 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 http://www.developmentalscience.com/blog/2017/3/31/what-is-a-secure-attachmentand-why-doesnt-attachment-parenting-get-you-there 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.[1] 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. ”Yes, Piglet?” ”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.[2] 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.[3] “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:[4]
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: 0-3 months:
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.[5] “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.” [6] 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.”[7] 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. References: [1] 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. [2] This section refers to primary caregivers as mothers since this research focused just on mothers. [3] This section was adapted from the chapter on Attachment, in D. Davies’ Child Development: A Practitioner’s Guide, Guilford, 2011. [4] Sroufe, A. & Siegel, D. “The verdict is in: The case for attachment theory.” [5] From Schore, A. (2017). Modern attachment theory, in APA’s Handbook of Trauma Psychology, p. 6. [6] Schore, A. (2017). “Modern attachment theory.” In APA Handbook of Trauma Psychology: Vol 1 (publication pending). [7] 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.
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 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, Dr. Jordan 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, Dr. Jordan 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.  VICTIM. RESCUER. PERSECUTOR. That about covers it sometimes, right? Ever feel like you are in some weird play where there are always the same three characters? One person is getting screwed, one person is the hero trying to rescue that person and one person is the villain who is always seen as the bad guy. Which one do you most often get cast as? And how can you get out of that dynamic? That dynamic is called Karpman's (Drama) Triangle. I would love to say that I invented this dandy little concept. But it's actually been around for a long time. Since 1968 actually. It was invented by Stephen Karpman, a student of transactional analysis, and was called Karpman's Triangle or the "drama triangle". As anyone who has ever been in this dynamic can attest, it is definitely drama-producing! None of the roles are actually healthy and the goal if you find yourself in this situation is to move as much to the middle as possible, not aligning yourself with any of the positions. Despite what they might say about how they feel in the moment, be aware that the Victim role is not actually a person who is being harmed, it's a person who is emotionally invested in looking like they are being harmed. It is also a person who does not want to have to take responsibility for helping themselves out at all. They want everyone else to come and rescue them. They often complain to others that they are being abused, oppressed or victimized and that they cannot do anything about it. They are likely to block any suggestions that they can change their circumstances by saying things like "that won't work" or "I can't do that because _______". In reality they are invested in not acting as agents of change for themselves. These roles are usually learned in childhood by having them modeled by a parent, so if your mom played the victim role, you may find yourself repeating that pattern. Interestingly people who tend towards the Victim role will seek out Perpetrators if they don't have one in their life currently. Unconsciously they don't feel comfortable not being in that position so they have to create it. Sometimes what is at the bottom of this is a history of having been rewarded for being helpless and small and dependent as a child. This creates a conflict where they feel that in order to get their needs met they cannot actually do things for themselves or "grow up" and act as mature adults. They have to find ways to get a Rescuer to save them from a Perpetrator because they were trained never to "rescue" (or take care of) themselves. Remember that all of this is happening unconsciously so no one is actually "asking" to be victimized while being aware that is what is going on. The Victim thinks that they are just in a bad spot and can't seem to find a way out until they find the magic Rescuer who rushes in to save the day. I am not in any way saying that we cannot be compassionate about someone whose life is not going the way they want it. I am also not saying that whatever is done to someone in the victim role is acceptable. I am not victim-blaming. I am, however, saying that everyone has some power to make some changes in their lives and that victims often have a hard time seeing this. Rescuers are compulsive helpers. This is the classic Martyr role. Rescuers are so inclined to rescue that if they see a person in need and don't rush to their aid they feel terrible. They feel compelled to help others and don't see that this can deprive the Victim of learning to do for themselves. It also allows the Rescuer to focus on other people, which tends to be much more comfortable for them. They derive a lot of status and satisfaction from taking care of others and they don't have to face any of their own issues. Al-anon was originally developed for Rescuers and one of their mottos is "keep the focus on yourself (not the Victim!)". However just like the Victim, Rescuers are usually totally unaware that their role serves to keep them from dealing with their issues since it is