​This article is by Diane Poole Heller, Ph.D.,She is an established expert in the field of Adult Attachment Theory and Models, trauma resolution, and integrative healing techniques. She is a trainer, presenter, and speaker offering workshops, teleseminars and educational materials on Trauma, Attachment Models and their dynamics in childhood and adult relationships, as well as many other topics. Learn more at https://dianepooleheller.com


“As I travel and teach around the world, I feel we are experiencing a global epidemic of loneliness.” 


Once strongly tied together, families or marriages are now often fragmented, disconnected, or slowly growing farther apart. Love relationships seem to be dissolving faster than ever into divorce or separation. We all deserve to experience healthier, more resilient relationships. To do so, we need the skills, tools, and practices to heal our past wounds.


In practical terms, we may need to learn to “re-relate” into resiliency bonding versus trauma or wound bonding. Resiliency Bonding is a term I have devised to describe relationships that are based on our original design before it may have been disturbed. These relationships reflect secure, safe attachment within a Relational Field of mutual respect, appreciation of differences, acceptance of healthy interactions, and well-defined boundaries. They also include a mostly positive holding environment that allows an easy flow between aloneness and connectedness. 


My sincere hope is that relationships with our partners, spouses, parents, children, friends and colleagues can be more enjoyable, fun, sustainable, mature, rewarding and loving. I want us all to have this possibility and share it with our near and dear. 


We all grow up in a relational field with our original caregivers—a matrix of sorts that embodies the relational dynamics of the family and thus become “familiar” to us, as in “of the family.” These ingrained patterns may strongly influence how we see and feel in all of our later relationships. They create a “blueprint of expectations” of sorts, built out of our early encounters with others. When we are raised with secure attachment, we tend to find relationships are easier. We expect to be treated well and know that is what we deserve. We treat our partners with respect as well. We trust our partners and others realistically, and have Basic Trust in humanity and the world more or less unconditionally. Even when the chips are down, we still feel a basic optimism. 


We answer “Yes!” to Einstein’s famous question, “Is the Universe friendly?”


Those of us that are fortunate to begin life in secure attachment typically find it easier to connect, to commit when we find a good potential partner, and to maintain contact. We predominantly feel safe in our relationships and partnerships. We have a sense of humor and playfulness. We can disagree, have different styles, and still respect each other. We make enough pro-relationship choices that are win-wins for each person that our “coupledom” is preserved and rich. 


If the original bonding or attachment patterns were too painful, the residue of hurt often influences us from behind the scenes—without us even being aware of it. 


If attachment was impaired by too many disruptions in bonding with caregivers, we may later fear that our adult relationships will bring us the same pain. We may unconsciously or consciously react based on past experiences. We may project the past onto the present without realizing that it dooms us to relive our worst moments over and over again. 


“Though we may be in a present-day relationship, we expect to wake up in the living room of Mom and Dad.” 


There we “know” we will be confronted with the same controlling attitudes, criticisms, lack of presence or appropriate boundaries, manipulations, or other problems we may have experienced as a child as part of the familiar family scenario. We worry we will not be seen or met or that our very essential nature will be annihilated. 


Attachment patterns are so easily transmitted through the generations that it is the human condition to project the past onto our present. Because of this tendency, we may be blind to the love we actually have in our lives now. And if we cannot first sort out what belongs to the past and what is actually happening in the present, “It is possible that we cannot even believe OUR OWN STORY about what is happening in our current relationships.” 


We may be more in relationship with the old hurtful patterns from our history than in relationship with our partner or friends. 


“How can we change this destiny and live fully and freely in the present?” 


Attachment Styles: Secure Attachment 


Secure Attachment, as illuminated and defined in Dan Siegel’s book on Attachment Theory, The Developing Mind, is what we hope to encounter with our original parents. If we have not had this original experience of security, safety, and caring, we need to learn how to find our way back to it later in life. Fortunately, this can happen even after attachment disruptions have occurred in childhood. 


“Later we can ‘earn’ or ‘learn’ how to reorient to Secure Attachment through a healthy relationship of any kind—such as therapist, significant other or marriage partner, good friend or even a neighbor or doctor.” 


In childhood, Secure Attachment includes a “healthy holding environment” that occurs with “good enough” parents who are loving, responsive, and attuned. These caregivers are present, safe, available, and allow for the natural flow or rhythm between connection and aloneness. The child grows up and develops good boundaries, feels secure, has a sense of basic trust in others, and has a strong sense of integrated identity with self esteem intact. This is the kind of attachment I believe we are designed for. 


In secure attachment, adults join children in play. They know how to initiate and repair when misattunements happen. The parent-child dyad knows how to find harmony again. Parents can contain whatever the child is experiencing: from pain, anger, and frustration to joy, bliss, and expansion of the life force. 


“Secure Attachment is there waiting to be excavated from the mire and tar of past hurts. We can rediscover it because it is hard-wired as a ‘bonding blueprint’ into our psycho-physiology. We just need to ‘dust off the diamond’ of our true ‘in-light’- enment.” 


