Addiction is an attachment disorder.  Human beings, addicts or not, only know and repeat what was modeled for them during childhood.  I like to call ages 0-10 healthy narcissism given that the world, as it should, revolves around the child.  If the child is not fed, he/she will be hungry; if the child is not given shelter, he/she goes without shelter; and if the child’s diaper is not changed, he/she will be wet.  Moreover, if, for example, the child’s parents divorce, who is at fault in the child’s mind?  Obviously, given that the world revolves around the child, the child believes he or she is to blame.  ‘If I just would have cleaned my plate’, ‘If I would have been a better boy…’, ‘If I just would have kept my room clean.’  These types of messages form the messages or models for future behavior of the child.    

 Part I of this article provided a definition and basic framework for Attachment Theory. Attachment theory provides that most individuals did not grow up with a model for secure attachment; thus, treatment for addiction requires providing a model of secure attachment so that individuals can practice healthy behavior in response to pain and discomfort other than acting out in addictive behavior.    

Theoretically, Mary Ainsworth PhD (1969) defined secure attachment as developing when a caretaker shows awareness of a child’s emotions and quickly attends to the child when distressed.  The child’s perception is that the caretaker is consistent in presence and provision; thus, the child feels safe in exploring their world because of their sense of certainty that their caretakers will be there for them in a nurturing manner if needed.  Overall, attachment theory assumes that the experiences of childhood relationships shape adult attachment style; thus, for example, the reason why adults who were physically abused as children have a high propensity for abusing their children.  This is the behavior that was modeled and typically the only mode that the adult has for responding to anger. 

The Scientific Link Between Attachment and Addiction: 

Attachment theory posits that an infant learns necessary skills for survival and the development of an Internal Working Model (IWM) whereby the definition of how the person views the world, themselves, and others is defined.  “Attachment representations show predictive associations with a wide range of pathological behavior including personality disorder(s), mood disturbance, [substance dependence] and psychopathology” (Caspers, Yucuis, Troutman, & Spinks, 2006).  Therefore, the authors conclude that childhood attachment styles (secure or insecure) have a direct impact on the prevalence of Substance Abuse Disorders.    

Researchers Kendler and Prescott (2006) reviewed the findings of the Virginia Twin Study of Adolescent Behavioral Development (VTS) for the purpose of exploring the depth of influence between genetics and environment as it relates to addictiveness and mental health disorders.  VTS had a sample size of 2,762 white twins between the age of 8-16 years old and their families.  Kendler and Prescott concluded that there are no genes specifically responsible for Substance Use Disorder, but rather, there are genes that an individual can inherit that predispose them to patterns of behavior closely associated with Substance Use Disorder.  Additionally, the authors concluded that if children are brought up in “protective environments”, even though genetically they are predisposed to patterns associated with Substance Abuse Disorder, the environment has a likely potential to be a protective factor against Substance Abuse Disorder.  

The Brain: 

Finally, researchers have directly correlated neurobiology of the human brain and the importance of caregiver attachment relationships during childhood to mental health in adulthood (Miehls, 2011, p. 82).  Additionally, the research has indicated that insecure attachments during childhood affects, negatively, the development of certain areas of the brain.  Moreover, Miehls states “relationships have the capacity to rebuild certain parts of the brain that influence our social and emotional lives,”) (Miehls, p. 81).   

 The benefit of the connection between neurobiology and attachment is that brain neuroplasticity (the ability of the brain to be re-formed) allows for a corrective experience or secure attachment model during adulthood leading to positive changes in the patient; thus, lessening the need to utilize addictive behavior to deal with abandonment, trauma, abuse, and emotional pain etc.  Moreover, the implication for treating substance dependence indicates the importance of a secure attachment relationship between the clinician and the patient to provide a baseline model or definition.   

Addiction as an Attachment Disorder 

The attachment system of a person is developed as a child in proportion to the relationship between the child and the caregiver; thus, if the attachment process is deficient, the child will have issues related to emotional regulation.  Therefore, as an adult, the person is likely to utilize drugs and other substances to regulate emotions as a means of adapting to an inability to regulate emotions learned as a child (Kohut 1977).   

Drugs create an ability for a person to have the illusion of self-esteem, self-confidence, worthiness and “increase feelings of being alive” (Kohut 1977).  An addict attempts to define comfort and security (missing in their vocabulary) through the use of addictive substances or behavior; however, outside sources other than secure modeling will lead to continued dysfunctional definitions and continued addictiveness.   

Treating Addictiveness and Substance Dependence through Attachment Theory:  

Recent studies have positively confirmed that a direct link exists between insecure attachment and substance dependence (Schindler, Thomasius, Sack, Gemeinhardt, 2007; Schindler, Thomasius, Sack, Gemeinhardt & Eckeert, 2005).    

“Attachment Oriented Therapy” (AOT) has been described as “a way of eliciting, integrating and modifying styles represented within a person’s internal working model” Flores (2004) p. 214).  Flores (2001, 2004) goes on to explain that the IWM must be changed or addiction will continue or substitution of one addiction for another will persist.  The key point is that when an individual begins to learn (which requires a model) how to self-soothe, thus, learning how to regulate emotions and feelings, they will avoid seeking outside sources as a means of managing these emotions (Blaine & Julius, 1977; Flores, 2001; Flores, 2004).  

The vast majority of individuals in treatment today have been exposed, multiple times, to the treatment experience; Therefore, what is missing?  Why the extreme difficulty in remaining sober?  Haven’t they been taught well?  Has the education system (the treatment industry) failed them?  The answer is not black and white, but rather, exists within the statement:  We must begin to treat patient’s differently.  The idea that we are able to teach patient’s how to stay sober doesn’t equate to their ability to apply what they have learned or feel safe enough to explore the deeper problem of why they continue to utilize addictive behavior to escape emotional pain. 

AOT is rooted in providing a “secure base” for an individual so that they may begin to explore themselves from the inside out.  Attachment theory correctly posits that by providing a model in treatment of a safe, secure base, the patient will have the ability to cease seeking answers outside themselves (drugs, alcohol, sex, food etc.) and begin to heal from the inside out.  Moreover, by providing this safety, patient’s have the ability to express and feel emotions in a vulnerable and authentic capacity; thus, the willingness to address the problem, rather than the solution (the addictive behavior).    

“A Different Way to Treat People”  

Conclusion 

Overall, what is missing in treatment today is the understanding and compassion of being relational with patients.  The irony in this statement is that AA promotes compassion and being relational with individuals; however, this is the part that most traditional treatment misses. Alternatively, traditional treatment provides an education as opposed to modeling behavior that provides the ability to develop secure attachment needed for change.   

Unfortunately, most addicts (probably most human beings in general) have not had a model for secure attachments, thus, leading to substance abuse and addictive behavior as a means of avoiding emotional pain. For treatment and thereafter, AA and therapy to be effective, the following suggestions are necessary: 

1. Treatment must be focused on modeling secure attachment.  This requires risk on the part of the treatment provider and a demonstration of self-disclosure and identification from the treatment team as opposed to a one-up position of authority; 
2. Development of trust and alliance with the patient is critical if the patient is going to address and change learned abusive and dysfunctional patterns during childhood; thus, leading to the need to utilize addictive behavior as a means of avoiding emotional pain; 
3. Continuation of care is critical.  Thirty days in treatment merely scratches the surface.  Without a long-term aftercare plan, i.e., Partial Hospitalization, Intensive Outpatient and therapy, that focuses on abuse, attachment, and secure attachments, we can expect relapse rates after inpatient treatment to remain near 5-7% within one year of inpatient treatment; and 
4. “A different way to treat people” must become the norm as opposed to the exception in treatment. 

 

By Dr. Jocelyn Markowicz, PhD, Psychologist

Attachment Hope for Couples: How to Improve Your Security Odds

You walk into the room and lock eyes with the most gorgeous human being you have ever seen. This individual locks eyes with you as well. You begin talking and realize that the chemistry between you is intense. You plan a date. You have several great dates. You fall in love and begin to talk about spending the rest of your lives together. You have the wedding. You go on the honeymoon. You begin to live your day-to-day lives together. (Perhaps not quite in that order.) But then, as you settle into shared lives, you notice that something is changing. The arguments are more frequent. The emotions are not all positive. Why does your partner leave when there is conflict? Why does your partner walk away when you need soothing? Why are they sometimes exhaustingly clingy and other times too independent? John Bowlby and Mary Ainsworth offered an answer rooted in attachment styles to these questions. Several researchers after them offered solutions. I’d like to share them with you. 