entirely unconscious. They just tend to think of themselves as "good" people in a world where a lot of folks need a lot of help! They were often raised in families with a Victim and they learned early on to care for the Victim, which made them feel better about the situation of the family. The Persecutor tends to come from families in which one or both parents were bullies. They have seen this behavior modeled and follow along, blaming others, trying to control them, being critical, rigid, angry and often acting (or at least feeling) superior. The Persecutor thinks of themselves as "realistic" and "hard-nosed" but typically not malicious. They feel that the Victim and the Rescuer are naive and don't realize that it's a cold world out there and people are going to take what they can. It's kill or be killed and they plan to be on top. They view Victims as people from whom things can be extracted-- work, love, sex, money, status-- but not in a mutual way that cares for both people. When they have gotten what they need from others they may discard them. This can come in the guise of "realizing it just wasn't working out" because they have detected a "fatal flaw"in the person. As parents they tend to want to "toughen-up" their kids and may make kids feel like no matter what they do it's not good enough. Or they may blow up and rage at the kid(s) and then blame the kid(s) for causing them to get angry. They may have unreasonable rules that must be followed and refuse to allow kids (or partners) to negotiate on their own behalf. While we often learn one of these roles more deeply than the others in our families of origin we can also switch roles at any given time. A Victim may see an opportunity to retaliate against someone who has been a Perpetrator and take it, often in a passive-aggressive way that is not easy to detect. In this way they temporarily enjoy being a Perpetrator while maintaining the image of the Victim. A Rescuer may get tired of taking care of others and experiment once in a while with throwing up their hands and acting like a Victim. A Perpetrator may find that by occasionally acting like a Victim they can avoid taking responsibility for bullying others. However if we do this "drama triangle" regularly we do tend to gravitate towards one position based on our early experiences. Again the goal of emotional health is to not enter into any of these roles. Each of us has the capacity to be passive and dependent and wish that some fairy God mother/father would come along and take care of everything for us. And each of us has the fantasy of being the knight in shining armor riding in to save someone. And yes, even if we often don't like to admit it, we can also all be the kill-or-be-killed person who steps on others to get ahead and gets a thrill out of winning, even at any cost. If you suspect that you came from a dysfunctional family you may want to spend some time honestly asking yourself whether or not your parents show up in this triangle. If they do then you can ask yourself do YOU show up? And where? And what work do you need to do in order to move more to the middle? Victims need to learn to do for themselves and to feel pride and competence by growing up and owning their own power rather than wanting others to fix things. Rescuers need to ask themselves how they are avoiding their own pain, anxiety, sadness, grief, etc. by focusing on others all the time. And Perpetrators need to learn to be vulnerable and realize and express their own desires to be dependent sometimes rather than to only feel safe when they are lording themselves over others. Therapy can be a great way to learn about the Karpman triangle and other dysfunctional dynamics. It is also one of the best ways to change those dynamics. You don't have to stay stuck in the Drama Triangle forever. Wishing you health, happiness and balance in all of your roles in life, Dr. Jordan
At it's most severe form it is when a person who has Post-traumatic Stress Disorder is exposed to something that reminds them of their trauma and their nervous system has a big reaction. For example if I was trapped in a burning house as a child I may be triggered by getting too close to an open bonfire. My body might react by a racing heart, feelings of panic, difficulty breathing or other symptoms of sympathetic arousal of my nervous system. A less intense but much more common form of being "triggered" is when someone does or says something that touches an emotional "nerve" you have, such as someone questioning your competence when all of your life people treated you as though you were incompetent. We tend to have the biggest reactions to things that have been sore spots for us emotionally, especially from our childhoods. So what is happening in the brain when we are triggered? Effectively we lose IQ points. We lose cognitive flexibility, we lose problem-solving skills, we lose the ability to see things from another person's point of view. We become more self-centered, protective and defensive. Sound familiar? Anyone who has been in a non-productive argument (yes, there are such things as productive arguments, read my blog on anger...) knows this feeling or has seen in in the person you are arguing with. The logic has gone out the window and the person is just trying to "win" the argument at any cost. Where "triggering" happens in the brain is in the amygdala. It's a tiny almond-shaped structure inside of the limbic system, which is part of our mid-brain. This part of the brain has been around for a LONG time and was designed, in part, to keep us safe from saber-tooth tigers and other long-ago predators. Unfortunately the limbic system is sorely in