Mary Ainsworth calls this our primary attachment system. The good news? If we were not lucky enough to have had a “healthy holding environment” in the beginning, with the proper support, more often than not, we can find our way home to Secure Attachment later in life. This return to our innate design for health is the basic and predominant focus of my work. I want to help answer the important question, “How do we cross that bridge from any type of attachment disruption back to Secure Attachment and reap the rewards of enjoyment and connection from enduring, stable, fulfilling and loving relationships?” 


We are all social beings who need connection. We also need the alone time to connect deeply with ourselves and be in touch with the depth or our own being. We long for intimacy with others AND intimacy with self. 


Disrupted attachment styles cause us to have an imprint for pain, rather than consistent love, in our relationships—especially our dyadic partner relationships which pull on our attachment histories the most. These patterns are easily imported into our adult relationships consciously or unconsciously. Unresolved early attachment disruptions may wreak havoc later. They often run our relationships into the ground before we and our partners even know what hit us. 


When disruptions occur in our early years, the patterns get formed so quickly, and often occur pre-verbally and pre-cognitively. In this way, they become wired into our sensory motor awareness. For example, a child learns to block their kinesthetic and corresponding muscle movement to reach out if he or she experienced a lack of responsiveness to needs early on. She may later need to resurrect this latent or thwarted impulse. 


“I had a client who had recurring dreams of having their arms chopped off when needs arose for them, due to a history with a troubled parent where having needs was severely punished.” 


These examples reflect one reason why it is often crucial to include body-based therapies in healing early attachment wounds (along with emotional and cognitive work). The emerging body-oriented therapies help access and lay the groundwork for allowing the original sensory-motor patterns to eventually arise, complete, and prevail. Bringing our awareness back to secure attachment in the body as well as integrating the emotional cognitive self helps us to heal the old wounds more effectively. This healing frees us from repeating old, destructive patterns. 


Unfortunately, attachment disruptions are easily transmitted through the generations. Because this happens so naturally it is best to not focus on blaming our parents or our parents’ parents. Many of our parents did not have the opportunity to do therapy and did not know how to self-reflect about this important topic in their lifetime. 


“Blame would have to go back to the caveman and what is the point of that?” 


The culture and the time period deeply influence our experiences as well. Many of us have children of our own now and know how difficult parenting can be. But this is not about being perfect parents or perfect partners. 


According to John Gottman’s relationship research in The Seven Keys to Successful Marriage, having the empathetic attunement to realize there has been a break in the connection of a relationship and then initiating and/or receiving repair attempts to restore the connection in a more harmonious way is 80 percent of what gives relationships sustainability over long periods of time. 


The art of repair is one of the best predictors of longer, happier, healthy relationships. When people develop and practice their ability to repair, this capacity results in deeper intimacy and well-being in all of our relationships. Given its 80 percent chance of improving our connectedness, this skill is definitely worth investing some time and energy in. 


Of course, in all relationships, it helps to recognize that we all have unresolved history homework to do. This includes our partners and friends. Compassion for our own journey and the journeys of others is an invaluable key when exploring this tender territory. Often we need to unlearn attachment disruptions and relearn how to find our way back to Secure Attachment. How do we build and eventually cross this bridge back to Secure Attachment? If our original patterns were not healthy, we need to recognize them internally, heal the original wounding, and then practice specific exercises to help us learn Secure Attachment. 


When we do the hard work of discovering the dilemmas we carry within us from childhood, we become freer and more transparent to present-day reality. We can stop watching the same old recurring movie built out of the past that we continue to project onto our lives. 


When we cease calling on the “Central Casting of our Unconscious” that keeps us locked into passed down old patterns, we have the opportunity to replace those well-worn relationship blueprints with new designs. We are empowered to write new, fresh scenes to live by. 


For most of us, resolving early wounding is possible. I have gathered an array of effective Corrective Experiences that help heal specific attachment disruptions. 


Exercises include excavating the various elements of Secure Attachment, one by one to specifically target what may have been disturbed when we were younger. Examples include healing the attachment gaze by connecting to kind eyes, the welcome to the world exercise, and initiating bodily or emotional impulses, such as reaching out and trusting others, and several more beyond the scope of this article. 


Re-discovering Secure Attachment is NOT done solely through “wound tracking,” emotional catharsis, or talk therapy alone. As therapists, we need to realize how to evoke the original healthy impulses for Secure Attachment and bonding on an intrinsic level. This means healthy impulses arise naturally in the safe context of therapy or other “safe enough” relationships. We also need to be able to “presence” Secure Attachment ourselves to be effective. Most of us have a mix of disruption styles if we did not imprint a secure style first. Let’s look briefly at the most commonly described disruptions as noted in Dan Siegel’s The Developing Mind. 


Avoidant Attachment Style 


Avoidant attachment results when parents have been extremely unavailable, neglectful, absent, or outright hostile toward a child. This environment teaches the child to regard relationships as unfulfilling because they do not meet their natural needs. The child learns to avoid relationships in order to survive or to diminish pain. Adults with this history often diminish the importance of relationships and focus more on work or hobbies and avoid investing emotional energy in others beyond a superficial level. 


