Attachment and
Intimate Relationships
The greatest happiness of life is the conviction that we are loved.
Victor Hugo
THE POWER OF secure attachment is at the core of all nurturing, supportive, and healing relationships. It is therefore easy to understand why aspects of friendship, mentoring, and parenting all appear during successful psychotherapy. While secure attachments can take many forms, they all share a minimum of criticism, competition, and conflict. Feeling accepted by others is a profound experience, resulting in states of brain and mind that enhance neuroplasticity and positive change. This is why the Rogerian cornerstones of caring, empathy, and positive regard have remained central to our field through hundreds of therapeutic fads and new techniques.
One of the primary reasons I appreciate a neuroscientific approach to therapy is that in the eyes of science, both therapist and client are bipedal primates with flawed brains. The humility and vulnerability this perspective brings to therapy supports the establishment of a secure attachment. Engaging in a shared struggle to make up for some of evolution’s less brilliant choices levels the playing field in a nice way. As a therapist, it reminds me that I struggle with many of the same challenges and conflicts for which my clients come to me for help. We are all in this together.
Safety is at the heart of positive change. If therapists can put aside their need for status, their intellectual agenda, and their personal struggles for a while, they can create an interpersonal matrix of change. If clients have the strength and the courage to be accepted and explore their inner worlds, they can join in this connection in ways that may lead to insight and healing. If both can admit that they are just two people trying to make it through the day and that the roles of client and therapist don’t imply status or power, there is hope.
What Is Attachment?
For small creatures such as we, the vastness is bearable only through love.
Carl Sagan
Attachment is an evolutionary strategy to keep parents and children close. Attachment emerged during natural selection because proximity enhanced the survival of children and, hence, the survival of the group. The same biological levers were utilized with tribes as larger and more coherent groups increased the odds of survival. At the core of attachment circuitry is the amygdala, our organ of appraisal and the executive center of fear processing.
When parents and children are close, they both feel safer and calmer and experience a general sense of well-being. When separated, parents and children become distressed as their amygdala signal danger. This triggers parents to search and call out and children to emit distress calls to make their location known. When reunited, their chemistry shifts as they transition from a sense of fear to safety.
Like all biological organisms, we are constantly shifting from states of homeostatic balance to imbalance and back again. We become hungry and eventually eat; we become frightened and eventually find safety; we become cranky and tired and eventually fall asleep. These are all examples of a pattern of going from regulation, to dysregulation, to reregulation, which our brains summarize and use for future reference as they make connections and construct conscious experience.
During infancy and childhood, we have a vast number of experiences of going from being safe and calm to feeling distressed and endangered. We are sleeping soundly, only to wake up hungry, wet, or needing to be burped; we are joyfully running through the kitchen, only to fall and bump our heads; we wander into a room and become terrified by the unexpected darkness. In each of these situations we cry out in confusion, pain, or fear. We have gone from a state of calm or positive excitement to one of upset and fear.
If we are dysregulated as infants, we reflexively cry out to summon our parents. If the caretaker arrives and we move to a state of regulation, our primitive brain circuitry pairs the presence of the other with positive emotion. So in reality, we may have been crying out because our wet diaper was burning our skin. After a successful change, we now feel comfortable, smell better, and have experienced some positive sights, sounds, and touches from our mom or dad. This is a piece of building secure attachment—the association of the arrival of another with a shift to a positive state of body, emotion, and mind. As the theory goes, if we have enough of these positive associations to the presence of others, we have a good chance of having a secure attachment.
The opposite occurs when we are dysregulated and the arrival of the other either doesn’t lead to reregulation or, even worse, increases our dysregulation. So in the above example, if we are crying out and no one arrives, or if they add to our distress by screaming at us for annoying them, we will not associate the arrival of the other with reregulation. We may even come to associate the other with an increase in distress. A preponderance of these experiences may lead to an insecure attachment style. People with insecure attachment styles lack the ability to be soothed by others in a consistent and predictable way. Overall, the difference between a secure and insecure attachment style is this—secure attachments help to regulate arousal and anxiety while insecure attachments do not.
Attachment theory is based on the assumption that these experiences are stored in systems of implicit memory. Are others attentive to our distress, able to discern what has happened and to bring us back to a state of calm and safety? Or are they unavailable, unattuned to our needs, or unable to make us feel better? Our early experiences with caretakers shape our predictions of the ability of others to soothe our distress and make us feel safe. These implicit memory patterns, or attachment schema, so named by John Bowlby, are activated in future intimate relationships and shape the way we experience and relate to others.
Attachment Schema
We can only learn to love by loving.
Alice Murdock
An attachment schema is essentially a pattern of expectation established within us about the ability of other people to help us feel safe. Four categories of attachment schema have emerged from research: (1) secure, (2) avoidant, (3) anxious-ambivalent, and (4) insecure-disorganized. The descriptions that follow are general tendencies observed in children and their mothers in these four categories.
