupied partner escalates the appeal to have dependency needs met, this, in turn, activates the dismissing partner’s representational model imbued with discomfort with intimacy and sets in train procedural responses of withdrawal and emotional distancing. This leads to subsequent pursuer-distancer escalations, a relational dynamic that may be seen as a negative example of bi-directionality or mutual influence (Renn, 2012). When the closeness/distance struggle cannot be negotiated to suit both partners’ intimacy needs, the conflict, fuelled by chronic fear and distress, may escalate out of control and erupt into violence (Byng-Hall, 1999).

Dismissing individuals, then, tend to deactivate their attachment system and withdraw from conflict situations, presenting as overly independent, self-reliant and emotionally detached. By contrast, preoccupied people hyper-activate their attachment system and are chronically hyper-vigilant and anxious about rejection and abandonment (Cassidy & Kobak, 1988). They often have such excessive needs for support and reassurance that they are inevitably frustrated and disappointed in not having these needs met. In consequence, they may become increasingly demanding and potentially violent when their attachment needs are not fulfiled (Bartholomew, Henderson & Dutton, 2001). Indeed, research has identified an association between couple violence and withdrawal from conflict, with violence being used to protest the distance and prevent the partner from leaving the scene of conflict. Therapeutic approaches that are unfamiliar with such attachment dynamics often employ “time out” as a safety strategy. However, unless carefully thought through and managed, the time out strategy may unwittingly escalate the conflict, being misconstrued as a defensive withdrawal, and thus place one or other partner at greater risk of a violent assault.

Individuals whose attachment histories have made them especially susceptible to anxiety, rejection, separation and loss may be most likely to appraise ambiguous behaviour by a partner as rejecting and unsupportive. This is likely to be subjectively experienced as posing an imminent threat to their security and integrity as a psychological self. Sexual jealousy and fear of rejection and abandonment are common triggers of violent incidents in intimate relationships with the violence functioning in a wholly maladaptive way to regulate intimacy and maintain proximity to the loved one whose loss is so desperately feared (Bartholomew, Henderson & Dutton, 2001; Hazan & Shaver, 1987; Holtzworth-Munroe, Stuart, & Hutchinson, 1997; Renn, 2012; Shaver & Mikulincer, 2004).

The ‘stuckness’ that characterises couple relationships that are in trouble may be seen in terms of Sandler’s (1976) theory of role-responsiveness. This relational, systemic model is eminently adaptable to clinical work with couples, a crucial aspect of which is to bring into focal attention the way in which each partner is repeatedly eliciting from the other emotional responses and patterns of behaviour that maintain non-conscious roles and sets of expectancies encoded in implicit-procedural memory. In addition, I have found it therapeutically beneficial to help couples build into their relationship three interlinked features that keep a relationship viable and on track: safe haven/secure base functions, a process of rupture/repair, and emotionally meaningful communication.

The concept of the safe haven/secure base derives from attachment theory and is shorthand for being emotionally available, responsive and supportive. This needs to be a one-way process in respect of the parent and child so as to preclude the parent inverting the relationship, thereby using the child inappropriately as his or her attachment figure (Bowlby, 1988). However, it needs to be a two-way process in adult relationships, especially in adult romantic relationships. Thus, the distressed person needs the partner to be his or her safe haven and to respond in ways that afford emotional understanding and psychobiological regulation. In so doing, the partner becomes a secure base, facilitating exploration and elaboration of the emotional states and difficulties that have emerged in a particular relational context, thereby deactivating the fear behavioural system. Ruptures to the attachment relationship or love bond will inevitably occur, on both a micro and macro level of misattunement. If, however, the romantic relationship is characterised by rupture after rupture, without adequate repair, the couple will become increasingly estranged and alienated from one another.

Self-evidently, both safe haven/secure base functions and the process of repairing disruptions to the attachment relationship involve good, emotionally meaningful communication. What often gets in the way of such communication is fear of feelings, which may become so intense in intimate encounters that they erupt into a violent enactment. Therefore helping the couple to be less frightened of their own affective states and to start to take emotional risks that subjectively may feel very dangerous is a crucial aspect of therapeutic action. Over time this process generates new neural connections and thus lays down more optimal procedural memories characterised by a sense of trust and safety.

