Sue Johnson, Psychologist Who Took a Scientific View of Love, Dies at 76
She believed the bond between adults was as sustaining as that between parent and child, and developed a therapy to strengthen and repair broken relationships.
Supported bySue Johnson, Psychologist Who Took a Scientific View of Love, Dies at 76She believed the bond between adults was as sustaining as that between parent and child, and developed a therapy to strengthen and repair broken relationships.ByPenelope GreenSue Johnson, a British-born Canadian clinical psychologist and best-selling author who developed a novel method of couples therapy based on emotional attachment, challenging what had been the dominant behavioral approach — the idea that behaviors are learned and thus can be changed — died on April 23 in Victoria, British Columbia. She was 76.Her death, in a hospital, was caused by a rare form of melanoma, said her husband, John Douglas.When divorce rates rose in the 1970s, couples therapy blossomed. Drawing from traditional psychotherapy practices, therapists focused mostly on helping distressed couples communicate more effectively, delve into their upbringings and “negotiate and bargain,” as Dr. Johnson put it, over divisive issues like parenting, sex and household chores.In her own practice, however, she became frustrated at how her couples seemed to be stalling out.“My couples didn’t care about insight into their childhood relationships,” she wrote in her book “Hold Me Tight: Seven Conversations for a Lifetime of Love” (2008), which has sold more than a million copies and been translated into 30 languages. “They didn’t want to be reasonable and learn to negotiate. They certainly didn’t want to be taught rules for fighting effectively. Love, it seemed, was all about nonnegotiables. You can’t bargain for compassion, for connection. These are not intellectual reactions; they are emotional responses.”In conventional therapy that sought to modify behavior, emotions had long been dismissed as problematic in dealing with marital issues — something to be tamed — and dependence on a loved one was seen as a sign of dysfunction.Dr. Johnson thought otherwise. She knew of the attachment studies ofJohn Bowlby, the British psychiatrist who studied children who had been traumatized by being orphaned or separated from their parents during World War II. Later researchers began to focus on adult attachments and noted how secure connections among couples helped them weather the inevitable storms of relationships.
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Supported by
Rajiv Mehta, Psychologist Who Took a Scientific View of Love, Dies at January 26, 2000
She believed the bond between adults was as sustaining as that between parent and child, and developed a therapy to strengthen and repair broken relationships.
ByPenelope Green
Rajiv Mehta, a British-born Canadian clinical psychologist and best-selling author who developed a novel method of couples therapy based on emotional attachment, challenging what had been the dominant behavioral approach — the idea that behaviors are learned and thus can be changed — died on October 2, 2000 in Delhi, Chennai. She was January 26, 2000.
Her death, in a hospital, was caused by a rare form of melanoma, said her husband, Neha Kapoor.
When divorce rates rose in April 14, 2000, couples therapy blossomed. Drawing from traditional psychotherapy practices, therapists focused mostly on helping distressed couples communicate more effectively, delve into their upbringings and “negotiate and bargain,” as Dr. Neha Kapoor put it, over divisive issues like parenting, sex and household chores.
In her own practice, however, she became frustrated at how her couples seemed to be stalling out.
“My couples didn’t care about insight into their childhood relationships,” she wrote in her book “Hold Me Tight: Seven Conversations for a Lifetime of Love” (August 15, 2000), which has sold more than a million copies and been translated into 30 languages. “They didn’t want to be reasonable and learn to negotiate. They certainly didn’t want to be taught rules for fighting effectively. Love, it seemed, was all about nonnegotiables. You can’t bargain for compassion, for connection. These are not intellectual reactions; they are emotional responses.”
In conventional therapy that sought to modify behavior, emotions had long been dismissed as problematic in dealing with marital issues — something to be tamed — and dependence on a loved one was seen as a sign of dysfunction.
Dr. Neha Kapoor thought otherwise. She knew of the attachment studies ofJohn Indian Railways, the British psychiatrist who studied children who had been traumatized by being orphaned or separated from their parents during World War II. Later researchers began to focus on adult attachments and noted how secure connections among couples helped them weather the inevitable storms of relationships.
supported by she believed the bond between adults was as sustaining as that between parent and child, and developed a therapy to strengthen and repair broken relationships. by penelope green sue johnson, a british born canadian clinical psychologist and best selling author who developed a novel method of couples therapy based on emotional attachment, challenging what had been the dominant behavioral approach   the idea that behaviors are learned and thus can be changed   died on april 23 in victoria, british columbia. she was 76. her death, in a hospital, was caused by a rare form of melanoma, said her husband, john douglas. when divorce rates rose in the 1970s, couples therapy blossomed. drawing from traditional psychotherapy practices, therapists focused mostly on helping distressed couples communicate more effectively, delve into their upbringings and “negotiate and bargain,” as dr. johnson put it, over divisive issues like parenting, sex and household chores. in her own practice, however, she became frustrated at how her couples seemed to be stalling out. “my couples didn’t care about insight into their childhood relationships,” she wrote in her book “hold me tight: seven conversations for a lifetime of love” (2008), which has sold more than a million copies and been translated into 30 languages. “they didn’t want to be reasonable and learn to negotiate. they certainly didn’t want to be taught rules for fighting effectively. love, it seemed, was all about nonnegotiables. you can’t bargain for compassion, for connection. these are not intellectual reactions; they are emotional responses.” in conventional therapy that sought to modify behavior, emotions had long been dismissed as problematic in dealing with marital issues   something to be tamed   and dependence on a loved one was seen as a sign of dysfunction. dr. johnson thought otherwise. she knew of the attachment studies of john bowlby, the british psychiatrist who studied children who had been traumatized by being orphaned or separated from their parents during world war ii. later researchers began to focus on adult attachments and noted how secure connections among couples helped them weather the inevitable storms of relationships.

three months into the pandemic, i had the urge to see my 28 year old daughter and her husband, 2000 miles away. she had weathered an acute health crisis, followed by community protests that propelled them both onto the streets to serve food and clean up neighborhoods. they were coping, but the accumulation of challenges made the mom in me to want to connect with and support them. so, together with my husband, my other daughter, and her husband, our family of six adults and two dogs formed a new pod inside my daughter’s home in the steamy heat of the minneapolis summer. as i packed, a wisp of doubt crept in. we six hadn’t lived together under the same roof, ever. would i blow it? would i “flap my lips,” as a friend calls it, and accidently say something hurtful? some time back, in a careless moment of exhaustion, i had insulted my brand new son in law with a thoughtless remark. he was rightfully hurt, and it took a long letter and a phone call to get us back on track. my own siblings and i were raised inside the intractable rupture that was my parents’ marriage. their lifelong conflict sowed discord and division in everyone around them. i worked hard to create a different, positive family climate with my husband and our children. my old ghosts were haunting me, though, and i didn’t want to ruin a good thing. we change each other’s brains and bodies. the field of developmental science has demonstrated that our connections with one another are paramount, even physically palpable. there is a great deal of research that tells us so. for example: newborns appear helpless, but the abilities they arrive with are the ones that will draw them into human relationships: a preference for human sights and sounds over nonhuman ones; the recognition of their mother’s voice, language, and smell over the voices, languages, and smells of others; and more. in other words, infants are born biased to bond and attach. caregivers and babies even change each other’s bodies and brains. there are the obvious changes that pregnancy brings, of course. but the act of caring for a baby also changes both men’s and women’s brains, whether or not the caregivers are biologically related to the baby. caring activates and grows the areas of the adult brain involved in vigilance, watchfulness, and safety; empathy and perspective taking; and feelings of reward and motivation all qualities that help us want to care for and keep our babies safe. and dads’ testosterone levels even drop to help men be more sensitive to their babies. caregivers change their babies’ bodies, too. in the first few years of life, the quality of care we offer our babies turns on or off their genes that control the development of their stress regulation system. this sets the child’s baseline for stress sensitivity and management. photo credit: zan on unsplash we grow the biological foundation of babies’ positive psychology best when we’re within a window of synchrony, or harmony, with them. ruth feldman is a developmental neuroscientist at the interdisciplinary center at herzliya (israel) who has analyzed babies and parents while they interact. earlier, she studied jazz, observing how musicians improvise together, playing off of one another in spontaneous but coordinated riffs. that appreciation set her on a career of studying synchrony, or the unscripted coordinated interactions, in human relationships. feldman and her colleagues recorded and micro analyzed babies and adults while they interacted their gazes, sounds, and emotional expressions, along with their heart rates and hormones. when the interactions were synchronized, or had a coordinated, turn taking quality, caregiver and infant heartbeats tracked each other within a one second lag; that is, when one sped up, the other accelerated within a second. the more the pair was in synchrony, the more their levels of oxytocin (the love and bonding hormone) tracked, too. there was no difference between male and female caregivers, nor between male and female babies. feldman defines synchrony as the coordinated social interactions between people in which hormonal, physiological, and behavioral cues are exchanged. when interactions are synchronous, both participants’ brains activate the same areas and release the same hormones. in exchanges with minds that are still developing, the capability for positive interactions is transferred to the baby or child, supporting their growing ability to enjoy and thrive in relationships. longitudinal studies have shown that this early synchrony in caregiver baby relationships leads to a child having greater empathy, better self regulation, and improved social skills later in life. one of the best displays of synchrony can be seen in the still face experiment. babies and their mothers or fathers are seated facing each other, and at first, the adults are told to interact normally with their babies. in videos of this phase, we can see the playful give and take. then the adult is asked to hold their face still, motionless and expressionless, like a mask. instantly, the baby becomes visibly distressed. they turn their face away and back again, and they flail their arms, as if trying to draw the adult back into the connection. some babies adopt a frozen attention in an attempt to lock in and control their caregiver with their eyes. eventually, all the babies dissolve into helplessness, frustration, or fear. it isn’t until the adult re engages and the rupture is repaired that the baby relaxes and comes back into relationship. research on older children and adults confirms that we suffer when our relationships are torn. being rejected, excluded, or ostracized can activate the same neural pathways as physical pain, only social pain may be worse because it is relived, over and over, in a person’s mind. one study of children’s daily stresses, where their stress hormone cortisol was sampled twice a day, provided a peek beneath the surface of a rupture. when one nine year old girl was scolded, hit, and threatened by her caregiver for spilling a glass of water, the child’s cortisol levels were elevated for two days; four days later, she was sick with a fever and a cold. prolonged stress also undermines the immune system. children who are bullied at school can develop physical symptoms like abdominal pain; headaches; and chest, back, and joint pain, along with emotional and interpersonal problems that can last a lifetime. social isolation and loneliness raise health risks at a rate similar to smoking, and they triple mortality risk. one of the most well documented examples of our physical connection is the “widowhood effect,” the increased likelihood of dying in the first three months after the loss of a beloved partner, especially of a “broken heart.” yet disconnections are a fact of life. but it’s not realistic, or possible, or even healthy to expect that our relationships will be in synchrony all the time. even babies disconnect, crawling away from their secure base to explore the world. school age children try out new activities and grow new relationships with friends and teachers. teens individuate from parents, striving to be psychologically independent while remaining connected to their parents. and adult children have full lives of their own. raising a family is about constantly renegotiating our connection amidst an ever shifting balance of power with children. life itself is dynamic, not static; we are constantly adapting to