The Happiness Blog:

An Unhappy Man Seeks Help - Part 10:

How to fix problems of insecure attachment

Copyright (c) Jim Byrne, 18^th June 2010

Preamble: if you want to be happier than you are, try practicing daily meditation; and write out three things you can be grateful for at the end of each day.  Practice focusing on helping others, rather than ruminating about your own problems.

And every morning when you wake up, choose happiness.  Chose to focus your mind on the positive aspects of your day, and let the negatives slip away. ("I let it go!")

Introduction

Last Friday, I set the agenda for this week by writing:

"Next week I plan to look at two ideas from David Wallin's book: Mary Main's references to ‘meta-cognition' as a way to resolve attachment problems; and Peter Fonagy's references to ‘mentalizing'.  My point of origin will be the following statement by David Wallin (2007)[1]:

‘We might reasonably infer that the strength of the (mother's) capacity to reflect coherently on her past will significantly affect her ability to impart security to her child.  And ... the security of our own ‘state of mind with respect to attachment' may ultimately depend less on the particular facts of personal history - however problematic - than on the success of our efforts to make meaningful sense of that history'." (Page 34).

Achieving attachment security

My own experience confirms the second part of this statement by Dr Wallin.  In my papers on CENT, and in my book (‘Therapy after Ellis, Berne, Freud and the Buddha: The birth of CENT'), I explored my early relationship with my mother - up to about the age of three; and also, less significantly, the period beyond that stage.  By working through the difficulties in my relationship with my mother, which I was eventually able to identify (or infer), I was able to reach ‘completion' - to be able to allow things to be the way they were, and to be able to move on.  I had completed my sense of grief at not being able to ‘re-unite' with my mother at about the age of 15-18 months (the so-called ‘rapprochement crisis').  Nothing has changed in the actual history of my relationship with my mother, but my self-therapy and therapeutic help from others has allowed me to move on, despite having had an unsatisfactory and insecure attachment bond with my mother at that time.

This outcome also lines up with the third of three points made by David Wallin on page 1 of his 2007 book, where he says: "...that the stance of the self toward experience predicts attachment security better than the facts of personal history themselves".  This is equivalent to the Stoic perspective (from Epictetus and Marcus Aurelius) that it is not what happens to you, but your attitude towards it, that determines how you will feel.  However, when we are very young, and acting from innate wiring, there are not many choices available to us in terms of how to respond when things of an unpleasant nature happen to us.  The only sensible relevance of Wallin's point here is this: when we are older, we can change our stance towards what happened to us way back at the start of our lives, and thus change our feelings about it.  But we do not have any obvious options and choices when we are very young.  We respond the way we respond; and that sets the direction for all subsequent developments - cumulative, interpretive experience is the name of the game!

Preverbal decisions

The difficulty that I have outlined in the previous paragraph is underscored by the second point made by David Wallin on page 1: "...that preverbal experience makes up the core of the developing self".  In other words, I got upset about how my mother was with me long before I had the words to describe what she was doing, or not doing, and what was happening to me, and what I was upset about.  Therefore, no matter who I am, I will have to wait until I have grown up, and can get the help of a relational therapist to take me back to that period, and to help me to dig up whatever can be dug up of my relationship with my mother, and look at it so I can digest it, and allow it to be. But the problem with preverbal experience is that much of it cannot realistically be dug up again, for it has no linguistic labels or handles to get hold of.  It may not even have any visual labels or handles to get hold of.  So that just leaves visceral handles, which might be accessible in relationship with a good enough therapist, who can go back over the original territory where I got lost, while seeking a secure bond, seeking a secure base, fleeing to a safe haven; so that I can have the missing experiences now, in the present moment, with a ‘mother substitute', of being securely attended to, affectively reflected, and whatever else I seem to need to achieve in order to feel secure in my relationship with that therapist.

And whatever I say about me in this piece also applies equally to Fred and Dora, our unhappily married couple who have been the subject of this series of blogs for the past ten weeks.

Defining attachment

Attachment is an emotional bond to another person.  John Bowlby was the main theorist of attachment, and he argued that, depending on how sensitively a mother responded to the needs of her baby, the baby would develop either a secure or an insecure attachment.  Mary Ainsworth did some empirical research on this theory, with her ‘Strange Situation', in which a mother and her toddler are alone in a room; the toddler is allowed to explore the materials in the room; a stranger comes into the room and talks to the mother and approaches the toddler; the mother slips out of the room for a brief period; the parent then returns; and the behaviour of the toddler is observed to see how it handles the Strange Situation, the departure of the mother, and the return of the mother.  Ainsworth found that toddlers are either securely attached to their mothers, and handle the Strange Situation well; are insecurely and avoidantly attached to their mothers; or they are insecurely and ambivalently attached to their mothers.  The insecurely attached toddlers handle the Strange Situation badly.

Subsequent research by Mary Main has shown that these attachment ‘styles' (secure or insecure) are transmitted from mother to child, to grandchild, so are multigenerational patterns of relationship style. (Wallin, 2007, pages 39-51).

Attachment, rapprochement and power relations

Attachment is a feature of all relationships, including romantic or marital relationships.  According to Zick Rubin[2], romantic relationships have three elements: attachment, caring and intimacy. The attachment element is a straightforward outworking of the original attachment to the mother, as subtly modified by all subsequent relationships.   

General responsiveness by the mother to the needs of the baby and toddler determine the attachment style.  However, there is also a particular crisis in early development that predicts an insecure attachment.  This is called the rapprochement crisis[3].  The rapprochement crisis is one which follows the exploration phase: in which the infant, having learned to walk, then expands into an explorer of the novelty of its physical environment, runs back to mother from time to time for an ‘emotional refuelling', and off again to explore.  However, somewhere in the period between 15 months to 2 years of age, the infant hits a crisis of confidence and tries to return to the earlier stage of symbiosis with the mother, no longer wishing to work towards autonomy.  If the mother can handle this clinging and regressing stage, the infant will once again turn confidently towards the world, and resume its explorations.  However, I failed to achieve my rapprochement with my mother because she had by then a new babe-in-arms, and she no longer had any time for me. 

