Reality Matters: Attachment, the Real Relationship, and Change in Psychotherapy

By Duquette, Patrice | American Journal of Psychotherapy, April 1, 2010 | Go to article overview

Reality Matters: Attachment, the Real Relationship, and Change in Psychotherapy


Duquette, Patrice, American Journal of Psychotherapy


Early attachment relationships and their inherent emotional regulation formatively effect psychoneurobiologic development. Implicitly learned relational interactions begin within the context of such relationships, and as habitual responses to strong emotions, such as fear, ultimately define character. The psychotherapeutic attachment relationship can positively affect change in developmental processes compromised in earlier relationships, influencing character change. The early attachment relationship is evaluated for features that become relevant as the therapeutic attachment relationship and real relationship-the realistic and genuine elements of the therapeutic relationship, affect psychoneurobiologic change in the patient. This paper asserts that the real relationship deepens therapeutic attachment relationships, improves emotional regulation processes, and stimulates further development of processes such as mentalization. Current research studies are considered regarding areas of the brain potentially affected in psychotherapeutic processes.

KEYWORDS: real relationship; attachment; mentalization; emotional regulation; psychotherapy; character; character change

I don't go to therapy to find out if I'm a freak

I go and I find the one and only answer every week

And it's just me and all the memories to follow

Down any course that fits within a fifty minute hour

And we fathom all the mysteries, explicit and inherent

When I hit a rut, she says to try the other parent

And she's so kind, I think she wants to tell me something,

But she knows that it's much better if I get it for myself. . .

"What do you hear in these sounds?"

- lyrics by Dar Williams

INTRODUCTION

Within the context of early attachment relationships, infants develop characteristic ways of relating to their internal world and the external world. Gaining the ability to interactively regulate their emotions with another, and then self-regulate their emotional experience, are initial steps in a long process of psychoneurobiologic development. The ability to separate internal and external experience, discern reality, and think, will follow. Research during the last few decades has shown that the attachment relationship is paramount as the infant, deeply affected by powerful emotional stimuli such as fear, develops habitual physiological and neural responses and ultimately, behavioral responses to the world (Bowlby, 1988; Schore 1994; Siegel, 1999; Cozolino, 2006). The infant's developing brain and physiology are compromised to the extent that there is difficulty in the attachment relationship. Patients seek psychotherapy in the midst of a crisis due to the lasting effects of this compromised state as expressed in their character and relationships. In the process of psychotherapy, effective work must alter characteristic patterns of relating that have become maladaptive in adulthood, affecting change at the level of the brain (Bar-Levav, 1988; Siegel, 1999; Cozolino, 2002; Wallin, 2007).

In the interest of psychoneurobiologic change, the work of the therapist is to facilitate a therapeutic attachment relationship, furthering the processes of development that have stalled earlier in the adult patient's life. This basic therapeutic task, it is proposed, cuts across theoretical orientations. With this goal in mind, an important aspect of the therapeutic process is the real relationship. The real relationship is the reality-oriented element of a functional therapeutic relationship (Greenson, 1967; Viederman, 1991; Morgan, Brunshweiler-Stern, Harrison, Lyons-Ruth, Nahum, Sander, Stern, & Tronick, 1998; Couch, 1999; Gelso & Hayes, 1999; Gelso, 2009), and it serves as an orienting wedge between past experience and current reality. If it is anchored well, by a self-aware and realityoriented other, the real relationship can be a driving force in the process of changing the brain, resulting in improved affect regulation and greater access to higher mentalization processes. …

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