Integrative Attachment Therapy - Dr. David Elliott

追加: 2026-05-05

[00:00:00]attachment is relationally formed either in its secure forms or insecure forms the relational Dynamics are fundamental to the creation of the attachment pattern then resolving attachment insecurity must also be relational so a cognitive behavioral approach to resolving attachment insecurity will have some benefit but I don't think that it it will completely resolve or even significantly resolve the fundamental insecure patterns but there is value in in certain cognitive approaches as [Music] well David welcome to the show thank you I'm really glad to be here appreciate uh this this conversation we're about to have no I heard in another interview that you decided you wanted to become a psychologist at the age of 12 um can you maybe tell us about uh how you came to this realization and yeah what where where this comes from yeah well it had to do primarily with my sense of identifying with people that I observed as having some challenges particularly in you know insecurities anxieties uh worries I was a pretty anxious this young kid and when I saw uh television shows that that showed people with anxiety problems and insecurities and how they could be helped through Psychotherapy by psychologists by mental health professionals I thought oh that sounds really good I can relate to that uh one of the early sitcoms that that was really influential in this was the the Bob newart show where he played a psychologist and uh and the show showed him meeting with some of his patients or clients and I liked what I saw I felt reassured I felt oh you know there's there's hope there's possibility there's there's there are people out there who would be interested in helping others helping me um so I decided to be a psychologist and that fits very well with what is commonly recognized within the field the mental health field um of the notion of the Wounded healer that many mental health professionals can relate personally to the challenges that they help others deal with uh so yeah for sure for sure and you've been on an incredible trajectory since then um you know in addition to uh I think you went graduated from Harvard you have developed a very unique approach to uh trading attachment as well and you've done some really interesting research in this area too but I wanted to ask you why dedicate your life or your working life to studying researching and trading attachment why is this so important like why is this such a central thing for you yeah great great question yeah well you know it certainly relates to what we were just talking about in terms of my personal history of insecurity basically having some a form of anxious preoccupation anxious preoccupied attachment as a kid so I you know I know from the inside what this is like and what some of the challenges uh a child and developing person can experience as a result um but I didn't initially Orient toward uh focusing on attachment that came actually much later in my in my life and in my work back in the the early 2000s I guess when I took some training with Daniel Brown who who is a brilliant psychologist a brilliant and creative integrative thinker and practitioner uh who offered through offered in his his his wonderful uh educational forums um topics that were quite relevant to mental health and mental health professionals in their work and one of those was attachment insecurity and adults so I took some training with him got very interested in that connected with him and with several others who are also interested in training deeper on this matter and this topic with him so there were 11 of us that decided to meet in an ongoing way a couple times a month to explore deeper the whole notion of attachment and particularly how to help resolve attachment insecurity in adults so it was through that and through the collegial aspect the relational aspect of shared exploration and interest that really built cemented and and and built within me more fully my passion for this fantastic so not only did you have a great mentor and Dan you also had this this group of 11 people that would meet up twice a month and really get to sort of share ideas and collaborate and there must been a great energy around that time as well I'm imagining very much so yeah with our shared interests and and you know when you think about a collaborative exploration like that it it it you know it brings some wonderful connecting experiences and it also brings challenges because we didn't always agree on everything right those disagreements actually you know were part of the creative foment and what led to you know deeper uh understanding and and uh new ideas of trying to resolve the the differences that that some of us were presenting and I think that that was really fruitful in terms of the process of that group it makes a lot of sense you know when you think even about like people competing in sports or anything you know like having others around them that are at a at a high level that they can sort of push their weight against and bounce ideas off and you know that's going to bring out the best than them and and to see him in this kind of field as well like just to be to be in that kind of environment must have been so so good for your development so another thing I've heard you mention David is that maybe I'm getting the start wrong but it was around 40% of the western the population in the western world are insecurely attached is that first of all is that right and the second part of the question is should should we be should we be aiming to create secure attachment sort of make so that would be the almost like the default attachment pattern within Society what what are your thoughts on that yeah well that statistic that you cited is is accurate um based on the research that's been done and and there's variation across cultures and countries but the general uh understanding from the research that is available about prevalence of attachment and Security in adults is that about 40% within Western countries particularly say the USA and then Western Europe about 40% of adults have um depending on the criteria used of course um