need of an upgrade (or more accurately about a dozen upgrades!). Clearly we don't hunt wooly-mamoths anymore but our brain is still using that same operating system. Seems like a recipe for disaster, right? I found a great article by Diane Musho Hamilton on the Harvard Bussines Review. I have posted it below for your edification, I hope you find it helpful in understanding how this tiny little part of our brain can really run the show at times, and in a not-so-helpful way. Calming Your Brain During Conflict "Conflict wreaks havoc on our brains. We are groomed by evolution to protect ourselves whenever we sense a threat. In our modern context, we don’t fight like a badger with a coyote, or run away like a rabbit from a fox. But our basic impulse to protect ourselves is automatic and unconscious. We have two amygdala, one on each side of the brain, behind the eyes and the optical nerves. Dr. Bessel Van Der Kolk, in his book The Body Keeps the Score, calls this the brain’s “smoke detector.” It’s responsible for detecting fear and preparing our body for an emergency response. When we perceive a threat, the amygdala sounds an alarm, releasing a cascade of chemicals in the body. Stress hormones like adrenaline and cortisol flood our system, immediately preparing us for fight or flight. When this deeply instinctive function takes over, we call it what Daniel Goleman coined in Emotional Intelligence as “amygdala hijack.” In common psychological parlance we say, “We’ve been triggered.” We notice immediate changes like an increased heart rate or sweaty palms. Our breathing becomes more shallow and rapid as we take in more oxygen, preparing to bolt if we have to. The flood of stress hormones create other sensations like a quivering in our solar plexus, limbs, or our voice. We may notice heat flush our face, our throat constrict, or the back of our neck tighten and jaw set. We are in the grip of a highly efficient, but prehistoric set of physiological responses. These sensations are not exactly pleasant — they’re not meant for relaxation. They’re designed to move us to action. The active amygdala also immediately shuts down the neural pathway to our prefrontal cortex so we can become disoriented in a heated conversation. Complex decision-making disappears, as does our access to multiple perspectives. As our attention narrows, we find ourselves trapped in the one perspective that makes us feel the most safe: “I’m right and you’re wrong,” even though we ordinarily see more perspectives. And if that wasn’t enough, our memory becomes untrustworthy. Have you ever been in a fight with your partner or friend, and you literally can’t remember a positive thing about them? It’s as though the brain drops the memory function altogether in an effort to survive the threat. When our memory is compromised like this, we can’t recall something from the past that might help us calm down. In fact, we can’t remember much of anything. Instead, we’re simply filled with the flashing red light of the amygdala indicating “Danger, react. Danger, protect. Danger, attack.”In the throes of amygdala hijack, we can’t choose how we want to react because the old protective mechanism in the nervous system does it for us — even before we glimpse that there could be a choice. It is ridiculous. Practicing Mindfulness in Conflict Mindfulness is the perfect awareness technique to employ when a conflict arises — whether it’s at work or home. It allows us to override the conditioned nervous system with conscious awareness. Instead of attacking or recoiling, and later justifying our reactions, we can learn to stay present, participate in regulating our own nervous system, and eventually, develop new, more free and helpful ways of interacting. Practicing mindfulness in the middle of a conflict demands a willingness to stay present, to feel intensely, to override our negative thoughts, and to engage our breath to maintain presence with the body. Like any skill, it takes practice. There are different approaches to working with a provoked nervous system and intense emotions, but they all have some elements in common. Here are four simple steps (which I also describe in my book, Everything is Workable) that I try to use when I find myself with an overloaded nervous system and a body racing with a fight or flight impulse. Step 1: Stay present. The first step in practicing mindfulness when triggered is to notice we are provoked. We may notice a change in our tone of voice, gripping sensations in the belly, or a sudden desire to withdraw. Each of us has particular bodily and behavioral cues that alert us to the reality that we feel threatened, and are therefore running on automatic pilot. We have to decide to stay put and present, to be curious and explore our experience. For me, it helps to remind myself to relax. I have a visual cue that I use that involves my son. When I’m worked up, he has the habit of looking at me, raising and lowering his hands in a calming fashion, and saying “Easy Windmill.” I try to reflect on this and it helps me calm down because he’s so charming when he does it. Step 2: Let go of the story. This might be the most difficult part of the practice. We need to completely let go of the thinking and judging mind. This is a very challenging step because when we feel threatened, the mind immediately fills with all kinds of difficult thoughts and stories about what’s happening. But we must be willing to forget the story, just for a minute, because there is a feedback loop between our thoughts and our body. If the negative thoughts persist, so do the stressful hormones. It isn’t that we’re wrong, but we will be more far more clear in our