Posted by violette on August 23, 2010, at 22:28:51
In reply to Re: strange anxiety sensation » violette, posted by Phillipa on August 21, 2010, at 20:23:04
> Mother sick from when you were two who blamed you for the illness, had temper tantrums and they were directed at you as the meds she was on high dose cortisone I'm sure caused the reaction, foaming at the mouth, I'd be afraid to come home from school not knowing if the ambulence had taken her away again, and a Father who I just can't remember where he was alot of the time. Phillipa
Phillipa, you've been questioning what to/not to do-you might benefit from reading this short article/interview on the implications of childhood attachment experience to well-being in your adult life. This article is a good synthesis for futher research if it resonates with you.
"And what Ainsworth and her colleagues - and this research has been replicated dozens, if not hundreds, of times..."
An Interview with David Wallin, Ph.D. on the Implications of Attachment Theory for Psychotherapy
David Van Nuys, Ph.D.: Mon, Jul 13th 2009 - 07:06:22 PM
In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews David Wallin, Ph.D. on Attachment in Psychotherapy. Dr. Wallin describes the history of Attachment Theory, as developed by John Bowlby and Mary Ainsworth, and then later by Mary Main and Peter Fonagy. Attachment refers to the character of the early parent-child relationship from the perspective of the child. In addition to secure attachment (a 'best' outcome), where a child feels secure enough with the parent to be able to balance affiliation with exploration, there are also two 'second best' outcomes, avoidant, and ambivalent in which children choose exploration over affiliation, or vice versa, respectively, and a forth and least optimal 'disorganized' solution. Implications of childhood attachment style for psychotherapy are discussed.David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.
On today's show we'll be talking with Dr. David Wallin about attachment in psychotherapy. David Wallin, Ph.D. is a clinical psychologist in private practice in Albany and Mill Valley, California. A magna c*m laude graduate of Harvard College, he received his doctorate from the Wright Institute. He's been practicing, teaching and writing about psychotherapy for nearly three decades. He's the author of the 2000 book Attachment in Psychotherapy and co-author of Mapping the Terrain of the Heart: Passion, Tenderness and the Capacity to Love. He has lectured on attachment and psychotherapy throughout the United States and taught for the Wright Institute, the Northern California Society for Psychoanalytic Psychology, and extension programs of the University of California and California School of Professional Psychology.
Now, here's the interview.
Dr. David Wallin, welcome to Wise Counsel.
David Wallin: My pleasure.
David: Well, one of my listeners suggested that you'd be a good person to interview on attachment theory and its role in psychotherapy; and I've been reading your book, Attachment and Psychotherapy, and I have to say, it's a real eye opening tour de force.
David Wallin: Thank you.
David: And attachment theory is a phrase I've been hearing for years, but - I blush to admit - never really looked into. Having come through a very psychoanalytically oriented training myself many years ago, I assumed I had some sense of what it was about, but your book is really filling a gap in my education.
David Wallin: Well, good.
David: So, as I understand it, your book is organized around three key insights. One is the fundamental importance of relationships, both the early ones and the later ones; secondly, is the importance of pre-verbal experience on the developing self; and thirdly, the stance towards one's own experience as a predictor of attachment security. So during the course of our interview, I'm hoping we can step through each of these three insights and expand upon them, as you do in your book. And after we've done that, we'll focus on the implications for therapy. Does that sound like an okay plan?
David Wallin: Yeah, that sounds good, sure. We'll see how it goes.
David: Okay, so let's start with the basics. First of all, what is attachment and why is it so important?
David Wallin: Well, attachment theory is the brainchild of John Bowlby, a British psychiatrist and psychoanalyst, who was thinking about what's responsible for people's difficulties; how can their difficulties be understand in developmental terms and how can psychotherapy work to heal their suffering? And Bowlby was a guy who, starting in the '40s, was getting training as an analyst and was finding himself dissatisfied with a lot of the prevailing analytic explanations of the day, which, in some ways, were more Freudian than Freud. He was studying with people like Melanie Klein, who understood development and people's problems and psychotherapy's healing potential in terms of what went on entirely inside people's heads, and particularly their fantasies about what was going on. And Bowlby was very, very dissatisfied with that point of view because, having worked with delinquent boys, having worked with and studied the refugee children who were made homeless by the ravages of the Second World War, having worked with infants suffering the consequences of separation from their mothers, he was impressed with the actualities of people's experience - not their fantasies about experience - as the important determinant of their health or difficulties in life. And so Bowlby came up with the understanding that, in contrast to Freud who made a priority of sex and aggression as the motivators of human behavior, Bowlby came to understand - partly through studying the development of other species besides the human species - he came to understand that we were actually designed by evolution to be primarily motivated by the need to attach to other human beings.
