When it comes to mental health, there is a wide variety of treatment options available.  Practically any combination of three or four letters will render an acronym for a particular brand of talk therapy you can undergo with a certified practitioner eager to help - CBT, DBT, EFT, ACT, EMDR, REBT, etc. Not only that, but there's a whole world of psychiatric medications and newer hallucinogenic drugs on the market and under research, each designed to treat mental health issues. How do you ultimately decide what kind of approach is best? Before undertaking such a serious and important question, I want to help explain some preliminary concepts that underlie the diversity of approaches to helping people with mental health conditions.  What makes mental health so unique?  Why are there so many types of therapy for mental health conditions?  Why is this not the case in other areas of medicine?  

The fundamental difference between psychology and other disciplines relates to the difference between the mind and the body - an infamous distinction that has been the topic of debate in the history of philosophy for centuries.  The reason there are so many types of treatment approaches when it comes to mental health has to do with the fact clinical psychology studies the mind, and the mind has properties that differ from the body.  ​In this article, I'll explain what distinguishes the mind from the body/brain by looking more closely at what it means for something to be "objective" versus "subjective."  While not without its limitations, this general distinction has important implications for the study of mental activity and helps explain why there are so many treatment approaches when it comes to mental health conditions compared to other maladies.  
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Generally speaking, bodily processes are objective, meaning that they occur independent of our mental activity.  They don't require our participation, we can't will them to act differently, they don't change based on how we feel or think about them, etc.  When a person has biological indicators signaling cancer, for instance, the person's experience of cancer - his or her thoughts and feelings about the disease - make relatively little difference to the pathophysiology of cancer (although it should be noted more and more research is demonstrating the influence of the mind and mental states on numerous physical diseases, including cancer).  Biological and physiological markers are objective facts, independent of our thoughts and feelings.  These facts directly dictate diagnosis in many areas of medicine.  As a result, medical treatments for the body are often unified across physicians.  Physicians might vary from one another with regard to treatment details, but the variability of approach is more limited because the thing being treated is fundamentally objective.  

Treatment approaches differ widely among mental health professionals because the "thing" being treated is not only the body, but the mind - and the mind has properties that are distinct from the body.  The mind is fundamentally subjective instead of objective.  Psychology uniquely explores our subjective experience - the way the world feels and presents itself to us from the first-person perspective.  By definition, the subjective qualities of an experience are more variable across individuals because they are comprised of the particular experiences of each person.  While this might make the scientific study of subjectivity more difficult, it's also what makes psychology so explanatorily rich and fascinating.

Consider the difference between objective and subjective aspects of something like depression.  An objective, bodily-based (and radically over-simplified) view of depression might be "a below average quantity of serotonin in the brain," while a fundamentally subjective view of depression might be "the debilitating feeling that 'I mean nothing in the world' and 'I would be better off if I never existed.'"  The first definition focuses on the objective properties of depression - something that can be measured, counted, and quantified.  This is conducive to empirical methods of investigation but yields a more mechanical description and fails to address what it actually "feels like" to be depressed.  The second is less conducive to the same quantitative methods of study (though, by no means, not all), but it renders a definition of depression that is much richer and "experience-near" [1].   ​Neither definition is wrong; rather, they each address mental functioning from different levels of explanation.  

Because subjectivity is so fundamentally different from objectivity, some branches of psychology have departed from quantitative methods of inquiry altogether.  Hermeneutic, qualitative, and some psychoanalytic approaches to inquiry arose to study precisely the subjective facets of our experience.  These approaches utilize in-depth case studies and interviews that yield insights into human functioning that give rise to incredibly rich and interesting methods of treatment.  Treatment approaches arising from these methods, such as some approaches to psychoanalysis, are often not only clinically meaningful, but demonstrably effective in helping people make desirable changes in their lives.  These approaches consider the following kinds of questions: What does it actually feel like to be "depressed?"  What relation might one emotional experience (such as hate) have to do with alternative emotional experiences (such as sadness or love) within the same person?  Why is it that we seem to repeat the very same behaviors we most avidly denounce?  These are important questions about our subjective experience that can't as easily be studied quantitatively.  

