When clients have had insecure childhoods, healing and growth can be facilitated by thinking of therapy as a reparative attachment relationship in which the therapist deliberately tunes into the non-verbal interactive dynamics at play. The following post explores this idea.
Attachment Theory and Non-Verbal Communication
Attachment theory explains how a person’s internal emotional world and external interpersonal behavior is related to the environment, threat and the need for security throughout the lifespan.i Our first “environment” is the one we inhabit as infants. As infants we are utterly dependent on our primary caregivers for all of our physical and emotional needs. Our attachment to them is not a choice – it is a biological necessity.
Security for an infant means having physical proximity to caregivers to provide food, warmth and protection etc., but also emotional availability to provide affect regulation (the monitoring and modifying of states of emotional arousal to remain within tolerable limits).ii Affect regulation involves caregivers recognizing, identifying, modulating (as needed), and reflecting upon (as development permits) their child’s emotional experience, as they can not yet do this on their own.
When caregivers actively soothe states of distress and encourage states of comfort and pleasure, they are modulating affect.iii When this happens consistently, infants (and children) will experience the attachment relationship as a source of relief, comfort, and pleasure wherein emotions are welcome, understandable and manageable.iv
This begs the question of what happens when caregivers are not responsive to their infant’s needs for soothing and protection? For example, when caregivers are generally angry in response to distress? Or they are responsive only some of the time? Because infants are thoroughly dependent on their caregivers for their survival, they must adapt to them. Infants accommodate the idiosyncratic strengths and/or weaknesses of their caregivers by adopting corresponding behavioral strategies (which are in essence, affect regulating strategies) in something of a hand-in-glove manner.
In attachment theory, three primary behavioral strategies have been identified. These include the so-called secure, avoidant and ambivalent strategies. Wallin explains: “Confident of their mothers’ responsiveness, secure infants could well afford to be attuned to their own attachment-related feelings and needs: They could be aware of and could express them. Avoidant infants, anticipating mother’s rejection and their own anger in response, could afford neither to be aware of nor to express their attachment-related feelings and needs. Hence the avoidant strategy of inhibiting or minimizing such internal experiences. Ambivalent infants, responding to their mother’s unpredictable availability, apparently developed a strategy for amplifying or maximizing both the awareness and the expression of their attachment related feelings and needs as if to ensure continuing care.”vThus the avoidant strategy involves a hypo-activating adaptation (downplaying) of attachment needs and behaviors and the ambivalent strategy involves a hyper-activating adaptation (escalating) of attachment needs and behaviors to fit the care giving environment.
Infants and caregivers communicate using an intricate “body language” which involves touch, tone, sounds, gestures, facial expressions, eye contact and action tendencies. Spoken (verbal) language generally only begins gradually around the second year of life. Moreover, the brain structures which encode memory in a verbally accessible, symbolic form don’t generally come online until the third year of life.viThe period prior to the establishment of deliberately accessible (explicit) memory is referred to as infantile amnesia, because “memories” as we generally think of them cannot be consciously retrieved. Nonetheless experience from this period is “remembered,” is highly formative, and will be experienced later as a sense of knowing how to be and how to be with others.vii This type of memory is referred to as procedural or implicit memory; it is non-verbal, non-symbolic, and generally unavailable for conscious recall or reflection. Its content involves procedures, emotional responses, and patterns of behavior.
When implicit memory is activated the person has a sense of unconsciously “knowing how” and of “familiarity with” rather than of conscious recollection. These memories can be a therapeutic gold mine because they contain unarticulated content about the self and about the self in relationship. For this reason intersubjective and relational theorists refer to this set of memories as “implicit relational knowing”.
Reparative Attachment: The Potential of Therapy
It only stands to reason that those feelings, thoughts and behaviors which might jeopardize crucial attachment relationships would be defensively excluded from awareness and behavior and that those which sustain and protect it would be emphasized. It also stands to reason that a new attachment relationship could offer new and distinct possibilities for what can be safely known, felt and acted upon.
To the extent that a therapist has the capacity to facilitate, witness, tolerate, integrate and reflect on that which was historically off limits, new facets of a client can be encouraged to emerge. Thought of in this way, therapy has the potential to permit a client to “risk feeling what he is not supposed to feel and knowing what he is not supposed to know” by explicitly deconstructing (reflecting upon) past attachment patterns while experientially creating new ones in the present.viii
So how do attachment oriented therapists access that which is disavowed, unknown, undeveloped and not available for conscious or symbolic recall in their clients? The answer to this question leads to the realm of ‘non-verbalizable’ experience and non-verbal communication.
