The Paradox of Attachment in Therapy: When Care Awakens Old Wounds
Navigating Attachment, Repair, and Relational Complexity in Psychedelic Therapy
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Offering a secure attachment figure is one of the most meaningful solutions1 we can provide our clients. In trauma work—especially developmental and complex trauma— it’s not just helpful, it’s foundational. A secure relational presence creates the scaffolding that allows traumatic material to surface, be metabolized, and reorganize. It gives shape to the transferential field2, provides a container for the emergence of bad objects3, and offers the raw material for good objects4 to form and be internalized. It’s often through these relational correctives that prediction errors occur, the small disruptions that help a client begin to experience themselves and the world outside the old, inherited templates.
But this very asset, the secure attachment figure who can change the trajectory of treatment, is also the place where so many trauma-affected individuals have been most deeply hurt. For clients with early relational wounding, the attachment figure was both the essential source of care and the primary source of threat, shame, confusion, or violation. When the “bad” far outweighs the “good,” the system adapts: protective defenses tighten, mistrust becomes a survival strategy, while the smallest memories of safety get preserved like artifacts, waiting to be touched into when the nightmare subsides. This dynamic creates a painful paradox: the wound amplifies the urgency for relational solution, yet that same wound can make receiving solution feel almost impossible.
In clinical practice, this paradox isn’t abstract. It shapes the trajectory of treatment, how close we can come, when distance is needed, how much direction a client can tolerate, and what forms of contact their system can actually use. Meeting core attachment and developmental needs is not just a matter of offering support, it’s a matter of finding the right form, pace, and entry point for each individual system.
A recent PSIP5 session with a client I’ll call Jacob brought this paradox into sharp focus. Jacob and I have done extensive work together, and over time I’ve learned the contours of his system - its strengths, its compensatory structures, and the relational templates that quietly guide his responses. These inform how I meet him clinically, especially during medicine sessions. The session I describe here took place during a solution-oriented ketamine session with 100 mg of oral ketamine. Jacob is highly functional, well-resourced in daily life, and deeply stable in many ways. Yet beneath that stability lies a longstanding, tightly held identity of shame and disgust that traces back to his earliest experiences, in his words, “it was like this even in the womb.”
Rather than recount the session minute by minute, I want to focus on the moments that became central to how his attachment and developmental needs were met.
Disengaging the Ongoing Nightmare
Entering the session, I was aware of a recurring relational tension that had taken shape in past sessions. My physical proximity had consistently landed inconsistently - at times soothing, at times overwhelming, and at times oddly muted. Distance, on the other hand, often left him without enough relational pressure for any corrective experience to take hold. While it was clear that closeness reliably disrupted the process, it was not yet clear what, specifically, was being activated beneath it.
Drawing from patterns observed over prior sessions—some interventions helpful, others resisted—I decided to test a modification of contact rather than withdraw it altogether. I offered physical contact with my back turned to him, deliberately removing my gaze from the relational field. The intention was not to target shame explicitly, but to clarify whether the disruption arose from intimacy itself or from the implicit threat of being seen. With my lower back pressed against the side of his right leg, I could maintain a steady, protective presence without placing him under the weight of my eyes.
What followed shifted the entire session. The moment my gaze was removed, something in his system settled. Only then did the extent of what had been operating in the background become apparent. The implicit shame that had been activated by my eyes, by my attention, by the possibility of being perceived, softened as soon as visibility was no longer required. He could register my presence and stability without the threat embedded in being seen. In that opening, something long buried began to separate - the recognition that the shame he carried so fiercely was never his to begin with. It belonged to the caregiver who had offloaded it onto him before he had any ability to refuse it.
The grief that followed was immense: grief for the shame he inherited, and grief for how long he had believed it was his identity rather than something imposed.
Maintaining the Solution
As we continued, Jacob moved through waves of pain, clarity, and anger; anger at the caregiver who had deposited so much disgust onto him, and anger at the lifelong impact of carrying it. While I gave space for these emotions to unfold, I could feel that we were entering a narrow corridor where their system was open to a different possibility: that he is not the problem.
This is where the paradox of attachment becomes especially delicate. Jacob’s defenses were built to protect against the very relational presence that was now allowing something new to form. I knew how quickly his system could revert to the inherited narrative if we veered even slightly in the wrong direction.