1. Securely attached children have parents who are good at being available and are attuned to their children’s’ needs. They have the ability to fluidly switch their attention from what they are doing to their child and to disconnect when they are no longer needed. When distressed, their children seek proximity, are quickly soothed, and return to exploration and play. These children seem to expect their caretakers to be attentive, helpful, and encouraging of their continued autonomy. It is believed that they have learned that when they are distressed, interacting with their mothers will help them to regain a sense of security.
2. Avoidantly attached children tend to have caretakers who are inattentive and dismissive of them and their needs. When these children are under stress, they either ignore their parents or just glance at them without engagement. Despite their anxiety, these children lack the expectation that their parents are a source of soothing and seem to have learned that it is easier to be self-reliant and regulate their own emotions.
3. Anxious-ambivalent children have enmeshed or inconsistently available caregivers. They seek proximity when distressed, but they are not easily soothed and are slow to return to play. In many cases, their distress seems to be worsened by their mothers’ anxiety and uncertainty. These children tend to cling more and engage in less exploration, as if they have learned from their mothers’ anxiety that the world is a dangerous place and better to be avoided.
4. Children with disorganized attachment, when under stress, appear to have a conflictual relationship with their mothers. They want to approach to be soothed while at the same time appear to be afraid to approach. It is as if they are experiencing an internal approach-avoidance conflict that is reflected in chaotic and even self-injurious behaviors; they spin, fall down, hit themselves, and don’t know what to do to calm themselves. They appear to dissociate and are overcome by trancelike expressions, freeze in place, or maintain uncomfortable bodily postures. It has been found that disorganized attachment in children correlates with unresolved grief and/or trauma in their mothers, which makes them both frightened and frightening to their children.
Humans love categories, especially ones that foster a sense of understanding and certainty. Attachment researchers have spent a half century exploring, articulating, and confirming the validity of these categories. From this perspective, it is easy to think of them as distinct and well-defined ways of connecting (or not) in close relationships. But as a psychotherapist, my primary concern has been to understand how I can assist individuals with insecure and disorganized patterns of attachment to gain security and change categories. From this perspective, therapists are far more interested in the fluctuations and instability of attachment schema. So the big question is, do the neural systems of implicit memory that encode attachment schema remain plastic?
There is no remedy for love but to love more.
Henry David Thoreau
Research with other social mammals has demonstrated patterns of mother-child interaction similar to what we see in humans. This research strongly suggests that both the intrauterine environment and maternal behavior after birth serve as mechanisms that shape brain development in the direction of adaptation to specific environmental conditions. For example, mothers who live in the presence of more danger build their children’s brains in ways that lead them to be less exploratory and more vigilant. In other words, both their biochemistry and their behavior become a template upon which their babies’ brains are sculpted. In this manner, the fetus and infant get a heads-up that they had better be ready for danger.
It thus appears that the transmission of stress to the fetus, infant, and juvenile shapes adaptational patterns matched to the type of environment they will be facing. There is also evidence that when the environment becomes less stressful, patterns of behavior shape a greater sense of security. In humans, more insecure children are born to mothers in areas with fewer resources and more violence. It appears that nature is preparing these children for the world they will have to survive in.
If attachment schema are adaptational strategies that can change with environmental changes, then one of our main objectives in therapy is to assist those who are unable to feel safe with others to learn to do so. After all, the ability to love is not only one of life’s main objectives, it also allows us to benefit from the naturally healthful impacts of positive relationships.
Despite the evidence of an attachment schema by our first birthday, research strongly suggests that it is not set in neural stone. These naturally occurring changes and the fact that we attach and reattach with many people throughout our lives suggests that the underlying neural systems maintain their plasticity. In support of the neuroplasticity of attachment networks, adults can create secure attachment for their children despite negative experiences in their own childhoods.
The flexibility of schema reflects the underlying reality that attachment schema are survival strategies that can be modified in the face of new experience. It appears that if someone who is insecurely attached is lucky enough to stick with a securely attached person for about five years, it increases her own attachment security. I suspect that you would find a similar change in the other direction for secure individuals who end up with someone who treats them badly. The stress of negative events and relationships operate to maintain insecure attachment by continuing to send danger signals to the amygdala and the networks it controls. Secure attachment, while not impervious, appears more resistant to change than insecure attachment.
Thus, the powerful shaping of childhood can be modified through personal relationships, psychotherapy, and/or experiences that increase self-awareness. The ability to consciously process stressful and traumatic life events appears to correlate with more secure attachment, flexible affect regulation, and an increased availability of narrative memory. A healing relationship with a secure partner or with a good-enough therapist, in which past fears can be processed and resolved, can help us to achieve secure attachment schema. The major implication for psychotherapy from all of these findings is that insecure attachment is subject to change as a result of positive connectivity.
