In forming long-term relationships with clients, I’ve come to appreciate and utilize Attachment Theory. The theory purports that the childhood bonds formed with our caregivers shape how we relate to others and ourselves for the rest of our lives. In connection with others, we will either seek what is familiar to us or try to re-create accustomed patterns – this is our attachment style. For some of us, this is a helpful tendency. If our relationships were warm and attuned then we will seek out similar feeling relationships. Conversely, if our relationships with caregivers were conflict-ridden or inconsistent then we will unconsciously seek out others that will fulfill these expectations or create that same dynamic with partners. Researcher Mary Ainsworth and her 'Strange Situation' study (done in the 1960’s-70’s) were crucial in understanding how our attachment style forms during our infancy. While previous generations of researchers and psychologists already placed value on early childhood development, Ainsworth's broad categorization of attachment styles helped adults more easily understand the effects of their childhood on their adult relationships. Through observing the reactions of young children and their primary caregiver, usually the mom, Ainsworth assessed the quality of the infant-parent relationship a.k.a. attachment style. The ‘Strange Situation’ study was conducted in a few systematic steps. First, a caregiver and infant would play in a room together for some minutes, then a stranger would enter and be present with the infant along with the parent. After a few minutes, the caregiver would leave the room then return shortly thereafter, all the while Ainsworth and her researchers observed through a two-way mirror. Based on her observations, Ainsworth developed four categories of infant-parent attachment style: 1. Secure attachment 2. Insecure-anxious attachment 3. Insecure-avoidant attachment 4. Insecure-disorganized attachment. Attachment styles may be thought of as parts of a continuum with secure attachment at one end and disorganized attachment on the other end. Secure attached infants played and explored freely in the presence of their caregiver and showed little fear of the stranger. When their parent left, they became upset and upon their return, were happy and soothed by them. Secure attachment reflects a child’s belief that their parent is attuned and aware of them and will help in times of distress. This safe relationship instills in a person a belief that people are generally helpful and trustworthy. Conversely, insecurely attached children carry complicated beliefs that people are unhelpful, untrustworthy, or dis-regulating. The different variations of insecurely attached children reflect caregiver relationships that are inconsistent, absent, or at worst, another source of distress for the child. Anxiously attached children were wary of strangers (even in the presence of a parent), were highly distressed when the caregiver left, and upon return of the parent were either angry or displayed helplessness. These children had caregivers that were unpredictable in their care – alternating between presence and absence. Anxious children’s big displays of anger or helplessness were seen as cries for more steady contact. Avoidant attached children mirrored the behavior of a caregiver that snubbed or avoided the child’s bids for attention. These children explored little of their environment and ignored or tepidly approached their caregiver when they returned. While these children were clearly distressed by their caregivers’ absence - their belief that their needs would not be met prevented them from making an outward show of suffering. Why cry if no one is listening? Their silent protestations were a way to have some closeness with their caregiver, but not so close as to experience the painful rejection of an absent parent. Lastly, disorganized children were symbolic of a highly dysfunctional and un-attuned caregiver-infant relationship. Sadly, these children had parents that not only rejected or ignored their children’s requests for help but may have become enraged, upset or despondent by their child’s request for help. When their caregiver returned to the room the child displayed erratic behavior, they would approach their caregiver with irregular motion and display a flat affect while clearly being distraught. The infant was displaying the inner conflict of wanting care and attention but also a fear or wariness of their caregiver. Often, the parents in these relationships had recently experienced a major trauma or had serious depression. This study has proven to be important because attachment style has proven to carry over into adulthood and emerge in our romantic relationships, close friendships, or in our own created families. For those of us with secure attachment, we have a belief that we can trust our feelings and those that are close to us. We probably don’t have much need for psychotherapy. For those of us with some insecure attachment, our relationship with others and ourselves is more complicated. We may notice troubling patterns and tendencies that emerge over time - different partner, same issues. Sometimes we might be unpleasantly reminded of how we felt as a child or notice that we’re responding to others as we responded to our parents. Anxiety and depression may be present. If we are an anxious (pre-occupied) type, our partners may give us feedback that we’re too needy or overwhelming. Jealousy and a fear of abandonment may drive our actions. If we are avoidantly attached, we may retreat if we feel hurt or angry – it may be safer to spend time alone rather than deal with issues. Perceptions that we are frequently distant are common. Disorganized attached individuals may have chaotic relationships with others, oscillating between rage and helplessness. Craving time with another while also being terrified of them.