David: Yeah, let me just insert a question here that popped into my mind as I was reading this portion of your book, where you were discussing Bowlby. I was wondering if there might be a critical time for imprinting in infancy, you know, as with Konrad Lorenz's geese. Do we know anything about that? Is attachment something like imprinting in animals?
David Wallin: That's an interesting question. What seems to be the case is that infants are certainly powerfully predisposed - because their survival depends on it - they're predisposed to attach. And I think that if in the first days, weeks and probably months of life, if infants are continually deprived of the opportunity to attach, their development as human beings and their capacity to attach to other human beings will be profoundly stunted.
David: Yes.
David Wallin: And I think the evidence for this is to be found in studies like that of René Spitz, who found that, in hospitals, kids who were deprived of - you know, all of their physical needs were met, but their emotional needs, their needs for physical nurturing and so on, were not met. And these kids typically failed to thrive and sometimes failed to survive. You know the other evidence is in the Romanian orphanages, where kids were in some ways similarly deprived of the sustenance of human nurturing and contact for the first weeks, months, and years of life. And it's been profoundly difficult - if not impossible - for those kids to attach and to develop ordinary relationships with other people.
David: Right. Is attachment the same as bonding? That's another term that I've heard used.
David Wallin: That's a fascinating question. I think there's probably a couple of differences between attachment and bonding, but I think that one difference is that attachment, strictly understood, is a relationship of - how shall I put it? The attachment relationship is one where, at the start, an infant attaches to the mother, meaning that the infant turns to the mother for protection, ultimately. You know Bowlby talked about how it is that infants are designed by evolution, when they feel threatened or in pain or frightened, to turn to a stronger and/or wiser other. So the idea is that attachment is an asymmetrical relationship; it's a relationship of a threatened, vulnerable, upset, pained human being to another human being who is felt to be stronger and/or wiser; in other words, is a source of comfort, of safety. So Bowlby talked about the attachment figure serving as a secure base, as a safe haven - a safe haven in moments of danger - so the infant or small child turns to the attachment figure for protection when threatened. And when safe, the attachment figure is used as a secure base, meaning that what enables us to explore our experience, what enables a little infant to wander away from mom a little ways and play with the toys and not be terribly preoccupied with mom's whereabouts, what makes that possible is the infant's understanding, intuitively and on the basis of her experience, that mom is available as a secure base. So that if the little child starts to feel threatened, gets in trouble in some way, there can always be a retreat to mom as a safe haven.
David: Maybe bonding is really talking about the other side of the equation then, often referred to as talking about whether or not a mother has bonded with her child. Would that be the distinction?
David Wallin: My own sense of it is that bonding is a two-way relationship, and that attachment, at least strictly understood is, as I say, it's kind of a one-way relationship or at least it's an asymmetrical relationship. But certainly that's true primarily in childhood; I think in a context like that of a marriage, two partners are attachment figures for one another and alternatively - hopefully in kind of a balanced fashion - one depends on the other when necessary and then they switch roles. But I think early in life and most strictly understood, attachment is an asymmetrical relationship and I think the relationship of bonding can be seen as one that has more symmetry.
David: Okay, now you were talking about the work of the British analyst John Bowlby and it was a real learning experience for me reading what you had to say to recap his career. And then you talked about an American researcher who went to work with him.
David Wallin: Oh, a Canadian actually, Mary Ainsworth. You know I said at the beginning of this interview that attachment theory was the brainchild of John Bowlby and he's often referred to as the father of attachment theory, but I think it's meaningful to think of attachment theory as a theory that has two parents and the other - or the mother - was Mary Ainsworth, a Canadian psychologist who traveled - I think following her academic husband - from Canada to London in the early '50s where she became a researcher for Bowlby. You know, she is said to have confirmed, through her research initially in Africa and then later in Baltimore, she's said to have confirmed many of Bowlby's hypotheses. But I think, actually, she made some very, very significant contributions of her own to attachment theory.
David: Yes, there's one you discuss in the book in particular. Maybe this would be a good place to talk about the types of attachment that you discuss in your book: secure, avoidant, ambivalent and disorganized. Can you sort of briefly run through those?
