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A clinical case of somatoform disorder illustrates the process of a type of psychotherapy informed by attachment theory and research that pays heed to motivational systems that differ from attachment, and to the dynamic tensions between attachment and other motivational systems. The multimotivational theory that underpins case formulation and psychotherapy interventions is based, congruently with Bowlby’s attachment theory, on evolutionary thinking and is summarized in the first section of the article. As a necessary premise to understanding the clinical case, the second section of the article briefly outlines current knowledge on infant attachment disorganization and its developmental sequelae, considered from the perspective of the evolutionary multimotivational theory. [ABSTRACT FROM AUTHOR]

A taxonomy of basic motivational systems (reptilian, mammalian, and neo-mammalian), that emerged in phases during the course of millions of years, is proposed. These different phases did not replace each other, but became reorganized in the brain at different hierarchical levels. It is argued that (a) humans are an ultracooperative species and (b) high degrees of cooperation put strong selective pressures toward the development of sophisticated forms of intersubjective communication. These two developments had cascading effects on human evolution, creating both the conditions upon which humans were able to understand intentions, gestures, emotions, and, ultimately, the minds of others, and the emergence of language and symbolic forms of cultural evolution. Possible evolutionary steps that led to this ultracooperative survival strategy and some of their genetic mechanism, with special emphasis on a multilevel model of selection, are described, and the implications for psychotherapy and psychoanalysis are explored. [ABSTRACT FROM PUBLISHER]

In this comment to Paolo Stramba-Badiale’s description of his clinical case, I argue that the therapist’s acknowledgment of feelings of powerlessness both in self and in the patient, without surrendering to them and without untimely attempting to overcome them, is a major factor of therapeutic change in the treatment of dissociative adults who had been chronically traumatized since early childhood. Consideration of the dynamic tension between the motivational system engaged in coping with environmental threats (freezing-fight-flight-feigned death) and the care-seeking (attachment) system provides the background for the argument, together with the knowledge of the controlling interpersonal strategies that typically follow, during childhood, infant attachment trauma. [ABSTRACT FROM PUBLISHER]