​When new areas of inquiry arise that can't easily be studied according to current methods, new branches of science are born.  The history of science bears this out.  Cell biology, for instance, came into existence only after the technological innovation of the microscope.  This made possible the observation of an entirely new realm of inquiry, and cell biology became a new discipline.  This is similar to the development of psychoanalysis within the field of neurology and psychology.  Freud examined more closely the subjective experiences of hysterical female patients otherwise largely neglected by the methods of treatment available at the time, and he discovered the operation of unconscious processes.  In doing so, Freud ushered in an entirely new way of conceptualizing mental activity, and, ultimately, a new discipline and area of inquiry was born: psychoanalysis.

Psychoanalysis might be considered, in essence, the science of subjective experience.  The hallmark of psychoanalysis is that there are unconscious processes at work in our mind, and these processes direct the flow of thought, feeling, and behavior and form the foundation of our personalities.  Freud’s innovation/discovery of psychoanalysis pioneered the very concept of talk therapy.  All major branches of therapy stem from this foundation in some way.  
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With the progress of science, the distinction between the mind and brain became somewhat artificial compared to what it was in the history of philosophy.  Now, we understand the brain as the physical "place" where the activity we call our "mind" resides or emerges.  The electrochemical interactions among the highly intricate neural architecture comprising our physical "brain" constitute the objective properties of our brain that give rise to the mind and mental activity.  The mind is not a physical thing somehow located in the brain; rather, we use "mind" to refer to the various mental activities constituting our subjective experience (such as our feeling sad or our thinking about the beauty of a flower).  In other words, our mind is the subjective “thing” that emerges from the physiological interactions within our brain.  

Our mental functioning thus represents the culmination of the intricate interplay between our brains and our minds.  It is the frontier between the objective and the subjective - a bodily organ possessing properties that are both objective and subjective.  As a result, it would perhaps be more accurate to refer to the "mind/brain" when trying to describe mental activity.  When we describe something like depression as a deficit of serotonin and the feeling of sadness/despair, we are describing the same phenomenon from alternate levels of explanation. 

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The distinction between treating mental suffering as either objective or subjective has implications for the kinds of treatment approaches we take.  Psychiatrists who tend to examine depression from a more objective body-based perspective, for example, will emphasize organic and physiological factors.  Medication and other physical interventions become predominant modes of intervention in psychiatry because the brain is more the focus of inquiry.  Modifying its chemistry yields changes that are often helpful from this perspective.  When the problem is viewed through an objective, brain-based lens, the treatment approach will tend to be fairly uniform.  

Psychological approaches emphasize the exploration of depression from the perspective of subjectivity.  Because subjective facts, by their nature, differ according to the experience of the particular person, they admit a wider variety of possible conceptualizations and treatments.  Some approaches emphasize thought processes, while others emphasize emotional experience, the mental experience of physiological processes, or unconscious processes.     

There are many types of therapy for mental health conditions because mental health conditions pertain to the mind/brain, which possesses properties that are not only objective but fundamentally subjective.  The mind/brain is comprised of objective and subjective qualities.  Subjective qualities, by definition, are concerned with the way things feel to us from the first-person perspective.  Whichever qualities are emphasized will differ according to the areas emphasized by different theorists.  Subjective qualities thus intrinsically admit a wider variety of approaches than objective qualities.

Theoretical perspectives among psychologists vary widely in direct proportion to the wide variability in perspective about subjectivity among individual theorists.  Different theorists have selected different aspects of subjective experience to explore, rendering differing ideas abut the nature and origin of complex mental problems.  Instead of examining something like depression through the lens of neurotransmitters and chemical re-uptake inhibitors, psychology examines depression through the lens of what it feels like to be a depressed person - the realm of the subjective.  Differing views of these subjective properties render different theoretical treatment orientations.  As long as there are differences between people, there will likely be different ways of understanding subjectivity. 

Footnotes:
[1] It should be noted that psychology is a large umbrella encompassing many branches.  Not all areas focus on the subjective.  Some areas focus on the more biologically-based aspects of brain functioning, including such branches as experimental psychology, neuropsychology, and neurobiology to name a few. 