can be considered to have some form of insecure attachment anderia differ so there's different ways of identifying and categorizing but I think that is a fair and fairly shocking statistic as well for sure have there been any studies comparing this with hunter gatherer populations gee that I am not aware of uh that's an interesting question but I I don't know of that yeah be interesting to understand you know if cultur cultural drivers of insecure attachment as a like are we you know are we wired to be secure like predominantly with insecurity being like an anomaly or is it like should that ratio be around the 6040 Mark I I don't know I think we are wired to be secure that that uh John BBY back in the uh starting back in the 50s or even earlier he he um highlighted The evolutionary aspect of this the survival aspect of the attachment behavioral system in infants that that from the earliest days after birth or even hours there are there are innate behaviors that tend to try to Capt support the infant capturing the attention of the caregiver to try to get the caregiver to be closer to to have greater proximity to the infant and thereby hopefully be able to attend to the infant's needs which are basically survival needs during the earliest days and weeks and and months of life now attachment is a dietic phenomenon it's not only something in the infant ideally something within the caregiver gets activated as well by the infant smiling the infant crying the infant reaching something in the caregiver the reasonably available the good enough caregiver will pay attention to those signals and will come closer to the infant and try to provide uh for whatever the infant is needing at that time whether it's food um con physical contact for comfort and reassurance whether it's stimulation so that the sensory systems will develop further um it's a dietic dance that develops ideally in a good enough way so that developmental processes within the infant are supported and the relational dynamic between the infant and caregiver is strengthened so that that Bond can support development over the next years of of the infant um coming into childhood and Adolescence and ultimately adulthood wow okay what I don't know if you thought about this or not but what kind of difference would it make in our world if tomorrow by some magical Miracle everyone woke up and the whole world was securely attached what kind of difference would societ or how would Society look if everybody was securely attached what kind of effect would that have wow what a what a scenario yeah what a fantasy that would be wonderful I would say um first of all it would it would the the amount of conflict in the world would diminish it wouldn't go away and as I you know I think some degree of conflict is actually important it's part of a creative developmental process it's part of uh you know the birthing of new ideas and possibilities when they certain form certain forms of conflict but the more toxic and noxious forms of conflict that of course take place and or or take the form of battles and and wars and and violence that harms people on small and large scales I think that would significantly diminish there's some very interesting research that that that highlights that people with insecure attachment in contrast to people so adults with insecure attachment as in contrast to adults with secure attachment um tend to be more dogmatic in their thinking they tend to stereotype others more they tend to be more resistant to change their opinions about things when they're presented with evidence that is contrary to their opinions okay um so if you think about those characteristics and how prevalent they are in our world now unfortunately um those things would diminish so there' be less stereotyping there would be U more flexibility cognitively mentally uh in terms of opinions people would be more willing to change their minds when they're presented with with new information rather than disputing the information because it conflicts with their beliefs you so yeah that that would be this would be a good thing if this happened tomorrow morning let's see if it does that's huge because so many of the world's problems are caused by you know say some kind of charismatic leader with some ideology that he just you know promotes and then people that are insecurely attached because they're more vulnerable and more susceptible to Dogma as you're saying then they blindly follow that Authority but whereas if they were securely attachs they more cognitive flexibility and they can think for themselves and they're less likely to fall into that trap you know so that that's so so important you know um now another question I wanted to ask you David was about you have developed this very unique model um I think it's called the integrative attachment therapy approach and I wanted to ask what what's the unique contribution you feel that this can make to our understanding and treatment of attachment issues yeah well thank you yeah that's uh we my my colleagues and I who've developed this um integrative attachment therapy model uh are quite excited about it we think it it really does offer a contribution to the field and I want to highlight just once again the um contribution of Dan Brown who died uh two about two years ago April of 2022 and he was really the innovator of a lot of the basic foundational ideas of what we were calling then the three pillars model of attachment repair and what we're now calling the integrative attachment therapy model integrative attachment therapy is essentially the application of the three pillars framework to treating adult attachment insecurity through Psychotherapy so that's that's the connection to these different terms um we feel that IAT theg gr of attachment therapy builds upon what's developed within the field that has been really useful the field of psychotherapy for attachment insecurity and that field the traditional model for therapy is what I like to call the therapist as good attachment figure model T A g-f TF and this also was originated originated with some of the ideas of John Balby who highlighted that he and others particularly Mary answorth