Thankfully our attachment style is like our brain – malleable. Through therapy or even through relationship with other securely attached individuals, we can come to change the way we relate to people and ourselves. Kindness and empathy from others teach us to be kind to others and ourselves. We come to understand much of our feelings are by-products of the attachment style or schema laid during childhood, from ages 1-5. Some of us need to deepen our trust of our feelings while others may need to learn to ignore them! The more awareness we turn towards our inner workings the greater chance we have of choosing a healthy path and avoid repeating the same detrimental patterns. There have been many important contributions and challenges to attachment theory since its inception in the 60's. We don’t all neatly fall into one of the categories – we all exhibit some streaks of each of these styles that manifest at different times. However, the essence of the theory remains important – that our early relationships are remarkably important to our long-term well-being.
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Two weeks ago, my partner and I completed a ten-day Vipassana meditation retreat as taught by S.N. Goenka. This technique of meditation considers itself secular and non-religious, however it is a technique that traces back to the 2500-year-old teachings of the Buddha. Over the course of ten days, I along with about 100 others attendees meditated for about 8 hours/day while maintaining total silence. We were neither able to talk or make eye contact with one another nor distract ourselves with our usual methods, i.e. no phones, books, journal writing, or exercise. The focus of our experience was meditation and all other activities such as rest and meals were regimented to support our internal work.
Dread filled me in the days prior to the experience because of a fear of what would come up and whether I would be able to handle it. What I was undertaking would be emotionally and mentally challenging especially because of the solitude. Even before the meditation instruction began, I noticed how difficult it was to be entirely cutoff from the warmth and caring of my relationships with my friends and family. As I went deeper into the technique, different internal tensions were exposed. In the Buddhist tradition, Vipassana means to see things as they really are or to have insight into the true nature of reality. In essence, Vipassana meditation is how to harness the wisdom of the body to tame the mind. Through careful, repeated, and encouraging lessons, I learned the technique. It quickly became apparent that my mind was unruly, agitated, and anxious. My mind did not want to focus on the object of attention; it instead desired to live in fantasy or projection. At times, the speed and nature of my thoughts was deeply terrifying. For the majority of the retreat, I struggled to make meaning out of my mind’s activity. Was I just totally insane? Thankfully, the kind and experienced teacher reassured me that my experience was normal and that these thoughts and emotions were, in fact, a sign that I was doing good work and moving through my accumulated tensions. He encouraged me to stick with the technique and have good faith that it would be helpful. Vipassana and Buddhism in general, emphasize change. That everything is always changing and the more we become comfortable with this truth the less suffering we will experience. We create pain by either craving a sensation or emotion or by being averse to a sensation of emotion. If we sit with our body and mind enough, we gain insight into these relationships and no longer live a life of reactivity. The choices in life become clearer. Vipassana also emphasizes compassion. If we are to live a happy life we must also help those around us to be happy. Somewhere around the seventh day, I gained confidence that I could handle the crazy activity of my mind and its’ accompanying emotions. I became less attached to the meaning of my thoughts and actually began to enjoy the meditations because it gave me an opportunity to do self-help work. Since the conclusion of the course, that enthusiasm has continued into my daily life as I have maintained the meditation practice. In our culture, we emphasize work. We work our jobs, we work our bodies at the gym, and many of us work diligently at a hobby to have fun. We understand that work should payoff, that there should be some tangible benefit to the expense of our energy. Vipassana brings this same belief to the domain of the mind. If we think of mediation as work for the mind, then the payoff will be peace, balance, and happiness. Like any pursuit, the more we put in - the more we get out. Recently, I read 'The Interpersonal Neurobiology of Group Psychotherapy and Group Process' edited by Susan Gantt and Bonnie Badenoch. The text is an exploration into two fields of psychology that excite me: group therapy and neurobiology. Interpersonal Neurobiology (IPNB) is a recent theory of mind that seeks to define mental health through a multi-disciplinary study of biology, cognitive science, anthropology, mathematics, sociology, and more. Psychologist Daniel Siegel coined the term Interpersonal Neurobiology and created the acronym FACES to define the characteristics of a healthy mind: flexible, adaptive, coherent, energized, and stable. The centerpiece of a healthy mind is coherent life narrative that makes sense to us as well as to others in our life. Group therapy began as an efficient way for therapists to treat the boatloads of soldiers returning from WWII and needing therapy to process their experiences. Since that time, group therapy has blossomed into a mode of treatment that is seen as effective as individual therapy and in some ways, superior to it. Since the roots of