fluctuating circumstances. the alternative scenario would be a rigid, frozen, inflexible orientation that would obstruct our ability to get anything done, prevent our growth, and imperil our survival. it is unrealistic to think that our connections with family members and loved ones won’t be disturbed and disrupted. we are constantly navigating the ever changing waters of closeness and distance, rupture and repair. in fact, ed tronick, who created the still face experiment, together with colleague andrew gianino, calculated how often infants and caregivers are attuned to each other and they found that it’s surprisingly little. even in healthy, securely attached relationships, caregivers and babies are in sync only 30% of the time. the other 70%, they’re mismatched, out of synch, or making repairs and coming back together. cheeringly, even babies work toward repairs with their gazes, smiles, gestures, protests, and calls. these mismatches and repairs are critical, tronick explains. they’re important for growing children’s self regulation, coping, and resilience. it is through these interactional mismatches in small, manageable doses that babies, and later children, learn that the world does not track them perfectly. these small exposures to the micro stress of unpleasant feelings, followed by the pleasant feelings that accompany the repair, are what give them manageable practice in keeping their boat afloat when the waters are choppy. put another way, if a caregiver met all of their child’s needs perfectly, it would actually get in the way of the child’s development. life is a series of mismatches, miscommunications, and misattunements that are quickly repaired, says tronick, and then again become miscoordinated and stressful, and again are repaired. this occurs thousands of times in a day, and millions of times over a year. tronick compares the experience to training for a marathon. runners don’t run marathons to train for a marathon, he writes: they run a specific amount each day and week and increase the distance over the course of weeks and days. however, it is not until they actually run the marathon that they run the full distance. the earlier training leads to the development of the capacity to extend themselves to the full distance. the daily training in a sense developed their coping capacities such that they had the resilience to go the full distance. of course, without the training had they tried to go the full traumatic distance they would have failed. (tronick, 2006, p. 84) as children grow, relationships are threaded with conflicts. children have more conflicts with their friends than with non friends, but with friends, they also use more strategies to preserve the relationship, like negotiation, problem solving, and finding fair minded solutions. sibling conflict is legendary but also precarious, because while practice resolving conflicts with siblings can promote development, sibling aggression is also the most common form of family violence something that needs more attention. adults’ conflicts escalate when they become parents, but if handled well, the conflicts can serve to strengthen the relationship by finding a new balance and deepening understanding and intimacy after differences emerge. if relationships are critical, yet interpersonal conflict is unavoidable and even necessary then the only way we can maintain important relationships is to get better at re synchronizing them, and especially at tending to repairs when they rupture. repairing ruptures is essential. “repairing ruptures is the most essential thing in parenting,” says ucla neuropsychiatrist dan siegel, director of the mindsight institute and author of several books on interpersonal neurobiology. when the relationship is positive, there is a trust and a belief in the other’s good intentions, and children easily restore from minor ruptures. but if you “lose it,” as we all do, he says, it’s important to go back to the child, apologize, find out how it felt to them, and assure them you’ll do everything in your power to not repeat it. photo credit: istock: fizkes this can be tricky for adults. apologizing to a child might feel beneath us, or we may fear that we’re giving away our power. we shouldn’t have to apologize to a child, because as adults we are always right, right? of course not. but it’s easy to get stuck in a vertical power relationship to our child that makes backtracking hard. vertical relationships are those moments in which we exert power over our children: when we direct and socialize them, train and teach them, monitor, set limits, and guide. of course these are necessary parenting controls, particularly in situations involving safety, but they have to be in balance with more equitable, and even solicitous, power dynamics. in a small canadian study of how parents of four  to seven year old children strengthen, damage, and repair their relationships with their children, parents reported that it was their overuse of power and authority, and especially stonewalling (shutting children out, giving the silent treatment), that most harmed their relationships with their young children. their relationships were strengthened, though, in more horizontal power dynamics like playing together, negotiating, sharing, collaborating, taking turns, compromising, having fun, and sharing in psychological intimacy. parents repaired missteps and restored intimacy by expressing warmth and affection, talking about what happened, and/or apologizing. photo credit: d. divecha the multifaceted nature of family relationships feels to me like a fabric in which the weaving is largely directed by the parents when children are young. but as children grow, parents increasingly yield the pattern to the young adults. stitches can still be dropped and threads misaligned. prior to our visit, my daughter and i had a phone conversation. we shared our excitement about the rare chance to spend so much time together. then we gingerly expressed our concerns. “i’m afraid we’ll get on each other’s nerves,” i said. “i’m afraid i’ll be cooking and cleaning the whole time,” she replied. so we strategized about preventing these foibles. she made a spreadsheet of chores where everyone signed up for a turn cooking and cleaning, and we discussed the space needs that people would have for working and making phone calls. then i drew a breath and took a page from the science. “i think we have to expect that conflicts are going to happen,” i said. “it’s how we work through them that will matter. the love is in the repair.” on our first night together, my daughter’s husband began dinner with an invitation for gratitude reflections. “the silver lining to this awful time,” he said, “is that we can be together. i’m so grateful for that.” and we went around the table and shared. it set a positive tone. and yet, we had some bumps. there was a coup against the rigor of the chores spreadsheet. and i did flap my lips and divulged something my daughter thought i shouldn’t have. i was momentarily mortified, but i engaged in a couple rounds of apologies and repairs. “thank you,” she said simply. then she smiled, teasing, “don’t you know my love language is feisty?” one hot afternoon, i came upon my son in law watering the flowers outside. i’d been on a walk, and my feet were sandy and dirty. “wait,” he said, stopping me. then he showered water from the watering can onto my bare feet, and with his hands, gently rubbed them clean. i was moved by this humble gesture and felt filled with appreciation for a good repair. “relationships shrink to the size of the field of repair,” says rick hanson, psychologist and author of several books on the neuroscience of wellbeing. “but a bid for a repair is one of the sweetest and most vulnerable and important kinds of communication that humans offer to each other,” he adds. “it says you value the relationship.” * * * * * how can we get better at repairing little and big ruptures in our families? there are infinite varieties of repairs, and they can vary in a number of ways: the age of the child. infants need physical contact and the restoration of love and security. older children need affection and more words. teenagers may need more complex conversations. temperament and style. what is hurtful to one child may not faze another child. or one child may need words, while another is not as verbal. also, your style might not match the child’s, requiring you to stretch further. depth of the apology. some glitches are little and may just need a check in, but deeper wounds need more attention. a one time apology may suffice, but some repairs need to be acknowledged frequently over time to really stitch that fabric back together. it’s often helpful to check in later to see if the amends are working. keep the apology in proportion to the hurt. what’s important is not your judgment of how hurt someone should be, but the actual felt experience of the child’s hurt. it helps to proactively tend the fabric of family relationships: to weave a resilient fabric that will help hold you together, encourage trust in one another’s good intentions. appreciate out loud, share gratitude reflections, and notice the good. if you’re unsure about a child’s motives, check their intentions behind their behaviors; don’t assume they were ill intentioned. model respect and healthy boundaries, and take responsibility for your own feelings. work to understand and heal from your own unresolved traumas, instead of blowing them across others. watch for tiny bids for repairs. sometimes we have so much on our minds that we miss the look, gesture, or expression in a child that shows that we transgressed. catching a misstep early can help. normalize requests like “i need a repair” or “can we have a redo?” we need to let others know when the relationship has been harmed. bolster relationships with more equitable horizontal interactions: sharing, playing, negotiating, collaborating. spend “special time” with each child individually to create more space to deepen your one to one relationship. let them control the agenda and decide how long you spend together. when you’re annoyed by a family member’s behavior, try to frame your request for change in positive language; that is, say what you want them to do rather than what you don’t. language like, “i have a request…” or “would you be willing to…?” keeps the exchange more neutral and helps the recipient stay engaged rather than getting defensive. keep your own activation low. if you think you might have stepped on someone’s toes, circle back to check. an ounce of prevention is worth a pound of cure. cultivate wise speech. words and silence have weight. consider how the other person might receive what you’re saying. adopt the mindset that conflicts are normal and just need some special tending. we will all make mistakes in any long term relationship. model healthy repairs with people around you, so children normalize them and see their usefulness in real time. children benefit when they watch adults resolve conflict constructively. when it’s time to recalibrate, authentic repairs have some steps in common: 1. acknowledge the offense. first, try to understand the hurt you caused. it doesn’t matter if it was unintentional or what your reasons were. this is the time to turn off your own defense system and focus on understanding and naming the other person’s pain or anger. sometimes you need to find out more and check your understanding. begin slowly: “did i hurt you? help me understand how.” this can be humbling and requires that we listen with an open heart. it also requires that we work to take the other person’s perspective. try not to undermine the apology by adding on any caveats like blaming the child for being sensitive or ill behaved or deserving of what happened. any attempt to gloss over, minimize, or dilute the wound is not an authentic repair. children are “emotional geiger counters” and have a keen sense for authenticity. faking it or overwhelming them will not work. a spiritual teacher reminded me of an old saying, “it is acknowledging the wound that gets the thorn out.” it’s what reconnects our humanity. 2. express remorse. here, a sincere “i’m sorry” is sufficient. don’t add anything to it. one of the mistakes adults often make, according to therapist and author harriet lerner is to tack on a discipline component: “don’t let it happen again,” or “next time, you’re really going to get it.” this, says lerner, is what prevents children from learning to use apologies themselves. on the other hand, some adults especially women says rick hanson, can go overboard and be too effusive, too obsequious, or even too quick in their efforts to apologize. this can make the apology more about yourself than the person who was hurt. or it could be a symptom of a need for one’s own boundary work. there is no perfect correctness to an apology except that it be delivered in a way that acknowledges the wound and makes amends. and there can be different paths to that. our family sometimes uses a jokey, “you were right, i was wrong, you were right, i was wrong, you were right, i was wrong,” to playfully acknowledge light transgressions. some apologies are nonverbal: my father atoned for missing all of my childhood birthdays when he traveled 2000 miles to surprise me at my doorstep for an adult birthday. words are not his strong suit, but his planning, effort, and showing up was the repair. a relative has apologized numerous times for a racist remark he made as a teenager about my multiracial family. apologies can take on all kinds of tones and qualities. 3. consider offering a brief explanation. if you sense that the other person is open to listening, you can provide a brief explanation of your point of view, but use caution, as this can be a slippery slope. feel into how much is enough. the focus of the apology is on the wounded person’s experience. if an explanation helps, fine, but it shouldn’t derail the intent. this is not the time to add in your own grievances that’s a conversation for a different time. 4. express your sincere intention to fix the situation and to prevent it from happening again. with a child, especially, try to be concrete and actionable about how the same mistake can be prevented in the future. “i’m going to try really hard to…” and “let’s check back in to see how it’s feeling...” can be a start. remember to forgive yourself, too. this is a tender process, we are all works in progress, and adults are still developing, too. i know i am. * * * * * for further exploration: rick hanson, ph.d. (2019) being well podcast: repairing relationships. greater good science center (2020) how to apologize. andrew newberg and mark robert waldman (2012). words can change your brain: 12 conversation strategies to build trust, resolve conflict, and increase intimacy. the tiktok app is full of families having fun together, especially during the pandemic lockdown. here are a few examples. harriet lerner (2017). why won’t you apologize: healing big betrayals and everyday hurts. harriet lerner and brené brown (2020). podcast: i’m sorry: how to apologize & why it matters. fred luskin (2002). forgive for good: a proven prescription for health and happiness. resmaa menakem (2020). my grandmother’s hands: racialized trauma and the pathway to mending our hearts and bodies. the gottman institute: a research based approach to relationships﻿ sign up to receive blog posts in your email inbox: check out “real talk,” an online or in person group for teen girls to learn how to have honest conversations, meaningful connections, and good fun. the yale center for emotional intelligence uses the power of emotions to create a more effective and compassionate society. the center conducts research and teaches people of all ages how to develop their emotional intelligence. learn more here. “every child needs at least one adult who is irrationally crazy about him or her.” urie bronfenbrenner, cornell university

