Mary Ainsworth’s experiment called The Strange Situation was conducted in the 1970’s and has been instrumental in understanding attachment. Her study involved exposing 12- to 18-month-old children to a series of situations to observe the way they interact with the world in the presence and absence of their caregiver. Her findings generated knowledge about four different attachment styles: secure attachment, anxious-ambivalent attachment, anxious-avoidant attachment, and disorganized attachment. Below, you will find a breakdown of each attachment style, a summary of the hypothesis underlying each style, and a brief overview of the concept of rupture and repair. 

Secure Attachment

The Strange Situation experiment included observation of the child through tests such as being alone with their mother, having a stranger enter with their mother still present, their mother leaving them alone with the stranger, their mother returning, etc. These observations revealed that babies with a secure attachment to their caregiver appeared to explore their surroundings more readily in the presence of their mother, regardless of if a stranger was present or not. When their mother left, babies with secure attachment showed signs of distress, but were easily comforted upon the mom’s return. These observations indicate a secure attachment because these caregivers have been able to act as a secure base for their child. When children see their caregivers as a secure base, it fosters the child’s ability to feel safe enough to explore their surroundings. Becoming your child’s safe place also means that they are going to seek proximity to you in times of distress, which is what these children do when their caregivers return to the room after their brief separation from the child. Secure attachment is fostered through hundreds of interactions where the caregiver is consistently present for their child in times of stress. 

Anxious-Ambivalent Attachment

The children with anxious-ambivalent attachment styles exhibited signs of anxiety and distress through each phase of the experiment. These children were distressed before, during, and after separation. Their caregivers were not able to easily console them upon reunion. It is hypothesized that this attachment style stems from a caregiver who is often inconsistent. Caregivers who are inconsistent in the way they respond to their child in times of distress often fail to act as a secure base for their child because their child is unsure how their caregiver will respond from situation to situation. Children require a high amount of predictability from their caregivers. Predictability fosters a child’s ability to regulate because they can rest in the knowledge that their caregiver will show up for them in times of hardship. Regulation creates a sense of safety so that children can explore and learn about the world around them. It is clear through this study that children with caregivers who are inconsistent in meeting their needs do not feel safe to explore in the presence or absence of their caregivers and this is likely due to the lack of safety and predictability that they experience in their daily lives. 

Anxious-Avoidant Attachment

The children with an anxious-avoidant attachment style were often perceived as having a flat affect at each stage of the experiment. They did not seem to explore much regardless of where their caregiver was and did not indicate signs of distress when they were separated from their caregiver. Upon reunion, their affect did not change. The hypothesis behind this attachment style is that these children likely have caregivers who are either absent or rejecting of their children. These children learn from an early age that their caregiver will either not respond at all or will not respond with loving-kindness and understanding. They have learned that it is not safe to express their emotions, and that their needs would not be met even if they did show emotion. Exploration of their surroundings is hindered because their caregivers are not a secure nor safe base for them.  

Disorganized Attachment

These children often exhibit unusual behaviors in the presence and absence of their caregivers. Their behaviors upon separation vary and can include, loss of body control, high amounts of fear, or completely freezing/shutting down. Upon reunion, these children will often vacillate between connecting with their caregiver and disconnecting from their caregiver. Disorganized attachment stems from caregivers who instill fear in their children either through abuse or neglect. They have often experienced so much abuse and neglect that they are highly dysregulated, which is another reason you may see the bizarre reactions to separation and reunion. When a child has disorganized attachment, connecting with their caregiver is often confused as secure attachment. This is especially true for children with disorganized attachment who are adopted. However, this is not the case. Connection for these children is often done purely for the sake of survival. Simply taking a child from an abusive home does not automatically undo the years of trauma that have led to this way of interacting with the world and others. This will be discussed further in part four of this blog series. 

To summarize, the way that children are parented has the greatest impact on a child’s method for relating to others and exploring the world. Children require a consistent parent who is attuned and responsive to their needs and emotional states. They need to feel that they have a safe and secure base with their parent so that they can regulate their bodies and emotions and take developmental steps forward. If any of the insecure attachment styles ring true for you or your child, it is important to understand that hope is not lost. Today, I have talked about many ways that ruptures can happen in relationships but in future parts of this series, we will talk more about how repair can also happen in relationships. Listed below are each of the sections I will be posting regarding the topic of attachment. If you, your child, or someone you know is struggling with issues related to trauma, attachment, etc., please contact me, Madison Slinkard, LCSW, through Psychology Today, or schedule an appointment at Little Rock Counseling and Wellness. I would be happy to talk more with you about treatment options! 

Series Outline: 

Part One: The Biology of Attachment (already released on 10/5/22—can be found on our Facebook page or our website)

Part Two:  Trauma and Attachment: Secure Vs. Insecure Attachments 

Part Three: Attachment into Adulthood 

Part Four: Neuroplasticity: Therapy for Attachment Issues 

Part Five: Attachment and Regulation 

Part Six: Attachment and Inner Connection 

Part Seven: The Inner Working Model and Feelings of Self-Worth

Clients often come to me confused and hopeless about themselves or their child. They may say things like “I just don’t know what else to do,” “it’s just so hard to trust people,” “behavior interventions don’t work for my child.” I have found through working with these clients that attachment theory is often their missing link. It’s the thing that makes it click for them and understand why they (or their child) think/act/feel the way they do. If you relate to this (or even if you don’t) keep reading. We are all effected by attachment. Today, I will be discussing how attachment impacts us on a biological level.

The human brain is wired to search for cues of safety and danger. This innate survival mechanism is one of the many reasons babies form attachments to safe people. When we are born, our brains have not yet created connections that will lend a hand to healthy attachment relationships throughout our lives. However, our brains are typically ready to make these important neural connections as soon as we enter the world. Of course, there are exceptions to this rule, but today we are talking about neurotypical brains. Let’s look at a child with a loving caregiver who attunes to the baby’s emotions, meets their needs, and is available when the baby is in distress. These loving and nurturing interactions will help the child form neural connections in their brain’s limbic system in ways that allow the child to feel safe in their world and with those around them. The brain has three levels: the brain stem, the limbic system, and the pre-frontal cortex. Our limbic system is the part of the brain that handles attachment.