one of his close colleagues and others who followed them that because attachment in attachment is relationally formed either in its secure forms or insecure forms the relational Dynamics are fundamental to the creation of the attachment pattern then resolving attachment insecurity must also be relational okay so a cogni behavioral approach to resolving attachment insecurity will have some benefit but I don't think that it it will completely resolve or even significantly resolve the fundamental insecure patterns but there is value in in certain cognitive approaches as well so the IAT model uses three pillars pillars meaning essential components that are integrated and interwoven through a therapeutic process the first pillar is what we call the enhancement of collaborative skill collaborative ability that's a that's fundamentally the relational component to this model and again this gets to bul and ainsworth's notion and also the tag model the the the relational component of the therapy is very very important this also uh comes from the psychotherapy research which consistently highlights that the that the factor that is most predictive of psychotherapy outcome regardless of therapeutic approach is the therapy relationship how the patient or the client experiences the therapy relationship so in various ways we highlight that as the foundation for IAT first pillar the collaborative enhancement you know all good therapy is collaborative even if it's not named to be that it's a relational pattern where one person uh the client comes for help from another person the therapist but both have important roles to play neither can replace what the other is doing and both collaboratively have they establish goals and figure out the ways to work on those goals hopefully successfully so the second pillar is is uh is all this relates to perhaps the cognitive domain that I referred to just a moment ago but it's very specific we we call it the enhancement of metacognition or metacognitive abilities essentially that's perspective taking it's the ability to recognize that what's in my mind is in my mind that something is going on in your mind in your experience that might be different than mine or it might be similar and also that certain in inner states might be affecting my behavior so if I am hungry I might be a little more irritable and you might experience me as being irritable toward you and you might think oh he doesn't like me but in in fact that would be your interpretation you would be mentalizing about why I'm being irritable but in fact it's not that I don't dislike you I mean it's I like you very much but I'm hungry and so I'm a little more irritable that that would be one way of thinking about mentalizing or or recognizing that we can take perspectives various perspectives on our experience and the experience of others I would say that all Psychotherapy regardless of whether it names this or not has as part of its effective component not just the relational Dynamic with therapist but whether and how it enhances the clients or the patients perspective taking the understanding about the ability to take a larger perspective at whatever the experience in the moment whatever is happening is so various ways in IIT we work on enhancing metacognition we draw a lot from Peter foni and Alan Batman's and John Allen's work on mentalizing and their work on mentalization based therapy we think that's really terrific we'd like to include components of that in our model which we feel is larger and more comprehensive for specifically resolving attachment insecurity but you know so that's a component of again we build upon what's out there we respect what's in the field and um and and hopefully add something to it the third pillar is really what is most unique about this model and that's the use of embodied mental imagery to work on changing the internal working models of insecure attachment relationship the John BBY wrote a lot and spoke and taught a lot about internal working models which are essentially the the internal representations of attachment experience so if I with my caregiver caregivers most of the time more often than not experience them as available or my primary caregiver as available as interested in me as attuned to what my needs might be as being delighted by who I am as a as a as a distinct and unique child supportive of my exploration and Discovery uh as I look more out into the world then I'll develop uh an inner representation that people close to me are likely to be that way not everybody but that I can reasonably expect that the world first through the form of caregivers but then later on the world in its larger sense uh is reasonably available to provide for my needs so that would be the internal working model of attachment security if I didn't develop that didn't have those kinds of experiences with my primary caregiver or caregivers then my internal experience would be very different it would be that oh I can't really expect that somebody will be there to recognize me and be ATT tuned to me someone I can't expect that I'll be protected sufficiently I can't expect that somebody will be delighted by just who I am so maybe I have to perform and accomplish in order to get love rather than just be able to be my unique distinct self that would be internally represented kind of through forms of memory traces and memory experience uh as as insecure or that would be described as an insecure internal representation the traditional approach to psychotherapy for insecure adults is the therapist as good attachment figure model it aims to give the client or the a a new and positive different experience with a significant person in his or her life their life and that's the therapist the therapist aims to be a good attachment figure now that's helpful and there are limitations to that so for example the therapist is the the the internal working models are of the self as child in relation to an adult caregiver there is a caregiving relationship in a patient and therapist Dynamic but the patient is not a child if it's an adult patient and that's what this work is focused on the patient is an adult and the therapist is