Background
Peter Cummings, LCSW is the originator of the Adult Attachment Repair Model (AARM), a comprehensive approach to treating complex trauma. As a Licensed Clinical Social Worker with more than 40 years as a mental health professional, Peter’s professional passion and his excitement is reflected in this later career contribution to the field in the form of the AARM.
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Peter has presented the AARM at international conferences and has been training therapists since 2005. Peter has devoted the last 15 of his 40 years of practice to a full-time practice experimenting exclusively with various neural modulating approaches. His efforts have culminated into a comprehensive model for emotional healing and even self-actualization.
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In recent times, the field of neuropsychology has exploded with new ideas and insights into how we think, feel and interact. To date, the most notable result in the major therapies has been to reinterpret what therapists were already doing successfully in the new terms of neurobiology. The new wisdom taken from neurobiology is to interact, sense, feel and then think in contrast to think, feel and interact. It is the mission of this training to demonstrate a method to implement this new approach.
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Real innovation based on newly discovered neurobiological findings has yet to occur in the form of a comprehensive therapeutic model. To paraphrase Professor Alan Schore, a leading researcher in the field of psychoneurobiology, “In spite of all of the supportive research, we still do not have a comprehensive right brain approach to therapy.“ The AARM responds to that challenge by turning all of the therapies based upon left brain approaches upside down or in this case from left to right brain-driven interactions within the treatment room.
Our approach began at an observational level within the clinical setting. Observation was then followed by the study of the latest neuropsychology research that placed a significant emphasis on the importance of including the right brain in the work.
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The AARM is grounded in the experience of right brain sensory exploration and only integrated later by left-brain conversation. Sensing, feeling, and then thinking became a grounding principle in better understanding the client’s felt life script on a day-to-day basis. Our mission is to demonstrate how this process works.
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Sensation of Discovery
The following excerpts come from Sensation of Discovery, a manuscript prepared by Peter Cummings, LCSW and Bill Latta, Ph.D. This manuscript covers the theories and treatment schemas of the Adult Attachment Repair Model (AARM).
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“Over the better part of two decades, as I have studied neurobiology and applied its principals, I have witnessed a natural healing phenomenon happening to my clients due to the automaticity of their responses that in retrospect, seemed magical. It was not until I discovered Dr. Stephen Porges’s findings, that for the first time, I found a scientific explanation for my clinical experiences.”
Overview of the Clinical Challenge
“Optimal attachment neurobiology is described as an ongoing parent-child interaction that includes the minimization of defensiveness and shame, while promoting risk taking and tolerance for emotional vulnerability and optimism. On the other hand, compromised attachment neurobiology is described as creating a rigid defensiveness and pessimism producing all of the common maladaptive behaviors and negative thought patterns: depression, drug abuse, anxiety, and behavioral compulsions.”
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“Attachment trauma is a disorder of ego state functioning. Ego states are charged with the regulation of emotional balance through the biological workings of the central nervous system. There is a constant adjustment between the balance of inhibition and excitation through ego state and nervous system mechanisms. These are the principle players to effect emotional balancing on an ongoing basis. Ego states play a key role in the way the nervous system operates to either maximize the shifting of energy in an efficient or an inefficient manner.”
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“An internal neural-architecture of covert personality disorders evolves as a result of interactive failures between the caregiver and child. Bowlby postulated in the 1970’s that it is important to address covert personality entities in therapy."
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“Trauma creates neural fragmentation through what is commonly accepted as separation of defenses within the constellation of ego states preventing ego accretion. Each ego state exists separately from the others. The result is accumulated emotional disappointments that delay developmental benchmarks. When a personal crisis hits, a separation and isolation of the ego state and/or traumatic event is reactivated, causing acute fearfulness and compromised emotional functioning.”
“Attachment trauma presents primarily as a fragmentation of ego states. A child’s security or insecurity is exhibited in the integration versus fragmentation of ego states. Traumatized ego states throw the delicate balancing act among ego states off by remaining emotionally stuck in time. They impose immature coping strategies that depend upon the degree of trauma accumulating from developmental disappointments. An ego state with the greatest negative valence has the most influence on the overall system. In general, the Child Ego State holds more trauma and greater negative valence making it the target of therapy.”
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“When trauma or developmental disappointments occur, an internal neural-architecture of personality disorders evolves as a result of interactive failures between the caregiver and child. Trauma creates neural fragmentation through an increased emphasis on neuroception (24/7 scanning of the environment for danger) at the expense of neocortex development. Fragmentation separates defenses into many partial ego states making it very difficult to achieve integration and/or to reassemble back into one adult ego state. This prevents the maturation of an adult ego state entity. Bowlby postulated in the 1970’s that it is important to address healthy and unhealthy formations of personality.”