As the anger widened, Jacob expanded into a broader critique of whiteness and collective harm, with the disgust in his voice carrying the same contempt his caregivers had deposited into him. What became salient in that moment was not the meaning of the critique, but its function. Because he is white, moving into a collective identity frame risked collapsing him back into the bad object, pulling him into an identity position that carried the very inherited badness we were in the process of disentangling.
In moments like this, identity-level narratives can serve a protective role, especially when the system approaches something both relieving and destabilizing. Following that expansion could have undermined the emerging recognition by reassigning badness at the level of racial identity rather than allowing it to reorganize within the relational field where it had first been installed. For this reason, I redirected him to our connection to protect the emerging recognition that the badness wasn’t his, maintaining the boundary long enough for it to take hold. Whatever content might have unfolded if we followed that thread was far less important than protecting the corrective that was forming.
Expanding the Solution
As the emotional waves settled, Jacob’s system entered a floaty, expansive state - classic state 46 dissociation, but with a depth and spaciousness I hadn’t seen in him for some time. With the earlier relational correction still intact, he was able to drop into this dissociation without losing the solution we’d built.
I offered another layer of support: “I’m going to push every bit of badness out of your space and keep all of it far, far away from you. I’ll make sure not even a drop of it gets anywhere near you while I’m here.”
This landed immediately. His system expanded further, as if the dissociative space itself became safer and more navigable as I expanded and maintained their boundary for him. In the previous session, Jacob had experienced his mother’s womb as toxic, a world he couldn’t escape or differentiate from. The intervention of turning my back in this session had already begun separating him from that “bad womb.”7 Now, as he moved into dissociation, that differentiation deepened.
Here, dissociation was not merely a retreat from the unresolvable threat embedded in the traumatic memory itself. It became a state in which reorganizing processes could unfold, held within a relational container that countered the earliest relational imprint carried by that memory.
The Aftermath
Since this session, Jacob has described a new internal stability that feels entirely bottom-up - involuntary and originating from Primary Consciousness8. Much of this, I believe, emerged because ketamine temporarily disrupts the sophisticated strategies he uses to maintain daily stability. The medicine destabilized his usual protections just long enough for us to introduce a different type of relational solution. Freed from his top-down resourcing, his system could take in and internalize this new bottom-up support.
This session illuminated the same paradox I began with: the relational presence that is most essential for healing is also the place where the deepest injury resides. The work is learning how to meet that paradox—not bypass it, not force it, not medicate it—but actually work within it.
For clinicians, this invites ongoing questions:
How do we know when our presence is protective versus activating?
When does the system need more boundary, and when does it need us to step in more directly?
When is direction necessary for something new to form, and when does direction disrupt what’s trying to emerge?
There are no formulas for this. Only the relational field, the nervous system in front of us, and our willingness to keep listening even when the path forward isn’t obvious.
What I continue to return to is this: there is always a way. Always a way to reopen possibility, even in systems shaped by profound contradiction. Our task is to find that way with each client—slowly, precisely, sometimes imperfectly—inside the paradox itself. And when the system finds even a moment where the conditions align, something fundamental reorganizes. Not because we forced it, or the client pushed through, but because the relational conditions finally supported what their psyche had been waiting to do all along.
Thumbnail image credit: bro_yoon
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1 Solution: The necessary condition for the nervous system to engage the self-organizing healing response. Within the therapeutic container, some form of secure attachment is often the solution.
2 Transferential Field: The dynamic space in therapy where a client unconsciously projects feelings, expectations, and relational patterns from past relationships onto the therapist, and the therapist’s responses shape how these projections are experienced and processed.
3 Bad Object: A mental representation of a caregiver who is inconsistent, threatening, or harmful, internalized during early development, shaping defensive patterns, shame, and mistrust in relationships.
4 Good Object: A mental representation of a reliable, nurturing caregiver internalized during early development, which provides a template for emotional security and healthy relational functioning.
5 Psychedelic Somatic Interactional Psychotherapy (PSIP)
6 State 4: A dissociative state that arises when survival defenses are exhausted and no escape, fight, or safety is possible, leaving the system profoundly disconnected from their body and affect.
7 Bad Womb: A pre-verbal, pre-conscious experience of the prenatal environment as threatening, constrictive, or toxic.
8 Primary Consciousness (Robin Carhart-Harris): A fundamental, immediate mode of awareness involving raw sensory and emotional experiences, without reflective thought or conceptual processing.