A shorthand for working with implicit relational material is to consider that what we cannot put into words we often either enact with others, embody somehow, or evoke in others.ix I will explain each of these in turn and then offer clinical anecdotes to illustrate them.
Enactments
An enactment involves the action(s) stemming from the words spoken i.e., the resulting interactive dynamics or the relational effects of the words. Do they push us away or draw us near? Pull us into the past or move us toward the future? Do they serve to obfuscate or do they reveal?
I once had a client who was a troubled, bright young man. He was the oldest of three and he was furious with his parents for their failings and particularly for ‘parentifying’ him in his youth. He and I had good rapport and we were making considerable progress in his therapy. At around our tenth session or so, he told me he could not believe he was capable of being so open with me or how much he was learning about himself in therapy. Then, surprisingly, at our very next session he announced that he was finished with therapy. He explained maturely that he believed that he had simply outgrown my usefulness to him. Not wanting to come across as disappointed or defensive (which I was a bit), I outwardly graciously accepted his termination of me. Then an extended awkwardness hung in the air between us. He kept asking me in various ways if I thought I could be of more assistance to him and I kept reassuring him that he should trust his own intuition about it.
Gradually it dawned on me that he needed me to tell him that he could benefit from more and that I had more to offer him. Because of his childhood, it was outside of his relational repertoire to know how to ask for more, what that “more” might be or how to trust that I would not disappoint him (as had his parents) if he allowed himself to ask for, need, or want it. Beginning to grasp the enactment at play, I said, “I am feeling this interesting pushing and pulling going on right now. You say you don’t want more therapy with me (action: pushing), but then ask me to tell you that I have more to offer you (action: pulling). Does this fit with your experience of what is happening right now?” He said, “Yeah, especially the pushing and pulling part, my girlfriend tells me I do that all the time.” For this to be reparative for him, I had to demonstrate that it was okay for him to want/need more from me even if he didn’t know what that was yet (we would figure it out together), I would not let him down, and none of this would jeopardize our relationship.
Embodiments
The ambivalent and the avoidant attachment strategies are associated in adulthood with distinct bodily expressions. The ambivalent (hyper-activating) strategy usually involves an internal physiology which includes sympathetic nervous system dominance, a low threshold for nervous system arousal, and diminished cortical control over emotional reactions.x Outwardly there is a tendency toward more pronounced and demonstrative facial and bodily gestures, a preference for physical proximity and for postures involving moving forward and reaching out. Physical movements tend to be less contained and sometimes agitated.xi
The avoidant (hypo-activating) strategy internally generally involves a deactivation of the sympathetic nervous system, a bias toward left-hemisphere cortical processing and parasympathetic nervous-system activation.xii The outward bodily expression of this strategy often involves more restricted movement, less facial expressiveness and limited direct eye contact. It also tends to be associated with pulling back or pushing away and other movements associated with withdrawal as well as diminished bodily responsiveness to relational overtures.xiii
The young man discussed above had an avoidant strategy. He rarely made direct eye contact. When asked about feelings of need or vulnerability, he would often pull back his torso, neck and head and extend his arms straight out in front of him with his palms facing out, his eyes closed and his head shaking “no.”
One day I asked him if he would do an experiment with me: To simply look directly into my eyes for as long as he could tolerate it. After balking, he tried it a few times. Each time he was able to maintain eye contact with me a little bit longer and, as he did so, I said really simple encouraging things like “good” and “that’s it.” I also reflected back to him what I noticed about changes in his face, his breathing and how he held his body. For example, I noted that his shoulders came down a little with one of his exhales and that his eyes and his jaw softened a bit and so on.
While engaged in this exercise, it was as though we fell under a dyadic spell together with all of his awareness focused on staying present with me in this unfamiliar way and all of mine on simply noticing and reflecting back what I witnessed. Afterwards, crying slightly, he told me how hard it was for him to look at me without thinking how I might “just disappear right before his eyes.” Later, he asked me how he could know that our relationship wouldn’t end in a wrenching and painful way as so many of his others had. A long and important conversation followed.
