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애착외상(attachment trauma)의 이해와 치료적 함의

Understanding and Therapeutic Implications of Attachment Trauma

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초록

본 연구는 복합외상 중 아동기에 부모 혹은 양육자와의 관계에서 발생하는 애착외상에 관심을 갖고 애착외상이 아동의 성격변화 및 성인기 정신건강에 미치는 영향 및 치료에 대해 검토하였다. 애착외상과 증상 간 단편적인 관계를 넘어서 증상형성과 사회부적응을 초래하게 되는 핵심적인 심리적 기제를 확인하였는데, ‘애착체계의 붕괴’, ‘정서관리의 실패’, ‘해리’, ‘자기체계의 손상’이었다. 또한, 애착외상의 치료접근들을 개관하여 각 치료법의 핵심적인 치료기제와 공통적인 치료과정을 살펴보았다. 핵심적인 치료기제는 ‘인지재구성’, ‘애착관계의 강화’, ‘정신화 능력의 강화’, ‘정서표현 및 조절’이었고, 공통된 치료과정은 안정, 외상 처리, 일상생활의 적용이었다. 애착외상 치료법 개관을 바탕으로 외상 처리, 재건, 성장 단계의 통합적 치료모형과 통합적 애착외상 치료 프로그램을 제안하였다. 이를 토대로 현재 애착외상을 경험하고 있는 아동들과 애착외상 경험자들의 치료개입과 적응에 대한 시사점을 논의하였다.

Abstract

This study focused on the attachment trauma which manifests in a relationship between parent and children in complex trauma and reviewed the effect of attachment trauma on personality change of children and adult’s mental health. We found key psychological mechanisms that cause symptom formation and social maladjustment beyond fragmentary relationship between attachment trauma and symptom. There were 'collapse of attachment system', 'failure of emotion management', 'dissociation', and 'impairment of self-system'. We also studied the most prominent therapeutic approaches for attachment trauma and identified the core therapeutic mechanism of each system and common therapeutic factors among the therapeutic approaches. The core therapeutic mechanisms we identified were 'psychological education for attachment trauma', 'building working alliance', 'cognitive reformation', 'expression and management of emotion', and the common therapeutic factors were 'restoration of mentalization' and 'reinforcement of attachment relationship'. Based on such findings, this study discussed implications of therapeutic interventions and adaptation for children who experience attachment trauma and its survivors.

참고문헌 (106)

  1. 김진화, "아동기 외상과 성인애착, 데이트 폭력의 관계", 모래놀이치료연구, 6(2), pp.67~87 (2010)
  2. 2012년 전국 아동학대 현황 보고서, "보건복지부", ~ (2013)
  3. 안무옥, "청소년의 외상경험, 정서조절, 대처방식 및 사회적 지지가 외상 후 스트레스 장애 증상에 미치는 영향", 석사, 심리학, pp.2008
  4. 안현의, "복합외상(complex trauma)의 개념과 경험적 근거", 한국심리학회지:일반, 26(1), pp.105~119 (2007), 한국심리학회
  5. 안현의, "자기체계의 손상으로 본 복합외상증후군", 한국심리학회지:일반, 28(2), pp.283~301 (2009), 한국심리학회
  6. 이양자, "외상후 성장에 대한 연구 개관 : 적응과의 관계 및 치료적 적용을 중심으로", 한국심리학회지: 건강, 13(1), pp.1~23 (2008), 한국건강심리학회
  7. 이유경, "여대생의 아동기 외상경험이 심리적 증상과 대인관계문제에 미치는 영향 : 애착의 매개효과를 중심으로", 석사, 심리학, pp.2006
  8. 이주성, "아동기 피학대 경험이 폭력행동에 미치는 영향 : 해리와 감정표현불능증의 매개효과 검증", 박사, 심리학, pp.2005
  9. 정나희, "아동기 외상경험이 신체증상에 미치는 영향 : 해리경험과 감정표현불능증의 매개효과", 석사, 심리학과, pp.2013
  10. 정희진, "여성의 복합외상경험이 자기역량의 변화와 우울에 미치는 영향", 석사, 심리학, pp.2008
  11. 최은영, "여대생의 아동 청소년기 대인간 외상 경험과 자기역량 손상의 관계에서 내면화된 수치심의 매개효과", 한국심리학회지:여성, 16(3), pp.285~302 (2011), 한국여성심리학회
  12. Adam, K. S., "Attachment organization and history of suicidal behavior in clinical adolescents", Journal of Consulting and Clinical Psychology, 64(2), pp.264~272 (1996)
  13. Allen, "트라우마의 치유" (2010), 학지사
  14. Allen, J. G., "Mentalizing in the development and treatment of attachment trauma" (2013), Karnac Books Ltd
  15. Allen, J. G., "Mentalizing in clinical practice" (2008), American Psychiatric Publishing
  16. Diagnostic and statistical manual of mental disorders, "American Psychiatric Association", American Psychiatric Association, ~ (1980)
  17. Diagnostic and statistical manual of mental disorders, "American Psychiatric Association", American Psychiatric Association, ~ (1994)
  18. Diagnostic and statistical manual of mental disorders, "American Psychiatric Association", American Psychiatric Association, ~ (2013)
