I wrote this piece 6 months ago, before I went to a month-long retreat in the forest focused on intense emotional healing. The retreat spun me around and threw me on my head – it took a long time to digest and integrate to the point where I could come back to this post. Delightfully, I've realized that while I have a richer conception of trauma, emotional processing, and how to heal now, the building blocks are still very similar. So, here's my already-outdated-but-hopefully-still-useful write up of transformative psychological healing :)
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If you’ve talked to me in the last few months, I’ve probably given you my soapbox on Ideal Parent Figure therapy and attachment theory. I am a little bit obsessed. I’ve been fascinated by the themes underlying different therapy treatments for a while, and I’ve been astounded at how much it feels like attachment theory explains.
I’ve also become just dramatically more secure from doing Ideal Parent Figure therapy. All my friends now do IPF therapy, and the emotional breakthroughs roll in every week.
I wanted to try and put all my amorphous soapbox thoughts on paper and share them here. This is partly a love letter to IPF therapy, and partly sketches of my current working model of effective psychotherapy.
A summary of attachment theory
A working model of effective psychotherapy
We learn beliefs that help us in an environment, and these beliefs influence how we navigate the world.
We can update beliefs with contradictory evidence
The process works better if it’s embodied
The process works better if it’s repeated
The process works better if it targets root beliefs
A case study: IPF therapy really worked for me
Other nice things about IPF
A summary of attachment theory
As I’ve learned more about attachment theory, I’ve been astonished at how much literature there is on it and how far-reaching the effects of attachment beliefs seem to be. I originally wrote a full summary of attachment theory, but then this post became like 5,000 words long. So here’s a quick summary:
Attachment beliefs are beliefs we learn early in our life about how to be in the world such that we get our needs met. In their first few years of life, children form internal working models (i.e. maps of what to expect from the world). From interacting with their caregivers, they learn what to expect from others (can they expect consistent care, or should they expect rejection?), how to view themselves and their self-worth (are they affirmed and delighted in, or viewed as an annoyance and burden?), and what protective strategies they need to survive (should they shut down their emotions to protect themselves, learn to display whatever emotion will get them the care they need, or learn to express themselves authentically?). These beliefs form clusters, called attachment styles, which persist into adulthood. In one study, 77% of adolescents who were given the Adult Attachment Interview (a measure of attachment style as an adult) had the same three-way attachment categorization (secure, avoidant, ambivalent) as they did at 12 months. (1) Which is kind of insane. Beliefs you learn when you’re a 1 year old are still a dominant force in your life at adolescence and beyond.
In adults, there are 4 main attachment styles, which fall into secure or insecure:
Secure: People with secure attachment styles value both attachment and exploration. They are comfortable depending on others and asking others for help, and also able to operate independently. They have a strong sense of personal identity.
Insecure:
Dismissing: People with dismissing attachment styles avoid getting close to people. They don’t often ask for help. They can often be aloof and contemptuous. They minimize emotional expression, have a hard time tapping into what they’re feeling, and use other strategies (like cognitive strategies) to cope.
Preoccupied: People with preoccupied attachment style worry a lot about relationships. They’re afraid of being abandoned, and need a lot of approval and reassurance. They can be clingy, resentful or frustrated if a partner is not available, easily upset, and have intensified emotions.
Disorganized. People with disorganized attachment style switch between both dismissing and preoccupied strategies.
Attachment styles are associated with basically every psychological disturbance (from eating disorders and substance abuse to borderline personality disorder, anxiety, depression, and antisocial personality disorder). And, there are themes: disorders with an internalizing dimension (which are characterized by fear, e.g. anxiety, PTSD, or depression) are associated with preoccupied attachment style, while disorders with an externalizing dimension (which are characterized by outwardly observable behavior, e.g. substance abuse) are associated with dismissing and preoccupied attachment styles. (2)
The implication of all of this is an appealingly neat frame: Children form internal working models about themselves and others through their interactions with caregivers. They then carry those working models into adulthood. These working models contribute to relationship issues and mental illnesses.
It’s appealing in part because it gives a very specific mechanism for healing mental illnesses: target and change the attachment working models.
