“We would rather be ruined than changed”*

*from “The Age of Anxiety”, (Britannica.com): “poem by W.H. Auden, published in 1947. Described as a “baroque eclogue,” the poem was the last of Auden’s long poems; it won the Pulitzer Prize for poetry in 1948.

The poem highlights human isolation, a condition magnified by the lack of tradition or religious belief in the modern age. The setting is nighttime at a bar in New York City, where four strangers—three men and one woman—meet, talk, and drink. The carousing ends in the woman’s apartment. Two men leave, and the third disappoints her by passing out drunk.

After exploring the spiritual emptiness, the loneliness, and the anxiety-ridden purposelessness of these characters’ lives, the poem ends at dawn on the streets of the city.”

Elitsa Dermendzhiyska, science writer and social entrepreneur, wrote for The Guardian of 10 Jan 2020:

“…When you delve into it, the question of how people change through therapy can make your head swim. Here’s a psychological intervention that seems to work as well as drugs (and, studies suggest, possibly better over the long term), and yet what is it, precisely, that works? Two people sit in a room and talk, every week, for a set amount of time, and at some point one of them walks out the door a different person, no longer beleaguered by pain, crippled by fear or crushed by despair. Why? How?

Things get even more puzzling if you consider the sheer number of therapies on offer and the conflicting methods that they often employ. Some want you to feel more (eg, psychodynamic and emotion-focused approaches); others to feel less and think more (eg cognitive behavioural therapies, or CBT). The former see difficult emotions as something that needs to come out, be worked through and re-assimilated; the latter as something to be challenged and controlled through conscious modification of negative thoughts…

A lot of researchers, however, believe that this is not the only explanation. For them, the deeper reason why no single psychotherapy seems to provide unique advantages over any other is that they all work because of shared elements. Chief among these is the therapeutic relationship, connected to positive outcomes by a wealth of evidence.

The emotional bond and the collaboration between client and therapist – called the alliance – have emerged as a strong predictor of improvement, even in therapies that don’t emphasise relational factors…

Attachment theory traces its roots to the British psychoanalyst John Bowlby, who in the 1950s combined evolutionary theory and psychoanalysis into a brave new paradigm. Aghast at his profession’s lack of academic rigour, Bowlby turned to the burgeoning science of animal behaviour. Experiments with infant monkeys (some so plainly cruel that no ethical board would permit them today) had challenged the then prevailing notion that infants see their mothers chiefly as a source of food…

Bowlby realised that “the mother-infant bond is not purely generated by the drive to latch onto the breast, but it’s also motivated by this idea of comfort”, says Jeremy Holmes, a British professor of psychological therapies (now part-retired) and co-author of the book Attachment in Therapeutic Practice (2018)…

This pattern of empathising, then reframing and de-shaming looks uncannily like the mirroring-and-soothing exchanges between mother and infant in the first years of life. Spend any amount of time around a newborn and you’ll see that, when baby cries, mum swoops in, picks him up and then scrunches her face in an exaggerated imitation of his distress. According to Peter Fonagy, a psychopathology researcher at University College London, who has long studied children and young people, the mother’s amplified reflection forms a key part of the child’s developing a sense of self and emotional control. “Anxiety, for example, is for the infant a confusing mixture of physical changes, ideas and behaviours,” he told me. “When the mother reflects, or mirrors, the child’s anxiety, he now ‘knows’ what he’s feeling.”

This knowledge, says Fonagy, doesn’t come prewired into us. We don’t understand the meaning of our internal experiences until we see them externalised, or played out for us in the faces and reactions of our caregivers. “Paradoxically, even though I now know perfectly well when I feel anxious,” Fonagy explains in a video interview from 2016, “the anxiety that I recognise as my anxiety is actually not my own anxiety but is my picture of my mum looking back at me when I as a baby felt anxious.” The sensitive mother picks up on the infant’s mental and emotional state and mirrors it; the child learns to recognise his internal experience as “sadness” or “anxiety” or “joy”. Previously chaotic sensations now become coherent and integrated into the infant’s sense of who he is, allowing emotions to be processed, predicted and appropriately navigated.

But mum doesn’t just mirror baby’s emotional pain; she soothes it. Rocking the infant in her arms or cooing in that mellifluous voice that stops tears in their tracks, the responsive mother contains the baby’s negative feelings. Distress, writes Holmes in 2015, “is transmitted from baby to mother, ‘metabolised’ via mother’s musings” and so predigested. It is given back to the baby in an altered, less intense form…

A similar process occurs in therapy. After a while, clients internalise the warmth and understanding of their therapist, turning it into an internal resource to draw on for strength and support. A new, compassionate voice flickers into life, silencing that of the inner critic – itself an echo of insensitive earlier attachment figures. But this transformation doesn’t come easy. As the poet WH Auden wrote in The Age of Anxiety (1947): “We would rather be ruined than changed.”…

This happens not just through talking but wordlessly, too. In fact, according to the psychologist Allan Schore of the University of California, Los Angeles, who has studied attachment from the viewpoint of neurobiology over the past 20 years, change in therapy occurs not so much in the intellectual communication between client and therapist but in a more imperceptible way – through a conversation between two brains and two bodies. Perhaps this mode of attachment predominates in therapies where there is less talking, and more rule-following.

Once again, the process mirrors good caregiving early in life. Long before speech, mother and infant communicate with each other via nonverbal cues – facial expression, mutual gaze, vocal nuance, gesture and touch. In the squeeze of his fist, in the batting of an eyelash, the sensitive mother “reads” her child’s emotional states and responds appropriately through her own body. These wordless communications, writes Schore, get registered and processed by the baby’s right-brain hemisphere, shaping the nascent neural systems involved in emotion processing and automatic stress responses. Mum’s nonverbal signals become encoded as implicit, non-conscious strategies that the infant’s right brain will later activate unconsciously to regulate his emotions…

Again, something similar plays out in therapy. The good practitioner subconsciously tunes in to those emotions left unsaid, to the internal states the client might not even be aware of. Moment by moment, the therapist adjusts her own body language in response to her client’s internal rhythms, engaging them in a kind of dance in which both partners mutually influence and synchronise themselves to each other. According to Schore, over time the nonverbal attachment communications from the therapist can become imprinted into the client’s right brain, revising stored coping patterns, and giving rise to more flexible and adaptive ones…”

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