However, what I had not realized until reading Wallin (2007) is that, in essence, the rapprochement crisis is also a crisis of power relations.  (David Wallin does not make that point explicitly, but it is implicit in some of his statements).  For if I want to re-establish symbiosis with my mother when I am aged about two years old, I cannot go back to non-consciousness and protracted periods of sleep.  Instead I must insist that she adapt to me, to my feelings, my perceptions, my wants and needs, and that she not attend to her own feelings, wants and needs. Clearly many mothers would find this kind of behaviour very trying, and if they were themselves insecurely attached to their mothers, they may well experience this as an intolerable demand from an infant, and thus many rapprochement crises are likely to be painful and difficult; though some are likely to be more difficult than others.

Attachment is a two way street

Wallin's third point, on page 1, is this: "...that co-created relationships of attachment are the key context for (child and adult) development".  This is a very important point.  What it means is this: We each co-create a relationship with our mothers, and that becomes the template for our relationships with our fathers, and those in turn become the templates for our relationships with siblings, peers at school and in our neighbourhood, and so on.  And later in life, our friends and life partners have to fit the mould of those early relationships.  Of course there is some plasticity in our relationship moulds, but not much.  So when we find that our adult relationships are not working, the place to look is way back in the embrace of our mothers, and on from there for the first couple of years of life.  That's where the die is cast.  And we each come out of that moulding experience with a secure or insecure attachment style which we apply to all future relationships.

Let us now go back to the first part of David Wallin's statement: "We might reasonably infer that the strength of the (mother's) capacity to reflect coherently on her past will significantly affect her ability to impart security to her child. ..."

This makes sense, in the same way that we may reasonably infer that I now have a greater capacity to ‘impart security' to those people with whom I relate closely, including my therapy clients, because ‘my capacity to reflect coherently on (my) past' was greatly improved by my own therapy journey, in which I dug up the early years of my relationship with my mother, and completed my experience of my great distress and disappointment, which had previously rattled around, out of awareness, in the inaccessible lockers of my non-conscious mind.

Fred and Dora and secure attachment

What this means for Fred and Dora is this:  I have already hypothesized that, based on their declared behaviours towards each other, Fred and Dora were probably both insecurely attached to their mothers, and are now insecurely attached to each other.  Dora avoids intimacy with Fred by carping about him and criticizing him; and Fred avoids intimacy with Dora by fretting about her carping and criticising behaviours.  In this way, they both maintain the kind of distant relationships they originally had with their mothers, in the first two or three years of their lives.  If they are going to achieve greater closeness and intimacy in their relationship, then they are going to have to review what happened in their relationships with their mothers, and perhaps to experience a warm and secure base with a therapist who can model ‘good enough substitute-mothering' for them, so they can establish a secure attachment to their therapist, and then to each other.  (This partly answers the question: What kind of counsellor would be most effective for Fred and Dora?)

What does it mean to have a ‘secure attachment'?  Here's an illustration.  I recently went to a website that runs a quiz on attachment styles in romantic relationships and took their test.  This is the result I got:

"Based upon your quiz answers, you appear to have a secure attachment style. People with secure attachments tend to feel comfortable with themselves and their relationships. Securely attached individuals tend to have happier, long-lasting relationships. You feel comfortable sharing your feelings with your partner and are able to turn to your partner for support."

"While this quiz cannot fully describe every aspect of your attachment style, it can provide a basis for understanding more about your romantic attachment style."  (Source: About.com, available online: http://psychology.about.com/library/quiz/bl-attachment-quiz.htm. Accessed: 14th June 2010). 

Helping Fred and Dora

But what kinds of processes are likely to be used by a ‘good enough' therapist, in order to help Fred and Dora?  Wallin (2007), in Part One of his book on attachment and psychotherapy, focuses in on the concepts of ‘meta-cognition', from Mary Main, and ‘mentalizing', from Peter Fonagy.  What could these concepts mean? 

The simplest definition of meta-cognition would be ‘thinking about your thinking', or ‘knowledge of how your thinking processes work'.[4]  It has aptly been said that most people do not think: they merely have thoughts.  And much research by Richard Nisbett and his colleagues has shown that human beings have very little insight into their thoughts, feelings or behaviours[5].  Indeed, we could go further and say that most people ‘are had by their thoughts'.  That is to say, the thoughts are automatic and they run the life of the individual, who simply responds like one of Skinner's pigeons to environmental stimuli.  This is the theory of the adaptive unconscious[6], which suggests that about 95% of our moment to moment behaviour is managed from non-conscious levels of mind. (See: Gladwell[7], Gray[8], Bargh and Chartrand[9]).

An example of a therapy that promotes meta-cognition would be Rational Emotive Behaviour Therapy (REBT), which asks its clients to answer such questions as:

Where is the evidence for your belief about X?

How does it follow logically from Y that Z is the case?

How does it help you to respond with behaviour P when you are presented with stimulus Q?

And so on.  The idea is to teach the client how to think about their life, their attitudes, behaviours, feelings and, yes, their thoughts.  What are they?  How valid are they?  How helpful are they?

General CBT therapists also use questioning strategies to oblige their clients to think about their thinking, and to justify or abandon their conclusions.

And CENT uses many systems of questioning, from REBT, CBT and the questions linked to its own Windows Model.

In theory, then, any of these therapies could be used to address problems of attachment, by working on meta-cognitive questions about attachment.  What happened?  Who did what?  What failed to happen?  How did you feel about X happening or not happening?  How do you relate today?  How well is that working?  What could be some new ways of framing your relationship situation?  How much do you trust and feel secure with your partner?  How much of this can be justified by the facts of your relationship's history? And so on.

Mary Main and metacognition

What did Mary Main conclude about meta-cognition and attachment?  According to David Wallin (2007, page 41)[10]: "It was quite clear to (Mary Main) that a functioning capacity for metacognition (in the mothers who participated in her attachment studies) was associatedwith security (in their babies), and its lack with insecurity.  However, she was unready to declare whether metacognition fostered secure attachment, or secure attachment fostered metacognition".

I need to make three points about this:

(1) We know from the history of psychotherapy, that metacognitive skill development can help therapy clients (in cognitive and rational therapies) to become significantly less distressed than they were, and help them to act more self-helpingly. 

(2) We know, from Smith and Glass, and Bruce Wampold and his colleagues[11], that all systems of counselling and therapy (the cognitive and the non-cognitive) produce broadly equivalent outcomes for their clients; and thus the outcomes cannot be accounted for by reference to the cognitive dimension of those therapies.