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Repairing Attachment Deficits
“Missed developmental experiences are addressed within the AARM. It is this accommodation to incremental healing, through the cumulative windows of corrective somatic experience via the AARM that produce such a deep seated change in the involuntary nervous system like a reset of breathing, swallowing, tolerance of noise, etc. After amassing enough positive experience through these incremental windows of therapeutic connection, a physiological tipping point occurs shifting the body from fear to calm and resetting the body’s set point for anxiety. This organic realization becomes a primary neural pathway to accomplish lasting emotional modulation.”
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“By shifting my focus to the senses rather than continuing with traditional cognitive explorations, I embarked on a professional journey that engaged me in many unfamiliar disciplines requiring a consilience of approaches to create an orderly approach to healing. In my search for answers, the neurobiology of attachment became a gold mine of possibilities for tapping into the biological epicenter for emotional healing, the social attachment system. Neurobiology, an emerging science that is fast becoming the staple of information has grown in prominence over the past 20 years. It weaves together the biology of the nervous system and complementary information from other branches of science. The synthesis of these heretofore unrelated scientific discipline helps to explain how interactions in daily functioning affect the psychobiological connection in animals, ethology, and humans.”
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“The need for therapeutic passive vigilance on the parts of both client and therapist is for the sole purpose of being receptive to the inner dictates of the healing process. The therapist naturally achieves this state through daily practice. Once the therapist achieves this state of choiceless mindfulness as the lens through which the therapist sees, then through partnership an innate somatically driven healing process unfolds bringing all the right somatic experiences for emotional healing. This innate healing process then becomes threatened with being derailed by the unresolved emotional trauma lurking dormant in the system.”
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“The therapist as a compassionate witness encourages and guides the client’s natural processes with interventions to avoid system shutdown. As my clients and I focused on somatic processing, new concepts about the process of emotional healing emerged. This co-construction of the client’s sensory narrative occurs through trial and error and choiceless awareness to allow any and all particles to float by the viewing screen. This is the business of parenting brought to the treatment setting. The somatic union aids in building through integration a more robust and even at time self-actualized ego structure. The results seem to parallel and echo optimal development patterns.”
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“The challenge for the therapist is to co-create somatic experiences that teach the client how to regulate her emotions through her own somatic processes. This somatic processing occurs though assisting clients to become increasingly aware of the discrete windows of experience that make up a defined episode of somatic processing, referred to in the AARM as a therapeutic set. Successful neural modulation in this realm results in a shift from fear to confidence and has the capacity to amplify the effects even after therapy has ended.”
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AARM Definition
“The Adult Attachment Repair Model (AARM) simulates reparative childhood attachment experience, desensitizes distinct-event trauma, and creates deeply embedded feelings of security. The AARM is a neural modulating treatment strategy for emotional disorders favoring an innate healing process. This approach seems to repair flaws in the neuronal templates forming a complex architecture of the brain’s social engagement system. The AARModel proposes that the readjusting of an important set point created by counterbalancing instincts: The Flight/Fight/Freeze Instinct and the Attend and Befriend Instinct provides optimal emotional equilibrium. With the creation of complimentary inhibition and excitation of the nervous system, the physiological triggers are better harnessed as evidenced by more harmonious emotions, even when stressed.”
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“It is a comprehensive healing process that looks deceptively simple to the casual observer. The deceptiveness lies in the nuances of somatic processes that have to be decoded on a moment-to-moment basis. The therapist must consistently exercise emotional attunement as a somatic guide for the attachment deficient client. To do this, the therapist must develop an intimate knowledge of the natural healing process and anticipate its innate energetic ebb and flow.”
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“Neuro-modulating skills require the ability to interweave related theories that attempt to explain the brain’s processing capacities from a psycho-physiological level. There are three complimentary theories that propelled AARM development. They are: Attachment Theory (AT), The Poly Vagal Theory (PVT), and the Top down-Bottom up (B-up) Theory. The implementation of neuro-modulating skills has been interpolated from the three theories forming the structural framework on which the AARM method has been built.”
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“Dr. Bowlby hypothesized an imagined structure in the neural networks of the brain that he called an “Internal Working Model.” The Internal Working Model is comprised of neuronal templates from the caregiver- child’s interactive relationship developed through experience and over time. Bowlby (1969): ‘Attachment psychotherapy addresses dysfunctions of the ego. In repairing dysfunctional ego states, the internalization of an integrated, fluid, protective family of ego states must be established before an optimal family of ego states can be realized; a prerequisite for a healthy and happy life’.”
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“Social-relatedness is shaped by the manner in which ego states communicate with each other both internally and externally with other people. Ego states can be pictured on either end of a horizontal pole anchored at each extreme by how well or how poorly they relate to each other. Whether the ego states are permeable and interactive or they stay separate and fail to work together, both outcomes are a product of successful or unsuccessful bonding with the primary caregivers, respectively.”