“So where did we leave off last time?” a client recently asked at the start of the session.  Having just read my note from the previous session, I had a very good idea of where we left off.  I might have simply reminded him of our previous discussion, and we might have simply continued where we left off, seemingly making progress towards the goals of treatment.  The problem is that things are rarely so simple… 

People ask questions in therapy for all sorts of reasons.  The reason I might not simply answer a question in a straightforward manner is because I don’t regard the question as a straightforward event.  In fact, as a psychoanalyst, I don’t regard most of the problems my clients struggle with as “straightforward” problems.  We are complex and intelligent beings, and the things we say in treatment - even the questions we ask - are the medium through which our very complexity is communicated.  The conscious things we say are often motivated by unconscious thoughts and feelings we’re not aware of that need to be explored and better understood.  From a psychoanalytic perspective, to simply answer questions, without considering the greater context within which they are asked and the potential meanings they might contain, is to fail to appreciate the immense complexity of the person in our offices.  

​There are numerous potential reasons why someone might be asking, “Where did we leave off last time?”  For instance:  

All of these possible reasons are why it is imperative to be curious when a client asks a question.  Listening to and answering questions at face value often causes therapists to miss these underlying dynamics that then lay dormant only to surface in other ways.  A psychoanalyst tends to hear most questions as statements the person is making that need to be better understood.  When clients ask me where we left off last time, I often simply ask in reply: “Why do you ask?”  

​Back to my client at the beginning.  When I asked why he was now asking where we left off, he acknowledged he was hoping to “buy time” since he was unsure what to talk about.  I asked how it made him feel to not know what to talk about.  He explained it made him very anxious and eventually confessed he tried numerous other strategies of allaying the strong anxiety he felt in sessions.  We came to learn that his anxiety about speaking in sessions was very similar to his anxiety in social relationships and that he often superficially engaged in conversations with people that appeared meaningful.  It was only later that he felt relieved to be alone and by himself when he no longer had to perform.  This was how he had been feeling about talking in treatment, and we finally had the chance to discover its operation within our relationship - hiding in plain sight.  This launched us into a much more meaningful discussion concerning his anxiety in relationships and what he does to fill in spaces that protect him from anxiety but that ultimately insulate him further from feeling deeply connected to others.  

Whether or not a therapist answers questions should, by no means, be considered some kind of “rule” or index by which to evaluate a good from a bad therapist.  Additionally, many questions merit an answer.  Questions like, "what's your theoretical orientation?" is an example of an excellent question to ask your therapist (read more about this important question here). Not answering certain questions can not only represent a defense on the part of the therapist, but may also be unethical.  What I'm trying to illustrate instead is that there are many nuances contained in human interactions.  Mining these nuances for the precious data they contain is a hallmark of a psychoanalytic approach to treatment, and this can have a major impact on helping people live lives that are more meaningful, loving, and authentic.

Whether due to COVID fears, job loss, relationship conflicts, or the extreme political polarization dividing people from one another across the country, many people are turning to therapy as a place of solace. In addition to helping us feel less anxious and depressed, therapy has the potential for helping us make meaning out of our lives and discover lasting changes. In this post, I'd like to clarify what I believe to be the most helpful question to ask when looking for a therapist.

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​“What’s your specialty?” This is one of the most common questions people ask when trying to find a therapist, but it's also one of the least helpful.  Implied in this question is an assumption that a given problem has a given treatment, and finding a therapist with expertise in working with that problem will be the best way to find the best therapist.
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​In some areas of medical practice, this makes sense. If you’re having a problem like joint pain, you want to find a physician specializing in pain or joints (perhaps an orthopedic specialist, a rheumatologist, or a neurologist). This is because, in most areas of medicine, a given problem corresponds to a given treatment in a fairly straightforward manner.  Although there might be variations of joint pain, once the condition is properly diagnosed, the treatment options will be dictated largely by the diagnosis. This is because physicians who specialize in treating joint pain (whatever their sub-specialty) tend to share a common understanding of what defines the condition, what causes it, and how to treat it.  This is where psychological problems differ.
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Unlike most areas of medicine (which address physiological processes of the body), psychology addresses the operation of the mind. The mind has properties that differ from the body in important ways. Specifically, the mind is subjective in addition to being objective. Subjective domains of human experience are, by definition, more varied and expansive.  They include our experience of our bodies, but they comprise a number of other domains that are central to our human experience such as:

