Individuals with the Attunement Survival Style have difficulty attuning to their own needs; knowing, allowing, and expressing their needs is associated with humiliation, loss, and fear of rejection.
Many individuals with the Attunement Survival Style become caretakers. They have learned to cope by attuning to other people’s needs and neglecting their own. They are the givers of the world, the shoulder on which everyone cries, the ones who adopt stray animals and take care of lost people. They can be highly attuned to, and able to identify with and address, the needs of others. The problem is that they are not attentive to their own needs. Because their own needs are not obvious to them, they often develop codependent relationships in which, on the surface, they are the rescuer, the need provider, and the caretaker. This is an indirect way for them to get their own dependency needs met. Given their propensity to take care of others, they are disproportionately represented in service professions such as psychotherapy, nursing, and social work. Identifying as givers, yet having difficulty attuning to their own needs, over time they can become burned out and bitter.
This survival style has its roots in the first two years of life. At this stage, the baby’s brain and nervous system are developing at a rapid rate. During these first two years, a baby’s fragile organism is completely dependent on the mother’s care, and the infant is learning self-regulation in the attachment relationship with the mother. The baby receives nourishment and learns regulation through attuned gaze, breastfeeding, skin contact, touch, and secure holding during which, ideally, the needs for attachment, nourishment, nurturing, and regulation are lovingly met.
In the first eighteen months of life, a number of factors, all relating to the themes of misattunement and loss, can compromise a baby’s development. The early developmental dynamic for this survival style is as follows:
• The baby cries out for mother. If she does not come or is unable to provide adequate, attuned nurturing, the baby protests.
• When adequate nurturing remains unavailable, the baby experiences frustration and distress, and the protest escalates.
• If the lack of fulfillment becomes chronic, the baby gives up, resigning psychologically and physiologically. Giving up is a parasympathetically dominant collapse state expressed as profound resignation. This resignation develops into a psychobiological depression that is experienced as the sense that one’s needs can never be met.
The Attunement Survival Style develops as an adaptation to experiences of attachment difficulties, inadequate nurturing, scarcity, and deprivation. Infants who experience deprivation give up their demand for caring and love, and this giving up becomes structural in the body and in the identity. Lack of fulfillment is familiar to most individuals with this survival style who have learned to want no more from the environment than what is available and who are used to living with unmet needs. One client succinctly expressed her adaptation to scarcity: “I’m an expert at making do with the minimum.”
Deprivation and attachment difficulties signal the baby’s brain and nervous system to implement life-protecting strategies. Depending on the severity and the duration of the nurturing disruptions, there is a progressive loss of the ability to attune to and express one’s needs. Along with the loss of attunement comes increasing autonomic dysregulation:
• Babies learn to limit their needs to match the amount of nurturing available. There is intelligence to this strategy because it is the only way dependent babies can cope with a deficit over which they have no control. At the onset, this response reflects a healthy capacity to adapt. However, if the nurturing and attunement deficits continue for too long, the psychophysiology of the developing infant is negatively affected.
• Babies begin to ignore their own needs. Again, there is intelligence to this response because it is too painful for babies to continue feeling their needs when satisfaction is not forthcoming.
• Babies disconnect from—“depress”—their needs and eventually lose touch with them. The reaction not to need leads to a numbness to sensations and feelings. The bodily signals related to attachment needs, along with the needs for physical and emotional nurturing and nourishment, are foreclosed.
• Some dysregulated mothers use their infant for their own self-regulation. Many infants of mothers in distress learn to attune to their mothers’ needs rather than to their own. To the baby, it feels imperative to alleviate the mother’s distress which becomes more important than taking care of his or her own distress.
• The relationship with food becomes distorted. Children can become over-focused or under-focused around issues of eating.
• Family trauma, a mother’s death, or serious illness during the first two years of a baby’s life.
• Mothers with significant developmental difficulties themselves. If a mother has never developed a capacity for secure attachment, she will not be able to provide secure attachment for the infant. When a mother has experienced lack of care and nourishment during her own development, she will lack the resources to care for and nourish her baby. Called upon to give her baby what she never received herself, this mother may be conflicted about giving, unconsciously wanting her baby to give her the love and nurturing she never received.
• Any prolonged separation from the mother. In these early years such a separation can have a profound effect on babies and can interfere with their ability to develop a strong attachment bond.