not the adult patient's parent so that can you know there can be great benefit to a positive relationship between the two and the experiences the patient has with the good therapist but it's not likely to change the original internal working model so what we do and this was a an innovation from Dan Brown who drew from several others throughout you know years and decades before before he first proposed this um is that we collaboratively engage the patient in creating we'd say co-creating embodied relation imagery of the patient as a child interacting with an imagined new and different parental caregiver who is providing just the right ways of Being for the needs for that particular child to develop security so for example um after after explaining all of this approach you know and and and the process of the mental imagery to to a patient I might say okay now imagine yourself coming to feel yourself more and more as a very young child feel yourself younger and younger and more and more as a very young child so that from the inside you feel yourself as a as a young child you are and we we work with that to to help the person kind of imagine and really Envision this and then when the when the client the patient is indicates that here she's there feeling the self as a young child then I might say now being the young child you are imagine that you're not alone imagine that you're with parents but not the parents you grew up with imagine you're with a new and different set of parents parents who are ideally suited to you and your unique nature as the child you are these parents can be any ways that you'd like them to be so through the creative freedom of your imagination you can play and and and work with this sense of their characteristics and their qualities until they feel just right for being the parents that you would most need to feel secure in your connection with them and sorry to sorry to interrupt David um just it's important to underline here that you don't actually you shouldn't use your own parents even if there were good elements to that relationship because other associations will get brought in is that is that right that's correct yeah that's a very good observation yeah many people will ask they'll say well how about if I imagine my actual parents but a better version of them um and I'll respond to that by saying you know we can appreciate that your actual parents did the best they could given who they are who they were and they you know they have their own attachment history their own difficulties that probably led to some of the difficulties that you've experienced with them so we're not we're not criticizing or rejecting your actual parents but but let's see if you can create a new and different set of parents so that all aspects of them as you experience them them experience them now in the imagery can be different and you won't associate with these parent figures now anything that you had as problematic in your experience with your actual parents so that's an important point that you raise you okay soorry well andr was there anything else you wanted to say about the about the method or so so I I described the creation of the imagery first of the experience of the self as a very young child and then of the uh imagined parent figures but there's a step that comes before that you notice if if you recall when I first started describing this I I labeled it as embodied mental imagery or embodied imagined parent figures or IM embodied experience with imagined parent figures the embodied aspect is a really important component to this model and why we think it's effective when during the first two years of life when attachment representations are formed a child operates not according to a developed cognitive system or narrative linear language based system that doesn't kind of start start developing till you know around three years of age and isn't fully online and functioning till around four or so so for the first two years of life the processing system let's say we could say the the operating system of the child is is more bodily based it's physical it's visceral it's it's behavioral it's about movement it's about sensation it's about feeling uh it's the physicality that's why hugging and and physical contact is so important in a safe way you know between a a parent and and a child um so as part of the foundation for creating new and different internal working models we the first step in this sequence of of the of the therapy process is to help the client or the patient Orient toward his or her or their physical experience to get out of their head right and to there's going to be thoughts there of course that it just continues to happen but to try to shift the attention and the awareness to what's going on in the immediate felt sense of the body so I might say well feel yourself in the chair just notice you know the arrangement of the arms and the legs and take a couple of breaths feel the sensations where the body's in contact with the chair look through the body notice if you want to move or shift or adjust in any particular ways bring attention to the breath the inhalation the exhalation there's many ways to do this but the basic principle is bring attention to the body so that that becomes more the center of focus and experience as much as possible in the moment because that creates the conditions that are more similar to what was operative during the first two years of life when attachment experience got internalized if as an adult in the therapy sessions the client or the patient comes into that operating system then we do the imagery it's much more likely we think and we find in terms of positive outcomes that the internal representation will get modified towards security do you think it's whenever you're doing that whenever you're getting into this embodied State you're almost enhancing the the neuroplasticity of those attachment patterns whenever it's happening so they're more flexible to change whereas if you just go cognitively you're not really you're not really getting that that's a another really important point because um there's some very interesting Neuroscience research that has