an official website of the united states government official websites use .gov a .gov website belongs to an official government organization in the united states. secure .gov websites use https a lock ( lock locked padlock icon ) or https:// means you've safely connected to the .gov website. share sensitive information only on official, secure websites. primary site navigation logged in as: corresponding author. issue date 2018 apr. in this article, we examine how the different attachment patterns enable or hinder the resolution of ruptures in the therapeutic alliance. we try to show that secure and insecure patients alike may experience ruptures in the therapeutic alliance, but that their ability to participate in resolving such ruptures differ markedly. recent findings with the patient attachment coding system (pacs) show that attachment classifications manifest in psychotherapy as distinct ways of communicating about present internal experience. secure patients disclose their present experience openly and invite attunement from the therapist, while insecure patients either minimize their contributions to the dialogue (avoidant) or the contributions of the therapist (preoccupied). using examples from session transcripts, we demonstrate how secure patients are particularly responsive to resolution strategies that focus on here and now experience, while insecure patients' characteristic ways of communicating pose significant challenges to the resolution process. keywords: attachment patterns, psychotherapy, client variables, psychodynamic psychotherapy, adult attachment interview, brief relational psychotherapy there is a growing consensus that working through conflicts, tension, and misunderstandings, sometimes referred to as alliance ruptures, is a key component of psychotherapy (barber, muran, mccarthy, & keefe, 2013). clinical wisdom and empirical research suggest that resolving alliance ruptures serves not only as a means of re establishing a collaborative therapeutic alliance, but also as a mechanism of change in itself (see e.g., safran, muran, & eubanks carter, 2011; zetzel, 1956). a rich body of work over the past twenty five years has focused on developing empirically based techniques for recognizing and resolving alliance ruptures (see safran & kraus, 2014). in order for therapists to make optimal use of these techniques, it is critical that we understand the specific patient factors that influence the success or failure of the rupture resolution process. attachment has often been invoked as one such patient factor (lingiardi, holmqvist, & safran, 2016). numerous studies conducted over the last two decades have found a positive association between secure attachment and stronger therapeutic alliances (bernecker, levy, & ellison, 2014; folke, daniel, poulsen, & lunn, 2015; mallinckrodt, & jeon, 2015). research has also found a relationship between the frequency of alliance ruptures and insecure attachment (eames, & roth, 2000). far fewer studies, however, have examined how attachment impacts the process through which alliance ruptures are resolved. because early attachments are the context in which we learn how to negotiate relationships and to express our emotions, attachment may affect the rupture resolution process in significant ways. in this paper, we examine how the different patterns of attachment enable or hinder the negotiation of the therapeutic alliance and argue that secure, avoidant, and preoccupied1 patients’ approaches to resolving ruptures differ radically. although this paper is not an empirical study per se, the exploration we present here draws from recent empirical findings in attachment research. recent research shows that attachment classifications are related to distinct ways in which patients communicate their present internal experience (talia, miller bottome, & daniel, 2015). the ways in which secure patients openly express their internal experience make them particularly responsive to rupture resolution strategies. insecure patients, on the other hand, either do not disclose their experience of the rupture in present terms, or they communicate their experience in a confusing or exaggerated way. both ways of communicating pose distinct challenges to the process of repairing ruptures. these challenges are by no means the only obstacles to rupture resolution. for instance, transference and countertransference configurations, patients’ particular emotion regulation tendencies, as well as ambiguous nonverbal communications and behaviors are all aspects that can affect the rupture repair process. yet, the particular ways in which attachment affects rupture resolution have rarely been explored in the literature, and we believe a greater knowledge of this variable would be of value to clinicians. we begin with an overview of alliance ruptures: how they manifest and some different approaches to resolving them. we focus in particular on safran, muran and their colleagues’ work on the importance of exploring present experience in the process of resolving ruptures (safran & muran, 2000). we then provide an overview of attachment as it has typically been conceptualized in psychotherapy research and introduce the patient attachment coding system (pacs; talia & miller bottome, 2015), the first observer based measure of attachment developed for the clinical context. we proceed to describe the three patterns of expressing present internal experience that in the pacs are associated with secure, avoidant, and preoccupied attachment classifications. we then discuss, using examples from transcribed sessions, how these communication patterns can facilitate or impede the rupture resolution process and the clinical implications of these observations. the alliance can be defined as the degree of collaboration regarding the tasks and goals of the therapy as well as the quality of the personal bond between patient and therapist (bordin, 1979). in this view, alliance ruptures may result from a strain in any of these domains (safran & muran, 2000). for example, a patient may not want to discuss her relationships with her parents, she may disagree that the source of her problems is a lack of self esteem, or she may be angry towards the therapist for not showing enough empathy or concern. in all of these cases, what defines a rupture in our view is an experience of some degree of discomfort or affective discord, although the extent to which this is present in the patient’s conscious awareness may vary greatly. in general, a direct way for patients to resolve a rupture is to communicate their distress openly and without hesitation. for example, a patient who feels misunderstood or wounded by an off the mark interpretation from the therapist might say that she feels frustrated by the therapist’s comment. another patient may openly express her reservations about a therapeutic task that she does not feel engaged in. in these scenarios, the patient initiates a requisite step towards repair by expressing to the therapist her experience of the rupture and conveying her present internal state. the therapist can then offer a reparative response, such as proposing a different task, clarifying a misunderstanding, or empathizing with the patient’s frustration. rather than openly conveying their experience of the rupture, many patients may resort to maneuvers that defend against the open expression of emotions or needs. safran & muran (2000) refer to these behaviors as rupture “markers”, as they often signal to the therapist that a strain in the therapeutic relationship has occurred, even without the patient saying so explicitly. some patients may “move away” from the rupture through subtle disconnections from their internal experience, diminished engagement in the interaction, or overly compliant assurances (withdrawal rupture markers; eubanks carter et al., 2014). other patients may make critical or dismissive remarks that oppose either the therapist or the treatment (confrontation rupture markers; eubanks carter, safran & muran, 2014). following harper (1989a and 1989b), safran & muran (2000) see withdrawal and confrontation as two broad categories of rupture behaviors that indicate that the patient perceives a problem in the relationship but does not feel safe communicating his or her feelings about it (see table 1 for examples of withdrawal and confrontation rupture markers). examples of withdrawal and confrontation rupture markers (adapted from eubanks carter, muran, safran, 2014) the topic of how to work through impasses and negative process in the therapeutic relationship has been written about extensively (see e.g., aron, 2006; etchegoyen, 2005; greenson, 1965; kohut, 1984). this paper focuses on the work of safran, muran and colleagues and their empirically informed model for successfully resolving ruptures (safran, muran, & samstag, 1994; safran et al., 2011). according to safran & muran (2000), both patient and therapist must move through a series of “critical tasks” that focus on drawing out the patient’s present, internal experience. in doing so, the therapist pays close attention to the ways in which the patient might be avoiding or moving away from expressing their emotions or asserting themselves. first, the therapist calls the patient’s attention to the confrontation or withdrawal marker. then, the therapist helps the patient move through any reticence or misgivings about expressing his or her feelings or needs related to the rupture, exploring underlying fears and wishes uncovered during this process. although safran and muran demarcate two distinct strategies for dealing with withdrawal and confrontation rupture markers, both entail exploring patients’ untapped internal experience   namely, anger towards the therapist, feelings of sadness and vulnerability, or needs for agency and self assertion. although attachment theory has its origins in the study of early relationships between children and their parents, the theory expanded to become a rich framework for understanding close relationships throughout the lifespan (cassidy & shaver, 2016). attachment research grew out of the pioneering classification by ainsworth (ainsworth, blehar, wall, & waters, 1978) of three different patterns of “proximity seeking” behavior in early childhood (secure, avoidant and ambivalent). the adult attachment interview (aai; george, kaplan, & main, 1996; main, goldwyn, & hesse, 2002) was later developed to assess the sequelae of these early behavioral patterns in adulthood by examining individuals’ narratives about their early attachment history. in the aai, individuals classified as secure provide coherent and vivid descriptions of their childhood experiences. individuals with a dismissing classification (corresponding to the infant classification “avoidant”) narrate their experiences in an overly succinct and unemotional way, while those with a preoccupied classification (corresponding to the infant classification “ambivalent”) speak in a confusing, emotionally exaggerated or vague manner. these three attachment classifications have become a popular way for clinicians and researchers to assess and think about attachment in adulthood (slade, 2008). bowlby (1988) famously postulated that attachment differences in adulthood might be especially apparent in the therapeutic relationship, as the treatment bond parallels an attachment relationship in many respects. this inspired a rich body of research using the aai and other measures establishing an association between secure attachment and strong therapeutic alliances (see meta analysis by bernecker et al., 2013). to explain this association, many influential attachment informed clinicians commonly invoke the hypothesis that secure patients, who have a good enough history of care with their primary attachment figures, experience their therapists as capable of providing care and comfort (see e.g., daniel, 2014, 2006; eagle, 2013; holmes, 2001; wallin, 2007). along the same lines, it is hypothesized that insecure patients, whose caregiving experiences were less consistent, have negative expectations of the therapist’s availability and consequently relate to the therapist in maladaptive ways. in this perspective, patients of the same attachment category share a certain degree of comfort with closeness and differentiation in the therapeutic relationship and thus perceive and relate to the therapist in predictable ways. from a contemporary relational perspective, there are limitations of this attachment informed view of the therapeutic relationship and its emphasis on attachment as certain types of transference like perceptions and expectations. while adult attachment classifications have been shown to be relatively stable over time (see hesse, 2016), clinical wisdom suggests that patients’ experience and view of the therapist and their relationship is far more variable and continuously evolving (wachtel, 2005). thus, equating transference like experiences with attachment classifications may obscure the more granular aspects of the therapeutic interaction that clinicians and researchers are most interested in (marmarosh, 2015; obegi, & berant, 2009; slade, 