  19. Antoni, M. H., "Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer", Health Psychology, 20(1), pp.20~32 (2001)
  20. Arvidson, J., "Treatment of Complex Trauma in Young Children : Developmental and Cultural Considerations in Application of the ARC Intervention Model", Journal of Child & Adolescent Trauma, 4(1), pp.34~51 (2011)
  21. Bateman, A. W., "The effectiveness of partial hospitalization in the treatment of borderline personality disorder : a randomized controlled trial", American Journal of Psychiatry, 156(10), pp.1563~1569 (1999)
  22. Bateman, A. W., "Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization : An 18-month follow-up", American Journal of Psychiatry, 158(1), pp.36~42 (2001)
  23. Bateman, A. W., "Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care", American Journal of Psychiatry, 160(1), pp.169~171 (2003)
  24. Bateman, A. W., "Psychotherapy for borderline personality disorder : Mentalization based treatment" (2004), Oxford University Press
  25. Bateman, A. W., "8-year follow-up of patients treated for borderline personality disorder : mentalization-based treatment versus treatment as usual", The American Journal of Psychiatry, 165(5), pp.631~638 (2008)
  26. Beeghly, M., "Child maltreatment, attachment, and the selfesteem: emergence of an internal state lexicon in toddlers at high social risk In Annual Process in child Psychiatry and Child Development", pp.1996, Brunner
  27. Bifulco, A., "Childhood experience of care and abuse(CECA) : A retrospective interview measure", Journal of Child Psychology and Psychiatry, 35(8), pp.1419~1435 (1994)
  28. Bifulco, A., "Problem partners and parenting : Exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder", Attachment and Human Development, 11(1), pp.69~85 (2009)
  29. Brent, B., "Mentalization-based psychodynamic psychotherapy for psychosis", Journal of Clinical Psychology, 65(8), pp.803~814 (2009)
  30. Briere, J. N., "Immediate and long-term impacts of child sexual abuse", Sexual Abuse of Children, 4(2), pp.54~69 (1994)
  31. Briere, J., "Sexual abuse histories and sequelae in female psychiatric emergency room patients", American Journal of Psychiatry, 146(12), pp.1602~1606 (1989)
  32. Briere, J. & Rickards, S., "Self-awareness, affect regulation, and relatedness differential sequels of childhood versus adult victimization experiences", The journal of Nervous and mental Disease, 195(6), pp.497~503 (2007)
  33. Browne, A. B. & Finkelhor, D. F., "Impact of child sexual abuse : a review of the research", Psychological Bulletin, 99(1), pp.66~77 (1986)
  34. Brown, R, J., "Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder", American Journal of Psychiatry, 162(5), pp.899~905 (2005)
  35. Bryer, J. B., "Childhood sexual and physical abuse as factors in adult psychiatric illness", American Journal of Psychiatry, 144(11), pp.1426~1430 (1987)
  36. CATS Consortimy, "Implementing CBT for traumatized children and adolescents after September 11 : lessons learned from the child and adolescent trauma treatments and services project", Journal of Clinical Child and Adolescent Psychology, 36(4), pp.581~592 (2007)
  37. Cloitre, M., "Skills training in affective and interpersonal regulation followed by exposure : A phase-based treatment for PTSD related to childhood abuse", Journal of Consulting and Clinical Psychology, 70(5), pp.1067~1074 (2002)
  38. Cloitre, M., "Beyond PTSD : Emotion-regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse", Behavior Therapy, 36(2), pp.119~124 (2005)
  39. Cohen, J. A., "Trauma-focused CBT for youth with complex trauma", Child Abuse & Neglect, 36(6), pp.528~541 (2012)
  40. Cook A., "Complex trauma in children and adolescents", Psychiatric Annals, 35(5), pp.390~398 (2005)
