by Dr Hester Bancroft, BSc (Hons) Psych, DCPsych, CPsychol

Attachment, the emotional bond between an infant and their primary caregiver, has been studied for over 50 years. Early theorising and research was based primarily on mother and infant interactions (Winnicott, 1949; Bowlby, 1969, 1982, 1988; Ainsworth, 1963). Significantly, Mary Main (1984, 1985, 1996) later moved the emphasis from observable behaviour to the world of internal representations providing a shift in methodology that later facilitated research into adult attachment styles.

In the last two decades, however, huge advances in neuroscience have allowed us to see, how, and why, our early attachment relationships affect us so fundamentally. Through the use of neuroimaging and non-invasive electrical brain stimulation, neuroscientists have confirmed what the early theorists long suspected; secure attachment is crucial for optimal brain development. Specifically, we now know that a lack of attunement between a mother and her infant impedes development of neural connections and thus limits the infant’s ability to feel their emotions (Wallin, 2007). In contrast, secure attachment, shapes the brain in a way that prepares and equips an individual for a collaborative and cooperative existence with others (Fonagy and Target, 2006). Our attachment history, therefore, literally shapes our neurobiology and sets the course for our ‘biopsychosocial’ self (Schore, 1996, 2009).

It is hard not to agree with his assertion; the deeper understanding the neuroscience of attachment has provided has huge implications for clinical practice. Knowing, as we do now, that integration of the brain structures is necessary for optimal psychological health, combined with the knowledge we have neural plasticity across our lifespan (Raskin et al., 2011; Siegel, 2010), we now have a clearer understanding of how psychotherapy can enhance changes in neural circuits that facilitate healing (Cozolino, 2002).

Most significantly, affective neuroscience has highlighted the vital importance of right-brain-to-right-brain communication between the therapist and the client to facilitate change at both a psychological and a neurobiological level. Indeed, an empathically attuned therapist, paying attention to what Siegel (1999) calls the ‘critical micro-moments’ of interaction, provides an opportunity for their client to come to know and accept themselves and their inner mental world and achieve ‘earned secure attachment’ (Siegel, 2010).

Advances in neuroscience have allowed us to see how subjectively felt ‘experience’ corresponds to the activation and firing of neurons which then establish synaptic connections in the brain that literally shape its structure and functioning (Siegel, 1999).  

Both Allan Schore (1994, 2002, 2003) and Daniel Siegel (1999, 2001, 2006, 2010) have done much to forge a link between neuroscience and psychology. Both Schore and Siegel’s work is underpinned by attachment theory and has vastly deepened our understanding of how mother and infant interactions serve to establish neural networks and shape the circuitry of the brain.

Crucially, secure attachment provides an individual with access to both somatic sensations and emotions, thus allowing an individual to become ‘embodied’ and able to recognise, and manage, difficult emotions. In stark contrast, individuals with an insecure attachment history are typically ‘disembodied’ and unable to readily access the way their body feels (Wallin, 2007). Neuroscience has highlighted the necessity of integration of different brain structures to achieve ‘embodiment’ and thus, as we will see, a sense of self.

Bowlby (1988), Stern (1985) and Schore (1994) all recognise the centrality of affect regulation to our sense of self; our emotions drive our actions, triggering immediate helpful, or unhelpful, decisions and behaviours. Indeed, our emotions allow us to sense what is being felt in the body (Damaiso, 2003) and assign meaning to our experiences that inform our choices (Siegel, 1999). Regulation of emotions is therefore fundamental to the development of the self and it is through our early attachment relationships that we learn how to regulate our emotions (Fonagy et al., 2002; Schore, 2003).

We now know that the mother and infant relationship directly shapes maturation of the infant’s right brain (Schore, 1996). This hemisphere has connections to the limbic system and the body and responds non-verbally, emotionally and relationally. The left hemisphere, in contrast, responds linguistically, logically and analytically (Wallin, 2007). Crucially, however, in the first few years of life, the right hemisphere is dominant; thus, early attachment memories are recorded experientially, through face-to-face, body-to-body, right-brain-to-right-brain interactions (Schore, 1996, 2009; Travarthen, 2001). It is the right brain’s pre-linguistic, somato-sensory-motor structures then that store the experience of secure attachment as well as the experience of rejection, abandonment or neglect (Schore, 2009).