A working model of effective psychotherapy
One of the exciting things about attachment theory is its alignment with my previous working model of psychotherapy, which is based on the book Unlocking the Emotional Brain. The thesis of Unlocking the Emotional Brain is that effective psychotherapy is tapping into memory reconsolidation. When an event occurs, it gets consolidated into our long-term memory over a period of time. While we used to think that memory was static, there's now a lot of evidence that shows that when we retrieve the memory, we can reconsolidate it – i.e. we store the memory with additional learnings every time we retrieve it.
Psychotherapy can leverage this learning mechanism: Effective psychotherapy activates the memory to trigger the reconsolidation window (where the memory can be changed with new information), and then provides contradictory evidence to the original learning such that the memory is reconsolidated with new learnings. This means we can unlearn beliefs that we learned earlier on in our lives. Our brain does this precisely so that as our environment changes, we can adapt better to it.
There are several important components of what Unlocking the Emotional Brain talks about that are mirrored by attachment theory and Ideal Parent Figure therapy. My current model, which is mostly based on Unlocking the Emotional Brain and Attachment Disturbances: Treatment for Comprehensive Repair, but also has a bunch of personal learnings thrown in there, is:
We learn beliefs that help us in an environment, especially when we're young, and these beliefs influence how we navigate the world.
We can update those beliefs by activating them and then providing contradictory evidence.
The process is more effective if:
It’s embodied
It’s repeated
It targets root beliefs
We learn beliefs that help us in an environment, and these beliefs influence how we navigate the world
In attachment theory, these beliefs are our internal working models, formed between 12 and 18 months based on our interactions with caregivers. They’re beliefs like “My emotions are unacceptable”, “If I reach out for care I won’t get it”, and “I will be abandoned when I need care”.
An important theme across many therapy modalities is that these beliefs had what Unlocking the Emotional Brain calls a powerful purpose. At some point in time, they protected us and were very important for our survival. When we’re young, if we don’t get cared for we quite literally die; so what we learned to expect from our caregivers and how we got care from them were extremely helpful. Internal Family Systems therapy also taps into this: When you talk to different parts, a lot of the interaction is based around understanding why that part developed and what it’s trying to achieve, and being grateful to it for helping protect you.
These beliefs are a lens through which we view the world as an adult. We seek out what is familiar. We pay attention to only what our high level models tell us to expect. And, unfortunately, the beliefs are self-fulfilling. For example: If you grew up with a rejecting caregiver, as an adult, you hold onto the belief that you can't rely on people to give you the care you need. Because of this, you don’t let yourself get close to people, and so you never learn that actually you can rely on people.
When we’re an adult, we’re in a vastly different environment. We’re no longer in our family setting, and we have far more emotional and physical resources than we did as children. The original beliefs that we learned when we were a few months old are no longer helpful in our new environment. But they’ve become so core to our survival, identity, and way of orienting in the world that it’s hard to unlearn them. It’s hard to even notice that they’re our own beliefs and not inevitable facts about the world.
We can update beliefs with contradictory evidence
By tapping into the brain's mechanism for learning (memory reconsolidation), we can update the beliefs we formed when we were children. By default, our brain doesn't want to touch these core survival beliefs. Without specifically activating them (and having a safe environment to do so), our brain ignores the evidence we encounter as part of day-to-day life that these beliefs might no longer be true in our new environment. If we activate the beliefs and bring them into conscious awareness in an embodied, safe way, then they can update to match our current environment.
Each therapy has its own framing of how to update the beliefs with contradictory evidence.
Attachment therapies: Early attachment therapies emphasized the role of the therapist. The therapist is meant to become a surrogate parent and provide a secure base from which the patient can learn what secure support and care look like. It’s targeting beliefs around what to expect from other people, and the contradictory evidence is new experiential data about what to expect: “I have experience with an adult who delighted in my presence, held space for my emotions, was there beside me as I processed difficult feelings, and didn’t abandon me”.
IPF: Ideal Parent Figure therapy is similar, except the secure adults are imagined. You imagine your ideal parents, who delight in your presence, are attuned to you and know exactly what you need, and are capable of supporting you and holding space for you. Each memory with your biological parents gets updated with the imagined experience of having ideal parents there supporting you.
