It should be no surprise with the rapid advances in genetics these days that they have identified a gene that may help to explain what a lot of folks call the Highly Sensitive Person. A researcher at the University of California Berkeley, Dr. Levenson, postulates that a variation of the serotonin transporter gene on chromosome 17 may may account for people who feel their emotions very acutely. This serotonin transport gene can have two common variations-- the "short allele" or the "long allele" version. It's the short allele version that seems to be responsible for some people feeling things more intensely. This gene variation also seems to be correlated to higher rates of depression, anxiety and ADHD. Which bolsters what clinicians who work with those populations have noticed for decades-- that if you have anxiety, depression or ADHD, you are likely to have not just one of those but two or even all 3. And that if you have some of those difficulties you are also likely to see those same problems in blood relatives, hinting that there is a genetic linkage.
Dr. Levenson posted a fantastic youtube video that explains his research in a very understandable and fun format (he even uses emojis!). If you resonate with the idea that you tend to feel things more deeply than others you may want to look at other sources of information about this trait such as the wonderful website The Highly Sensitive Person which has books, videos, research links, self-tests and more.
So if you are a highly sensitive person what can be done about it? Well, years ago I encountered a theory in psychology that seemed so completely WRONG to my therapist's ear-- that the goal of therapy should not be to change people but teach people who they already are and how to live the in the world given who they are.
Anyone who reads my blog or does therapy with me knows that I am a huge fan of splitting the difference, finding the middle path or blending opposing ideas. So while at first I balked at what sounded like a completely hopeless perspective-- that we should not try to help people even try to change-- I came to realize that there is room for some of this perspective in my view of personal growth. Whether you are a Highly Sensitive Person, someone with ADHD (you can be both of course), an extrovert or on the spectrum, all of which are known to be highly genetically determined, or have some other genetically linked trait, you CAN make some changes to how you operate in the world. And, at the same time, there WILL be things you cannot change and, as the old 12-step saying goes, it's learning "the wisdom to tell the difference" that is the key to really thriving. So if the idea of a highly sensitive person resonates with you I encourage you to learn more about it and educate those that are close to you so that your behaviors do not get misinterpreted. Then set about learning how you can navigate the world with a little more comfort.
A few examples of HSP that I have known or worked with-- one woman notices that too much noise is very overwhelming for her, so she has skin-colored ear plugs that she wears if she is going out in public (like the mall, a noisy restaurant, etc). They dampen the ambient sound but she can still hear the people she is talking to just fine. If this idea appeals to you I suggest trying the off-the-rack cheap kind first and if you really love them you can order ones that are more high-end or even have them custom made by shops that cater to musicians.
Another HSP I know gets a lot of anxiety when entering into social situations because of the increased complexity of interactions. The combination of more voices, conversations bouncing around, more eye contact, etc. just jangles her nerves and she used to find herself making excuses and not joining into groups. Once she learned that she was an HSP she experimented with different methods of entering into groups that reduced her feeling of exposure to the increased input. She found that when she enters a room, house, venue, etc. if she can wait a minute (she can pretend to check her cell phone, go find a restroom, etc.) her nervous system has time to acclimate to the new environment. Once she has done that if she is still feeling a bit overwhelmed she can stand sideways to the group (this does not have to be too noticeable, the main thing is the have your torso perpendicular to the group but your head can be facing them). This has an interesting impact on the mammalian nervous system. Mammals are most physically vulnerable when their guts are literally exposed. So when one mammal faces another mammal if their torso is exposed the mammalian brain notices this and there is a deep evolutionary alarm that can sound and may feel like anxiety. This is especially likely if the group includes people you don't know or if you are in an environment you have never been in before (a new restaurant, a new friends house, etc). But by simply turning your torso 90 degrees, like you would if you were fencing, your mammalian brain is more likely to ratchet down the threat level and you will relax more.
For this particular person she even had a third level of "defense" for her nervous system if the first two things did not help enough-- she to develop particular imagery that was settling to her nervous system (if you are not familiar with the amazing power of guided imagery I recommend taking a look into it!). For this person imagining standing behind a huge one-way mirror when she was entering a new group was helpful. In the mental image she could see others but they could not see her. This deactivated her fight-flight response that was predicated on the idea of being seen. Again --to go back to how we are just large bipedal animals dressed in clothing-- being seen is the first step to being eaten. So for some HSP just being looked at can trigger a lot of anxiety. Because the brain, while in some ways is extremely sophisticated, in other ways it is very dumb. Sometimes the brain does not always know the difference between a very well rehearsed imagery and reality (just try thinking about biting into a lemon and see what your salivary glands do). So once this person had locked-in to that image as one that reduced her anxiety and she had rehearsed it numerous times she could call it up when under stress in social situations and it would reduce her feelings of being overwhelmed.
Again I am not suggesting that a HSP can turn themselves into a non-HSP. On some level we are who we are. But learning strategies to help modulate one's innate responses can give us more flexibility in our lives and lead to less stress and anxiety.
If you feel you are an HSP therapy can be a wonderful way to learn about yourself and get some help managing your beautiful but slightly tricky nervous system. Our office offers FREE 30-minute consultations so you can see if any of our therapists would be a good "fit" for you. And if you are an HSP in a relationship couples therapy can be a wonderful way not only to learn about yourself but to have your partner also learn about you in ways that can deepen the intimacy and de-personalize some of the problematic things that can crop up with a HSP in partnerships.
As always I wish you well in all of your endeavors and explorations in life, whether you are an HSP or not. The world has room for all of us and we all contribute in meaningful ways to create the rich diversity of the human condition.
PS If you have found this blog to be helpful PLEASE help us reach more people! "Like" it on Facebook or "tweet" about it on Twitter. Or share it in whatever other social media aps you use! And thanks for helping us get more mental health information out to the public!
We've all been there. You're in the middle of a screaming fight (OK, some of you are probably not screamers, so maybe a glowering fight) with the exact person that just 24 hours earlier you were feeling so incredibly in love with. Or you are furious with your 15 year-old for breaking curfew YET AGAIN when just last week you were sharing a touching moment with them where they thanked you for being such a great parent. And now you want to kill that same child. Not literally, but...
Yes, it happens. We can hate the ones we love. So what's going on here?
Psychologists call this a "complex feeling". It is literally a feeling that is a combination of other feelings. Just like "dusty rose" is a combination of pink and grey, many of the feelings we have during the day are actually combinations of other feelings. There are several schools of thought in my field that believe that there are only six truly distinct emotions: happy, surprised, afraid, disgusted, angry, and sad. Paul Eckman suggested that there are six basic emotions that are universal throughout human cultures: fear, disgust, anger, surprise, happiness, and sadness.Newer research is actually asserting that there are only four! Regardless of how many "distinct" emotions we have, in my experience the ones that really confuse us and cause most of our trouble are the "complex" or "blended" feelings. I feel great about liking my co-worker but then one day when she breaks my favorite coffee mug after I have asked her not to use it. I now have the weird experience of liking her overall, but at that moment being perturbed with her. What's even worse is what if she broke the coffee mug in the process of grabbing me the last piece of that amazing chocolate cake from the kitchen because she knew I was under deadline and missed the birthday celebration? And she knows how much I love cake! Ugh!! Now I feel really confused. Let's add in maybe that I envy my co-worker's amazingly fit figure and she never seems to even want cake. But she brings me cake. I do love cake. And I want cake. But I feel slightly guilty eating it in her presence because her size 6 jeans make me feel insecure. So we now have "happy" (yay! she brought me cake!), "surprised" ("wow, thanks for the cake, I though it was all gone!"), angry ("you broke my mug! I asked you not to use it!") and sad ("that was my favorite mug!"). I also apparently feel envy, which those smarty-pants researchers did not include on their list, but I would assert seems to be a very real feeling for many of us!
Why make the fuss about complex feelings? So what. We feel lots of feelings at the same time. Well, in my experience, lots of people find complex feelings unsettling. In fact, being able to tolerate complex feelings is a real developmental achievement according to mental health practitioners. Humans like to keep things simple. It frees up processing space in our brains. Really. We like to sort things into categories-- good/bad, smart/dumb, safe/dangerous, Republican/Democrat... This unfortunate evolutionary tactic to reduce load on our brains so that we can function more efficiently can make it hard to acknowledge or manage complex feelings. It's like being in a tug of war with your cortex-- one part of you knows that this person is important to you and that you like or even love them, but the other part of you is trying to "keep it simple stupid" and focus only on one feeling in that moment.
I have learned as a therapist that even just pointing this out is helpful to folks. Again the way humans evolved we are not geared to even notice this much less know what to do with it. So this is one of those situations in which even noticing the problem really helps. The next thing that has proven useful to me as a therapist is literally to tell the person to "make space for" each of the feelings. Don't judge them or try to get rid of one of them. Just notice them (mindfulness skills here!) and accept that they are co-existing in your brain right now. Allow both of them to be there. Don't beat yourself up for having some or all of them. Don't expect yourself to be internally consistent. Humans are inherently internally inconsistent, trust me.