David Wallin: Sure. You know, what Mary Ainsworth did in Africa and then repeated in Baltimore were studies in the homes of mothers with infants; she studied their relationship, 26 infant-mother pairs in Uganda, 26 in Baltimore. And I think in some ways she may have surprised Bowlby. On the one hand, her research confirmed many of his theories, but to some extent perhaps the surprise was that, while there were securely attached and insecurely attached infants, meaning by secure infants who had a balanced capacity both to attach but also to explore - in other words, they could find consolation and connection to their mother, but they could also explore and play and self-define independent of mother. So there were secure infants who matched that description, but it turned out that insecurity came, so to speak, in a variety of flavors; and specifically what Ainsworth discovered were that there were two, you might say, second best attachment strategies. I mean the first attachment strategy is the biologically built-in attachment strategy which has babies - and has all of us - turning to other people when we feel threatened or in pain. But the two second best strategies that Ainsworth discovered were an avoidant strategy on the one hand, where there's a skew away from attachment towards exploration - in other words, the kids don't turn to mom when they're afraid; instead they turn to the toys and they turn to activities and they kind of ignore mom, they avoid mom. That's a kind of second best strategy. And a second, second best strategy is the ambivalent strategy which involves a skew away from exploration in the direction of attachment. So these were kids who were so preoccupied with attachment, so preoccupied with mom's emotional and physical whereabouts and availability, that they couldn't really explore autonomously, they couldn't play on their own. And that first avoidant strategy has been described as a de-activating strategy because it knocks offline the built-in, primary, biological strategy which is, you know, you turn to others when you're freaked out. It knocks it offline. It's as if these infants turned way, way down the volume on the internal cues like distress that might prompt them to seek the comfort of connection; so they kind off turn the attachment behavioral system that Bowlby described. And then the ambivalent kids have a hyperactivating strategy, so they keep the attachment behavioral system activated in a chronic way, so they're constantly on the lookout for cues, external and internal, that will prompt the attachment behavioral system to go into high gear. And the attachment behavioral system is that system, designed by evolution, which prompts us to turn to others when we feel threatened. So these are babies and subsequently children and adolescents and adults who are constantly scanning for cues of threat which will prompt them to turn to others. So, basically, what Ainsworth did was identify three attachment strategies: a secure strategy, an avoidant strategy, and an ambivalent strategy. And then there came, you might say, the offspring of Bowlby and Ainsworth
advertisementDavid: Yeah, before you go on, let me just insert here - one of the things I learned was that Ainsworth developed a kind of research protocol on which everything that you just described was based, a situation in which - and I don't recall the term for it - but it was a situation
David Wallin: The Ainsworth Strange Situation, often described simply as the Strange Situation.
David: Right, where they would bring mother and infant into a laboratory room, I guess with a one-way mirror, and the kid would get settled and comfortable and then the mother would leave for awhile and then come back. And it was in that situation that they could see whether the kids were comfortable enough that they could off and explore and play and then
David Wallin: I was just going to say that, essentially, the Strange Situation is a 21 minute procedure, subdivided into seven three-minute segments. So initially mother and baby are alone together, then they're joined by a stranger - hence the Strange Situation. And each of these segments are three minutes, so mother-baby three minutes, mother-baby-stranger - who's a trained baby watcher, you might say - for three minutes; then the stranger leaves the babies alone for three minutes. And when I say baby, these are kids right around 12 months generally the research is conducted. Then the stranger leaves the babies alone; then mom returns; then mom leaves; then mom returns. And in this series of seven sort of mini-psychodramas there's two separations and two opportunities to observe reunion. And what Ainsworth and her colleagues - and this research has been replicated dozens, if not hundreds, of times - what the researchers have discovered is that what's most revealing are the babies' responses to separation and, even more so, to reunion.
David: Fascinating, fascinating.
David Wallin: Yeah, it's the reunion episodes, actually, that prove most telling. You know, the secure babies upon reunion with mother, after feeling quite stressed by mother's absence, the secure babies immediately turn to mother to be picked up; they're held by mother and very quickly they're reassured, and then they start to play again. The avoidant babies, you know, they're not particularly upset by separation, they ignore or they snub mother upon reunion; and the ambivalent babies can hardly stand the separation. In fact, often the separation episodes have to be interrupted. But upon reunion with their mother, and this is where the term "ambivalent" arises, they may approach mother in a very, kind of a desperate, clinging way and then reject mother angrily.
David: Yes, this is fascinating, you know, just to kind of foreshadow - I don't want you to go there yet - but just to foreshadow a bit, is that what the research showed was that these patterns at such a young age - at first year of life, toddlerhood - really seemed to predict adult defensive strategies much later in life, and what you might call psychopathologies. But before we go there, one of the things that struck me was there no mention of Harry Harlow.
David Wallin: Well, that's fascinating you should say that. You know, Bowlby actually was quite familiar with Harlow's work. He may or may not - I'm not sure - have known Harlow personally, but certainly Harlow's work can be seen as, what shall I say? The corollary of Bowlby's work in observing the relationship of babies and human moms, you know, the corollary is in Harlow's work where he studied baby monkeys.