(3) If only parents who are good at metacognition could produce securely attached babies, then we would be in one hell of a mess, because the research evidence cited above suggests that most humans operate non-consciously most of the time, and have very little insight into their thinking, feelings or behaviour. 

Thus, it is highly likely that Mary Main was on the wrong track here; and it is very much to her credit that she was "...unready to claim a decisive role for the quality of the parents' metacognition in determining whether their children were securely or insecurely attached..." (Wallin, 2007, page 42).

That, then, is my brief introduction to metacognition as a way of dealing with attachment problems.  This will need to be revisited again soon.

Peter Fonagy, ‘mentalizing', and emotional intelligence

What about Peter Fonagy's concept of ‘mentalizing'?  Well, Fonagy had none of the reticence of Mary Main.  According to Wallin (2007, page 44): "...Fonagy would later remark that the hallmark of the ability he referred to as mentalizing - that is, ‘the process by which we realize that having a mind mediates our experience of the world" - was not self-knowledge, but rather knowledge of minds in general.  (Fonagy, Gergeley, Jurist and Target, 2002, p.3)[12].  While such knowledge is largely implicit, Fonagy and Target (in press) use the term ‘mentalizing proper' to describe the activity of ‘thinking explicitly about states of mind' (p.2).  Mentalizing activity (say, a daughter noting that her father's ‘rejection' of her might have resulted from his depression rather than his hostility) is rooted in what Fonagy called the capacity for reflective function". 

What Main and Fonagy are here referring to might be seen to overlap what is normally called ‘emotional intelligence', or ‘emotional literacy'.  That is to say, the ability to read the emotions of others; to read and understand one's own emotions; to manage one's own emotions; and to communicate effectively with others about emotionally-laden topics and situations.

What would then be being said is this: If attachment problems occur in families of high emotional intelligence, they are readily fixable.  If attachment problems occur in families of low emotional intelligence, they are unlikely to get fixed in the family context or situation.  However, if the emotional intelligence of the insecurely attached child can be raised in subsequent psychotherapy - (when they are young, or when they reach adulthood) - then the original attachment problems can be dissolved or resolved.

If that is what is being said, then I would agree.  I would also say that that is what Fred and Dora need to work on: their emotional intelligence. 

As to what is actually being said by Peter Fonagy, I will return to that subject again in the next post to this blog.

I hope you find this interesting and helpful.

Best wishes,

Dr. Wallin's book Attachment in Psychotherapy is available from Amazon.com

Dr. Wallin's website is avaialble at www.davidjwallin.com

---

[1] Wallin, D. (2007) Attachment in Psychotherapy.  New York: The Guildford Press.

[2] Rubin, Z. (1970). Measurement of romantic love, Journal of Personality and Social Psychology, Vol 16, pages 265-273.

[3] Mahler, M.S., Pine, F. and Bergman, A. (1975/1987) The Psychological Birth of the Human Infant: Symbiosis and individuation.  London: Maresfield Library

[4] Colman, A.M. (2002) A Dictionary of Psychology. Oxford: Oxford University Press.

[5] Jones, E.E. and Nisbett, R.E. (1971) The Actor and the Observer: divergent perspectives of the causes of behaviour.  Morristown, NJ: General Learning Press.

Nisbett, R.E., Caputo, C., Legant, P., and Maracek, J. (1973) Behaviour as seen by the actor and as seen by the observer.  Journal of Personality and Social Psychology, 27: 154-165.

Nisbett, R.E. and Wilson, T.D. (1977) Telling More than We Can Know: Verbal Reports on Mental Processes, Psychological Review, 84(3): 231-259.

[6] Harris, K. S. (2003). Review of ‘Strangers to Ourselves: Discovering the Adaptive Unconscious' by Timothy Wilson. Human Nature Review. 3: 488-490.

[7] Gladwell, M. (2006) BLINK: The power of thinking without thinking.  London: Penguin Books.

[8] Gray, J. (2003) Straw Dogs: thoughts on humans and other animals.  London: Granta Books.

[9] Bargh, J.A. and Chartrand, T.L. (1999) The unbearable automaticity of being.  American Psychologist, 54(7): 462-479.

[10] Wallin, D. (2007) Attachment in Psychotherapy.  New York: The Guildford Press.

[11] Messer, S. & Wampold, B. (2002) Let's face facts: Common factors are more potent than specific therapy ingredients'.  Clin Psychol Sci Pract. 9: 21-25.

Smith, M.L. and Glass, G.V. (1977) Meta-analysis of psychotherapy outcomes studies, American Psychologists, 32, 752-760.  (Summarized in: Banyard, P. and Grayson, A. (1996) Introducing Psychological Research: sixty studies that shape psychology. Basingstoke: Macmillan Press Limited).

Smith, M., Glass, G. and Miller, T. (1980) The Benefits of Psychotherapy, Baltimore, Maryland: The Johns Hopkins University Press.

Wampold, B.E. (2001a) Contextualizing psychotherapy as a healing practice: culture, history and methods, Applied and Preventive Psychology 10: 69-86.

Wampold, B.E. (2001b) The Great Psychotherapy Debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum.

Wampold, B.E., Ahn, H., and Coleman, H.K.L. (2001) Medical model as metaphor: Old habits die hard.  Journal of Counselling Psychology, 48, 268-273.

Wampold, B.E., Mondin, G.W., Moody, M., Stich, F., Benson, K., and Ahn, H. (1997) A meta-analysis of outcomes studies comparing bona fide psychotherapies: Empirically, "All must have prizes". Psychological Bulletin, 122, 203-215.

[12] Fonagy, P., Gergeley, G., Jurist, E.J. and Target, M.I. (2002) Affect regulation:, mentalization and the development of the self.  New York: Other Press.

The Happiness Blog:

A supplementary post on the evolution of Cognitive Emotive Narrative Therapy (CENT)

Copyright (c) Jim Byrne, 15^th June 2010

HAPPINESS BLOG UPDATE

Introduction

Over the past eight or nine weeks, I have been focussing on couple conflict in this blog.  On this Friday (18^th June) I will be posting Part 10 of the story of Fred and Dora, which will deal with the use of attachment theory to try to help clients to resolve their couple conflict problems.