Without nurturing experiences with a secure and safe attachment figure, however, these connections will not happen, and the brain will ultimately cease to develop naturally. A healthy limbic system sets babies up to begin developing their pre-frontal cortex. The pre-frontal cortex is the part of the brain that handles planning, organizing, empathy, etc. These are skills that are often required of children to be perceived as “successful” when they begin school and socialization. So, to summarize, nurturing children and creating secure attachments with them, is a building block to their success as they move forward in life.

Let’s look at a child who does not receive the care and nurture that every baby requires for healthy development. In this example, the parent may have a hard time understanding and attuning to the baby’s emotions, therefore they may struggle with knowing what the baby needs in times of distress. This child learns that their needs will not be met by their attachment figure, and their brain does not develop the neural connections needed for healthy brain development. Each of us has what is called a threat activation response that causes us to seek proximity to attachment figures when we feel distressed, fatigued, threatened, or fearful. This response is even more activated when our fear is related to losing our secure attachment figure. For people who grew up with healthy attachments, this response will likely turn off when the threat goes away. However, for individuals, such as the baby in the example above, who have experienced attachment trauma (i.e., loss of a caregiver through adoption, foster care, death of a parent, divorce, neglect, etc.), it may be harder to feel that the threat is ever neutralized. They may consistently live with the feeling that people are going to leave them or fail them because that is all they have ever known.

So, as you can see, attachment is a huge deal for healthy development in all human beings. Healthy attachment comes from nurturing, attuned, and reciprocal relationships with caregivers during early childhood. It is important to note that just because someone has experienced attachment trauma, does not mean that they cannot heal and function normally in society. It may just mean that they need extra help and healing, and that is okay. Only you know your journey! I will be discussing more about attachment as I move forward in this series. Listed below are each of the sections I will be releasing regarding the topic of attachment. If you, your child, or someone you know is struggling with issues related to trauma, attachment, etc., please contact me, Madison Slinkard, LCSW, through Psychology Today, or schedule an appointment at Little Rock Counseling and Wellness. I would be happy to talk more with you about treatment options!

Series Outline:

Part One: The Biology of Attachment

Part Two: Trauma and Attachment: Secure Vs. Insecure Attachments

Part Three: Attachment into Adulthood

Part Four: Neuroplasticity: Therapy for Attachment Issues

Part Five: Attachment and Regulation

Part Six: Attachment and Inner Connection

Part Seven: The Inner Working Model and Feelings of Self-Worth

Have you ever felt stuck in a relationship where part of you wants to take a risk and move closer to your person, but part of you wants to protect yourself from that same person? If you’re breathing, the answer will be a definitive yes. It’s because you are human. And in our humanness, we hold an interesting dilemma of trying to hold two parts of ourselves in one space. Part of us has a longing to be connected to another person, to be loved, accepted, comforted, and safe while the other part of us feels the need to protect ourselves from the pain of feeling alone, rejected, disconnected, and hurt by the people we love. This presents a dilemma for our closest relationships whether it’s dating, marriage, parent and child, and/or close friendships. The closer we are, the more inevitable it becomes for this dilemma to present itself.

Partners, like past attachment figures, are then simultaneously a source of safety and a source of threat, and every interaction is a potentially impossible choice between isolation and dangerous connection.

– Sue Johnson

We feel the tension between this source of safety and this source of threat as we live alongside others. We don’t live in a bubble; instead, we are forced to live out these two very important parts of ourselves. I sometimes relate it to a parent and child going to the fair. I remember my first experience of going to the fair with my children. They wanted to run from one ride to another so quickly that they didn’t want to wait for mom and dad to hold their hands. I can remember the fear I had when one time they moved too quickly into a sea of people and I couldn’t see them. My children longed to experience all of the fun and excitement of the rides and all-you-can-eat funnel cakes without a care in the world. My children didn’t think about if there were dangerous people lurking or if the rides were put together safely with all of the screws. But my husband and I, as protective parents, saw the possible dangers as we looked for the threats that our children could not see. When you think of this scenario, is there a right one and a wrong one? Of course not! There’s nothing wrong with having a longing to ride rides and eat funnel cakes and there’s also nothing wrong with wanting to protect our children.

If we only allowed the protective part to have a voice, we would have been too afraid to risk our children getting on any ride or eating food from a fair concession stand. Who wants to go to a fair and not experience the rides and food? If we only allowed the longing part to have a voice, our children would have run from one ride to another without any supervision and eaten anything and everything that appealed to their eyes and stomach. The beauty occurred when we, as the parents, saw the longing our children had and embraced that part while our children saw the need to be protected and embraced that part. The longing and protective parts were both seen as healthy and vital by all of us and the holding of both parts allowed us to enjoy the experience in a safe and fun way with rides and funnel cakes along the way.

It is the same way for us in our relationships. We all want to learn to hold both the longing part of us and the protective part of us in a way that helps us experience love and connection with our people in safe ways. If you are struggling in finding this balance in your relationships, please know you are not alone. We all struggle holding both. You are only human. As therapists, we want to offer a safe place for you to be able to find healthy ways to hold both in your current relationships.

In life, there are rarely very many true quick fixes.  But occasionally it is my experience that I come across ideas/truths/concepts that can provide significant value for the vast majority of us at certain points in our lives (think Brené Brown’s material, for example).  One of these popped up for me recently while listening to a podcast a friend had recommended by Melissa Urban where she did an excellent job describing one of these pure gold concepts.  I’m not going to completely spoil it for you here because I strongly believe the whole podcast is worth a listen. To summarize, she talks about a process that was prompted by her therapist that she calls the “self-review.”  It consists of taking a minute to truly look in the mirror and honestly assess ourselves instead of solely allowing other people’s opinions of us to determine or supply the “truth” about us.