If the original “relationship restaurant” was terrible, adults adapt by minimizing the importance of all relationships and stop “eating out.” In the extreme, they stop looking for “contact nutrition” at all and go on a fast. 


Why keep going back to the same bad restaurant when it is usually closed for dinner, no one is waiting the tables, the food can be toxic, the music too loud, the environment blank, and the atmosphere rejecting? 


In Avoidant Attachment, a person adapts to such severe disappointment in relationships from poor bonding by no longer reaching out. They may avoid connection at all costs as it is associated with great pain of abandonment, lack of presence, or fear of rejection. Avoidantly-attached adults may “decide” they are loners and isolate by choice. They may feel that expressing few, if any, needs or dismissing support from others makes them better off, or even superior to, others who are in contact with emotions and real needs. However, this is usually a survival-based adaptation, made by default due to extreme early bonding deficits with caregivers. It’s not a conscious choice. 


Avoidantly-attached children, as they move into adulthood, overly rely on themselves and dismiss others as not important. As David Wallin points out in his excellent, clinically oriented book, Attachment in Psychotherapy, this dismissing stance enters into the therapist-client relationship, too. A client might say, “Oh, you are going on vacation for three weeks? No big deal. I don’t need you anyway. Therapy with you doesn’t do anything for me. I prefer to do it myself.” These statements may be—and usually are—far from the truth.


Let’s get down to the nitty-gritty of what helps us and our clients clinically. I suggest specific Corrective Experiences that can help break the grip of a wounded past and bring other people back into the Avoidantly-attached person’s life in nourishing ways. These Corrective Experiences include the Kind Eyes Exercise that involves a person looking out into the world into the kind, loving eyes of someone looking back at them. 


In this exercise, you imagine someone lighting up when they open their door and see you. You take that image and feel “into” your eyes and allow your eyes to reach out to that joy you see in the other person’s eyes. Sounds nice, right? But this exercise requires a tremendous amount of trust and the overcoming of intense fear as an Avoidantly-attached person takes the huge risk of “looking again” after years of blinding themselves to contact, especially in their eyes. 


When successful, this exercise helps to restore healthy contact and reduces the defenses and/or disconnection in the eyes. The disconnection or dissociation can become a pattern from meeting too much hostility or vacancy as a child. This exercise accesses the original attachment gaze and gives it support, and perhaps emotional limbic nourishment as well, and exposes the original wound. We work with the attachment gaze to give it time to heal, discharge emotion, over-arousal and the original distress. Often the eyes have stopped “seeing” in terms of actual contact. Safety in contact has to be restored to resurrect the possibility of deeper connection and for the client to literally see anew in a way based on the reality of today. 


Welcome to the World Exercise is another highly effective Corrective Experience exercise for repairing Avoidant attachment. In this exercise, clients create their version of a perfect, well-celebrated welcome of themselves as a unique being with very special contributions to make to the world. The fulfilling and “full-feeling” experience communicated by the therapist (or other) and received by the client (or person) is: “We are so glad you are here. We have been waiting for you. I celebrate you and your very existence. You have the birthright to exist. I want to be in real contact with you. I welcome you. You belong here. We want you here!” 


This Welcome to the World Corrective Experience helps clients regain the sense of their existence being celebrated. Instead of having one foot on the planet and one foot off—as if they have never committed to arriving here in the first place—they can land on their feet in a more connected, embodied, grounded way. Now the life force and brilliancy predominantly residing in their heads, including their often extraordinary intelligence, can more fully inhabit their physicality and beingness. 


Ambivalent or Anxious Attachment Style 


The “here today, gone tomorrow” Ambivalent Attachment type of bonding leads to continual frustration and relational insecurity. 


Even if, at times, the parents were authentically loving, unpredictable caregiving and emotional inconsistency may have manifested in a way that the person feels incapable of ever being truly loved or lovable. 


The following story may aptly illustrate part of how Anxious Attachment is installed as a bonding style. In the story, researchers put a pigeon in a cage with a little bar at one end to access food with its foot. At first, every time the pigeon hit the bar a pellet of food came out. For a little while, the pigeon keeps hitting the bar and eating pellets until it is no longer hungry or interested. The pigeon seems to forget about it and just explores the cage. The bird goes back once in a while when it’s hungry. 


Then the experimenters only change one thing—to have the pellets come irregularly (intermittent reward). The pigeon then becomes obsessive, continually hitting the bar (like many gamblers in Vegas at the slot machines). 


Researchers surmised that intermittent reward was a major cause of obsessive focus. To up the ante, they electrify the floor underneath the cage where the unpredictable pellets fall out. In order to hit the bar, the pigeon has to stand on the electrified floor. The pigeon does not choose to retreat to safety of the unelectrified side of the cage away from the bar. It chooses to keep pushing the bar to see when the next pellet will arrive—even when it is very painful to do so. 


I make this analogy to Anxious or Ambivalent Attachment where love from parents was, in fact, present (like the nutritional value of the pellets), but the child never knew when, why or where, or for how long until it would be gone again. This is a ”here today, gone tomorrow” parenting style. 


