Back From LA Attachment Conference

how people change

I just returned from an amazing 3 day conference in Los Angeles. The title was How People Change: It was about how the therapeutic relationship is a crucial element in the effectiveness of psychotherapy. Did you know that even in Cognitive Behavioral Therapy, where the tradition is to de-emphasize the relationship, research shows that the quality of the therapeutic relationship is even more important than in other therapies? Yes, that’s what the studies show.

But there were two overriding points made in different ways throughout the conference, which included such luminaries as Daniel Siegel, Alan Schore, John Norcross Irvin Yalom and Mary Pipher. The first theme was that growth and healing take place when our mind is in a certain zone, not too afraid or defensive and not too “shut down.” The second was about how profoundly social we are as beings.

Practically every speaker had a diagram with three zones of mental activation. At the top, the brain was on high alert, totally focused on survival. This is traditionally described as “fight-flight” mode, where we are on autopilot, functioning instinctively to attack or defend. The important finding is that there is a good reason for our actions being largely automatic. Functional brain scans show that the frontal cortex, the most thoughtful of our brain areas, is largely turned off when we are in this state. When survival is paramount, it simply goes off line. So when we are in this state of high alert and vigilance, we can’t expect to be creative or have much perspective on what is happening. All our energies are focused on what we have to do. Have you noticed that when you are dealing with an emergency, time seems to stand still? Seeing our lives in the perspective of time is a higher function that involves the prefrontal cortex.

The bottom level of the diagram is also one where we are not accessible to new ideas or growth or change. It is a state of minimal activation and energy conservation. When we feel depressed or hopeless or apathetic, ancient mechanisms are at work to help us survive by conservation and inactivity. Just as some animals instinctively “play dead” when they are cornered, we are capable of going into a state of collapse.

In the middle of the diagram, our minds are alert and active. We are capable of perspective on ourselves, or mindfulness. In this state, all the layers of the brain are working together. Fibers running up and down connect our highest human brain, the cortex, to the mammalian or emotional brain, and on down to the reptilian brain that regulates our breathing, and bodily functions as well as providing much of the coordination that knits all the parts together. When I think of this state, I think of children on a holiday with their parents. They are excited and happy. They point and chatter, explaining things to relaxed and loving grown-ups. This is the state when we are at our most creative and most ready to try new patterns of thought and behavior. It is also a state where we can see ourselves through the eyes of others.

The implication for therapy is quite simple. You will first need to be in the middle zone for growth and healing to take place. I am not sure that therapists always pay enough attention to the state we are in. When we are not in the growth zone, then the goal of therapy should be to find a way to get there.

And that brings me to the second main theme of the conference. It is how relationship can bring us into the middle zone where we are ripe for growth and how it can also be the instrument of change.

The human nervous system is a social one. The construction of the human brain is profoundly oriented towards social interaction. We have special nerve endings that are just sensitive to soft touch. We have “mirror” neurons that allow us to feel what others feel as if it were ourselves. One of the most pleasurable feelings we can have is when we connect with others, understanding them and feeling understood by them. 

This is the basic stuff of therapy. It is what Carl Rogers referred to as “accurate empathy.” It is what makes sessions feel good even when we start out feeling bad. It is the equivalent of parents going on a summer outing with their small children, when everyone is participating and all are joyously tuned in to one another.

In scientific terms, it means that our cortex or human brain is fully active and connected with our emotional, mammalian brain. These, in turn, are in sync with our reptilian brain, the one that regulates infrastructure and links all the parts of our body and mind together. This is what happens when we feel empathically connected to one another.
But in psychotherapy, we are not just there to feel good. We are there to use our good feeling as a platform from which we can venture into uncharted waters. We need to feel safe and connected in order to confront the feelings we have instinctively dreaded. We need that state in order to try out new behaviors that are going to make us feel strange or uncomfortable. Laura, a young woman I saw some time ago, felt uncomfortable when everything in her life was going well. She called it “survivor guilt.” When she was doing well in school and had a boyfriend who treated her well she would feel increasingly fidgety and uncomfortable. She would find herself yearning for the “ex” who treated her badly. At these times, she experienced a chorus of impulses to do self-destructive things. (See earlier post on the Black Box of Motivation). For her, therapy meant choosing to live an increasingly healthy life and each time coping with a wave of discomfort and impulsiveness till it passed and she could feel better.

Therapy is about taking emotional risks. The basic operation is to use the therapeutic relationship as a home base allowing us to venture into feelings and actions we normally avoid. Sometimes these feelings are stirred up within the relationship itself (See recent posts about “Attachment to Your Therapist.”) At other times, feelings are stirred up in the course of self exploration, through voluntary changes in behavior or from new ways of thinking.

As discussed in “Attachment to Your Therapist III,” placing ourselves on the cusp of two feelings is what allows long term change in our dysfunctional patterns. For this to happen, the nervous system must be activated, but not in an emergency state. Being in that middle zone of high safety and increased willingness to explore sets the stage for change. Then, it is the activation of the specific neural networks that are involved in our unique difficulties that makes it possible for their synaptic connections to change. This mental micro-surgery is where we heal and grow. So, as relational beings, we should not be surprised that:

The therapeutic Relationship:
1. Makes us ready to take risks and prepare for change.
2. Often brings up just those difficult feelings that we need to confront.
3. Is a vehicle for seeing ourselves and our lives in new ways.
4. Helps us weight the pros and cons of new patterns of behavior.
5. Is the medicine that makes the discomfort of change feel OK in the end.

NOTE:  To my Chinese Friends– I see that many of you have visited this post. Please leave me a comment and tell me how you heard about this website. I hope you like it, and would be pleased to answer your questions.Yours, Jeffery Smith


  • Diana writes asking what I think of Attachment Theory and it’s importance in therapy.

    Attachment Theory is a small window on the first two years of development when infants and toddlers learn to navigate relationships. It is small because data comes mainly from one experimental paradigm where mother is taken away from the child and then returns. The patterns tots develop are the best that small, non-verbal children can do to attach and stay emotionally connected to their caregivers. Research has focused especially on four patterns. Roughly speaking, the secure pattern is when caregiver and infant were reliably successful at connecting. The avoidant one where the child learned to deny any need for attachment, the ambivalent one where connections weren’t reliable and the disorganized one, where the child couldn’t figure out any successful strategy. (Wikipedia has a pretty good exposition of all this.)

    The patterns developed at this early, non-verbal period have lasting effects and are central to adult problems that involve intimacy and those automatic reactions when we unconsciously detect and react to triggers from pre-verbal life.

    On the other hand, not all of our problems originate in this period. Many people have conscience problems where we internalize values that are not really in our own best interest. People who have been deprived can put high value on not needing anyone, then feel shame when they legitimately do have needs. I think of conscience issues as coming in around age 3. Four and five-year-olds have different ways of solving problems. Fours tend to develop an agendas to teach others a lesson. Typical of fives is to “someday” plan to become so (great, lovable, strong, etc.) that all your problems of childhood will finally be solved. The variety is infinite, but the point is that while those early attachment years are extremely important, they are not all there is to our psychological makeup or our problems.

  • Great article. And no, baby years are certainly not exclusively formative. One can have a great babyhood with loving parents for the first 3 years….then begin to have horrible abuse when they’re outside the home and continue to have for the rest of childhood years…essentially living in two worlds at once with total contradiction between them. Parents and home, ok or at least near ok. But time away in an abusive home where there is absolutely no one to help, protect, or who will choose to put the childs best interest as first priority. Trust me…the rest of childhood is most definitely formative, for good or very ill.

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