our suffering often began in our early family experiences and our own day-to-day difficulties manifest in our close relationships, group therapy offers us a microcosm of the people that shape our personality. In the first chapter of 'The Interpersonal Neurobiology of Group Psychotherapy and Group Process' the authors Bonnie Badenoch and Paul Cox explore the neurobiology of a coherent life as it relates to group therapy. Coherency represents the centerpiece of IPNB mental health because it is the summation of multiple steps of neural or brain integration. Brain integration equates to a healthy and happy person. By finding the words to describe our internal thoughts and feelings, we are integrating many aspects of ourselves. This process begins with emotion and culminates with words and meaning. As we tune into our bodily sensations and feelings, energy travels up our spine and nerves into our limbic system and passes through our amygdala - a brain structure that regulates mood and emotion. The amygdala and its associated vagus nerve have the capacity to kick us into fight-or-flight mode or to keep us calm and receptive to others. Our amygdala assesses for safety several times a second and sounds the alarm if things go awry. The alarm may be silenced by the hippocampus – the memory keeper of emotion and the structure representative of the next phase of brain integration. Part of assessing whether the present moment is dangerous or safe is comparing the present to the past. For example, if we open the door to a friend’s house to find a barking dog, our amygdala may default to a fight-or-flight state in order to protect us from a potential bite. However, the hippocampus may calm the amygdala by associating this moment to memories of this same dog being friendly and just overly excited. From body to amygdala to hippocampus energy lastly moves to our pre-frontal cortex where our felt sense of our history in our right brain hemisphere finds words and meaning in our left hemisphere. Up to this point, our experience is wordless, there are sensations, emotions, and memories, but no verbal meaning attached to them. The left pre-frontal cortex puts words to our experience and allows us to have autobiographical memory and a coherent life narrative. Successful integration of body to amygdala to hippocampus to pre-frontal cortex leads to self-awareness and a capacity for empathy for us as well as for others. In group therapy, we are invited into vulnerability and asked to put into words our here-and-now emotions and thoughts. From an IPNB perspective, group therapy allows our system to integrate previously dis-integrated experiences and find new meaning for old wounds while deepening our capacity for intimacy. These are all part of weaving a coherent life. For example, Bill was not allowed to be angry as child because his anger was amplified by his own mother’s inability to handle strong emotions. Bill’s complicated relationship with anger has manifested in his failed relationships with women that, over time, find him dispassionate, distant, and generally on ‘auto-pilot.’ Bill also suffers from chronic depression. Using the IPNB model to explain Bill’s challenges, we surmise that Bill’s early childhood was so overwhelming that his young brain was unable to integrate his experiences with anger and he has turned that same emotion inwards. Aspects of the brain develop in a hierarchy, from amygdala to hippocampus to pre-frontal cortex. So at the age of two, Bill’s amygdala (alarm system) was online but his hippocampus (emotional memory keeper) and pre-frontal cortex (meaning maker) were not available to help regulate him. So he has only wordless feeling states and behavioral impulses that unconsciously say to him ‘do not experience or express anger.’ In IPNB jargon, these are known as implicit memories – feeling states that have no memory attached to them. Since these feeling states are unconscious, Bill is unable to harness the regulating capacity of his hippocampus and pre-frontal cortex. So he remains silent and brooding in the group especially when a female member with a disposition similar to his own mother triggers him. Through his amygdala function, Bill notices sickness in his stomach and a desire to move away from what is happening internally. This is an early childhood feeling state for Bill – an implicit memory state. Through tone of voice, eye contact, and general attunement Bill stays with his feelings and begins to remember, through hippocampal functioning, certain instances of his mother being angry and causing him to ‘bottle up’ or swallow his feelings. Bill reflects on these experiences and sees how they have caused him so much pain in his relationships with women. Through integration with the pre-frontal cortex, Bill puts words to these experiences giving them meaning that he and the group can understand. Bill is beginning to feel the full spectrum of his emotions and to harness them as powerful messengers of his experience. His relationships feel more alive and nurturing and he views the symptoms of his depression in a healthier manner. The group has allowed Bill to experience his strong emotions without shaming thus allowing his brain to make new neural connections. These neural connections have attached new meaning to his implicit memory states and allowed the unconscious to become conscious. In short, his life is more coherent. Group offers us a chance to put new meaning to difficult feeling states associated with childhood or other difficult life experiences. Group members learn to trust that they can bring their full selves into relationships and use one another to make sense of the complexity of life. By inviting compassion and attunement into the group to hold powerful feeling states the brain finds new connections and heals itself.