​These domains of subjectivity are much less conducive to the methods of investigation used to study other body-based medical conditions. As a result, the kinds of treatment approaches for psychological conditions are much more varied than in other areas of medicine. In place of the microscope, psychological phenomena require a kaleidoscopic lens, where each lens yields a very different image of the object under study. The different ways problems might be defined and conceptualized in psychology is what constitutes one's theoretical orientation.
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​This is the single most important question to ask your therapist. It has enormous implications for the type of treatment you will receive and offers a glimpse into your therapist’s way of thinking about mental life. When asking what is someone’s specialty, I suspect what a person is wanting to know is whether or not the therapist will be someone who can truly help them in ways that are effective, lasting, and personally meaningful. To know the answer to these questions, a different question must be posed to the therapist - one that will lend much more meaningful insight into how he or she thinks about problems, what constitutes health, and what you can hope to achieve as a result of beginning a healing relationship with this person.
Ultimately, discovering your therapist's theoretical orientation can lend much insight into who your therapist is as a person and how they manage the therapeutic relationship, which, as the research continues to demonstrate, is one of the most important variables impacting the success of any treatment. [1]
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As the coronavirus spreads across the world, it also spreads across our social media platforms, news apps, desktops, and TV screens.  We are each contending with a variety of difficult thoughts and feelings the virus arouses.  Whether or not we've been touched by the virus physiologically, there's a way we've all become infected by the virus in other ways.  I think there’s something we might learn from construing our relation to the virus as one of an “encounter.”  
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​I think "encounter" is the best way of considering our relation to the virus because it is not exclusive to any particular kind of impact, and it does not presume any particular emotional valence attached to our various experiences (e.g., fright, anger, panic, etc.).  I think there are three broad ways that might characterize the kinds of encounters we can have: 1) Looking Out, 2) Looking Up, and 3) Looking In.  ​I would describe these encounters as “movements” or “positions” of our psyche-in-relation-to-the-world at any given time.  They are like lenses through which we filter our experience of the world at any given moment.  They organize our perceptions, influence our feelings, and guide our actions.  In describing them as movements, I hope to convey the idea that they are dynamic, always in process, and subject to change.  I also mean to foreshadow what I believe to be a kind of “solution” to the anxiety and terror this pandemic can generate for many of us.

• ​​We pause thinking and dedicate our efforts to matters of survival. We find ourselves consumed by matters of survival and ask questions like: “What will happen if I, or someone I love, gets the coronavirus?”  “Will I lose my job?”  “How will our economy ever recover?”  We are suddenly running to buy more food, toilet paper, and bare essentials out of our panic to survive.  We are looking out for ourselves and our families to ensure our continued survival.  The benefit is that we survive; the liability is that we may not enjoy the life we have struggled so hard to preserve.

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• ​We look for opportunities contained in this outbreak in an effort to transcend it.  We wonder how this terrible event will bring new possibilities.  We ask ourselves questions like: “How can we make something good out of this tragedy?” or “Although it seems disastrous, what good things might be hidden in disguise by this virus?”  We look towards hope and possibility for comfort and search for hidden opportunities that are disguised by the tragedy.  There is intrinsic benefit to this hopeful stance, yet it becomes dangerous when it is overly idealistic as it risks keeping us from taking adaptive precautions.  At its extreme, it can become moralistic.  We can privilege hope and optimism at the expense of recognizing the reality of fear and terror surrounding the virus.​

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• ​We become philosophical, asking ourselves questions and attempting to make meaning of what we encounter.  We begin asking: “How might we understand the impact and meaning of this event?”  “What will the future of the world look like in response to this global pandemic?”  “What might this mean for me and/or my family and the ways we live our lives in the world?”  This option is beneficial in that it opens us up where things might have before felt constrained and closed.  (In many ways, this article might be understood as, itself, an expression of this encounter; however, I hope to be saying something more nuanced.)  Though opening and becoming curious are intrinsically valuable endeavors, the risk with this option is that it may be too intellectual and divorced from our bodies and experience of emotion.  We can become paralyzed to inaction by obsessive thinking and consideration.

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​​The crucial point I most want to emphasize is this: regardless of which position we are most inhabiting, we must strive to remain open to the full range of mental states we might inhabit in our experience of the coronavirus.  When any one position predominates, our capacity to even recognize the presence of alternatives dissolves and, with it, our peace within and with one another, our flexibility of thought, and our sanity.  