  41. Courtois, C. A., "Complex trauma, complex reactions: Assessment and treatment", Psychotherapy: Theory, Research, Practice, Training, 41(4), pp.412~425 (2004)
  42. Courtois, C. A., "Complex trauma, complex reactions : assessment and treatment", Psychological trauma: Theory, Research, Practice, and Policy, S(1), pp.86~100 (2008)
  43. Elliott, R., "Contemporary brief experiential psychotherapy", Clinical Psychology : Science and Practice, 8(1), pp.38~50 (2001)
  44. English, D., "The extent and consequences of child maltreatment", The Future of Children, 8(1), pp.39~53 (1998)
  45. Foa, E. B., "Effective treatments for PTSD: practice guidelines from the international society for traumatic stress studies" (2000), Guilford
  46. Fonagy, R., "a child’s understanding of others", Bulletin of the Anna Freud Centre, 12, pp.91~115 (1989)
  47. Fonagy, P., "Mechanisms of change in mentalization-based treatment of BPD", Journal of Clinical Psychology, 62(4), pp.411~430 (2006)
  48. Fonagy, P., "The relation of attachment status, psychiatric classification, and response to psychotherapy", Journal of Consulting and Clinical Psychology, 64, pp.22~31 (1996)
  49. Fonagy, P., "Attachment and reflective function : their role in self-organization", Development and Psychopathology, 9, pp.679~700 (1997)
  50. Fonagy, P., "The mentalization-focused approach to self pathology", Journal of personality disorders, 20(6), pp.544~576 (2006)
  51. Fonagy, P., "Attachment and borderline personality disorder : A theory and some evidence", Psychiatric Clinics of North America, 23, pp.103~122 (2000)
  52. Ford, J. D., "진단명 : 외상후스트레스장애" (2009), 시그마프레스
  53. Ford, J. D., "Treatment of Complex Posttraumatic Self-Dysregulation", Journal of Traumatic Stress, 18(5), pp.437~447 (2005)
  54. Ford, J. D., "Trauma-Focused, Present-Centered, Emotional Self-Regulation Approach to integrated Treatment for Posttraumatic Stress and Addiction : Trauma Adaptive Recovery Group Education and Therapy", American Journal of Psychotherapy, 60(4), pp.335~355 (2006)
  55. Fosha, D., "Quantum transformation in trauma and treatment : Traversing the crisis of healing change", Journal of Clinical Psychology, 62, pp.569~583 (2006)
  56. Frisman, L., "Outcomes of Trauma Treatment Using the TARGET Model", Journal of Groups in Addiction & Recovery, 3, pp.285~303 (2008)
  57. Gleiser, K., "Contrasting Exposure and Experiential Therapies for Complex Posttraumatic Stress Disorder", Psychotherapy Theory, Research, Practice, 45(3), pp.340~360 (2008)
  58. Gobin, R. L., "Betrayal and revictimization : preliminary findings", Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), pp.242~257 (2009)
  59. Ghosh, Ippen, C., "Traumatic and stressful events in early childhood : Can treatment help those at highest risk?", Child Abuse and Neglect, 35, pp.504~513 (2011)
  60. Grienenberger, J., "Maternal reflective functioning, mother-infancy affective communication, and infant attachment : exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment", Attachment and Human Development, 7, pp.299~311 (2005)
  61. Hankin, B. L., "Childhood maltreatment and psychopathology : prospective tests of attachment, cognitive vulnerability, and stress as mediating processes", Cognitive Therapy and Research, 29(6), pp.645~671 (2005)
  62. Herman, J. L., "Complex PTSD : A syndrome in survivors of prolonged and repeated trauma", Journal of Traumatic Stress, 5, pp.377~391 (1992)
  63. Hildyard, K. L., "Child neglect : developmental issues and outcomes", Child Abuse & Neglect, 26, pp.679~695 (2002)
  64. Hornstein, N. L., "Clinical phenomenology of child and adolescent dissociative disorders", Journal of the American Academy of Child and Adolescent Psychiatry, 31, pp.1077~1085 (1992)