perceptions when the nervous system has relaxed. Step 3: Focus on the body. Now simply focus on feeling and exploring whatever sensations arise in the body. We feel them naturally, just as they are, not trying to control or change them. We allow the mind to be as open as possible, noticing the different places in the body where sensations occur, what is tight, shaky, rushing, or hurts. We pay attention to the different qualities and textures of the sensations, and the way things change and shift. We can also notice how biased we are against unpleasant or more intense sensations. Step 4: Finally, breathe. Everybody knows that it helps to breathe. There are many different qualities of the breath, but we only need to learn about two: Rhythm and smoothness. As Alan Watkins explains in his book Coherence: The Secret Science of Brilliant Leadership, if we focus on these two dimensions, even for a few short minutes, the production of the cortisol and adrenaline will stop. To breath rhythmically means that the in-breath and out-breath occur repeatedly at the same intervals. So if we inhale, counting 1, 2, 3, and 4, and then exhale, counting 1, 2, 3, 4, 5, and 6, then inhale again, counting 1, 2, 3, and 4, and then exhale again, counting 1, 2, 3, 4, 5, and 6; this establishes rhythm. At the same time, we should invite the breath to be even or smooth, meaning that the volume of the breath stays consistent as it moves in and out, like sipping liquid through a narrow straw. If we manage those two qualities for just a few minutes, the breath assists us in remaining present, making it possible to stay with intense sensation in the body. Paying attention to our body re-establishes equilibrium faster, restoring our ability to think, to listen, and relate. This takes practice, but eventually, we retrain ourselves to respond rather than to react. Anger becomes clarity and resolve, sadness leads to compassion, jealousy becomes fuel for change. There will also be certain moments when we fail. Becoming more intimate with our body’s response to a hijacked nervous system is challenging, to say the least. This is because the sensations are very uncomfortable, our emotions are volatile, and our mind is usually filling with unsupportive thoughts like “Get me outta here,” or “How can they be saying that?” or “This is a waste of my time.” Each time we succeed in being mindful of our body in moments of distress, we develop our capacity. Even more, we may observe something new when it occurs. A moment of pause, an unexpected question when it appears or a laugh that erupts. When anything new happens, taking note of it helps to free us of the pattern to our old way of doing things. Before we know it, our old habit of fight or flight is changing, and the world is a safer place." I hope you have found this information helpful. While we are not born with an "owner's manual" for this amazing brain that we have we can, through self-study and experience, learn how to better use our hardware and software to achieve the kind of life we want. Despite our triggers. Remember that if you have had a difficult or stressful childhood you may have certain "buttons" pre-installed and that you may need help getting under control. Therapy can help. Wishing you health and happiness, Dr. Jordan PS Please remember that if you found this information helpful to "like" this blog post on Facebook and/or to tweet it on Twitter. Or post it on any other form of social media you have (I am sure at this point I don't know them all!). And if you post a comment or question I will respond. Also if you want to get these blogs delivered directly to you please fill out the form below.  In a nod to the Irish, who have been noted to have "a tear in the eye and a song in the heart", I decided to revive a former blog on crying today. People often remark that they "need a good cry" and feel better afterwards. I've been curious about the underlying mechanisms involved in crying and just why it seems to help us feel better. Dr. Judith Orloff, Assistant Clinical Professor of Psychiatry at UCLA, has done some research on this very subject. She explains that we actually produce three different kinds of tears that are made up of different chemicals and reflect different needs of the body. Reflex tears help us clear out irritating particles in our eyes such as pollens, dust or dirt. Continuous tears are produced on a regular basis to keep our eyes lubricated. This is what goes wrong when someone suffers "dry eye syndrome". Our eyes need to stay moist even in the absence of irritants and so continuos tears perform this function. They contain a chemical called "lysozyme" which also is an anti-bacterial and helps the eyes avoid infection. Emotional tears have unique qualities as well. "Tear expert” Dr. William Frey at the Ramsey Medical Center in Minneapolis investigated the chemical differences in tears and discovered that reflex tears are made up of 98% water, whereas emotional tears actually have stress hormones in them. This is the bodies way of getting rid of these potentially damaging hormones and other toxins after a stressful event. Crying also causes our body to produce endorphins, which are natural pain relievers. Since the brain processes physical and emotional pain in the same areas it makes sense that the same chemical that the body produces on the battlefield to help and injured soldier survive is produced in the midst of a painful breakup or other significant stressor. In addition to riding our body of noxious chemicals produced from intense emotional states crying also slows our breathing and heart rate, creating a calmer physiological and emotional state. Certainly