The last step in dealing with complex feelings is assessing whether or not the person you are feeling them towards is a safe person to talk to about all of this. If that person generally can take feedback well and does not blow up then I recommend just telling them "hey, right now I feel mad at you but I also love you" or "right now I don't want to be around you but that's weird because I also have missed seeing you". (sidebar-- if the person does not seem like they are safe to talk to and it's someone that is important to you-- a spouse, a child, a friend-- you probably want to consider doing some therapy with that person to improve the communication between you!)
Mixed feelings are only problematic if you try to ignore them or judge yourself for having them. If you just let them sit there like the weird little creature that they are (OK, maybe weird BIG creatures if you are a big feeler like me!) and be like "oh, hey, yeah I see you there. It's weird that my love for my spouse is sitting right next to my desire to throttle him right now. Yep. Weird. But OK." then they will tend to subside. If you can accept the incongruence and explore it and hopefully talk about it the discord usually resolves all on it's own. Until it comes back. Which it will. Then it's wash, rinse, repeat. Welcome to humanity.
If you struggle with accepting feelings in general, or maybe just some specific feelings like hate or envy or whatnot, take a look at my blog on Acceptance and the resources there. And as mentioned above, Mindfulness also has great skills to help with tolerating things that make you uncomfortable. The more you can tolerate and accept what's going on inside you the more energy you will have to fight battles on the outside of you, like getting your taxes done or cleaning out the garage. Or maybe planning that fabulous vacation.
Wishing you health and happiness even when you feel conflicted,
Attachment styles represent the strategy that we learned as infants in order to keep our caregivers in close physical proximity. Human infants literally can't last more than an hour or so without having an adult caregiver nearby. Babies MUST keep this in their awareness and work hard to keep their caregiver close.
Different caregivers respond to different methods in order to maintain contact. If you
have a parent who is highly distractible, for example, it would pay off to intermittently cry or fuss a bit so that s/he doesn't forget that you are there. And you probably also want to cock your head in their direction periodically to see if they have absentmindedly wandered off on you. Now if you have a parent who doesn't like to be bothered you might try the opposite strategy-- be quite and don't cause a fuss. That way your parent will let you lie close by and stay safe.
Infants are hard-wired to develop these kinds of strategies to adapt to whatever caregiver they end up with. Kids who learn to "signal" a lot and keep track of their caregivers are termed "Anxious-Ambivalent" or "Angry-Resistant" in infant research. Dr. Stan Tatkin calls them "waves" as adults. Kids who learn to lay low and not ask for much are labelled "Anxious-Avoidant" or just "Avoidant". Dr. Stan Tatkin calls these folks "islands" as adults. Kids who are lucky enough to land a caregiver who does not need much adapting to are called "Secures".
There is a third attachment quality that was not even realized in the early research. These are kids who are in a bad dilemma. The caregiver they are with may, at times, provide nurturing and support. But that same caregiver can also be neglectful, abusive or can accidentally do things that scare the child.
Researchers found that parents did not even necessarily need to be abusive or neglectful to produce this attachment pattern. Parents who had themselves been abused or neglected sometimes looked scared when their babies cried. It's as if they were remembering on some deep level their own experiences of distress and fear related to their own parents. Babies see these faces full of fear and become fearful themselves. This stems from our evolution as primates who survived by living in groups. If one monkey in a tree sees a tiger it looks scared. A monkey sitting next to this one may not see the tiger but sees the fear on the face of its friend and therefore also gets scared. This fear behavior triggers a fight/flight response in BOTH monkeys. The one who saw the tiger and the one who only saw his friend looking scared. But now both monkey's bodies are in a fight/flight state, giving them both an equal chance of getting away safely. So as humans when we see someone who looks scared, we also get scared, even if we have no idea what they are responding to.
To a dependent baby, having a caregiver who is all of a sudden acting scared or checked-out can generate fear in the infant. Babies depend on caregivers to be calm and present. So if they see you really scared or off in another place in your head for more than a few second they can get scared themselves. Are you going to be able to take care of them in that moment? Will they be safe?
This kind of situation, if it happens regularly, can create what we call and "unresolved" or "disorganized" attachment style. Babies can, of course, also end up with a disorganized style from direct abuse or neglect. So if your parent was violent, or regularly threatening, or even severely depressed or drunk a lot of the time, you may as a baby have been scared that you were not going to be well cared for. And you may have had experienced where your caregiver was directly hurting you. This puts you in a bind-- the same person who is supposed to help you feel safe is now making you feel unsafe. The human brain does not have a good way of dealing with that dilemma. The kids are trying to attach to a parent to stay safe (our evolutionary strategy of being physically close to our protector) while at the same time either knowing in that moment that the parent may not be safe or having had numerous experiences that the parent has not been safe in the past.
As Dan Siegel, MD, explains it "The child is stuck in an awful dilemma: her survival instincts tell her to flee to safety, but safety may be in the very person who is frightening her. The attachment figure is thus the source of the child’s distress. Children in this conflicted state develop disorganized attachments with their parental figures. Disorganized attachment arises from fright without solutions."
Children who simultaneously feel a desire to move towards their parent for comfort but remember also not feeling safe with the same parent are caught in a "double-bind". There literally is no solution for this situation. Researchers observed a lack of organized behaviors in these babies because they could no reliably predict the right way to respond to their parents. They were called "disorganized" babies. They would display a mix of behaviors. For example, when upset they may start to crawl towards a parent, only to freeze mid-way and "zone out" for 10+ seconds. This is what is considered a "lapse" in strategy. A secure baby will continue to move towards the parent, not stop mid way and freeze for a prolonged period of time. Or a baby may back away from a parent when upset, which is the opposite of what a secure baby will do. Of all of the 4 strategies researched these kids had the highest risk for bad outcomes such as mental illness (including depression, anxiety, substance abuse, personality disorders, etc). They were also at risk for criminal behavior and had more trouble in school academically and behaviorally. Kids in this category show more dissociation-- from mini episodes to more prolonged states of "checking out". They may also block experiences from memory so that they have gaps in memories from childhood. For example they may say when interviewed "I don't remember second grade. It's just a big blank".
If you are a parent you may be freaking out right now thinking "oh no, did I ruin my children? Was I a terrible parent?" Let's be clear. No parent is perfect. I know because I am a parent and I have worked with hundreds and hundreds of parents in my career. Even great, wonderful people make mistakes rearing children. Some of us make BIG mistakes. Almost never because we don't care and even more rarely because we are trying to make our kids miserable or mess them up. I am fond of saying that the incidence of psychopathy is less than 1% of the population. Psychopaths are the only type of people who would lie awake at night trying to figure out how to ruin their child's life. So 99% of parents, no matter how poorly they are doing, are actually trying to be decent parents. But unfortunately sometimes even a parent who is trying to do a good job can lack the tools and create these fear states in their babies too often.
How often does this happen? Research suggests that anywhere from 15-30% of average (not particularly high-risk) families babies or toddlers meet criteria for disorganization. If you limit it to just "high risk" families (where at least one parent has a serious mental illness, substance abuse problem or is violent) then the risk for disorganized/unresolved attachment jumps to 80%. So if you are a therapist you should expect to see more disorganization than not in your practice. If your childhood background includes abuse or neglect it is probable that you also meet criteria for this type of problem. Or if one or both of your parents experienced abuse or neglect in childhood or suffered from unresolved PTSD as an adult.
How does this show up in your everyday life? Remember that our attachment system most strongly triggered in two situations-- parent-child interactions and long-term romantic partner interactions. So with friends, or co-workers, or the person who is checking you out at the grocery store you are not going to see much fall-out from this. But as mentioned above, if you are a parent and your child does something that reminds you of your own fears in childhood, you may either look or act scared, move into anger or dissociate. In romantic relationships you will likely have trouble soothing yourself when you get upset (similar to those with the anxious-ambivalent/angry-resistant style). But you will ALSO, simultaneously, have trouble using another person to soothe yourself (similar to the anxious-avoidant/avoidant style). Again, like the disorganized baby, you are caught in a dilemma with no clear solution. You will want comfort from your partner but feel anxious/fearful about how to effectively engage them. It is likely that you will have difficulty trusting your partner. This can actually trigger your partner to feel as though you can't be trusted! You are may frustrate your partner as your signals are confusing. Remember, you are not doing this on purpose! You are stuck in a dilemma from your early childhood which you had no control over.
So what can be done about this situation? First, if you think you may have a disorganized/unresolved style I STRONGLY recommend seeing a therapist who is both trained in attachment theory AND trauma treatments. This will give you the best chance of moving from what in adults we call an "unresolved" style to a "resolved" one. Making this jump helps to reduce or alleviate the problematic behaviors of not being able to trust or rely on your attachment figure and problems in self-soothing. This type of work can be done in individual therapy or in couples therapy as long a the therapist has the right training. It is not short-term therapy, you can expect it to take a year or more rather than weeks or months. However it is definitely worth the investment!