NLP: The NLP technique from a course I did involved you coaching your younger self, and looking for contradictory evidence from the world that the younger self would believe. For example, I would tell my younger self: “I know you’re scared that people will leave you, but what about your relationship with your friend who’s stayed by your side for years?” Importantly, you had to keep trying different angles until your younger self actually believed it – it wasn’t enough to just cognitively present the evidence.
Coherence therapy: Coherence therapy, which is the modality that the Unlocking the Emotional Brain authors advocate for, uses many different strategies for finding contradictory evidence. Some of these include going out into the world and looking for it. You bring a certain belief (like “If I speak up in groups I’ll be judged”) to the top of your mind, and then your brain starts to notice instances where, for example, other people speak up in groups and you notice that you’re not judging them.
IFS: In Internal Family Systems, you befriend your parts from a place of "Self" (a place of compassion, curiosity, clarity, creativity, calm, confidence, courage, and connectedness). Your parts learn that they can let go, it's safe now, and that you, as Self, can hold them.
There’s a really interesting distinction that Unlocking the Emotional Brain makes between transformational change, and incremental change (or symptom management). They say:
New learning always creates new neural circuits, but it is only when new learning also unwires old learning that transformational change occurs, and this is precisely what the therapeutic reconsolidation process achieves. The process fulfills the brain’s requirements for allowing a new learning to rewrite and erase an old, unwanted learning—and not merely suppress and compete against the old learning. The result is transformational change, as distinct from incremental change and ongoing symptom management. (3)
Basically, the idea is that transformational therapies are actually updating beliefs, whereas incremental therapies and symptom management just address the thought habits on top of the belief without unlearning the original belief. So, the important core of transformational therapies is that you’re actually unlearning the original belief.
The process works better if it’s embodied
I found this snippet from Attachment Disturbances in Adults: Treatment for Comprehensive Repair fascinating:
Jeffrey Young served as the director in Aaron Beck’s research about the cognitive distortions typically found in depression and anxiety disorders. However, when Beck, Young, and others started applying the triple-column technique (Beck, Rush, Shaw, & Emery, 1979) to patients with personality disorders and addictions, Young found that these largely cognitive-focused techniques brought little benefit. Therefore, he developed a new treatment largely based on emotion-focused or experiential methods. (4)
This aligns strongly with my experiences with different types of therapy, and with how Unlocking the Emotional Brain talks about ‘activating the memory’. According to Unlocking the Emotional Brain, you only trigger the reconsolidation process if you actually activate the original memory. This works best if you pull up the memory in the same context it was first formed in. I’ve observed that therapies that focus on talking about memories or emotions create a feeling that you’re making progress, but don’t actually lead to change. In comparison, therapies like IPF and NLP focus primarily on feeling the emotion associated with the original memory (fear, sadness, etc) and take place in a somewhat hypnotic state. These modalities reliably lead me to a feeling of relief that persists.
This also seems pretty intuitive, given that many of the most powerful beliefs that are influencing our lives were formed very early in life. At that age, cognitive faculties (and even our narrative memory system) haven’t developed yet, so the beliefs are mostly going to be emotional and visceral. This quote from Attachment Disturbances in Adults: Treatment for Comprehensive Repair puts it nicely:
Because our first relational experiences are mainly lived outside the domain of language, our crucial internalizations of early relationships register as representations, rules, and models that cannot be linguistically retrieved. For these hard-to-reach representations to later be modified . . . they must be accessed, that is, experientially engaged. In therapy, such representations in the patient often become accessible only as they are communicated through other-than-verbal channels . . . [T]he foundations of our internal working models . . . are . . . nonverbal and unconscious . . . [W]e lack verbal access to many of the experiences that shape us most profoundly. (Wallin, 2007, pp. 113, 116, 117) (5)
Similar to how each therapy has different ways of getting contradictory evidence, each therapy has a different method for accessing and activating the beliefs in an embodied way:
IPF: You start with an emotion that’s difficult. Feel into that emotion, and let your mind take you back to a memory in childhood where you felt a similar way.
IFS: Start with an emotion that’s difficult, and give a shape and voice to the parts of yourself that are involved in the difficult feeling.
NLP: Lean into the difficult feeling you want to work with. Then, let your body tell you a number for how old you were when you first felt this feeling.