Interpersonal Neurobiology, a.k.a. IPNB is a term coined in 1999 by psychologist Dr. Daniel Siegel to describe the interdisciplinary field that seeks to understand the mind and mental health. A dimension of IPNB is the study of human nervous systems in relation to one another – the interpersonal aspect of neurobiology. I’m lucky that my supervisor Juliane Taylor-Shore LPC-S, LMFT-S has studied under both Dr. Daniel Siegel and Bonnie Badenoch, a therapist and author at the forefront of the application of IPNB to psychotherapy. Jules’ specialty is IPNB and she encourages us to utilize Badenoch’s ‘The Brain-Savvy Therapist’s Workbook.’ The workbook artfully integrates neuroscience with psychotherapy. Badenoch’s advocacy regarding mindfulness caught my attention:
…mindful attention is one key agent of change. From the moment we hear our patients’ voices for the first time, our minds may begin to reach toward understanding, forming pictures of the many layers being shared. This kind of deep listening is the beginning of mindful awareness in the interpersonal realm, a tender, curious openness to another person’s body, nervous system, and inner world. In this caring observer state of mind, our more integrated activation can begin to weave our patients’ brains into similar patterns, bit by unseen bit. In this way, our ongoing attentiveness also teaches our patients’ minds the pathways of mindful awareness and we will see their capacity for greater mindsight gradually emerge. As time passes, we may sense that our two attending minds are creating an environment in which neural nets holding old wounds may open to the safety and comfort being offered. In this way, we develop a foundation that can support whatever else may need to happen in therapy. In the above passage we come to understand the power of awareness and the ability of a mindful listener to help another through difficulty. If we think of depression and anxiety and other mental heath conditions as dis-regulation of the brain and nervous system then mental health may be the ability of the mind to handle the inherent stress of life without becoming de-stabilized. Depending on our temperament, we may soothe ourselves during times of difficulty, but we all need help sometimes. If we’re lucky, we talk with a close friend or family member that deeply listens to us. Oftentimes, just having another closely listen helps us feel better. Using Bonnie’s IPNB language to understand what is happening when we share our difficulties, a well-integrated individual helps bring a disintegrated individual back to stability and greater mindsight (more on this later). If we’ve spent time with children we may have seen this phenomena of co-regulation. When a young child is hurt or upset they usually seek comfort from their caregivers. Perhaps the adult says something like ‘I see you’re upset, tell me what happened,” - this is attunement. After receiving re-assurance the child feels ready to separate and return to interacting with the world. In this way, parents are teaching their children that other humans will help when they’re overwhelmed. However, many of us with complex childhoods may have received conflicting messages about care when we were upset. Our caregivers may have amplified our difficulties and caused us to feel shame or to turn our emotions inwards. Using IPNB language, parts of us may have become disintegrated. As adults, these difficulties may manifest as depression, anxiety, rage, or a lack of close relationships. Engaging with a attentive and caring therapist helps us to heal these old wounds and re-integrate parts. As our sense of safety and comfort grows with a therapist we develop greater mindsight. Another of Dr. Siegel’s terms, mindsight is the ability to perceive the mind of the self and of others. Buddhists might recognize this same idea as mindfulness. Mindsight puts separation between our feelings/thoughts and our overall experience. It allows us to choose how we respond to our emotions. Instead of ‘I am depressed’ we think ‘I notice I’m feeling depression’. This small difference, allows us to not be defined by our feelings and thoughts and remain stuck in self-reinforcing loops. We accept our feelings and, eventually, move through them. Mindsight also allows us to help others who are disintegrated by staying stable and available when they are overwhelmed. Bonnie concludes her passage on mindfulness with a call for formal mindful practice such as meditation or yoga: As we will see, the addition of formal mindfulness practices can also deepen and speed our integrated process at times. However we approach the inclusion of mindfulness, the accumulating body of research tells us that sustained practice produces not only momentary functional changes and neural connections, but enduring structural changes as well. That is, states of mind that originally require effort can become effortless traits of being with practice. Bonnie highlights the new scientific insights regarding the physiological brain changes produced by mindfulness practice. Interestingly, these findings integrate well with Buddhist spiritual concepts. Based on functional MRIs, scientists have learned that long-term meditators have a well-developed orbitofrontal cortex (OFC) with strong connections to the amygdala - a deeper area of the brain responsible for emotional reaction. It is thought that stronger linkages between these areas allows for greater control of emotions. By consistently meditating, practitioners are able to strengthen the synapses between the OFC and the amygdala actually changing the structure of the brain. Interestingly, the OFC is located in the skull behind the brow, the same area where Buddhists believe the third eye chakra to be located. A Buddhist spiritual concept, the third eye chakra represents humans’ ability to develop higher consciousness and enlightenment. The third eye perceives extra-sensory information that is only available through dedicated and long-term meditation practice and adherence to Buddhist philosophy. Buddhists intuitively knew that developing the OFC led to higher consciousness. As brain science continues to advance there will be exciting cross-pollination between psychology, spirituality, and religion. We will continue to learn the specific characteristics of a healthy brain and how we can improve our own minds. We know now that being consistently attentive to our own minds and as well as to the minds of others is of great benefit and produces long-term changes. ‘You make me crazy!’
