Very interesting and thought provoking session that resonates with me. Just like belief in the therapeutic regimen and the therapist is helpful, belief in the medication treatment is helpful too, as we're finding. Even if the person knows they're taking a placebo pill, it still works! So I imagine that even if the person knows that this is the brand of therapy they believe in for some reason versus other brands, it will work. All the more reason for transparency and education of the patient and the therapist.

Could you kindly post the 3 elements that Dr. Kagan said are important when a therapist is helping a client.
Thank you,
Randi McAllister

Dr Kagan, Although the influences you mentioned are clearly important, aren't we still Talking about ATTUNEMENT & receptivity, mirroring & empathy as the tools or instruments needed to build successsful bonds between parent & child (at various stages) or between therapist and client? It seems to me these are still the essential qualities describing the supportive & healing dynamics of the "good enough" relational or attachment environment; a milieu which would by its very nature include awareness about the variables you mention as part of the secure attachment. Joan Merlo

Thank you for a thought provoking discussion. I have two main questions:
1. How do we unpack the concept of class and identification. Indeed, if we know that class is the strongest predictor of mental illness, then what about class (is it poverty, stress, threats of violence, social insecurity, etc) that impacts development and to what extent? How do they impact each other in a causal model?
2. As a recent graduate student, I am struck by how little class figures as a concern in therapists' education. I believe I was taught about how to recognize my biases in an effort not to alienate a diverse clientele, and also to recognize biases in treatment. However, I do not believe that I have been taught about how to work on class issues -- and to understand what nodes/ issues are important in class experience. In fact I would say that the training undervalues the role of class -- in an effort perhaps to counteract inherent class bias in our culture.
Eliza Gomart, MA

This discussion left me wanting to see the results of a study showing the development of babies of similar temperaments but completely different caregiver reactions to those temperaments. The mother who is incredibly anxious about her child's shyness and let's them know in some way that their inner temperament is wrong or weak. The father who, in his own insecurity and vulnerability, lashes out the toddler who directly challenges him with the confidence born of her inate temperament. I agree that temperament is an important factor independent of caregiver reaction but also believe that the reaction of the caregiver to the specific temperament is of great importance in development. Race, culture, religion are also huge factors in how society "parents" the individual--in what ways do they accept this person based on who they are (same as temperament) or reject them? I wasn't as convinced by Kagan's arguments for the respected professor and professionals who still doubted themselves only because of society prejudice. Clearly society prejucide is an important factor but what about the way that society prejudice influenced the parents of these professionals and they ways they were able to intimately connect with their children? Trauma survivors who still live to some degree in the trauma (for example, a racist or antisemitic society) may have barriers in abilities to connect with their children based on thier own sense of unworthiness and basic fear. And to add, someone being the President of a University with career success does not remove them from emotional dysfunction. How are we defining success?
Additionally, I as a therapist am not going to tell a client that, because this is the year 2011 she should be working and then she'll be more fulfilled. I believe that one of my roles as a therapist is to explore with a client the ways that customs and beliefs of current culture are affecting them in order to, as Kagan promotes, help them and myself to understand and come to an agreement around where the distress lies and how to address it. This is, of course, in addition to the issue of temperament and ways client was parented as well as experiences outside the family of origin.
I was also wondering if Kagan was defining class as financial, education or a combination of both. Do people feel they have more in common with someone who has a similar education but not similar wealth or someone who is financially as secure but differently educated? Do they feel more valued by society due to wealth or education which do not always go hand in hand? My experience is that education appears a stronger factor due in part to a mastery component and as more and more people are going to college and loans to do so are becoming wider known and easier to recieve, I wonder how this will influence these arguments. Great discussion, thank you.

Perhaps the fact that there is a debate indicates the degree to which ideas have become static and, in becoming static, face the natural process of entropy and decay. What I particularly notice about this presentation is that Attachment Theory is not being discarded, but placed back into a wider mix of ideas, theories and practices. It is the interplay between the different elements that gets lost when we get stuck in a single idea. These elements are extracted from the whole and they certainly give us greater insight. It is not, however, the separateness of the theory that makes it powerful, but how we are better able to understand the collective interplay because we have separated the elements. At the bottom line of therapy Kagan reminds us that it is the interpersonal process of mutual engagement that seems to open the door to making beneficial change. So simple, but then again so difficult.

Thank-you Dr. Kagan for sharing your time and wisdoms with us and thanks Rich for your activist role in "getting Jerry". I found myself listening and often nodding, sometimes up and down and other times side to side.... realizing yet again that just as the "attachment debate" heats up..what emerges is similarity. Dr. Kagan notes at the end that it is through the connection between us humans that we can again feel restored and hopeful.

Conceptually I have two comments; firstly in working with parents for 30 years I finally realized that most are far more focused on self improvement and improving felt relationships with their kids then in wondering if their child's attachment pattern will persist into adulthood. I also am particularly interested in others learnings and ideas regarding how we can mentor and guide parents to utilise their attachment relationship with their child to bring forth the positive expression of the child's basic temperamental proclivities. How does one engender "gene expression" in a pro-social manner which also includes a child's vitality and uniqueness. Could a refined/expanded/updated attachment model be one of these methods? Can we find a pathway which begins to integrate psychoanalytic, attachment, genetic and social learning models of human behavior and development???
I look forward to this conversations unfolding over the next several months.

Dr. Kagan talked about class being first, then wiring, then the first year. I am an upper middle class woman, wiring- sensitive, emotional, and grew up with an ambivalent, not so nurturing mother. I got all the things I (and my mom I think) thought I needed- good education, never worried about food or money, lots of activities, etc. I'm 37 and finally recovering (through therapy) from borderline personality disorder. Everything I had was "picture perfect"- unless you look a little closer. As a sample of one, which of course is meaningless, I fall on the side of attachment being the biggest factor...I guess because I'd rather not think there's something inherently "wrong" with me. And if I thought that, I don't think I'd have worked so hard to correct all the things I've worked so hard to correct.