The process works better if it’s repeated
Many of the effective therapies I’ve done emphasized repetition. I often think back to my NLP coach comparing retraining your mind to training a dog: If you let the dog sit on the couch even once, it learns that it’s okay; if you want to train it not to sit on the couch, you have to change its behavior every single time. When I was doing the course, I would switch out negative thought patterns for positive ones hundreds of times a day. I’d be in the middle of a conversation, have a negative thought pattern come up, then run away and find a corner to mutter to myself in. Ideal Parent Figure therapy emphasizes re-running the sessions on your own – I have recordings of every session to replay each week. I’ve spent hours looping the same memory with my ideal parent figures. Some fear will come up, my ideal parent figures will soothe me until I feel relaxed, it’ll last a second, then the fear will come back up. After a long enough time just being soothed over and over, my brain starts to learn that it doesn’t need to be so afraid.
I’ve gotten a lot of mileage out of thinking about emotional work like exercise. It’s like building a muscle. It’s hard at first. It requires you to look at emotions that feel terrifying and overwhelming. Before you do it, you always would kind of prefer to lie in bed and chill out, but after you do it you feel much more relaxed, calm, and happy. You have to do a bit every day to get stronger, and you can feel yourself getting better and better at it as you practice more. I think it intuitively makes sense as well – you’re learning new beliefs, and so the more you repeat the positive thought patterns and emotional experiences, the stronger your learning will be.
The process works better if it targets root beliefs
This section is mostly me theorizing (ok the whole post is me theorizing, but this section is especially theorizing-y). I suspect that what makes IPF so powerful is that it’s targeting the foundational beliefs that we learned before we even have narrative memories. While you can run the memory reconsolidation process on any belief, attachment theory says it’s these initial beliefs that define most of our insecure patterns as adults.
I think other beliefs then get layered on top of the foundational beliefs. You could spend a lot of time unwinding these higher level beliefs (like: trying to reduce anxiety about public speaking via targeting a belief that you'll be judged if you don't do well). The higher up you go, the more entangled the beliefs become – they're part of large belief complexes that rely on and are blocked by each other. But the root beliefs are often very simple: I am not loved just as I am; I will get rejected instead of getting the care I need. If you unwind these root beliefs, a lot of the higher order beliefs become the kinds of things you can work through as a well-resourced adult without being blocked by existential fear underneath.
A case study: IPF therapy really worked for me
Ideal Parent Figure therapy was developed by Daniel Brown and David Elliot in 2016, based on both the literature on attachment theory and the authors' experiences with Buddhism.
The basic strategy is:
Create a mental representation of ideal parents, who give you a sense of:
Felt safety and protection
Feeling seen and known
Felt comfort, soothing, and reassurance
Feeling valued and delighted in
Feeling supported and encouraged to be your best self
Go into a meditative state where you:
Embody the ‘mind state’ of an issue you're facing
Go back to a memory from childhood that's relevant to the issue
Imagine the ideal parents being part of that memory, and giving you exactly what you needed at the time
I've been doing this therapy for 8 months. In that time, I've had many moments of deep, felt senses of relief. I've tasted what it's like to actually have unconditional love and a true belief that I am safe and cared for. I feel like Mary in the colorless room: Before, I could describe what security would feel like and point to moments where I had felt more secure. But what I've felt since starting IPF is like a different qualia that I couldn't have imagined before. I didn't possess the experiential building blocks to be able to imagine this feeling of security.
I think this is one of the fascinating things about IPF therapy: If you grew up with parents who didn’t give you what you needed, you don’t actually have a conception of what it would feel like for it to be possible for someone to give you what you need. When we bumble through the world and meet people who have healthy relationship patterns, we may expand our boundaries of what we think is possible. But most of our beliefs just go unnoticed. When I first started doing IPF, I had to fight a lot of disbelief. My therapist would say something like “Your ideal parents are able to completely hold your emotions. They’re capable of handling their own emotions and boundaries, and have complete space to hold yours”, and I would basically just be like “No this is not possible”. After a while, my sense of what was possible expanded.