The context of violent enactments in the couple’s everyday life frequently revolve around the emotional unavailability of the other in situations involving a stressful event, interpersonal conflict or a separation and reunion that is left unmarked. With regard to the latter, this may be something as “minor” as continuing to watch a TV program when the partner arrives home from a day at work. This may be subjectively experienced as an intense narcissistic mortification, reflecting an attachment history of being repeatedly negated, unseen and unrecognised by the other. Not infrequently, such encounters lead to an excessive emotional response which, in itself, is an indication that an archaic representational model has been activated. I would emphasis that, regardless of whether we are working clinically with individuals or couples, building in and explicitly consolidating the three interlinked aspects of a good enough relationship, as discussed above, is not only therapeutically beneficial but also essential to establishing a sense of security that is a prerequisite for effective clinical work to commence.

Conclusion

From the foregoing, then, it may be seen that instead of focusing on perpetrators and victims in isolation, a relational or systemic approach, informed by attachment theory and research, explores the interaction between the partners’ adult attachment styles or states of mind and the non-conscious emotional procedures that they habitually employ in their intimate relationships. This shifts the focus from the individual to the dyad, and to a discussion of the relational context in which the violent behaviour develops and is being maintained in the implicit-enactive domain of being and relating (Clulow, 2001, 2017; Mikulincer et al., 2002; Roberts & Noller, 1998; Renn, 2012). Therapeutic action consists in making explicit such procedural ways of relating, and in linking the way in which emotional conflict about closeness and distance, particularly in contexts involving separations and reunions, activates dissociated, archaic self-other representational models imbued with early attachment trauma encoded in the systems of implicit memory.

Clearly, this paper is written from an attachment, trauma and neurobiological perspective and focuses on intimate violence in a domestic setting. In more general terms, however, it is important to emphasise that a broader understanding of intimate personal violence and abuse needs to take account of the social, cultural and political context of unequal power relations within which intimate violence occurs (Clulow, 2001). This would include a consideration of a patriarchal system of society within which women are largely excluded from the power wielded by men. Such a system, with its inherent misuse of power, may be seen as being reflected in the #MeToo movement, a campaign that has highlighted just how commonplace sexual assault and harassment are in the fields of sport, entertainment and business.

Intimate personal violence, then, is a complex phenomenon that has socio-cultural, relational and individual origins. From an attachment perspective, understanding the traumas, adult attachment states of mind, and implicitly encoded representational models that people bring to their intimate relationships in the context of their early attachment histories may help us to assess whether or not, and under what specific circumstances, couple violence is likely to occur, and to intervene clinically in an effective and efficacious way.

Violence, as a relationship trauma, corrodes trust, violates the couple’s love bond, and compromises the capacity for the relationship to serve as a safe haven and secure base for either partner (Bartholomew, Henderson & Dutton, 2001). Following a comprehensive assessment of risk, the employment of an attachment-informed psychodynamic couple therapy may enhance the partners’ understanding of their mutual needs for security, love and closeness. The overarching goals are for the couple to end the violence and abuse, soften their blaming attitudes, repair any relationship traumas, and communicate their hurts and needs in an emotionally engaged and direct way (Johnson, 2004). Optimally, the therapeutic process will help the couple to function more effectively and mutually as a source of security for one another, thereby decreasing the likelihood of violence and abuse in the future (Bartholomew, Henderson & Dutton, 2001; Bowlby, 1979, 1984; Renn, 2003, 2006, 2012).

Paul Renn is a UKCP accredited psychoanalytic psychotherapist, supervisor and couples therapist. He has a background in the National Probation Service where he specialised in working with high risk violent individuals and couples. He subsequently trained at the Bowlby Centre where he devised and taught modules on Child and Adolescence Development, Trauma and Dissociation, and Relational Perspectives on Psychosis. He is a member of the Anna Freud Academic Faculty, the Forum for Independent Psychotherapists, the International Association for Forensic Psychotherapy, the International Association for Relational Psychoanalysis and Psychotherapy, the International Attachment Network, and the Society for the Exploration of Psychotherapy Integration. He is on the editorial board of Psychoanalytic Inquiry, recently editing a special issue of this journal on the role of attachment theory in clinical practice. He is the author of numerous book chapters and journal articles, and of the Silent Past and the Invisible Present: Memory, Trauma, and Representation in Psychotherapy. He has a private practice in south-west London.