As a psychotherapist interested in positive change, I want attachment schema to be a changeable form of implicit memory so relationships with clients can alter them in a salubrious manner. In this way, psychotherapy can become a guided attachment relationship for the purposes of assisted emotional regulation and the eventual adjustment of insecure schema. Most importantly, intergeneration patterns of maltreatment and insecure attachment can be disrupted with the proper professional interventions or personal experiences.
Attachment in Psychotherapy
The first duty of love is to listen.
Paul Tillich
Clients who come to therapy with the ability to develop secure attachment bonds are able to use us relatively quickly to regulate their anxiety. That is, they join in the creation of a dyadic organism (therapist and client) and are able to use the therapist’s brain to regulate their own. This will happen as a natural outgrowth of time spent together and the accumulation of positive interactions.
Clients who are insecurely attached may be sitting in the same seat with the same issues and even saying the same words, but they are watching the therapist from the other side of a protective screen. They established these defenses long ago to protect themselves from the pain and disappointment of a lack of availability, care, and emotional attunement from others. These are the clients who are often said to have personality disorders.
So, the big question: how do you help someone who is insecurely attached to develop a secure attachment with you? And how do you overwrite the memories of their first parenting experiences with a new set of experiences based on your abilities to be consistent, present, and attuned? Wouldn’t it be great if there were a simple and straightforward manual for that?
Just like parenting the first time, reparenting is long and difficult, with many bumps along the way. It takes a lot of patience and emotional regulation on the part of the therapist. It’s the client’s job (unconsciously of course) to get you to respond to them the way their parents did. If they expect rejection, they will make themselves worthy of rejection. If they expect to have their boundaries violated by being seduced, they will make themselves available for violation, act seductively, and become angry whether you do or don’t live up to their expectations. In a sense, the client’s job is to take you hostage into their past and your job is to elude capture, while naming what is happening and remaining supportive in the process. Thinking in terms of these three steps may be helpful:
Step 1: You have to be the parent they didn’t have—someone who is present, stays attuned to them, and respects their perspective. The goal of this is to get to the point in the relationship when clients realize that they continue to use their defenses even though they are no longer necessary—Carl Rogers was great at this.
Step 2: When a true connection is established, sadness and grief often emerge. These emotions are reactions to having not gotten what they needed during childhood and to the realization that their defensive reactions have kept them from getting these things in adulthood. This grief period should be attuned to and encouraged but after awhile, you should encourage clients to begin with new experiments in living. Remind them from time to time that grief is a stage, not a lifestyle. This is not an emotional state that you want them to become trapped in.
Step 3: The real neural reshaping process occurs during experiments in living after new ways of connecting and interacting with others are discussed. Each client with an insecure attachment history will have a long list of past social behaviors that had negative outcomes. The first stage is to stop doing the things that don’t work. As clients experiment with new behaviors, therapy becomes the crucible for planning and post hoc analysis of new ways of interacting. The biggest challenges that you can help clients with are their faulty and shame-based thoughts, emotions, and behaviors. The second stage is to help clients deal with the anxiety of taking on the experiments and working with techniques for stress reduction, such as meditation, yoga, or whatever means they can use to downregulate amygdala activation.
It’s helpful to think of insecure attachment as a form of posttraumatic memory, not resistance. This makes it easier to avoid blaming clients for their behavior and helps the therapist to avoid feeling rejected. Although we don’t like to admit it, therapists get hurt by “noncooperative” clients. Thus, in their personal therapy, therapists should explore their own need to be loved, appreciated, and listened to.
Building Inhibitory Circuits From the Cortex to the Amygdala
Love cures people—both the ones who give it and the ones who receive it.
Karl Menninger
So what is the mechanism of action that changes insecure to secure attachment? How do repeated cycles of attunement, misattunement, and reattunement result in our ability to regulate stress and stay connected in the face of anxiety and fear? Kohut used the term transmuting internalizations to describe this process—very poetic, but what does it mean?
The amygdala is at the core of fear circuitry. Based on our current findings in neuroscience, it is believed that our amygdala have evolved to store negative associations on a permanent basis. Insecure attachment schema have, at their core, an association within the amygdala of fear, negative experiences, and emotional dysregulation paired with intimate relationships. So as much as someone may desire intimacy, the amygdala activates a danger signal, triggering autonomic arousal and a fight-flight response to closeness. This pairing needs to be inhibited if a secure attachment relationship is to be established.
When we overcome fears and phobias, heal from posttraumatic stress, or move from insecure to secure attachment schema, we are building new neural systems or reinforcing those already in place. These systems will most likely include descending inhibitory circuits from the prefrontal cortex down to the amygdala. Although we think of the cortex as primarily excitatory and a storehouse of our memories and knowledge, its role as an inhibitor is just as important. Here is a good example of its inhibitory role.