Dan Siegel, MD, has developed an online course that helps with creating what is called a "coherent narrative" to work on an “Unresolved Style ”. I also strongly recommend actually working in person with a therapist as this is how the human attachment system was meant to be "wired"-- through live interaction with another human nervous system. This is definitely not the kind of problem that you can fix by reading articles about it and journaling or doing phone therapy or even Skype or FaceTime therapy. You need to be in the room with a real live therapist.
I hope that understanding this category of attachment is helpful. Remember, as much as a third of us from "low-risk" families may be disorganized and the rates are even higher if your parents struggled with significant emotional issues including their own past childhood trauma. No one is passing this along on purpose". And having a disorganized/unresolved classification does not mean that you cannot be successful in life. I can hazard a guess that certain well-known figures who have become very successful probably would fit into this category (think any celebrity/public figure who have mentioned abuse or severe neglect in their childhood, such as Oprah Winfrey, Maya Angelou, Chevy Chase, Queen Latifah, Bill Clinton, Gloria Steinham, Ludwig van Beethoven, Billie Holiday, Carlos Santana, Johannes Brahms). If many of these highly successful people can rise above their difficult childhoods and potential unresolved attachment then we all have that capacity. However, getting the right kind of help will significantly increase your odds and make the journey a lot easier.
And just to make sure that my blogs are completely scientifically accurate I need to add an addendum here. Researchers never simply classify a kid (or adult) as disorganized/unresolved. They always give a secondary classification of "best fit". So you can be avoidant and disorganize/unresolved, or angry-resistant and disorganized/unresolved, or even secure and disorganized/unresolved. The disorganization/unresolved category has to do with whether or not your attachment strategy is consistent or if it gets derailed and confused when under stress. The other classification of best-fit has to do with what most of your attachment behaviors look like aside from those episodes of disorganization.
Hopefully this explanation itself is not too confusing! Attachment research is rich and complex and sometimes difficult to explain. However, understanding some of the basics about it can be IMMENSELY helpful to individuals and couples.
One final note. If you find "attachment style" quizzes on the "inter webs" (as my friend Margaret likes to call it) please know that, so far, research has not found self-reports like quizzes that you fill out about yourself to be terribly accurate in determining your attachment style. I can attest that when I first learned about attachment I thought I was definitely and completely a wave but actual attachment testing later proved me wrong! So be careful about assuming you know for sure what your own classification is. We seem to have a hard time assessing this component of ourselves without an outside observer. If you are interested in having your attachment style professionally determined you can look for a clinician who is able to administer the Adult Attachment Inventory or the Adult Attachment Projective. Those are two well-researched, well-validated instruments that can tell you what research category your attachment behaviors fall into. A PACT-trained couples therapist can walk you and your partner through various exercises that can also tease out what attachment style behaviors you manifest with your partner under attachment-related stress.
As always I hope that this information is helpful and if you have questions or comments feel free to send them to me!
Wishing you success in your relationships,
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The following article appeared on time.com last month and is a HUGE topic in my work with couples. One of the first things I try to teach couples is that memory is faliable and so the "he said/she said" fight where one person opens with "when you said/did _____" and the other person fires right back "THAT'S NOT WHAT I SAID/DID!" to which the other now disbelieving partner yells "Oh my gosh YES IT IS!" followed by something like "I remember EXACTLY what you said, it was Tuesday and we were standing at the kitchen sink and Timmy was watching Sponge Bob and I was making lasagna and you said/did ____!!" Wash, rinse, repeat...
Believe me, watching this cycle is just as frustrating and pointless for the therapist as it is for the participants. If a couple can't learn to get past this stalemate they are doomed. They will keep arguing without "moving the ball forward" as Dr. Tatkin likes to say. This ongoing stalemate will contribute to both feeling hurt, unheard, invalidated and hopeless. Over time intimacy wanes, distance increases and thoughts of divorce, affairs or falling into addictive patterns creep in.
Interestingly research done by Dr. Gottman indicates that the goal of healthy couples is not to stop fighting. It's to USE fights for what they are meant for-- again, as Dr. Tatkin says-- "moving the ball forward". Each partner needs to feel that their own agenda has been advanced while also NOT harming the other partner. This is a LOT harder than it seems!
I have studied a lot of different theorists and clinicians that work with couples. My absolute favorite is Dr. Stan Tatkin. He is practical, realistic and science-based. What follows here are excerpts from an article that was written by BELINDA LUSCOMBE on 12/12/18. She is an editor-at-large at TIME and interviewed Dr. Tatkin. Luscombe writes about the "inevitable really stupid fight you keep having over who threw whom under the [bus] last time you went over to that person’s place for that thing." She talked to Stan Tatkin who has just released his new book We Do: Saying Yes to a Relationship of Depth, True Connection and Enduring Love about his experience with couples fighting and his approach, the Psychobiological Approach to Couples Therapy.
Luscombe discusses how Dr.Tatkin "studies couples by filming them during a fight and then doing video microanalysis (a slow-motion, frame-by-frame examination of the footage) to see what’s really going on. Through this analysis, he has found that the human brain has a set of characteristics that can make fights with our loved ones worse—and that we can out-maneuver, to find better resolutions faster." She states that Dr. Tatkin found predictable errors that partners make, including the following:
And by the way, here is a hint-- the right responses to the bold-faced mistakes are in bold italics!!
I found Luscombe's article well-written, clear and very helpful! I recommend reading it and trying to apply these tips in your relationships with other fallible, poorly communicating, subjectively-limited but wonderful human beings. If you want to reach out to her or the editors at time.com contact them at email@example.com.
Wishing you love and connection in all your relationships,
PS If you have found this information helpful or interesting please "tweet" about it on Twitter, re-post it on Facebook or spread it via other social media platforms! Help me spread the word about good mental health resources! Thanks!
And of course if you want to leave a comment I will respond ASAP. Also feel free to suggest future blog topics.
"An Introduction to PACT Therapy" will cover the fundamental aspects of PACT therapy that make it so distinctly different (and arguably more effective!) than other forms of couple's work. If you have avoided working with couples for fear of the complexity this talk will help excite you to the possibilities and show you a clear and coherent model that is elegantly simple. If you already work with couples and find that there are particular couples, dynamics or situations that you struggle with this talk may help you see how to work in a new and different way that taps implicit learning and deep emotional patterns, creating fast and lasting change.
In an effort to spread the word about PACT I’m going to be giving a talk in Houston on Friday, January 11, 2019. All are welcome to attend. If you would like to purchase a ticket please click on the link below!
For many decades, spirituality, and even more so religion, was considered to be at odds with psychology and psychiatry. It is true that Sigmund Freud, arguably the inventor of "the talking cure", was not a fan. However, as with everything in life, things change. Psychology is no longer as opposed to spirituality and religion as it's creator may have intended it to be. Personally, I am a researcher by nature, so as with all questions I like to consult the data.
I realize that may sound quite contradictory for something that is predicated on instances and people whose existence cannot be proven-- God, the Holy Spirit, immortal life, karma, reincarnation, sin, heaven, hell, deities, etc. However, the position I take as a therapist is not to have an opinion on the veracity of any particular religion or spiritual belief system, but to have a position on the benefits or utility of such beliefs for the human condition. And this is where research is the perfect tool.
There has actually been a fair amount of research on the impact of a spiritual or religious belief system on mental health. For example the American Journal of Psychiatry and Archives of General Psychiatry found that of articles published over a 12-year span that included an assessment of spiritual or religious commitment in clients, 72% of those variables were shown to be beneficial to mental health. Additionally this same study found that participation in religious services, social support, prayer and a relationship with God were beneficial in 92% of citations.
There have been numerous studies showing that a spiritual or religious belief system, and an active relationship with that belief system (as evidenced by attendance in services, prayer, meditation or other regular expressions of this belief system) have a beneficial protective factor against depression (for example see Brown and Prudo).
However depression is not the only diagnosis that seems to benefit from this quality. Sharma, et al (2017) looked at 3151 military veterans and found that religious or spiritual belief systems were associated with decreased risk for lifetime PTSD, major depressive disorder and alcohol use disorder. The higher the rating of spiritual or religious beliefs the higher the rating of a sense of gratitude, purpose in life, and good recovery from PTSD.
Perhaps even more impressive is a study done on people suffering from schizophrenia, a severely debilitating and life-long mental disorder. The Department of psychiatry at Christian Medical College, Vellore did a multi-site study involving three clinics over 5 years of follow-up. The results showed that those patients suffering from schizophrenia who spent more time in spiritual or religious activities tended to have a better prognosis.
Spirituality and/or religion seems not only to benefit the individual but also their offspring. Thomas Ashby Wills, Professor of Epidemiology and population health at Albert Einstein College of Medicine found that having a strong investment in one's religious beliefs "kept children from smoking, drinking and drug abuse by buffering the impact of life stresses." (emphasis added) Gene H. Brody, a research professor of child and family development at the University of Georgia, Athens, found that parents who incorporated regular spiritual or religious activities into their lives had better marital relationships and parenting skills. Their children rated higher on measures of competence, self-regulation, psychosocial adjustment and school performance. Miller et al. made a 10-year follow up study on depressed mothers and their offsprings and reported that mothers who had a strong spiritual or religious belief system and who had children who also agreed with these beliefs had less incidence of depression in their children. In terms of how people with mental illness rate the importance of spirituality or religious beliefs, Wagner and King conducted a study of patients who had psychotic illness and found that the existential (i.e. spiritual or religious) needs were the most important even compared to things like housing or employment.
