The economy is causing many of our clients great psychological stress. Although the immediate future may look grim, this is a particularly exciting time to be a psychotherapist. The proliferation of new research in such areas as attachment and the neurosciences means that we are in a much better position to help clients deal with the stresses and concerns now facing them.

Attachment Theory

The Russian writer Leo Tolstoy opens his classic novel, Anna Karenina, with the sentence: "All happy families resemble one another, each unhappy family is unhappy in its own way." This quote captures the essence of attachment theory: Secure babies are all alike; insecure babies are unhappy in their own ways. Secure babies have developed flexible affect regulation skills due to their caregivers' skills. Insecure babies develop inflexible affect regulation strategies as a result of their caregivers. These problematic strategies fall into three categories: down-regulators (those unaware of their emotions); up-regulators (those overwhelmed by emotions) and those who experience a collapse of strategies. I am going to direct my focus to the first two categories, since they are the most common forms of insecure attachment.

Emotions and Feelings

Neurologist Antonio Damasio has documented that throughout the day, our bodies are continually experiencing emotion. We may not be aware these emotions, but we are having them just the same. Not being constantly aware of our emotions is probably a good thing. Although emotions can provide us with important information about an event and help us make decisions in daily life, if emotions are constantly entering consciousness, they can be distracting from other important tasks (such as cognition or physical activities) at any moment. Emotions are busy solving problems and endorsing opportunities without our even knowing it is happening.

However, because our emotions are executing solutions outside of our consciousness, we run the risk of acting out our emotions in destructive ways. So, too much -- or too little-- emotional awareness can be problematic. Feeling occurs when the brain, the pre-frontal cortex in particular, recognizes a change in our physical body state (emotion), and labels that change in terms of emotion. The mental representation of the emotion is feeling. Recognizing our own emotions and representing them cognitively as feelings is critically important to knowing what our clients are experiencing at any moment in time. Fine attunement to the ebb-and-flow of our own emotions can teach us something about the client's inner world. I am speaking about projective identification. It turns out that this analytic concept has a neurobiological correlate: the mirror neuron system.

Neurologist Marco Iacoboni, has described the mirror-neuron system as allowing our mind to read the intention of others through non-verbal cues. During the course of a session, we are constantly picking up the non-verbal emotional cues of our clients. Our mirror neuron system, located in the prefrontal cortex of our brain (the attachment center), simulates that state in ourselves. It has been suggested that this system is the neurological basis of empathy. Many clients come into therapy valuing intellect over emotion, reflecting this larger societal value. By reflecting back to clients what they may be experiencing emotionally, but are unaware of, we can help them become more attuned to their own body and emotional responses within, and, in doing so, their affect is in better balance with cognition.

Flexibility in the Time of Economic Angst

What has attachment theory and the neurosciences taught us about helping clients in the midst of this huge social angst? The key is flexibility, that is, knowing when a situation needs calming (down-regulating) and when a situation needs awareness (up-regulating). Many of our clients lack flexibility in their affect regulation strategies (stuck in up or down regulating), and therefore therapy can help them develop greater balance.

Individuals who habitually down-regulate (dismissing attachment) are often unaware of their emotional reactions to situations. These emotions are being behaviorally solved outside of consciousness, which is why they encounter problems. It is important for them to reconnect with their body to realize that they are affected by circumstances, and, as the famous attachment researcher Mary Main, once said, "(T)hey need to learn how to talk about their emotions rather than show their emotions."

With people who habitually up-regulate (preoccupied attachment) emotional processes, the therapist is charged with the task of helping them learn calming strategies. Both groups need to achieve flexibility with managing emotions, up-regulate when needed and downregulate when needed.

The Therapist's Responsibility

Of course, the entire process here begins with therapists having fine attunement skills and adaptive affect regulation strategies themselves. The more attuned we are to our own emotional processes, the more attuned we will be towards the client's emotional processes. Our mirror neuron system is at work simulating the emotional intention of others. So with down-regulators, we can feel the emotions they disavow and help them experience them in the safety of the relationship. Likewise, with upregulators, if we can stay calm in the face of their emotional overwhelm, not only do we help them calm, but we open the door to help them experience more nuanced emotions obscured by intense anxiety, anger or fear.

Both the attachment field and affective neurosciences have tremendous value for clinicians addressing social angst. By understanding our client's affect regulation strategies as well as our own emotional world, we can better organize the clinical material and develop a roadmap to greater emotional competency.

References
Damasio, A. (2005). Descartes Error: Emotion, Reason, and the Human Brain. New York: Penguin.

Iacoboni, M., "Mirroring People: The New Science of How We Connect with Others", Farrar, Straus & Giroux, New York, NY (2008).

Daniel Jay Sonkin, PhD, is a licensed Marriage and Family Therapist in Sausalito, California, and is the author of numerous books and articles. For the past 17 years he has been incorporating attachment theory and neurobiology in his clinical work. To read the full version of this article, visit his web site at: www.danielsonkin.com.