Workshop Review: From Attachment to Relational Neuroscience Presenter: Professor Jeremy Holmes

Fitzwilliam Hotel, Dublin, 3rd May, 2014
Reviewed by Debbie Hegarty

Professor Holmes is a wonderful presenter. He is charismatic, knowledgeable, informed and prepared. I was struck by his appearance; his stance and gait are that of a much younger man. I signed up for this workshop because I am familiar with his work and respect it. I had first been introduced to his literature in 2000 whilst in the early stages of my training. In addition, I am very interested in psychoneurology and am already familiar with the correlation between attachment theory, affect regulation and neural plasticity. I was intrigued as to how Holmes would make sense of it all.

Holmes has developed a model of therapy and states that certain conditions need to be in place for therapeutic change to occur. He delineated his model during the afternoon session. In the morning session the focus was on the background and theories leading up to the movement from Attachment Theory toward Relational Neuroscience. Holmes also incorporated a live supervision session with volunteers from his audience into both sessions.

The workshop began with a brief checking in with participants as to what interested them about the theme of the workshop. He explained that Attachment Theory is a marriage between John Bowlby (a psychiatrist and psychoanalyst) who developed the theory and Mary Ainsworth (a psychologist and experimentalist) who was primarily interested in empirically researching and subsequently proving the theory. Ainsworth is largely responsible for developing the ‘Strange Situation Classification (SSC)’. Holmes explained that this observational study of attachment conduct measures relationships rather than individuals. Mary Main followed on from the work of Bowlby and Ainsworth and developed the Adult Attachment Interview (AAI). This therapeutic tool allows the practitioner to measure an individual’s attachment style by analysing the discourse of the interview. The capability of the client to relate their self-narrative in a timely, accurate and coherent way indicates a healthy, secure attachment style. I was interested to find out that Bowlby was influenced by a biologist from Edinburgh named Waddington who was contemporaneously writing about epigenetics.

I listened with a mixture of curiosity and admiration and surprised myself by how much I learned, given that I have been studying the workshop topics for three years now. There were opportunities for questions at various points in the morning session. Holmes explained that attachment behaviour is activated by threat and is a protective strategy against predators. By virtue of evolution (survival of the fittest) attachment dynamics are part of our genetic design but (reassuringly) relationship security can be earned later in the lifespan.

Holmes referred to Mikulincer and Shaver (2007) Attachment in Adulthood: Structure, Dynamics and Change when defining attachment dynamics and explained that if the attachment figure, be they mother or father, is insecure then she/he will not have the capacity to co- regulate and modulate the infant’s negative affect. The result is that the infant develops an intolerance of negative affect and becomes an adult whose need to avoid negative affect may result in depression, anxiety, suicidal ideation, suicide, dissociation, etc. In addition, when the caregiver is the source of the child’s (dis)stress, avoidance strategies come into play and can result in narcissistic adaptations. Holmes encouraged practitioners to consider the client’s current situation as well as their developmental environment because attachment behaviour, although inscribed in the body and brain, evolves across the lifecycle (a concept taken from Belsky, 1999). I have included the reference for Belsky’s article below. I highly recommend it to readers.

Holmes proceeded with some findings from neurobiological research relating to the brain functions that are relevant to stress and affect regulation, namely the limbic system, the hypothalamus and the pre-frontal cortex. Due to the confines of a workshop review, an attempt will not be made to delineate these processes except to mention mentalising. The capacity to mentalise is experience-dependent and the emotional impact of these experiences needs to be co-regulated.

Holmes finished the morning session with live supervision with two volunteers. He describes his supervision style as having two dimensions to include free association and interruption. He explained that when a client is discussing an external relationship, they are really talking about their internal working model and that what a client most wants is often what they learned not to want and most fear. Watching Holmes at work with the two therapists was inspiring.

After a rather dissatisfactory lunch of sandwiches (cold and cut into quarters) served with tea and coffee (included in the workshop fee and served in the hotel) we regrouped for the afternoon session. During this time Holmes discussed the components of therapy necessary in transforming (mutating) the client’s stress. There are five:

  1. Primary Attachment
  2. Reverie
  3. Logos (meaning language as affect-regulatory)
  4. Decision
  5. Reflection

I won’t define each element because most of them are self-explanatory except to say reverie intrigued me. It depicts the therapist ability to ‘dream the client’; a notion Holmes borrowed from Thomas Ogden, a prolific writer on psychodynamic theory who has been very influenced by the works of Wilfred Bion.

Reverie is non-intrusive support. In order to illustrate the concept, Holmes used the story of Daniel Deronda, written by George Eliot (1860), which tells the story of Deronda’s experience of coming upon a suicidal Mirah and how he saved her life by creating a favourable environment wherein he utilised the skill of reverie. He states that sensitivity and mirroring in therapy are necessary but not sufficient. In order to create the kind of favourable environment that can override genetic vulnerability and transform narcissistic wounds, the therapist needs to consider ‘partially-contingent mirroring’ (meaning mirroring that is slightly contingent but not exactly accurate). By definition, partially-contingent mirroring is ‘inexact’ but responsive, with the therapist using theory to build on and elaborate the possible meaning of the client’s dialogic exchange. This practice creates space for disagreement or correction by the client. In short, this skill requires taking what the client says and changing it slightly (i.e. yes…but) because too much contingency, similar to anxious assimilation, can result in collusion. On the other hand non-contingency, because it is too dissimilar, is non-relational.

Finally I will end with a critical evaluation. Certainly Holmes has enough material and skill to hold a two-day workshop and at times I felt he was rushing through the slides. Having said that, I wouldn’t have enjoyed the experience as much if he had made the slide show the mainstay of the workshop. Participants received the workshop slides via email shortly afterward and there are very many slides. I would have spent the full day witnessing him supervise. It was live and I like to learn experientially. A hot lunch works better for my energy and concentration levels.

References:

Belsky, J. (1999). Modern evolutionary theory and patterns of attachment. In
J. Cassidy & P. Shaver (Eds.) Handbook of Attachment: Theory, Research, and Clinical Applications. (pp. 141-161). New York: Guilford Press.

Mikulincer, M. & Shaver, P.R. (2007). Attachment in Adulthood: Structure, Dynamics and Change. New York: Guilford Press.