This immediately brought to mind a process that I picked up somewhere along the way that I have used with rookie counselors I supervise.  Imposter’s syndrome is real and probably somewhat healthy. But when a new (or experienced) counselor comes to me wondering if they’re any good at this or are they this enough or that enough to be someone’s therapist, my answer almost always comes in the form of a question, “Well, are you?”  In this instance, the reality is that I’m not in the room with them. Though I generally have some level of opinion about their skill or development level, at the end of the day, they have their master’s degree in this and have hopefully been to therapy themselves.  They know what good is.

Often our problem isn’t that we don’t know the answers to questions about ourselves- Am I good at my job? Am I a good therapist? Am I a good parent? Am I attractive? Do I look good in yellow? All the above. The problem is that we (1) haven’t taken the time to ask ourselves and/or (2) haven’t cultivated trustworthy judgment or decided/learned to trust our own judgment.  I know the example might seem trivial but why does anyone else’s judgment have any more weight than mine when it comes to whether or not this outfit or that color looks good on me? I have a mirror. Why do I need someone else to tell me whether or not I’m a good writer? I can read and I know what good writing looks like. Now, I’m not saying other people’s opinions don’t matter at all. For example, sometimes I’m on the fence about my judgment/self review because I’m really just not sure and I trust this person’s judgment. Or I’m aware that I just can’t see this clearly (my example about color is kind of ironic since I’m slightly color blind). People’s input matters. I love what Brené Brown says, though, about feedback: “If you aren’t in the arena also getting your ass kicked, I’m not interested in your feedback.”  The flip side of that, then, is when we have people in our lives who are “in the arena”- who are showing up, are seeking truth, attempting to live whole-heartedly- their feedback is useful and worthwhile. My bigger point here is that, if we are in the arena, this is also true of our own feedback. Keep asking other people for their feedback; just don’t forget to also ask yourself.

People are important. On our better days, I think we all know that. But we all probably have those days where we lose sight of that. Those days when everyone is getting on our nerves or when people close to us disappoint us in one way or another. Those days when we seriously consider moving to a far-off cabin in the woods. Another version of that mindset, I think, also rears its head when we’re struggling. There’s some part of us, often, that thinks we can do something on our own that we simply can’t or, at best, shouldn’t. We might even look at someone else going through the same thing and say something wise about needing to lean on other people or that it’s simply impractical for them to try this or that on their own when they can get help (Ironically, counselors can be especially susceptible to this pattern).

One of the most predominant areas of research in the world of counseling, psychology, and social sciences is the topic of attachment.  The most well-known and cited research on the topic comes from John Bowlby. Bowlby’s main contributions to the field came in the 1950’s and since then countless studies have been conducted and books have been written following his initial theoretical framework of attachment.  Essentially, Bowlby explained that the early bond between caregiver and child creates a template for all future relationships. The idea is that when a parent responds to and interacts with a child in a healthy way the child internalizes this safe and secure presence. So, in a sense, this “secure base” is with the child, and later the adult, wherever they go, even when the parent is not present. What all constitutes responding to and interacting with a child in a “healthy way” is a question beyond the scope of this article. However, I have always appreciated the simplicity of the idea that a caregiver’s main job is to teach a child in their early years about the world, specifically whether the world is a relatively safe place and whether people can be trusted.

As a therapist who primarily works with individuals struggling with the effects of traumatic stress and/or PTSD, I’ve come to appreciate the impact of attachment from multiple angles. Even since I started my career almost a decade ago, I have seen a significant increase in the attention given to early attachment and developmental trauma (simply defined by some as trauma that occurs in the first three to five years of life). Research continues to illustrate how our early relationships affect us for a lifetime. The world of trauma and PTSD research takes this step further, as well, by spotlighting the impact of others on an adult’s ability to cope with trauma and traumatic stressors. Peter Levine, the originator of Somatic Experiencing, even includes the clause “in the absence of an empathetic witness” in his definition of what constitutes calling an experience “trauma.” Also, while I’m not sure there has been much research on this yet, it is a somewhat universally known phenomenon among those that work directly with trauma that kindness, even from strangers, can have a significant positive impact on an individual working through a traumatic experience. I continue to be amazed that while hearing details about terrifying and incredibly difficult circumstances how I will often witness a client light up when they talk about that one relatively kind stranger that showed up somewhere in the story. To be clear, I’m not talking about cape-worthy heroics here. Some of the most common kindnesses I’ve heard about are things like stopping and asking if they’re okay or if they need anything or just sitting with them and perhaps holding their hand until the ambulance or police get there.

This one actually popped up for me recently in a very real way. A few months ago, I was in a car accident. Thanks to my background in trauma, I knew that PTSD and the effects of traumatic experiences are primarily physiological/body-based, so very physically disruptive/high impact, violent experiences (just check out one of those crash test dummy videos if you balk at the idea of calling a car accident violent) are not something to take lightly in regards to traumatic impact. So, even though I was shaken up at the time, I was paying extra close attention to how my mind and body were responding to all that was going on around me. As I mentioned above, I also knew that the people I would interact with right after the accident would play a significant role. Then came Jo, the traffic cop. She may have been the kindest stranger I have ever met and the impact and relief of that fact was palpable for me. There is no doubt in my mind that her kindness and the role she played in this event had a huge positive impact on my response in the moment and later.