Email: [email protected]

Address for correspondence: 13 Seaton Road, Twickenham, TW2 7AT, UK

References

Bartholomew, K., Henderson, A., & Dutton, D. (2001). Insecure attachment and abusive intimate relationships. In Adult Attachment and Couple Psychotherapy: the ‘secure base’ in practice and research. In C. Clulow (Ed.), (pp. 43-61). Hove: Routledge.

Bartholomew, K., Kwong, M. J., & Hart, S. D. (2001). Attachment. In W. J. Livesley (Ed.), Handbook of Personality Disorders: Theory, Research, and Treatment, (pp. 196-230). New York: The Guilford Press.

Beebe, B., Jaffe, J. & Lachmann, F. M. (1992). A Dyadic Systems View of Communication. In N. J. Skolnick & S. C. Warshaw (Eds.), Relational Perspectives in Psychoanalysis, (pp. 61-81). Hillsdale, NJ: Analytic Press.

Black, D. M. (2001). Mapping A Detour: Why Did Freud Speak Of A Death Drive? British Journal of Psychotherapy, 18(2), 185-198.

Bograd, M., & Mederos, F. (1999). Battering and Couples Therapy: Universal Screening and Selection of Treatment Modality. Journal of Marital and Family Therapy, 25(3), 291-312.

Bond, S. B., & Bond, M. (2004). Attachment Styles and Violence Within Couples. Journal of Nervous and Mental Disease, 192(12), 857-863.

Bowlby, J. (1944). Forty-four juvenile thieves: Their character and home-life. International Journal of Psycho-Analysis, 23: 1-57, 207-228.

Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. London: Pimlico.

Bowlby, J. (1973). Attachment and Loss, Vol. 2: Separation: Anger and Anxiety. London: Pimlico.

Bowlby, J. (1979). The Making and Breaking of Affectional Bonds. London: Routledge.

Bowlby, J. (1980). Attachment and Loss, Vol. 3: Loss, Sadness and Depression. London: Penguin.

Bowlby, J. (1984). Violence in the family as a disorder of the attachment and caregiving systems. American Journal of Psychoanalysis, 44, 9-27.

Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. Bristol: Arrowsmith.

Bradley, S. J. (2003). Affect Regulation and the Development of Psychopathology. New York: The Guilford Press.

Byng-Hall, J. (1999) Family and Couple Therapy: Toward Greater Security. In J. Cassidy & P. R. Shaver (Eds.). Handbook of attachment: Theory, research and clinical applications, (pp. 625-648). New York: Guilford Press.

Cartwright, D. (2002). Psychoanalysis, Violence and Rage-Type Murder: Murdering Minds. Hove: Routledge.

Cassidy J., & Kobak, R. R. (1988). Avoidance and its relationship with other defensive processes. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachments, (pp. 300-323). Hillsdale, NJ: Erlbaum.

Clulow, C. 2001). Attachment theory and the therapeutic frame. In C. Clulow (Ed.), Adult Attachment and the Therapeutic Frame: The ‘secure base’ in practice and research, (pp. 85-104). Hove: Routledge.

Clulow, C. (2017). Before, Between, and Beyond Interpretation: Attachment Perspectives on Couple Psychoanalytic Psychotherapy. Psychoanalytic Inquiry, Vol. 37(5), 343-354.

Cohn, D. A., Silver, D. H., Cowan, C. P., Cowan, P. A., & Pearson, J. L. (1992). Working models of childhood attachment and couple relationships. Journal of Family Issues, 13, 432-449.

Cortina, M., & Liotti, G. (2007). New approaches to understanding unconscious processes: Implicit and explicit memory systems. International Forum of Psychoanalysis, 16, 204-212.

Cozolino, L. J. (2002). The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. Norton: New York.

Cozolino, L. J. (2006). The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. Norton: New York.