Two distinct areas in the prefrontal cortex are important to psychotherapy as each have links to the hemispheres of the brain (Wallin, 2007); our emotionally orientated right brain has links to the middle prefrontal cortex region and our linguistically orientated left brain has links to the dorsolateral region (Siegel, 2006). Whilst the dorsolateral region allows us to think consciously about our experiences, the middle prefrontal cortex region, with its connections to the body, brainstem and limbic system, is effectively the mediator of attachment behaviour, affect regulation and social communication (Schore, 1994, 2002; Siegel, 1999, 2006). Indeed, this region monitors and modifies the firing patterns of the lower limbic and brainstem areas (Siegel, 2010).

Importantly, relational trauma impairs integration of these two areas. Deficits in the prefrontal cortex have been associated with a difficulty in managing one’s emotions, recognising one’s impact on others and responding appropriately to social cues (Wallin, 2007). This area also plays a key role in ‘interoception’; the ability to be aware of, and pay attention to, our own bodily states. Thus, the prefrontal cortex provides us with vital information about how we feel about ourselves and others (Damasio, 2003).

Our limbic system allows us to process our feelings and appraise our lived experiences (Wallin, 2007). Unsurprisingly then, right-brain-to-right-brain processes are also crucial for regulation of our autonomic nervous system. The amygdala, a key part of this system, gives us the ability to read facial cues and have a ‘feel’ for other people (Baron-Cohen, 1999). It also primes the sympathetic nervous system, located in the brain stem, to trigger a fight or flight response when the cues or the ‘feel’ is threatening to us (Rothschild, 2000).

The hippocampus, the other key part of the limbic system, does not come into play until around our second year. The hippocampus organises our memories autobiographically (in time and space) and can also be thought of as the ‘brake’ that engages the parasympathetic nervous system, allowing a person to calm down when perceived threats are recognised as false alarms (Siegel, 1999).

Importantly, therefore, our early, pre-linguistic experiences register in the amygdala as highly influential, overgeneralised, emotional memories that are accessible only through sensations, feelings or impulses (Wallin, 2007). These unconscious memories fundamentally bias our appraisals (LeDoux, 1996). Thus, a person with insecure attachment may be prone to misreading social cues and incorrectly seeing certain situations as threatening.

Where there is attachment trauma caused by a chronic lack of attunement, the resulting stress inhibits integration and damages the cortical and subcortical structures of the brain (Lyons-Ruth, 2006). This damage can result in an overactive right amygdala (from being on high alert and in a chronic state of activation), a shrunken hippocampus (from overwhelming emotions suppressing hippocampal activity) or the production of chronically high levels of cortisol (Schore, 2003, 2009). The neurobiological impact of insecure or disorganised attachment therefore is now understood at a microscopic level.

Children with secure attachment, however, achieve neural integration, allowing them access to somatic sensations and emotions. This integration gives them emotional balance, the ability to relate successfully to others and the capacity to reach their intellectual potential (Siegel, 2010).

Neuroscience then, has helped us to understand how our attachment history fundamentally shapes our brain’s structure and functioning in a way that affects our ability to tune into our inner world, achieve affective competence and manage dyadic affect regulation (Lipton and Fosha, 2011).

Importantly, not only does affective neuroscience increase our understanding of the impact of attachment on a child’s developing brain, it assists us in understanding, and thus optimising, the best psychotherapeutic interventions for adolescents and adults with insecure attachment. Given that over a third of us have an insecure attachment history (Siegel, 2010), this is a fundamentally important area in clinical practice.

Research now shows us that the adult brain, like the brain of a child, can be reshaped and new neural connections can be made (Raskin et al., 2011; Siegel, 2010). Whilst adult neural plasticity may not match the remarkable plasticity of the developing brain (Petit & Ivy, 1988) lifelong plasticity brings with it huge possibilities. Specifically, new relationships have the potential to foster positive therapeutic change. Indeed, just as repetitive relational experiences trigger activity in the infant’s brain establishing synaptic connections, so too can the psychotherapeutic relationship enhance positive changes in neural circuits (Cozolino, 2002).