David: Yes, and he had the wire monkeys and the terry cloth monkeys.
David Wallin: Right, exactly, and rather than turn to the wire monkey that had milk or some other kind of food, they turned to the cloth monkey without food because somehow that cloth monkey was more nurturing. So I think Harlow concluded that, in some ways, the nurturing of the mother was more important than the baby's being fed by the mother as a motivator.
David: And Ainsworth and others' research seem to find that with the humans, too. I recall you talking about the importance of the kind of communication that comes from the mothering figure.
David Wallin: Oh, precisely. I mean, it seems like what's really, really at the heart of what makes psychological, emotional security possible for the infant, for the developing child, is to have a relationship with a mother who's capable of reading the baby's nonverbal cues and signals. It's as if this is a mother who can read the baby's mind in some sense, and know now's the time to pick up the baby, the baby feels a need to be held and comforted, and now's the time to put the toddler, the little child, down because now the child feels the impulse to play and explore and be independent of mom. So the key seems to be the mother's capacity, you might say, to read the baby's mind or to attune to the baby.
David: This doesn't seem to come naturally to all mothers. It seems to come naturally, maybe, to most but I'm wondering to what extent it might be trainable, you know? There's that old metaphor of pulling babies out of the water. Somebody's throwing babies in the water upstream and that, rather than doing psychotherapy in adulthood, maybe it would be better to go upstream and do an intervention early on.
David Wallin: I think there's a lot to be said for that. I mean, there's research that shows that the - how shall I put it - that these skills are trainable. That on the one hand, as you say, it may well be that the majority of mothers come to mothering with these mind reading skills that allow them to attune to their babies nonverbal cues. On the other hand, there are a whole lot of mothers and fathers who don't come well prepared on the basis of their own experiences as babies and small children with parents who were attuned to them. They don't come well prepared to attune to their infants and small children in this way, but it appears that a lot of these skills are teachable. But what's quite interesting to me is that a big part of what is helpfully taught, when it comes to allowing parents to tune into their babies' nonverbal communications, what's most helpfully taught, in some ways, is the ability of these parents to tune into themselves. Because it appears that, to a very large extent, we understand others on the basis of our capacity to tune into ourselves, to understand ourselves. We have to be able to resonate with our own experience in order to be able to resonate with someone else's experience. So in one of these studies conducted by some folks at Yale, Linda Mayes and others, basically what they were doing was teaching high risk mothers - mothers who came from situations of very high stress, poverty, or what have you - teaching these high risk mothers parenting skills. And one of these mothers, who had become capable, so to speak, of reading her baby's mind, one of these mothers said, "It's so much easier to understand my baby now that I've started to understand myself." So tuning into the self, tuning into what's going on inside the mother - we'll talk about this later, perhaps - but what's going on inside the therapist, that's a big part of what allows us to tune into the baby or subsequently the patient.
David: Yes, I want to make sure we get there. Synchronistically, there was an article in my local paper as I was preparing for our interview. I wonder if you saw it. It was about a recent study at the University of Michigan in which it appears that female bonding may benefit health. According to the report, when women feel emotionally close to a girlfriend, levels of the hormone Progesterone increase, helping to boost mood and alleviate stress.
David Wallin: How interesting.
David: It seemed to me relevant to what we're talking about.
David Wallin: Well, I think that's true. One thing that's quite amazing is research which shows that, to the extent that babies experience the mother's attunement, their immune systems function much more effectively. I mean, it appears that mothers and fathers, to some extent, who take care of babies and small children in an attuned fashion, these are parents who are not only, you might say, helping the kid develop psychologically, but they're also helping to maintain the kid's, you might say, physiological homeostasis, so they're promoting the kid's physical health as well.
David: Okay, well, getting back to our sort of chronological development of attachment theory, you mentioned two other key figures, Mary Main and Peter Fonagy. So take us a bit through their contributions, if you will.