De Zulueta, F. (1993). From Pain to Violence: The traumatic roots of destructiveness. London: Whurr Publications.

Downey, G., Khoun, H., & Feldman, S. (1997). Early interpersonal trauma and later adjustment: The mediational role of rejection sensitivity. In D. Cicchetti & S. L. Toth (Eds.), Developmental perspectives on trauma: Theory, research and intervention, (pp. 85-114). New York: University of Rochester Press.

Dozier, M., Lomax, L., Tyrrell, C. L., & Lee, S. W. (2001). The challenge of treatment for clients with dismissing states of mind. Attachment and Human Development, 3(1), 31-61.

Dutton, D., Saunders, K., Starzomski, A., & Bartholomew, K. (1994). Intimacy-anger and insecure attachment as precursors of abuse in intimate relationships. Journal of Applied Social Psychology, 24, 1367-1386.

Dutton, D. (1995). The Domestic Assault of Women. Vancouver: University of British Columbia.

Eagle, M. N. (2017). Attachment Theory and Research and Clinical Work. Psychoanalytic Inquiry, Vol. 37(5), 284-297.

Edelman, G. (1987). Neural Darwinism. London: Basic Books

Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128-152). New York: Guilford Press.

Fonagy, P., Target, M., Steele, M., Steele, H., Leigh, T., Levinson, A., & Kennedy, R. (1997). Morality, Disruptive Behaviour, Borderline Personality Disorder, Crime, and Their Relationships to Security of Attachment. In L. Atkinson & K. J. Zucker, (Eds.). Attachment and Psychopathology, (pp. 223-274). New York: Guilford Press.

Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2004). Affect Regulation, Mentalisation, and the Development of the Self. New York: Other Press.

Freud, S. (1920g). Beyond the Pleasure Principle. In J. Strachey (Ed. & Trans.). The standard edition of the complete psychological works of Sigmund Freud (Vol. 18, pp. 1-64). London: Hogarth Press.

Gilligan J. (2000). Violence: Reflections on Our Deadliest Epidemic. London: Jessica Kingsley Publishers.

Grigsby, J., & Hartlaub, G. H. (1994). Procedural learning and the development and stability of character. Perceptual and Motor Skills, 79, 355-370.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualised as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524.

Herman, J. L., & van der Kolk, B. A. (1987). Traumatic antecedents of borderline personality disorder. In B. A. van der Kolk (Ed.). Psychological trauma, (pp. 111-126). Washington, DC: American Psychiatric Press.

Hoare, J., & Povey, D. (2008). Violent and sexual crime. British Crime Survey 2006/07. London: Home Office.

Holmes, J. (2017). Attachment, Psychoanalysis, and the Search for a 21st-Century Psychotherapy Practice. Psychoanalytic Inquiry, Vol. 37(5), 309-318.

Holtzworth-Munroe, A., Stuart, G. L., & Hutchinson, G. (1997). Violent versus nonviolent husbands: Differences in attachment patterns, dependency, and jealousy. Journal of Family Psychology, 11(3), 314-331.

Home Office Statistical Bulletin, (2006/07). Homicides, Firearm Offences and Intimate Violence 2006/07. London: Home Office.

Home Office Statistical Bulletin, (2014/15). Homicides, Firearm Offences and Intimate Violence 2014/15. London: Home Office.

Johnson, S. M. (2004). The Practice of Emotionally Focused Couple Therapy: Creating Connection. New York: Routledge.

Klein, M. (1933). The early development of conscience in the child. In S. Lorand (Ed.), Psycho-Analysis Today, (pp. 149-162). New York: Covici-Friede.

LeDoux, J. E., Romanski, L. M., & Xagoraris, A. E. (1989). Indelibility of subcortical emotional memories. Journal of Cognitive Neuroscience, 1, 238-243.

LeDoux, J. (1994). Emotion, memory and the brain. Scientific American, 270, 32-39.

LeDoux, J. (1996). The emotional brain: the mysterious underpinnings of emotional life. New York: Touchstone.

Liotti, G. (1992). Disorganised/Disoriented Attachment in the Etiology of the Dissociative Disorders. Dissociation. 4, 196-204.