Today I want to present some insights into the way in which CENT has emerged out of REBT, and how the two differ.  I will use a case study of an individual client for this purpose.

Jack and his relationship problems

A few days ago, I saw a regular client in Hebden Bridge.  This man - let's call him Jack - has been coming to see me for four years.  Initially he came once a week for a couple of months, then once a month for a couple of years, and since then, once every three or four months.  He lives in the Isle of Man (name of island disguised), and so it is quite a journey for him to get to see me.

His original problem was that he thought he would have a ‘nervous breakdown' - or what I call an inability to cope with the present time emotional distress using his mental maps from the past - when his wife of ten years left him because he refused to ‘give her a baby'.

Our original work was focussed on helping him to be strong in the face of this loss, and to do the grief work involved.  Months later the agenda became: ‘How do I get a new female partner?'  And later we worked on different aspects of that goal, for one hour, three or four times per year.

Jack makes progress and I move deeper

Over time Jack became stronger, and also encountered other life difficulties on which we worked together.

Last week he arrived in my home office, in Hebden Bridge, looking quite happy and calm.  We talked about his recent experiences of trying to hook up with a woman, and the barrier presented by the fact that he automatically rules out any woman who shows any sign of wanting to have a baby.

For the first time, the way the conversation opened and evolved, I found myself focussing on his childhood, which we had touched on briefly at the start of his therapy. 

We began to talk about his childhood, but he suddenly asked:

"Didn't you say we would stick to working on the present moment, and work on what can be changed, instead of digging up the past?"

"Well, yes, I suppose I did", I responded.

"Yes.  Right at the beginning, you told me to follow Albert Ellis's approach of only working on what is here and now!"

I felt awkward.  He was pointing to an apparent contradiction in my advice or message.  He seemed to be "calling me back" to my Ellisian roots.  But I was resistant.

My presentation of Ellis and me

"Ellis gave us some very good ideas", I said.  "But he also said some things that are indefensible, when you get right down to it".

"Like what?" he asked.

"Well, his instruction to: ‘Forget the god-awful past'; which seemed like a good idea at the time.  Who wants to go over old memories endlessly?  But actually he was wrong about that.  The ‘memories' that disturb us are not ‘conscious memories', but non-conscious ‘memories'.  That is to say, we are (often) distorted in the present moment because of non-conscious distortions of our mental state in the un-rememberable past.  So, what he was saying, without realizing it, was this: ‘Forget your un-rememberable past'.  However, you cannot forget what you cannot remember".

Jack looked at me with a quizzical expression on his face: "This is a long way from where we were four years ago", he said.

"I know", I said.  "While you have been on your journey of healing and growing, I have been on my own journey of development as a therapist".

I then invited Jack to consider what aspects of his past were driving his resistance to having a child.  This brought up a lot of pain about his mother being cold and distant, and his father being dismissive of Jack's attempt to make contact with him; and his father even physically assaulted him for relatively minor acts of childhood naughtiness or negligence.  Jack then told me of some of his memories of being beaten by his father which came to him mind.

Learning to accept our emotions

"I'm sorry about the crying", said Jack, as he (reluctantly) allowed a few tears to run down his cheeks.

"Don't be silly", I replied.  "If I told you a joke, you'd laugh, wouldn't you?"

He nodded, with a little smile.

"Well if I told you something very sad, or you shared something very sad from your own childhood, don't you think it often might be appropriate to cry?"

He snuffled and smiled, and cried a little more. (He won't win any awards for crying for some time to come! When I cry, you can hear me in the next street! And when I laugh, my home rocks!)

When Jack had worked through his story about how miserable it had been in his family home; his cold, distant, miserable faced mother; his angry, dismissive, often absent, and physically abusive father; weekends spent with granny so mum and dad could spend time together; and so on; I moved into an area we had never discussed before:

"And don't you think that, given your family history, it is absolutely predictable that you will not want to reproduce?  Why would a man who has never experienced the happiness of reproduction, want to reproduce?  If reproduction is such a great idea, why was your mum so miserable?  Why was your dad so angry and hostile towards his own flesh and blood (meaning you)?"

"You're right", said Jack.  "When I see a little kid in the street, all I feel is unhappiness.  Childhood equals misery for me".

"Now, instead of running away from a woman you are romantically interested in, at her first mention of wanting to have a baby, why don't you say: ‘I would love to be able to meet you halfway on that, but I want you to understand that I had a miserable childhood, and I cannot possibly enjoy the idea of being a father, or having a son.  I have no experiences that would cause me to want that; to enjoy that; or to know how to do that.  So if you don't mind, I would prefer not to get into conversations about having a baby'.  Some of them might want to move on straightaway; while some might spend some time with you. And don't you think it is possible that you might meet one woman who would love you so much that she would be willing to forego the pleasures of being a mother?  Perhaps a woman who also had a miserable childhood?"

"You're right", said Jack.  "That would make me more human, and less apparently hostile towards children.  It would make my preferences understandable to the woman I am dating".  He smiled and visibly relaxed in his chair.

We then moved back to how different this approach was to where we had been four years ago.

Getting Albert Ellis into perspective

"Well, I'm not saying Ellis was totally wrong", I told Jack.  "Some of his ideas were brilliant.  But he also made some major errors.  One of those errors was not to notice the distinction - which I have created in CENT - between the Good Wolf and Bad Wolf sides of the human individual.  All of Al's therapy interventions assume he is dealing with the Bad Wolf side of the client.  He assumes the client is either being demanding, or awfulizing about something, or whining about the difficulty of bearing something, or condemning and damning themselves, other people or the world.  All of these are manifestations of what I call the Bad Wolf side of human nature.  (The Bad Wolf side is centred on anger, hatred, egocentricity, etc; while the Good Wolf side is centred on love, empathy, compassion, charity, and sociability, etc).  Now, when he is actually dealing with manifestations of the Bad Wolf, his challenging questions are perfectly fine: 'Why must you get what you demand?'  'Prove that it is totally awful to lose one battle out of six?' Etc.  That is when REBT is at its best. 

"But your problem with reproduction is not a manifestation of your Bad Wolf side.  It is a manifestation of a wound, or several serious wounds, in your Good Wolf side.  Love is the core of the Good Wolf, as Hatred is the core of the Bad Wolf.  You are not able to be more loving with the women you date because you were not actively loved by your parents.  Your mother was dutiful and physically caring, Monday to Friday, but she was not obviously loving towards you, and she was not much fun to be around. 