During psychotherapy, early attachment experiences are played out. These enactments, co-constructed by the therapist and the client, have the potential to be hugely reparative. Indeed, psychotherapy can provide a much needed ‘secure base’ for exploration and change (Wallin, 2007). Neuroscience highlights how this change may occur at both a psychological and neurobiological level. Indeed, Siegel (2010) sees neural integration of the different layers of the brain as vital to healing and asserts that the changes induced by a new secure relational experience strengthen the integrative fibres of the brain.

Accelerated Experiential Dynamic Psychotherapy (AEDP) is a model of psychotherapy, which specifically links affective neuroscience and the phenomenology of attachment in clinical practice. This model emphasises the importance of right-brain-to-right-brain communication. In addition to focusing on the somatic and conceptual experiences of clients, AEDP has a clear aim to facilitate a new system of ‘wired in capabilities’ for growth and transformation. It aims to do this through unearthing and validating a client’s attachment needs and attempting to provide a secure attachment experience within the psychotherapeutic encounter (Lipton and Fosha, 2011).

The importance of an empathetically attuned therapist is clear; when a therapist reads and regulates their client’s levels of arousal, they assist their client in becoming embodied and thus able to recognise their feeling, sensing body as an essential part of themselves (Wallin, 2007). For this change to occur, however, clients need to feel their therapist will welcome their full range of their emotional experiences, including those that have not been welcome before. Just as an attuned mother contains their infant’s distressing events (by recognising, understanding and coping) we, as therapists, must contain our client’s distressing events (by recognising, understanding and coping).

Siegel (2010) asserts that it is through being ‘mindful’ ourselves, that we can move our clients, and indeed ourselves, towards neural integration and health. He argues, convincingly, that being mindful allows us to be open and intentional in what we do, as well as to be conscientious and to have presence. It is through being mindful in this way that we can facilitate neural integration and relieve mental suffering (Siegel, 2010).

Indeed, the ability to be mindful, or reflective, fosters empathy and insight that facilitates a sense of personal agency and freedom (Wallin, 2007). This mindful, or reflective, self emerges through a secure attachment relationship, which provides a ‘secure base’ from which the world can be explored; including our own mind and the world of our inner states. Without a secure base, we can become overwhelmed by, or dissociated from, our internal world.

Internal working models of our early relationships can be thought of as generalised representations of interactions (Stern, 1985). When faced with new interactions, an individual with secure attachment, and thus neural integration, has the ability to revaluate their representations in light of new experiences, which are informed by their feelings. In stark contrast, individuals with insecure attachment tend to have a compromised ‘response flexibility’ (Siegel, 1999). Crucially these internal working models are normally dominated by emotions outside conscious awareness, having been shaped pre-verbally within the context of their early attachment relationship. Main et al. (1991) suggest that these experiences are, therefore, encoded as images, beliefs, feelings or desires.

Right-brain-to-right-brain communication is, therefore, crucial; therapists need to be alert, not only to the explicit spoken word, but also to the emotional, symbolic and bodily forms of representation. A client’s somatic experience has the potential to provide information about what may be going on at an implicit level, rather than the logical, conscious processing of the situation or event which many clients present (Lipton and Fosha, 2011). Siegel (2010) asserts that, through helping clients become aware of their own bodily states, we, as therapists, can create an opportunity for neural links between the right and left hemispheres of the brain to be created.

Importantly children come to know themselves through the experience of having their mind held in the mind of another; they subjectively identify with their parent’s mentalizing response to them. When the parent is empathetically attuned to their child, this allows them to accept themselves and their inner world. As Fonagy et al. (2002) suggest, during psychotherapy, the client, too can “come to know himself in the process of being known by another”.

It is, therefore, crucial for a therapist to communicate what he holds in his mind of his client’s subjective experience, however chaotic or contradictory. In this way, the therapist provides the client with the chance to come to know and accept his inner world as both valid and important. Just as between a mother and child, the psychotherapist’s non-verbal attunement to the client, is crucial in allowing a therapist to ‘fit’ with the emotional and relational selves of their client and, by doing so, aid neural integration and foster a sense of acceptance and agency (DeYoung, 2015).

Where there has been attachment trauma, we are likely to see dysregulation that makes developing and maintaining adaptive relationships extremely challenging (Van Der Kolk et al., 2005). This challenge, of course, also extends into the therapeutic encounter. We now know that physical neuronal firing can be constrained by past synaptic learning, which creates behavioural patterns and engrained emotional responses (Siegel, 2010). Thus, where there is unresolved trauma, it affects an individual’s ability to cope with certain situations in a flexible and adaptive manner.