Liotti, G. (1999). Understanding the Dissociative Processes: The Contribution of Attachment Theory. Psychoanalytic Inquiry, 9(5), 757-783.

Lyons-Ruth, K. & Jacobvitz, D. (2008). Attachment disorganisation: unresolved loss, relational violence and lapses in behavioural and attentional strategies. In J. Cassidy & P. R. Shaver, (Eds.). Handbook of attachment: Theory, research and clinical applications (2nd ed.). (pp. 666-697). New York: Guilford Press.

Main, M., Kaplan, N., & Cassidy, J. (1985). Security in Infancy, Childhood, and Adulthood: a move to the level of representation. In I. Bretherton & E. Waters (Eds.), Growing points in attachment: theory and research, (pp. 66-104). Monographs of the Society for Research in Child Development. Chicago: University of Chicago Press.

Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs multiple (incoherent) models of attachment: findings and directions for future research. In C. M. Parkes, J. Stevenson-Hinde, & P. Marris, (Eds.). Attachment across the Life Cycle, (pp. 127-159). Hove: Routledge.

Meloy, J.R. (1992). Violent Attachments. London: Jason Aronson.

Mikulincer, M., Florian, V., Cowan, P. A., & Cowan, C. P. (2002). Attachment security in couple relationships: A systemic model and its implications for family dynamics. Family Process, 41(3), 405-434.

Mikulincer, M., Gallath, O., & Shaver, P. R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.

Mirrlees-Black, C. (1999). Domestic Violence: Findings from a new British Crime Survey self-completion questionnaire. London: Home Office.

Mitchell, S. A. (1993). Hope and Dread in Psycho-Analysis. New York: Basic Books.

Mitchell, S.A. (2000). Relationality: From Attachment to Intersubjectivity. Hillsdale, NJ: The Analytic Press.

Mohr, J. J. (2008) Same-Sex Romantic Attachment. In J. Cassidy, & P.R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications. (2nd ed., pp. 482-502). New York: Guilford Press.

Office for National Statistics (2016). Intimate personal violence and partner abuse. ONS Crime Statistics.

Pally, R. (2000). The Mind-Brain Relationship. London: Karnac Books.

Pally, R. (2005). A Neuroscience Perspective on Forms of Intersubjectivity in Infant Research and Adult Treatment. In Beebe, B., Knoblauch, S., Rustin, J., & Sorter, D. Forms of Intersubjectivity in Infant Research and Adult Treatment: A Systems View, (pp. 191-241). New York: Other Press.

Panksepp, J. (2001). The Long-Term Psychobiological Consequences of Infant Emotions: Prescriptions for the Twenty-First Century. Infant Mental Health Journal, 22, 132-173.

Perry, B. D., Pollard, R. A., Blakely, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain. How “states” become “traits”. Infant Mental Health Journal, 16, 271-291.

Povey, D. & Allen, J. (2003). Violent Crime in England and Wales. In J. Simmons & T. Dodd, (Eds.), Violent Crime in England and Wales 2002/2003, (pp. 75-90). London: Home Office.

Renn, P. (2003). The Link Between Childhood Trauma and Later Violent Offending: The Application of Attachment Theory in a Probation Setting. In F. Pfäfflin, & G. Adshead, (Eds.). A Matter of Security: The Application of Attachment Theory to Forensic Psychiatry and Psychotherapy, (pp. 109-144). London: Jessica Kingsley Publishers.

Renn, P. (2006). Attachment, trauma and violence: Understanding destructiveness from an attachment theory perspective. In C. Harding (Ed), Aggression and Destructiveness: Psychoanalytic Perspectives, (pp. 57-78). Hove: Routledge.

Renn, P. (2007). Stop Thief! But What Has Been Stolen and By Whom? Discussion of Paper by John Bowlby. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 1(1), 71-77.

Renn, P. (2008a). Attachment, Affect Regulation and Trauma: The Transmission of Patterns Across Generations. In E. Arnold & B. Hawkes (Eds.), Internalising The Historical Past: Issues for Separation and Moving On (pp. 24-33). Newcastle: Cambridge Scholars Press.