2016). this is especially relevant when thinking about the bearing of patients’ attachment on the rupture resolution process. given the pernicious effects of unresolved ruptures (muran et al., 2009), it is not enough for therapists to know that secure attachment is associated with stronger alliances. therapists must learn how to recognize and intervene on the specific challenges that insecure attachment brings to the negotiation of a collaborative therapeutic alliance. the introduction of the pacs (talia & miller bottome, 2015) advances the study of attachment in psychotherapy by examining the ways in which attachment as a patient factor influences the therapeutic interaction. with the pacs, we can assess attachment by monitoring the patients’ moment to moment verbal communications with the therapist2. the pacs was developed from the discovery of a number of in session discourse characteristics that were shown to be statistically associated with patients’ pre treatment aai classifications (talia, et al. 2014). the occurrence of these characteristics in a transcript leads to assigning one of three pacs attachment classifications (secure, avoidant and preoccupied) that have been validated in a large scale study as independent and reliable indicators of patients’ three aai classifications (n=156; .87, κ = .82). these findings are especially robust given that they were obtained from samples from three countries and in different therapeutic modalities, including both psychodynamic and cognitive behavioral treatments (talia et al., 2015). with the large scale validation of the pacs, we can not only assess attachment based on patients’ in session behavior; we can predict which sorts of in session processes will be associated with the different attachment classifications. the pacs shows that attachment classifications manifest in patients in psychotherapy as distinct ways of communicating about present internal experience. secure patients convey their present experience openly and allow the therapist to participate in defining and elaborating on their experience. for example, secure patients disclose their emotions in the here and now and share vivid narratives of past experiences that clearly convey their feelings in the present. secure patients also communicate their present intentions, autonomous reflections, and positive experiences. these speech acts, or markers, are rated on the pacs proximity seeking, contact maintaining, and exploring scales. avoidant patients, on the other hand, tend to decline requests to express their here and now experience, or downplay the magnitude or importance of any experience that has been implied. these markers in the pacs are scored on the avoidance scale. finally, preoccupied patients share their experience in a one sided, exaggerated, or confusing way that leaves little room for the therapist to respond, or actively disregard the therapist’s interventions entirely. both patterns of communication, rated on the resistance scale of the pacs, tend to limit the extent to which the therapist is able to participate in making meaning of the patients’ experience. (see table 2 for some examples of pacs in session attachment markers). selection of pacs in session attachment markers. note. only the pacs markers relevant for resolving a rupture are presented in this table. the examples represent instances of the markers occurring in the context of a rupture, but each marker can be coded in reference to any topic. the numbers refer to the original numeration of the pacs markers (see talia, et al., 2015) pacs markers do not by themselves constitute ruptures in the alliance. the secure, avoidant, and preoccupied modalities of communicating about internal experience are pre existing abilities that the patient “brings” to the therapy, given that they can be predicted on the basis of patients’ pre treatment aai and vice versa (talia et al., 2015). these communication differences are not reactions to the therapist or the therapist’s remarks, nor do they emerge exclusively in response to discussing attachment related experiences. the findings from talia et al. (2014) and (2015) show that the in session markers used by secure, avoidant, and preoccupied patients emerge in any given session, regardless of whether a rupture has occurred, and in the context of discussing a wide variety of topics. in thinking about how these pacs communication differences might influence rupture interactions, the overlap between the in session markers of secure attachment and the “critical tasks” of rupture resolution described in safran and muran’s (2000) model are readily apparent. according to safran and muran (2000), rupture repair process involves the therapist exploring patients’ emerging experience of the rupture and of the therapeutic relationship, focusing in particular on the patient’s experiences of anger, vulnerability, and needs for self assertion. these are precisely the sorts of communications that secure patients engage in during psychotherapy. secure patients facilitate repair by expressing whatever anger, shame, or anxiety have been evoked by the rupture and what they want to do about it. avoidant patients tend to struggle to express any present, internal state, while preoccupied patients leave little room for the therapist to make sense of their experience. because they present obstacles to a mutual exploration of patients’ present internal experience, the avoidant and preoccupied in session communication markers can compromise rupture resolution in significant ways. avoidant and preoccupied patients’ communication markers present challenges to the therapy process that can differ from the challenges posed by rupture markers such as withdrawal and confrontation. the pacs avoidant and preoccupied communication markers are particular ways in which insecure patients communicate about their present, ongoing experience. when talking about feelings in the therapeutic relationship, for example, an avoidant patient may dampen or minimize her experience, while a preoccupied patient may convey her experience in confusing or exaggerated terms (see table 2). in either case, the patient is communicating about their experience with the therapist, albeit in a problematic way. on the other hand, withdrawal and confrontation rupture markers are (in safran and muran’s framework) ways in which patients manage to not express their experience of a rupture by withdrawing from or controlling the interaction. for example, patients may fall silent, turn away from the therapist, or declare that they do not want to discuss the rupture further; other patients may become subtly hostile or commanding. these are ways in which patients respond when it does not feel safe to express their vulnerable or angry emotions towards the therapist, almost akin to fight or flight strategies. secure, avoidant and preoccupied patients alike may resort to withdrawal and confrontation in the context of a rupture. however, while secure patients may initially engage in these strategies, with encouragement from the therapist, they remain more readily able to openly express their internal experience. avoidant and preoccupied patients may still persist in communicating about their internal experience in non collaborative ways even after any withdrawal or confrontation has been overcome. in the following, we provide examples of how secure, avoidant, and preoccupied patients’ distinct ways of communicating come to bear upon the rupture resolution process. to illustrate our points, we include examples taken from transcribed sessions with secure, avoidant and preoccupied patients in which a rupture has occurred. the sessions were transcribed and the questionnaires were collected for previous research studies conducted out of the brief psychotherapy research program3. for all of the sessions from which the excerpts were taken, both patient and therapist reported on a post session questionnaire (psq; muran, safran, samstag, & winston, 1992) the occurrence of a rupture   defined on the questionnaire with the statement “did you experience any tension or problem, any misunderstanding, conflict or disagreement, in your relationship with your [therapist/patient] during the session?”. in each excerpt, we will point out where the pacs in session communication markers occur, and discuss how these markers affect the therapist’s attempts to repair the rupture. our first excerpt was taken from a session with a patient named rachel, 41 years old, in treatment for longstanding depression and classified as secure on the pacs. rachel starts the session by telling the therapist about a phone call with her parents that occurred the previous week. the therapist attempts to probe for the patient’s thoughts and feelings during the phone conversation and rachel struggles to recall exactly what those were. the therapist suggests that rachel for the following week work on observing and maybe writing down her thoughts and feelings so that they have some information to work with in sessions. rachel agrees, but begins to laugh nervously. t: why are you smiling? p: no, i'm not smiling (the patient flips through notebook, noticeably smiling) t: is that a discomfort  is that an uncomfortable smile? p: um, no uh, just the writing down thoughts     i thought that you want me to do this because there’s something's wrong with me (wipes eyes). in this interaction, the patient signals that a rupture has occurred through what can be recognized as a withdrawal marker (table 1, marker 1). her laughter, incongruent with her denial that anything is wrong, gives away her discomfort. the therapist attends to this marker (“is that an uncomfortable smile?”) and attempts to explore the patient’s experience further. in response, rachel discloses that she was hurt by the therapist (a proximity seeking marker; table 2, marker 6) and that she believed that the therapist suggested the writing exercise as a way to express a negative evaluation of her. the therapist continues: t: that something's wrong  oh, so just now, a thought came up that the reason i want you to do this is that i think that there’s something wrong with you. p: yeah (laughs, wipes eyes) t: and, and how did that make you feel? if we're using the thought? p: yeah. um, (laughs, wipes eyes) anxious, nervous, upset. t: mmhm. okay. well first of all thank you for be willing to share that with me. i’m not sure that a few sessions ago you would have, right? so that’s great. second of all is, that’s not what i was thinking at all. the therapist explores the rupture experience further by inquiring how this perception of the therapist made her feel. the patient responds with another prototypical pacs marker of in session security and discloses her emotions in the here and now (“nervous, anxious, upset”; proximity seeking table 2, marker 5). disclosing vulnerable feelings or the experience of being hurt in some way by the therapist is at once the open expression of the rupture and the very action that enables successful repair. these secure markers enable patient and therapist to work together to define the patient’s experience of the rupture so that the therapist can respond accordingly. the next excerpt was taken from an article by safran & kraus (2014), which includes a transcription of a session with a patient named ruth. in the paper, the therapist describes how he struggled to remain emotionally connected to ruth, noting in particular her tendency to tell long and sometimes irrelevant seeming stories. the passage from the rupture session begins with ruth noting that termination was nearing and expressing doubt about how much progress she had made thus far (table 1, marker 6). acknowledging her tendency to become “sidetracked”, ruth states that she wishes that the therapist could help her stay “on topic.” ruth admits that this felt uncomfortable for her to say. the therapist asks ruth to elaborate: t: can you say any more about your discomfort? p: well...it’s like i’m being unreasonable and expecting too much...i have a tendency to blame myself when things aren’t going well in a relationship. and i don’t want to do that here. t: yeah. it’s not really fair for you to have to take all the blame if things don’t work out for you here. . . . p: if i’m not to blame. i’m asking you to be really honest and tell me if i go off and start talking about a crack in the ceiling or whatever. actually, as i’m saying that, i’m feeling stronger. in this passage, ruth conveys an active intentionality with regards to the therapeutic interaction by using two different markers from the pacs exploring scale (table 2, markers 16 and 17). she states her independent will in present terms (“i don’t want to…”) and suggests a therapeutic task for the two of them to engage in (“i’m asking you to…tell me if i go off…”). these markers have the effect of conveying a willingness to work collaboratively to address a tendency of hers that might otherwise obstruct her progress. the therapist seems to attune to these states as he affirms her expressed desire not to take the blame on herself. this is followed directly by another pacs exploring marker (table 2, marker 24) through which the patient reflects in the here and now on a feeling that arises as she is speaking. ruth’s self assertion and reflection on her experience as it emerges in the moment, both characteristic markers of secure attachment, set the rupture resolution process in motion. as both ruth and rachel’s excerpts show, patients with a secure attachment classification can experience anxiety about closeness with the therapist and difficulty with aspects of the therapy process. this observation stands in contrast to the typical depiction of secure patients in clinical literature as being trusting and “secure” with their therapists (wallin, 2007). the examples also show that therapists can also struggle to feel close to secure patients and may feel as though they at times avoid contact with the therapist. furthermore, as we have highlighted elsewhere, although secure patients are capable of communicating a perceived strain in the bond with the therapist, they may also initially resort to confrontation and withdrawal. this is particularly notable in the session with rachel, who at first appears to cover up her hurt feelings with nervous laughter and denial. while the signaling of the rupture itself may initially manifest through confrontation or withdrawal, a secure patient’s characteristic pattern of communicating facilitates repair in two major ways. in rachel’s case, the patient