Again this is just a sampling, but having reviewed many more articles over the years it is my firm belief that having a strong spiritual or religious belief system, coupled with an active practice of those beliefs (through prayer, meditation, attendance of services, reading of literature or other activities) can be a significant source of help and protection in the area of mental health. Research shows it not only protects us against developing many mental illnesses but helps us recover better from or live better with those disorders. It strengthens our pair-bonds/marriages, helps us be better parents and improves our outlook on life. As a therapist I am an unabashed fan of spirituality and religion. What kind is up to my client and their spiritual advisors. But I do encourage anyone who has not found a spiritual belief system or religion that feels comfortable for them to continue to look. There are many options and, so far as we can tell from the research, no one provides more mental health benefits than the other.
I hope during this holiday season, when images and reminders of spirituality and religion abound, you will pause to consider whether or not you have these beliefs in place and how that may impact your mental health. While no one can argue that religion and spiritual beliefs have at times been grossly misused, it may be time not to throw the baby out with the bath.
Wishing you health, happiness, peace and serenity in this holiday season and into the new year,
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Some time ago I published a blog on the "Care and Feeding of your Island/Avoidant Partner". For those of you unfamiliar with the Psychobiological Approach to Couples Therapy (PACT), "Islands" and "Waves" are the terms coined by Dr. Stan Tatkin to help people understand attachment styles and how they show up in romantic relationships.
"Wave-ish" partners have a few hallmark qualities that can help you identify them. They tend to like to talk, especially at night as they are settling down. They tend to be soothed by contact, so they tend to like physical touch. They tend to be more expressive with their faces and their voices, some would say leaning towards the dramatic...In terms of weaknesses, waveish folks may complain about feeling overwhelmed more than others. They also have a tendency to have more of a negativity bias so they may regurgitate old hurts in the midst of an argument. It can feel like they never really let go of anything.
Since one of the main principles of successful relationships is that they are fair and equal it only makes sense after writing about how to care for an island that I now go on to talk about how to take great care of wave-ish partners too. So here goes...
Wave-ish folks, like the rest of us, are subject to becoming more extreme versions of themselves once married. This has to do with breaching that final level of commitment to where our partners are now also family. We all carry around inside of us memories of how we were treated in childhood, and how we observed our family members treating each other. These templates are more flexible and less evident in our relationships with our friends and co-workers. Once someone enters into the realm of true family these templates are often re-activated in powerful ways and they tend to amplify our natural tendencies learned as children. This is the reason that you hear "but I don't have these problems with ________ (insert my co-workers, my friends, my neighbors...). We use different neural networks in relating to our attachment figures (like our romantic partners) compared to other people in our lives. That's where the real rubber meets the road...
So as with Islands, once Waves are truly committed you may see the following tendencies emerge more strongly:
Fear abandonment, even in ways that seem more minor. Wave-ish folks experienced inconsistent parenting, such that they were sometimes coddled and given lots of attention but then sometimes unexpectedly rebuffed or pushed away and even shamed for being "too needy" or "too much". They intuitively expect the other shoe to drop and expect to be rejected. This gets worse with commitment for the reasons mentioned above. Your wave-ish partner may start reacting to you leaving, even if you are just running some errands, causing you to feel bewildered and frustrated. Know that departures can be triggering for them and leave with an extra dose of love. Let them know that you are going but will be thinking of them while you are gone and look forward to seeing them when you get back. Give them a hug before you leave. Send them a text (doesn't have to be fancy, a heart or smiley face will do) while you are out. Think of them as a kid who gets nervous when their mom or dad are suddenly unavailable. They need reassurance around both departures and reunions.
Can get prickly when you reunite after being apart. Again this can be VERY confusing for their partners, who have no idea that the separation was stressful. They come home from running some errands to a wave-ish partner picking a fight. Crazy, I know. But remember that they fear you leaving and when you do they may feel a surge of anger at being left. Since they tend to have trouble letting go of the past they may think about this the whole time you are gone. Then when you get back, wham! they let you have it. THEY DON'T DO THIS CONSCIOUSLY OR ON PURPOSE. Please, please, keep this in mind. It is no picnic for them either. No one likes to feel upset, so if your wave-ish partner is being cranky or downright mad remember that what is underneath that is emotional pain. They are hurting. One of the most fool-proof ways to soothe a wave-ish person is to hold them. They usually melt under touch. They also tend to love eye-contact. So hold them, gaze lovingly into their eyes and tell them that they can depend on you to never abandon them. Tell them that you know that they don't like it when they are alone and tell them you missed them! This, along with a good warm hug, usually works wonders on a cranky wave.
Can ramp up their emotional intensity, especially if you are island-ish. Remember the opposite styles amplify each other. So if you are island-ish, after marriage or deep commitment you will tend to move away a bit. This is likely to bring about protest behavior from your wave. It may be more clinging or it may be more frustration and accusations about how aloof you are. Or both. Try to remember that a wave-ish person is like a fussy baby. They make a lot of noise and you may be inclined to simply leave rather than deal with the fuss. But just like a crying baby they need your help, love and soothing. They tend to calm down MUCH faster than their partners think. So moving in, using touch, soothing words and eye contact can usually get a wave-ish person to get some emotional equilibrium pretty quickly. Even if you are not an island your wave-ish partner may get extra emotional after the deep commitment. Be prepared for this and don't blame them or tell them they are crazy. They are expressing their fear that you are not going to connect to them. Waves need a lot of connection and get more dramatic and emotionally messy when they don't get sufficient connection. Sadly they often unconsciously drive people away with their "fussiness", depriving themselves of the connection they need to get calm again. So know this and help them. It will pay you back tenfold in that you will not only have a more calm partner but you will have a partner who is eternally grateful to you for knowing what they need and giving it to them. Like islands, waves are often misunderstood. Your job is to not fall into that trap, to know them and take care of them.
May "spoil" things you try to do for them. This one is bound to make you feel crazy but remember they are not doing it intentionally. They want to be happy, just like any person does. However, since they have a childhood history of having the other shoe constantly dropped they anticipate being disappointed. So if you do something nice for them they may just turn around and "spoil" it somehow. If you take them out to dinner they may complain about the restaurant. If you buy them a gift they may tell you it's not their style, or the wrong color, or whatever. While the natural reaction to this would be to tell them to take a hike, you need to remember that they are acting from childhood pains. Tell them how much you love them and that you know they have been disappointed in the past. Tell them you don't want to disappoint them and you are open to hearing what they need from you. Don't take it personally when they try to spoil a gift or kindness. I know it's a tall order but you will be healing a deep and very painful wound from their childhood. Which is really, in my opinion, what marriage is all about. And that's a two-way street, so when you heal your wave's painful childhood issues they will do the same in return. And once wounds are healed you will see a lot less of this behavior, so it pays dividends forward.
Tend to respond with a negative a lot of the time. So if you propose a vacation to the beach they are likely to tell you the five reasons that's a bad idea. Don't bite. Just let them know that you know that they tend to find "what's wrong with the picture" before being willing to see what might be right. Tell them you are going to overlook their first response and give them another chance. If your partner is good with humor, you can say something like "OK my beautiful nattering naybob of negativity, now that you have gotten all the no's out of your system, can we revisit the idea?". Then flash them a loving smile. When used with love and kindness humor can be a great way to re-boot an activated wave.
May get really preoccupied with being "too much" or "too needy". Remember that wave-ish folks had childhoods where people alternately showered them with attention and told them they were too much and rebuffed them. So they are naturally afraid of overwhelming people. Paradoxically this leads to a lot of anxiety, which can make them more emotional, more clingy and more negative. Which has the unintended consequence of making their parter get exasperated with them! Be on the lookout for your wave-ish partner feeling judged as too needy or overwhelming. A wave-ish partner may misinterpret signals like you looking away during a conversation or sighing when they tell you something they need. Be careful to let your wave-ish person know they are NOT too much for you and that you have no intention of leaving them. Help them feel safe and secure and you will find their wave-ishness will actually diminish!
May have trouble ending an argument or letting it go afterwards. Wave-ish folks have trouble with endings, even arguments! They may keep it going because closing up something feels in a way like loss. They may also hold on to hurts from the past to act as a bulkhead against being vulnerable towards you in the future, which they fear will be rewarded with more hurt! Help your wave let go in an argument by reminding them that while there may be a part of them that tends to hang on, their body and mind deserve relief. Hold them tight at the end of a rough conversation and reassure them that if they let go they are not going to be setting themselves up for additional injury.
May not look out well for their partner in social situations. If you go to a party or event your wave-ish partner may wander off to socialize and "drop" you. This is because their parents dropped them (emotionally) as kids. Don't take this personally and remind them before you go out to social events that you would like for them to keep track of you and circle back at predetermined intervals to keep you feeling connected.