Ironically and understandably, it is often the case that the parents are distracted or preoccupied with their own unresolved relationships histories. 


The child cannot figure out what makes the relationship good or bad, so they are constantly trying to rearrange themselves to fit the parents’ changing moods and responses. Or they attempt to manipulate or control the parent to eke out the positive merging, support and/or love. 


The result is the child, and later the adult, becomes obsessively over-focused on the parent or external resources and severely under-focused on themselves. They become habitually unaware of internal sources of satisfaction and fulfillment. 


In adulthood this manifests as obsessive focus on the other in relationships—a bit like gambling. You keep investing more money in the game and never feel like you can win. They try to get the love they need but never feel it is enough. 


The Anxiously-attached child or adult can never relax in the relationship. Instead of parents helping with affect modulation, their inconsistent behavior disrupts it. Neither self-soothing nor feeling content in the interactive regulation with another feels satisfying in any kind of sustaining way. 


If they feel loved now, the question always arises, “What about tomorrow?” “Will it last?” “This is too good to be true.” There is the tremendous desire for loving connection entangled with the debilitating fear of losing it. 


Corrective Experiences for this attachment style include re-establishing a felt sense of consistency and the ability to receive love and caring when these essential qualities are actually present. “I want and yearn for love and connection but cannot have it.” The basic personal identity is formed around that idea —the“parent-patterned” experience that “I can want, but cannot have”. This can result in yet another dilemma that it is critical for the Anxiously-attached person to realize: 


If and when love actually presents itself, they often need to create distance themselves or dismiss the love in order to keep this original identification intact. They then create their own worst nightmare by never being available to receive the love they so actively seek because, paradoxically and predictably, it has to be rejected or deflected for self identity to remain intact. 


As therapists, we need to help our clients to see this pattern if it fits and to actively “disorient them towards health.” It entails restructuring the identity to regain its capacity to actually receive love. Healing Exercises include increasing one’s capacity to receive love and nurturing from others without dismissing it. As easy as it sounds on the surface, this is very challenging. The identity of the Anxiously-attached adult is literally based on “I can want, but I cannot have.” Or, “I cannot have without the uncontrollable and unpredictable loss that I am always anxiously awaiting and anticipating.” 


Another relevant exercise is to have the client look at all the ways people in their lives try to show them love. The Five Languages of Love is a good reference. Have the person see if they dismiss or minimalize others’ love for them. It is helpful to point out how painful it may be for their partners or friends to have the love they offer deflected. I had that happen in my own life when my partner said how much he loved me and how much it hurt him that I could not seem to take it in. 


I initially felt insulted and was certain that he was wrong—until I took an honest look at myself and realized I did not feel deserving of love, and was determined to believe that his love could not be true. 


Let me share another example of how painful this can be for an Anxiously-attached individual. I once had a friend share with me that when her boyfriend would turn over in his sleep away from her she would experience a terrible sense of abandonment and a severe sense of loss. She would lie in bed weeping even although she knew cognitively that he was simply turning in his sleep and not really leaving her. 


It seems that this turning away was enough of a trigger to re-stimulate the intermittent reward patterning of the “here today, gone tomorrow” style of loving from unpredictable parents. This causes the child to be stressed while searching to attach to a moving target, never knowing when the rug will be pulled out from under them—even when the love was real and present for them because they could lose the love at any moment and not understand why. Instead of the parent’s interactions with the child increasing self or interactive regulation, the inconsistency actually increases the relational distress. This terrible unpredictability sets up a hyper-awareness of the “other,” and an over-focus on looking for need satisfaction, nurturing, or external love. 


Because of this pattern, the Anxiously-attached person remains anxious because they lose contact with themselves, in fact abandon themselves, and then try to get themselves back from other people. The obvious trouble lies in the fact that you can’t get yourself back from others. You get yourself back by learning to recognize or develop your sense of self and to stay connected to yourself in the first place—when alone and in the presence of others. You include yourself in the relational field rather than all of your attention flowing out into the other. 


Anxiously-attached persons want interactive regulation and affect modulation with others and prefer not, or lack the capacity, to self soothe or self-regulate. Avoidantly-attached persons prefer the opposite. In Secure Attachment both can return to having self regulation as well as interactive regulation and affect modulation in a harmonious way. This opens many more options for well-being. 


Another exercise teaches clients how to stay connected to their inner self with greater ease as they learn to keep their sense of self intact when in the presence of others. This requires developing a dual awareness: one that does not eliminate the self but includes the other in the relational field without using manipulation. 


Another paradox is that once you abandon yourself for another, you are in double trouble. When you leave YOU, you are, by definition, disconnected and abandoned. And in abandoning yourself, where are you going to go? 


You can’t, in reality, leave yourself! REALLY, where are you going to go? 


Until we learn to stay connected to ourselves in the presence of others we are doomed to be and feel abandoned. We must recognize this pattern as an internalized map that came from early bonding deficits and repair connection to self and redefine connection to others so we do not continue to see the partner or other as the Source. 


It is a perceptual trick. Once you learn to stay connected to your inner core, you will naturally find it a stable, consistent source of nourishment and fulfillment, as well as finding contact nutrition from relationships outside of the self. 