Renn, P. (2008b). The Relational Past as Lived in the Interpersonal Present: Using Attachment Theory to Understand Early Trauma and Later Troubled Relationships. In E. Arnold & B. Hawkes (Eds.), Internalising The Historical Past: Issues for Separation and Moving On (pp. 59-69). Newcastle: Cambridge Scholars Press.

Renn, P. (2010). Psychoanalysis, Attachment Theory and the Inner World: How Different Theories Understand the Concept of Mind and the Implications for Clinical Work. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 4 (2), 146-168.

Renn, P. (2012). The Silent Past and the Invisible Present: Memory, Trauma, and Representation in Psychotherapy. New York: Routledge.

Renn, P. (2017a). Relational Lacunae: Gaps in the Relational Literature and Clinical Practice? Commentary on Paper by Paul Wachtel. Psychoanalytic Dialogues, Vol. 27(5), 522-529.

Renn, P. (2017b). Prologue: Creative Attachments: Clinical Practice Through an Attachment Theory Lens. Psychoanalytic Inquiry, Vol. 37(5), 275-280.

Roberts, N., & Noller, P. (1998). The Associations between Adult Attachment and Couple Violence: the role of communication patterns and relationship satisfaction. In J. Simpson & S. Rholes, (Eds.), Attachment and Close Relationships, (pp. 331-350). New York: Guilford Press

Sandler, J. (1976). Countertransference and role-responsiveness. International Review of Psycho-Analysis, 3, 43-47.

Schacter, D. L. (1987). Implicit memory: history and current status. Journal of Experimental Psychology: Learning, Memory, and Cognition, 3, 501-518.

Schacter, D. L. (1996). Searching for Memory: The Brain, the Mind, and the Past. New York: Basic Books.

Schore, A. N. (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillsdale, NJ: Lawrence Earlbaum.

Schore, A. N. (2001). The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22, 201-269.

Schwartz, J. (2001). Commentary On David Black: Beyond The Death Drive Detour – How Can We Deepen Our Understanding Of Cruelty, Malice, Hatred, Envy And Violence? British Journal of Psychotherapy, 18(2), 199-204.

Shaver, P. R., & Mikulincer, M. (2004). What do self-report attachment measures assess? In W. S. Rholes & J. A. Simpson (Eds.), Adult Attachment: Theory, Research, and Clinical Implications. New York: The Guilford Press.

Siegel, A., Roeling, T. A. P., Gregg, T. R., & Kruk, M. R. (1999). Neuropharmacology of brain-stimulation-evoked aggression. Neuroscience and Biobehavioural Reviews, 23, 359-389.

Simpson, J. (1990). Influence of attachment styles on romantic relationships. Journal of Personality and Social Psychology, 59, 971-980.

Solomon, J., George, C., & De Jong, A. (1995). Children classified as controlling at age six: Evidence of disorganised representational strategies and aggression at home and at school. Development and Psychopathology, 7, 447-463.

Sroufe, L. A., & Waters, E. (1977). Attachment as an organisational construct. Child Development, 48, 1184-1199.

Stein, A. (2007). Prologue to Violence: Child Abuse, Dissociation, and Crime. New York: The Analytic Press.

van der Kolk, B. A. (1989). The Compulsion to Repeat the Trauma. Psychiatric Clinics of North America, 12(2), 389-411.

van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of post-traumatic stress. Harvard Review of Psychiatry, 1, 253-265.

van der Kolk, B. A., & Fisler, R. (1995). Dissociation and the Fragmentary Nature of Traumatic Memories: Overview and Exploratory Study. Journal of Traumatic Stress, 8(4), 505-521.

Wekerle, C., & Wolfe, D. (1999). Dating violence in mid-adolescence: Theory, significance, and emerging prevention initiatives. Clinical Psychological Review, 19, 435-456.

West, M., & George, C. (1999). Abuse and violence in intimate adult relationships: New perspectives from attachment theory. Journal of Attachment and Human Development, 1(2), 137-156.

Wilkinson, M. (2010). Changing Minds in Therapy: Emotion, Attachment, Trauma and Neurobiology. London: Norton.

Winnicott, D. W. (1974). Fear of Breakdown. International Journal of Psycho-Analysis, 1, 103-107.