  65. Jackson, C., "Cognitive behavioral therapy In Treating complex traumatic stress disorders : An evidence-based guide" (2009), Guilford
  66. Kilpatrick, D. G., "A special section on complex trauma and a few thoughts about the need for more rigorous research on treatment efficacy, effectiveness, and safey", Journal of Traumatic Stress, 18(5), pp.379~384 (2005)
  67. Kinniburgh, K., "Attachment, self-regulation & competency : A comprehensive intervention framework for children with complex trauma", Psychiatric Annals, 35, pp.424~430 (2005)
  68. Kissane, D. W., "Cognitive‐existential group psychotherapy for women with primary breast cancer: A randomised controlled trial", Psycho-Oncology, 12(6), pp.532~546 (2003)
  69. Kluft, R. P., "Discussion : A specialist’s perspective on multiple personality disorder", Psychoanalytic Inquiry, 12, pp.139~171 (1992)
  70. Koos, O., "A contingency-based approach to the etiology of"disorganized"attachment : the"flickering switch"hypothesis", Bulletin of the Menninger Clinic, 65, pp.397~410 (2001)
  71. Lawson D. M., "Complex Trauma in Children and Adolescents : Evidence-Based Practice in Clinical Settings", Journal of clinical psycho0lgy, 69(5), pp.497~509 (2013)
  72. Lieberman, A. F., "Toward evidence-based treatment : Child-Parent Psychotherapy with preschoolers exposed to marital violence", Journal of the American Academy of Child and Adolescent Psychiatry, 44, pp.1241~1248 (2005)
  73. Lieberman, A. F., "Child-Parent Psychotherapy : 6-month follow-up of a randomized controlled trial", Journal of the American Academy of Child and Adolescent Psychiatry, 45, pp.913~918 (2006)
  74. Linley, P. A. & Joseph, S., "Positive change following trauma and adversity : A review", Journal of Traumatic Stress, 17, pp.11~21 (2004)
  75. Liotti, G., "Disorganized", disoriented attachment in the etiology of the dissociative disorders, 1992, pp.5(4), 196~204
  76. Lyons-Ruth, K., "From infant attachment disorganization to adult dissociation : relational adaptations or traumatic experiences?", Psychiatric Clinics of Norht America, 29(1), pp.1~18 (2006)
  77. Lyons-Ruth, k., "Expanding the concept of unresolved mental states : hostile", helpless states of mind on the adult attachment interview are associated with disrupted mother-infant communication and infant disorganization, 2005, pp.17(1), 1~23
  78. Macfie, J., "The development of dissociation in maltreated preschool-aged children", Development and Psychopathology, 13, pp.233~254 (2001)
  79. Main, M., "Predictability of attachment behavior and representational processes at 1,6, and 19 years of age In Attachment from infancy to adulthood: the major longitudinal studies", pp.245~304 (2005), The Guilford Press
  80. Maughan, A, "Impact of child maltreatment and interadult violence on children’s emotion regulation abilities and socioemotional adjustment", Child Development, 73(5), pp.1525~1542 (2002)
  81. McLewin, L. A., "Attachment and social support in the prediction of psychopathology among young adults with and without a history of physical maltreatment", Child Abuse & Neglect, 30, pp.171~191 (2006)
  82. Morris, A. S., "The role of the family context in the development of emotion regulation", Social Development, 16(2), pp.361~388 (2007)
  83. Muller, R. T., "Social support and the relationship between family and community violence exposure and psychopathology among high risk adolescents", Child Abuse & Neglect, 24(4), pp.449~464 (2000)
  84. Muller, R. T., "Childhood psysical abuse, attachment, style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse", Journal of Traumatic Stress, 13(2), pp.321~332 (2008)