David Wallin: Part of what I'm aware of is that if we're going to talk about therapy, I should probably be quite brief when I sketch the background here, so I'll try to do that. Mary Main was a student of Mary Ainsworth's who initiated the first longitudinal study of attachment. So she was observing babies and she had to guess, based upon everything that Ainsworth and Bowlby had studied, she had to guess that the parent's psychology was very important as a determinant of the attachment relationship that the parent was going to be able to generate with the child. And so Mary Main started studying the psychology of the parents, and first of all, she found a fourth category of attachment in infancy, which was disorganized attachment. You remember I said that there's the biological strategy and two second best strategies - the avoidant and the ambivalent. Well, those are organized strategies; but what she found were infants who exhibited essentially the collapse of an organized strategy. They became disorganized as they related to the attachment figure, the mother or the father. And this disorganization was manifest in the Strange Situation and episodes of behavior that were bizarre or incomprehensible. These were babies, who upon reunion, would drop to the floor or would freeze in place or would seem to go into a trance, space out. And what Main discovered was that these were kids whose parents were not only, you might say, insensitive - it was not only that they had a difficult time reading the baby's cues - but these were parents who were actually frightening to the kids. Either they were frankly abusive or their own histories of trauma in childhood were triggered as they related to their infant, so they might become withdrawn or dissociated. They might pull back from the infants, and that, too, is scary for infants who are dependant upon parents for their very survival. So, anyhow, there's this fourth category, disorganized attachment in infancy.
But she identified, by studying the psychology of the parents, four characteristic states of mind with respect to attachment that were found in adults, and these four states of mind, both resembled the states of mind in the infants - the secure or the avoidant or the ambivalent or disorganized infants - the states of mind in the parents resembled the behavior that was observed in these infants and the parents who had a secure state of mind tended to raise secure infants; parents who were in what Main called a "dismissing" state of mind, in other words they had a dismissing attitude toward the importance of attachment, they raised avoidant infants, for the most part. Parents in what Main called a "preoccupied" state of mind - these were parents who were extremely preoccupied with their own past histories of attachment - they raised ambivalent kids. And then parents who were unresolved with respect to their own histories of trauma, they tended to raise disorganized infants. And so Main discovered, and then her research was supported by the research of Peter Fonagy in England, that one could predict the attachment status of a baby at 12 months on the basis of an interview with the parents that asked the parents to recall and reflect on their own attachment history. You could predict the infant's attachment status on the basis of this interview with the parents that was conducted before the baby was born.
David: Wow.
David Wallin: So the idea is that the parent psychology is enormously influential as a determinant of the quality of the attachment relationship that they're going to be able to provide for their baby.
David: Like so much of psychology, when we hear that, part of us just goes, duh, like shouldn't that be obvious?
David Wallin: Yeah, right, exactly.
David: But these people have really nailed it down with such specificity as to make it very, very impressive.
David Wallin: Right, yes. I mean, where this stuff sort of goes beyond the obvious is in identifying the particular states of mind in the parent that lead to particular kinds of adaptation or attachment strategies on the part of babies. And, as you say, the history of attachment early in life is a powerful influence on our subsequent ways of relating to ourselves and to other people, and it's a powerful determinant of our capacity to raise secure kids of our own.
David: Which was a key Freudian insight on the one hand but, as you pointed out, there was so much garbage, if you will, wrapped around sex and aggression; whereas this really anchors it more in the
David Wallin: You might say in love or in intimacy and attachment and in healthy dependency or not so healthy dependency.
David: And communication patterns.
David Wallin: Exactly, like to what extent we're able to be in touch with ourselves, to what extent we're able to recognize what's going on in other people. I mean, part of what was so powerful about what Main and Fonagy came to understand, and what has some very significant implications for psychotherapy, is that it's the parent's capacity for what Mary Main called "meta-cognition" - thinking about thinking - or what Peter Fonagy called "mentalizing", which is understanding our own behavior and other people's behavior in terms of underlying mental states. It's that capacity for reflecting on one's own experience and the experience of others that allows us 1) to raise secure children, and 2) to unshackle ourselves, so to speak, to free ourselves from the constraints of our own pasts. Because it turns out that to the extent that we can shift our stance toward our experience, our relationship toward our experience, our attitude toward our experience, to that extent, when we can shift the stance away from one in which we're embedded in our experience and we believe everything we think or feel - that what we think or feel is just the last word on the subject - to the extent that we can step out of that kind of embeddedness in order to reflect on our experience and try to make sense of it, to that extent our pasts no longer imprison us to the same degree. So even if we came from circumstances of insecurity and a difficult attachment history, to the extent that, perhaps in therapy or through some other relationship, we're able to learn to reflect on our experience, to that extent we can raise secure kids.
David: Well, you know, therapists used to talk about the people would do well in therapy, who tend to do best, are "psychologically minded." Is this a different way or perhaps a more specific way of thinking of psychological mindedness?