explored this whole notion of internal working models um nobody has seen an internal working model you know it's not something you can identify in you know somewhere particularly in the brain but it turns out that there are certain brain cortical structures and brain networks um the the the core network of the brain it's often been termed is considered to be relevant to the formation of internal working models in research that various neuroscientists have done in recent years in the last 20 years particularly it's been found that remembering or imagining new and different experience imagining a fictive experience something that didn't happen but uh somebody can create through their imagination actually engages the same cortical Network that is considered to be relevant for internal working model formation so when we Engage The we Engage The Body we we support the embodiedness of this whole process and we support the creation of fictive experience imagining new and different positive attachment experience with caregivers that didn't actually happen in the client or patient's life we think that that as you referred to that that actually creates change at the level of of um of the brain and of the whole nervous system and there's some compelling research there's still a lot to be done in this area but what has been done so far is quite compelling that's fascinating can you just on the research Point can you maybe tell us about the 2017 study that was done I think it was in Paris on PTSD and the use of was it imagery is that right yeah yeah yeah thanks for bring that up that was done by um Federico par and uh Carol George who is very well known for her work in uh the adult attachment picture system as an assessment tool for for attachment but uh the the two of them and and several others were involved in this in a study that didn't look specifically at attachment but we're interested in how the introduction and the use of the ideal parent figure imagery method might help adults with complex post-traumatic stress disorder so the study was rather small there were 17 adults there were 17 women who were considered to have complex PTSD and they were introduced to the the study method and in one session they were LED through they were guided through a standardized vers version of the ideal parent figure imagery I should say here and and the authors of this study also highlighted that they that that that we don't recommend standardization because everybody's different and even though you know there's a general framework for how to create the imagery co-creation is very important so the therapist needs to attend to the particularities of the person in front of him or with them that that uh every imagery process every imagery session will be different but for the purposes of research and to try to you know reduce the uh the range of variables to try to find a a research effect these researchers did do a standardized script of the ideal parent finger imetry so they did it in one session then they um uh uh gave they made a tape for an audio tape of that uh session and they asked the study participants to listen to that session between subsequent um therapy sessions and they had five therapy sess or four therapy sessions total where they were also given this this um protocol and they listened in between a lot or a little that it wasn't calculated wasn't assessed how many times each participant listened to to the recorded tape but what they found was that after just the the five sessions the initial session where it was introduced and the four subsequent sessions that various symptom measures showed reduction in complex PTSD symptoms significant reduction and measures of quality of life experience showed in significant increases just after those five sessions at 8-month followup those results persisted that the symptomatology of the complex PTSD remained low or lesser than it was at the beginning of the study and the quality of life scores were were higher than at the beginning of the study there were some indications that attachment benefited the security of attachment benefited but again in this small study there wasn't a a a specific assessment of what the attachment patterns were so it was intriguing it was supportive it validated the power that this method can have in certain areas uh but we do need to conduct more research in a more more attachment focused way in order to show more people more therapists more researchers more the world that this method that clinically we see as quite useful and quite effective also has empirical support that's so interesting do you think there's a case to be made that when someone comes to a therapist that might have experienced PTSD or developmental trauma that there's a case to be made for maybe addressing attachment issues first or at least concurrently along with the trauma so that should be a primary focus of the of the therapy we find that attach well not just we but the research highlights that attachment insecurity is a risk factor for other types of psychological emotional mental health challenges and difficulties uh it seems that attachment security supports resilience so that when a child encounters the inevitable challenges that are going to come up through development a secure child will have more inner resilience and coping mechanis isms and ways to process and ways to not get more hurt by the challenges that arise somebody with a child with insecure attachment will be less resilient will be more vulnerable and um more vulnerable to abuse and and and Trauma which may be why they were insecure in the first place so there can be a a vicious cycle where problematic parenting creates insecurity the continuation of the problematic parenting a negative or adverse childhood experiences can then have a deeper impact on the child because of the vulnerabilities we find that when adults come to treatment that if they have an underlying attachment in security that it's most effective it makes the therapy most effective and efficient to treat that attachment insecurity first so for example um I think of one one client who was uh had a post-traumatic condition based on uh unfortunately