evolution has helped us to develop a mechanism whereby our bodies can help us recover from intense emotional duress. Regardless of the origins of this wonderful mechanism we can all be grateful that we can cry and use that gift to help heal us from deep emotional pain. Far from the ideas that crying belies weakness, a good cry might just be the smartest and most adaptive thing you can do when the emotions get overwhelming. I occasionally meet people who tell me that they cannot cry. Often this pattern has been in existence for a long time, such as a person who says "I haven't cried since my mother's funeral when I was 8". It is often associated with some adult encouraging the poor kid not to cry, such as "she would want you to be strong, son". Other times a person may have been raised in a family where they were warned "I'll give you something to cry about" if they began to tear up. These kinds of experiences when we are young can lead to feeling blocked when it comes to crying as adults. Interestingly I have known clients who suffered from sinus pain or headaches from this difficulty in doing what Mother Nature intended us to do when distressed-- fall apart and have a good cry. If you are lucky enough to let the water-works flow when watching Terms of Endearment, A.I. or Bambi consider yourself lucky and let the crying begin. If you are feeling stuck and wishing you could get passed feeling blocked you may want to check out some of these movies. Or pick up a copy of Watership Down, Old Yeller or The Fault in Our Stars. Still not sobbing? Consider a consultation with a good therapist to take a look at what might be keeping you from Mother Nature's natural stress-buster. Wishing you happiness, health and the occasional good cry, Dr. Jordan As always if this blog has been helpful please consider "liking" it on Facebook or "tweeting" it on Twitter to help spread the word about mental health information and resources. Thanks!
 What do you see? A cute puppy with floppy ears? Or two cats with a hear hovering between them? Or both? And what might predict which image you see first? Growing up with dogs? Owning a cat? To me as a therapist one of the most useful things about optical illusions is to show us that we can't necessarily trust our perceptions. Remember the blue versus brown dress controversy? I would have sworn on my life that dress was a golden color and had not a hint of blue in it. The actual statistics on what people saw are that 1,401 people were asked what color they thought the dress was and 57 percent described the dress as blue/black, 30 percent described it as white/gold, 11 percent as blue/brown and 2 percent as something else. So who's right? The reality is that no two human brains are identical. Just as we all see colors slightly (or sometimes vastly!) different, and just as one person loves spicy food and another shuns it, so too do we interpret the outside world quite differently. Most of the time this goes unnoticed as long as no one is feeling threatened emotionally or physically. But when a disagreement arises our differences in perception can become battering rams against the person we are engaged with. We cry out "you've got it wrong! I never said that!" or "you say you aren't mad but I can tell that you are!". Sometimes the disagreements are even more subtle. We walk into a room and see our partner sitting on the couch looking at a magazine. We think to ourselves "oh gosh, isn't she cute?" and our partner looks up and thinks "he's wondering why I haven't done the dishes yet. Why is he always on my case?" What can account for these vastly different ideas? Part of it of course is just wiring. Our brains really are all unique in some aspects. But part of it is also our histories. If I grew up in a household where my value in the family was based on being helpful then I am likely to be prone to thinking that my partner is wondering why I haven't done my chores yet. If I grew up in a home where I "couldn't do anything right", I am prone to thinking that my partner is disappointed in me if their toast is a little too dark. Believe me, this kind of stuff can cause HUGE disruptions in your relationships. And everyone does it. How do you know if what is going on in the present moment is being infected by the past? There is a pithy saying in the recovery community "If it's HYSTERICAL, it's HISTORICAL". Or, as we say in psychology, if the response (in the present moment) is out of proportion to the event, there is probably something in that person's history coming up. What can you do about it? The #1 rule when you think your partner is coming from the past is DO NOT try to defend, argue, convince, counter-attack or analyze what the other person has said. While on some level this seems like the BEST thing to do (I mean, after all, this poor person has lost their grip on reality, right?) I can tell you with 100% assurance that the other person is going to get more entrenched, defended and frankly pissed-off. It is going to quickly widen the gap between the two of you and you will have even less of a chance coming to any kind of detente or mutual understanding. So suck it up (yes, I know, this is going to be HARD!) and do this instead: Validate. Yep. I know, it sounds crazy. It's like telling the person who thinks the FBI has implanted a micro-chip in their nose that they are right. Seems like a bad idea. But in this case you validate the feelings, not the details of the particular accusation. So it looks something like this: Person A SAYS: "I can't believe that you were late again! You know how much I hate waiting on you! You are completely unreliable!" Person B THINKS: "Oh my gosh you