Wednesday, September 25, 2013

Attachment Theory Part Two: The post in which I cite research


After my last post on attachment theory, I received a thought-provoking response from a friend. He said:
I don't understand why someone would want to change their attachment style. In your article, you just assume that everyone will want to have secure attachment. But why? Why not just accept that people have differences?
I think this is a great point. I remember being told by a professor once, "If you can't cite text, you're just pissing and moaning." So here is my answer to that question, with some references. (Please notice I'm going to talk about “secure attachment” contrasted with “insecure attachment.” As you might assume, all the other three attachment styles besides “secure” are considered “insecure.” )

First, is insecure attachment a mental illness?

No. Insecure attachment is not pathology. It is a style of personal relationships, and is more like a personality trait. There is some research that insecure attachment underlies some pathology (in other words, people with insecure attachment are more likely to be depressed), but in an of itself, insecure attachment styles are not a mental illness.

But that does not meant that you won't hear clinicians talk about insecure attachment styles as if they were pathology.

For example, I once attended a lecture at which a speaker was making a case that “sexual addiction” should be identified as an “attachment disorder.” (As you may know, there is much disagreement in the field about whether or not sexual addiction is a real disorder.) This man made a case that people in insecure attachments often turned to sex to feel secure in the relationships, and to improve their sense of themselves. He used the evidence that sexual acting out behavior is often based on insecure attachment to make a case that “sexual addiction” is a real diagnosis and a real disorder.

I must admit that I was not brave enough to raise my hand and ask him why he felt that two fictitious disorders added up to one real disorder. But I was sitting in a room full of therapists, and no one else challenged him, either. This speaker had made the assumption that insecure attachment is a disorder, and no one in the audience challenged that.

The truth is that “attachment disorder” is not a diagnosis in adults. (Please note: There is a diagnosis called “Reactive Attachment Disorder,” but it can only be diagnosed in children under the age of 5. It is not the same thingthat I'm talking about here.) The take-away message is this: Adults are not considered mentally ill merely because they have difficulty with attachment. 

So what is the problem with insecure attachment? Why would anyone want to change?

Just because something is not an illness does not mean that you want it. For example, hunger and thirst are not illnesses, but you probably don't want to be hungry or thirsty all the time. In a similar way, illiteracy is not an illness, but being able to read might make your life easier.

Insecure attachments can cause difficulties for the individual and for their relationships. I've seen it in my practice more times that I could count, and so has any other therapist you care to ask. But you don't have to take my word for it: Mountains of research have been done on attachment styles. (Make a quick Google search of “attachment theory research inadults” to see what I mean.) Here is just a sample of what the research shows:

People with secure attachment are more likely to reach out for social support.  
People with secure attachment are slower to anger, and cope more effectively once they do get angry. 
People with secure attachment cope better in times of transition.

People with secure attachments are more successful at regulating emotional distress.

People with secure attachments are generally happier in relationships.

Insecure attachment is correlated to worse health overall.

People with insecure attachment are more likely to develop depression. There are two studies on this. 

And on it goes. Basically, insecure attachment style can make life's stressors more challenging.



The common mistake therapists make about attachment theory

Most therapists will likely take this view: Since your adult attachment style is related to the relationship you had with your childhood caregivers, healing your childhood wounds will help you change your attachment style. Sounds good, right?

The problem is there is no research to support this.

As it turns out, childhood attachment styles do not always predict adult attachment style. Yes, attachment style is stable across long periods of the life course, but it also fluctuates in response to negative events during the life course. But more importantly, the process by which adult attachment styles change is not really understood. (Also, this article.)

And it seems that attachment changes occur in the context of the individual's current relationship, rather than in the process of “healing childhood wounds.” 

Many therapists will talk about “the unfinished business of childhood.” Well, if you are an adult, then your childhood is over, and you cannot change any part of it. Changing attachment style, if you should choose to do so, happens in the here-and-now. So while understanding your childhood experiences of attachment is important to self-knowledge, mere understanding will not help you change your attachment style.