Waves are not any more difficult than islands. And like islands they do not do these things "on purpose" or with the intent of making their partner crazy. Learn to love your wave and help them to manage their emotional reactivity. They will greatly appreciate your help in containing some of their intensity and you will feel calmer knowing you are not about to be plowed under by a tsunami!
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Wishing you happiness and health,
I recently came across an amazing article that really helps to delineate the difference between attachment parenting, which is a style of parenting that promotes specific behaviors like co-sleeping, breastfeeding and "wearing" your baby, versus secure attachment, which is more about repeated patterns of moment-to-moment attunement in interactions and how repairs are made (or not made). While many parents, myself included, would like to think that practicing attachment parenting guarantees secure attachment in your child, it actually does not.That isn't to say that there is no merit in attachment parenting suggestions, however, in and of themselves they are insufficient to produce a securely attached kid.
I felt like this article did such a good job explaining all of this it seemed crazy to try to paraphrase it on my own. So I am just copying it here. I hope others will find it as helpful and thought-provoking!
What is a Secure Attachment? And Why Doesn’t “Attachment Parenting” Get You There?
April 3, 2017
A few months ago, a young friend of mine had a baby. She began a home birth with a midwife, but after several hours of labor, the baby turned to the side and became stuck. The midwife understood that the labor wouldn’t proceed, so she hustled the laboring Amelie into the car and drove the half-mile to the emergency room while Amelie’s husband followed. The birth ended safely, and beautiful, tiny Sylvie emerged with a full head of black hair. The little family of three went home.
When the baby was six weeks old, Amelie developed a severe breast infection. She struggled to continue breastfeeding and pumping, but it was extremely painful, and she was taking antibiotics. Finally she gave in to feeding her baby formula, but she felt distraught and guilty. “Make sure you find some other way to bond with your baby,” her pediatrician said, adding to her distress.
“Piglet sidled up to Pooh from behind. “Pooh!” he whispered.
”Nothing,” said Piglet, taking Pooh’s paw. “I just wanted to be sure of you.”
— A. A. Milne
Fortunately, sleep came easily to Sylvie; she slumbered comfortably in a little crib next to Amelie’s side of the bed. Still, at four months, Amelie worried that the bond with her baby wasn’t forming properly and she wanted to remedy the problem by pulling the baby into bed. Baby Sylvie wasn’t having it. When she was next to her mother, she fussed; when Amelie placed her back in the crib, she settled. Again, Amelie worried about their relationship.
“Amelie” is an amalgam of actual friends and clients I have seen in the last month, but all of the experiences are real. And as a developmental psychologist, I feel distressed by this suffering. Because while each of the practices—home birth, breastfeeding, and co-sleeping—has its benefits, none of them is related to a baby’s secure attachment with her caregiver, nor are they predictive of a baby’s mental health and development.
“Attachment is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.”
— Alan Sroufe “Attachment is not a set of tricks,” says Alan Sroufe, a developmental psychologist at the Institute for Child Development at the University of Minnesota. He should know. He and his colleagues have studied the attachment relationship for over 40 years.
Why the confusion about a secure attachment?
Over the last 80 years, developmental scientists have come to understand that some micro-dynamics that take place between a baby and an adult in a caring relationship have a lifelong effect, in very specific ways, on the person that baby will become.
“Attachment,” Sroufe explains, “is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.”
A secure attachment has at least three functions:
In spite of the long scientific history of attachment, psychologists have done a rather poor job of communicating what a secure attachment is and how to create one. In the meantime, the word “attachment” has been co-opted by a well-meaning pediatrician and his wife, William and Martha Sears, along with some of their children and an entire parenting movement. The “attachment parenting” philosophy promotes a lifestyle and a specific set of practices that are not proven to be related to a secure attachment. As a result, the movement has sown confusion (and guilt and stress) around the meaning of the word “attachment.”
The attachment parenting philosophy inspired by the Searses and promoted by an organization called Attachment Parenting Internationalis centered on eight principle concepts, especially breastfeeding, co-sleeping, constant contact like baby-wearing, and emotional responsiveness. The approach is a well-intentioned reaction to earlier, harsher parenting advice, and the tone of the guidance tends to be baby-centered, supportive, and loving. Some of the practices are beneficial for reasons other than attachment. But the advice is often taken literally and to the extreme, as in the case of my “Amelie,” whose labor required hospital intervention and who suffered unduly in the belief that breastfeeding and co-sleeping are necessary for a secure attachment.
Attachment parenting has also been roundly critiqued for promoting a conservative Christian, patriarchal family structure that keeps women at home and tied tightly to their baby’s desires. Additionally, the philosophy seems to have morphed in the public consciousness into a lifestyle that also includes organic food, cloth diapers, rejection of vaccinations, and homeschooling. The Searses have sold millions of books, and they profit from endorsements of products that serve their advice.
“These [attachment parenting principles] are all fine things,” observes Sroufe “but they’re not the essential things. There is no evidence that they are predictive of a secure attachment.”
Sroufe unpacks feeding as an example: A mother could breastfeed, but do it in a mechanical and insensitive way, potentially contributing to an insecure attachment. On the other hand, she could bottle-feed in a sensitive manner, taking cues from the baby and using the interaction as an opportunity to look, talk, and play gently, according to the baby’s communication—all behaviors that are likely to create secure attachment. In other words, it is the quality of the interaction that matters. Now, one might choose breastfeeding for its digestibility or nutrition (though the long-term benefits are still debated), but to imply, as Amelie’s pediatrician did, that bottle-feeding could damage her bond with her baby is simply uninformed.
There is also confusion about what “constant contact” means. Early on, the Searses were influenced by the continuum concept, a “natural” approach to parenting inspired by indigenous practices of wearing or carrying babies much of the time. This, too, might have been taken up in reaction to the advice of the day, which was to treat children in a more businesslike manner. There is no arguing that skin-to-skin contact, close physical contact, holding, and carrying are all good for babies in the first few months of life, as their physiological systems settle and organize. Research also shows that the practice can reduce crying in the first few months. But again, what matters for attachment is the caregiver’s orientation and attunement: Is the caregiver stressed or calm, checked out or engaged, and are they reading a baby’s signals? Some parents misinterpret the prescription for closeness as a demand for constant physical closeness (which in the extreme can stress any parent), even though the Searses do advise parents to strive for a balanced life.
“There’s a difference between a ‘tight’ connection and a secure attachment,” Sroufe explains. “A tight attachment—together all the time—might actually be an anxious attachment.”
And what of emotional responsivity? This, too, has a kernel of truth, yet can be taken too far. It is safe to say that all developmental scientists encourage emotional responsiveness on the part of caregivers: The back-and-forth, or serve-and-return, is crucial to brain development, cognitive and emotional development, the stress regulation system, and just authentic human connection. But in my observation, well-meaning parents can become overly-responsive—or permissive—in the belief that they need to meet every request of the child. While that is appropriate for babies in the first half to one-year year of life (you can’t spoil a baby), toddlers and older children benefit from age-appropriate limits in combination with warmth and love. On the other hand, some parents feel stressed that they cannot give their child enough in the midst of their other responsibilities. Those parents can take some comfort in the finding that even within a secure attachment, parents are only attuned to the baby about 30% of the time. What is important, researchers say, is that the baby develops a generalized trust that their caregiver will respond and meet their needs, or that when mismatches occur, the caregiver will repair them (and babies, themselves, will go a long way toward soliciting that repair). As long as the caregiver returns to the interaction much of the time and rights the baby’s boat, this flow of attunements, mismatches, and repairs offers the optimal amount of connection and stress for a baby to develop both confidence and coping, in balance.
What is the scientific view of attachment?
The scientific notion of attachment has its roots in the work of an English psychiatrist named John Bowlby who, in the 1930s, began working with children with emotional problems. Most professionals of the day held the Freudian belief that children were mainly motivated by internal drives like hunger, aggression, and sexuality, and not by their environment. However, Bowlby noticed that most of the troubled children in his care were “affectionless” and had experienced disrupted or even absent caregiving. Though his supervisor forbade him from even talking to a mother of a child (!), he insisted that family experiences were important, and in 1944 he wrote his first account of his observations based on 44 boys in his care. (Around the same time in America, psychologist Harry Harlow was coming to the same conclusion in his fascinating and heart-rending studies of baby monkeys, where he observed that babies sought comfort, and not just food, from their mothers.)
Bowlby went on to study and treat other children who were separated from their parents: those who were hospitalized or homeless. He came to believe that the primary caregiver (he focused mainly on mothers) served as a kind of “psychic organizer” to the child, and that a child needs this influence, especially at certain times, in order to develop successfully. To grow up mentally healthy, then, “the infant and young child should experience a warm, intimate, and continuous relationship with this mother (or permanent mother substitute) in which both find satisfaction and enjoyment.”