have got to be kidding me! I was 5 minutes late! How can 5 minutes matter? Plus I told you there was a roll-over accident on the freeway? How can I control that?!!!" Person B SAYS: "Wow I am so sorry. I can see how upset you are. I know it is frustrating to have to wait on someone and I know that you in particular really hate that. I also know that it would feel really crappy to feel like you can't depend on someone who is important to you. I mean, if you can't depend on me (your best friend/partner/whatever) then it must feel like the whole world is full of unreliable people. That would be terrible. I am so sorry that my being late lead to all of those painful feelings. I will try harder in the future to be on time." Yes. No kidding. That is what you say. Now, if you are like me, you have an inner 2-year old screaming THIS IS NOT FAIR!! I DID NOTHING WRONG!! S/HE IS A CRAZY PERSON!!! However, I 100% guarantee you (I literally do this, I tell clients if they try this and it doesn't work I will give them a free session, and in 20 years I have never had to do it!) that this approach will work. Let's see what is likely to happen: Person A FEELS: "Phew. Finally someone who understands me! Sometimes it does feel like the whole world is full of unreliable jerks who just don't care about upsetting me. Thank goodness this person is so thoughtful and kind. I am so glad that they are in my life." Person A SAYS: "Thanks. It means a lot to me. I know that maybe 5 minutes is not a lot to you but for some reason it just really throws me off. Maybe next time if you are running late you can text me and I can go grab a coffee or something. I am not trying to be unreasonable but it really does bother me. So thanks for seeing that." So what is "really" going on here? Person A probably has a history of being disappointed, let down or otherwise hurt by parents or other significant people in their childhood who were not attuned to their needs and feelings. They may have also been left waiting on caregivers who were busy taking care of themselves rather than attuning to the child. Your partner is responding from this history and assuming you are going to be the same way. That is coloring their interpretation of the Present because of input from the Past. We all do this. We all try to anticipate what is going to happen moment to moment based on past experience. We have to because otherwise we could not "automate" things and we would never be able to get out of the house. If I don't have an idea of what will happen when I step on the gas in my car and have to re-learn that every time I get behind the wheel I am not going to be very fluid in getting to work every day. I base my anticipated present experience of pressing on the gas against my past experiences with this. Which allows me to automate a certain percentage of that, which frees up my brain to think about other things like whether or not I should take the expressway this morning because I heard there was a wreck on the central artery. We all do this. I repeat, we all do this. Our brains are set up to. But just like screaming at the top of your lungs at your 16 year old while they are behind the wheel in heavy traffic is probably going to cause an accident (they will be so startled and freaked out by you yelling at them to slam on the breaks they may lose control of the car), you will also freak out and amp-up your partner if you try to disagree with them when they are bringing the past into the present. Your best shot is to remain calm, not take it personally (did I mention that we all do this?) and de-escalate the person by attuning to their feelings and validating them. Once they have re-oriented themselves to reality (whatever that is, because really we construct it moment-to-moment and all have a different experience of it) we can have a discussion about what both of us experienced in that moment. If you find yourself feeling resentful about the thought of doing this ("it's not fair!") I would encourage you to think about whether or not in your own history your parents or other significant caregivers showed you that your feelings mattered or made you cater to their needs an unreasonable amount. If not then you may have some work to do in order to feel ready to extend that to others. Wishing you happiness and growth in your connections to others, Dr. Jordan As always if you have found this blog post helpful please "like" it on Facebook or "tweet" the link on Twitter. Or share on any other social media platform! And feel free to leave a Comment, I always respond. Thanks!  There is a saying that expectations are resentments waiting to happen. I have to say that personally every time I find myself sitting with a resentment it has boiled down to that. I had expected that a person would do something (or not do something) and they did not act as I had expected. find myself feeling perturbed or sometimes downright angry about it. It's that kind of self-righteous indignation that can feel so powerful and intoxicating. It has real lasting power. So what is at the root of this strong emotion? The word resentment comes from the French "re" and "sentir", meaning to re-feel. Which is such a great insight into the experience, because when we hold on to a resentment we are literally re-feeling the original upset. Which I find a useful thing to contemplate. If I was so unhappy with the experience the first time, why on earth would I keep deliberately re-feeling it? The entomology points out the futility of the situation. If you are resentful that, for example, your spouse forgot your anniversary, then by holding on to that resentment you continue to re-feel that original