Attachment Theory Bonus Easter Egg: Baby Talk

Attachment theory provides a model for both parent-child attachment and romantic partner attachment because these two kinds of relationships have a lot in common. Hazen and Shaver, two researchers mentioned in the previous piece on attachment theory, noted some of the commonalities between adult romantic relationships and parent-child relationships in their 1987 article. Here are a few:

- Feeling safe when the other is physically near and responsive
- Engaging in close, intimate body contact
- Feeling insecure when the other is inaccessible
- Sharing discoveries with one another
- Playing with facial features
- Engaging in “baby talk”
So your Bonus Easter Egg: Attachment theory explains why you engage in “baby talk” with your partners, or with your cat, or your car, or anything else you love. 

(PS: One of the people I asked to proofread this piece said the Easter Egg is “not satisfying.” So, if you did not find that Easter Egg as enjoyable as I did, then I am a bigger nerd than you are, and I apologize. I'll try and do better next time.)




Wednesday, September 4, 2013

“Why is my partner so needy?” or “Why can't I meet Mr. Right?” or “Why do I need so many reassurances?” Attachment Theory 101


Here are some things I hear frequently in my practice:

“Why does my partner need to call me three times a day to ask me if I love him? It drives me crazy!”
“If I don't respond to every text message my wife sends me, she gets angry. Doesn't she realize that I'm busy?”
“My husband won't let me in. I ask him what he is feeling, and he just shrugs. Is something wrong with him?”
“I can't seem to find anyone that I am compatible with. I've met lots of people, but none of them make it past the third date. What's wrong with the world?”

If any of these sound familiar, or if they sound similar to things you've said or heard in your relationships, you might want to learn about attachment theory.

Basically, people attach (or bond) to each other in predictable ways, and attachment theory is a model for understanding how people form those attachments. Originally it was developed by Mary Ainsworth and John Bowlby and described how children bonded with their mothers. In the 1980s research done by Hazen and Shaver showed that attachment theory applies to adult romantic relationships. Now we think that attachment theory applies to most kinds of human relationships.

(Bonus fun fact! Research from theUniversity of Haifa shows that people's emotional responses to television characters matches their attachment styles, particularly when those television characters were taken off the air. In other words, that Big Sad you had when Firefly was canceled might have had a lot to do with your attachment style, not just your love of quality narrative and innovative Sci-Fi.)

According to attachment theory, there are four broad styles of attachment. Here they are, and to make it easier to remember, I provided a familiar example of each.

Secure (Clair Huxtable)

People with secure attachments are comfortable being in relationships and also comfortable being independent. They can set boundaries and maintain them. People with secure attachment can recover from rejection, even if they do not like it. Generally, people with secure attachments are confident that their partner loves them, and do not seek many reassurances.






Anxious-Preoccupied (Rachel Berry)

As the name suggests, the anxious attachment type is characterized by anxiety around intimacy. Often, people with this style have trouble being alone or single, and sometimes they would prefer to be in any relationship—no matter how bad—rather than be single. They need frequent reassurance and affection from their partners. The theory holds that people with anxious attachment are looking for reassurances from their partners to counter their negative opinions of themselves. This is the attachment style of the person who asks, “do you love me?” dozens of times a day. This is also the attachment style of the person who goes through your text messages or your email looking for evidence that you're cheating—behaviors like this are driven by anxiety around the security of the relationship.



Dismissive-Avoidant (Liz Lemon)

The avoidant type is uncomfortable with intimacy, and is often characterized by high levels of independence. Sometimes people with avoidant attachment will feel “suffocated” or “smothered” when in relationships with others, regardless of the level of intimacy. The person with dismissive attachment style usually has the ability to talk themselves out of any relationship. When confronted with their avoidant behavior, this person will likely rationalize it away. (For example: I have been told that “there aren't any good dating prospects in metro Detroit.” Really? We're supposed to believe that there are 3 million people in metro Detroit, and all of them are either taken or terrible? Somehow, this is hard to believe. You may have heard something similar.)



Fearful-Avoidant (Ebeneezer Scrouge)

Basically, it's a combination of both the anxious type and the avoidant type. This person is is frightened of intimacy, and but actively seeks it out. In order to balance these conflicting desires, the fearful-avoidant type often lashes out at anyone who gets close to them, even though this person very much wants to be close to others. This is the least common attachment style.






