Summary and Takeaways from Attachment in Psychotherapy by David Wallin PhD

Hi, everyone!  This is Lara Hammock from the Marble Jar channel and in today's video, I'll give you my summary and takeaways from the book -- Attachment in Psychotherapy by David J. Wallin, PhD.

I'm doing my residency as a mental health therapist and am reading a ton of books so that I can be as helpful as possible to my clients.  Some of these books, such as this one, fall pretty hard into the "training manual for clinicians" category, but it really helps me to synthesize the information better when I summarize for you, so I'm putting it out there for anyone who might be interested or is considering buying this book.

The more research I do, the more convinced I become that our attachment history is at the heart of most of our relationship and emotional issues as adults.  By attachment, I mean the quality of the relationship with our primary caretaker as infants.  The more I learn, the more significant I believe the impact is -- on our sense of self, on our ability to regulate emotions, and even on our beliefs about the world.  This is the first book that I've read that fleshes out some of the thoughts that I've been having about why therapy works and why a strong attachment relationship to a therapist is required for positive change.   I read this book twice already and it is dense.  Plus I took 97 pages of notes -- I kid you not.  I really benefited from it, but it will be difficult to squeeze even a brief summary into a 10 or so minute video, so, let's get started. 

Overview of author and theory

First of all, the author, David Wallin, is a psychologist who is a graduate of both Harvard and Berkeley and who has been a practicing psychotherapist for over 30 years.  I'm going to assume that most people watching this video have at least a glancing knowledge of attachment theory, but in case you don't, in a nutshell, it's the theory that the quality of our attachment relationship with our primary caregiver (usually, but not always, mom) determines how we interact with others, how we explore the world, how we handle our emotions, and how we know ourselves.  And this "style of attachment" that we developed as babies tends to follow us into adulthood and affect our relationships -- particularly our primary love attachment, our parenting style, and how we think about ourselves and others. 

Attachment Styles

Here's the deal -- some of us were lucky enough to be born to primary caregivers who were attentive and loving.  When we got hurt or needed emotional care, they turned to us and comforted us.  As a result, these folks largely became securely attached and have continued to feel emotionally safe enough to explore the world.  But there are plenty of people -- upwards of 40% of the population -- that didn't have that.  When they got hurt or scared, their caregiver wasn't always there to comfort them.  Depending on how intermittent that care was and the baby's temperament, these folks developed either an attachment style that is anxious -- meaning they are always worried about whether their caregiver will be there for them -- or avoidant -- meaning they just assume they won't be and so they fend for themselves and shut down any need for emotional care from others.  And then there are the babies who were actively afraid of their primary caregiver, which results in a disorganized attachment style.  

And as I said, these styles tend to follow you into adulthood.  Secure babies turn into secure and autonomous adults who can be emotionally open, trust appropriately, and ask for what they need.  Anxiously attached adults continue to be preoccupied with how much affection that they are receiving from their romantic partner.  Avoidantly attached adults tend to be dismissive and uncomfortable with emotional intimacy.  And people with disorganized attachment have just that -- really unpredictable and unresolved attachment patterns.

Since we can't pick our parents or redo our childhoods, this might all be pretty depressing if it weren't for new research demonstrating the neuroplasticity of the human brain.  What this means is that we can learn new attachment strategies and behaviors as long as we are in a secure and healthy  relationship.  And why would you want to develop a more secure attachment style?   Because those folks tend to be more trusting, more connected, and more comfortable in their relationships.  They can be independent and allow their partners to also be independent.  They can set boundaries when needed and can handle disappointment or rejection.   In short, they are happier, more confident, and more resilient. 

So, Wallin starts his book with a history of Attachment Theory, which talks about its two founders: John Bowlby and Mary Ainsworth.  And then goes on to discuss contributions by Mary Main and Peter Fonagy that have helped us understand more about how attachment styles are created.  He then talks about how this formative relationship shaped the self and the neurobiology of attachment.  This is all pretty fascinating stuff which I am just glossing over, but I encourage you to buy the book and read the whole history.