hurt. Ouch. I find that people who have trouble with letting go of resentments are often very sensitive. If I am the sort of person who gets their feelings hurt easily (which, by the way, is NOT a bad quality, it's just a personality trait like being extroverted), then if I let myself forget that you hurt me I won't keep you at a distance. And then if I am not keeping you at a distance you have a chance to hurt me again. If I am a very sensitive person (sometimes called a Highly Sensitive Person), then it takes me longer to process my hurt feelings and they tend to run very deep. So it makes sense for me to really hold on to my hurts so that I don't forget about people who have hurt me. I can keep them at arms length by holding on to the resentment, or re-feeling the original hurt on a regular basis. That keeps me holding them at bay and not letting them close to me. Which reduces the chances that they will hurt me again. It's a good strategy if your primary goal is not getting burned twice. Let's just say that most therapist are highly sensitive people so I *may* know a thing or two about resentments. Enough to know that while they protect you from further hurt in one way they also rob you of the opportunity to deepen intimacy in other ways. If we don't let people matter to us, if we don't let them in to our hearts, then we also cannot feel all of those wonderful feelings of intimacy, love, acceptance, joy, humor, delight and other things that people can revel in together. The Recovery Podcast has a great episode on resentment. That is where I learned about the origin of the word. For people who are using 12-step programs there is a teaching that resentments are going to interfere with you successfully "working your program", which is to say getting past your character defects and becoming a better person. Some alcoholics I know (ones in recovery) have said that resentments and shame are two of the biggest risks for relapse. I would argue that shame can actually be tied to resentments we hold against ourselves. If I had an expectation that I was going to be the best mother in the world and then once I had my kids I realized that sometimes I come unglued and yell at them, I may feel shame. Underneath that feeling, I would argue, is (1) my expectation that I "should" have done better and (2) my continuing to re-feel my disappointment in myself. Which sounds a lot like holding a resentment against myself. A part of me may feel that by continuing to re-feel my anger and disappointment towards myself I can force myself to not make that mistake again. However in my experience what usually happens is that we walk around feeling so crappy about ourselves that we don't have a lot of emotional resources to actually learn to do better. A better strategy may be acceptance. In this situation acceptance of one's own shortcomings and failings to live up to one's standards can be a pathway to letting go of shame (aka self-resentment). It's also a powerful exercise to ask oneself now and again what expectations one is holding. Good places to check for hidden expectations are towards yourself, towards your significant other, towards your children if you have them, towards your boss, or your career, or your friends. Really anything that matters to you. If you find expectations, think about challenging yourself to let go of them. Ask yourself if you can imagine accepting the person or situation however it is on an moment-to-moment basis. See what kind of freedom that can bring. A note of reality here-- just as with my blog on acceptance I am NOT saying that one should never have basic expectations of safety, decency and the like. I think it's perfectly OK to expect that the person in the grocery store line is not going to spontaneously turn around and clock you for no reason. There are some basic expectations that I think we all have that allow us to leave our house and move around in the world without feeling terrified. Likewise I am not saying to settle for mediocrity in all areas of life and have no aspirations. I personally think that aspirations are different from expectations. If I aspire to make six figures and instead I end up making half of that I can still be happy. It was a goal but not an expectation. To me an expectation is the belief that something SHOULD happen. As in, I am entitled to it. If it does not happen that's not "fair". The word stems from Latin meaning "an awaiting". We don't wait for things that we are not sure will happen. We wait when we feel confident that they will/should happen. So if the thing we are waiting on does not happen, we feel surprised and let down. That is different from having a goal, which one understands is potentially going to happen but also may not. I fully believe in setting goals but not expecting any particular outcome and, most importantly, having the mental flexibility to accept whatever outcome does occur. Since humans are pretty messy, imperfect creatures it's not a bad habit to check and ask ourselves are we actually creating expectations that are setting us up for future disappointments and resentments? And are we willing to let go of those? Consider the possibilities that choosing acceptance over resentment and expectation can bring in to your life. Dream big but know that nothing is promised. Accept the imperfections in yourself and others. Stay open even when things don't go the way you wanted. Live bravely. Wishing you health and healing, Dr. Jordan As always if you find this blog helpful PLEASE "like" it on Facebook or "tweet" it on Twitter. Or share on any other social media you use! And feel free to leave a Comment, I do respond to all of them! Thanks.