The Evolution of a Relationship

It is important to acknowledge that it takes time for interpersonal patterns to emerge within a romantic relationship. A perception bias occurs when you first fall in love that naturally heightens your connection to your partner’s strengths and limits your awareness of their weaknesses. Thus, it is in day-to-day living that you develop more accurate perceptions of patterns that are problematic. 

Why You Relate the Way You Do

In the 1960s, John Bowlby asserted that we learn positive and negative ways of relating based on our parent-child experiences. Our ways of relating are designed to strengthen our bond with our attachment figures (parents/caregivers) growing up. They help us survive. An attachment behavioral system gradually emerges wherein we attempt to regulate our emotions and behaviors toward an attachment figure. To do this, Bowlby (1980) asserted that the attachment system essentially asks the following fundamental question: Is the attachment figure nearby, accessible, and attentive? According to Bowlby (1980), an individual who has experienced a secure attachment is likely to view attachment figures as available, responsive, and helpful. An insecurely attached individual would view attachment figures as inaccessible, untrustworthy, and unreliable.

Different Attachment Styles

Ainsworth expanded on Bowlby’s attachment behavioral system and introduced specific attachment styles that explain our attachment behaviors. She outlined three specific attachment styles: (1) secure attachment and two insecure attachment styles: (1) anxious-resistant, and (2) avoidant (Ainsworth, 1979). In adult romantic relationships, the insecurely attached adult who is anxious-resistant would be dependent on their partner and yet reject their soothing attempts. The insecurely attached adult who is avoidant would not seek emotional or physical comfort from their partner when experiencing emotional distress. 

Bowlby and Ainsworth helped us to understand that our way of relating to others is guided by our early attachment experiences, but do we indeed exhibit the same attachment behaviors in our adult romantic relationships?

Further Research into Attachment Styles 

Hazen and Shaver (1987) evaluated Bowlby’s theoretical premise that early attachment behaviors extend to adulthood and are relatively stable. They conducted research and found that adults also reported the three attachment categories that Ainsworth determined (secure, anxious-resistant, and avoidant). Their research identified that romantic relationships are attachment bonds and share similar attachment behaviors that characterize parent-child interactions. In essence, Bowlby and Ainsworth were right to suggest that we can look at our adult relationships and evaluate our partner’s attachment behaviors based on their childhood attachment experiences. 

Are People Stuck Forever in Patterns from Childhood? 

What happens if you partner with someone with an insecure attachment style? Can their attachment style become secure? 

Researchers had the same questions about whether or not early attachment behaviors could be changed in adulthood. Findings across several studies did indicate that while early attachment style is relatively stable (Kim, Baek, & Park, 2021), attachment behaviors can change (Tmej, AMA et al., 2020; Sims, 2000; Rimane, Steil, Renneberg, & Rosner’s, 2020; Overall, Simpson, & Struthers, 2013; Gazder & Stranton, 2010; Park, Johnson, MacDonald, & Impett, 2019). Therein lies the hope for the couple. So, back to the question, what happens if you partner with an insecurely attached individual? How can you increase your secure attachment odds in your relationship?

Distress in romantic relationships is the leading cause for adults to seek psychological services (Bradbury, 1998). There are specific interventions that increase attachment security or reduce the negative impact of insecure attachment behaviors in romantic relationships. The following interventions are supported by empirical examination.

Transference-Focused Therapy

Transference-focused therapy (TFT) is a therapeutic intervention that aims to reduce impulsivity, stabilize mood, and improve interpersonal and occupational functioning. The intervention is specifically designed for individuals who struggle with borderline personality disorder. Trauma can impact the internalized representations of personality. It is not uncommon for individuals to develop maladaptive personality traits in response to trauma. Trauma impacts attachment bonds. TFT is a great choice for an individual partner in a couple dyad who may also struggle with borderline personality. A recent study found that individuals who participated in TFT moved towards securely attached with some preoccupied behaviors away from insecurely attached with preoccupied behaviors (Tmej, AMA et al., 2020)

Emotionally Focused Therapy

Emotionally focused therapy (EFT) for couples focuses on reshaping distressed couples’ structured, repetitive interactions and the emotional responses that evoke partners and foster the development of a secure emotional bond (Jonson, 1996; Jonson, 1999). The EFT model assumes that the negative emotions and interactional cycles typical of distressed couples represent a struggle for secure attachment (Bowlby, 1969). Sims (2000) randomized 26 couples in which at least one partner had been rated as insecurely attached to EFT or a waitlist control group. Couples in the EFT treatment condition increased their attachment security (and decreased attachment-related avoidance) more than the control couples. 

Trauma-Focused Cognitive Processing Therapy

Trauma-focused cognitive processing therapy (CPT) focuses on changing the dysfunctional beliefs associated with trauma. Trauma during our early attachment years impacts our attachment functioning, thereby shaping how we related to others in romantic relationships. CPT offers hope for couples in that an insecurely attached partner, who has been the victim of trauma, can participate in this mode of treatment to improve functioning. In Rimane, Steil, Renneberg, and Rosner’s (2020) study, individuals who participated in CPT experienced reduced avoidance attachment (insecure) behaviors when assessed post-treatment.

Dyadic Regulation Processes

Dyadic regulation processing occurs in couples therapy and is designed to improve attachment-relevant dyadic interactions between them. Applying the Dyadic Regulation Processing Model, researchers evaluated how partners can buffer the impact of their partner’s anxious resistant or avoidant behaviors due to their insecure attachments. Overall, Simpson and Struthers (2013) videotaped romantic couples discussing relationship problems identified by one partner who wanted changes in the other partner. Results indicated that insecurely attached partners whose partners displayed more softening exhibited less anger and withdrawal, and their discussions were more successful. These partners buffered their insecurely attached partner’s responses by learning to be sensitive to their autonomy needs, validating their viewpoint, and acknowledging their constructive efforts and good qualities.

Partner Relationship Mindfulness

General mindfulness is defined as the awareness of what is happening in the moment. In their study, Gazder and Stranton (2010) defined relationship mindfulness (RM) as open or receptive attention to and awareness of what is taking place internally and externally in a current relationship. They found that an individual’s own daily relationship mindfulness did not buffer the effects of their own insecure attachment on same-day relationship behaviors, but their partner’s daily relationship mindfulness did. In essence, you can buffer the impact of your partner’s insecure attachment behaviors by increasing your own relationship mindfulness. Therapy is a great place to learn how to practice relationship mindfulness techniques.

Partner with Someone with a Secure Attachment Style

As outlined, various treatment interventions can move an individual and couple towards more secure attachment relating. At this point, you may be thinking that hope is only achieved within a therapeutic setting. I have good news for you. If you are a securely attached individual, you play an important role in your relationship with an insecurely attached partner. Experiencing secure behaviors within romantic relationships can reduce representations of insecure attachment style (Park, Johnson, MacDonald, & Impett, 2019). How romantic! Your secure attachment behaviors can provide a secure base for your insecurely attached partner to grow. In the context of your relationship, you and your partner will experience many life events together. In their most recent study, Fraley, Gillath, and Deboek (2020) found that life events could change attachment style presentations in adulthood, with some changes yielding an enduring pattern.  

What Lies within Our Power?

We cannot go back to our childhood and choose caregivers that would prevent us from developing an insecure attachment style. We, therefore, cannot prevent the impact of any dysfunctional early childhood attachment experiences on who we are, interpersonally, as adults. However, there is hope. We can increase our secure attachment odds by choosing partners who are securely attached. We can participate in couples therapy interventions. We can also offer a secure attachment base for our insecurely attached partner. Attachment styles do not equate to fixed potential in your relationship – there is always room for growth. 

If you’re ready to explore how therapy can help you and your relationship, click through to find a couples therapist near you.

References

Ainsworth, M. D. S. (1979). Attachment as related to mother-infant interaction. In Advances in the study of behavior (Vol. 9, pp. 1-51). Academic Press.