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​The coronavirus becomes an object of overwhelming fear and panic to the extent that it becomes the exclusive organizing narrative in our minds.  As we become bombarded by story after story of the coronavirus and its nebulous and mortal influence, it begins to calcify and setup like concrete.  If the essence of health is flexibility of thought – the capacity to stand between the spaces of various self-states (Bromberg, 1996) – the most threatening aspect of the coronavirus (as far as our mental health is concerned) is its tranquilizing effect on our capacity to flexibly inhabit a variety of alternative states of mind.  
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​Just as we are sheltering-in-place physically, there’s a way in which our minds can become sheltered in place.  And this kind of psychic sheltering-in-place is the antithesis of flexibility and multiplicity that constitute mental health and flourishing.  The dominance of the singular theme of the Coronavirus tranquilizes movement in our thought.  The virus becomes the way the world is instead of a temporary way aspects of our world have become in response to a complicated set of circumstances at this time and place in history.  We need to refurnish our internal world with the rest of the features that animate life to which we have selectively inattended in our preoccupation with the pandemic.  

​What might all of this mean on a more practical level?  I think it can mean different things for each of us.  It might mean that we need to appreciate other aspects of the world we live in right now: the quality of our relationships, the pursuit of our hobbies, enjoying our play activities, engaging our work.  We might need to enjoy our physical bodies and ground ourselves in appreciating the physical health we do enjoy in its many varieties.  We might need to re-examine our sense of spirituality, journal, fix up the house, clean, or bake a cake.  It might mean we need to recruit our collective memory in the service of contextualizing this pandemic according to other times our world has suffered from pestilence, tragedy, and economic instability.  We might need to remember that in the past other solutions have been found and other epochs of ailment have transpired and, finally, expired.  

​Whatever practical application we might employ must  be understood as, in some sense, an effort to keep the proverbial psychic "ball rolling."  Much like keeping our coughs from becoming dry, we must keep our internal chain oiled and the concrete from setting.  
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Bromberg, P.M. (1996). Standing in the Spaces: the multiplicity of self and the psychoanalytic relationship, Contemporary Psychoanalysis, 32, 509-535.

“Encounter”, Merriam-Webster Online, https://www.merriam-webster.com/dictionary/encounter, Accessed 15 April, 2020.
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Depending on the level of security of our original attachment relationships, we develop different styles of attachment that persist into our adult relationships [1]. Many of us came from families where our attachment was more secure. Our bids for attention were met with reliable responsiveness from a loving caregiver, and we continue to reap the benefits by establishing and maintaining relatively healthy adult relationships.

​For others, our attachment was more insecure. Acceptance and love was contingent on our behaving in particular ways, and our pleas for attention were either ignored or met inconsistently. Although we each likely experience aspects of ourselves all along the spectrum, the security of our attachment relationships may be characterized by 1 of 4 main attachment styles. Each attachment style has implications for the dynamics we find in our personalities. Keep in mind that each category below is a short summary and does not fully capture the full complexity, variation, and nuance we find in our day-to-day lives  [2]:
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Secure Attachment: Secure attachment is characterized by a healthy dependence on others for comfort and soothing. When these infants sought safety and reassurance from their parent in stressful circumstances, they were met with comfort and protection. Adults who are securely attached are free to explore, connect, and reflect on their experiences. They exhibit an ability to experience and express a full range of emotions, they see others as sources of comfort when upset, and they seek others for help when facing problems. They have an ability to experience both pleasurable and upsetting emotions without becoming unduly overwhelmed by either, and they retain the ability to reflect on their experiences of themselves (this is referred to as positive “reflective functioning”). Secure attachment thus represents the "healthy" category through which the other styles of attachment may be compared and contrasted.