"They knew that there was a power and a beauty deep inside me, but that I was afraid of this and I was in fragments. Men and women alike, old and new at teaching, were like aunties or grandparent in their firm patience with me, in their conviction of my worth. They had a divine curiosity about me-- "Hey, who's in there? Are you willing to talk straight and find who you actually are, if I keep you company? Do you want to make friends with your heart? Here-- start with this poem. This is who I want to be in the world. This is who I think we are supposed to be, people who help call forth human beings from deep inside hopelessness." Indeed. I agree. I believe in the inter-connectedness of all beings and in the interdependence of people as an essential part of the human condition. We are now learning that loneliness is a greater risk factor than smoking for disease and death. I believe it is not only a capability but a responsibility of all of us to reach out to each other. To be that curious person who will keep company and share poems and generally help our fellow humans. To quote John Lennon, "imagine" how the world could be if we all took on that job. And I can't bear not to share just one more excerpt from this book: "When we agree to (or get tricked into) being part of something bigger than our own weird, fixated minds, we are saved. When we search for something larger than our own selves to hook into, we can come through whatever life throws at us." Again the research on social isolation and altruism comes to mind. How we can help ourselves by literally helping others. I think it's not a coincidence that many 12-step programs tell folks to do "service work", literally to go serve others, as a way to save themselves from their destructive habits and addictions. Sometimes spending too much time navel-gazing can drive a person crazy. Sometimes you just need to get out of yourself and realize that other people are struggling and you can probably do something to help them. So Stitches is about pain, it's about how life can knock the wind out of you and then kick you while you are down. And that while you are down there you just may realize that there is some beautiful little insect crawling around on a blade of grass that you would have never seen had you not been face down in the lawn gasping for breath. It's about how just when you need it someone can come along and offer you a hand, and you may find yourself helping them in kind. About how somehow we keep finding ways to mend and darn and pull the threads together to keep this sometimes fragile thing we call life from fully unraveling. It's a mercifully short book given how busy we all are these days. The writing is beautiful. It may make you feel better about being human and messy and confused a lot of the time. I loved it and I am looking forward to delving in to another one of her works soon. Wishing you health and happiness, and feel free to recommend books for me to read and review! Warmly, Dr. Jordan
By now you may have heard some of the buzz. Scientists first started experimenting in rats and are now doing human studies which seem to show that by introducing certain strains of bacteria into the gut symptoms like depression and anxiety can be altered. Very exciting indeed! I am imagining in 20 years instead of taking Prozac or Xanax we will be eating carefully cultivated symptom-specific yoghurts or kefirs. A much more elegant solution to mood disorders with little to no side effects. I recently read a study (Steenbergen, Sellaro, van Hemert, Bosh & Colzato, 2015) in which the researchers gave a combination of Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus brevis, Lactobacillus casei, Lactobacillus salivarius and Lactococcus lactis to a group of depressed patients. The participants took the supplement for 4 weeks and showed a significant decrease in symptoms of negative thinking, including negative thoughts directed towards the self. Anyone who has experienced a depressive episode can attest to the painful cycle of rumination on negative thoughts and events as well as the painful self-recrimination and self-attack that occur so often in depressions. While all of us experience a sad mood from time to time some of us begin to slide down the slippery slope, ending up in a clinical depression. Much of the time mental health providers attribute this vulnerability to genetics, and it very well may be just that. However our ability to influence our genetics at this point is extremely limited. Better to impact the sad mood before it gains momentum and turns into an insidious depressive episode that can span months and debilitate a person. So how is the magic happening? The mechanisms are still being worked out but our gut actually produces an abundance of chemicals that interact with the brain. Some, like tryptophan, reach the brain through the endocrine system. Others impact the immune system which in turn impacts the brain in areas linked to mood. Research so far seem to indicate that gut microbiota communicates with the nervous system via neural, endocrine and immune pathways. Microbiota also seem to be involved in the regulation of the stress response (e.g. hypothalamic-pituitary-adrenal axis). So having the optimal gut bacteria may actually help us shut down the stress response or even avoid engaging it. The gut is also involved in the inflammatory response and inflammation has been shown to be related to depression (as well as other problems like cardiovascular disease). So far human studies are limited (I have reviewed 4 to date) but ALL have shown improvement in symptoms of depression and anxiety. Unfortunately the studies don't all use the same bacterium so it's not yet clear which ones are the most powerful. This most recent study utilized a combination of 7 and that seems to be a good way to "hedge your bets". Lactobacillus casei has been used in 3 of the 4 studies I have reviewed so that might be one to look for. As always consult your medical professional if you are going to make changes to your diet including any supplementation. And keep a lookout for more studies to be rolling in. The way to improve your head may just be through your gut! Wishing you health and happiness, Dr. Jordan |
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. Archives
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