So how do I know which type I am?

First, let's recognize that these are technically points on a complex continuum of our lives. In other words, you may find that your attachment style alternates between two, or that you are mostly one style, with some features of another. Our lives are complex tapestries, and any psychological model is just that—a model designed to give us a way to understand and talk about complex people.

So once we have that understood, if you want to know what your type profile looks like, you can take a test here.

Too much work to take that test? Hazan and Shaver, the researchers mentioned earlier, used these three paragraphs to determine attachment style very quickly. Read them all, and notice which one you identify with.

A. I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, others want me to be more intimate than I feel comfortable being.

B. I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don't worry about being abandoned or about someone getting too close to me.

C. I find that others are reluctant to get as close as I would like. I often worry that my partner doesn't really love me or won't want to stay with me. I want to get very close to my partner, and this sometimes scares people away.

If you identify as paragraph A, you are likely dismissive-avoidant in your attachments. If you identify with paragraph B, you are likely secure in your attachment. And if you identify with paragraph C, you are likely anxious-preoccupied. If you identify with both A and C, you are likely fearful-avoidant.

So now what? Can my attachment style be changed?

Yes, it can. But it will take time and hard work. The kind of attachment style you have will dictate what you can do to begin the process of working on developing a secure attachment.

If you have anxious-preoccupied attachment, you will probably benefit from working on your sense of your self. If you can come to place where you can say, “I'm OK and you're OK,” then you're doing a good job of working towards secure attachment. Work towards being able to look at your own life and say, “I'm a human, and I have flaws, but overall, I like who I am. Other people will like me, too.” How do you do this? Well, think about ways of developing self-esteem and self-acceptance. There is not room here to talk about how to improve these things, but there are lots of resources out there. Get some psychotherapy if you need it.

If you have dismissive-avoidant attachment, you will probably benefit from improving your opinion of others, and your openness towards them. See what your particular pattern is—do you work until you don't have time for relationship? Do you find fault with everyone in your life? Do you refuse to let other people see “the real you?” Figure out what it is that keeps you from opening up, then stop doing that. Be prepared for some anxiety to accompany this process. Get some psychotherapy if you need it.

If you have fearful-avoidant attachment, you want to do what is suggested in both paragraphs above. You want to develop a sense of yourself as being capable and likable. And you want to learn that you can protect yourself and still stay in a relationship, not run from it. This requires both an improvement in your own self-assessments, and an increased ability to tolerate others. While this is a challenging path, it is certainly possible. Get some psychotherapy if you need it.

You may have noticed that I wrote “get some psychotherapy if you need it” for all of these. Why did I do that? Because individual talk therapy is a very effective way of coping with challenging attachment styles. The reason is the therapeutic relationship itself. Developing and maintaining a relationship with a therapist is a major factor in changing attachment styles.

My partner is driving me nuts! S/he has anxious/avoidant/fearful attachment. What can I do?

Well, one of my cardinal rules in relationship therapy is “if you have a need, say it out loud.” So consider sending your partner the link to this article (or one like it—use Google) and have an honest conversation. Your partner deserves the opportunity to have emotional healing, just like you do. Sometimes, the best thing you can do for someone who is struggling is to point them in the direction of help.

And—I cannot stress enough how this is an “in addition to” suggestion, and not an “instead of” suggestion—get really honest about your attachment style. Be fearless in your assessment of your own style, so you know if you are feeding into the relationship dysfunction. Then take the steps necessary to get the healing you need.

Helping yourself develop a secure attachment will also go a long way towards your partner's healing as well. Studies have shown that people who have insecure attachment styles will actually start to be more secure when they are in relationships with people who are secure in their own attachment style.






References:

Bartholomew K, Horowitz LM, (1991). "Attachment styles among young adults: a test of a four-category model". J Pers Soc Psychol 61 (2): 226–44

Fraley, Chris R. 2010. “A Brief Overview of Adult Attachment Theory and Research.” Retrieved online at http://internal.psychology.illinois.edu/~rcfraley/attachment.htm

Hazan C., Shaver P.R. (1987)."Romantic love conceptualized as an attachment process". J Pers Soc Psychol 52 (3): 511–24.