"If you went to see Albert Ellis (if he was still alive) and told him your story, he would go after your Bad Wolf: ‘Why must you have had a happy childhood, when you obviously had an unhappy one?' he would ask - completely missing the point.  The fact that you had an unhappy childhood is the relevant variable here, not how you are talking about it today.  You see, Ellis had a miserably unhappy childhood, and (because he never worked on that, in therapy) that rendered him incapable of helping people who had a miserable childhood, because what he seems to have done with his childhood misery is twofold:

(1) He turned himself into a ‘little mother' for his younger brother and sister, (which you could not do because you were an only child); and:

(2) He repressed his misery out of conscious awareness, from where it drove the whole of the rest of his life as an ‘avoidant person', who did not get into successful and loving relationships.  So Ellis was great for dealing with the manifestations of Bad Wolf upsets, but he had nothing to say about the injuries that impair the life of the Good Wolf."

"That makes a lot of sense to me" said Jack.

Digesting stories of relationship

I then gave him a homework activity which involves him in reading my story of relationship - which is Chapter 11 of my new book: ‘Therapy after Ellis, Berne, Freud and the Buddha: The birth of CENT' - and then writing his own story of relationship.  The purpose of this activity is to allow him to dig up, and become conscious of, the detail of his childhood hurt and pain, (involving his mother and father in particular), to digest it, to complete his experience of it, and then to allow it to go into the background of his life, where it will no longer bother him in his present time relationships.  He is to always end every writing session (of about 15 minutes duration) with some positive coping statements, including those developed and promoted by Albert Ellis. For examples: "Why must my childhood have been any different from the way if was?"  Or: "Prove that it was totally unbearable to be treated in the unloving way that I was". 

But before reaching that point, Jack will have dug up some buried pain and completed his experience of it.  Once you have completed your experience of some aspect of your past, it goes into the background of your life.  It will never trouble you again.  That was why Ellis's instruction to "Forget the god-awful past" was so far off target.  "Forget the god-awful past" effectively means "Repress it; deny it; and don't you dare mention it to me!"  But in CENT we dig up the god-awful past, stare it in its scary face, and complete our experience of it until it shrinks and shrinks, and is burned out, and no longer has any ability to disturb us.

Conclusion

Jack had an insecure attachment to his mother and father, and now he has insecure relationships with fellow adults in his grown up life.  That makes perfect sense.  But we can learn to relate in more secure ways in the present moment, no matter what happened in the past, provided we find ways to mentally process the past, feel the feeling component, no matter how negative; and reframe it cognitively (or in our thoughts), so that the felt and thought meanings change, from distressing to benign.

I hope Jack finds a nice woman who will understand the wound in his Good Wolf side; who will cherish him for the lovely man he undoubtedly is; and with whom he can find a shared happiness which can focus on something other than reproduction. I hope he finds happiness and peace of mind.

I could not have helped Jack in the early years without the cognitive/rational work of Dr Albert Ellis; and I could not have helped him with this final stage of his journey without the more emotional psychodynamic and attachment ideas of Freud, Klein, Bowlby, Ainsworth and others.  So as Ellis himself was fond of saying: "It's not either/or; but both/and".  We cannot survive on cognition and reason alone, because we are fundamentally emotional beings.

