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The Attuned Therapist - Page 4

By the mid-1980s, "attachment labs" had sprung up around the United States—at the State University of New York at Stony Brook, the University of California, Davis and Berkeley, and the University of Minnesota, among others. There, social and developmental research psychologists not only observed mothers and babies, but began to study the long-term effects of secure and insecure attachment on adolescents and adults. As children who'd undergone the Strange Situation experiment grew up, they were studied to determine the continuity of early attachment patterns in their development. The University of Minnesota's Institute of Child Development, led by Alan Sroufe, has been running a longitudinal study of parents and children since 1976, focusing on the role of attachment and other issues on individual development (see p. 38).

Clinical Applications

It was one thing to provide a theoretical explanation of people's unhappy attachment experiences; it was another to develop therapeutic approaches by which clients could get beyond the limits of those early experiences. Bowlby himself, never an early-attachment determinist (he believed that it was never too late to change), thought that a therapist could provide what the parents hadn't—a safe, dependable, empathetic, and attuned presence that would enable the client to do some of the "growing up" he/she couldn't afford to do in the unsafe early environment. Attachment theory seemed to suggest that what mattered most in this clinical relationship was the therapist's capacity for emotional attunement—the ability to hear, see, sense, interpret, and respond to the client's verbal and nonverbal cues in a way that communicated to the client that he/she was genuinely seen, felt, and understood. Attachment research had emphasized the psychobiological core of attunement between mother and child—the continual, subtle, body-based, interactive exchange of looks, vocalizations, body language, eye contact, and speech. Attunement—or "contingent communication," as Daniel Siegel coined it—was really a highly complex, supremely delicate, interpersonal dance between two biological/psychological systems. If this contingent communication was a characteristic of healthy attachments between parent and child, or between husband and wife, or friend and friend, then wasn't it also critical to good therapy?

Of course, the idea that therapists should establish a close, empathic bond with clients—provide "unconditional positive regard" and a "corrective emotional experience" for clients—was old hat, at least for psychodynamic therapists. But at a time when brief, technical, pragmatic therapies were all the rage, attachment research seemed to offer genuine scientific validation for a deeper, emotion-focused approach that took infancy and early childhood seriously. The rich, evocative descriptions of attachment theory, the basic allure of it (what could be more appealing, more psychologically nourishing, than mother-love?), the very fact that such a pretty package was gaining scientific heft made it almost irresistible to many therapists. While attachment theory in itself didn't provide an accompanying toolbox of tactics and techniques, it did offer a new therapeutic attitude, justifying deep, soul-felt work, which would offer the client a genuinely new beginning.

Even so, it's still possible that attachment theory wouldn't have "caught on" if a virtual revolution in brain science hadn't happened at the same time. Bowlby always believed that attachment was biologically necessary in itself for survival. Looking at attachment through the lens of neuroscience from the late '80s to the present, researchers found that the mother–child bond, in effect, began to knit together the neural filaments of the newly emerging baby-brain—literally altering both the structure and activity of neural connections. In 1994, UCLA psychology researcher and therapist Allan Schore explained in his multidisciplinary book, Affect Regulation and the Origin of the Self, how the back-and-forth interaction between parent and infant regulates the swirling sea of intense, turbulent emotions registering in the baby's brain. In the process, the attuned parent is actually helping the baby begin to develop the neurological capacity to regulate his/her own emotions.

Schore's synthesis comprised a psychoneurobiological theory of human emotional development from infancy. The book wasn't about psychotherapy, per se, but he did discuss certain serious clinical issues that originated in poor early attachment—personality disorders, for instance. He quoted UCLA psychiatry professor and psychoanalyst James Grotstein, writing in 1986, that "All psychopathology constitutes primary or secondary disorders of bonding or attachment and manifests itself as disorders of self- and/or interactional regulation." Putting it crudely, the insecurely attached infant never got the maternal neural imprinting that would help her learn to regulate her own nervous system, thus making her susceptible to uncontrollable storms of inconvenient and unpleasant feelings throughout much of her life. Unless, that is, she got the chance at neurobiological-psychological repair from an attuned therapist, ready to meet her emotionally where she was—via nonverbal, affect-mediating, right-brain-to-right-brain communication—to help her undertake a kind of affective makeover.

Schore's book and two that followed (Affect Dysregulation and the Disorders of the Self and Affect Regulation and the Repair of the Self) received rave reviews from the psychiatric and psychoanalytic establishment, as well as the attachment and neuroscience research communities. But these technical, abstract, scholarly works aren't for the casual reader at the beach, or for those without at least some fairly intense grounding in neuroscience. What was needed was somebody who could make this complex, deep, basso profundo material sing in a lighter voice, appealing to a broader clinical constituency.

Of the core group of therapists influenced by attachment theory in the late 1980s and early '90s, that person turned out to be Daniel Siegel, who's probably done as much as anybody in the field to induce therapists to clasp both attachment theory and neuroscience to its collective bosom. Siegel's own discovery of attachment theory reads like a conversion story. As a newly hatched resident psychiatrist at UCLA in the mid-'80s, he was disillusioned by the professional infatuation with the Diagnostic and Statistical Manual and medications—the growing tendency of his colleagues to see patients for half an hour, assign them a ready-to-wear diagnosis, prescribe medications, and send them off until it was time for their next meds check. In 1988, when he was a fellow in child psychiatry and pediatrics, he heard Mary Main give a talk about her work with the AAI and how it demonstrated adults' capacity for "coherent narrative," which was related to how they made sense of their attachment histories. For Siegel, the rest, as they say, was history. He was particularly struck by the fact that if adults could, through therapy or other reparative life experience, learn to create a reflective, coherent, and emotionally rich story about their own childhoods—no matter how neglectful, abusive, or inadequate—they could "earn" the emotional security they'd missed and still be able to form a good relationship with their own children. "I loved the way attachment research showed that fate (having less-than-perfect parents) isn't necessarily destiny," says Siegel. "If you can make sense of your life story, you can change it."

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