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

Bowlby, J. (1980). Loss: Sadness & depression. Attachment and Loss (vol. 3); (International psycho-analytical library no.109). London: Hogarth Press.

Bradbury, T. N. (1998). The developmental course of marital dysfunction. New York: Cambridge University Press.

Gazder, T. & Stanton, S. C.E (2020). Partners’ Relationship Mindfulness Promotes Better Daily Relationship Behaviors for Insecurely Attached Individuals. Int J Environ Res Public Health. 5;17(19):7267.

Hazen, C., & Shaver, P.R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.

Johnson, S. (1996). The practice of emotionally focused marital therapy: Creating connection. New York. Brunner/Mazel.

Johnson, S. (1999). Emotionally focused couples therapy: Straight to the heart. 

In J. Donovan (Ed.), Short term couple therapy (pp. 14-42). New York Guilford Press.

Fraley, R.C., Gillath, O. & Deboeck,P.R.(2020, August13).Do Life Events Lead to Changes in Adult Attachment Styles? A Naturalistic Longitudinal Investigation. Journal of Personality and Social Psychology. 

Kim, S.‐H., Baek, M., & Park, S. (2021). Association of parent–child experiences with insecure attachment in adulthood: A systematic review and meta‐analysis. Journal of Family Theory & Review.

Overall, N.C., & Simpson J. A.( 2013) Regulation processes in close relationships. In: Simpson JA, Campbell L, editors. The Oxford handbook of close relationships. New York: Oxford University Press; 2013. pp. 427–451.

Park, Y., Johnson, M. D., MacDonald, G., & Impett, E. A. (2019). Perceiving gratitude from a romantic partner predicts decreases in attachment anxiety. Developmental Psychology, 55(12), 2692–2700.

Rimane, E., Steil, R., Renneberg, B. & Rosner, R. (2020). Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. European Child and Adolescent Psychiatry.

Sims A. Unpublished doctoral dissertation. University of Ottawa; Canada: 2000. Working models of attachment: The impact of emotionally focused marital therapy.

Tmej, A., Fischer-Kern, M., Doering, S., Hörz-Sagstetter, S., Rentrop, M., & Buchheim, A. (2021). Borderline patients before and after one year of transference-focused psychotherapy (TFP): A detailed analysis of change of attachment representations. Psychoanalytic Psychology, 38(1), 12–21.

Editor’s note: Early attachment trauma can also occur due to non-abusive circumstances, such as when a child is separated from their primary caregivers due to medical concerns. However, this article focuses primarily on attachment trauma caused by neglect and abuse.

Early attachment trauma is a distressing or harmful experience that affects a child’s ability to form healthy interpersonal relationships. It includes abuse, abandonment, and neglect of an infant or child prior to age two or three. These traumas can have subtle yet long-lasting effects on a person’s emotional health.

Understanding Infant Memory

As adults, or even children, we cannot recall narrative memory from our lives as infants. For most, the concept of memory is thought of as the ability to recall events, usually in the form of cognitions and images. In general, people cannot recall any events prior to ages three or four. Because of this, there is a pervasive and inaccurate view that infants do not recall any experiences, including traumatic experiences.

In fact, the human brain has multiple ways to recall experience. Think about it. Infants, at some point, obviously learn to walk and talk. Everything that occurs in our human experience is stored in our memory. However, not everything is stored narratively or explicitly. We have motor, vestibular, and emotional memory as well.

All incoming sensory information creates neuronal patterns which are “imprinted” in our brains. These neuronal patterns are a form of memory. We create memory “templates,” or stored patterns, the majority of which are non-cognitive and preverbal. These templates will influence us for the rest of our lives.

When Attachment Trauma Occurs

Unfortunately, when attachment interruptions (such as abandonment) occur in infancy, abnormal associations may be created. Physiological state memories, motor vestibular memories, and emotional memories are stored, and they can be triggered in later life. These triggers can manifest as mistrust or fear of interpersonal attachment.

Since the original template for how relationships work was formed in early childhood, all future relationships can be corrupted. The person may find themselves struggling with difficulties in relationships, particularly with respect to trust, bonding, and intimacy—the core elements of healthy attachment. Part of the problem may be the person having absolutely no cognitive awareness of the source of their fears or that they were betrayed in infancy. This can make treatment efforts difficult.

The brain is designed to change in response to experience, and all experience has an impact on the brain. With respect to traumatic experiences, the impact is on the parts of the brain involved with stress and fear. These would be the parts of the brain known as the limbic system (e.g., amygdala), neuroendocrine system (pituitary-adrenal axis), and the cortical systems; all of which can be altered in traumatized children.

The Inner Working Model

How a person relates to the self and others as an adult involves their “inner working model,” which consists of:

• How they see themselves (Am I worthy? Am I loved?)
• How they see others (Are they available? Are they responsive?)
• How they see the world (Is it safe? Is it fair?)

This inner working model has developed since birth and involves how relationships worked in the person’s life. Was the person attuned to and connected with? Or were they left to fend for themselves, crying themselves to sleep each day? The experiences people had with their parents and other important relationships shaped their developing inner working models.

As people progress through life, their working models can become further developed and influenced by each new experience. Remember, the brain is elastic (neuroplasticity), and neural connections can be “rewired” through experiencing all of life’s different influences.

That being said, the relationship templates people seem to draw upon the most are those created in early life. The job of psychotherapy, using the knowledge of neuroplasticity, is to create adaptive working model templates in place of maladaptive ones.

Barriers to Treatment

The problem with early attachment injuries is that while implicit memory is affected, there is no explicit or narrative memory to recall.

This can create the following constraints in therapy:

• There is no image from memory to draw upon.
• There is no language associated with the psychological injury.
• There is no cognition associated with the early attachment trauma.
• There is no awareness of the injury.
• There is no body sensation associated with the hurt.
• There is no recognition of a hurt to repair or release.

Instead, therapist and client must “work with the gaps.” Veracity need not be challenged in the process. The goal will be to process implicit memory. This is good to know, but how does one, exactly, process implicit memory?

Working with the Adult with Attachment Trauma

The psychological injuries could involve both the self as well as one’s interpersonal relationships. Perhaps victims of early attachment disruption have an “internal attachment disorder,” mirroring the emotional injuries experienced in early childhood. Perhaps victims of this type of neglect have learned to alienate from both self and others as an essential survival strategy.

A key to recovery is learning to identify the person’s various parts of self. In order to heal the “hurt inner infant,” one has to be cognizant of the fact that there are various “parts” to one’s psyche, and each needs recognition.

It is helpful to realize that unresolved internal attachment issues can surface as otherwise normal life stressors that evoke the fears and feelings of one’s disowned, abandoned inner parts. You can help your client heal by teaching them to embrace the parts of self that were unconsciously “disowned,” even as these parts are causing havoc in their current life. This process involves befriending the parts of self by listening internally and paying attention to the likes, dislikes, fears, fantasies, and habits of each one.

Healing the “Inner Infant”

This involves imagery: visualization and learning to see within. Part of the process involves learning to embrace one’s inner infant by holding it close and nurturing the part of self that is vulnerable and lacking in trust. Healing will come as the person learns how to meet their inner unmet needs from infancy. Judgment has no helpful role in this process; instead, self-compassion and acceptance are key to recovery.

The Role of Others

In addition to working with oneself, healing broken inner working models and relationship templates requires developing and nurturing healthy relationships with others. This can be done by being in relationships with people who already have a secure attachment style. It can also be accomplished through therapy and with the help of support groups.

References:

1. Fisher, J. (n.d.) Healing Early Attachment Injuries by Listening to Our Trauma: Using Sensorimotor Psychotherapy to Speak with Shameful Inner Parts. Retrieved from: https://www.psychotherapynetworker.org/blog/details/695/healing-early-attachment-injuries-by-listening-to-our
2. Garza, N. (n.d.) Learning to See Differently: Why the Adult Attachment Model Succeeds When Others Fail. Retrieved from: https://www.fulsheartransition.com/our-program/treatment/adult-attachment-model
3. Paulsen, S.L. (2017). When there Are No Words: Repairing Early Trauma and Neglect from the Attachment Period with EMDR Therapy. Bainbridge Island, WA: Bainbridge Institute for Integrative Psychology.
4. Perry, B. (2014). Helping Traumatized Children A Brief Overview for Caregivers. Published by: The Child Trauma Academy. Retrieved from: https://childtrauma.org/wp-content/uploads/2014/01/Helping_Traumatized_Children_Caregivers_Perry1.pdf
5. Pietromonaco, P.R. & Barrett, L.F.(2000). The Internal Working Models Concept: What Do We Really Know About the Self in Relation to Others? Review of General Psychology Copyright 2000 by the Educational Publishing Foundation 2000, Vol. 4, No. 2, 155-175.