I feel with and for my clients, and I think with and for them.  In the process I am modelling new ways for them to feel about their own lives, and new ways for them to think in their lives.  I am modelling acceptance of emotionality as normal human functioning.  I am also practicing good intersubjective affect regulation: (as described by Dr David Wallin, in his book on Attachment and Psychotherapy.  This is similar to the concept of 'limbic regulation' which I described, when I talked about Lewis, Amini and Lannon, 2001, a couple of weeks back).  I can do this work because I have completed my own experience of my miserable childhood.  I no longer have to tell myself to forget the god-awful past.  (See Chapters 7 and 11 of ‘Therapy after Ellis, Berne, Freud and the Buddha: The birth of CENT).

~~~

That's all for now.  More on Friday.

Best wishes,

The Happiness Blog:

An Unhappy Man Seeks Help - Part 9:

The question of ‘the right kind of therapist' for Fred and Dora

Copyright (c) Jim Byrne, 11^th June 2010

Announcement: Jim Byrne is scaling back his activities on the Internet: "As I approach my sixty-something birthday, and after 10 years on the internet, I have decided to retire from social networking to concentrate on writing whatever books are within my power to write.  I will close down all my internet operations by 19^th July.  I will miss the excitement and the world-wide connection to many friends and associates.  Best wishes, Jim".

"PS: I will still see some face-to-face clients in Hebden Bridge.  Please use my home phone number to make an appointment: 01422 843 629."

"PPS: If any of my international clients still want to work with me, please phone me on 44 1422 843 629 to arrange the details."

"PPPS: If you wish to correspond with me for any (good) reason, please write to:  Dr Jim Byrne, 27 Wood End, Keighley Road, Hebden Bridge, West Yorkshire, HX7 8HJ, UK"

Is it possible to recommend a therapist for ‘attachment related problems'?

Introduction

As I got to the end of last week's blog, I wrote this sentence: "In other words, if Fred and Dora go into counselling and therapy with the right kind of therapist, they could ‘rewire themselves' (mentally) for happy and healthy relationships". 

As I wrote that sentence, I noted a change in my ‘state' - something occurred in my cognitive-emotive wiring in response to that sentence.  I venture to say that, had I been a philosophical ‘foundationalist'[1], I might well have heard ‘the ice crack beneath my feet'.  However, since I am actually a ‘coherentist', I realized that I might just have uttered a statement which does not ‘fit' with some other elements of my beliefs about ‘reality'.

In fact, I was ‘begging the question': assuming that there is such a thing as ‘the right kind of therapist', in some absolutely certain sense of that description. 

Research evidence

When Renata read that blog statement, she asked: "What is the right kind of therapist?"  I could not produce a clear, positive answer, so instead I offered a negative definition: "Well, it could not be somebody who follows Albert Ellis's practice of challenging everything as if it was a demand - by asking: ‘Why must you have had a secure relationship with your parents, when you obviously did not'; or somebody who tells them to ‘Forget the god-awful past!'."

In response, Renata skewered me on my own lance, when she asked: "But isn't it the case, according to Smith and Glass[2], and Wampold and Messer[3], that all systems of counselling and therapy, which are designed to be therapeutic, are broadly equivalent in terms of their outcomes?"

Checkmate!  This is what the meta-analyses seem to demonstrate.  When you ask former counselling clients to rate their (subjective) experience of counselling and therapy services, and you then crunch the data to produce an individual report - and you then amalgamate all the reports together - no significant evidence is produced that any one system of therapy is any better than any other.  In 2001, I wrote a PhD proposal for the University of Leeds, to test two systems of therapy against each other, and I realized that I would need to monitor the physiological levels of arousal of the research participants before and after therapy in order to collect ‘objective data' about their gains.  Unfortunately, each experiment would then cost more than £250,000 (in 2010 prices) - so the first four experiments could cost about £1,000,000 - the kinds of monies that are never invested in counselling and therapy research; and never will be!  I subsequently realized that it would all be in vain anyway, because my control groups, who would be offered ‘fun therapy', would be quite likely to spot that they were getting a placebo!  So strictly speaking, we do not currently have any evidential basis for saying that one system of therapy is more effective than another, and we also do not seem to have any way to get beyond this situation.

Common sense

But that is at the level of global abstractions.  At the level of individual choice, it is always possible to determine differences between systems of counselling.  Do you want to be listened to, while you work out solutions to your own emotional or practical problems?  If so, then you need a person centred counsellor.  Do you want to dig up your childhood and work on your relationships with your family of origin, if so you need a psychodynamic system of counselling?  Do you want to be coached on how to think better in order to reduce your emotional agitations?  In that case you need a cognitive or rational therapist.

So it is possible to say, to some extent, what kind of therapist a person would most likely benefit from.  And it is also important to note that some therapists are rogues, and will exploit their clients - therefore it is important to get personal recommendations, and to protect yourself from exploitation and abuse.  In this sense the counselling and therapy profession is no different from the broader medical profession, psychiatrists, the clergy, and on and on.  Fallible humans, with a good and bad side to their character.  A small percentage of every profession, it seems, is prone to act from their ‘Bad Wolf' side.  So be careful!

Back to last week.  What kind of counsellor would be right for Fred and Dora?  Well, I can only give you my ideas.  Firstly, I think they should avoid counsellors who will tell them to forget the god-awful past.  They need to work on the past history of their emotional attachments or they are doomed to repeat their current dysfunctional system of relating.  They will repeat what they know, until they digest what lies undigested in their unconscious minds.  Who would be best to help them do that?  A psychodynamic counsellor seems to be called for; or perhaps a Gestalt therapist; or a CENT counsellor; or any kind of relational counsellor.  They should try one session, and evaluate the relationship to see if it seems likely to be good for them.  They should not agree to a series of sessions with an untested counsellor or therapist.

Thoughts and feelings

A colleague on LinkedIn contacted me after last week's blog appeared, to say that Lewis, Amini and Lannon's (2001)[4] emphasis on ‘limbic resonance' and ‘limbic revision' seems to rule out ‘insight' forms of therapy - like Freudianism etc - for Fred and Dora.  (His point seemed to be that ‘insight' is ‘cognitive' [or involves thinking to the exclusion of feeling] while Lewis et al emphasise the curative effects of emotion [or feeling to the exclusion of thought]).  That helped me to clarify an important point.  Lewis et al's view is somewhat distorted.  Let me explain how:

The scientific view of love is that it is "an attachment related emotion" - that is to say, the function served by love is that it attaches a newborn infant to its mother, and the mother to the infant, in the service of survival of the species.  That seems to be the evolutionary function of love.  Loving attachment then gets into the culture of humans, and gets carried on into adult relationships.

But human love is somewhat different from the love of other mammals, because humans have the capacity to think and talk about love, to contrast it with non-love, or with hate and war and conflict, and to develop preferences for love (or hate) over other kinds of ways of being.  And to distinguish between kinds of love, and to develop virtues such as chivalry, and vices such as forced marriage.

In CENT we hypothesize that humans are born with both love and hate as innate urges and feelings.  We love the ‘good breast' and we hate the ‘bad breast', where good breast is Melanie Klein's  metaphor for finding pleasure in our connection with mother, and bad breast is a metaphor for finding frustration and unpleasure in our connection with mother. 

The ‘trick' of human culture is to minimize the hatred and maximize the love.  If the opposite happened - the hatred was maximized and the love minimized - then society would break down and civilization would become impossible.

So love is central to human survival: for infants and children; for young adults; and for older adults.  Love is centrally important to humans - full stop (period).

For decades, mainstream psychology has been obsessed with the ‘cognitive revolution' in which we discovered the importance of attention, perception, memory and language.  In the process, in a desperate attempt to get away from Behaviourism and Freudianism, mainstream cognitive psychology dumped emotions, including the emotion of love, in favour of thoughts and thought processes. 

The beauty of Lewis, Amini and Lannon's (2001) book is that it begins to correct that bias towards thoughts and thought processes; and draws attention to the scientific definition of love as warm attachment between related mammals.  And, to quote the Washington Post: "(Lewis, Amini and Lannon) (c)onvincingly connect love and biology".  However, because they, like their cognitive predecessors, failed to construct visual models of the human brain/mind, they go too far with this ‘correction' and are in danger of discounting, or downplaying, the language-based culture of the mother in her encounter with her limbic-brain dominated baby.

Our model of the mother-child dyad in CENT is this:

Figure 1: The most basic model of CENT - The dialectical nature of the individual/social ego.  The ego is a product of relationship, and cannot exist without (external and/or internalized) relationship

It shows the overlap of mother and child which corresponds to the colonization of the newborn baby by its mother.  The circle representing the baby is genetically determined and dominated by the limbic system and brainstem.  Almost nothing is happening in the neocortex of the baby, which is pure potential for being wired up through experience. (In fact the newborn baby does have some, minimal experiences wired in: experiences of hearing sounds and having sensations within its mother's womb). 

On the other hand, the circle representing the mother is a limbic-system and brain stem which have been modified by years of language-based and power-mediated cultural experience (stored in her neocortex).  She does not operate exclusively from her limbic system, as her baby does.  And that is the central error in Lewis et al (2001).

David Wallin (2007)[5] describes how Mary Main (a follower of Bowlby and Ainsworth) established that the mother's mental model of relationship, arising out of her own experiences as a child (primarily with her own mother), will get passed on to her own baby, and on to her grandchildren.  When mother and baby lock eyes, we are not seeing the dance of two limbic systems (which Lewis et al claim), but the wiring up of a limbic system with generations of relationship patterns, which are dominated by neocortical patterns of connection.

Human beings are ‘fundamentally' emotional (which the cognitive psychologists overlooked for decades!)- that is to say, our foundations are emotional - but we have language-based cultural superstructures mounted on those foundations.  Thus when a human mother and baby relate, the mother's cultural superstructure is dominant within her (despite her emotional foundations).  This is the central difference between a human mother-baby dyad and, say, a mother cat with her kittens.  And Lewis et al (2001) seem to have over-generalized from the non-human mammal world to the world of human intercourse.

The CENT perspective

In CENT we see humans as ‘strange loops'[6], or braids, constructed from the interaction of an emotional baby with its cognitive-emotive mother; which sets up a lifetime of cumulative, interpretative experiences: of changing others and being changed by them.  The accumulation of vast numbers of interpretative experiences gives rise to an ‘emergent phenomenon', know as ‘the I', or ‘the Self', which is a manifestation, in relation to some present time stimulus, of a ‘virtual being'.

Fred and Dora have such virtual selves, including habitual ways of relating to each other and the rest of the world.  For any change to take place in their relationship, some kind of change has to occur in their virtual selves, perhaps beginning with some kind of change in one virtual self.  That change is made up of both apparently cognitive (or thinking) components (such as ‘insights') and apparently emotive components (such as getting in touch with previously hidden sadness, and perhaps tears).  However, in CENT, we do not engage in the black and white thinking that sees cognition and emotion as separate entities.  There never was, in a person aged two years or above, such a thing as a ‘pure emotion', nor such a thing as a ‘pure thought'.  Our so-called thoughts are also emotional; and our so-called emotions are also ‘narrative emplotments'[7].  In CENT, we preserve clarity about these elements of human functioning by having a detailed set of models of aspects of human relationship, human experience accumulation, and human self emergence.  By keeping our eyes on those models, we avoid the hypnotism of popular cultural and ideological categories that serve as icebergs into which most systems of therapy eventually crash, and sink themselves.  These guiding models are described in detail in the first book on CENT, which is available from this page. (This ebook will not be available after 19th July, so get it now if you want it).