Disorganized Attachment Style 


Disorganized Attachment can result when a parent is terrifying or overly chaotic. The relationships were so overwhelmingly scary, painful, harmful that the child had no safe holding environment in which to process or cope with this terror and pain. With the original caregivers, there was regular, devastating disruption of the attachment system without the relief of a safe haven. Because of this extreme situation, ANS regulation and Affect Modulation are severely interrupted, thus leaving the child with multiple incoherent models of the self, the other, and the relationship between them. In place of a coherent well integrated sense of self, fragmentation rules. 


The main difficulty in addressing Disorganized Attachment clinically is in the major double bind of conflict between two of our major human pyscho-biological drives, 1) the deep need to attach to a safe attachment figure and 2) the strong need to survive. 


Later, adults with the disorganized attachment style become very afraid when they begin to feel close or intimate because closeness is over-associated with fear of the original parents who could not be trusted. They become stuck and mired in an approach avoidance pattern. For the person to feel safe enough to stay in the relationship and enjoy it in a relaxed and nourishing way, the need for connection and fear for survival must get untangled. 


A Corrective Experience may include the Installation of a Competent Protector to establish the essential quality of safety missing as resource. Ideally parents model protective sensitivities toward their offspring as most animal species are biologically designed to do. A rabbit runs from predators such as coyotes, fox, hawks, snakes etc., but once it returns safely to the rabbit hole she lavishes her affection on her young. Snuggling happens—not attack from one’s own species. 


However, when children are terrified by one or both of their parents, it does not make sense biologically, psychologically, or soulfully. This terror disorganizes the attachment system, designed to operate and facilitate deep bonding in the environment of relative safety. 


The need to attach is so strong that we are said to bond with any caregiver no matter what their actual behavior—even if life-threatening. This may require the child to literally override his or her own survival system or warning signals to allow them to walk into danger instead of running away from it or risking fighting back. They must be provided clarity in communication to override the original double messages presented to them by parents or caregivers. The attachment system must have a safe place to land, usually in relationships outside of the family. 


This can be done in the safe context of therapy, where the defensive responses for self-protection (fight or flight) can be re-directed toward the original threat of one of both of the parents. 


Allan Schore’s synthesis of research finds that the best modalities for healing attachment wounds include body-based therapies. In other words, the body needs to feel the return of safe Secure Attachment in a deeply physical way—as well as emotionally—so that the new corrective experiences of healthy relating can eventually override the original negative wounding. 


The challenge is that attachment patterning happens so early, beginning in the womb. We need to develop skills to work pre-verbally, nonconceptually, within bottom-up processing for most of the session. But we also use top-down processing, to educate and help integrate the healing at the end of the session. What we need to appreciate with our clients and our relationship partners is that much of our current adult behavior can be considered a reflex from our early attachment patterning. We need to learn how to develop skills to function as securely attached adults (as partners and therapists) even if we had insecure attachment in childhood. 


Somatic Experiencing® (SE) developed by Peter Levine and the Dynamic Attachment Repatterning experience (DARe) that I have developed over the past seven years are two such therapies. I believe that our original design is organized for Secure, safe attachment and that our bodies and brains can rediscover how to embody and live from this foundation. 


We can then integrate this felt sense emotionally and cognitively. 


This heals the scars and dysregulating impressions of the past left in our brain, autonomic nervous system, and attachment system. 


My biggest passion in teaching is to help clients become “unimpressed” by the disturbing elements of their history. They literally discharge the hurtful emotions and fear from the body and brain so that they can risk opening to themselves and others again. 


I believe our birthright is to give and receive love open-heartedly, and derive deep satisfaction, fulfillment, and nourishment from nurturing healthy relationships. 


We can return to a state of pure transparent beingness—our deep nature and true authentic self—from where we can be truly intimate with ourselves and share intimately with others.


This is our greatest gift to ourselves and to everyone else. It takes great courage to really “show up”. I believe that, in most cases, we can heal in the context of a corrective securely attached relationship in our lives at any time, with anyone, or directly from the “universal field of being” that holds the archetype for all that is true for us as spiritual essential beings. 


We are naturally social beings and need a strong relationship both to ourselves and to others. On an Essential level, we have all that we need in just Being. Part of our fulfillment comes from sharing our “beingness” with others. We need our alone time as well, some more than others. Secure Attachment allows for an easy transition between connection and aloneness. 

It is this balance of the inner and outer would that gives us wholeness. 

This is the journey home to secure attachment. 

For more information about Diane and her upcoming teaching schedule and training DVDs please visit dianepooleheller.com
Copyright 2019 Dr. Diane Poole Heller   
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​by Aline LaPierre, MFT, SEP, PsyD 

Five arguments in favor of the use of touch in therapy

There is a widespread belief in the psychological community that the use of touch in psychotherapy is illegal. The “taboo” against the use of touch was established long ago. This prohibition, which still persists today, prevents touch from being accepted as a valuable psychotherapeutic approach.