Life does not always turn out the way we’d like. We carry our stories. In some moments, we might feel like kings. In others, we feel like failures. We feel grotesque. For some, the story says, “I’m too much.” For others, it might say, “I will never be enough.” In certain states, every line of the story reminds us we are defective, unsafe, lacking power to choose our life. Some stories empower and open up the world before us. Others isolate us, from people or from goals that seem unattainable.

Some stories confirm themselves. Despite our best intentions, some might appear to play out again and again as our behaviors sabotage our desires or elicit the reactions we fear most. It might seem as if we’re doomed to repeat the play forever.

 Meaning-Making and Automating Our Reactions

“The real connection we long for is the connection with ourselves; the connection with where we are here and now…When the connection with our own presence is broken everything just starts to feel empty.” —Jeff Foster

We carry stories. These stories are about our identity in the world, our connection to others, our purpose, what we are allowed, what they are permitted, our motives, and their intentions. These stories are the underlying codes that dictate the most mundane of choices. These choices might include what we eat, how we present our bodies when in public, or how we react to a romantic partner’s facial expression. These stories, created in response to experience, shape our predictions of every interaction between Self, Other, and World. While only occasionally accurate, they become the automatic, unquestioned backdrop of life. [fat_widget_right]

Subconsciously, we keep watch at an animal level. We track bodily reactions and micro-expressions of others, internalizing these as reflections of our identity in the world and creating rules around the best ways to navigate social interactions. At every emotionally charged moment, we are either building new stories or confirming old ones, and confirmation is easier.

We adapt, invisibly—especially in childhood as our templates are being set—to the surrounding culture and climate. We take it in and recreate it internally. And often in that process we separate from parts of Self. We reject or contain parts that threaten our survival in those settings, opting instead to present or create parts that harmonize with our environment.

This is the original trauma: disconnection from Self.

And in those overwhelmed, transformative moments, we forget our choices. We forget the parts we’ve exiled. We land in other parts of consciousness, and we often fail to recognize that our experience has changed because our relationships have changed. We don’t remember any other way of being. We simply go on, saying, “This is who I am.”

This is a dissociation, a disconnection. It’s also a new story, now running in the background, invisibly directing our play.

The parts of Self we contain remain present at some level. Unchanged, hidden within, they insinuate themselves into our daily choices. They are present in the ways we respond to emotion, our confusion, our unwanted thoughts or behaviors, our nameless depressions or anxieties, our reactive tantrums or withdrawals in romantic relationships.

These are the lower layers of experience. They’re the real agents behind our choices and behaviors.

When it comes to trauma, we cannot change the past. There is no do-over. Our storyteller simply weaves our experience into our narrative.

But while we can’t change the past, we can change its meaning. We can change the stories. And if we have patience and intention, if we bring the secret stories up to awareness, we can change our connection to Self, Other, and World.

Parts Framework

A parts framework simply echoes what we know from neurological studies: the brain is constantly making sense, forming a story, building a cohesive picture out of scattered and unrelated fragments. It finds patterns and creates the illusion of a cohesive whole.

In mindful exploration, we come to recognize that we are both the judge and the judged. We experience both simultaneously in our bodies. With practice, we can actually land fully in either position. We might be the abandoned or oppressed child one moment and then flip to become the part that hates that child or some part that feels love and empathy for the child.

By separating our experience into parts, we can observe the relationship between parts. We can recognize and mediate internal conflicts. We can step in and out of states, accessing them for the purpose of learning about them and finding empathy for them.

This is the work.

In these tiny moments of genuine empathy for the parts of Self that have survived trauma, we integrate. We acknowledge, accept, embrace, and join. In these moments, we are feeling what could not be felt in the past. We are seeing it through new eyes and gifting it a new story. This new story, something more palatable, releases us from the need for internal containment. We are providing some hurting parts with the love they need, the relational connection that should have happened after a traumatic moment.

The framework itself invites curiosity, decreases judgment and conflict, and opens up windows of access through which we can provide this missing experience. The end result is a felt sense of gentle witness. We feel seen, heard, felt, known, accepted, and loved.

Regulation First: External, then Internal—Other, Then Self.

“A friend is one to whom one may pour out the contents of one’s heart, chaff and grain together, knowing that gentle hands will take and sift it, keep what is worth keeping, and with a breath of kindness, blow the rest away.” —George Eliot

At a subconscious level, we track surroundings and social connections for physical and interpersonal threats. Doing with others utilizes our sympathetic nervous system. Being with someone is healing. Accessing our parasympathetic branch allows us to rest and digest, both physically and metaphorically.

External regulation occurs when we can witness the body of someone else in close proximity, remaining externally present to our experience without physical overwhelm on their part. When their body calms, smiles warmly, looks back at us with soft eyes, and remains connected to ours, our body calms. This is co-regulation. This is where we feel free and welcome to express ourselves with the knowledge that an Other is not burdened by us, wants us, will see the best of our intentions and “get” us. This is also an antidote to shame, an invitation to reveal those parts we thought we had to hide in exile.

Someone else can provide the regulation, by remaining calm and offering verbal assurance, validation, and permission, for example. But once we have internalized this experience at some point in life (whether with another person or even through watching movies), we can also provide our own calming as an internal process.

Many of us default to dissociation, controlling, fixing, placating, distracting, or other methods of internal management. These are often reactions internalized from early life caregivers. But our bodies naturally calm when internal parts are finally met in the ways they have yearned to be met.

Mindfulness and Distancing: States, Transitions, and Cycles

As trauma is stored in parts or states, with particular networks formed during traumatic periods, the way to heal is to head toward and access those states. By doing so, we bring new energy and kinder eyes. We amend an old story that was written with limited perspective. Each state comes with its own state-dependent memories, perceptions, expectations, rules of engagement, emotions, physical posture, and beliefs. Meeting each as a part—as a different version of you with its own persona—requires development of an observer. In other words, a part that is outside and separate that can provide empathy and support.

With practice, many people find state-shifting becomes easier. Quick shifts might require nothing more than remembering a friend’s smile or imagining a favorite place in nature. Longer-term shifts come when actually bringing novel experience, or missing experience, to some part of self that is expecting and preparing for negative outcomes.

Life becomes a bit easier when we recognize we are not our thoughts, not our sensations, and not our emotions. We can do this through mindful awareness, or by observing mind and bodily reactions. These will all play out on their own, and we can observe them safely, from a chosen distance. When we start to actually feel our own physical responses to each internal/external stimuli, when we give each response a name, we remove the mystery from these micro-transactions. Things may then become a bit more predictable, a bit more understandable, a bit more acceptable. We recognize that we’re okay, that things are as they are and nothing more. We recognize a story that makes sense, coming from a source we trust, and our body calms.

When it comes to trauma, we cannot change the past. There is no do-over. Our storyteller simply weaves our experience into our narrative. But while we can’t change the past, we can change its meaning. We can change the stories.

This in itself is a missing experience.

For many of us, there was nobody in childhood just sitting with us, looking at us with soft eyes, saying, “This is what you’re feeling in your body… It’s okay to feel this. It makes sense. Everyone feels this. This is a word we use to describe it… This is what you can expect… It will pass. You will be okay. I’m here with you. I’m not going anywhere, and I’m not burdened at all by your experience. Let’s just sit and feel it together.”

In working mindfully, we can observe all of these processes in real time. By accessing states, we can witness physical reactions, notice changes in perception and expectation, and begin mapping out the different parts that arise in response to triggers and resources. (In this case, triggers describe anything connected to defeating beliefs and resources describe anything connected to empowering beliefs.)