This isn’t only true during traumatic experiences, though. The power of the positive impact people can have in our healing journey also often occurs after the fact. This is where a lot of counselors will bring up attachment theory, especially as it pertains to the therapist-client relationship. The reality is that we bring our attachment patterns and style into all of our relationships. Due to the extra vulnerability present in the psychotherapy relationship, these patterns and habits play an even more distinct role. The majority of our hurt happens in relationship. A human being, whether a main attachment figure or not, almost always plays some type of role in our trauma narrative. As I alluded to above, these interactions teach us something about how safe people are in general and more broadly how safe the world is. It follows then that healing must happen in relationship. We can’t restore our faith in humanity without, well, humanity. And that’s a key element to the counseling process. If the hurt happens in relationship so does the healing. This is why it never works to go at it on our own. This is where the good stuff happens in counseling- in the container of connection, empathy, seeing, and knowing that happens between therapist and client. And it’s a truly beautiful process to be a part of.

If you’re interested in reading more about attachment and developmental trauma, I recommend the new book by Kathy Kain and Stephen Terrell “Nurturing Resilience” and “Healing Developmental Trauma” by Laurence Heller. You can also learn more on Diane Poole Heller’s website which includes a free attachment style quiz.

In talking about kids and parenting in therapy, there are a couple topics I find that my counseling clients and I come back to often.  At the top of this list is what to make of and how to respond to children’s behavior. Parenting is complex. If it wasn’t, there wouldn’t be countless books written on the topic.  A lot of these books give pointers on specific situations and specific interventions that a parent is instructed to mimic in order to be a more effective parent. As with any important topic that is written about extensively, some of it is useful and some of it isn’t.

Often I find that it is useful to look at specifics. For example, it is helpful to have some ideas for what to do when your child refuses to brush their teeth or use the big kid potty.  I often also find it useful to zoom out and think more broadly (think forest instead of trees) about important topics. Along these lines, I’m talking more about major beliefs and perspectives on children, child development, and the job of a parent.  For example, what do you believe your main “job”/goal is as a parent? What is appropriate to expect cognitively and emotionally out of a child of this age? And specific to this article, what do I believe about a child’s behavior?

As we all know, a child’s communication is limited by the development of their vocabulary.  The reality is, though, that kids are excellent communicators. When I think of this topic, I always think back to my niece whose language was delayed as a preschooler.  What stuck out to me about her specifically was that she didn’t have many words but she was one of the best little communicators I had ever seen. What she lacked in words she made up for in all kinds of non-verbals.  If you paid enough attention to her or were around her enough, you would find that she could communicate just fine. You just had to listen to her the right way, in her language.  One of the languages of children that we can easily miss, as many people did with my niece, is their behavior.  A child’s behavior is never random. Your kid is never just “being difficult” for the sake of being difficult.  They are hard-wired to communicate and their behavior is doing just that, in a much more effective way than their words could anyway.

In The Connected Child, the authors talks about how the first things you should ask yourself or a child when they start to act out is “Are they tired? Are they thirsty? Or are they hungry?” They encourage caretakers to start with the basics, first, because often this is the root of acting out behaviors especially and, as adults, we’re in charge of helping children get what they need.  If your child is too tired to function, then you- the adult in charge- should designate some rest time for them.  When a child is acting tired, they are effectively communicating that they need more sleep or rest.  Obviously, how you handle this depends on the age of the child but, at the end of the day, you’re the boss in charge of naptime and limit-setting.  More broadly you’re in charge of helping a child learn what they need and how to meet those needs for themselves as they grow and become more independent.

The authors of The Connected Child also speak specifically to seeing beyond misbehavior of a child who is struggling emotionally:

“Play detective and watch closely for situations that trigger physical or behavior reactions in your child. This will help you respond more effectively to your child’s needs…Children who act out may appear strong but are surprisingly fragile inside. When their externalized misbehaviors are met with an assault of adult force, they come to believe that no one understands them or cares about their needs…We always need to look beyond a difficult behavior and ask ourselves:

-What is the child really saying?

-What does the child really need?

Although we address misbehavior directly and quickly, we also must address it sensitively and responsively as a clue to the deepest needs of the child” (p. 46)

The authors here allude to another excellent point in the discussion of children’s behavior: the fact that kids often don’t know what they need and easily confuse needs and wants.  Neuroscientists now tell us that our ability to exercise sound decision-making is limited until our brain is done developing in our mid to late 20s. Again, this is the job of the parent to help guide them. If we simply went with what a child wants or thinks he/she needs, a kid will often make poor, or even harmful, choices. When this fact comes to mind, I always think about how my nephew as a toddler was always so fascinated by my morning coffee. Eventually, he understood enough and would only point at it and say “Hot. No, no.”  But at first, you would have thought that I was killing his hopes and dreams by saying no to his requests to drink, touch, or hold this enticing mystery beverage. In those moments, he needed me to be the adult in charge because he didn’t and couldn’t know what was best for him.

The reality that many of us don’t think about is that kid-as-boss also creates significant anxiety for a child. Try thinking about it from a survival standpoint: Kid’s simply can’t survive on their own and any feeling that they are being asked to would naturally create significant distress. Keep in mind, though, this is distress that there’s no way a child could fully understand and articulate due to its depth and complexity. It is true that often kids act as if they want to be in charge (again, like a toddler absolutely insisting on drinking that coffee). But what happens when a child has been given too much responsibility or power in the family?  Anxious or acting out behaviors. Attachment expert Nancy Thomas writes, “A child feels safe when the loving parent is strong enough to be in control. When the parent sets limits and maintains established limits, the child can learn to trust. A child will not learn to trust someone who is weaker” (p. 78). I would add that a child is unable to feel safe in an environment where he/she feels as if no adult is in charge or when an immature adult doesn’t seem confident in their ability to be in charge. It’s as if something inside a child knows something isn’t right but they don’t have the capacity or language to explain what is missing. This happens in adult systems as well. Have you ever worked somewhere or been a part of a project where it felt like no one was in charge? Did it feel organized/directed/”right”? In my experience, ships without captains simply don’t feel as stable and sometimes even “unsafe” in a sense. If we experience this to some extent as adults, imagine how much more impactful this feels to our children.

At the end of the day, this topic may feel complicated at first but is really rather simple. To put it succinctly, a child’s behavior is communication. Specifically, it is communication about what a child needs. Whether it be a nap, snack, some juice, or better limit-setting, a child is constantly telling us what they need if only we’re willing to calmly and respectfully listen.