being impacted by a terrorist attack uh and and he had understandably PTSD in response to that he was treated it was offered some of the standard PTSD treatments for that but it made worse he was actually having more nightmares as a result and and more internal disorganization and so he dropped out of that particular treatment and found his way to me and I did an assessment because about his attachment status because based on what he was telling me in addition to his description of the trauma it seemed to me that he had uh an anxious preoccupied form of insecure attachment an assessment validated my impression of that for the first part of treatment we didn't address the trauma at all we addressed his attachment in security until he developed what's called earned security which is the presence of the indication of an internal pattern of security uh in somebody who initially had been insecure so once he was ear secure then we started addressing the trauma and he didn't get more over welmed as we were doing that and he didn't get more disorganized and our interpretation of that we we've seen that you know many patients our interpretation of that is that again security creates inner stability it supports the formation of inner structure so that there's more resilience against impacts negative impacts of things that will inevitably occur and for somebody like this client I just described when we started addressing the trauma in a very direct way he had the inner stability and the inner structure so he would not get more disorganized or certain kind of collapse into the uh in into the inner disorganization that was happening before and the treatment proceeded quite well so our general recommendation is that it's given how pervasive attachment insecurity is you highlighted that 40% of adults by you know many estimates have insecurity that's the general population we it's also found that within the clinical population within the group of people who seek Psychotherapy or are hospitalized for mental health problems the prevalence is much much higher so as a general rule I think and my colleagues think that it's really helpful as part of the initial assessment which should be comprehensive so the therapist can get a good understanding of who it is and what it is the person is coming to treatment for and with um whether attachment in security is a component of that if it is that's the pathway for many people as the initial approach U which will make therapy more more efficient overall amazing now another part of your model is about enhancing people's abil ability to collaborate with others let's say I was coming to you and you identified that that was a major issue for me and something that I needed to improve how would you go about helping me to impr improve my capacity to collaborate with with other people well first of all I would highlight very explicitly that therapy is a collaborative process um so so I would I would uh say that okay the first first things we're going to do we're going to do an assessment so that we can understand more about you and what has contributed to some of the problems that you're coming to therapy for uh we might identify in the case that you're referring to that the person has had difficulty in relationships difficulty engaging in a mutual give and take in relationships and if that's the case I would talk to you about that i' say you know one thing it seems to be seems to be pretty consistent through through your history is that you've had these particular kinds of relational problems where it's hard for you either to let somebody offer their input to a particular task or into the relationship uh because you think you're you have the right way all the time or most of the time or alternately maybe with someone else it would be you you undervalue your own contribution you look too much toward the other person for figuring things out or taking the lead because the self-esteem is not welldeveloped uh so I would say you know I I would say isn't that interesting you know and we would talk together about these patterns I would say let's explore these patterns together so that in this therapy process that we are both involved in we can find the ways to most benefit what it is the goals are that together we can come up with for this therapy so notice all the relational collaborative language I just use we and lets and us and our so that becomes woven in through the process just in a natural way because I see it as a collaborative process so I'm not I'm not making up that language I'm not you know manipulating with it it's actually how I see the relational aspect of the therapy and how valuable that is um so so yeah that's that's that's the foundational component then of course there would be other ways over the course of therapy to maybe practice collaboration either with me in the therapy process or have some homework so the person practices being a little more collaborative in their other relationships very cool so it's almost like they're they're doing a test drive collaboration with you and just just the process of therapy itself that is the collaboration and then that can then be modeled in other areas of their life too yes and that comes it really comes from developmental literature that highlights the collaborative aspect of a healthy secure attachment diad between the infant or child and the caregiver that's fundamentally collaborative the infant has to give signals to the caregiver the caregiver has to pick up those signals has to know how to respond to those signals the child uh experiences those signals and will have some other Expressions as a result there's this back and forth that sometimes is called a dance you know the relational dance uh that we hope happens because that tends to support security for sure for sure there's something I want to ask you about before the end end of the interview is about the five primary conditions that promote secure attachment and why these are so important for everybody to understand great thank you yeah yeah I I um I indirectly referred to them earlier and as I as I name them again you you'll remember um that I that I made reference to these um