Siegel (2010) asserts that trauma can be thought of as the outcome of separation of our implicit and explicit memories. Implicit memories, as previously mentioned, are those that are created from behavioural learning, emotional reactions and perceptions of the outer world. In contrast, explicit memories are factual or autobiographical. Unlike explicit memories, implicit memories lack any sensation of having been in the past; instead we experience them as a stream of sensations that feel raw and from the present moment. Siegel (2010) suggests that, by helping clients differentiate between the different streams of information, it is possible to link and integrate them.  

In our clinical practice this is of critical importance; a client with unresolved attachment trauma may experience not only the narrative ‘knowing’ but also the implicit sensory stream. Therefore, when helping clients make sense of their relational experiences, our focus needs to be on integrating their implicit memory (by assisting them in observing their sensory and conceptual streams) into its more integrated, autobiographical, explicit form. This is crucially important as these implicit filters shape and bias our present perceptions, trigger emotions and cause behavioural reflexes (Siegel, 2010).

Clearly, psychotherapy can facilitate change at both a psychological and neurobiological level. These changes bring with them the opportunity to develop a new sense of self by allowing clients, sometimes for the first time, to truly access their somatic sensations and emotions. Whilst childhood attachments structure the biopsychosocial self in infancy, a client’s attachment to their therapist may later re-strucure it. Indeed in this way, just as mothers can raise secure children, we, as therapists, can raise secure clients (Wallin, 2007).

Attachment relationships have a fundamental impact on the developing infant. Over the last two decades, methodological and technological advances in neuroscience have provided us with hugely enlightening insights into how our attachment history shapes and structures the brain. It has highlighted how and why, integration of the brain structures is necessary for optimal psychological health. Neural integration brings with it the ease of well-being; without it, we now know, physical neuronal firing can be constrained by past synaptic learning, which creates behavioural patterns, and engrained, sometimes chaotic, emotional responses (Siegel, 2010).

Neuroscience has also shown us how neural plasticity across our lifespan allows change and growth at a neurobiological, not just a psychological, level (Raskin et al., 2011; Siegel, 2010). Indeed, we now have a real understanding of how psychotherapy enhances changes in neural circuits that facilitate healing (Cozolino, 2002).

Specifically, it has highlighted how, understanding the way we live in the world in response to our attachment history empowers us to alter our way of being, both with ourselves and with others. Encouragingly, where there has been attachment trauma we now know that the capacity for secure attachment is there for the activating (Lipton and Fosha, 2011).

Assisting clients in becoming aware of, and paying attention to, their own bodily states, facilitates integration and creates neural links between the right and left hemispheres of the brain. In addition, focusing on implicit memories, by turning our clients attention to their sensory and conceptual steams, allows memory integration. Finally, by helping our clients to develop the ability to talk about their history in a flexible and open way, allows narrative integration (Seigel, 2010).

At this moment in time, whilst it is possible to see changes in certain areas within the brain, scanning techniques do not allow us to see if neural integration has occurred. It is important to recognise that affective neuroscience is still a relatively new science and refinements to the imaging techniques currently used are needed to allow us to see structural connections and fibres relating to neural integration (Siegel, 2010). There are still, of course, many fundamental questions to answer. Perhaps most importantly we still lack an accepted neuro-scientific explanation of how brains make minds (Roiser, 2015). Put simply, no one really knows how neurons firing creates consciousness (Siegel, 2010).

Affective neuroscience has, however, made important contributions to our understanding of attachment and has huge implications for clinical practice; we now have a deeper understanding of how our attachment history affects us at the level of the brain. We also understand how psychotherapy can bring about neural changes in adulthood that can provide profound healing from previous attachment trauma. One cannot help wondering, as neuroscience methodologies and scanning technologies continue to develop, what exciting discoveries will be made and what consequences those discoveries will have on how we understand and treat emotional disorders in the future.

Ultimately, psychology and neuroscience have much to learn from one another. As Rosier (2015) asserts both ‘mindless’ neuroscience and ‘brainless’ psychology are, on their own, incomplete frameworks; together, however, they can address the same questions and provide us with different, but hugely complimentary, levels of explanation.

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