David Wallin: I think in some ways it is. I think when we talk about the capacity for mentalizing, in other words, the capacity, as I say, to make sense of our own experience, our own behavior, and the experience and behavior of others in terms of underlying mental states, like beliefs, feelings, desires; to the extent that we're able to make sense of behavior on the basis of those underlying mental states, it serves us. And the way in which that's, in a sense, different from the concept of psychological mindedness is that psychological mindedness is something that exists. It's inside you or it's inside me. I think mentalizing, making sense of difficult experience, is of necessity a two-person enterprise. And the reason this is so, is that when you or I or anyone else is in the grip of overwhelmingly intense feelings, we simply can't reflect on our experience. We can't take a step back from experience to try to make sense of it. It's only with the benefit of a relationship to somebody who is, so to speak, mentalizing our experience, that we can come to occupy a stance toward our own experience that's more reflective, more understanding, and so on. So psychological mindedness, you might say, it's kind of like a one-person psychological concept. Mentalizing, in some ways, is a relational, it's a two-person psychological concept. And so the whole idea here is we learn about ourselves through being understood by other people. Babies learn about their feelings by having their feelings understood by someone else.
David: So it sounds like we're talking about psychotherapy now.
David Wallin: You're right.
David: And do you conceive of psychotherapy, then, in terms of, I guess, a kind of re-parenting? I know there's an approach called re-parenting and this isn't that, but it sounds like the therapist is trying to offer, maybe, a better attachment figure than the person experienced as a toddler.
David Wallin: I think that's exactly right. I think of psychotherapy as a form of transformation through relationship. It's a process that gives those who enter psychotherapy as patients or clients - or however you want to describe those of us who seek the help of a therapist - but the therapeutic relationship gives our patients and gives us a second chance by providing what is essentially a new attachment relationship, in which experiences that could not be processed in our first attachment relationships and therefore had to be split off or disowned - you know, our dependency, for example, or our anger, or our sexuality, or whatever. If those experiences could not be handled, could not be accommodated in our first attachment relationships, then they will not have been integrated into our personalities. Our anger or our dependency or our sexuality, or whatever, will not have had a chance to develop in a healthy fashion. It will have been dissociated. And so the new attachment relationship, it seems to me, is one in which ideally what has had to be dissociated can ultimately be integrated.
David: Okay, now, I initially said that there were three legs to your work: the attachment piece and we skipped ahead to the third leg, which is the mentalizing or mindfulness piece
David Wallin: Well, we haven't talked about mindfulness. I would just add very briefly that a staple of attachment research is the focus on mentalizing, but in the course of writing my book, it became clear to me - not so much through an exposure to some ideas, but rather through kind of a very powerful personal experience I had - that not only a mentalizing, but also a mindful stance toward our experience is one that can transform that experience. You know, a mindful stance, as many people know, is one that allows us to be present for our experience with a modicum of acceptance. So that, to the extent that we can as therapists or as human beings or as patients, to the extent that we can find a way to be as fully present as possible and as aware as possible of our experience in the present moment, without judging it, without evaluating; to that extent, experience does not have the same grip on us; you know, our experience is no longer a straitjacket.
David: Yes, it's been interesting to me to see that there are a number of therapeutic approaches recently that are advocating mindfulness.
David Wallin: When I started the book, mindfulness was simply not on my personal radar screen, but in the course of writing the book, it became quite clear to me that mindfulness deserves a place right up there with mentalizing as a way that human beings can potentially respond to their experience, that enhances their internal freedom, allows them to manage difficult emotional experience, allows them greater insight into themselves, and into other people.
David: There was something that you said, if I understood it correctly when you were talking about that, that really struck home for me, which was that as one began to achieve or work towards mindfulness, the possibility that there would be kind of constellated - either transpersonally outside or somewhere inside their unconscious or whatever - a third place of sort of acceptance, some inner place almost like an inner good parent, if you will.
David Wallin: Yes, exactly. You know, I talked earlier in this interview about the whole concept of the secure base; and I think those of us who were lucky enough to have had parents who provided us a secure base from which to explore our experience, when we've had experiences over and over again of that secure base - we've been held, we've been reassured, we've been protected - those experiences are internalized and they come to take shape as a reassuring, internal presence, which might be described as an internalized secure base.
That's one kind of secure base, but it seems to me that the experience through mindfulness, through meditation perhaps in particular, the experience of the - and here this can sound a little mystical - but I think the experience of, you might say, the no-self at the center of the self - in other words, that spark of consciousness or awareness which really makes up our very core, our very center - that experience, in some ways, is one that allows us to appreciate that there is less need for protection. I think most of us are constantly in the grip of strivings to achieve positive self states and to avoid negative self states. You know, I want to feel great about myself as a father and as a therapist and as an author; and I don't want to feel terrible about myself as a failed husband or a terrible father or an unsuccessful professional, or whatever. We strive to occupy those positive and avoid those negative self states, but what we come to understand, I think, through mindfulness practices is that at the core of us are not those personal and, in some ways, superficial sense of ourselves as good or bad, positive-negative, successful or failure; but rather what's at the very core of ourselves is something that we share with all other human beings, and maybe our pets and - I don't know how widely dispersed this is - but I think what we share is awareness, is consciousness. So that at the center of ourselves - you and I and everyone we know - we're all alike, we're all the same. And I think that awareness can be extremely productive of a sense of security. So I think that awareness of awareness at our core can provide another internalized secure base.