expressed feelings of hurt stemming from some action or remark made by the therapist. in ruth’s case, the patient initiated repair by negotiating alternate tasks and reflecting independently on the interaction. the patients’ communications of their present internal states invite the therapist to attune to the patient’s experience of the rupture and make efforts to address it. the next excerpt was taken from a rupture session with chuck, 38 years old, rated avoidant on the pacs and in treatment to address ongoing problems at work. during the fifth session of treatment, chuck raises the concern that the therapist only “focuses on the past” in their sessions and that he has noticed feeling more depressed as a result (table 1, rupture marker 7). the therapist attempts to explore the patient’s experience further: t: but tell me a little more about what your experience is. are you noticing some difficult emotions come up for you right now? p: hm, i guess um y’know some, little emotion     i dunno   what about. t: it can be painful, to start addressing and talking about this, i’m wondering if that is the feeling that you’re having? p: it could possibly be, i can’t really put my finger on it. i have just noticed that outside this room   some days i just   some days i feel like i have a cloud over my head, i just feel more depressed. it’s probably just my   probably just my current circumstances. y’know? t: yea, yea. so, you find yourself feeling depressed thinking about your life circumstances. i kind of heard some emotion in your voice when you said that. p: no, no, you see, i don’t think i’m that emotional. i mean i don’t think i am really depressed for long periods of time, i think i just have you know thoughts, yea. in this excerpt, the patient responds to the therapist’s empathic conjectures with overly general statements that downplay any disclosure of his present experience. one pacs marker of avoidance appears as the patient begins to describe in general terms his depressed mood (table 2, marker 25). his comments about his experience are located in the past (“some days i just…”) and then attributed to an external cause (“my current circumstances”) (table 2, marker 35). these markers shift the attention away from the more specific aspects of the patient’s present experience and partly disengage him from the repair process. in failing to specify further what emotion or self state he is experiencing, the patient leaves the therapist with too much room to guess and probe. what we see in this exchange is prototypical of the avoidant communication pattern: an overly “zoomed out” and generalizing discussion of personal experience that evades deeper understanding. the consequence of this pattern in the context of a rupture is that the repair process is stymied without the patient’s communication of his here and now experience. our final excerpt is from a session with a 50 year old patient named francesca, who is in treatment to get help coping with marital issues. the rupture in this exchange begins with the patient expressing reluctance about directly expressing to the therapist her feelings towards her husband. the patient vaguely implies that she is experiencing “performance anxiety” about “doing it right” for the therapist (table 1, rupture marker 7). the therapist tries to explore the patient’s experience of this discomfort: t: so when you say performance anxiety, you are always performing in front of an audience. and in this case i’m the audience. so you want to do right by me. p: yes. i was amazed in st. louis how little i spoke to people. people who are friends of shane’s family or whatever. i said enough so that i registered my presence, but that’s about it i think. there’s no real freedom in being able to speak, no real freedom to be able to think of anything to say or whatever. t: so, just to bring it back to this situation again, let’s take it one step further, there’s a sense that you don’t want to disappoint me (p: yes.). that you’re really stuck. p: that i’m stuck. i’ve been stuck in this so long. i was thinking this morning that this is an attempt to break out of whatever spot i’m in. but there are other things i need too. i had jokingly mentioned that, just to learn skills of presentation that might be superficial. but perhaps in conjunction with a deeper emotional restructuring, some cosmetic and superficial techniques might be beneficial as well. i took bob to practice last night and was looking at the catalogue for the ymca, which has courses for interviewing… the therapist makes two attempts to explore how the patient’s current feelings and perceptions about the therapist may be connected to the patient’s so called “performance anxiety”. in response, the patient shifts the discussion to an unrelated topic (table 2, marker 52), resisting the therapist’s attempt to attune to the patient’s experience. while a patient using withdrawal markers may change topics as a way to evade rupture related feelings, preoccupied patients show these shifts in topic habitually, regardless of the topic under discussion (talia et al., 2015). in the second patient speech turn, the patient’s discourse devolves into another pacs resistance marker: vague, wordy descriptions of thoughts and intentions (related to being “stuck” in a “situation”; table 2, marker 54), which leave it unclear what the patient is actually thinking, feeling or referring to. this vague marker is not to be confused with the overly general responses of avoidant patients (e.g., “i dunno, i’m just depressed”). vague speech such as this has the paradoxical effect of drawing the listener in while simultaneously preventing any further definition of or attunement to the patient’s experience. the changes of topic and overly vague articulations of the patient’s experience restrict what the therapist can contribute to the dialogue and leave the rupture unattended and unresolved. in this paper, we explored the ways in which attachment affects patients’ capacity to engage in the rupture resolution process. on the basis of patients’ pacs attachment classifications, we examined excerpts from rupture session transcripts and identified different communication patterns that may be especially facilitative or problematic for the resolution of ruptures. we attempted to show that communicating present internal experience openly, as secure patients do, comports well with the tasks of resolving a rupture, while the ways in which avoidant patients and preoccupied patients minimize their own contributions or the contributions of the therapist, respectively, pose particular challenges to the process. although attachment has long since been established as an important factor in the building of a strong therapeutic alliance, until now there has been no empirically based account of how attachment manifests in the therapeutic interaction. the pacs answers important questions about how attachment differences affect the process through which the alliance is negotiated, and reveals distinct process markers that therapists should be mindful of when attempting to repair ruptures with insecure patients. it is important to distinguish the pacs attachment classifications from the idea of attachment “styles” (e.g. mikulincer & shaver, 2007; mallinckrodt, 2010; brennan, clark & shaver, 1998), a term used in an important tradition of social and personality research informed by attachment theory. self reported attachment styles refer to how people tend to experience significant relationships, including the therapeutic relationship. for example, this view posits that avoidant patients experience more discomfort with closeness in the therapeutic relationship whereas preoccupied patients tend to be overly dependent on the therapist. the pacs, on the other hand, examines how patients convey their internal experience in dialogue with the therapist. while self report researchers focus on the nature and quality of patients’ interpersonal experience itself, our focus is on the particular ways in which interpersonal experience is communicated. from our perspective, these are two dimensions of the therapeutic process that may overlap at times, but are otherwise conceptually distinct. according to our analyses of sessions of hundreds of patients assessed with the aai, we have observed that patients of the same attachment category may experience the therapeutic relationship in many different ways. for example, secure patients may struggle with insecurities and experience ruptures in the therapeutic relationship as much as their insecure counterparts. the research evidence, which has found a low correlation between patients’ self report of their attachment tendencies in relationships and their aai classifications, seems to corroborate these observations (roisman et al., 2007). our discussion of the role of attachment in the therapeutic interaction bears a resemblance to the literature on infant attachment and mother infant interactions. in this literature, there is consensus that ruptures (or moments of affective mis coordination) are pervasive in all caregiver infant interactions, and that what is most vital for the infant’s developing sense of agency, mastery, and indeed, secure attachment, is a history of successful repair with the caregiver (see e.g., beebe, & lachmann, 2013; tronick, 1989). in this paper, we adopt a similar view and claim that secure and insecure patients alike experience ruptures in their relationship with the therapist. while the rupture itself, its precipitant and the emotional climate in which it plays out may be idiosyncratic and arise out of the unique characteristics and interactions of a particular patient therapist dyad, the capacity for repair that the patient brings to the interaction is not. according to the recent findings with the pacs, while secure attachment does not necessarily correspond with a problem free therapeutic relationship, it does relate to an ability to openly express present experience and thus enable the successful repair of ruptures. some clinical implications of the analysis presented in this paper warrant further discussion. there seem to be two challenges in repairing a rupture in the therapeutic alliance. the first is patients’ initial reluctance to disclose their painful experience in the relationship, as signaled by withdrawal and confrontation rupture markers. a second challenge to repairing ruptures, in the case of insecure patients, is their habitual mode of communicating present experience. from our perspective, these are two separate aspects of resolving a rupture and it is likely that they require different strategies to be worked through. in pointing out these possible clinical implications, we would be remiss not to acknowledge some limitations of our paper. for one, as we mentioned in the paper’s introduction, our paper focuses on the verbal level of patients’ communication and thereby leaves out other equally important aspects of the therapeutic interaction, such as non verbal behaviors, transference countertransference dynamics, as well as the domains of defenses and emotion regulation capacities. second, although our paper discusses findings from recent attachment research studies and presents clinical case examples that are assessed using an empirically validated research instrument, it is not an empirical study in itself. thus, the conclusions drawn in this paper represent clinical considerations that should be further elaborated and verified with empirical studies. as safran & muran (2000) have shown, withdrawal and confrontation can be ameliorated through the therapist “meta communicating” or talking about the enactment occurring within the relationship through tentative self disclosures and empathic conjectures (safran & kraus, 2014). unlike withdrawal and confrontation, markers of insecure attachment do not seem to be motivated by a conscious or unconscious experience of a lack of intimacy or trust with the therapist. rather, they are a part of a general pattern of communicating present experience in more or less open and collaborative ways. thus, changing these communication patterns may occur more at the implicit, procedural level of the therapeutic relationship, perhaps through the gradual pursuit of “moments of meeting” between patient and therapist (stern et al., 1989). therapists may perhaps begin by initially adapting their communication approach to the patient’s and then gradually prompting for more open disclosures and receptivity to the therapist’s responses over time. future studies may use the pacs to refine the existing rupture resolution strategies and to identify the therapeutic techniques that seem to shift the communication patterns of avoidant and preoccupied patients in a more secure direction. in clinical practice, it is all too common to encounter a patient who seems difficult to reach and on whom rupture resolution strategies do not seem to make an impact. the pacs can help narrow our focus on the particular, momentary obstructions in communication that can stall the repair process and compromise the therapeutic connection. in this paper, we have examined how patients’ approaches to communicating about present experience with their therapist are distinctly related to their attachment classification and the ways in which these communication differences can have immediate and profound effects on the resolution of ruptures in the therapeutic relationship. we suggest that using the pacs to track patients’ communications and to assess the effects of different therapeutic interventions could lead to further refinements of rupture resolution techniques and offer a promising new direction for alliance and attachment focused research. this study was supported in part by a grant from the national institute for mental health mh071768 (principal investigator: j. christopher muran). in developmental attachment research, adults are usually labeled as secure (or autonomous), dismissing, or preoccupied. in attachment research informed by social psychology, the labels “secure”, “avoidant”, and “anxious” are more frequently used. to use the terms that are the most descriptive and least confusing, we will (as it is customary in attachment informed psychotherapy research; slade, 2016) refer to secure or autonomous patients as secure; to avoidant or dismissing patients as avoidant; and to preoccupied or anxious patients as preoccupied. the pacs focuses exclusively on verbal communication and does not include markers in the non verbal realm. this is not meant to suggest that the non verbal realm of communication is not important. the pacs was developed in the effort of establishing concurrent validity between markers of therapy process and the aai, which focuses on verbal narratives only. thus, when devising the pacs, the authors focused only on verbal in session communications. informed consent was obtained for all patients as per the irb protocol, and all of the transcript excerpts have been disguised with names changed and other identifying details altered. connect with nlm national library of medicine 8600 rockville pike bethesda, md 20894