Purvis, K. B., Cross, D. R., & Sunshine, W. L. (2007). The connected child: Bring hope and healing to your adoptive family. New York, NY: McGraw-Hill.

Thomas, N. L. (2005). When love is not enough: A guide to parenting children with RAD- Reactive Attachment Disorder. Glenwood Springs, CO: Families By Design.

We cultivate love when we allow our most vulnerable and powerful selves to be deeply seen and known, and when we honor the spiritual connection that grows from that offering with trust, respect, kindness and affection…Love is not something we give or get; it is something that we nurture and grow, a connection that can only be cultivated between two people when it exists within each one of them – we can only love others as much as we love ourselves.

– Brené Brown

This beautiful quote from Brené Brown summarizes the joy and the potential pain of relationships.  The essence of secure attachment is felt when we are seen and truly resonate with another.  For couples, this can be experienced in healthy sexual intimacy.  Yet, sexuality is also an area which can be very problematic for couples.  In even the strongest relationships, their sexual relationship ebbs and flows across time.  I love the word “cultivate” from Brown’s quote above because it implies that connection can be grown within a relationship, with work and attention any aspect of a couple’s relationship can grow and thrive, including their sexual intimacy.

In our previous blog post, we examined the significance of “differentiation” and how an individual can navigate the tension which can exist between the desire to connect to others and also remain as an individual.  This process is at the core of emotional connection.

When we speak specifically about sexual intimacy between two people and what it means to have a healthy sexual relationship, we again look toward the concepts of vulnerability, differentiation, and self-soothing.  For couples, sexual issues often crop up at some point in their relationship.  They are very common yet still difficult to navigate.  We at times find it difficult to discuss issues related to our sexuality.  Perhaps sex was not something that was spoken about in your home, perhaps you grew up in a church or home culture where all the negatives of sex were talked about but none of the positives, leading to the development of shame around sexual issues.  It might be that you have sexual trauma in your past.  Whatever the reason, issues related to sex can be challenging to openly talk about.  It requires vulnerability and honesty.  It requires the ability for a person to be able to hold onto themselves in the presence of another and appreciate the ability of their partner to do the same.  When couples are able to do this, they are able to not only have a fulfilling and healthy sexual relationship but also able to navigate their relationship when they may be experiencing sexual difficulties.

Defining sexual health can be tricky as what impacts our sexual development and our sense of self is vast.  I appreciate the World Health Organization’s definition stating, “Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a)

This definition includes the many aspects of our sexuality as well as the nature of sexual health.  The concept of sexual health is deeply ingrained with an individual’s ability to hold onto themselves in the presence of another.  To set appropriate boundaries yet enter into a space where they are able to let go and be with the other.  Of course, as many couple’s therapists and those who have written extensively on the subject will tell you, sexuality is but one part of overall couple intimacy.  In a recent discussion in the marital therapy course I teach, we discussed the many different aspects of intimacy such as emotional connection, conflict resolution, companionship and recreation, communication, intellectual intimacy, spiritual connection, and of course the couple’s sexual relationship.  All are significant aspects to creating intimacy in a relationship and are intricately connected to one another.  None of these exist in a vacuum.  This is definitely true of a couple’s sexual relationship.  Healthy sexuality exists within the totality of the couple’s overall intimacy in their relationship yet, it is also not guaranteed even when the couple is connected deeply to one another.  Ester Perel, a Belgian psychotherapist and author who specializes in couples work and has researched and written on the concepts of erotic intelligence, sex, and relationships, has an excellent TedTalk discussing the complexity of keeping passion alive in a loving, committed relationship.  The video, “The secret to desire in a long-term relationship” can be found here.

In the video, Perel talks specifically about the paradoxes which exist in long-term relationships which often make healthy sexuality difficult for couples.  She discussed our innate need for both security and adventure, and connection and autonomy.  These paradoxes naturally create tension for couples.  Can we be deeply committed to the other while we remain deeply committed to our own sense of self, feelings, dreams, and goals? Can we learn to connect deeply through vulnerability and authenticity while also remaining independent and able to stand on our own two feet and self-soothe? Can we build a loving, stable, and dependable relationship while still experiencing the adventure and mystery in life? These questions are at the core and the couples who are able to navigate the tension inherent in these opposing desires are the couples who are able to navigate the issues facing them sexually.  They know the ebb and flow of sexual connection and are able to continually come back to one another with both a deeply connected but also a deeply passionate sexuality.

Individuals who are able to navigate these innate paradoxes in long-term relationships are able to keep passion alive in their sex lives.  All of this is dependent on a loving secure attachment bond as well as each individual’s ability to hold onto themselves within the relationship.  This brings us back to the concept of “differentiation”.  On her website, Perel states, “I want to speak to those of you who view commitment as a loss of self.  The idea that we lose ourselves in the presence of our partner is deeply ingrained in the modern perception of love, particularly in the United States. As almost all of our communal institutions give way to a heightened sense of individualism, we look more frequently to our partner to provide the emotional and physical resources that a village or community used to provide.  Is it any wonder that, tied up in relying on a partner for compassion, reassurance, sexual excitement, financial partnership, etc. that we end up looking to them for identity or, even worse, for self-worth?”  This quote is at the heart of remaining connected to ourselves within a relationship.  When we hold onto ourselves we are able to embrace another with more depth, quality, and availability.  We are able to allow them to offer the same.  It creates a beautiful space for each individual to grow as well as space for the relationship to thrive and grow, including the couple’s sexual relationship.