We come to see patterns in the way we relate to others, by observing internal reactions in triggered moments. We notice protective parts that seek confirmation of our worst fears, present evidence by bringing up memories, and project old fears into present experience. And in this, we find choice points: windows of opportunity to respond instead of react.

We can begin a relationship with these parts, once we differentiate from them. When we meet a stranger and feel our body constrict, we can recognize this reaction as that of the child inside, reacting to meeting a male that reminds it of its father. We can talk to the child, meet it, give it assurance and validation.

Transitions, too, come with stories. Transitions between physical settings, between internal states, or between modes and strategies used to navigate present needs. With practice, we can feel our body respond. Maybe it contracts to protect or expands to connect. In this, we can learn to tolerate uncomfortable states for longer periods of time, even breaking them down to simple bodily sensations. Those who are avoidantly attached may find peace in physically calming with an Other. For those on the anxious end of attachment, we can find genuine connection internally, ever present and responsive.

Distancing allows both space and connection. This is the process of stepping out of a hurting part and landing in a more safe or neutrally-observing part. We separate in order to meet, in order to experience an Other at an internal level.

In moving toward more cognitive distancing techniques, we might notice ourselves calming as we head toward “big picture” thinking. Outside of our present states, we may elicit curiosity, awe, and wonder when stepping back to observe patterns and cycles. From the simple in-and-out of our breath to the contractions and expansions of our life and the universe, to the rhythms of connection and disconnection in the present moment.

Sometimes just imagining hovering above our own body can create a distance that helps us differentiate from internal parts that are experiencing intense emotion. And this separation is actually what gives us the ability to come back and be with those parts in a healing manner. [amazon_affiliate]

Rather than being in the pain, we learn to be with it.

If you would like help beginning this process, contact a compassionate counselor today.

Read on for Part 2: Mindfully Heading Toward Discomfort

References:

1. Gendlin, E. T. (1981). Focusing. New York: Bantam Books.
2. Kurtz, Ron. (1985). The organization of experience in Hakomi Therapy. Hakomi Forum Professional Journal, 3(1), 3-9. Retrieved from http://www.hakomiinstitute.com/Forum/Issue3/OrganizationExperience.pdf
3. Lewis, T., Amini, F., & Lannon, R. (2000). A general theory of love. New York: Random House.
4. Noricks, J. S. (2011). Parts psychology: A new model of therapy for the treatment of psychological problems through healing the normal multiple personalities within us: Case studies in the psychotherapy of mental disorders. Los Angeles, CA: New University Press.
5. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: W. W. Norton.
6. Schwartz, R. C. (1995). Internal family systems therapy. New York, NY: The Guilford Press.
7. Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York: Bantam Books.
8. Van der Kolk, B. (2014). The body keeps the score. New York, NY: Viking.

In part 1 of this series, we touched upon the blissful and frightening states that can occur when we feel merged with a partner whom we love. These states are drawn from our earliest experiences outside the womb and tend to awaken parallel states of extreme helplessness. As exciting as these experiences of full absorption can be, humans are not designed to remain helplessly dependent. We are designed to learn to love autonomously.

One of the primary feats of early development is the forging of a self separate from mother. Out of the cacophony of fleeting images, sensations, drives, and demands swirling within our infant experience of the world, we somehow identify enough patterns within the chaos from which to propel our very own imprint of that world. The acorn cracks and the sapling lifts its first tendrils toward the sky. As our distinct character emerges, we begin the long craft of personalizing our experience. We learn to abide by a singular rhythm that makes sense only to ourselves while somehow maintaining the approval of mother.

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The journey toward becoming a “me” continues from the first year of life well into our 20th. Then, just as we’ve gained some mastery at selfhood, we attempt to reverse the journey. We long for experiences of merging with another: adult intimacy. Our self-will, though still active, takes a back seat to the more instinctual parts of our brain. One day we are content to greet the object of our desire from a distance; the next there seems to be no distance at all. Before we know it, the fragile “me” we’ve carefully constructed over the years has merged into a “we.”

Just how we experience adult intimacy depends as much on our inborn character as it does on how we differentiated our self from our primary caregiver. Below, I refer to four of the later separation-individuation stages, as defined by classic psychologist Dr. Margaret Mahler, for clues as to how we first managed the capacity to hold on to—while separating from—our merged existence with mother. The marks of these infant/toddler achievements make a dramatic reappearance in the work of adults attempting to navigate bonding—while maintaining autonomy—with their life partners.

Hatching: (5-9 months old)

Julie has felt hopelessly in love with Brian for a few weeks now. They’ve consecrated their affections during long weekends together, and the melding seems to have lifted Julie beyond time itself. With Brian, she feels solid and truly herself. During the intervening weeks without Brian, however, Julie feels she has lost any capacity to go through the motions of ordinary life. She doesn’t miss Brian or recall their time together. Instead, she finds herself unable to function at all. Having identified her true self as that which is beyond her grasp, she has no self left with which to even dream of reunification with Brian.

We might pity Julie, but we all remember at a visceral level the trouble she’s in. Waking hungry in our crib at night, we cry out and are met with no immediate response. No sound of approaching comfort. It takes but a few minutes before our cries threaten to steal our breath from us. We are inconsolable. We learn the dark contours of an unmerciful absence and we don’t forget it. How do we survive these early stages of helplessness?

We learn the dark contours of an unmerciful absence and we don’t forget it. How do we survive these early stages of helplessness?

We start, during what’s called “hatching,” by learning to hold on to imagery of our caregivers. Babies at this stage become obsessively interested in the sights and smells associated with mother. Mothers report there being a dramatic increase in the intensity of their child’s attachment at this stage. Fathers report feeling far less replaceable. During the hatching stage, babies are ingesting the image of their mother into their minds. The eventual result: the arising of an internal representation of the mother’s life-giving forces.

Revisiting the primal instinct for this transition in her adult life, Julie might ask Brian if she can keep his jacket so she can wear it during the week or update her profile with photos of the two of them, training herself to identify with the accessories and imagery of their partnership. To friends and family, Julie may appear more helpless than ever as she begins to fixate on her phone, always anticipating Brian’s next text or rereading old threads. But in terms of how we are designed to love autonomously, this is a necessary and critical part of her process. Internalizing the sights and smells of our beloved sets the stage for a sense of wholeness while living apart.

Practicing: (9-14 months old)

Children in the “practicing” stage are exchanging notions of symbiosis with mother for ones of possession. Instead of needing direct physical touch to feel connected, children practice feeling it at a distance. A child notices his mother leave to the kitchen while he is temporarily absorbed with his toys. His interest wanes and, instead of crying out for her to come comfort him, he calls out instead for her acknowledgment. “Juice?” “Sure, honey, I’ll get you some.” These interactions establish a sense of safety within a proximal distance. The more reliable these exchanges, the more distance opened up for exploration. In this way, the organic parameters of loving connection are found to reach far throughout the house and eventually throughout the neighborhood.

Sam and Phil are fully hatched as a couple. They are both enthralled with how important they are to each other and have begun regaling their friends with stories of their latest romantic triumphs. Their Instagram feeds contain large volumes of them holding, hugging, and having each other. Time apart is tolerable only insofar as they fill those empty hours with memories and plans for their next rendezvous.

Though their mutual world feels established, all is not always harmonious in the land of honeymoon. If Sam doesn’t hear from Phil for a day, he notices he starts to get cranky. Phil learns to oblige Sam’s moods by using a lot of soothing, reassuring tones when arriving after an extended absence. For his part, Phil gets anxious when Sam is given attention by others. Sam has learned to accommodate Phil’s jealousy by referring to Phil often when speaking to others. Phil relaxes each time he hears Sam describe himself as happily partnered. Some might judge Sam and Phil’s doting accommodations to each other’s insecurities as setting a poor precedent for their future. However, at the practicing stage, there can never be “too much” attention to sensitivity. It’s only closely wired couples whose love can span the distance as both partners venture a return to their autonomous lives.

Rapprochement: (14-24 months old)

Children in the “rapprochement” stage are confounded by two separate needs: the drive to individuate and the impulse to stay safe. Classically, this stage is depicted as a 2-year-old on her first day of preschool, clinging to her mother’s dress with one hand and reaching out toward the block room with the other. The job of the mother is to find grace as a selfless launchpad while the girl vacillates between hiding within the folds of mother’s dress and throwing her recklessly aside. The mother’s tolerance of this continual flip-flopping between extremes transmits to the child an ability to tolerate her own ambivalence.