the the the the foundation for this is Mary ainsworth's description of what she called ma maternal responsiveness so maternal responsiveness is according to Mary answorth the category of the ways of being of the caregiv she used maternal because that was most prominent in in her era that the mother was the primary caregiver and probably in general that's still the case but fathers typically are taking a much bigger role now in caregiving so we could say parental responsiveness but Mary nsw Worth's term was maternal responsiveness and Through the Years subsequent to her presentation of that principle and that and the characteristics that are included in that many attachment researchers and and and clinicians have highlighted what they consider to be fundamental parental ways of being that are important for promoting security and Dan Brown and I and others in the group uh the the the nine of the original 11 in addition to Dan Brown um or nine of the additional 11 created the the book the uh attachment disturbances in adults book which came out in 2016 but in that in that book we published the category that that that we termed the five primary conditions that promote secure attachment and these are not only the ways of being of the parent or the caregiver remember I've highlighted how important it is to see attachment as dietic it's a dietic relational phenomenon between the caregiver and the infant so in our model of the five primary conditions that promote secure attachment there are parental ways of being and there are also what the child hopefully experiences in response to the parental ways of being so the first one is protectiveness if the caregiver provides adequate protection against harm can never be 100% the child's going to trip and fall and skin skin the knee or or get scared and cry you know but in general a caregiver is neither under prototec nor overprotective and then hopefully the child will will have an experience over time of the parent being protective to a good enough degree so that that gets inter alized as the internal message that you know sometimes I get hurt or sometimes I get scared but more often than not my caregiver will be available to help it's not a conscious thought necessarily but it's an implicit memory it's a bodily based felt sense of being able to trust the availability of the caregiver or being protective the second condition that promotes attachment security is the Al Attunement the degree to which the parent can tune into the child's States inner states and thereby be aware of the child's needs and be able to respond in a contingent way meaning an accurate way to what the child is actually needing in the moment so the child is kind of irritable and and uh um you know is clearly needing something the parent who's who tries to be attuned may be accurately attuned to what's creating that state or may not be so for example the the parent might think oh he's hungry so I'm gonna feed him I'm gonna feed my infant he must be hungry tries to feed the infant the infant pushes away no no no well oh okay so the parent wasn't accurately attuned even though the interest in being a present to the child was there but the parent notices that even though the child's not feeding the child is calming just by being held aha so what the child what my infant needed right then was just some comforting just being held in that moment so the parent tries to be attuned as much as possible to the inner states of the child and tries to respond effectively and um yeah effectively to whatever those needs are if that happens to a good enough degree say more often than not the child will feel seen will feel will have the inner experience that oh you know when I have a need somebody is interested somebody cares somebody can be available can recognize me and what my needs are that promotes security third is um the availability for providing comfort and soothing when the child is hurt is upset is ill or sick in some way so the child of course is going to feel you know uncomfortable States an attuned caregiver will recognize those States and will know the child well enough to know in that moment how best to offer soothing and comfort for the child and then the child will feel oh okay when I'm upset soothing and comfort is available interestingly the good enough presence of this during development is a significant factor in our development of internal emotion regulation skills so initially we depend on our caregivers the world to regulate our emotions because everything's chaotic or you know not everything's wired up early on to promote emotional regulation but if it happens to a good enough degree more often than not that the caregiver can provide soothing and comfort when the child is upset or hurt or scared that gets internalized so that over time when the child becomes hurt or scared or upset there'll be an internal representation of their having been comfort and soothing and so the child becomes less dependent only on the external when that doesn't happen to good enough degree the child and then the Adolescent and then the adult keep looking into the outside world for comforting and soothing for example that might lead to addictions then addictions alcohol drugs shopping uh sex um uh internet addiction in some way um so looking to the outside because there's not enough internal uh regulation ability fourth condition is um the parent being delighted by the very being of the child not only what the child does okay the child is a human being not a human doing it's fine for the parent to be excited and happy when the child draws a beautiful picture or gets a good grade in school but even more important is that the child experience the parent as happy just that the child exists you know and expresses that the the parent lights up when the child comes into the room the child will experience that as oh I didn't do anything in particular but I'm just here and Mama's happy you know that gets internalized in a way that support security Now youve notice I've been highlighting phrases to a good enough degree more often than not obviously no parent is going to be delighted every time the child comes into the room