  85. Muller, R. T., "Attachment as a mediator between childhood maltreatment and adult symptomatology", Journal of Family violence, 27, pp.243~255 (2012)
  86. Ogawa, J. Sroufe, L. A., "Development and the fragmented self : a longitudinal study of dissociative symptomatology in a non-clinical sample", Development and Psychopathology, 4, pp.855~879 (1997)
  87. Pearlman, L. A., "Trauma and the self : a theoretical and clinical perspective", Journal of Emotional Abuse, 1(1), pp.7~25 (1998)
  88. Paivio, S. C., "Efficacy of Emotion Focused Therapy for Adult Survivors of Child Abuse : A Preliminary Study", Journal of Traumatic Stress, 14(1), pp.115~133 (2001)
  89. Paivio, S. C., "Affective change processes in therapy for PTSD stemming from child physical abuse", Journal of Psychotherapy Integration, 8, pp.211~229 (1998)
  90. Putnam, F. W., "Hypnotizability and dissociativity in sexually abused girls", Child Abuse & neglect, 19, pp.645~655 (1995)
  91. Pelcovitz, D., "Development of a criteria set and a structured interview for disorders of extreme stress(SIDES)", Journal of Traumatic Stress, 10, pp.3~17 (1997)
  92. Resick, P., "A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic PTSD in female rape victims", Journal of Consulting and Clinical Psychology, 15, pp.321~330 (2002)
  93. Resick, P. A., "Cognitive processing therapy for sexual assault victims", Journal of Consulting and Clinical Psychology, 60, pp.748~756 (1992)
  94. Roche, D., "Adult attachment : a mediator between child sexual abuse and later psychological adjustment", Journal of Interpersonal Violence, 14(2), pp.184~207 (1999)
  95. Rossouw, T. I., "Mentalization-Based Treatment for Self-Harm in Adolescents: A Randomized Controlled Trial", Journal of the American Academy of Child & Adolescent Psychiatry, 51(12), pp.1304~1313 (2012)
  96. Shipman, K. L., "managing emotion in a maltreating context : A pilot study examining child neglect", Child Abuse & Neglect, 29, pp.1015~1029 (2005)
  97. Shipman, K. L., "Emotional understanding : a comparison of physically maltreating and nonmaltreating mother-child dyads", Journal of clinical child psychology, 28, pp.407~417 (1999)
  98. Slade, A., "Parental reflective functioning : An introduction", Attachment and Human Development, 7, pp.640~657 (2005)
  99. Solomon, J., "The measurement of attachment security and related constructs in infancy and early childhood In Handbook of Attachment : Theory, Research, and Clinical Applications", pp.383~416 (2008), The Guilford Press
  100. Tedeschi, R. G., "The foundation of posttraumatic growth", Psychological Inquiry, 15, pp.93~102 (2004)
  101. Twaite, J. A., "Childhood sexual and physical abuse and adult and adult vulnerability to PTSD : the mediating effects of attachment and dissociation", Journal of Child Sexual Abuse, 13(1), pp.17~38 (2004)
  102. Van der Kolk, B. A., "Developmental trauma disorder : towards a rational diagnosis for chronically traumatized children", Psychiatric Annals, 35(5), pp.401~408 (2005)
  103. Van der Kolk, B., "Editorial comments : complex developmental trauma", Journal of Traumatic Stress, 18, pp.385~388 (2005)
  104. Van Dijke, A., "Association of childhood-trauma-by-primary caregiver and affect dsyregulation with borderline personality disorder symptoms in adulthood", Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), pp.217~224 (2013)
  105. Waldinger, R. J., "Mapping the road from childhood trauma to adult somatization : the role of attachment", Psychosomatic Medicine, 68(1), pp.129~135 (2006)
  106. Weinberg E., "Mentalization, Affect Regulation, and Development of the Self", Journal of the American Psychoanalytic Association, 54, pp.251~270 (2006)

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