Avoidant Attachment: Avoidant/dismissing attachment is characterized by the tendency to withdraw from connection, avoid closeness, and suppress attachment needs. When these infants expressed needs, they experienced their parent as consistently unavailable and formed relationship models shaped by unavailability, neglect, and rejection. Adults who are avoidantly attached are unable to experience healthy neediness and dependence since such emotions were met with neglect, silence, or discouragement from parents. Nothing they tried achieved the responsiveness they desired, so they learned to withdraw and “dismiss” their needs. By minimizing their needs, they learned to prevent the pain of disappointment. As adults, avoidantly attached people are often logical, more remote, and often dismiss and repress emotions of longing, affection, and neediness. They often take pride in their independence. When others desire closeness with them, they may feel threatened and withdraw, seeing others as overly needy and dependent. Although they too experience needs and feel things deeply, they tend to experience their own needs and emotions as flaws and liabilities, and may defend against awareness of these aspects in themselves for fear of being rejected or disappointed because of them.

Anxious Attachment: Anxious attachment is characterized by a fear of abandonment, a “preoccupation” with getting one’s needs met, and expressing needs in an overly emotional manner.  Because parents of these infants were inconsistent in their affection and responsiveness, ambivalently attached infants develop mental models in which they see others as inconsistent – sometimes their parent was responsive while at other times he or she was unresponsive or abandoning.  Since only their most dramatic displays of emotion evoked the recognition they desired, they learned their needs must be amplified in order to get a response.  Expressing their emotions loudly and frequently became the best way they could develop to ensure their needs would be met.  Preoccupied adults tend to have difficulty being alone and have difficulty achieving autonomy and independence in relationships.  Since they frequently exaggerate their emotions to obtain the responsiveness they once needed in the past, they now have difficulty identifying their actual emotions and discerning their preferences. Maintaining safety was so important, it precluded their capacity to know and discover themselves. As adults, they often struggle with a poor sense of identity, indecisiveness, and anxiety and depression. 

Disorganized Attachment: Disorganized attachment is characterized by confusion, chaos, and difficulty discerning reality at times. Parents of people with disorganized attachment were highly unreliable, absent, or dramatically inconsistent.  They were often both the sources of comfort and the sources of fear.  At times, these infants’ requests for comfort were met with loving kindness and responsiveness and at other times physical or sexual abuse – leaving the child unsure of what to expect.  Parents’ often contradictory responsiveness kept these infants in a state of constant arousal and prevented them from forming reliable expectations of the world. Adults with disorganized attachment often have a history of trauma, often feel confused, and can rapidly switch between different feeling states with little awareness of the transition.  When needs arise for people with disorganized attachment, they often fight, freeze, or dissociate in which they can feel disconnected from their body, have difficulty recalling significant portions of their lives, or re-experience in the present traumatic episodes from their past. Psychologically "splitting off" memory of traumatic experiences was a primary way of surviving for these individuals leaving them with discontinuous memories of the past and a disrupted sense of identity in the present.

​Many of the problems we experience have roots in these underlying attachment wounds.  As children, we repeat those behaviors that are met with affection and responsiveness and sacrifice those that are met with rejection or withdrawal to guarantee continued connection with our caregiver.  We learn that maintaining our vital connections to others requires that we sacrifice certain aspects of ourselves.  This sacrifice comes at a high price, however, and we can experience a variety of problems as a result of our restricted repertoire of behavior.  Below are some examples of the many ways our earlier attachment histories can lead to problems we are familiar with: 

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• We can develop a “false self.” [3] When we have exchanged what we truly want and need in order to maintain needed connections to important people in our lives, we can lose a sense of who we are, what we like, and what we want to do.  The self we present to the world becomes a false self, manufactured to maintain connection to others but divorced from our true wants and needs.  We may act overly “nice,” be overly accommodating, and dismiss our actual desires and preferences.  We may then feel empty and alone even when spending time with others.  Our hidden "true" self remains disconnected from the potential nourishment offered by relationship with others.

• Identity Problems.  When we give up our genuine desires, we don’t know who we are, what we want, what we like, and what we don’t like.  We become overly reliant on others’ opinions to gain a better sense of ourselves. This can leave us vulnerable to harm and manipulation by others. Being alone may be similarly intolerable since our sense of self remains so depleted. We can't afford to be discriminating about who we spend time with. 

• Depression & Low Self-Esteem.  Interacting with others from a false self keeps us from allowing our entire real selves to participate in our relationships.  We conclude the hidden parts of us are “bad” and begin to devalue and despise ourselves.  We unconsciously believe that if we are the ones to blame, our important relationships may be preserved.  Our self-blame and depression can even result in self-harm behaviors in which we deliver the punishment we feel we deserve.   