you know they're you know the child parents going to be distracted the parents going to be annoyed sometimes the parent you know whatever but again if to a good enough degree drawing from Donald wot's notion of good enough parenting this happens more often than not a child will internalize that in a way that promotes self-esteem and inner security the last condition is a little bit different than the first four the first four are all about the diad orienting toward each other now all that's important but we don't want only that to happen because the child also needs to have experience beyond the parent so there's the natural exploratory system that gets activated particularly when the child is secure or feels secure that the parent is going to be there there's a secure base that the child can go to whenever there's fear upset or just wanting to share something positive even but from the skure base the child it's really helpful for the child to look away from the parent and find out what's across the room or find out what's you know on the other side of the yard the parent obviously wants to keep an eye on the child that's the protectiveness aspect but also to allow the child to explore and discover and to give the child the experience that that's okay and not only is that okay that's good because that's part of what helps self-development the child has experience with the caregiver and also without the caregiver going beyond the caregiver and that's an important component of security and of self-development and of overall well-being too so those are the five conditions in their context well David it's been such a pleasure and we've covered so much important grind during this interview so thank you so much for sharing some of your insights and wisdom with us I know for people that want to go deeper after this conversation and learn more about your work you've got a really good online course um where can people find an information about that and could you also tell us about your book that you co-authored with uh Dan Brown as well sure so the course is um we're quite excited about the course it's a multimedia online-based self-paced program that has text video audio a lot of um links to external resources that if people want to go deeper into some of the concepts that that that we present they can they can go to if people take do everything that's in the course it's about a 100 hours total uh and we consider it the level one foundational training for integrative attachment therapy uh we have levels two and levels three which are live trainings in-person uh therapeutic uh clinically focused skills development uh course or or components levels two and level three level one has a lot of demonstration videos it gives people the the foundational Theory the foundational principles of IAT you know the three pillars and then a bunch of demonstration sessions so people can get a sense of how to go about this that more information about this is available at integrative attachment therapy.com integrative attachment therapy.com uh this course is of course based on the material that's that's in the book um that that I co- authored with Dan Brown and that that you know others who are part of the study group made contributions to that book was published in 2016 and although it's still very valid and very useful and tremend we think we think of course a tremendous resource for the field um our IAT training has built upon that work and has brought in some new developments both from the field uh since 2016 or since 2015 when we had to submit the manuscript for the book uh you know a lot has happened within the field so so we've included that in in the course we've also made some significant modifications even to the model itself so in the book people who are familiar with it or who may may get it and read it will see that in the book The Three Pillars have a reversed order that the first pillar is the embodied mental imagery the ideal parent figure process second is metacognitive development and the third is collaborative development we said well you know there were reasons that Dan and and and we at the time decided to put it in that order but subsequently we've decided to turn it on on its head which as I highlighted earlier is um informed in part by the foundational element of the collaborative relational component to all Psychotherapy so we wanted IAT to have that as its foundation as well so that is paid attention to and that's developed further even before we go into the ideal parent figure imagery I should say just very briefly that there are many people some therapists and some people who aren't even trained as therapists who are offering ideal parent figure coaching or ideal parent figure facilitation for people um we have concerns about this because ipf should be a therapeutic process and it should be practiced by people who are trained in therapy some of these people who say are not trained in therapy are going to be helpful to some people who come to them and get facilitated for the ideal parent figure imagery but I have had many people come to me who have worked with say non- therapists and people who aren't fully trained in this approach who've had bad experiences because maybe they started dissociating during you know the more severely insecure or the people with more SE severe insecure patterns because of say trauma histories or or whatever else may have contributed to that are are more likely to be vulnerable to a whole host of things that a trained therapist can um understand how to respond to but someone who's not trained therapeutically is not as likely to know how to respond so I been working with many people too many people who've had bad experiences with with the non-trained people so that's just a little let the let the let the client beware notification on that it's important to say and the website is integrative attachment therapy.com is that right cor yes yes okay David thank you so much it's been such a pleasure I want to wish you the best with your work going forward n thank you so much I appreciated your questions very sophisticated and happy to have the opportunity talk about this work so thank you