In the time I have left, I want to talk about his three overarching themes, which all deal with how to use attachment theory in therapy.  First of all, to date, attachment theory has not really been used clinically.  In other words, it is a way to understand how people are the way the are, but there aren't interventions and tools developed for therapists to use this to treat clients who present with different attachment styles.  The exception to this is Sue Johnson's Emotionally Focused Therapy, which uses attachment-based strategies to counsel distressed couples.  I should note that she has also expanded this to deal with families and individuals.  I'm reading about that next.  Back to this book -- Wallin essentially argues that relational or intersubjective theory can be seen to propose attachment-based interventions since they begin from the same basic set of assumptions.  He then goes on to make a compelling argument about how the two theories work together.  Okay -- here are the three themes:

• 1 - Relationships are healing - In other words, in order to change your attachment style, it's very difficult to do it alone.  That transformation generally requires that you are in a secure and healthy relationship.  And his point is that the therapeutic relationship can be just that.  In fact, I would argue that the emotional security of the alliance between therapist and client is the only thing that allows change of any sort to happen.  Someone once said, "Talk therapy is just an excuse to hang out long enough to let the relationship do the healing."  But Wallin goes beyond this.  He emphasizes the therapist's role not only co-creating a secure relationship, but also to push clients to think about their thinking.  Which we will talk more about in a second. The 2nd theme is
• 2 - Experience can't alway be verbalized - A lot of what goes on in relationships is not said out loud.  In fact, much of it doesn't even bubble up to consciousness.  If you feel awkward with your friend, are you going to say, "Why are things so awkward right now?" Probably not!  You're just going to muddle through.  But in a therapy room, we have to use everything -- especially the things that aren't being verbalized.  So, of course that means non-verbal communication like crossed arms, turning away, or rolled eyes.  But Wallin goes beyond this.  He believes that what can't be verbalized or even acknowledged gets enacted, evoked, or embodied. 
• Enacting means that you, the therapist, are participating in a pattern that the client has played in the past.  Maybe you are the caretaker and they are in a helpless role.  Maybe you are both avoiding emotions by over-intellectualizing.  Whatever it is, the therapist is required to be attuned to what is going on and to comment or invite conversation about the enactment. 
• Evoking means that if I'm feeling uncomfortable, maybe that's is being projected by the client!  Or if I feel irritable or sad -- those could be things that client is bringing into the room.  The therapist has to be aware of and willing to talk about the things that he or she is feeling as a way to access and discuss something the client may be feeling, but is unaware of or uncertain about. 
• Embody - And finally, the same thing happens with physical sensations.  Sometimes the client unbeknowst to them, brings something into the room that might cause the therapist's heart to race, stomach to hurt, or shoulders to tense.  This is called embodiment.  Therapists should also be aware of and willing to disclose those physical sensations as a way to reflect back their reaction to the co-created environment and relationship with the client.  Particularly with those clients who have problems feeling emotions -- like those who are avoidant or have unprocessed trauma in their backgrounds.  Having other ways to approach those emotions might help to start to feel them within the context of a safe therapeutic relationship.  And finally, the third theme is to
• 3 - Encourage mentalizing and mindfulness - Wallin then offers a lifeline and pathway that can lead to more resilience, more psychological flexibility, and ultimately a happier life.   He does this by describing three thinking styles -- which he calls stances towards experience.  At the lowest point is
• Embeddedness.  This means you are embedded with your thoughts, your emotions, your behavior.  You believe everything you are thinking and you don't have a sense that there are other perspectives, other thoughts, or other ways of feeling.  What you feel and think are the truth, full stop.  So, you could be thinking "everyone hates me" which is objectively not true, but when you are embedded, you believe that your thoughts and your feelings 100% reflect reality.  This feel crappy and leads to crappy decision making.  So, this is not entirely linear, but the sake of simplicity, let's just say the next step is
• Mentalizing - Mentalizing is the ability to perceive that you are having thoughts, but they might not be fully accurate.  And you are having emotions, but those are of finite duration and will pass.  Also, other people may have a different perspectives and mentalizing allow you to guess what other people might be thinking or feeling.  It's the ability to get a little distance from your inner world and Think about your Thinking.  Mentalizing is the first step towards psychological flexibility and peace of mind.  This is a hallmark of talk therapy -- although I guess that would actually be talking about thinking.  But an equally important ability is that of
• Mindfulness - If mentalizing allows you to take a step back from your thoughts and feelings, mindfulness allows you to be in the moment and observe your thoughts and emotions as you are having them without judgment or blame.  Mindfulness can make mentalizing easier and it serves to ground you in the present moment, get in touch with your physical sensations, and understand the temporary nature of life and experience.  These two skills -- mentalizing and mindfulness can be learned.  And these two skills are hallmarks of securely attached people.

That's all I have time for, but there is so much more in this book!  Go out and buy it now if any of this was interesting to you.  Let me know what you think.  Comments are always appreciated and thanks for watching!