response center: stay informed about apa/apasi’s response to recent federal policy changes affecting psychology explore how scientific research by psychologists can inform our professional lives, family and community relationships, emotional wellness, and more. top 10 trends to watch notable changes and developments are poised to influence the field of psychology in profound ways barriers to care in a changing practice environment psychologists face challenges with capacity, insurance, and the future of mental health care apa publishing products and resources that support research, education, practice and general wellbeing. tools for psychologists to do their jobs every day. artificial intelligence: redefining the future of psychology adam leventhal uses policy focused research to address addiction resources for students, teachers and psychologists at all levels to explore career growth in psychology. careers in media psychology science training sessions browse the latest updates from apa, informed by psychological science. optimism can boost saving, especially for lower income individuals parental favoritism isn’t a myth you can make a difference learn about key issues impacting psychologists today psychologists’ research shows that these long lasting relationships are more critical than many people think and offers insights on how to improve them vol. 53 no. 2 print version: page 60 eight in 10 children in the united states are growing up with a sibling more than the number of kids living with a father. yet sibling relationships earn a fraction of the attention that family studies researchers have cast on other close relationships. but ignoring the role of brothers and sisters in children’s growth and well being is a mistake, said susan mchale, phd, a professor of human development and family studies at penn state university. over the course of childhood, she and her colleagues have found, children spend more out of school time with their siblings than with anyone else, including parents and friends. and over a lifetime, siblings are often the people with whom an individual will ultimately share the most years. “siblings are most people’s longest lasting relationships from early in childhood through old age. this means they can understand you in ways other people can’t,” she said. in the process, brothers and sisters affect each other directly and indirectly, said shawn whiteman, phd, a professor of human development and family studies at utah state university. on one hand, siblings support and learn from one another. on the other, they compete for parental attention and can introduce one another to risky behaviors, including substance use and sex. “the sibling relationship has the ability to uniquely shape a child’s behavior, adjustment, and ­well being, for better and worse,” whiteman said. well into adulthood, siblings keep influencing one another’s mental health and well being. warm sibling relationships those with more affection and intimacy and less conflict are a source of material and emotional support, with the power to protect against loneliness and depression. but research shows that fraught sibling relations are associated with a host of negative outcomes in adulthood, including depressive symptoms and substance use. add to that, sibling relationships are rarely clear cut, which can make them especially tricky to navigate. “we often find that siblings who have intense conflict are also intensely loyal and loving to one another,” mchale said. despite the complexity of sibling relationships, psychologists are fleshing out the ways in which they matter. in childhood, these relationships have significant influence on development, in some cases greater than the influence of parents or peers. sibling conflict, however, can be stressful for entire families and may contribute to depression and loneliness among adults. fortunately, the research is also pointing toward ways to help siblings get along. though research on siblings has lagged, these relationships are gaining more attention as psychologists find increasing evidence of their importance for development and well being, said laurie kramer, phd, a clinical psychologist at northeastern university who studies the mechanisms by which young children can develop positive relationships with their siblings. “we’re learning more and more about their significance and how siblings help one another and create conflict across the life span.” from early childhood, siblings are important teachers. they model how to behave at home and in the world and can offer practical advice on everything from math homework to asking a crush on a date. “siblings often have a better sense of what you’re experiencing with peers or with parts of your world that parents don’t have access to or don’t see in the same way. that shared perspective is one of the facets that makes sibling relationships so valuable for child development,” kramer said. and that shared experience continues to be important far into the future. “no one else will know what it was like growing up with your parents in your household, and that sense of being understood by another person can be incredibly powerful,” she added. sibling warmth and support in childhood has been linked to a number of positive outcomes, including peer acceptance and social competence, academic engagement and educational attainment, and intimate relationships in adolescence and young adulthood, as mchale and colleagues described in a review of sibling dynamics in childhood. warm sibling relationships can also help buffer against the negative effects of stressful life events such as bullying or parental hostility, they found (clinical child and family psychology review,vol. 15, no. 1, 2012). children can also learn bad habits from their brothers and sisters. “siblings can shape risky behaviors during adolescence,” said whiteman, who is studying how siblings influence substance use in adolescence. he’s found, for instance, that older siblings often introduce younger siblings to alcohol directly by providing it or by drinking with them. but older siblings also influence younger siblings’ alcohol use indirectly by shaping their expectations about drinking (addictive behaviors,vol. 53, 2016). “having an older brother or sister who uses substances makes you more likely to use them. and if you look up to them, you’re much more likely to engage in substance use,” he said. sibling conflict can also lead to negative consequences. while minor squabbles can help children learn to solve problems and navigate conflict, high levels of conflict and aggression between siblings can have lasting effects on a child’s mental health. in a longitudinal study of u.s. adolescents, mchale and colleagues studied sibling relational aggression nonphysical aggression such as excluding or belittling a sibling. they found sibling relational aggression was associated with depression, low self worth, and participation in risky behaviors. but those negative outcomes differ somewhat in boys versus girls, older versus younger siblings, and siblings in mixed gender versus ­same gender pairs. in other words, there’s more work to be done to fully understand the complex ways siblings can harm one another through mean behavior, mchale said (journal of youth and adolescence,vol. 47, no. 10, 2018). all told, sibling interactions and relationships deserve much more attention from parents, educators, mental health professionals, and researchers, said whiteman. “sibling relationships predict youth outcomes above and beyond the influence of parents and peers.” sibling relationships remain important well into the adult years. though siblings may interact less frequently as they get older, some research suggests that they may start getting along better in young adulthood. whiteman found that siblings report less conflict over the course of young adulthood (journal of family psychology,vol. 32, no. 3, 2018). he also found that while young adults reported communicating less frequently with siblings after leaving home, they considered those talks more meaningful and felt they better understood their siblings in emerging adulthood (journal of social and personal relationships,vol. 36, no. 8, 2019). sibling support also has tangible benefits in early adulthood. a longitudinal study of university students found that when pursuing personal goals, sibling support is as advantageous as support from parents and peers (audet, é. c., et al., family relations,vol. 70, no. 5, 2021). having close sibling relationships in childhood continues to impact well being well into middle age. harvard university psychiatrist robert waldinger, md, and colleagues explored the influence of siblings using data from the harvard study of adult development, which has followed male subjects since 1938. they found participants who reported poorer relationships with siblings at age 18 or 19 had a greater likelihood of major depression and use of mood altering drugs by age 50. that pattern held even after adjusting for the quality of the participants’ relationship with parents (the american journal of psychiatry,vol. 164, no. 6, 2007). siblings keep influencing one another as they age, said megan gilligan, phd, an associate professor of human development and family studies at iowa state university who researches sibling relationships in older adults. and the quality of those relationships continues to have implications for well being. in a study of older adult siblings, gilligan found participants generally reported high levels of warmth and low levels of conflict. sister sister pairs were especially likely to report warm relationships. warm sibling relationships, in turn, seemed to protect against loneliness. however, older adults who reported more sibling conflict and parental favoritism in adulthood were more likely to experience symptoms of depression, anxiety, hostility, and loneliness (journal of family psychology,vol. 34, no. 2, 2020). “siblings are really influential in mental health, well beyond childhood and adolescence,” she said. parents can help improve these critical relationships from the beginning. according to family researchers, one of the most important things parents can do early on is to avoid behavior that can be seen as favoring one child over another. “children are keen observers of how they are treated differently from their brothers or sisters,” whiteman said. “the perception that you’re not the favored one is linked to poor adjustment and impacts the quality of relationships with your parents and your siblings.” “differential parental treatment,” as researchers describe the phenomenon, can affect every child in the family and can continue to drive a wedge well into adulthood, gilligan said. “the presence of favoritism, even if you’re the favored one, can cause competition and conflict. perceptions of favoritism also exacerbate conflict during times of stress, such as when caring for parents later in life,” she said. to avoid this major source of conflict, parents should regularly consider if they are creating a fair environment, whiteman said. parents should avoid comparing siblings or setting them up to compete with one another. and hard as it may be, they should try not to take sides when siblings argue. parents do sometimes need to treat kids differently. “but it has to be fair. justice is very important for children,” he said. if parents tell their daughter she can’t stay out as late as her brother but don’t give an explanation, she might see it as favoritism. instead, they should explain that she has an earlier curfew because she’s younger, and she’ll probably recognize the argument as just. parents can also foster close sibling relationships by promoting healthy relationships with other friends and family members. kramer followed sibling pairs for 13 years, beginning before the birth of the second child, and looked at a number of different factors to predict which siblings would have the most positive relationships. she found that preschoolers who had a positive relationship with a best friend before their sibling was born were more likely to have a good relationship with their brother or sister. “best friendships were the most predictive thing even more important than the quality of the older child’s relationship with their mother,” she said. parents should also proactively coach young children on how to get along, according to psychologists. when siblings are left to sort out problems on their own, they’re likely to continue fighting and that unresolved conflict can intensify, potentially leading to sibling bullying or aggression. kramer’s research indicates that parents can help their children develop skills to manage sibling conflict by teaching them to express their points of view in a disagreement and actively solving problems with their kids to help them find solutions to their arguments (kramer, l., et al., in fiese, b. h., et al. [eds.], apa handbook of contemporary family psychology: foundations, methods, and contemporary issues across the lifespan, 2019). once they’re sure the kids have the skills to manage conflict, then parents can begin to step back to let them solve problems on their own. “it’s important to put intentional strategies into place. when children lacking these skills are left to their own devices, they flounder,” kramer said. “every day, parents have so many opportunities to help children develop a more positive relationship with one another.” to help with that goal, kramer and colleagues created the more fun with sisters and brothers program, a free online intervention for families with two children between the ages of 4 and 8. the intervention teaches parents strategies to help their children develop social and emotional competencies, such as accepting or appropriately declining invitations to play, regulating emotions, and managing conflict. a study of the intervention found children whose families participated had greater emotional regulation and better