When people are in distress, seeking out the support and comfort of others can be a natural response.
But for clients who’ve experienced trauma, this response can sometimes signal something more. Their persistent attempts to elicit help from others may indicate that they’re stuck in the attach/cry-for-help response.
So how can we better recognize this defensive adaptation to trauma?
In the infographic below – which is based on the work of Janina Fisher, PhD and Pat Ogden, PhD – we lay out four behavioral patterns that can help you identify an attach/cry-for-help response.
Click the image to enlarge
The attach/cry-for-help response is one of the earliest survival strategies a child develops to elicit help from a caregiver – but it can also be a defensive adaptation to trauma. According to some experts, it’s the least understood of all defense responses and can be difficult to detect. Based on the work of Janina Fisher, PhD and Pat Ogden, PhD, here are four behavioral patterns that can help you identify the attach/cry-for-help response in your clients.
1. Excessive Contact Outside of a Session
Your client may frequently call or text you outside of a session. They may also be reluctant to leave at the end of a session, or complain that there is too much time between sessions.
2. Tumultuous Personal Relationships
The attach/cry-for-help response can be overwhelming in your client’s relationships. Your client may report their partner pulling away when they reach out, or say that their friends think they are too needy.
3. Prominence of a Childlike Part
Your client may use a childlike voice or even physically make themselves appear smaller. In some cases, this may be related to structural dissociation.
4. Idealization of the Therapist
It’s important for any client to feel safe in the therapeutic relationship. But when a client is experiencing the attach/cry-for-help response, they may begin to see you as infallible. This can lead to a fight response to disappointments. For example, if you have to reschedule a session, they might respond with anger.
(If you’re sharing this infographic, please attribute it to NICABM. We put a lot of work into creating these resources for you. And if you’re sharing this digitally, please link back to this page in your attribution. Thanks!)
If you’d like to print a copy, you can use one of these links:
To learn more about how you can work with the attach/cry-for-help response (as well as other emerging defense responses to trauma) check out the Advanced Master Program on the Treatment of Trauma.
You’ll hear from some of the masters in the field of trauma, including Bessel van der Kolk, MD; Janina Fisher, PhD; Peter Levine, PhD; Pat Ogden, PhD; Ruth Lanius, MD, PhD; Thema Bryant, PhD; and more.
Now we’d like to hear from you. Do you have clients who are stuck in the attach/cry-for-help response? What strategies have you found to be effective when working with this defensive adaptation.
The text above describes the Advanced Master Program on the Treatment of Trauma then says “It’s free to watch – just sign up here.” The link is to a $600 program. So what is free to watch? The introductory video advertising the program? If anyone can clarify that would be great. Thanks!
The infographic is very helpful, unless used by a therapist who isn’t sensitive to the needs of their patient and uses these “red flags” as more labels, for THEIR sloppy business practices: last minute cancellations/no shows, checking their phone during appointments, and condescending us vs. them approach, etc.
The trauma may be caused by “tumultuous relationships” & the reason for seeking counseling & therapy— patient doesn’t need another label that their “behaviors” are the cause of them. Inducing self-doubt is likely part of the trauma.
I’ve seen it from both sides and it would be so great if balance was applied or more clinicians actually put into practice the same careful depth of understanding as the panel.
Thank you for providing the information.
I’m prompted by comments below left by people who’ve seen the infographic and recognized behavioural patterns as similar to what they do/have engaged in. This is my plea: PLEASE, you are not only the above patterns. They are of course difficult to live with, but they can absolutely, with the right therapist, who’s had or is having specific training and supervison, get shifted in a substantial way. I’d like to offer this: Think of these patterns of behaviour as the unconscious’s way of communicating what your needs were in childhood, and they’re makeing sure that in adulthood, you get the chance to disentangle these needs from the rest of who you are so that your wisdom and beauty and courage can shine little by little until these patterns become manageable instead of ruling your life. This is how our nervous system will respond to protect us ….. it’s biology…. it’s not what you have made of yourself. We are ALL contradictions, we all have ‘blind spots’, and as a dear friend of mine once said: we ALL fuck up Fantastically in life, and are capable of acts of profound true selfless love. Thank you for being so brave in sharing your experiences here. I hope you gain a lot from these lectures. Sincerely.