But the attachment figure doesn’t have to be the mother or even a parent. According to Bowlby, babies form a “small hierarchy of attachments.” This makes sense from an evolutionary view: The number has to be small since attachment organizes emotions and behavior in the baby, and to have too many attachments would be confusing; yet having multiples provides the safety of backups. And it’s a hierarchy because when the baby is in need of safety, he or she doesn’t have time to analyze the pros or cons of a particular person and must automatically turn to the person already determined to be a reliable comfort. Research shows that children who have a secure attachment with at least one adult experience benefits. Babies can form attachments with older siblings, fathers, grandparents, other relatives, a special adult outside the family, and even babysitters and daycare providers. However, there will still be a hierarchy, and under normal circumstances, a parent is usually at the top.
In the 1950s, Mary Ainsworth joined Bowlby in England, and a decade later back in the U.S. began to diagnose different kinds of relationship patterns between children and their mothers in the second year of life. She did this by watching how babies reacted in a sequence of situations: when the baby and mother were together, when they were separated, when the baby was with a stranger, and when baby was reunited with the caregiver after the separation. Ainsworth and colleagues identified the first three of the following patterns, and Mary Main and colleagues identified the fourth:
The mothers who fall into this pattern are responsive, warm, loving, and emotionally available, and as a result their babies grow to be confident in their mothers’ ability to handle feelings. The babies feel free to express their positive and negative feelings openly and don’t develop defenses against the unpleasant ones.
The mothers in insecure-avoidant attachments often seem angry in general and angry, specifically, at their babies. They can be intolerant, sometimes punishing, of distress, and often attribute wrong motivations to the baby, e.g., “He’s just crying to spite me.” One study showed that the insecurely-attached babies are just as physiologically upset (increased heart rates, etc.) as securely attached babies when parents leave but have learned to suppress their emotions in order to stay close to the parent without risking rejection. In other words, the babies “deactivate” their normal attachment system and stop looking to their mothers for help.
As toddlers, insecure-avoidant children don’t pay much attention to their mothers or their own feelings, and their explorations of the physical world are rigid and self-reliant. By preschool, these children tend to be more hostile, aggressive, and have more negative interactions overall. Avoidance and emotional distance become a way of dealing with the world, and instead of problem-solving, they are more likely to sulk or withdraw.
These babies are not easily comforted. They seem to want the close relationship, but the mother’s inconsistency and insensitivity undermine the baby’s confidence in her responses. This pattern also undermines the child’s autonomy, because the baby stays focused on the mother’s behavior and changing moods to the exclusion of nearly everything else. In insecure-ambivalent babies, separation anxiety tends to last long after secure babies have mastered it. Longitudinal studies show that these children often become inhibited, withdrawn, and unassertive, and they have poor interpersonal skills.
This pattern can also result when the mother has a mental illness, substance addiction, or multiple risk factors like poverty, substance abuse and a history of being mistreated. Babies of mothers like this can be flooded with anxiety; alternatively, they can be “checked out” or dissociated, showing a flat, expressionless affect or odd, frozen postures, even when held by the mother. Later these children tend to become controlling and aggressive, and dissociation remains a preferred defense mechanism.
“The emotional quality of our earliest attachment experience is perhaps the single most important influence on human development.”
— Alan Sroufe and Dan Siegel
How important is attachment?
“Nothing is more important than the attachment relationship,” says Alan Sroufe, who, together with colleagues, performed a series of landmark studies to discover the long-term impact of a secure attachment. Over a 35-year period, the Minnesota Longitudinal Study of Risk and Adaption (MLSRA) revealed that the quality of the early attachment reverberated well into later childhood, adolescence, and adulthood, even when temperament and social class were accounted for.
One of the most important—and, to some ways of thinking, paradoxical—findings was that a secure attachment early in life led to greater independence later, whereas an insecure attachment led to a child being more dependent later in life. This conclusion runs counter to the conventional wisdom held by some people I’ve observed who are especially eager to make the baby as independent and self-sufficient as possible right from the start. But there is no pushing independence, Sroufe found. It blooms naturally out of a secure attachment.
In school, securely attached children were more well-liked and treated better, by both their peers and their teachers. In one study, teachers who had no knowledge of a child’s attachment history were shown to treat securely attached children with more warmth and respect, set more age-appropriate standards, and have higher expectations. In contrast, teachers were more controlling, had lower expectations, got angry more often, and showed less nurturing toward the children with difficult attachments—and who, sadly, had a greater need than the securely attached kids for kindness from adults.
The MSLRA studies showed that children with a secure attachment history were more likely to develop:
A large body of additional research suggests that a child’s early attachment affects the quality of their adult relationships, and a recent longitudinal study of 81 men showed that those who grew up in warm, secure families were more likely to have secure attachments with romantic partners well into their 70s and 80s. A parent’s history of childhood attachment can also affect their ability to parent their own child, creating a cross-generational transmission of attachment styles.
But early childhood attachment with a parent is not destiny: It depends on what else comes along. For example, a secure preschool child can shift to having an insecure attachment later if there is a severe disruption in the caregiving system—a divorce or death of a parent, for example. But the effect is mediated by how stressed and available the primary attachment figure is. In other words, it’s not what happens, but how it happens that matters. Children who were previously secure, though, have a tendency to rebound more easily.
Sroufe writes in several articles that an insecure attachment is not fate, either; it can be repaired in a subsequent relationship. For example, good-quality childcare that offers emotional support and stress reduction can mitigate a rocky start at home. A later healthy romantic relationship can offset the effects of a difficult childhood. And good therapy can help, too, since some of the therapeutic process mimics the attachment process. Bowlby viewed development as a series of pathways, constrained by paths previously taken but where change is always possible.
Without conscious intervention, though, attachment styles do tend to get passed through the generations, and Bowlby observed that becoming a parent particularly activates a parent’s childhood attachment style. One study looked at attachment styles over three generations and found that the mother’s attachment style when she was pregnant predicted her baby’s attachment style at one year of age for about 70% of cases.
What about parents who might not have gotten a good start in life and want to change their attachment style? There’s good news. Research on adult attachment shows that it is not the actual childhood experiences with attachment that matter but rather how well the adult understands what happened to them, whether they’ve learned some new ways of relating, and how well they’ve integrated their experience into the present. In other words, do they have a coherent and realistic story (including both good and bad) of where they’ve been and where they are now?
Support matters, too. In one of Sroufe’s studies, half the mothers were teenagers, which is usually a stressful situation. Sroufe found that the teenagers with good social support were able to form secure attachments with their babies, but if they didn’t have support, they were unlikely to form a secure attachment.
How to parent for a secure attachment and how to know if it’s working.
“The baby needs to know that they’re massively important,” says Sroufe. “A caregiver should be involved, attentive, sensitive, and responsive.”
“The baby will tell you what to do,” Sroufe explains. “They have a limited way of expressing their needs, so they’re not that difficult to read: If they’re fussing, they need something. If their arms are out, they want to be picked up. And if you misread them, they will keep on signaling until you get it right.” He gives the example of bottle-feeding a baby: “The baby might want a break, and she looks around. What does the baby want? To look around! If the parent misreads and forces the bottle back, the baby will insist, maybe snap her head away, or pull away harder.”
“How can I know if my baby is securely attached?” a client asked me about her six-month old. Clearly observable attachment doesn’t emerge until around nine months, but here are some clues that a secure attachment is underway:
Beyond this age, the attachment relationship becomes more elaborated. With language and memory, the rhythms of attachment and separation become more negotiated, talked about, and planned, and there is more of a back-and-forth between parent and child. By toddlerhood and beyond, an authoritative parenting style deftly blends secure attachment with age-appropriate limits and supports. A sensitive parent allows the changing attachment to grow and stretch with a child’s growing skills, yet continues to be emotionally attuned to the child and to protect their safety.
One of the best resources for how to parent for a secure attachment in the first few years of life is the new book Raising A Secure Child by Kent Hoffman, Glen Cooper, and Bert Powell, all therapists who have worked with many different kinds of families for decades. Their work is based squarely on the science of attachment, and they call their approach the Circle of Security. The circle represents the seamless ebb and flow of how babies and young children need their caregivers, at times coming close for care and comfort, and at other times following their inspiration to explore the world around them. The caregivers’ role is to tune into where on the circle their child is at the moment and act accordingly. Parenting for a secure attachment, the authors say, is not a prescriptive set of behaviors but more a state of mind, a way of “being with” the baby, a sensitivity to what they are feeling. The authors also help parents see the ways that their own attachment history shows up in their parenting and help them to make the necessary adjustments.
The neurobiology of attachment
“Attachment theory is essentially a theory of regulation,” explains Allan Schore, a developmental neuroscientist in the Department of Psychiatry at the UCLA David Geffen School of Medicine. A clinician-scientist, he has elaborated modern attachment theory over the last three decades by explaining how the attachment relationship is important to the child’s developing brain and body.
Early brain development, Schore explains, is not driven just by genetics. The brain needs social experiences to take shape. “Mother Nature and Mother Nurture combine to shape Human Nature,” he writes.
Infants grow new synapses, or neural connections, at a rate of 40,000 new synapses a second, and the brain more than doubles in volume across the first year. Genetic factors drive this early overproduction of neurons, Schore explains, but the brain awaits direction from the social environment, or epigenetic processes, to determine which synapses or connections are to be pruned, which should be maintained, and which genes are turned on or off.
