Attachment and Adult Love

Emotionally Focused Couples Therapy (EFT-C) is based on a new paradigm for understanding adult love relationships. The premise is basically this: humans have the need for secure attachment relationships across the life span not just in infancy and early childhood. This claim was not widely accepted a few decades ago, but is now enjoying a strong evidence base, which is likely to radically reshape the direction of couple and family therapy in the 21st century (Furrow & Bradley, 2011). This, dear reader, is big news. So you may want to pull out a highlighter for this section.

Bowlby’s (1988) attachment research with human and primate infants established the physiological, emotional, and survival need for a safe, nurturing relationship between caregiver and child and has long been accepted in the human sciences. However, it was commonly believed that this need dissipated with time, and that adults could theoretically be psychological and physically healthy without such a secure relationship. Current medical research not only supports the claim that secure attachment affects physical health, but specific correlations have been identified: avoidant attachment styles are correlated with pain-related complaints, and anxious attachment styles with cardiovascular conditions, yet secure attachment was not correlated with any specific health condition (McWilliams, & Bailey, 2010). Insecure attachment has long been correlated with higher rates of psychopathology. Additional research has shown that securely attached adults are better able to withstand physical pain than those with insecure attachment styles (Meredith, Strong, & Feeney, 2006). Neurological research suggests that humans need secure relationships in order to emotionally self-regulate (Siegel, 2010).

Sue Johnson’s work has been on the vanguard of the application of adult attachment theory to therapy, offering the most comprehensive approach for helping couples develop secure attachments in their intimate relationships. The theory of adult attachment helps explain much of the puzzling behavior related to intimate couple and family relationships: How come humans so often treat poorly those they claim to love the most? The problem is that humans are trapped in a paradox when tension arises in attachment relationships: the other person is both the primary source of comfort and safety and—during conflict—the most threatening danger (Johnson, 2008). This paradox goes a long way in explaining much of the extreme behavior that therapists often see in couple and family relationships.

Using Bowlby’s (1988) theory of attachment to conceptualize adult love, Johnson (2004) identifies 10 tenets of this theory, which I paraphrase below (pp. 25–32).

1. Attachment Is an Innate Motivating Force: The desire to be connected to others is an intrinsic physiological need of all humans. This implies that a therapist’s work is not done with any client until the client has at least one secure relationship in his or her life.
2. Secure Dependence Complements Autonomy: Neither complete independence nor overdependence is possible, only effective or ineffective dependency. Thus, in therapy, the therapist’s goal is to help clients develop an effective dependency (or interdependency, if you prefer) with significant persons in their lives.
3. Attachment Offers an Essential Safe Haven: Secure attachment provides a buffer against the stresses of life and measurably reduces their psychological and physiological effects.
4. Attachment Offers a Secure Base: Just like young children, adults also need a secure base to enable them to feel free to experience exploration, innovation, and openness, which are all correlated with positive psychological health and growth.
5. Emotional Accessibility and Responsiveness Build Bonds: Secure attachment is established by being emotionally accessible and responsive, and thus, this is the focus of the working phase of EFT.
6. Fear and Uncertainty Activate Attachment Needs: When threatened, a person experiences an unusually strong emotional need for comfort and connection; it is this need that fuels the destructive patterns too often observed in couples and families.
7. The Process of Separation Distress Is Predictable: If attachment needs are not met, the person experiences predictable responses of anger, clinging, depression, and despair. This distress is experienced as a primal survival need, thus helping to explain—but not justify—the often extreme and cruel acts committed in the name of love.
8. There Are a Finite Number of Insecure Attachment Styles: When a secure relationship no longer feels secure, a person will use one of these three typical patterns to defend him- or herself against the trauma of having a secure relationship threatened.

• Anxious and Hyperactivated: When needs are not met, the person becomes anxious, relentlessly pursues connection, and may become clingy, aggressive, blaming, and/or critical.
• Avoidance: When needs are not met, the person suppresses attachment needs and instead emotionally and physically withdraws, often focusing on unrelated tasks or other distractions.
• Combination Anxious and Avoidant: In this style, the person pursues closeness and then avoids it once offered.

9. Attachment Involves Working Models of Self and Other: People use the quality of attachments to define themselves and others as lovable, worthy, and competent and develop internal models about what can be expected and how to engage in attachment relationships.
10. Isolation and Loss Are Inherently Traumatizing: Isolation and loss of connection are inherently traumatic experiences that can trigger a panicked survival responses. Solitary confinement is a universal form of torture.

References:

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. London: Routledge.

Furrow, J. L., & Bradley, B. (2011). Emotionally focused couple therapy: Making the case for effective couple therapy. In J. L. Furrow, S. M. Johnson, B. A. Bradley (Eds.), The emotionally focused casebook: New directions in treating couples (pp. 3–29). New York: Routledge/Taylor & Francis Group.

Gehart, D. R. (2013). Mastering competencies in family therapy: A practical approach to  theory and clinical case documentation (2^nd ed.). Belmont, CA: Brooks Cole. ISBN: 9781285075426

Johnson, S. M. (2004). The practice of emotionally focused marital therapy: Creating connection (2nd ed.). New York, NY: Brunner/Routledge.

McWilliams, L. A., & Bailey, S. (2010). Associations between adult attachment ratings and health conditions: Evidence from the National Comorbidity Survey Replication. Health Psychology, 29(4), 446–453. doi:10.1037/a0020061

Meredith, P. J., Strong, J., & Feeney, J. A. (2006). The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain, 120(1–2), 44–52. doi:10.1016/j.pain.2005.10.008

Siegel, D. J. (2010). The mindful therapist: A clinician’s guide to mindsight and neural integration. New York, NY: Norton.