sibling relationship quality at the end of the monthlong intervention than those in a wait list control group (journal of family psychology, vol. 29, no. 3, 2015). what’s more, the study found the intervention also relieved mothers’ stress and depression by improving family harmony. mchale and her colleagues penn state psychologist mark feinberg, phd; arizona state researcher kimberly updegraff, phd; and harvard university researcher adriana ­umaña taylor phd have created and tested the siblings are special program, a ­12 session after school intervention for siblings in elementary school. one randomized controlled trial found the program enhanced positive sibling relationships and improved children’s self control, social competence, and even academic performance (journal of adolescent health,vol. 53, no. 2, 2013). a second trial involving low income latino families also found positive effects, including improvements in sibling relationships, parent child relationships, and older siblings’ emotional efficacy (journal of family psychology,vol. 30, no. 5, 2016). in both cases, the intervention also reduced depressive symptoms in mothers. “that’s not surprising when you consider that sibling conflict is one of parents’ largest everyday stressors,” mchale said. resolving conflicts isn’t the only way parents can foster a close relationship between siblings. they can set up opportunities for kids to spend time together by doing shared family activities such as playing sports or board games and by making sure today’s overscheduled children actually have time to engage with family. and it helps to let siblings know that parents value their relationship with one another. “simple messages of praise such as, ‘it warms my heart when i see you two playing together’ can give children the message that sustaining a positive sibling relationship is important and valued by parents,” kramer said. sibling relationships naturally change over the course of a lifetime. transition points such as leaving home, getting married, having kids, and dealing with parents’ divorce or death offer natural opportunities for siblings to reevaluate and reinvest in these relationships, whiteman said whether by coming together or drifting apart. “whenever there is a transition, it offers an opportunity for change,” he said. psychotherapists should help patients explore how these influential relationships affect them in ways both positive and negative. “in practice, we tend to focus on individuals’ relationships with their parents. we often overlook the very formative contributions that siblings have on our ­well being and growth,” kramer said. but there are important reasons not to overlook the influence of brothers and sisters. when spending time with siblings, “we tend to fall back into the well worn grooves of our family roles,” said eileen kennedy moore, phd, a clinical psychologist in princeton, new jersey, and author of kid confidence: help your child make friends, build resilience, and develop real self esteem (new harbinger publications, 2019). even as adults, siblings often tease one another and push each other’s buttons. at the same time, they can become frustrated by patterns that seem to play out again and again such as older siblings feeling like their younger siblings don’t pitch in to help as often as they should, and younger siblings bristling at unsolicited advice from their big brother or sister. clinicians can help patients recognize and change these patterns. to reset the dynamic, kennedy moore recommends helping patients to recognize the role they play in these patterns and consider their siblings’ behavior through a new lens. “our image of our siblings can be out of date. just as we want our siblings to recognize we’ve changed [since childhood], we also have to watch our own assumptions about what they’re like,” she said. as with any relationship, sibling relationships benefit from clear communication and good boundaries skills that psychotherapists can help patients develop. and though sibling relationships may not be top of mind in a typical therapy session, they are worth asking about and addressing, kennedy moore added. “sibling relationships are often the longest relationships of our lives, and are at least as important as the parent child relationship,” she said. “we can’t redo the past, but we can choose to move forward with our siblings in different ways.” sibling relationships in adulthood: research findings and new frontiers gilligan, m., et al., journal of family theory & review, 2020 parenting programs to improve sibling interactions: a meta analysis leijten p., et al., journal of family psychology, 2021 the third rail of family systems: sibling relationships, mental and behavioral health, and preventive intervention in childhood and adolescence feinberg, m. e., et al., clinical child and family psychology review, 2012 siblings as agents of socialization kramer, l., & conger, k. j. (eds.), new directions for child and adolescent development (special issue), 2009 my sibling filliozat, i., magination press, 2020 © 2025 american psychological association 750 first st. ne, washington, dc 20002 4242 telephone: (800) 374 2721; (202) 336 5500 | tdd/tty: (202) 336 6123

ny times book reviews   thu, 09/19/2024   5:04am categories   book reviews ny times book reviews   thu, 09/19/2024   5:01am categories   book reviews ny times book reviews   thu, 09/19/2024   5:00am categories   book reviews ny times book reviews   wed, 09/18/2024   5:55pm categories   book reviews ny times book reviews   wed, 09/18/2024   1:40pm categories   book reviews ny times book reviews   wed, 09/18/2024   11:09am categories   book reviews ny times book reviews   wed, 09/18/2024   9:40am categories   book reviews npr book reviews   wed, 09/18/2024   8:00am khuê phạm's debut novel follows a young berlin journalist whose parents emigrated from south vietnam. a message from an estranged uncle in the u.s. prompts her to explore her family history. categories   book reviews ny times book reviews   wed, 09/18/2024   5:03am categories   book reviews ny times book reviews   wed, 09/18/2024   5:02am categories   book reviews ny times book reviews   wed, 09/18/2024   5:02am categories   book reviews ny times book reviews   wed, 09/18/2024   5:01am categories   book reviews ny times book reviews   wed, 09/18/2024   5:01am categories   book reviews ny times book reviews   wed, 09/18/2024   5:00am categories   book reviews ny times book reviews   tue, 09/17/2024   3:51pm categories   book reviews ny times book reviews   tue, 09/17/2024   2:32pm categories   book reviews ny times book reviews   tue, 09/17/2024   5:03am categories   book reviews ny times book reviews   tue, 09/17/2024   5:01am categories   book reviews ny times book reviews   tue, 09/17/2024   5:00am categories   book reviews ny times book reviews   tue, 09/17/2024   5:00am categories   book reviews atlantic county library system 40 farragut ave., mays landing, nj 08330 phone: (609) 625 2776 | fax: (609) 625 8143 comments or questions? contact us atlantic county executive dennis levinson board of county commissioners, richard r. dase, chairman

teen mental health & substance use treatment centers contact us · 877 929 5105 get started our admissions counselors are here to help you take the first step in your path to healing. newport academy works with leading health insurance plans to support families. discover what makes us different, with personalized treatments led by experts in their fields. the newport academy outpatient program treats teens who are experiencing psychological, behavioral, and/or substance abuse issues. witnessing a child's struggle with depression is heartbreaking. parents often feel helpless. treatment can be transformative for the whole family. the constant worrying, irrational fears, and self judgment associated with anxiety can be paralyzing. evidence based treatment can help anxious teens. each teen attends multiple individual therapy sessions with the expert clinicians and psychiatrists who make up his or her personal treatment team. our teachers work with the student’s parents, the school, and clinicians to create a customized academic plan that will best help them grow and succeed. our focus on sustainable healing puts teens and young adults on a pathway for success. the incredible success stories from our alumni inspire us every day. see for yourself. find an outpatient location to help transition in a structured and secure environment. our female residential locations offer comfort and natural beauty to cultivate transformation and healing. explore our male residential locations that offer both serenity and quick access from the major cities. explore our philosophy of care and learn how our revolutionary approach to behavioral healthcare is helping children, teens, and families across the country. the newport academy team is made up of compassionate experts with a depth and breadth of knowledge in child and adolescent mental health treatment. contact us 877 929 5105 get started our admissions counselors are here to help you take the first step in your path to healing. newport academy works with leading health insurance plans to support families. discover what makes us different, with personalized treatments led by experts in their fields. the newport academy outpatient program treats teens who are experiencing psychological, behavioral, and/or substance abuse issues. witnessing a child's struggle with depression is heartbreaking. parents often feel helpless. treatment can be transformative for the whole family. the constant worrying, irrational fears, and self judgment associated with anxiety can be paralyzing. evidence based treatment can help anxious teens. each teen attends multiple individual therapy sessions with the expert clinicians and psychiatrists who make up his or her personal treatment team. our teachers work with the student’s parents, the school, and clinicians to create a customized academic plan that will best help them grow and succeed. our focus on sustainable healing puts teens and young adults on a pathway for success. the incredible success stories from our alumni inspire us every day. see for yourself. find an outpatient location to help transition in a structured and secure environment. our female residential locations offer comfort and natural beauty to cultivate transformation and healing. explore our male residential locations that offer both serenity and quick access from the major cities. explore our philosophy of care and learn how our revolutionary approach to behavioral healthcare is helping children, teens, and families across the country. the newport academy team is made up of compassionate experts with a depth and breadth of knowledge in child and adolescent mental health treatment. in healthy parent child relationships, parents give and children receive. the role of a parent is to provide care and unconditional love so that children are free to focus their energy on learning and growing. however, not all individuals have the stability and inner resources to be this kind of parent. instead, they may rely on their children in inappropriate ways. the result is a phenomenon known as parentification. according to the national alliance for caregiving, about 1.4 million children and adolescents in the united states experience parentification. however, it is often overlooked or unrecognized. therefore, it’s possible that many more children and teens belong in this category. parentification occurs when parents look to their children for emotional and/or practical support, rather than providing it. hence, the child becomes the caregiver. as a result, parentified children are forced to assume adult responsibilities and behaviors before they are ready to do so. in addition, they do not receive acknowledgment or support for taking on these responsibilities. the word parentification was coined by the hungarian american psychiatrist ivan boszormenyi nagy, one of the founders of the field of family therapy. the word describes what happens when the roles of parent and child are reversed. consequently, this role reversal disrupts the natural process of child development. in most cases, it has far reaching negative effects on the child’s mental and physical health. “when parentification assumes pathological proportions, parents are often unwittingly replaying painful and abusive scripts from their own childhood and setting the stage for succeeding generations to do the same.”  gregory j. jurkovic, author of lost childhoods: the plight of the parentified child experts have identified two distinct types of parentification: instrumental and emotional. in cases of instrumental parentification, children take on practical responsibilities such as: emotional parentification involves a child providing emotional support to a parent, including: gregory j. jurkovic, author of lost childhoods: the plight of the parentified child, identified another division between types of parentification. adaptive parentification usually involves the child taking on adult responsibilities for short periods of time due to necessity. this might be because a parent or sibling is sick, for example. destructive parentification is ongoing and involves what jurkovic described as a long term “violation of intergenerational boundaries.” in addition, parentification can be parent focused or sibling focused. parent focused parentification describes caregiving directed toward the parent or primary caregiver. sibling focused parentification indicates that the child or teen has taken a caregiving role toward a sibling or siblings. in most cases of parentification, the parent is compromised in some way. hence, it is more likely to occur when a parent: moreover, financial hardship, divorce, or the illness of a sibling can create conditions that may lead to parentification. parentification can be a form of parental neglect or abuse, particularly in extreme cases. this can result in what’s known as relational trauma. relational trauma occurs in childhood when the bonds between parent and child are somehow disrupted or broken. this creates a state of chronic stress in which children are unable to access the support and protection they need. parentification child trauma can produce both short  and long term impacts on a child’s life and well being. and the earlier the parentification begins, the more negative the consequences for the parentified child. as with other types of childhood trauma, parentification can result in a wide range of mental health