Dr. David Schnarch discusses how couples can navigate the difficult waters of sexual intimacy, individuality and connection, using the Four Points of Balance.  Schnarch talks about two primary drives within us; the drive for autonomy and the drive for attachment.  We desire both and we seek out both.  Differentiation allows us to handle the balance between the two and to enter into relationships while still being able to hold onto ourselves.  This is a key factor in the development of healthy sexuality.  Explained here are what Schnarch refers to as the Four Points of Balance:

1.  Solid Flexible Self- having a deep connection to who you are and your values and not requiring others to validate you
2.  Quiet mind, Calm Heart- maintaining a healthy inner world, being able to emotionally regulate and self-soothe and understanding and listening to how your body is reacting
3.  Grounded Responding- learning how to appropriately respond to others, not over-reacting or under-reacting
4.  Meaningful Endurance- willingness to stick with the difficult, being willing to do what you do not want to and learning to deal with stress

For more information, click here.

When it comes down to it, the health of a couple’s sexual relationship is similar to other aspects of their relationship which requires attention, communication, openness, vulnerability, honesty, and a willingness to grow all which can be cultivated.  It involves a commitment to each individual in the relationship as well as the relationship between them, ensuring a safe place for intimacy to develop within the relationship.  Yes, there will be challenges but there is also the opportunity for deep connection and a place where a relationship can grow and thrive.

Brown, B. (2010). The Gifts of Imperfection: Let go of who you think you are supposed to be and embrace who you are. Center City, MN: Hazelden.

Schnarch, D. M. (1997). Passionate marriage: Love, sex, and intimacy in emotionally committed relationships. WW Norton & Company.

Perel, E. (2007). Mating in captivity: Unlocking erotic intelligence. New York, NY: Harper.

Vulnerability is the essence of connection and connection is the essence of existence.

– Leo Christopher

Life is truly about connection in relationship.  We long to connect and feel seen by others.  This starts early in life with our first attachments.  We are social beings and we need one another.  Yet, it will not be a news flash to anyone reading this to state that relationships are difficult.  In all forms: from romantic relationships, work relationships, parenting relationships, to friendships, they all come with a certain level of challenge.  How we navigate these challenges in relationships has much to do not only with the quality of those relationships but also the quality of our life in general.

Why are relationships such a challenge? It starts possibly with the fact that to enter into a deep connection with another, we first have to be in that same type of relationship with ourselves.  Intimacy with another requires the ability to know and maintain who we are as we enter into that relationship with another.  One reason this is central in healthy, deeply connected relationships is its relationship with vulnerability.  Connection requires vulnerability.  Our ability to be vulnerable depends on our ability to handle the anxiety related to vulnerability.

Family therapy researcher, Murray Bowen, called this ability “differentiation”.  Differentiation is essentially our ability to remain connected to ourselves in the presence of others.  It is the ability to have a developed solid self which allows an individual to navigate the difficult emotions present in relationships.  It allows an individual to act and think for themselves while being able to connect and interact with others.

“A person with a well-differentiated ‘self’ recognizes his realistic dependence on others, but he can stay calm and clear-headed enough in the face of conflict, criticism, and rejection to distinguish thinking rooted in a careful assessment of the facts from thinking clouded by emotionality. Thoughtfully acquired principles help guide decision-making about important family and social issues, making him less at the mercy of the feelings of the moment. What he decides and what he says matches what he does. He can act selflessly, but his acting in the best interests of the group is a thoughtful choice, not a response to relationship pressures. Confident in his thinking, he can support others’ views without being a disciple or reject others’ views without polarizing the differences. He defines himself without being pushy and deals with pressure to yield without being wishy-washy.” (

This idea of differentiation interlocks with our ability to be intimate in relationships.  Brene Brown has written extensively on the concept of vulnerability and its correlation to belonging and connection in relationship.  In her most recent book, Braving the Wilderness, she states, “True belonging is the spiritual practice of believing in and belonging to yourself so deeply that you can share your most authentic self with the world and find sacredness in both being a part of something and standing alone in the wilderness.  True belonging does not require you to change who you are; it requires you to be who you are.” This is a difficult prospect and it demands action on our part.  When we are able to do this, we can hold onto ourselves and allow others to do the same.  We can tolerate the unique thoughts, feelings, and needs of others because we can tolerate those within ourselves.

How do we accomplish this? How do we find a way to be able to stand in our authentic self and bring that self to others in relationship?

This process starts and ends with us.  One key to the differentiation process is being able to own our stories.  If we are cut off and disconnected from parts of ourselves and our own stories it is difficult to connect to the same in others.  To be authentic, we have to first know ourselves.  For generations, stories are the fabric of our lives.  From movies, to books, to family history, stories help us heal, encourage us, and help us make sense of ourselves and the world around us.  When I was in graduate school, one of our tasks was to write our family story.  This required sitting down and interviewing family members and letting them tell their part of our family story.  I still have pages of written parts of these stories from family members, some who are no longer alive.  I treasure these pages.  While a challenge, the assignment was invaluable to my understanding of my own personal story.  Often we struggle with our own stories because they are frequently filled with pain, trauma, loss, and unfulfilled dreams.  Yet, all of what happens to us shapes us.  Dr. Dan Siegel calls this process, narrative integration.  It is the process of making sense of our stories and our inner world.  It is central in the attachment process with others.  Brene Brown stated that, “Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy—the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.” (Brown, 2010, p. 6).

A second key to differentiation is our ability to self-soothe or emotionally regulate.  Being in relationship with another is difficult but also deeply rewarding.  Navigating this process requires us to be able to manage our internal emotional world.  This is the process of emotional regulation.  Emotions can be challenging to navigate, particularly emotions such as anxiety, anger, fear, and frustration.  The process of regulation simply means that we are able to name these emotions and manage them instead of acting out of them.  We all know what it feels like to be overwhelmed by our emotions and the impact on relationships when we act out of our emotions, doing and saying things that we regret.  The process of regulation, or self-soothing, allows us to ride our emotional waves without being lost in them.  We are able to make healthy decisions about how to manage our emotions until they settle and we can re-engage in whatever needs our attention.  These are habits that require time and attention to develop because when we feel deeply, it is often difficult to think.  Practice these when you are not in crisis or emotionally overwhelmed.  The more differentiated we are from those around us, the easier it is to hold onto yourself when all of the feelings come and to self-soothe.