• A mother’s emotional unavailability to her baby. The mother may be physically present and provide adequate nourishment, but if she is chronically depressed, angry, or dissociated, her ability to provide emotional attunement and nurturing will be compromised.
• Strife in the family. Divorce, unemployment, and a father’s extended absence, to name a few, can have a profound effect on the mother’s availability to her infant.
• A baby sent to a foster home or given up for adoption.
• The infant’s own health problems, especially when there has been early surgery, prolonged hospital stays, or chronic illnesses. Even chronic severe colic can disrupt the nurturing attachment bond.
Babies manage prolonged attachment and nurturing disruptions through a process of disconnection, which in turn compromises several aspects of development.
• Expressing need and want becomes too painful.
• The ability to know what they need and want is impaired.
• The ability to express what they need and want does not develop.
• The capacity to take in and integrate experiences of caring and love is significantly compromised.
• The ability to bond and feel connected to a trusted other becomes limited.
• The ability to manage intense affect becomes dysregulated. The younger the baby is at the time of the attachment and nurturing disruptions, the more pervasive the impact and the resulting dysregulation. In particular, the capacity for pleasure becomes compromised.
• Cognitions become distorted by attachment loss and deprivation. On a cognitive level, children try to make sense of their painful experience. Children who are deprived of having their basic needs met come to believe that there is something wrong with their needs. As adults they hold the belief that they are not deserving or entitled to express their needs or to experience the fulfillment of their needs.
• In attempts to self-regulate, they become susceptible to eating disorders and addictions.
Because of the lack of environmental attunement, individuals with this survival style do not learn to attune to their own needs, emotions, and body and become so adapted to scarcity that later in life, they are unable to recognize and express their own needs or allow fulfillment. For people with this survival style, there is a conflict between, on one hand, the expression of the need for physical or emotional nourishment, and the expectation of disappointment on the other.
Depending on the timing and severity of the attachment and nurturing difficulties, two different subtypes develop with two different strategies for managing the experience of deprivation: the inhibited subtype and the unsatisfied subtype. Both subtypes live with a feeling of emptiness and deprivation, but they have different strategies for coping with that experience.
When attachment and nurturing losses are early and/or more severe, the tendency is to foreclose the awareness of one’s needs. The shame-based identification of these individuals is that needs are bad and wrong and that they are not entitled to have their needs fulfilled. These individuals often develop a counter-identification that is based on being proud of how little they need and how much they can do without. The extreme example of this strategy is anorexia.
When the attachment and nurturing disruption is later or less severe, the unsatisfied type develops a tendency to be left with a chronic sense of feeling unfulfilled. In contrast to the inhibited type who will not express needs, the unsatisfied type can be very demanding of people in their lives while living with the continual feeling that there is never enough.
A good example to illustrate the difference between the inhibited and unsatisfied types is the state of their cupboards: the cupboards of the inhibited subtype tend to be nearly empty, and these individuals become anxious if their cupboards are too full while the cupboards of the unsatisfied subtype are overflowing, and they become anxious when supplies start to diminish.
| THE INHIBITED SUBTYPE | THE UNSATISFIED SUBTYPE |
Stops or forgets to eat when stressed |
Overeats when stressed |
Pride about not needing |
Has the feeling of “never enough” in all areas of life |
Often thin and unable to gain weight |
Tendency toward overweight |
Anorexia |
Bulimia |
Lack of entitlement |
Unrealistic entitlement |
TABLE 3.1: Comparison of the Two Attunement Survival Style Subtypes
Individuals with this survival style identify so strongly with the early experience of deprivation that they come to see the world through the prism of scarcity. Their resignation to deprivation and the depression of their needs, which is an adaptation to scarcity, impacts both their psychology and their physiology. Remembering that depression and resignation were originally life-saving, the identity of individuals with this adaptive survival style develops around making sense of, and coping with, their underlying resignation and depression. An identity develops around longing for fulfillment while at the same time, not being able to allow fulfillment.
Becoming caretakers is the coping mechanism both subtypes have in common. Caretaking is a pride-based strategy that allows them to see themselves as being without needs: “I don’t have needs; everyone needs me.” By developing relationships and work situations in which other people depend on them, they do not have to confront the shame they feel about needing or the rejection they fear will happen if they express their needs.