The features of the fight give insight into the core rapprochement patterns established in their childhoods. This, in turn, gives insight into what’s in store for them as they attempt to resolve the current crisis.

When working with couples in crisis about their relationship, I’ll often ask them about their first serious fight with each other when they were just getting to know each other. As people recall the incidents, I listen for clues as to how they resolved the fight. Some scream and yell. Others are quick to kiss and make up. Some brood and punish indirectly for weeks before addressing the problem. Others discuss it ad infinitum until they slowly lose interest and move on.

The features of the fight give insight into the core rapprochement patterns established in their childhoods. This, in turn, gives insight into what’s in store for them as they attempt to resolve the current crisis. The need to shore up safety with a partner while also standing strong in one’s differences is a tense operation that doesn’t always resolve with the couple remaining intact. No matter the wedding vows, some partnerships can withstand an individual’s thrust toward self-growth, while others are shattered by the process. This period of rapprochement offers no promises, only an ability to tolerate the process.

Object Constancy: (24-plus months old)

Anyone who has witnessed a child progress through the early stages of attachment knows parenting is not for the faint of heart. Autistic merging, hatching, practicing, and rapprochement bring out the neediest and most demanding aspects of the human experience. Parents are asked not only to find a matching response to the child’s level of need but to express a reassurance that can somehow normalize the painful process of growing up. “It’s okay to be sad because I know you miss Mommy. I promise you, she’ll be right back.” With enough reassurance, children indeed arrive at the place where they can take comfort in imagining their mother’s goodness even while she is out for the day. “Object constancy” refers to a child’s capacity to feel the good qualities of their mother’s love inside of themselves.

As adults, we learn to return to and expand this childlike sense of object constancy to include:

• An ability to recognize and tolerate loving and hostile feelings toward the same person
• An ability to keep feelings of need centered on one person
• An ability to value that person for attributes other than their capacity to satisfy needs

There is no way to develop these abilities except by weathering the storms of disagreement, misattunement, and conflict with those we love. It’s never easy to be in opposition with the one you want to trust to take care of you. When tensions are high and the risk of separation appears imminent, some amount of “faking it ’til we make it” can be helpful.

“I can disagree deeply with you and know you will not leave me.”

“I can see your point of view, even come to agree with you, without losing my self-respect.”

“I trust us to negotiate solutions that will take care of both of us.”

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Couples might reach toward such statements with the hope their very utterance will somehow make them true. Lo and behold, with enough patience, time, and reassurance, it can work. The good of the relationship is instilled within the hearts of each as a reliable constant. Arguments can come and go, leaving the underlying love undisturbed. With each round, a chance to grow up all over again.

Reference:

Mahler, M., Pine, F., & Bergman, A. (2000). The psychological birth of the human infant symbiosis and individuation. New York, NY: Basic Books.

“NO, that’s NOT what I mean.”

“How could you say that?”

“I wasn’t finished. Where are you going?”

At first glance, sudden and intense misattunement between partners may indicate a need for a more disciplined approach to conflict. Perhaps both need a class to practice nonviolent communication strategies, a workshop to enhance empathy, or a therapist to work on anger management.

But what if the problem isn’t interpersonal? What if the deeper conflicts at stake are going on within—each person struggling to maintain two versions of self simultaneously, their personal self and their relational self? Look again at the arguments that confound couples and we can see they are frequently frustrated not at each other but at the delicate trapeze work required of each person to keep their own identity from crashing.

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I practice as both an individual counselor and a couples counselor. A core task in both practices involves helping folks navigate the space between their personal and relational selves. The personal self is busy with the task of differentiation: remaining autonomous and whole while with others. The relational self, meanwhile, is occupied with the task of merging: deepening intimate availability for connection.

As I talk with one person, I get a direct experience of their unique worldview. Speaking again on the same topic while that person is in the presence of a loved other, I often observe that worldview collapse. Here, the simplest facts, the clearest agreements, and the most bedrock values slip like disentangled particles through their grasp. Little that is true to the identity of a person necessarily remains true to their identity while in relationship.

Differentiation: Being Oneself in the Company of Another

Pay attention to couples as they slip into a casual disagreement and you’ll see any number of well-honed techniques to salvage dignity and equilibrium. It’s a supremely complex task. Not only must each preserve a sense of entitlement to their own opinion, they must simultaneously preserve a sense that the person to whom they are attached is worthy of respect. Most complex of all, they each need to handle a temporary rupture of relational attunement.

Differentiated couples have gained some measure of confidence that their relationship will survive its everyday ruptures. Such confidence is hard-won.

Differentiated couples have gained some measure of confidence that their relationship will survive its everyday ruptures. Such confidence is hard-won. It takes no small amount of faith and a whole lot of practice to establish a capacity to be caring while experiencing a sudden collapse of attunement (“How can I be right when the one I love doesn’t get me?”).

Over time, a belief in constancy ensues and stays intact even through argument. Nevertheless, beneath the light ribbing (“There you go again, hon”), the humor (“That’s okay, you don’t have to make sense for me to love you”), and the subtle redirection (“Remember that one time we weren’t fighting?”), the remnants of early wounding remain. To understand how to love, we have little choice but to understand how we managed those first wounds.

Merging: The Urge to Return to Unity

During the first month of life, children lead a non-differentiated existence. Blissful or frightening, there is no sense of self separating them from the outside world. The attunement taking place in the touch and eye contact between mother and babe renders both in a fused state. Mothers describe being transported to a regressed world in service of the baby. Both are engulfed in feelings of oneness and a mutual sensitivity to each other’s moods and states. It takes six to nine months for babies to emerge from this fused existence and prepare to “hatch” a separate personality from their primary caregiver.

During that time, their experience of oneness vacillates between two phases of merging: autistic and symbiotic. In the autistic phase, mother is viewed as an intrinsic part of the infant, devoid of a separate existence. When deprived of their mother, babes will feel themselves to be literally nothing, empty, nonexistent. In the symbiotic phase, mother is viewed vaguely as separate but only in terms of need fulfillment. It is in this phase that babes develop their reactive capacities to cry out, push away, and demand a return to unity. Even if the child has yet to develop a sense of self, their self-preservation instinct is active and they will not kindly receive anyone or anything keeping them from attunement.

Regression Happens

The quality of these two phases of merging constitutes the felt landscape of the longing for adult intimacy. Once the desire for intimacy is awakened in mature adults, so too awaken recollections of their primal urge for unity. The body remembers the fused state of those first months outside the womb, even if the mind holds no actual memory of it. Like a moth drawn to a flame, we are compelled to reexperience the ineffable sense of oneness that transpired there.

The quality of these two phases of merging constitutes the felt landscape of the longing for adult intimacy. Once the desire for intimacy is awakened in mature adults, so too awaken recollections of their primal urge for unity.

Spiritually, as adults, we might seek it through prayers for atonement. Sexually, it may be sought in the lust toward orgasm. Interpersonally, this urge for unity is evident when we tap into states of unbridled attraction that go beyond seeing the other as merely attractive. We don’t actually see them at all, captured in the moment solely by our own sense of selfless longing for connection.

For those anticipating the prospects of a deep merging experience, there comes a necessary softening of their power to self-regulate. Differentiation pauses as an opening occurs for fusion. When the merged state arises, we are engulfed by a return to those first blissful/frightening months of life. And when it is taken from us, we either collapse or rage.

Confronting everyday conflicts with partners soon after experiencing hopes for intimacy naturally provokes autistic and symbiotic memories of detachment from mother. (“What was once my world has been torn asunder.”) Regression into the autistic phase is marked by absolutisms: “I am nothing if you don’t see my point of view.” “I might as well kill myself if you see it that way.” Regression to the symbiotic phase is marked more by violent rejection: “How dare you!” “I want mommy. Go away!” These infantile responses get stirred in the middle of our grown-up lives, yet healthy adulthood never leaves these core feelings behind.

Do We Ever Truly Grow Up?