David: I guess part of the reason why that leapt out at me is I agree. We tend to notice the things that we also believe and agree on. Also, as you were talking about how parents can feed us with that nurturance, I'm also struck by - and your theory I think allows for this as well - the role of friends, of good friends. As I look at my own development there are certain friends; I mean, friends have been enormously important to me, and I think what friends have done is to reflect back to me a view of myself that I can love.
David Wallin: Yeah, you know, it's not only the child's relationship with the parent or the patient's relationship with the therapist; it's not only those relationships that, I think, have the potential to be developmentally facilitated and healing and transformative; I think it's also relationships with spouses and intimate friends.
David: Yes, now, we've skipped over that second leg that I just wanted us to at least touch on, which is the role of pre-verbal experience on the developing self, because I guess some of these defensive strategies and so on, we make decisions about how safe the world is, to some extent, before we even have language. So is this perhaps a slightly different version of the Freudian unconscious?
David Wallin: I think there's overlap, but I think the Freudian unconscious is often the realm of the prohibited. It's the realm of that which was unacceptable, excluded, verboten and so forth. So the unconscious is sometimes seen as a sort of cauldron of forbidden sexual and angry and destructive impulses. And I think the emphasis in my thinking, when it comes to pre-verbal experience and the necessity or desirability of focusing on nonverbal experience as a therapist trying to get to the core of the people with whom I work, the emphasis is not so much on what's forbidden on moral grounds or whatever; the emphasis is more on two things: one, as I've mentioned, what simply could not be accommodated in our first relationships; I think that tends to be relegated to the realm of the dissociated. But the emphasis in my thinking is also on experiences that registered, that had an impact, that shaped our sense of ourselves, and our understanding of other people, and our sense of what relationships are all about; experiences that occurred prior to the acquisition of language so that they simply could not register in a form that's linguistically retrievable.
And there's also studies nowadays in neuroscience which show that the brain structures responsible for speech and for autobiographical memory, they don't even begin to come on line until one-and-a-half to three years of age. The hippocampus, that part of the mind which is responsible for understanding sequence and context; the left brain and so on that's responsible for interpreting and making sense of experience and representing experience in words; those brain centers A) don't come on line until ages two or three; and B) those very same brain centers are knocked off line by trauma, either acute or chronic relational trauma. So the idea is that there's a lot of experience which has shaped our patients and a lot of predispositions to respond to experience with certain kinds of expectations, certain kinds of interpretations, as well as certain kinds of behavior. You know, there's a lot of experience that's simply not ever going to be accessible in words alone.
And so the implication for me as a psychotherapist is that if I'm going to get to the emotional core of the patient's experience, I have to get beneath the words. I have to get, you might say, to the nonverbal subtext of the therapeutic conversation. And for me that involves three things: it involves paying attention to what's evoked in me. Let me take a step back. I think what we can't put into words, what we can't communicate verbally, we nonetheless communicate, but we do so not by telling in words, we do by, you might say, showing or evoking. So the shorthand here is that what you or I or anyone else can't put into words, we tend to evoke in other people, or we enact it with other people, or we embody it. And so as a therapist I pay attention to the experiences, the emotions, the fantasies, the thoughts that are evoked in me as I sit with a patient. I pay attention to what is being played out in the enactments of my psychology as it interacts with the patient's psychology - you know, what am I doing, what is the patient doing, what are we doing together? That's extraordinarily revealing. And finally I pay attention to what's going on in the patient's body and what's going on in my own body, because as Babette Rothschild has said in the title of her book, the body remembers. Or as the researcher on trauma says, the body keeps the score; whereas the founder of the Hakomi method, Ron Kurtz, says the body reveals. So the idea is if we pay attention to what's evoked in us, what's enacted between us and our patients, and what's embodied, we're going to have a royal road, so to speak, to pre-verbal experience, to experience that, for whatever reason, our patients are unable to put into words.
David: What about nocturnal dreams as another way that these pre-verbal ideas might be expressed?
