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The Clinical Relevance of Attachment Theory and Research

There's now overwhelming empirical support for the fact that early experience is a powerful force in development. But what can clinicians draw from this work, beyond feeling reassured that their clinical intuition isn't simply an "article of faith"? For one thing, this extensive work can bring perspective to questions such as why change is so difficult and why emotional closeness can be so scary to some people. Long before children have the language and conceptual tools to process experience, negative or even traumatic patterns of interaction are incorporated in the brain, the functioning of their psyche, and even in the molecules that control the expression of their genes. Therefore, people can get "lost in familiar places" as they continually recreate their earliest patterns of interactions across the lifespan. One role of a therapist is to bring awareness to such patterns and then intentionally create new pathways for clients to take as they unlearn their long-established habits.

Another important implication of attachment research is that it's possible to develop a secure state of mind as an adult, even in the face of a difficult childhood. Early experience influences later development, but it isn't fate: therapeutic experiences can profoundly alter an individual's life course. Further, therapists can learn from attachment researchers' hard-earned insights into human development which features of relational experience are the most effective at optimizing well-being. When parents are sensitive to a child—when they pay attention to and tune in to the signals sent by the child, make sense of these signals and get a glimpse of the child's inner experience, and then respond in a timely and effective manner—children are likelier to thrive. The essential features of a therapeutic relationship mirror this process in many ways.

The brain continues to remodel itself in response to experience throughout our lives, and our emerging understanding of neuroplasticity is showing us how relationships can stimulate neuronal activation and even remove the synaptic legacy of early social experience. Developmental trajectories are complex, often having "islands" of positive relational experience, even within largely negative histories. Through therapeutic relationships and reflective practice, one can make contact with these islands—the "angels" in the nursery, to quote developmental psychologist Alicia Lieberman—and cultivate their growth to the benefit of parents, children, and adults alike. In this way, clinical practice can use the power of our attachment relationships to cultivate deep and lasting change throughout the lifespan and even stop the transmission of disabling early experiences across the generations.

Alan Sroufe, Ph.D., is the William Harris Professor of Child Psychology in the Institute of Child Development and adjunct professor of psychiatry at the University of Minnesota. He's been an associate editor of Develop-mental Psychology and Development and Psychopathology. His books include The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. Contact:

Daniel Siegel, M.D., is clinical professor at the UCLA School of Medicine, where he's coinvestigator at the Center for Culture, Brain, and Development and codirector of the Mindful Awareness Research Center. He's the executive director of the Mindsight Institute and the founding editor of the Norton Professional Series on Interpersonal Neurobiology. His books include The Developing Mind; Mindsight; and The Mindful Therapist. Contact:

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