Our emotional development occurred not in a straight line but as an outward flowering spiral. If we could look at the core stages we passed through from ages 0 to 9 months, we would likely find origins of the most-repeated habits we employ to attain intimacy as adults. Those automatic habits constitute our “unknown knowns”—the unconscious strategies that control our most sophisticated adult interactions.

Even though we never truly graduate from the feelings associated with our core identity development, we learn to recognize them better as they arise. With practice, we also learn to soothe and express those feelings with more finesse.

Fortunately for most of us, our emotional development did not end at 9 months. Collapse and rage are not the only tools at our disposal to deal with the temporary ruptures in our intimate lives. We can look at a blueprint of the separation-individuation stages as defined by classic psychologist Margaret Mahler for clues as to how we developed the capacity to leave our merged existence with mother, eventually to carry that sense of safety within our individuated selves. In part 2 of this series, we will look at how these stages are installed over the first two years of life and how we subconsciously reexperience them as we attempt to build trust with those we love as adults.

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• Differentiation/hatching (5-9 months): The infant becomes increasingly interested in discovering mother (e.g., how she looks or smells) rather than trying to become symbiotically unified with her.
• Practicing (9-14 months): Although able to explore freely, the child still regards mother as unified with child and thus explores surroundings while keeping within an optimal distance.
• Rapprochement (14-24 months): The child’s desire to be all-powerful and self-sufficient is marred by a fear of abandonment. The child reaches a healthy medium between the two extremes due to language and superego development.
• Object constancy (24-plus months): Successful completion of this phase marks the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated.

Reference:

Mahler, M., Pine, F., & Bergman, A. (2000). The psychological birth of the human infant symbiosis and individuation. New York, NY: Basic Books.

If you have ever been in a relationship, you have experienced hurt. It is inevitable. Even when two people have a connected, secure, and healthy relationship, they will experience hurt at some point. When couples come to therapy, it is often due to an experience or pattern of experiences that created hurt for one or both partners. They decide to pursue therapy because they are having a hard time resolving this hurt in order to feel safe with each other again.

When working with couples, I seek to understand the nature and significance of the hurt before moving toward resolution. How bad is it? How deep is the impact? First, we must understand the two levels of hurt: relational hurts and attachment injuries.

Relational Hurts

Secure couples can often navigate relational hurts on their own. Things like forgotten anniversaries, reactive insults, or blow-up fights can sneak into relationships. For secure couples (couples who feel they can depend and rely on each other in times of need), relational hurts are fairly easy to navigate. Partners can share their hurt feelings with each other, hear and empathize with the hurt of their loved one, and provide comfort and reassurance. Partners can move forward in the relationship with trust, security, and safety despite the hurtful experience. This is a natural and expected experience for healthy relationships.

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I can often tell when a hurt falls into the category of a relational hurt. In our sessions, couples may share feelings of sadness, anger, hurt, and pain in response to an experience. However, when I ask them if they feel their partner loves and cares for them, they can quickly answer “yes.” For them, even though the hurt happened, it hasn’t significantly changed the way they view each other or the relationship.

Attachment Injuries

Attachment injuries are trickier. They require much more care, consideration, and often more guidance, sometimes from a couples counselor. When couples are trying to respond to attachment injuries as if they are merely a relational hurt, they can stay stuck. Without recognizing the significance and impact of the injury, they can go down a long road of frustration and more hurt. An injured partner can feel even more hurt that the other person is not responding in ways that provide healing. The hurt deepens, becomes more complex, and can create great distress in the relationship.

Dr. Sue Johnson defines an attachment injury as “a feeling of betrayal or abandonment during a critical time of need.” When an attachment injury has occurred, a partner may view their relationship as changed or they may view their partner in a different way. An affair is a good example of an attachment injury. Infidelity often causes a partner to view a previously safe relationship as unsafe. While they used to view their partner as trustworthy, they now wonder, “Can I ever trust this person again?”

Attachment injuries are trickier. They require much more care, consideration, and often more guidance, sometimes from a couples counselor.

There are also more subtle attachment injuries. Consider the example of a wife, grieving the loss of her mother, crying in her bedroom. She sees her husband walk by on his phone, consumed in a work call. He sees her in tears but, after getting so caught up in his work, never returns to check on her. In that moment, she decides she is not important to him and she must go through this pain alone. In that moment, everything changes in how she views the relationship and how she views her husband. She was in need and he wasn’t there.

There are three key ways to determine if a hurt is an attachment injury. First, partners report they have apologized, but their hurt partner keeps bringing up the hurtful experience. Additionally, the hurt partner may report feeling as though they relive the hurtful experience when they think or talk about it. They can still feel the pain, almost as if it just happened. Finally, couples report a significant, defining shift in the relationship felt by one or both partners that can be traced back to a specific time or incident. If any of these things are happening in your relationship, there may be an attachment injury.

If you believe you are dealing with an attachment injury in your relationship, here are some potentially helpful things to think about:

• Try to understand the significance of the injury for yourself or your partner. How did the experience impact how you see yourself or how you see each other? How did it change how you or your partner view the relationship?
• What happens when you or your partner recall the hurtful experience? What do you feel? What do you think about? What images or memories do you have? What physical sensations do you feel (i.e., knots in the stomach, heart racing, shortness of breath)?
• What do you or your partner need from each other in those moments? Physical comfort such as a hug or embrace? Emotional comfort such as reassurance, understanding, and validation? Or just to be heard?

Often, couples benefit from therapy to help them navigate the process of healing after an attachment injury. When a couple learns how to find comfort in each other for the pain and hurt resulting from an attachment injury, healing and true reconnection are possible.

References:

1. Johnson, S. (2013). Love sense: The revolutionary new science of romantic relationships. New York, NY: Little, Brown and Company.
2. Johnson, S., Makinen, J., & Millikin, J. (2001). Attachment Injuries in Couple Relationships: A New Perspective on Impasses in Couples Therapy. Journal of Marital and Family Therapy, 27(2), 145-155.

Someone recently asked me why they needed to know about the interpersonal process. There seemed to be a misunderstanding that the interpersonal process is only focused on building rapport, when stronger rapport is, in fact, a byproduct of the interpersonal process. If you have similar questions about how or why this framework could strengthen your practice, read on.

Interpersonal Process as a Framework

It is important to know that the interpersonal process is not a new theory or technique. Instead, it is a framework that can be integrated with any modality you want to use. You lay your favorite theory or technique upon this framework. This makes the interpersonal process not only versatile, but the cornerstone of any practice in which it’s used. Your modality can change based on individual needs, but the framework stays consistent.

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The Cognitive Domain: A Crucial Component of Process Dimension

Tyber and McCluer identify three domains that make up the process dimension: the cognitive domain, interpersonal domain, and familial/contextual domain. While interpersonal domain addresses how a person experiences attachment brokenness, and the familial/contextual domain is where this brokenness is reinforced, the cognitive domain is at the origin of an person’s attachment brokenness.

The cognitive domain addresses the practical application of much of the attachment research that has been done. Under the cognitive domain, we identify the origin of the attachment style a person had or has with their primary caregiver. As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Therapists use these subcategories of the cognitive domain to identify attachment brokenness that occurred in response to real life experiences. To understand the importance of healing attachment brokenness using the interpersonal process framework, let us first look at how we treat attachment brokenness in children.

The Experiential Approach in Action: Play Therapy, Theraplay, and the Neurodeck

Becoming a registered play therapist requires candidates to spend 15 hours in training that specifically address attachment and how to build, repair, and strengthen a child’s ability to attach to a primary caregiver. But what is the common theme between attachment play therapy, theraplay, and the Brain Booster Neurodeck? Simply put, the common thread in these three modalities is an experiential approach. Healthy attachment is developed through experience, not reframing.

As therapists, we seek to uncover how a person’s values and identity were established, how they developed coping mechanisms, their covert thought processes, their beliefs about themselves and the world, how their value of self-care was determined, and what they need to restore their identity.

Play Therapy

In play therapy, clinicians provide experiences that support healthy, safe touch through activities such as foil hand prints, lotion on hands or feet, holding hands during activities, or working together on a task. All these activities encourage safe touch and eye contact. Eye contact in particular is important for our limbic systems to communicate and bond, as we learn from clinicians such as Curt Thompson or Louis Cozolino. Communication between our limbic systems is nonverbal; hence, the importance of eye contact.