Here, I evaluate five common questions I have encountered in my years of teaching the therapeutic use of touch:
1. Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?
2. Does touch gratify a client’s manipulative needs?
3. Can touch lead to transference and countertransference problems?
4. Is touching clients a slippery slope to sexual transgression?
5. Shouldn’t touch be reserved for family and social interactions?

Does Touching Clients Serve Or Hinder The Goals of Psychotherapy?

Current developmental research validates the use of touch as an important, if not essential, therapeutic intervention. There is now solid research indicating that critical levels of attuned touch are important for normal brain maturation and for socioemotional and cognitive development. Given that the primary importance of attachment is widely accepted, and that neuroscience provides evidence of the body’s critical role in development, the time is ripe to examine the vital contributions of touch and bodywork in the repair of relational and emotional trauma.

Argument #1

Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?

Psychoanalytic tradition asserts that using touch to satisfy a patient’s desire for the missing comfort of the mother fosters a clinging infantile dependency, and serves as a stimulant for Oedipal fantasies.

Counter-Argument

Touch is a fundamental mode of human connection in the infant–mother relationship. In order for mother and child to relax into breastfeeding and reciprocal gazing, a baby must be securely supported in its mother’s arms. Secure holding underlies a baby’s feeding and gazing connection.

Adults who seek psychotherapy have generally experienced some form of abandonment, abuse, or neglect in early life, and often report never having had the experience of being securely held in a way that allowed them to yield into trusting support. I am reminded of a client who insisted on lying down during his sessions, yet kept lifting his head to look around. His neck soon tired, and he could barely continue to lift it. Finally, he uttered the words: “Is anybody coming?” and burst into tears. He remembered lying in his crib for hours, waiting for his mother, who never came. He finally had given up hope that she would ever come, and had fallen into a collapse that became his basic stance in life: “No use trying; it won’t happen.” For this client, being touched was an immense relief. The experience of having someone hold his weary neck and tend to his preverbal needs was transformative. He was able to release the long-held pattern of hopelessness, and open to the gratifying sensations of supportive presence. As our somatic work progressed, he reclaimed his desire to live.

On an analyst’s couch, patients face away from the analyst, away from relational contact. This helps patients focus on their inner process, and leads to insight and growing maturity. But in cases of early relational trauma, the lack of contact can exacerbate the isolation of clients who yearn for connection, or who have not experienced satisfying nurturing relationships. Abused and neglected individuals have never had the experience British pediatrician and psychoanalyst Donald Winnicott called "going on being" — the secure holding within which a baby can be fully absorbed in the intense work of its development.
Avoiding touch contact can repeat the physical neglect or rejection undergone by a client as a child. The touch taboo can rob patients of effective, perhaps critical, ways to fulfill primary needs that were never met. Early traumatized clients need neurological repatterning experiences in addition to reworking the cognitive and emotional aspects of their relational traumas. A physically close, but nonsexual, nonviolent, non-abusive, nurturing, comforting, and affect-regulating touch experience can help clients (and their nervous systems) move through the painful early deficits that often continue to bring suffering in their adult relationships.

Avoiding safe, nurturing touch
is a cruel re-creation of the original relational trauma,
a repeat of the experience of physical neglect or rejection
undergone by an individual as a child.

Argument #2

Does touch gratify a client’s manipulative needs?

It is argued that while some patients are genuinely in need of the reparative contact denied in childhood, others will use contact to avoid self-awareness, and sidestep facing painful feelings.

Counter-Argument

Psychotherapists are trained to address manipulations and enactments, and a client’s manipulative strategies are not reserved to the arena of touch alone. The fear that gratification leads to avoidance or entitlement is a residue of childrearing techniques handed down from past generations, which were mostly concerned with shaming children into becoming compliant, obedient citizens.

If the findings of Harry Harlow on the innate need for touch in baby monkeys can be extended to human beings, it should be expected that the need to be touched would arise in the therapy of clients with attachment trauma who were touch deprived. It is detrimental to the nervous system and unfulfilled early need for connection to have clients relive painful memories of “wire-mesh mothers” or “cloth mothers” without offering somatic repair. Client manipulations are a sign that basic needs have been denied, and withholding touch may repeat the original missing experience. In order to avoid painful feelings of misattunement and neglect in their therapy, there is a high likelihood that traumatized clients may depersonalize their therapist and the therapeutic relationship.

It can therefore be argued that avoiding contact is a cruel re-creation of the original relational trauma — a repeat of the experience of physical neglect or rejection undergone in infancy. Caring touch that offers gentle support may, in fact, lay the foundation that helps patients deepen their capacity for self-exploration.

The psychotherapeutic use of touch encourages the preverbal self to be cognized, and brings about a strengthening of the body ego. Far from creating dependency, touch sets the separation-individuation process in motion:
Holding and rocking allows unconscious, preverbal healing to occur. Bodily feelings arising during touching can be profoundly self-communicative, self-informing. They bridge preverbal gulfs, integrating and resolving old emotional-bodily confusions and conflicts. It is as if, in the containing hands of the manual practitioner, the body-self understands itself a little more and can relax and grow in such understanding. (Bevis, 1999)

Argument #3

Can touch lead to transference and countertransference problems and block the expression of hostile feelings?