Tips for self-soothing:

1.  Going on a walk
2.  Talking to a trusted friend
3.  Listening to music/playing music
4.  Writing in a journal
5.  Mindfulness practices
6.  Therapy
7.  Yoga
8.  Artistic pursuits
9.  Taking a bath
10. Spending time with a pet

Each of these are simple activities that we can engage in to help us soothe when we are feeling overwhelmed emotionally.  When we learn this process, we learn to navigate the tricky waters of our emotional world and we are able to enter into relationships from a more solid foundation.   When we learn to hold onto ourselves we are able to hold onto others.

In our next blog post, we will focus on how differentiation applies to couples and healthy sexuality.


Brown, B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are. Hazelden Publishing.

Is there more to being faithful than being monogamous?

The lack of sexual confidence, growth, and connection in marriage is staggering and sad.

“Should I shut it down or go elsewere?

Too often married individuals respond to unsatisfactory or nonexistent sexual intimacy in their marriage with this binary question. In other words, they feel they have to shut down or “turn off” their sexuality because it hasn’t been working (or has never worked) or they conclude that they will have to look for a partner or other outlet outside of the marriage in order to find sexual fulfillment.

I see a lot of clients in my practice who have tried, or are still trying, one of these two options. Let me share how couples often find themselves feeling stuck between them.

Shut Down Sexuality

There are many reasons someone may have sexuality that is currently “shut down” (turned off, ignored, not acknowledged, repressed, etc.) Marriages where one or both of the spouses have “shut down sexuality” have healthy and fulfilling sex less than 10 times a year, some less than 6 times a year, and some who haven’t had sex at all in one or more years.

There are many reasons that someone may not be ready or willing to “turn it on” again after realizing that their sexuality is shut down. Many of these reasons come from fears. One fear that can keep someone from putting forth the effort to “turn it on” is the fear of rejection that may have occurred earlier in the relationship or in a previous relationship. Another is the fear of embarrassment. Our culture is pretty flawed in how it portrays what is “attractive” or “sexy” and most of us can’t live up to the Hollywood definitions. For some it’s the fear of failure to physically perform as they or their spouse expects them to perform. They fear that their bodies can’t respond sexually in the ways it once did or is expected to. Most of these fears present in the form of some level of sexual anxiety.

Other reasons someone may be unwilling or not ready to “turn it on” again are based on pain. Some of the pain associated with “shut down sexuality” can be from past painful sexual experiences that has resulted in damage to genitals, or other body parts. Some pain can be from physical challenges associated with other parts of the body that make sex physically uncomfortable, like pain in the knees or back. Sometimes various other painful sexual functioning issues that have never been addressed are contributing to keeping sex “turned off”, including emotional or relational pain.

Other reasons for “shut down sexuality” can include emotional trauma, previous sexual abuse, relational conflict, religious teachings, fear of intimacy, spouse unwillingness, or clinical mental health issues.

Go-Elsewhere Sexuality

The books and articles written for “why people cheat” are many and varied. Some today see “go-elsewhere” sex as “no big deal” sex and advocate for “open” marriages and relationships. Regardless of the varying opinions out there, most marriages want and expect sexual and emotional fidelity in their relationship with their spouse. And for those who have made vows of chastity, I’m not proposing justifications for going elsewhere, but there are reasons and situations behind all behaviors. Here’s a few of the common reasons (not excuses) some choose to “go elsewhere.”

The absence of or increasing distance in emotional intimacy can be a precursor to the “go-elsewhere” response. Sex is much more than an act, so many marriages with regular sexual contact can still be vulnerable to “go-elsewhere” behavior if the alternative sought holds the promise, or facade, of emotional connectivity and intimacy. This idea is more than just the lack of romance, though lack of romance can definitely contribute to the bigger issue of lack of intimacy. One date night a month or even one a week can be really helpful things to any marriage, but intimacy that is reduced to a few hours a month or a few hours a week is still likely to be missing the boat.

Sexual stagnation is often a factor in “go-elsewhere” decisions as well. Sexual stagnation occurs when sex has become predictable, lethargic, and repetitive in expression. The longer a marriage is in this situation, the more the rut feels like a sexual grave.  Stagnation can begin slowly and unnoticed. There are often good reasons it begins: job demands, time pressures, kids, religious activities, lack of physical fitness, or just assuming that you know all there is to know about your mate. Most of us innately know that sex wasn’t supposed to be this way. No one expects their married sex life to be the same 5 years after the wedding, they want it to be better! But when efforts for improvement fail (which they do at times for every marriage) some couples settle for stagnant sex.

My own practice would validate other contributing factors that occasionally pop up: early negative experiences with spouse, unplanned romantic relationship with a 3rd party, conflict in the marriage, a sexually “shut down” spouse, pursuit of media-fantasy sex, and clinical mental health issues. Marriages where one or both of the spouses have drifted toward “Go-Elsewhere Sexuality” are at risk of facing an extramarital sexual affair, heavy pornography use, addiction to sexually risky behaviors, and/or have had one or more sexual relationships outside of their marriage.

In some marriages, both spouses take the same response, and in some one spouse has chosen one response and their spouse the other. These two lists are far from exhaustive as every individual case is just that, individual. However, those noted here are common.

If you find yourself in one of these two responses to an unfulfilled married sex life, (or you think you drifting steadily towards one of them), get caring, supportive, and competent professional help.

This is one piece of insight that can be a bit tough to swallow for some of us at first, especially those of us who over-identify with our thoughts (a topic for another time) and/or overestimate the objectivity of our perspective. How many times have you been sure you judged a situation correctly and later hear more of the story from someone else’s perspective and realize you’d actually gotten at least part of it wrong? Maybe, instead, I should ask how many times that’s happened this week. Misinterpretation is normal and it’s going to happen. A healthy perspective, though, on how this process works can help us avoid a lot of mistakes in relationships.