The change in my life has been very obvious. When someone rejects me, instead of feeling hurt and lashing out, I feel calm and okay. When someone leaves, I feel a moment of fear and then remember that actually I’m okay and they’re not abandoning me. I’ve been able to say no to people without terror. I've felt the difference between what I thought was vulnerability before, and actual vulnerability of giving someone the power to really hurt me and trusting that they won't; and my friendships are so much healthier because of it.
IPF therapy has also made me a lot more attuned to what I need given an emotion I'm feeling. I've started to notice what I've been calling 'child emotions'. Child emotions are where there's some kind of unease (fear, anxiety, lack of safety), but when I imagine any of my friends or my partner soothing me, it doesn't feel satisfying. One clear red flag is if I try and verbalize it and it sounds something like "I want assurance that this person will never ever leave" or "I want to be able to just hand all of the responsibility I’m feeling over to someone else" (basically, things that are clearly not desirable for two independent adults). When I trace it back, it's because in that moment there's a one year old version of me screaming out and reaching out a hand to find their primary attachment figure to get care. If I try to get that care from the adults around me, I'll always feel dissatisfied; but if I imagine my ideal parents in that scene, I can get soothed within a few minutes and the feeling resolves.
Other nice things about IPF
Some other things I've been really impressed with about IPF that I've struggled to find in other therapies:
It makes predictions. Attachment theory says there are insecure attachment styles and secure attachment, both of which have clear behaviors associated with them such that they are externally recognizable. IPF says that you can go from insecure attachment styles to secure attachment, and you can do it in ~2 years. There's a goal (secure attachment); there are a set of behaviors associated with the goal that indicate that you've reached it (how you respond to a difficult situation, how you feel about yourself, etc); and there's a timeline for reaching it (2 years). In contrast, with most therapy, there's no indication of when you're 'done' because there isn't an algorithm that can reliably get you to the goal state.
It's an algorithm you can run on your own. My sessions with my IPF therapist are surprisingly algorithmic: I can often predict what he might say next. Part of the therapy is me running the process on my own in between sessions. It's become the most effective tool in my toolkit. When I'm feeling any kind of emotions that are difficult, I'll trace it back to a root memory and imagine my ideal parents there with me. I have sessions with myself where I do the same memory reconsolidation process over and over for an hour (imagining a memory, imagining my ideal parents soothing me, repeat). It's not cognitively intensive, and I feel so much relief afterwards. I'm really interested in therapy techniques that are algorithmic like this because:
It increases feelings of agency. One thing I think is really important about IPF and the NLP technique is that you learn not only local agency (resolving beliefs that might be limiting you in a particular area) but global agency (learning that you can actually resolve your issues on your own). This increases your overall feelings of emotional resilience: When faced with a difficult situation, rather than feeling helpless, you feel like you'll be able to process it.
It's a signal that we understand the mechanism. We're not relying on an amorphous concept of 'it works because the therapist is an expert'.
It's more amenable to automation from language models. It's much harder to automate a task done by someone who has trained for years to be able to make illegible judgment calls than it is to automate something that the average person can do. I'm really excited about LMs allowing this kind of emotional processing to become a lot more accessible and widespread.
It's highly embodied. In an hour-long session, I spend 30–45 minutes in a meditative state. Rather than spending a lot of time tracing the beliefs, understanding why they formed and understanding how they relate to each other (which, in my experience, doesn't actually lead to an internal sense of transformation or relief after a session), it's just about feeling the emotion, imagining getting soothed, and then feeling the relief.
It’s more complex than this
Yep that’s it. That’s my brain dump of what I think is going on with emotional healing. My actual model of it has become much more complex from the last month, especially regarding embodied somatic therapies, but I need to wait for all my embodied learnings to settle before I can integrate them into my cognitive mind. I’d love to hear what you think – whether these frames resonate or not, and what feels like it’s missing from this.
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Footnotes
(1) Attachment Disturbances in Adults: Treatment for Comprehensive Repair, pg 27
(2) There’s a lot of ambiguity about causality, both for whether parents’ behavior actually causes attachment styles, and whether attachment styles cause mental illnesses. One of the main books on attachment theory, Attachment Disturbances in Adults: Treatment for Comprehensive Repair, speaks as if both are causal, yet most of the evidence is correlational.