Shoshana couldn’t wait to grab a cup of coffee with Perel, her childhood friend. As they had known each other since preschool, there was no need for pretense or presumption.  Along with a steaming mug, the familiarity and acceptance was almost medicinal. There was so much waiting to be discussed: a controlling boyfriend, a demeaning supervisor, needy parents and intrusive friends. Shoshana could not understand why her interpersonal relationships were both terrifyingly difficult and anxiety inducing. Furthermore, she could not understand why the contemplation of attachment and commitment to a potential spouse felt akin to death.

 Shoshana’s relational difficulties are not unique. Many people find themselves approaching others in characteristic ways and inducing responses that follow a maladaptive pattern. In turn, they become reactive, precipitating a repetitive cycle. Change can be difficult and requires introspection. At times, experiences which occurred during the formative years need to be relived and processed.

 Adult interpersonal relationships can be rooted in early childhood attachments. Although there have been many studies of attachment theory, Mary Ainsworth’s Strange Situation Paradigm is largely hailed as the defining study of attachment. In this experiment, infants were brought into an unfamiliar room by their primary caregivers (usually mothers). The baby and mother were first accompanied by the evaluator, who subsequently left. Next, a stranger entered the room, and the mother soon left, followed by the stranger, while the infant stayed alone. The mother then returned and the stranger exited the room. The behaviors of the child and their intensity were both observed and scored. Thus, three attachment styles were identified and catalogued.

 A Secure Attachment was seen in 70% of the infants. It was demonstrated by distress when the child was left alone, and happiness at their reunification with their caregiver. The child showed avoidance of the stranger when alone, but friendliness in the presence of their mother. The caregiver was used as a safe base while exploration occurred. This sense of security indicated that the child was confident that the caregiver would meet his or her needs and boded well for appropriate future attachments.

 An Insecure-Avoidant Attachment was seen in 15% of the infants studied. They did not seek contact with their caregivers when distressed and were seen as physically and emotionally distant. This was indicative of a caregiver who rejected the child or was unavailable in their time of need. Security in future relationships was hampered, as was their ability to trust others, leading to an increase in depression/anxiety.

 An Insecure-Ambivalent Attachment was also seen in 15% of the infants observed.  They exhibited contradictory behaviors, displaying neediness initially, but rejection during desired interactions. This child was not able to gain a sense of security from their caregiver, as their needs were only inconsistently met. Thus, they were difficult to soothe and calm. Their future ability to modulate emotions and regulate affect was affected, with a similar association with anxiety and depression.

 Research has shown that these attachment styles are largely preserved in adulthood, potentially yielding confusion and anguish, much like Shoshana’s. They impact on romantic relationships and friendships, as well as interactions with supervisors and subordinates. Furthermore, they are correlated with levels of anxiety and inhibition.

 Although Shoshana has been able to maintain a healthy friendship for several decades, with a friend who provides support and security, she appears to be struggling to assert herself with her spouse and tolerates perceived ridicule from her boss. The neediness she reports from her parents likely harkens back to her early awareness relating to their fulfillment of her needs. This further impacts on the way she views her other friends and contemplates her readiness for a potential lifetime commitment.

 Hopefully, Perel will be able to provide an unbiased opinion, tinged with love and support, to clarify Shoshana’s dilemmas. Alternatively, a good therapist, with experience and training in attachment theory, could elucidate Shoshana’s conflicts, explore her beliefs, and theorize solutions. These explorations could help her to trust the right people, allow her to receive love and provide acceptance, while serving as a role model for her future children.

Pamela P. Siller, MD is a board-certified child, adolescent, and adult psychiatrist who provides medication management as well as individual and family therapy to children, adolescents, and adults.  She maintains a private practice in Great Neck, New York. Dr. Siller is also the director of child and adolescent psychiatry at the Interborough Developmental and Consultation Center in Brooklyn. She is an assistant professor of psychiatry at New York Medical College. She can be reached at 917-841-0663.