Theraplay

Theraplay is also quite experiential; in fact, it may be the most experiential of all the methods listed. Attachment brokenness is healed through re-experiencing the attachment-building interactions that were not provided (or were insufficiently provided) during the first years of life, such as eye contact made when a baby is fed and swaddled. In some cases, the child needs to be cuddled or rocked as they would have been as an infant, a process that is exceptionally experiential. It may also be that a traumatic event broke an initially secure attachment, in which case Theraplay is utilized to re-establish the previously secure attachment style.

The Neurodeck

The Neurodeck comprises activities that build the brain from the bottom up. It begins with activities that assist with sensory integration, utilizing many of the same type of activities used in other attachment play therapy techniques. These experiential approaches harness messy play and movement. For example, they may use the lotion activity mentioned above or swing a child in a blanket to mimic the rocking movements experienced in utero. As a clinician moves through the deck, the activities become increasingly relational. This is the attachment component of the Neurodeck approach.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics.

The deck specifically states that certain activities should be completed in a one-on-one context before they are used them in a group setting. The one-on-one context is important in establishing safety before engaging in group work. Attachment work is rooted in laying a foundation for understanding safe and unsafe characteristics in relationships through a one-on-one dynamic. This dynamic then informs the safety of other relationships, especially relationships in a group setting. Each phase in the protocol is experiential and progressive.

Addressing Attachment in Adults

It is evident how attachment work in children is achieved through experiential modalities. The same can be said for attachment work with adults. The cognitive domain mentioned above is at the root of an person’s attachment brokenness, while the interpersonal domain is where attachment brokenness is experienced, and the familial/contextual domain is where the brokenness is reinforced. Through our work as therapists, we provide an experiential repair for broken attachment that is evaluated through interpersonal skills. A person’s maladaptive interpersonal skills provide a wealth of information about what happened in the cognitive and familial domains, as well as crucial information for effective treatment planning.

While it is impractical to swing an adult in a blanket to provide experiential therapy, the interpersonal process provides relational experience to honestly, yet compassionately, bring awareness to a person’s interpersonal characteristics. Are they interacting in healthy ways that allow people to draw near to them and create a desire for others to be in a healthy relationship with them, or are they fracturing relationships unknowingly because they lack the awareness or skills to build healthy relationships? Sharing our experience of an person’s behaviors or words can help them develop self-awareness and contemplate whether they are communicating what they intend. This approach can also help with reality testing.

Strengths of Interpersonal Process

One strength of the interpersonal process framework is the way it helps build flexibility and other-focused awareness, which allows for healthy attachments and navigating unhealthy relationships more confidently and constructively. By highlighting awareness of how a person’s communication might be perceived by others, we broaden their understanding of themselves and of others. Maintaining a broader range of interpersonal understanding ideally increases a person’s window of tolerance in their relationships and creates a desire to repair a broken healthy attachment or confidently sever an unhealthy attachment. The individual becomes better equipped to advocate for positive change in their life through a strengthened commitment to repair healthy relationships or by valuing themselves enough to part ways with unhealthy relationships without behaving destructively.

The Effective Interpersonal Process Clinician

A provider who effectively uses interpersonal process reflects truths to people that help them feel heard and known so they may heal. Those on the receiving end of these truths may not always like what they hear. However, when they work with an empathic and skilled therapist, people can hear and understand their therapist’s reflections, even if they do not like what is said.

At the appropriate level of reflection, people learn to trust their therapist. Feeling known and understood improves rapport. In this context, rapport is equivalent to attachment. A grounded relationship with an effective interpersonal process therapist is emotionally supportive so people may engage in difficult, effective therapy that greatly improves treatment outcomes.

Reference:

Teyber, E., & McCluer, F. H. (2010). Interpersonal process in therapy: An integrative model (6th ed). Belmont, CA: Brooks/Cole.

Complex trauma is what happens when someone experiences multiple incidences of cruelty and abuse in the context of an unequal power relationship. This is most commonly found in people who grew up with abusive or neglectful parents, but also happens to kidnapping victims, prisoners of war, and people in abusive sexual or “romantic” relationships. The result of this complex trauma is C-PTSD (complex PTSD), which has similar effects to the posttraumatic stress (PTSD) experienced by people who have been in car accidents or similar traumatic events but involves deeper disturbances of the personality. Many people diagnosed with bipolar and other personality conditions are, in fact, survivors of complex trauma. This requires delving into the individual’s personal history and life story, rather than only analyzing their present symptoms.

Another way of looking at complex trauma and C-PTSD is the concept of attachment trauma. Attachment—the bonds that exist between one human being and another—sounds like a rather vague or abstract concept. Like all emotional states, however, such as happiness, fear, or anger, it is rooted in our biochemistry and is essential for human flourishing.

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While our level of intelligence distinguishes humans from other animals, it is only through working together that we were able to survive and thrive. There is simply no way an individual human could take down a woolly mammoth. Human beings evolved to cooperate and work together in groups. One aspect of this is our unique capacity for language acquisition. For true social cooperation, however, bare communication of information is not enough. In the modern world, one may be able to go about many items of daily business (shopping, for example) without any emotional bond, but the cohesive groups in which humans evolved required a much deeper level of connection.

Even today, we can observe that an office where there is no camaraderie between employees will not function well no matter how highly they are paid. Family life, friendship groups, and romantic relationships are, of course, quite difficult to maintain without attachment. As a result of our evolution, all, or almost all, human beings feel a deep need to be attached to others regardless of whether it is strictly necessary for their survival or material prosperity. People who do not form relationships are often plagued by feelings of depression and sadness, no matter how successful they may be in other areas of life.

Attachment, however, is hard. Forming a relationship with another human being involves both verbal and nonverbal communication, as well as an intricate dance of appropriate behavior. Express too little empathy in a relationship and you may be considered cold or distant. Express too much or too early and you may be considered overbearing. High-functioning people on the autism spectrum (commonly known as Asperger’s, though this has largely fallen out of academic usage) typically lack many of the native instincts for successful relationship formation that other people have, making their lives difficult in ways that those in the general population find hard to appreciate or understand.

However, like all human traits, the ability to form attachment bonds is not purely innate; it is learned behavior. And as with most human learning, attachment is learned by doing. From the moment they exit the womb, babies are learning attachment. This, and not only the need to materially provide for the child, is the basis of the family, a universal component of human society. Even utopian social experiments which aimed to replace the family had to fall back on structures that essentially mirrored mother- and fatherhood, with mixed success.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority.

It follows, therefore, that when the relationship between parents, or a replacement primary caregiver, and the child is seriously distorted by abuse or neglect, this has far wider implications than the parent-child relationship alone. Survivors of complex trauma typically emerge with gaps in their ability to form attachment bonds with others. This is not to say their desire for attachment is any less—far from it. The unfulfilled desire for connection and pervasive feeling of loneliness in survivors of complex trauma is a major contributing factor to the symptoms they experience, including depression, inability to regulate emotion, and engagement in risky or self-destructive behaviors.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority. It is also an extremely difficult process. As I have discussed in previous articles, C-PTSD is best conceptualized less as a process of damage than as a learning process in highly unfortunate circumstances. Like all children, people who grow up in an environment of persistent abuse are born with potential, which they develop in their own way under adverse circumstances.

In short, survivors of complex trauma in childhood learn to live in a world turned upside down because that was the only world they ever knew. Therapy for people with C-PTSD is a delicate undertaking, involving revisiting this initial learning process and initiating a new one that allows them to grow and develop in healthier and more fulfilling ways.

References:

1. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25097. Retrieved from http://doi.org/10.3402/ejpt.v5.25097
2. Lawson, D.M. Treating adults with complex trauma: An evidence-based case study. (2017) Journal of Counseling and Development, 95(3), 288-298. Retrieved from http://doi.org/10.1002/jcad.12143
3. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. Retrieved from http://doi.org/10.3402/ejpt.v2i0.5622
4. Sullivan, R. M. (2012). The neurobiology of attachment to nurturing and abusive caregivers. The Hastings Law Journal, 63(6), 1553–1570.
5. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. Retrieved from http://doi.org/10.1177/1534650113479442