After six years, Fulshear’s attachment model has evolved.  The executive clinical director, Kevin Randall,  LMFT vividly recalls the afternoon shortly after Nikki Garza, LCSW began as the Executive Director at Fulshear.  After meeting with a group of clients, he went to Nikki’s office to talk with her.  He had just met with six clients and asked them how many years of therapy they had prior to coming to Fulshear. The total number of years of therapy they had received was 64 years! What treatment did all of these women receive prior to Fulshear? The same kinds that are often offered wherever you go.  Not that this is bad — the methodologies are proven.  Yet, Fulshear was about to offer these women the same treatments that they had their whole lives.  Was Fulshear going to be just another stop in the continuous flow of lifelong therapy?  As Nikki and Kevin talked, they decided that they wanted to do something different than what was typically offered.  They began to brainstorm and then to research.  This was the beginning of what is now called the Integrated Attachment Model (I.A.M.).

I.A.M. model is developed to help understand behavior at its core through the lens of attachment.  Unmet relational needs to enhance internal distress and leads to symptomology, which in turn enhances the distress of the broader family or social system.  Distress can lead to a highly activated internal system, which leads to crisis level behaviors thus activating the family, or the distress can be turned inward and lead to an attempt to deactivate internal systems and distance from family or social supports.  Either way, the distress often moves towards unhealthy behavior, and when acted upon, reinforces an already negative worldview of self, others, and the world as a whole. 

Fulshear’s work with young adults has been to restore the power of individuals (seekers) to seek healthy connections.  In the model, this is done through eliminating secondary attachment strategies, restoring individual power to seek, and treating trauma.  At the same time, Fulshear’s team establishes a shift in the caregiver system that allows for attunement to the needs of the seeker. This often entails a shift in the experience of the caregiver to move towards understanding his or her daughter from a “best intentions/deepest needs” perspective and helping to learn to become available, responsive, and secure in ways that have not been done before. 

The evolution of this model has been exciting to experience.  One of the major shifts in the model was so major that it persuaded Fulshear to shift the name of the model from the Fulshear Adult Attachment Model to the current name, Integrated Attachment Model.  The change was when the realization occurred that Fulshear is not taking someone with a misaligned attachment pattern and creating security in attachment — secure attachment is created over thousands and thousands of experiences of a caregiver being available, responsive, and secure, and the person receiving that care in return starting before birth and throughout life. That is not something that be restored or created. 

Instead, Nikki and Kevin realized that Fulshear is able to assist in integrating important attachment elements and targets into the daily experience of a person and a family.  Through the therapy work and intentional relationships that are created, there begins to be a shift or awakening in the need for relationships and an awareness of doing something different on the part of the seeker.  The client is experiencing these connections daily and it creates an internal alignment.  Internal alignment is the knowledge of the importance of healthy, connected relationships.  Once internal alignment is experienced, the person may then begin to reach out in ways that have not been done successfully before.  It is a risk on their part as they demonstrate a high level of vulnerability with a risk of rejection.  But the work that has been done with caregivers leads to new experiences that establish alignment in relationships.  This leads to increased personal development of the self over time, and the cycle continues. 

At first, the cycle is very rough and not all elements work together well.  Over time, it becomes smoother and relationships become more manageable, emotional expression and vulnerability become more rewarding, and connection becomes joyful.  Sometimes, there is a pull towards old behaviors or breaks in the relationship.  This is to be expected, but when the breaks happen, continued repair leads them back to the new patterns of integrated attachment. 

The journey has been long and there is more to go.  It is an exciting thing to watch the lives of those Fulshear works with change as they experience the world, themselves and those that love them in a whole new way.  What started with a brief conversation in Nikki’s office has now helped in changing the lives of so many young women and their families.

About Fulshear Treatment to Transition

Fulshear Treatment to Transition, founded in 2003 and accredited by the Joint Commission, is located right outside of Houston in Needville, TX and Stafford, TX. Fulshear works with young women ages 18-24 struggling with mental health issues along with accompanying co-occurring disorders and is known for its development of the Fulshear Adult Attachment Model.