• Boundary Problems.  If our sense of stability is overly dependent on others, we will often sacrifice anything that threatens to disrupt these relationships.  Since setting boundaries and saying “no” to others can jeopardize these important connections, we can often find ourselves biting off more than we can chew and putting up with more than we should.  We can agree to do things to a degree that we are unable to sustain, leaving us depleted, exhausted, and more susceptible to illness, addictions, and more bad decisions. 

• Anger, Irritability, & Difficulty Trusting Others.  If we habitually sacrifice aspects of ourselves, we begin believing that others would reject us if they discovered who we really are.  We may develop anger and resentment in response to our anticipation of how others would perceive us were they to find out our true thoughts and feelings.  Pushing others away through our anger affords us a sense of control over being rejected and allows us to preserve the fantasy that we would be accepted if not for the angry rejecting behavior of our own making.

• Anxiety & Panic.  When our sense of worth and value is dependent on others’ responsiveness, we can become frightened by anything that threatens these important ties.  We can feel extreme panic and anxiety when confronting others whose diminished responsiveness or neglect has serious consequences on our sense of well-being.  We may be in a state of panic about losing our source of “emotional oxygen.” We may feel burdened to try harder to impress others and maintain their affection.

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• Addictive & Compulsive Behavior.  To cope with feelings of sadness, loneliness, anger, anxiety, fear, or shame, we can use substances or engage in excessive activities as a means of distraction.  We can reduce our pain by numbing our sensations, however, this only compounds our problems.  Drinking, dug use, or excessive activity can diminish the intensity of our feelings, but they often deplete us and push others away, leaving us feeling even more alone and susceptible to repeating these unhealthy behaviors. ​

​If we grew up with an insecure attachment, we are not destined to repeat our past.  Our attachment patterns may be modified and transformed resulting in the development of a different style of attachment called “Earned Secure Attachment.” [4] Individuals with earned secure attachment came from families in which they originally developed one of the three insecure attachment styles but modified their attachment patterns by developing relationships with securely attached individuals. 
 
The discovery that we may change our attachment style by developing new relationships with securely attached people has monumental implications for the possibility of transformation.  If we have an insecure attachment and begin the process of healing, we can begin choosing more securely attached individuals.  Our spouse or a close friend can become a new secure attachment figure where we can begin to work on changing our rooted relational patterns of attachment.  If we have an insecure attachment style, however, we tend to gravitate towards other insecurely attached people making it difficult to interrupt the vicious cycle of repetition.  Fortunately, there are other avenues for developing an earned secure attachment.
 
Psychotherapy provides an opportunity for repairing our attachment wounds.  By developing a deep relationship with a relatively securely attached therapist (or a therapist with an earned secure attachment), we have the opportunity to modify our own attachment patterns.  Our therapist’s attachment style can be transmitted to us in much the same ways a parent transmits attachment patterns to his or her child.  Our therapist can recognize hurts we have long dismissed, acknowledge our pain without abandoning us, and confront us gently to help us change in ways that are responsive to our needs.  He or she can notice nonverbal indications of our feelings, help us put words to experiences too frightening for us to talk about, and provide a sense of security and comfort when feeling threatened.  (See the "Most Important Question to Ask Your Therapist" blog post for how to choose a therapist since this is such an important factor in the possibility for genuine change in therapy).

Since it was within the context of relationships that we were hurt, it’s only within the context of a relationship where our painful patterns of relating may be modified if any hope for genuine change is to be realized.  A therapy relationship with a healthy therapist provides the right conditions for these new patterns of attachment to be coaxed back into existence and cultivated towards genuine transformation.  The next blog post will be exploring the kind of factors involved in making genuine transformational changes in therapy.

[1] Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. Monographs of the Society for Research in Child Development, 50(1-2), 66-104.

[2] Wallin, D.J. (2007). Attachment in Psychotherapy. New York: Guilford Press.

[3] Winnicott, D.W. (1965). Ego distortion in terms of true and false self. In D. W. Winnicott (Ed.), The maturational processes and the facilitating environment (pp. 140-152). London: Hogarth Press.
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[4] Main, M., & Goldwyn, R. (1984). Adult attachment scoring and classification system. Unpublished manuscript, University of California at Berkeley.