~~~

Looking ahead

Next week I plan to look at two ideas from Dr David Wallin's book: Mary Main's references to ‘meta-cognition' as a way to resolve attachment problems; and Peter Fonagy's references to ‘mentalizing', for the same purpose.  My point of origin will be the following statement by David Wallin (2007):

"We might reasonably infer that the strength of the (mother's) capacity to reflect coherently on her past will significantly affect her ability to impart security to her child.  And ... the security of our own ‘state of mind with respect to attachment' may ultimately depend less on the particular facts of personal history - however problematic - than on the success of our efforts to make meaningful sense of that history".

That statement is very encouraging for our view of the viability of CENT, because Cognitive Emotive Narrative Therapy is centrally focussed upon the exploration, analysis and digestion of personal narratives, and especially personal narratives of individual suffering, including childhood suffering.

...More next week...

~~~

If you like the sound of David Wallin's ideas, then you can catch him in London on July 24th, when he speaks on ‘Attachment and the Therapist', for the Cancer Counselling Trust.  The details can be found here: Cancer Counselling Trust.

~~~

That's all for this week.

Best Wishes,

[1] In ‘epistemology', or theory of knowledge, a ‘foundationalist' is one who believes that our knowledge is based on solid foundations; while a ‘coherentist' believes that our knowledge lacks clear foundations, but is justified by the way each element ‘coheres' with all other elements. 

[2] Smith, M.L. and Glass, G.V. (1977) Meta-analysis of psychotherapy outcomes studies, American Psychologists, 32, 752-760.  (Summarized in: Banyard, P. and Grayson, A. (1996) Introducing Psychological Research: sixty studies that shape psychology. Basingstoke: Macmillan Press Limited).  And:

Smith, M., Glass, G. and Miller, T. (1980) The Benefits of Psychotherapy, Baltimore, Maryland: The Johns Hopkins University Press.

[3] Wampold, B.E. (2001a) Contextualizing psychotherapy as a healing practice: culture, history and methods, Applied and Preventive Psychology 10: 69-86.

Wampold, B.E. (2001b) The Great Psychotherapy Debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum.

Wampold, B.E., Ahn, H., and Coleman, H.K.L. (2001) Medical model as metaphor: Old habits die hard.  Journal of Counselling Psychology, 48, 268-273.

Wampold, B.E., Mondin, G.W., Moody, M., Stich, F., Benson, K., and Ahn, H. (1997) A meta-analysis of outcomes studies comparing bona fide psychotherapies: Empirically, "All must have prizes". Psychological Bulletin, 122, 203-215.

Messer, S. & Wampold, B. (2002) Let's face facts: Common factors are more potent than specific therapy ingredients'.  Clin Psychol Sci Pract. 9: 21-25.

[4] Lewis, T., Amini, F. and Lannon, R. (2001) A General Theory of Love.  New York: Vintage Books.

[5] Wallin, D. (2007) Attachment in Psychotherapy.  New York: The Guildford Press. Pages 37-39.

[6] Hofstadter, D. (2007) I am a Strange Loop.  New York: Basic Books.

[7] Sarbin, T. R. (1989). Emotions as narrative emplotments. In M. J. Packer & R. B. Addison (eds.) Entering the circle: Hermeneutic investigations in psychology (pp. 185-201). Albany, NY: State University of New York Press.

The Happiness Blog:

An Unhappy Man Seeks Help - Part 8:

If Fred and Dora do not understand love, they are unlikely to figure out how to ‘do it'!

Copyright (c) Jim Byrne, 5^th June 2010

What happened to Fred and Dora's original love?

Introduction

Last week, I mentioned that this week's blog update would be late; and that, when I eventually wrote it, I would look at some aspects of the philosophy of love.  And here I am, at least one day late, getting down to writing this week's update.  However, it will not be about the philosophy of love, but rather about the science of love, augmented by common sense.