One of the first areas of the brain that begins to grow and differentiate is the right brain, the hemisphere that processes emotional and social information. The right brain begins to differentiate in the last trimester in utero, whereas the left-brain development picks up in the second year of life. Some of the regions that process emotion are already present in infants’ brains at birth—the amygdala, hypothalamus, insula, cingulate cortex, and orbitofrontal cortex. But the connections among these areas develop in specific patterns over the first years of life. That’s where input from the primary relationship becomes crucial—organizing the hierarchical circuitry that will eventually process, communicate, and regulate social and emotional information.
“What the primary caregiver is doing, in being with the baby,” explains Schore, “is allowing the child to feel and to identify in his own body these different emotional states. By having a caregiver simply ‘be with’ him while he feels emotions and has experiences, the baby learns how to be,” Schore says.
The part of the brain that the primary caregiver uses for intuition, feeling, and empathy to attune to the infant is also the caregiver’s right brain. So it is through “right-brain-to-right brain” reading of each other, that the parent and child synchronize their energy, emotions, and communication. And the behaviors that parents are inclined to do naturally—like eye contact and face-to-face interaction, speaking in “motherese” (higher-pitched and slower than normal speech), and holding—are just the ones shown to grow the right-brain regions in the baby that influence emotional life and especially emotion regulation.
The evidence for epigenetic effects on emotion regulation is quite solid: Early caregiving experiences can affect the expression of the genes that regulate a baby’s stress and they can shape how the endocrine system will mobilize to stress. Caregiving behaviors like responsiveness affect the development of the baby’s vagal tone (the calming system) and the hypothalamic-pituitary axis (the system that activates the body to respond to perceived danger). High quality caregiving, then, modulates how the brain and body respond to and manage stress.
Schore points out that the ventromedial prefrontal cortex, a brain region in the right hemisphere, both has the most complex emotion and stress-regulating systems of any part in the brain and is also the center of Bowlby’s attachment control system. Neurobiological research confirms that this region is “specifically influenced by the social environment.” 
Stress management is not the only important part of emotion regulation. In the past, Schore explains, there was an overemphasis in the field of emotion regulation on singularly lowering the baby’s distress. But now, he says, we understand that supporting positive emotional states is equally important to creating [what he quotes a colleague as calling] a “background state of well-being.” In other words, enjoy your baby. It’s protective.
A baby’s emotion regulation begins with the caregiver, and the Goldilocks principle applies: If the caregiver’s emotions are too high, the stimulation could be intrusive to the baby, Schore explains. Too low, and the baby’s “background state” settles at a low or possibly depressive emotional baseline. Just right, from the baby’s point of view is best.
And babies are surprisingly perceptive at registering their feeling environment. Hoffman, Cooper and Powell write:
The youngest babies can sense ease versus impatience, delight versus resentment or irritation, comfort versus restlessness, genuine versus pretending, or other positive versus negative responses in a parent when these reactions aren’t evident to a casual observer. Little babies may pick up on the smallest sigh, the subtlest shift in tone of voice, a certain glance, or some type of body language and know the parent is genuinely comfortable or definitely not pleased.
Schore explains that in a secure attachment, the baby learns to self-regulate in two ways: One he calls “autoregulation” which is self-soothing, or using his own mind and body to manage feelings. The second is “interactive regulation” which is going to other people to help up- or down-regulate feelings. This twin thread of self-reliance and reliance on others, then, begins in the earliest months, becomes very important in the first two years of life, and continues in more subtle ways throughout the life span.
This all might sound daunting for a new parent, who could still be tempted to overdo the focus on the infant and how the connection is going—potentially leading to the same kinds of stress and guilt that the attachment parenting movement creates.
But fortunately, the caregiver doesn’t have to be 100% attuned to the baby and ongoing repairs are an important part of the process:
“The idea that a mother should never stress a baby is problematic,” Schore says. “Insecure attachments aren’t created just by a caregiver’s inattention or missteps. It also comes from a failure to repair ruptures. What is essential is the repair. Maybe the caregiver is coming in too fast and needs to back off, or maybe the caregiver has not responded, and needs to show the baby that she’s there. Either way, repair is possible, and it works. Stress is a part of life, and what we’re trying to do here is to set up a system by which the baby can learn how to cope with stress.” Optimal stress, he explains, is important for stimulating the stress-regulating system.
Still, both Sroufe and Schore acknowledge the emotional labor of parenting. And they are vehement that parents need to be supported in order to have the space and freedom to care for babies.
“It takes time for parents to learn to read their baby’s signals,” Sroufe said.
Schore calls America’s failure to provide paid family leave—and we’re the only country in the world that doesn’t—the “shame of America.”
“We are putting the next generation at risk,” he explains, pointing to rising rates of insecure attachments and plummeting mental healthamong American youth. Parents should have at least six months of paid leave and job protection for the primary caregiver, and at least two months of the same for the secondary one, according to Schore, and Sroufe goes further, advocating for one full year of paid leave and job protection. And a recent study showed that it takes mothers a year to recover from pregnancy and delivery.
Intellectual and cognitive development have been privileged in our society, but it is our emotion regulation that organizes us, our existence, and how we experience life, Schore says. A study from the London School of Economics draws the conclusion that “The most important childhood predictor of adult life-satisfaction is the child’s emotional health…. The least powerful predictor is the child’s intellectual development.”
So where does this leave my friend Amelie? The hard part will be navigating the distracting advice and creating the workarounds she needs for the lack of cultural support. But she enjoys her baby immensely, and I’m confident that she’ll form a secure attachment with Sylvie, as she trusts her own “right-brain” flow of empathy, feeling, and being, and tunes in to Sylvie’s own unique ways of communicating.
And Sylvie will do her part to draw her parents close. Because regardless of babies’ individual personalities—and whether they cry a lot or sleep very little, whether they’re breastfed or bottle-fed—they draw you in with their wide-open gaze, their milky scent, and their tiny fingers that curl around your big ones. Before you know it, they light you up with their full-body smile that’s specially for you, and they draw you near with their plump little arms clasped around your neck.
And the sweet elixir of the attachment relationship is underway.
 While many medications are considered safe to take while breastfeeding, complete side effects may not be fully understood. For example, recent research suggests antibiotics may change the test baby’s microbiome (the implications of which are unclear), and some antibiotics are thought to discolor developing teeth.
 This section refers to primary caregivers as mothers since this research focused just on mothers.
 This section was adapted from the chapter on Attachment, in D. Davies’ Child Development: A Practitioner’s Guide, Guilford, 2011.
 Sroufe, A. & Siegel, D. “The verdict is in: The case for attachment theory.”
 From Schore, A. (2017). Modern attachment theory, in APA’s Handbook of Trauma Psychology, p. 6.
 Schore, A. (2017). “Modern attachment theory.” In APA Handbook of Trauma Psychology: Vol 1 (publication pending).
 http://onlinelibrary.wiley.com/doi/10.1111/ecoj.12170/full p. F720, in Layard,R., Clark, A.E., Cornaglia, F., Powdthavee, N. & Vernoit, J. (2014) What predicts a successful life? A life-course model of well-being. The Economic Journal, 124, p. F720-F738.
I get this question a lot. So I decided to write a blog post about it. Now, of course first you need to realize that you cannot control another person. Believe me, I have tried and tried hard. I like to say that I am just stubborn enough and strong-willed enough and persistent enough that if anyone COULD control another person it would be me. And I have always failed every time I tried.
So please realize that. You cannot force another person to do anything, least of all couples therapy. Not without firearms being involved (shotgun therapy?) which most therapists will strongly discourage.
That said you do have some options if you are a partner who wants to get into couples therapy and your person is not on board. First I would suggest trying to understand their position. This is best done when you are CALM. So not in the midst of a fight. Seriously. That's important.
So if you are calm, sit down with your person and ask them if this is a good time to talk about something that is important to you. This cues them to pay attention and reminds you not to try to have this conversation while you are driving to dinner, doing laundry together or generally distracted. These kinds of conversations need their own time and space. As a PACT therapist I also recommend that you sit in a way where you can face each other directly so that you can see each other's faces dead-on. This helps reduce the chance that you will mis-read each other's facial expressions or accidentally trigger a threat response and cause your partner to become instinctually defensive.
Now that the stage is properly set let your partner know that you have given this a lot of thought and that you would very much like them to go to couples therapy with you. I am pretty sure if you are in this situation you have asked them this before. So they may get a little activated and say "I already told you I don't want to do that!" or something equally contrary. STAY CALM AND CARRY ON! You could say something like "You are right", (people love it when you tell them they are right), "you did tell me that. And I wanted to know if we could talk about why you don't feel like couple's therapy is something you want to do. I want to understand more about how you feel about it." Generally people want to be understood so this is a pretty non-inflammatory statement. However look at your person and if the veins in their forehead or neck are starting to bulge make sure that you take a nice slow breath and settle yourself as best you can. Then just let them know you just want to talk about it for maybe 10 minutes. That way they know that they are not trapped there forever. You can also say "I'd like to talk about this for maybe 10 minutes to see if I can better understand how you feel about it, unless that's not OK with you." Phrasing it this way tends to help people who can be a little reflexively defiant to be more agreeable. Then set a timer on your smart phone and put it on the table so your partner knows you mean business. They are not trapped forever!