Neuroscience Corner: Descending Inhibition
The ability of the cortex to inhibit limbic midbrain and brain stem structures, allowing us to inhibit early reflexes and learned fear responses stored in these regions.
My son was handed to me by a nurse about 30 seconds after he was born. I stared at him as he struggled to open his eyes to make sense of the world. He was worn out from passing through an all-too-small birth canal, and I was nearly delirious from sleep deprivation and the terrors of fatherhood. The nurse pointed to the other side of the birthing room to a small Plexiglas box, indicating where I was to put him. Luckily, I made it across the room without falling and placed all six pounds of him on a thin blanket inside the plastic box.
A couple of feet above his head were heat lamps that reminded me of the ones that keep the French fries warm at McDonald’s. Of course, the lights were bright and they must have been especially bright for eyes that were a minute old. So I held my left hand above his face to protect his eyes from the glare. Within seconds, he reached up with his tiny right hand and grabbed my pinky and then with his left and grabbed my thumb, and pulled my hand down onto his face. Now I understand that this is a primitive brain stem reflex and has nothing to do with children recognizing and loving their parents. But of course, this was my child, not some anonymous child in a textbook, and I felt sure that he recognized me and was telling me that he loved me. So much for scientific objectivity.
This primitive grasping reflex, also known as the Palmar grasp, is controlled by the brain stem. It is believed to be an evolutionary holdover from when baby primates had to hold onto the fur of their mothers as they moved about and took care of business. I’ve seen it in action in newborns and infants. You can place your fingers against their palms, triggering them to clamp on. Their grasp is so strong that they can actually be lifted up in this way well into their second and third month of life. I had always assumed that this ability was lost when they became too heavy to hold themselves; turns out I was wrong.
What happens in those first few months is that the cortex sends descending fibers down to actively inhibit this brain stem reflex. The reason the cortex does this so early in development is to free the hands up from this primitive grasping reflex so that the motor areas in the cortex can take over the hands and turn them from a primitive pair of pliers into an orchestra of ten dexterous fingers. Here’s another interesting piece of the puzzle involving descending cortical inhibition.
When my son grows to be an old man and if he shows some signs of memory loss or confusion, his children may take him to a neurologist for an exam. When the neurologist examines him, she will ask him to hold his arms outstretched with his palms down. She will then slide her fingers along the bottom of his arms, starting at the elbow and moving toward his hands. When she gets to his hands, she will cup her fingers a bit to stimulate his palms to see if her touch causes a grasp reflex. If it does, it will be an indication that my son, now in his old age, may be beginning to lose neurons in his frontal and temporal lobes.
But why would the grasp reflex come back? Because it was being actively inhibited for decades to free up the hands to be used for writing and playing the piano. As the cortical neurons dedicated to inhibiting it after birth begin to die because of dementia, the brain stem once again asserts the power of the Palmar grasp. In neurology, this is called a cortical release sign—the return of these reflexes reflects a compromised cortex. The truth is, the Palmar reflex was there the entire time but actively inhibited by descending cortical circuits.
Neuroscience Corner: Cortical Release Sign
The return of a primitive reflex later in life that reflects damage to a region of the cortex that has been dedicated to inhibiting it. Cortical release signs are often an indication of some form of brain injury or disease.
I tell you this story not because you plan on being a neurologist, but because it is important in understanding the mechanism of action of helping clients move from an insecure to a secure attachment. Just like the inhibition of the Palmar reflex, the cortex also sends descending fibers to the amygdala to influence its activation in response to the world. When we are able to assist a client to get over a fear of intimacy, we have actually built new neural connections that are inhibiting the amygdala’s ability to activate our fight-flight response in relationships.
So when we are going through the repetitive cycles of regulation, dysregulation, and reregulation with our clients, we are remodeling the attachment circuitry that they came to therapy with. Every time clients have a negative expectation of us—such as criticizing, shaming, or abandoning them—a new and more positive memory is being added into the mix. The skills we give them to downregulate their anxiety allow them to remain self-reflective and stimulate more cortical activation, leading to the building and remodeling of new descending fibers. The more cortical activation they can maintain in the face of stress, the more emotional regulation they will develop.
Like helicopter parents, all our amygdala want to do is protect us from any potential harm. They scare the hell out of us to keep us out of harm’s way. Unfortunately, an overprotective amygdala can make life not worth living. By seemingly endless cycles of regulation, dysregulation, and reregulation, therapists, like parents, can build new cortical circuitry to convince the amygdala that we have nothing to fear. What is transmuted in the process of therapy is the strength, coherence, and connectivity of neural circuits that allow us to inhibit fears programmed decades before and learn new, more adaptive ways of being.