The reason this update is late is that Renata and I spent the week in Scarborough, by the sea; relaxing after a very hectic nine months of work.  Here is a photo of our hotel dining table, on our final evening.

The science of love

Where would anybody begin to work on the science of love?  I was surprised to find that Lewis, Amini and Lannon (2001) began with the evolution of mammalian life.  It seems reptiles do not have warm feelings for their offspring; but with the arrival of the mammalian brain, innate love of offspring emerges in the evolution of life on earth. 

Attachment theory, dating from Bowlby and Ainsworth, argues that the newborn human baby, like all primates, is wired up to seek an attachment figure; and to behave in ways that will bring that attachment figure (normally mother) running when the baby is scared or feeling hungry, isolated or alone[1]. 

Growing up and falling in love

Eventually, young humans reach puberty, and begin to develop as sexual beings, and to want to settle down with a love object from outside the family.  This process is shaped culturally, and varies from culture to culture, though the biological imperative and the desire to love and be loved is universal among humans.

In the western system of romantic love, an individual eventually finds somebody to love.  This happens in a blinding flash of infatuation, called ‘falling in love'.  This process takes us back to the state of bliss we once felt in mother's arms.  This state of bliss lasts from a few months to perhaps two or three years before collapsing.  During that time, historically, the couple would have reproduced, and the child would be physically strong enough to survive the departure of the father. 

Once the ‘in love' feelings die, most couples begin to engage in negative forms of interaction: blaming, criticising, carping, moaning, castigating the other, and so on.  Both parties are prone to blame the other for the ‘end of love'.  In fact, love is not over.  Love has not begun yet!  Love, in the mature sense, cannot happen until the ‘in love' phase has been lived through.

In the ‘in love' phase, two ‘babies' each cling to the other for one-way love injections.  This is doomed to failure.

When mature love begins to emerge, one partner decides to operate from a policy of giving 100% attention and love to their partner.  The partner likes this feeling, and reciprocates.  Thus is born a virtuous cycle of giving to the other, instead of taking and taking, like a babe-in-arms.

The process of attachment formation

Attachment begins at birth.  A new baby has to become attached to mother (or another) in order to survive.  And attachment is not just symbolic.  According to Lewis et al (2001)[3], it is a non-verbal connection from the limbic brain of the baby to the limbic brain of the mother/carer.  (The limbic brain, or mammalian brain, contains the emotional centres of the brain).  Limbic resonance is the sense of being non-verbally understood and accepted by another emotional being.  You can ‘see' this connection between mother and baby as they gaze into each other's eyes.  They are not connected eyeball to eyeball, but limbic brain to limbic brain.

Limbic resonance - (Lewis et al. 2001 page 63-65) - allows the mother to calm the baby's physiology; regulate the baby's blood pressure and heart rate; optimize the baby's immune system; and so on.  The baby is not wholly self-regulating, and without limbic resonance and limbic regulation with the mother, s/he would not survive.

As the child gets older, s/he takes back some of those regulatory functions for him/herself.  But not all of them.  Throughout life, until the day we die, we continue to be somewhat dependent upon having somebody outside of ourselves who will provide us with limbic resonance, and thus limbic regulation.  This is partly what is provided by our love/life partners.  (From this we can infer that adults need love.  Perhaps they do not need it to survive, in the short term.  But certainly to thrive, and certainly to survive in the longer term: adult humans need to love and be loved.  For example, isolated adults experience more bad health, and have shorter life spans than well connected adults).

When attachment goes wrong

However, the process of attachment between mother and baby does not always go well.  Some mothers are more damaged psychologically than others, and some environments exert stressors on mothers that tend to reduce their mothering effectiveness: e.g. poverty, violence, war, the neo-liberal policy of forcing young mothers into full time employment.

Some babies are securely attached to their mothers, and those individuals grow up to establish secure sex-love bonds with a life/love partner.

Some babies are insecurely attached to their mothers.  Some are so hurt and scared of their parents that they become ‘avoidant', and do not seek comfort from their parents.  Those individuals are prone to become bullies (Wallin, 2007: page 23)[4] and to establish distant relationships when they grow up.

Some babies are so unsure of their mother's/parent's love that they develop ‘ambivalent' attachment styles.  These babies tend to cling and whine.  When they grow up, they cling to their love objects.

Are Fred and Dora insecurely attached?

Where do Fred and Dora fit into this model?  Did Dora develop an avoidant attachment style when she was young?  Does she bully Fred?  Does she play it cool, because she does not expect to be loved in return for any love she expends?

Was Fred raised by an unreliable mother who caused him to develop an ambivalent style of attachment?  Does he cling to Dora, even though she hurts and offends him?

And what are the prospects for Fred and Dora?  According to Lewis et al (2001), ‘limbic revision' is a possibility for adults.  In other words, we can learn a new way of relating, or attaching, no matter how old we might be.  However, that is not perfectly effortless, and would require that they go into marriage guidance counselling with a counsellor who can ‘re-parent them'.  (See also, David Wallin's book on attachment in psychotherapy, where he says that "...the (client's) relationship with the therapist has the potential to generate fresh patterns of affect regulation and thought, as well as attachment.  Put differently, the therapeutic relationship is a developmental crucible within which the (client's) relationship to his own experience of internal and external reality can be fundamentally transformed". (Page 3)).  In other words, if Fred and Dora go into counselling and therapy with the right kind of therapist, they could ‘rewire themselves' for happy and healthy relationships.

What is the right kind of therapist for this work?  More next week!

Best wishes,

[1] For a definition and description of Bowlby's concept of ‘attachment', please see pages 11-13 of David Wallin's book: (Wallin, D. (2007) Attachment in Psychotherapy.  New York: The Guildford Press.)

[2] An ‘object', in certain schools of counselling, is a person who is significant for a baby.  The baby is the ‘subject' and the subject has ‘objects', or human beings represented in its mind.  An ‘object' then, is seen to be a significant person stored in long-term memory.

[3] Lewis, T., Amini, F. and Lannon, R. (2001) A General Theory of Love.  New York: Vintage Books.

[4] Wallin, D. (2007) Attachment in Psychotherapy.  New York: The Guildford Press.