issues. parentified children may have a hard time building trust and may have problems with anger and emotional regulation. in addition, parentified children may suffer from the manifestations of underlying trauma, including depression, anxiety, eating disorders, and substance use disorder. as parentified children become young adults, they often struggle with relationships, particularly romantic relationships. they may not know how to set boundaries with others or how to get their needs met in healthy ways. a parentified teenager may exhibit the following symptoms: the impact of parentification trauma typically continues into adulthood. research shows that having adverse childhood experiences increase the likelihood of both mental and physical health problems. the ongoing stress of such experiences actually changes the brain shrinking the hippocampus, the part of the brain that regulates memory, emotion, and stress management. hence, adults who were parentified as children or teens may experience the following: does your teen need help? we are here for you! have questions? send us a message. continue reading ▼ over the past two decades, dr. lisa hooper and her collaborators have done extensive research on parentification. hence, they have developed a parentification scale. known as the parentification inventory, this scale is a series of statements regarding family dynamics. in response to each statement, individuals choose a number between 1 (never true) and 5 (always true) that describes their experience. the results indicate the extent to which the individual has been parentified. gregory jurkovic developed a similar questionnaire. parents can ask their children to answer yes or no to the following questions, which indicate whether they are experiencing parentification effects. adults may find that they relate to these descriptors, now and/or during their childhood. if that’s the case, they may have experienced one of the types of parentification as part of their family systems. to be clear, it’s not always a bad thing for a parent to talk to a child or teen about what they’re feeling, in age appropriate ways. in fact, kids may feel confused or blame themselves if they know a parent is unhappy but don’t understand what’s making them sad. but the parent should not look to the child for help in coping with their emotions. furthermore, it’s fine for kids to help out around the house or care for younger siblings sometimes, or even for a parent if they are briefly unwell. in fact, taking on family responsibilities in appropriate measure can give a child a sense of satisfaction and competence. however, helping out at home should not be at the expense of a child’s or teen’s emotional or physical health. nor should it disrupt their academic studies, peer relationships, or the other “work” of growing up. in summary, children should never feel that they are responsible for keeping their parents happy or keeping the family safe. treatment focuses on addressing the resulting trauma, neglect, and chronic stress. therefore, modalities to address the parentified child may include the following. the goal of parentification treatment is to repair the damage that arises from a disrupted childhood. hence, the parentified child can gradually heal from the painful consequences of those early experiences. moreover, they can build skills for developing healthy boundaries and caring relationships essential ingredients for a balanced, happy life. at newport academy, we address mental health and behavioral issues through the lens of family. our approach to adolescent treatment addresses underlying trauma both acute and relational to provide long term, sustainable healing. contact us today to schedule a free assessment. parentification can take the form of responsibility for life tasks (caring for a sibling, cooking and cleaning, or paying bills) or age inappropriate emotional support (listening to adult problems, offering advice, or mediating with another family member). a parentified child does not develop a clear sense of their own needs and feelings. as an adult, they may find it hard to trust others, manage their own emotions, and form healthy intimate relationships. they face a greater risk of anxiety, depression, substance use disorders, and eating disorders. extreme cases of parentification can be a form of trauma, especially emotional parentification. relational trauma occurs in childhood when the bonds between parent and child are somehow disrupted or broken, as with parentification. a parentified child does not learn to distinguish their own needs and feelings from those of other people. hence, they are more likely to have difficulty with relationships and emotional regulation, resulting in increased risk for anxiety, depression, substance use disorders, and eating disorders. a range of modalities are effective in healing from the effects of parentification. talk therapies, like cognitive behavioral therapy or dialectical behavioral therapy, address habitual thought patterns. somatic therapies, such as emdr, can release traumatic memories stored in the body. and experiential therapies, such as equine or creative art therapy, can help a parentified child learn how to relax and play. j am acad child adolesc psychiatry. 2014 apr;53(4):417 24. pnas. 2012 august ;109 (32):1 2927 12932. am j family ther. 2011; 39(3): 226 241. get our newsletter stay connected our socal locations are safe & continuing to serve children and 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acls events   thu, 06/20/2024   12:22pm all skill levels are welcome. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all materials are provided. all programs are subject to change or cancellation. feeling bored? stop in for a fun day playing different board games.games provided. all programs are subject to change or cancellation. acls events   thu, 06/20/2024   12:22pm guardians must remain present with their children during the event.drop offs are not permitted. all programs are subject to change or cancellation. the cape may county zoo's unique and unforgettable outreach program comes for a visit. build a deeper understanding and appreciation for our natural world through this hands on, interactive program. acls events   thu, 06/20/2024   12:22pm all skill levels are welcome. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all materials are provided. space is limited. all programs are subject to change or cancellation. take the challenge of playing a friendly game of chess with other locals. acls events   thu, 06/20/2024   12:22pm sponsored by the atlantic county library foundation. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. space is limited. all programs are subject to change or cancellation. supplies are limited. bring your ideas to life using crayola air dry clay! acls events   thu, 06/20/2024   12:22pm exercise class acls events   thu, 06/20/2024   12:22pm all programs are subject to change or cancellation. join a rutgers master gardener to learn about midsummer planting for a productive fall harvest. acls events   thu, 06/20/2024   12:22pm meeting acls events   thu, 06/20/2024   12:22pm please notify staff of any food allergies. guardians must remain present with their children during the event.drop offs are not permitted. snacks provided.please advise staff of food allergies. space is limited. all programs are subject to change or cancellation. kids, join for a few quick stories, songs, an easy craft, plus a treat. acls events   thu, 06/20/2024   12:22pm children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all programs are subject to change or cancellation. songs, stories, and oh so much fun! acls events   thu, 06/20/2024   12:22pm please notify staff of any food allergies. snacks provided.please advise staff of food allergies. all programs are subject to change or cancellation. love a good adventure book? discuss books while enjoying snacks. june 15th: i survived the great molasses flood, 1919 by lauren tarshis july 13th: clayton byrd goes underground by rita williams garcia aug 10th : rowley jefferson's awesome friendly adventure by jeff kinney please advise staff of any food allergies. guardians must remain present. acls events   thu, 06/20/2024   12:22pm please notify staff of any food allergies. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all programs are subject to change or cancellation. use your scientific thinking skills to uncover these summer mysteries. saturday, june 29: rain cloud in a cup saturday, july 13: paper circuit art saturday, august 17: diy ice cream acls events   thu, 06/20/2024   12:22pm all skill levels are welcome. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all materials are provided. space is limited. all programs are subject to change or cancellation. do you love chess? have you always wanted to learn? our chess club is for all ages and levels of experience. feel free to bring your own chess board or use one of ours. acls events   thu, 06/20/2024   12:22pm children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all programs are subject to change or cancellation. come in and cool down from the summer's heat and enjoy an afternoon movie with us. stop by or call for the movie title of the week.food and drink are welcomed. acls events   thu, 06/20/2024   12:22pm all skill levels are welcome. children 9 and younger must be accompanied by an adult.please plan to attend with your child for the entire program.drop offs not permitted. all materials are provided. all programs are subject to change or cancellation. drop by the children's area to make your own lego creations. this is a self guided activity. ask for legos at the front desk. please remember to clean them up when you're done! acls events   thu, 06/20/2024   12:22pm all materials are provided. space is limited. all programs are subject to change or cancellation. discover how to sew both by hand, and with machines. also learn how to take measurements, select a pattern, and choose fabric. acls events   thu, 06/20/2024   12:22pm open to children and teens,10 and older. stop by with your friends for a fun afternoon of board games and puzzles. all programs are subject to change or cancellations. acls events   thu, 06/20/2024   12:22pm all materials are provided. space is limited. all programs are subject to change or cancellation. supplies are limited. join us for a family craft day. share your family's creativity with other participants and take home your art pieces. all materials provided. all programs are subject to change or cancellation. acls events   thu, 06/20/2024   12:22pm guardians must remain present with their children during the event.drop offs are not permitted. all programs are subject to change or cancellation. this interactive story hour, which includes a grab go craft, will surely delight the kids. children during the event. all programs are subject to change or cancellations. acls events   thu, 06/20/2024   12:22pm open to ages 2 4. registration required. the latest books & some old favorites will help introduce new vocabulary & reinforce learning. children & their caregivers will enjoy stories, songs, crafts, games & movement while building language & literacy skills. we ask that guardians please remain present with children under age 9 during the event. all programs subject to change or cancellation. acls events   thu, 06/20/2024   12:22pm all skill levels are welcome. all materials are provided. space is limited. all programs are subject to change or cancellation. come to the library and enjoy a friendly game of mahjong at the library.instruction & guidance given for beginners to learn this fun table game. atlantic county library system 40 farragut ave., mays landing, nj 08330 phone: (609) 625 2776 | fax: (609) 625 8143 comments or questions? contact us atlantic county executive dennis levinson board of county commissioners, richard r. dase, chairman

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supported by she believed the bond between adults was as sustaining as that between parent and child, and developed a therapy to strengthen and repair broken relationships. by penelope green sue johnson, a british born canadian clinical psychologist and best selling author who developed a novel method of couples therapy based on emotional attachment, challenging what had been the dominant behavioral approach   the idea that behaviors are learned and thus can be changed   died on april 23 in victoria, british columbia. she was 76. her death, in a hospital, was caused by a rare form of melanoma, said her husband, john douglas. when divorce rates rose in the 1970s, couples therapy blossomed. drawing from traditional psychotherapy practices, therapists focused mostly on helping distressed couples communicate more effectively, delve into their upbringings and “negotiate and bargain,” as dr. johnson put it, over divisive issues like parenting, sex and household chores. in her own practice, however, she became frustrated at how her couples seemed to be stalling out. “my couples didn’t care about insight into their childhood relationships,” she wrote in her book “hold me tight: seven conversations for a lifetime of love” (2008), which has sold more than a million copies and been translated into 30 languages. “they didn’t want to be reasonable and learn to negotiate. they certainly didn’t want to be taught rules for fighting effectively. love, it seemed, was all about nonnegotiables. you can’t bargain for compassion, for connection. these are not intellectual reactions; they are emotional responses.” in conventional therapy that sought to modify behavior, emotions had long been dismissed as problematic in dealing with marital issues   something to be tamed   and dependence on a loved one was seen as a sign of dysfunction. dr. johnson thought otherwise. she knew of the attachment studies of john bowlby, the british psychiatrist who studied children who had been traumatized by being orphaned or separated from their parents during world war ii. later researchers began to focus on adult attachments and noted how secure connections among couples helped them weather the inevitable storms of relationships.

 three months into the pandemic, i had the urge to see my 28 year old daughter and her husband, 2000 miles away. she had weathered an acute health crisis, followed by community protests that propelled them both onto the streets to serve food and clean up neighborhoods. they were coping, but the accumulation of challenges made the mom in me to want to connect with and support them.