Evocations
Clients may also evoke in (meaning relocate to and cause someone else to experience) that which they feel or think but cannot know, name or experience directly. Recent neuroscientific developments have shed some light on how evocations take place. The human brain comes equipped with “mirror” neurons which permit us to sense the emotions and intentions of others. Mirror neurons make emotions contagious explains Goleman, by “letting the feelings we witness flow through us, helping us get in sync and follow what’s going on. We ‘feel’ the other in the broadest sense of the word; sensing their sentiments, their movements, their sensations, and their emotions as they act inside us…we become like the other – at least a bit.”xiv
I had this experience with a client who was an elderly woman who spent a lot of time in her apartment knitting, sewing and doing artwork. She had convinced herself that she had developed a “mental illness.” While she talked (and talked and talked), she had precious few words to describe what she thought was the problem. All she could tell me is that “it” would come over her and she would not be able to enjoy anything, and then “it” would disappear as mysteriously as “it” appeared.
She claimed she was not depressed or anxious. We spent many sessions trying to discern what “it” was, what preceded “it” when “it” happened, what contributed to the abating of “it” and so on, but we got nowhere. In each progressive session she talked more and I talked less. Usually this would be good, but nothing of therapeutic value was transpiring and I was finding it very hard to stay present with her.
She also kept testing the boundaries of our relationship by trying to involve me in her social life. I explained repeatedly that it was not possible given that I was her therapist and then she would try again a bit harder and from a slightly different angle. Feeling exasperated one day, I said, “You know, I am feeling really stuck and frustrated right now; I want to help and attend to you in the ways that I am able, but it is almost as though I am not really here with you somehow, like you could just be talking to yourself. There is no a back and forth rhythm to our conversations.” She looked like she had seen a ghost. She said, “How strange, that is exactly how I feel at home when “it” comes over me. I feel all alone with nothing but my own stories and thoughts spinning around in my head. I feel lonely, stuck and frustrated.” It wasn’t until I tapped into the experience she was evoking in me that either of us knew what she needed help with.
Conclusion
These anecdotes illustrate how therapists can use attachment theory to interpret and work specifically with non-verbal client communication by thinking of it as cues and clues to undeveloped relational potential awaiting expression through a reparative therapeutic dynamic. Each anecdote involves an interactive tension between repeated experience and reparative experience and the forces acting toward familiarity, stasis and restriction of relational experience and those acting toward exploration, change and expansion of relational experience. “We find aspects of ourselves in the minds of others,” says Wallin. “Whether in the course of childhood development or psychotherapy…the self is discovered (or perhaps created) primarily as it is recognized and understood by others…in a relationship of attachment.”xv
Biography
Sarah Flynn, MREM, MA, RCC is a therapist in private practice (Synergia Counselling and Consulting) in the neighbourhood of Fernwood in Victoria, BC. She specializes in attachment, relational trauma, dissociative processes, non-verbal communication, and helping those with loved ones with mental illness. She offers individual, couples and family therapy as well as attachment oriented therapeutic case consultation. Feel free to contact her with questions or comments by phone at +1 (888) 316-0819 (toll free) or by email at sarah@synergiacounselling.com, or to visit (www.synergiacounselling.com).
References in the Body of the Article and Reference Section
i Bowlby, J. (1988). A Secure base: Clinical applications of attachment theory. London:Routledge.
ii Gerhardt, S. (2007). Why love matters: How affection shapes a baby’s brain. New York: Rutledge
iii Siegel, D.J. (1999). The developing mind. New York: Guilford Press.
iv Siegel, D.J. (1999). The developing mind. New York: Guilford Press.
v Wallin, D.J. (2007: p.35). Attachment in psychotherapy. New York: The Guilford Press.
vi Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
vii Wallin, D.J. (2007). Attachment in psychotherapy. New York: The Guilford Press.
viii Wallin, D.J. (2007: p.3). Attachment in psychotherapy. New York: The Guilford Press.
ix Wallin, D.J. (2007). Attachment in psychotherapy. New York: The Guilford Press.
x Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
xi Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton
xii Schore, A. (2003). Affect dysregulation and disorders of the self. New York: Norton.
xiii 0gden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton
xiv Goleman, D. (2006: p.42). Social intelligence: The revolutionary new science of human relationships. New York Bantam Dell.
xv Wallin, D.J. (2007: p.51). Attachment in psychotherapy. New York: The Guilford Press