Once you have set the stage as well as you possibly can, and assuming they have not stormed off, I recommend starting with asking them why they feel couples therapy would not be helpful. DON'T COMMENT!! Just listen. No matter what they say don't interject. This will be hard, trust me. But to be effective at this point you must just listen until they stop talking. Then repeat back to them what you think they said and ask "did I get that right?". Yes, folks, this is that "active listening" that you probably practiced in that hokey "emotional intelligence" class in High School. But trust me, it's important.
Then if they agree that you heard them right you can start taking their concerns one at a time. For example if they say "it's too expensive" you can say "yes, it is expensive, but I would be willing to forgo my weekly pedicures, or poker nights with the guys, or my daily Starbucks, or whatever, to contribute to the cause. Try to show that you understand that whatever their concern is there is some legitimacy to it but you are willing to give ground to allay their concern. If they say "I don't have the time" you could offer to take some chores off their plate or in some other way help them to create the time. You want to show that you are willing to put skin in the game.
Sometimes your partner may question how couple therapy can help. You can explain that having the right skills to be good in a relationship is just like any other skill we learn, like tennis for example. You can try to teach yourself tennis by reading a book or watching other people play tennis and you may learn to hit the ball but you may also develop some bad habits like holding the racket incorrectly or using a backhand when a forehand would be more effective in that moment. So if you really want to learn tennis well it makes a LOT more sense to engage a tennis instructor for a few lessons. After that you will understand the proper form and be able to practice on your own much more effectively. Couples can try to learn how to get along well without professional help, and they may make some progress, but they may also fumble more and even develop patterns that are not super healthy. Better to hire a "relationship coach" to help learn how to get along and after a period of time (3-6 months) you may have all of the skills you need to go do it on your own.
Another helpful offer in trying to get ones partner engaged in couples work is to ask him or her to just go to ONE session to see how s/he feels about it. Often a partner will be willing to go once (to an actual session by the way, not the 30-minute consultation, since no therapist could do enough in 30 minutes to help anyone see the value). In my experience I have never met with a couple once and had them not see the potential value of couples work.
Since I practice a very specific type of couples therapy (PACT) if you are interested in that style of couples work you could also ask your partner to at least familiarize himself/herself with PACT by :
These resources may help your partner understand what PACT couples therapy would look like and what kind of relationship principles you are interested in applying to your situation. It may spark some helpful conversations with your partner and/or help to get your partner more engaged around the idea of couples work.
Or finally if none of these suggestions works and you REALLY feel like you do not want to stay in the relationship if s/he is not willing to go to therapy then you have what we call a "deal-breaker" situation. You sit down with your partner and CALMLY tell him/her that you are simply not willing to continue in the relationship without professional help. You need to make VERY specific requests at this point (not vague) such as telling your partner that you need him/her to consent to scheduling meetings on a weekly basis for at least 6 months (these are the terms I recommend) and if s/he can't commit to that and show up and try it then you want to end the relationship. The thing about this option is that you MUST be willing to follow through with ending the relationship if your partner says no. So this only works if you are really at the end of your rope and don't want to go on without therapy.
Relationship are tough. Intimate relationships, in my opinion, are the toughest. Plenty of folks who can earn 6 figures, run companies, paint masterpieces, compose symphonies, run 4 minute miles or solve quadratic equations in their heads while doing back flips fail at intimate relationships. There is no shame in that. But there is help! I hope that these tips are useful to you in trying to engage a reluctant partner in therapy.
Wishing you happiness and harmony in your intimate partnership,
PS Remember if you have found this blog to be helpful to "like" it on Facebook or "tweet" about it on Twitter to help others find it! And always feel free to leave a comment, I will respond as soon as I can.
One of the clearest definitions of love addiction I have seen is "a compulsive, chronic craving and/or pursuit of romantic love in an effort to get our sense of security and worth from another person." Or, if you prefer something more pithy, author Ethlie Ann Vape calls it "affection deficit disorder". She goes on to say that "Every woman with an absent father-- whether through divorce, death, disease or distance-- is going to associate feelings of affection with feelings of abandonment" and therefore "confuse love and longing". That also seems pretty on target to me in terms of how people end up here. And men can be love addicts, too, and often have the same route to getting there-- a distant relationship with a parent that they desperately craved love and attention from.
Of course it's normal to gain a sense of security from being in a romantic partnership and we tend to feel especially good about ourselves if our partner occasionally tells us how great they think we are. Those are good and normal things. But in love addiction those normal aspects of being partnered become turbo-charged in an effort to prop up our inability to actually feel good about ourselves without a romantic connection. And unfortunately our culture is all to quick to provide is with totally unrealistic ideas of what love is. Sofo Archon, in his article "The Trap of Romantic Love", states that "Just like pornography fools us into believing that perfect sex exists, the romantic tradition fools us into believing that perfect relationships exist." We are fed a steady diet of Rom-Coms and images of celebrities falling madly in love and swimming off into the sunset on their private Caribbean island. It all seems so AMAZING and, insanely, we think that we too can have that and it will last forever...
Since our culture is obsessed with both sex and romance so it's no wonder that many of us are confused about what is healthy. I remember after my daughter was born walking down the aisles of Toys R Us acquainting myself with what little girls may want to play with. I was absolutely stunned when, in the aisle for 3-6 year olds I came up on a giant box about 3 feet tall that contained a mini wedding dress, tiny white plastic shoes, a veil, plastic flowers and a fake diamond solitaire ring. Yes, folks, it was a bride-in-a-box. The only thing needed was the poor hapless groom. I remember asking myself "what are we teaching our girls?" and noting that there was no corresponding "groom-in-a-box" option in the boys 3-6 aisle. While boys were busy being introduced to fake power tools, fireman's outfits and play lawn mowers girls were being trained to get hitched up and knocked up all before the age of 6. Sadly it was not the last of those surprises Then came all of the princess movies. The ones where princesses are cast into spells only to be awoken by a handsome prince. This was before the days of Frozen. And while Frozen is great, I still don't think it's enough to stem the tide of images that our girls absorb about the importance of romance and sex. Cosmopolitan magazine still has images of nearly eating-disordered young women scantily clad advising you on "how to give your man the best orgasm of his life" or "how to make him never forget you". The emphasis is still on a woman in relation to a man rather than as a stand-alone person. It's no wonder that MORE girls don't grow up to be love or sex addicts.
So what is love addiction? Is it a "real" addiction? If so, what does it have in common with other addictions? How can you tell if you suffer from Love Addiction? And if you do, what can you do about it?
One way to investigate whether or not the concept of Love Addiction might apply to you is to take an online test. The Center for Healthy Sex in Los Angeles, California has an online questionnaire that you can fill out. Love Addicts Anonymous (LAA) has their own version which may also be useful. I have worked with clients who used the Sex and Love Addicts Anonymous (SLAA) program and found that helpful also. SLAA has their own questionnaire that you can download as a pdf.
Once you decide whether or not you think you have a lot in common with this form of addiction what can you do? There are many ways to approach treatment. A qualified therapist can help you figure out what is unhealthy about how you create and participate in your romantic relationships and then format goals for what you would like to have with a partner. The therapist can help you develop a plan to achieve that goal which may involve therapy, support groups, readings and "homework" exercises to retrain your brain to relate romantically in a healthier way. Untreated love addiction, like any addiction, can create years or even decades of misery. By placing the love object at the center of your universe you lose the ability to know what is best for YOU and how to make decisions that will be equally beneficial to your partner AND yourself. This can result in a life that is woefully unfair and unfulfilling. The goal of treatment is to help you place yourself at the center of your priorities so that you can enter into a balanced relationship with others in which you enjoy them and value them but don't need them to plug holes in your self-esteem.
This year (2018) at the SXSW Film Festival a movie entitled Unlovable got rave reviews. It was written by, and stars, a woman who is a love addict. It is not yet available to rent but keep a lookout for it. I am betting it is going to be moving and funny and a great insight into one person's personal experience in looking to fill that "affection deficit" in all the wrong ways.
In the meantime if you feel like you may have a problem with love addiction I strongly encourage you to take one (or more) of the tests mentioned in this blog. The first step to fixing a problem is diagnosing the problem. Many resources exist to help those with love and/or sex addictions (by the way they are different but can co-occur). Like most emotional disorders this pattern can be changed and the result can be a much more balanced, fulfilling and peaceful live.
Wishing you health in your relationship to yourself as well as others,
P.S. As always if you have found this blog post to be helpful please "like" it on Facebook or "tweet" about it on Twitter. This helps others find the information and resources for mental health.
Krista Jordan, Ph.D.
Dr. Jordan has been in private practice for 20 years in Texas. She is passionate about helping people to overcome hurts and obstacles from their past to find more happiness and health in their current lives.