First, let’s start with the science. In his book Trauma and Memory, Dr. Peter Levine (2015) describes the subjective nature of the way our brain works by pointing out:

”We must live with the uncomfortable acceptance that memory is simply not something concrete, definitive, and reproducible, like a video recording that can be retrieved at will. It is instead more ephemeral, ever-shifting in shape and meaning. Memory is not a discrete phenomenon, a fixed construction, cemented permanently onto a stone foundation. Rather, it is more like a fragile house of cards, perched precariously upon the shifting sands of time, at the mercy of interpretation and confabulation” (p. 2)

Most of us who sat through Psych 101 heard the example of how two people that witness a car accident will swear by completely different details about what happened, even down to the color of the cars involved. We know this, especially when we’re pointing it out in someone else, but it’s definitely harder to apply to ourselves and our judgment. The reality is that we often act as if our perspectives are factual and objective, despite even scientific evidence to the contrary. This works great for attorneys, not so much for loving relationships.

Many of us have heard the recommendation to use “I” statements during difficult conversations (for example, saying “I felt hurt by…” instead of “You made me mad by…”). This is a great strategy. Another great way to help de-escalate a sensitive conversation is to go a step further and instead of presenting what we heard or interpreted as fact (which, as I’ve pointed out here isn’t true anyway) present it as what it is- an interpretation. One of my favorite recommendations for dealing with conflict in couples counseling is to ask each individual to start each interpretation statement (many of them are in an argument) with “What I make up in my head about what you just said/what just happened is…” It’s always a little clumsy at first but this works. In my best moments, I either say this in my head or out loud when I find myself in a situation where I’m interpreting said situation and want to be careful not to present it as if I believe it’s fact. Don’t get me wrong, this isn’t my way of saying that I don’t think my opinion matters. It’s simply an acknowledgment that the way my brain works is to take in what’s happening or being said, interpret it through my many lenses of personal experience, bias, etc (for better or for worse), and then come up with a finished product that can’t possibly be anything but subjective. It is what it is. I’m a human being; I’m just built that way. It’s not a flaw that I need to get better at avoiding. It’s a fact.

So what’s the solution? The solution is to have a healthy relationship with my thoughts and opinions and to never stop asking questions. What do I mean by a healthy relationship with my thoughts and opinions? I mean knowing and believing what I said at the end of the last paragraph. I need to be aware and at peace with the fact that I’m not meant to/can’t possibly be objective and I’m a better partner/friend/daughter/coworker for acknowledging that. Do you know anyone who always presents their thoughts/opinions/perspectives as factual and won’t listen to anyone else’s input? We all hate that, right? Then we should probably stop doing it ourselves. Solutions don’t get much simpler than that. The way we say things really matters. Language not only communicates how we think and feel; the reverse is also true. The words we choose to use can also change how we think and feel. That’s why practicing things like beginning our sentences with “What I’m making up in my head about that is…” matters.

The second recommendation I want to make is to never stop asking questions. That’s when communication dies. It’s when we stop coming up with questions and looking for answers. Don’t take my word for it. Next time you hear two people escalating into a verbal conflict, test my theory. It goes wrong at some point because they stop listening to each other and stop trying to understand what the other person is saying. At that point, we are no longer communicating and we might as well cut our losses and come back to that topic later. When we are no longer curious about and truly trying to understand the other person’s thoughts and feelings on whatever we’re talking about, we’re no longer having a conversation. We’re only talking at each other. We’re also no longer connecting.  At that point, I recommend you take a break until you are calm enough and grounded enough to find that empathy, desire for connection, and curiosity that are at the foundation of good relationships.

As I was researching some of my favorite books for thoughts on this topic, I found far too many to fit into one article. So I thought I would leave you with a few of my favorites here at the end. I’m a big fan of writing quotes that I find really impactful on an index card in a spot where I can occasionally read them back over. Remember, words matter and we soak up language like sponges. It never hurts to be intentional about soaking up the good stuff.


From Dr. Brené Brown’s Rising Strong:

“The rumble begins with turning up our curiosity level and becoming aware of the story we’re telling ourselves about our hurt, anger, frustration, or pain. The minute we find ourselves face down on the arena floor, our minds go to work trying to make sense of what’s happening. This story is driven by emotion and the immediate need to self-protect, which means it’s most likely not accurate, well thought out, or even civil. In fact, if your very first story is any of these things, either you’re an outlier or you’re not being fully honest.” (p. 78)

“When unconscious storytelling becomes our default, we often keep tripping over the same issue, staying down when we fall, and having different versions of the same problem in our relationships- we’ve got the story on repeat. Burton explains that our brains like predictable storytelling. He writes, ‘In effect, well-oiled patterns of observation encourage our brains to compose a story that we expect to hear.’”


From The Four Agreements by Don Miguel Ruiz:

“Your opinion is nothing but your point of view. It is not necessarily true. Your opinion comes from your beliefs, your own ego, and your own dream.” (p. 47)

“We have the tendency to make assumptions about everything. The problem with making assumptions is that we believe they are the truth. We could swear they are real. We make assumptions about what others are doing or thinking- we take it personally- then we blame them and react by sending emotional poison with our word. That is why whenever we make assumptions, we’re asking for problems. We make an assumption, we misunderstand, we take it personally, and we end up creating a whole big drama for nothing.” (p. 69)

“We make all sorts of assumptions because we don’t have the courage to ask questions.” (p. 74)

Brown, B. (2017). Braving the Wilderness: The Quest for True Belonging and the Courage to Stand Alone. New York: Random House.

Levine, Peter A. Trauma and Memory: Brain and Body in a Search for the Living Past: A Practical Guide for Understanding and Working with Traumatic Memory. North Atlantic Books, 2015.
Ruiz, D. (2008). The Four Agreements. Thorndike, Me.: Center Point Pub.