Clients with this survival style have learned to be very perceptive of the needs of others. This becomes the basis for a lifetime of attuning to others’ needs instead of their own. They give to others what they want for themselves. Since they believe they cannot express their own needs, they eventually become frustrated and angry that others do not attune to their needs in the way that they attune to the needs of others. Being ashamed of their own needs or finding it difficult to know what their real needs are, they can often express them only with anger after frustration and disappointment have become unbearable. This strategy alienates people around them and ensures that their needs will not be met, thus reinforcing their belief that expressing needs is futile.
Since individuals with the Attunement Survival Style do not want to recognize neediness in themselves, that neediness becomes covert. Looking for recognition for their caretaking or attempting to be the center of attention, they can be draining for the people around them.
• “If I express my needs, I will be rejected and abandoned.”
Compromised Core Expression
• “I need.”
Shame-Based Identifications
• Needy
• Unfulfilled and empty
• Longing: “When I get [the relationship, the recognition, the money, the fame, etc.] I need, then I will be happy.”
Pride-Based Counter-Identifications
• “I don’t have needs. I am the giver. Others need me … I don’t need them.”
Reality
• The rejection, abandonment, and deprivation they fear have already happened
Behavioral Characteristics
• Difficulty in sustaining energetic charge; they get excited about new projects but have difficulty finishing them
• Longing for their needs to be met without expressing them
• Clinging in a covert way
• Like to talk; getting attention is equated with getting love
• Often describe an emptiness in the belly
• Periods of elation at the beginning of a relationship or new, exciting project without the ability to follow through
• Do not reach out for what they want because of low energy and fear of disappointment
• Expression of anger is weak; tendency to be more irritable than angry
• Resignation
• Relationship to love object is self-oriented: “I love you … I take care of you … You have to love me.”
• Encourage others to depend on them
• Pick up strays: animals or people
Energy
• Generally low; they can sustain short-term charge when there is hope of fulfillment
• Depression in the chest
• Shallow
• Difficulty taking breath in
TABLE 3.2: Key Features of the Attunement Survival Style
Traditional therapeutic work often involves a focus on revisiting early experiences of inadequate attunement and nurturing as well as the abandonment that Attunement types have experienced. This regressive orientation can be re-traumatizing because it does not offer resources and can reinforce the identification of being a needy, helpless child.
NARM has developed a new orientation to help individuals with this survival style move toward resolution. The challenge for Attunement individuals is to learn how to attune to their own needs, to express them appropriately, and to tolerate more charge, fulfillment, expansion, and aliveness. The overall arc of therapy shifts from reliving experiences of abandonment and scarcity to learning how to tolerate fulfillment and expansion. We explore with these clients how there has been an adaptation to scarcity, to lack of attunement, and to abandonment that has affected both their sense of self and their physiology.
Working therapeutically with these individuals involves confronting the tendency to collapse in the face of strong feelings. Over time, growth takes place as their ability to tolerate more depth and expansion develops. Sadness and depression tend to be default emotions for these individuals, whereas expansive and positive emotions tend to be more challenging. Realizing that it is normal that grief about early broken connections will surface in the reconnection process, this grief needs to be acknowledged and integrated. The challenge for the Attunement type is to acknowledge old grief and loss as part of the growth process. Attunement types need help to work with their tendency to default to the familiar emotion of grief so that the identification with their early losses is not reinforced.
• Build the capacity to experience charge in all of its forms (strong sensations, emotions, attachment connections).
• Work with the cognitive distortion of not deserving.
• Work with the reality that their worst fear, abandonment, has already happened.
• Realize that by always being the giver, they abandon themselves.
• Acknowledge and help them integrate their split-off aggression.
• Work with their identification with longing but not having, with the fantasy “If [or when] I have … then I will be happy.”
• Help them to be realistic about their needs.
• Help them learn how to express their needs directly.
• Build the capacity for fulfillment and consistent connection.
TABLE 3.3: Therapeutic Strategies for the Attunement Survival Style
As clients with the Attunement Survival Style work through the shame of needing, they become more able to sustain connection with other people as well as develop an increasing capacity for positive emotion and aliveness. They are able to let go of their compulsive caretaking and find more fulfilling ways of meeting their own needs. Because they are more attuned to their needs does not mean they are any less attuned to the needs of others. A healthy balance is restored.