Thank you for sharing your thoughts — you’ve helped me to feel less ashamed of my tendency towards the behaviour described in the infographic, and I’m grateful.
help me I was with a beautiful girl with complex PTSD it was a rollercoaster of ups and downs in emotions for both of us I was very supportive and cautious to touch her if I didn’t forget but I quickly apologized after an sometimes she would lash out at me an say things that really hurt me but I would never hurt a girl ever and she is claiming domestic battery on me an I need to understand why.
If you touched her without asking for consent, it’s good that you realized it and apologized. However, if your friend has CPTSD, you must remember to get consent before touching her. It sounds like you’ve “forgotten” multiple times. She will never learn to trust you if you keep forgetting. Touch is always op-in for anyone, never opt-out. Always ask before you touch. Touch without consent is battery
This programme has been great this time around. Thankyou so much. I identify as a wounded healer and have done all 4 of these, I still feel thrilled when I am ready to complete my own therapy session as opposed to me being pushed reluctantly out the door and i love that my therapist is not perfect, most of the time tee hee. I have experienced these behaviours from others and realised I have them or had them once upon a time. Healing allows freedom from shame, the muddiest aspect of (CSA) Child Sexual Assault and other traumas.
I feel ashamed of my neediness. I did have 12 different caretakers from around age 5 to age 16. I always fear loss of attachment. Every job I obsessed over “getting fired.” Whenever I get attached to a therapist I worry about getting dumped because I’m too needy. Yes I did ask out my graduate student therapist (I’m 80 now so I don’t ask anyone out) I hope you don’t feel terribly ashamed. It’s a wonderful thing to want attachment with another human being. I think if you take the free training it may very well help. I found the last free training on dissociation very helpful. I think we must realize that these behaviors can be annoying or distressing to other people. Another person or therapist can help us understand they DO care by communicating that they understand our distress but are not responsible for removing it by acting perfectly. Terry Real (Google him) has some very good workshops on this topic and a terrific book, US. It really reduces my anxiety to know that my therapist appreciates my distress and feels sorry for it but can’t always magically (there’s that hero worship) reduce it. Distress is diminishing as I feel more understood and more attached.
3. Prominence of a childlike part – fascinating.
Have experienced this at times when counselling students between ages 6-18. I thought of it as regressed behaviour.I was advised to continue as if all was normal but never actually had an answer to why this happens. Looking back they were from families in trauma/conflict/ separation/divorce . Your explanation makes perfect sense.
Thank you.
I appreciate the effort you put into this resource. Thank you.
Ruth and your team, You are just the best. What a contribution you are making to the healing of many and the better craft of many healers!! Bravo! Thank you! Martha B
As a patient I am very familiar with the attach/cry-for-help response. I didn’t know this was an official response style and I was (and am) very ashamed of it. In therapy I tend to idealise and worship my therapists, I feel very needy and actually hope to be rescued by them. Yes, I behave like a child (big eyes, very sweet) but it’s all very subtle. I am very much aware as well as ashamed of this attachment response, so I do my utmost to hide it from my therapists and I’d rather die than admit to it. I think it’s important for therapists to realise that the attach/cry-for-help response is not always as easy to detect as this infographic may lead you to believe precisely because of the shame that is often linked to it.
I would second everything said above. There is massive, all-encompassing shame accompanying this response. We have been brushed off by others in our lives as excessively “needy,” to the point of learning to hide it well. Then it all lands in the therapist’s lap.
This trauma response can not be thoroughly addressed without full awareness of the abject mortification we feel as patients.
When I first read NICABM’s description of attach/cry a year ago, I was shocked that my “style” was “a thing” and was named. This led to realization of the deep shame I carry and where it comes from. Suddenly so much became clear. Knowledge is power. Thank you, NICABM.
The. Shame. Cannot. Be. Overstated. Being trapped in this response is torture. As overwhelming as the original trauma imho.
Thanks for your comment. I also felt torture because I felt no one understood how I felt. I had therapists say (in a patronizing way) “Tell your little girl not to feel anxious.” Therapist was “only” gone for 2 weeks after we started exploring memories of severe verbal abuse. It’s so reassuring to know that such “neediness” may very well be natural reactions to trauma. I recently loved watching a cat video with a very hypersensitive cat who seemed to startle easily and react very quickly. It was set to the background of a Michael Jackson song, and the cat’s movements were perfectly set to the song. And when Michael gave a little scream, the cat also opened his mouth and gave a quick meow. At one point the owner scratched his head, and the cat (black) rolled his eyes in ecstasy. Just doing things or wanting to do things in my cat nature, I guess. Anyway, it made me laugh and feel less ashamed.