David Wallin: You know, I actually did my dissertation as a graduate student, my Ph.D. dissertation focused on dreams. So I also make use of dreams. I think dreams are, as Freud said, a royal road to the unconscious.
David: You know, your approach seems to me to be very integrative, making room for many psychodynamic insights on the one hand, for Carl Rogers' client centered emphasis on the importance of relationship factors, for neo-Reichian and Gestalt perspectives on the importance of body language, not to mention research on micro-expressions using stop-video; and then the growing interest in the Buddhist concept of mindfulness.
David Wallin: Yes. I don't know, it's just like everything I've ever learned and everything I've ever made use of as a therapist found its way into this book and so it is highly integrative.
David: Yes. Now, as we wind down I wonder if there are any final thoughts you'd like to leave our audience with.
David Wallin: Yeah, I'll conclude with this final thought, which is not something that I focused on a great deal in the book though I touch on it in the book for sure. But, since writing the book, what I've become keenly aware of and what has become, in some ways, my dominant interest, is the impact of the psychology of the therapist on the extent to which he or she is capable of being helpful to his or her patients. You know, one of the things that the attachment research shows, as I've indicated in this interview, is that the parent's psychology is an enormously powerful influence on the development of the child, for better or for worse; and I think it's both a puzzle and it's also, maybe, easy to understand. The fact that the psychology of the therapist, as a determinant of the extent to which he or she is able to generate a developmentally facilitative relationship with a patient, that's not a subject that has got a lot of attention in the research or the literature on psychotherapy. And it seems to me that, just as the psychology of the parents exerts an enormous influence - the attachment history, the attachment patterns - broadly speaking the psychology of the therapist exerts a huge influence on the context of psychotherapy. And I tend to think that the therapist's attachment history is inevitably - let's put it this way, on the bright side, it is a source of insight into the patient's experience; and on the more problematic side, it can be at the root of many impasses in psychotherapy. So I think that as therapists, it behooves us to pay an enormous amount of attention to in a sense to simply ask ourselves what are we actually doing with this particular patient, what is the relational interpersonal impact of what we're doing with this particular patient, and what might be our motivations for what we're doing with this particular patient? I think asking those kinds of questions really enhances the likelihood that we will be able to derive insight from our own attachment experience and minimize the extent to which we're stuck in impasses with our patients.
David: Well, this sounds very much like the insistence of the various psychoanalytic schools that analysts themselves be analyzed.
David Wallin: I think that's right. I wouldn't argue with that and, certainly, it seems to me that part of the implication of what I'm saying is that therapists would do well to continually work on themselves. Therapists would also do well to find consultation; in other words, to find, perhaps, a more seasoned or experienced therapist with whom to discuss their work. Because I think some of the impact of our own psychology is we're never entirely transparent to ourselves. We tend to unconsciously turn away from sights that might unsettle us, and so I think often a second pair of eyes - the eyes of a consultant, the eyes of another therapist - can be useful to understand our own blind spots.
David: Well, that sounds like terrific advice for us to wrap up with. And I've held you longer than I promised.
David Wallin: That's fine.
David: Dr. David Wallin, thanks so much for being our guest today on Wise Counsel.
David Wallin: David, I've enjoyed it.
David: Me, too.
David: I felt a special rapport with Dr. David Wallin, and I hope that came through to you as well. I think his book, Attachment and Psychotherapy, is one that every psychotherapist ought to read, and it's written clearly enough that I think interested non-professionals will find it rewarding as well. You'll find an excellent website at www.davidjwallin.com and he has an email link there as well.
You've been listening to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net. If you found today's show interesting, we encourage you to visit Mentalhelp.net, where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content. Access the show's page and show archive information via the podcast box on the Mentalhelp.net home page.
If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at www.shrinkrapradio.com. Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.
Links Relevant To This Podcast:
Dr. Wallin's book Attachment in Psychotherapy is available from Amazon.com
Dr. Wallin's website is avaialble at www.davidjwallin.com
About David Wallin, Ph.D.David Wallin, Ph.D. is a clinical psychologist in private practice in Albany and Mill Valley. A magna c*m laude graduate of Harvard College who received his doctorate from the Wright Institute, he has been practicing, teaching and writing about psychotherapy for nearly three decades. He is the author of the 2007 book, Attachment in Psychotherapy (Guilford, 2007) and coauthor (with Stephen Goldbart) of Mapping the Terrain of the Heart: Passion, Tenderness, and the Capacity to Love (Jason Aronson, 1996). He has lectured on attachment and psychotherapy throughout the United States and taught for The Wright Institute, the Northern California Society for Psychoanalytic Psychology, and the extension programs of the University of California and the California School of Professional Psychology.
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