‘Laughing is so easy with you.’ ‘When I’m around you, I feel so drained.’ These are all common expressions between humans. We notice how we feel, think, speak, and behave around different people in our own lives. Most of us move towards others that make us feel good about ourselves and our lives. However, many of us (myself included), have also been in relationships in which anger, shame, and hostility seem more easily accessible than joy, laughter, or creativity. Oftentimes, when we are in connections like these we ask ourselves ‘Why and how did this happen?’ Or if we’ve had multiple failed relationships, ‘Why do I keep repeating different versions of the same mistakes?’ Psychologist Louis Cozolino, PhD provides some clarity on these questions in his neuroscience-based book 'Why Therapy Works: Using Our Minds to Change our Brains': Two consequences of human evolution seem particularly relevant to both the birth and success of psychotherapy. The first is that we evolved into social animals who are highly attuned to one another’s inner experiences. This sympathetic attunement allows us to influence each other’s thoughts, feelings, and behaviors. The second is that our attachment circuitry remains plastic throughout life. If you have any doubts about this, just ask grandparents how they feel about their grandchildren. Through the new science of epigenetics, we now know that we participate in the way each other’s brains are built, how they develop, and how they function. (p. 87) Cozolino points out that humans are highly social creatures whose inner experiences and overall well-being is both heavily influenced by and influential to other humans. Each of us has our own unique manner in which we relate to others which Cozolino links to our attachment circuitry. Our attachment style/circuitry may be thought of as the way our own nervous system expects close relationships to feel. This circuitry is most quickly and strongly laid during our early childhood years while our brains and bodies are rapidly growing. If most of our experiences and caretakers created a world that was coherent and safe, then we would expect the same and seek that from the world and the people in our lives. Conversely, if our caretakers or experiences informed us that the world and people were generally unstable or chaotic then our nervous systems will expect and even re-create those experiences - even to our own detriment. While it seems counter-productive for us to perpetuate hurtful relationships, our brain, like all of nature, conserves energy by following what it knows. Disconfirming and new experiences cause the brain to burn more energy - a risky evolutionary development. So we have a tendency to relationally seek what our brain has already experienced. Our own close relationships may be thought of as reflections of our own complex attachment history. Many of us have witnessed friends or family members (or ourselves) that pick or are attracted to wild and restless partners that bring more turmoil than peace. Then it may not be surprising if these same people had a caretaker early in life that was anxious, distant, or, at worst, abusive. While as an adult, half the responsibility for our relationships lies with us and our present-day choices, we cannot separate our present-day selves from our attachment style formed in the needful and dependent years of childhood. Thankfully, for those of us that have complicated attachment histories our attachment circuitry remains changeable or plastic throughout our lifetime, as Cozolino suggests. Psychotherapy, both individual and group, helps us by providing an empathic relationship that disconfirms our brains' expectations for anxiety or hostility. Ideally, clients are able to deeply reveal themselves and their vulnerabilities and be met with acceptance and warmth. We can use this therapeutic relationship as a guide and model for our external relationships and create depth and closeness as we’ve perhaps never experienced. We learn to rely on others to help meet our own needs and have others rely on us in a way that is deeply satisfying. In the final line of Cozolino's paragraph, the point is made that as we habitually experience positive and attuned connection and learn to act from that place ourselves, we are actually changing our brain structure and consequent gene expression by altering neuronal pathways. These benefits are passed on to our children and the world at large. Neuroscience is just beginning to accumulate knowledge that the world's religions and spiritual paths have posessed for thousands of years. The wisdom of 'The Allegory of the Long Spoons' is particularly relevant to the discussion about our social nature. A man asks God ‘What is the difference between Heaven and Hell?’ God leads the man to two doors. Behind the first door is a large round table with a pot of stew in the middle of it. The individuals seated around the table are emaciated and distraught. They each have very long spoons that are lengthy enough to reach the stew but so long that they are unable to contort their arms to reach the spoon into their own mouths. ‘This is hell,’ God says. God leads the man through the second door where he finds another group of people seated around a round table with a pot of stew in the middle of it. Except these individuals are healthy and full of joy and laughter even though they too only possess the same awkwardly long spoons. ‘This is Heaven,’ God states. ‘I don’t understand,’ the man confusedly declares. God replies, ‘It is simple, these individuals have learned to feed one another.’ |
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David HixonMy ongoing exploration into therapy related topics. Archives
October 2021
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