Psychoanalysis and traditional psychodynamic models maintain that touching patients violates the therapist’s neutrality and negatively intrudes on the therapeutic process. It is argued that, when working with primitive mental states, touch can hinder and contaminate the transference by: a) blocking the expression of hostile feelings, b) triggering the need to protect personal boundaries, and c) foreclosing free association. Additionally, in cases where transference involves the enactment of an abusive past, touch can rekindle a patient’s powerlessness in the face of violation, and trigger unaddressed issues of power differentials and microaggressions. Touch, it is therefore argued, is more than likely to lead to transference and countertransference problems.

Counter-Argument

Although these concerns are valid and important, they are also one-sided arguments that reveal a lack of knowledge about the psychotherapeutic use of touch. Why would the avoidance of touch not be equally contaminating to the transference?

A somatically-trained psychotherapist is aware of situations when touch is contraindicated. In cases where the transference involves the enactment of an abusive past, touch is used with great care, if at all. If the body has been violated, it is acknowledged so that if, and when touch interventions are chosen by therapist and client, they offer a reparative experience that does not rekindle the powerlessness of the original violation. Some types of touch and movement, such as grasping or pushing away, are intended to help clients externalize hostile aggression and assertively express re-owning their integrity.

Supportive touch that elicits trust and safety can give deprived clients a caring, comforting, affect-regulating, yet nonsexual, nonviolent, and non-abusive experience that helps the body, brain, and nervous system learn to receive nurturing. Touch encourages the nonverbal self to become known, and bodily memories that arise during a touch session are profoundly self-informing. Being held and nurtured allows healing to access unconscious preverbal experience that would not otherwise be reached. In the containing hands of the somatic psychotherapist, the body-self understands itself a little more and learns to overcome the debilitating effects of overwhelming traumatic triggers.

Argument #4

Is touching clients a slippery slope to sexual transgressions?

It is a major concern to those who mistrust the use of touch that it may be interpreted by a client as an invitation to intimate contact, and lead to sexual acting out. When exploring physical, sexual, and emotional abuse, some patients might experience the therapeutic use of touch that is meant to be empathic and compassionate as an invasion of personal space, or an expression of covert aggression.

It is also argued that since abusive, violating touch is used to enforce power, establish dominance, and maintain control, therapists could fall into the trap of using touch to dominate or manipulate clients — especially in situations where male therapists are working with female clients.

Counter-Argument

Psychotherapists are trained to sustain boundaried emotional intimacy in the therapeutic relationship. One may therefore wonder why the profession has such a fear that touch, more than any other intervention, would easily sweep away the professionalism of a trained psychotherapist. Because abused individuals often do not have access to their capacity to set boundaries, the issue of boundary breach is a serious therapeutic concern to the somatic therapist. It is not, however a reason to foreclose on using touch interventions.

Therapists who use touch interventions learn to track the subtleties of biological communication. The therapeutic use of touch, like any modality, requires professional training and emphasizes the development of personal somatic self-awareness on the part of the therapist. Those who see touch as dangerous do not understand the profound respect for the intelligence of the body that somatic training inspires in its practitioners. It is the therapist who is not trained in somatic techniques and body psychotherapy who is at higher risk of transgressions.

When exploring issues of physical, sexual, and emotional abuse, a somatically-trained therapist is aware that touch can trigger experiences of personal boundary breach that could shut down a client’s capacity to trust the therapeutic process. The touch taboo speaks to the violation of boundaries, and untold suffering caused by sexual and physical abuse. These tragic touch dysfunctions bring mistrust to the use of touch as a therapeutic intervention. Unfortunately, they also foreclose on the deep yearning and disappointment that neglect and the lack of loving touch leave in client lives.

Few of us have been touched in aware and attuned ways.
Our fears about touch reveal the pervasive dysfunctions of touch
that bring therapists to mistrust it as a therapeutic intervention.

Most body-centered disciplines, such as medicine, surgery, chiropractic, nursing, bodywork, and physical therapy, use some form of touch for which practitioners are professionally trained. Each of these disciplines has a code of ethics to safeguard the patient and ensure the practitioner’s professionalism. The ethical criteria for the use of touch in psychotherapy follow similar guidelines to those in other health professions:

• Professional training in the modality employed
• Proficiency in using the chosen techniques
• Obtaining client-informed consent
• Attunement to the client's therapeutic issues and needs, and maintaining open communication
• Confidence in the choice of the therapeutic intervention

Argument #5

Should touch be reserved for family and social interactions?

This argument holds that touching is a natural expression of emotional connection, and should therefore be reserved for family and social interactions such as handshakes to express friendship, a touch on the shoulder for empathy, or a congratulatory hug to express joy.

Counter-Argument

Avoiding touch can have the effect of perpetuating the belief that psychological issues do not concern the body, thereby reinforcing the split between psychological and somatic dimensions. Avoiding touch maintains the impression that psychological issues are more important than bodily experience.

