Disorganized Attachment: A Compass for Navigating the Confusing Behavior of the “Difficult-to-Treat” Patient

The concept of disorganized attachment gives a framework with which to understand patients who present a confusing pattern of relatedness. The therapist may experience feeling connected with the patient only to see a sudden retreat, expressed by silence, argumentativeness, or missed sessions. After presenting a theoretical summary of disorganized attachment, I give two clinical examples. The first illustrates the theoretical material that is presented and gives the reader an idea of what a disorganized attachment pattern looks like in the clinical setting, while the second briefly shows how use of this framework increased my comfort level.