The therapeutic use of touch and bodywork connects the cognitive self with its biological intelligence to help clients understand how thoughts, emotions, and sensations work as a unified whole. The therapeutic use of touch is an implicit language that directly addresses and integrates nonverbal physiological needs with psychodynamic awareness. Like attachment parenting, it puts a premium on giving individuals what they need to grow their capacity to be strong, independent, and loving.

In Conclusion

The following words by Bessel van der Kolk encapsulate the healing needs of the early traumatized self:
"How do you quiet down the frightened animal inside of you? The answer to that is probably in the same way that you quiet down babies. You quiet them by holding and touching them, by being very much in tune with them, by feeding and rocking them, and by very gradual exposure to trying new things."

References available on request: [email protected]

Dr. Aline LaPierre, PsyD, MFT, SEP is the founder and director of The NeuroAffective Touch® Institute which offers trainings in the therapeutic use of touch. She is past faculty in the Somatic Doctoral Program, Santa Barbara Graduate Institute (2000-2010). Aline is the coauthor of Healing Developmental Trauma: How Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship now available in ten languages. She is currently Vice-President of the United States Association for Body Psychotherapy (USABP) and Deputy Editor of the International Body Psychotherapy Journal (IBPJ). 

NeuroAffective Touch® (NATouch™) is a neurologically informed psychotherapy that uses somatic psychology, touch, and body-centered approaches as vital psychobiological interventions.​

​Complex PTSD is Now Recognized!
​
In June 2018, nearly 40 years after the APA controversially yet officially recognized Post-Traumatic Stress Disorder (PTSD) as a mental disorder that required clinical treatment, the World Health Organization released the ICD-11 including a new diagnosis: Complex Post-Traumatic Stress Disorder (C-PTSD).


This diagnosis has the potential to completely revolutionize the world of mental health.


Understanding the long-term impact of unresolved early trauma is indeed a world health issue. Attachment, relational and developmental trauma – which crosses all cultures, religions and communities – impacts the neurobiological development of children and creates life-long patterns of disorganization within the body, mind and relationships. Perhaps a greater understanding of Complex Trauma can help us understand the underlying causes of the disorders our clients are struggling with, in addition to the increasing social challenges like substance abuse, systemic injustice and violence. A trauma-responsive perspective brings great hope.


While PTSD evolved the field of psychology in a major way nearly 40 years ago, those of us that have worked in this field know that there are limitations to the diagnosis and the treatments addressing it. C-PTSD helps us evolve our understanding of trauma. Now that C-PSTD has been officially recognized, the next step is to finding treatments that are specifically geared to addressing Complex Trauma.


Many of us have experienced frustration with clients dealing with complex trauma due to their lack of progress in therapy, as well as those clients who make good progress only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair. These are usually the clients that therapists bring to consultation.


The question we as NARM consultants get asked repeatedly – how can I most effectively help my client?


To answer this, let’s revisit The ACEs Study (Adverse Childhood Experiences). The ACEs Study has a fascinating origin. Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out. This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals. He created a questionnaire to understand this phenomenon and discovered that a majority of those that dropped-out had experienced childhood trauma. Thus began the monumental research project we now refer to as the ACEs Study.


One fascinating aspect here is the underlying mechanism of self-sabotage. One would think that the closer a participant got to their goals the more motivated they would be to complete their program. But whether it’s weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.


We are now unwinding this puzzle through recognizing the “survival” function of shame and self-hatred. As young children, everything revolves around staying connected to our caregivers via attachment – this is essential for our basic survival and well-being. When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened. A child is unable to experience themselves as being a good person in a bad situation. Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival. A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and/or environment.


One of the things we have observed in consulting many somatic-oriented therapists internationally is that despite very effective and powerful somatic work, therapeutic process still gets thwarted without recognizing and working directly with the survival-based developmental strategies. Clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways. Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being. That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.


So what does this have to do with somatic therapy? What happens when a client is moving toward greater embodiment, self-regulation and empowerment (“bottom-up”), but we fail to recognize the underlying shame-based wounds that have led to the dysfunctional strategies, behaviors and symptoms? Or for traditional, talk-based therapists, what happens when we work with the psychodynamics of shame, self-hatred and self-sabotage (“top-down”) without shifting the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors? And, what happens when we are working with early attachment wounds and don’t recognize our own countertransference (our own unresolved trauma patterns and triggers) and how this impacts the therapeutic process?


The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with the unresolved wounds and patterns leftover from early trauma. This integrated “top-down” (psychodynamic-based) and “bottom-up” (somatic-based) approach works with the psychobiological patterns of shame and self-hatred within a deeply mindful, relational context. With a framework that identifies the developmental wounds from early trauma, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives. Freedom from childhood trauma is possible.


While research on this is still in its infancy, we at the NARM Training Institute are buoyed by clinical reports and early research demonstrating how effective the NeuroAffective Relational Model (NARM) is in resolving attachment, relational and developmental trauma. We have trained thousands of mental health clinicians throughout North America and Europe, and are rapidly expanding our NARM training programs throughout the world and online.


If you have clients that are struggling from unresolved early trauma and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.


To learn more about this revolutionary method to treat this paradigm-shifting diagnosis, please visit our website at: www.narmtraining.com.