As we enter this world we scream to announce our presence. Someone immediately bathes us, swaddles us, fills our stomachs, and, best of all, our mother may put us on her belly or breast for delicious skin-to-skin contact. As we grow up, we gradually learn to take care of ourselves, both physically and emotionally, but we get our first lessons in self-care from the way that we are cared for. Mastering the skill of self-regulation depends to a large degree on how harmonious our early interactions with our caregivers are.

Children whose parents are reliable sources of comfort and strength have a lifetime advantage, a kind of buffer against the worst that fate can hand them. Children are programmed to choose one particular adult with whom their natural communication system develops. This creates a primary attachment bond. The more responsive the adult is to the child, the deeper the attachment and the more likely the child will develop healthy ways of responding to the people around them. This attachment is the secure base that promotes self-reliance and instils a sense of sympathy and helpfulness to others in distress. From it, children learn that other people have feelings and thoughts that are both similar to and different from theirs.

Children become attached to whoever functions as their primary caregiver. But the nature of that attachment, whether it is secure or insecure, makes a huge difference over the course of a child’s life. Secure attachment develops when caregiving includes emotional attunement which starts at the subtlest physical levels of interaction and gives babies the feeling of being met and understood. Babies can’t regulate their own emotional states, much less the changes in heart rate, hormone levels, and nervous-system activity that accompany emotions. When a child is in sync with their caregiver, their sense of joy and connection is reflected in their steady heartbeat and breathing and a low level of stress hormones: a calm body and emotions. The moment this is disrupted, as it often is during a normal day, all these physiological factors change as well until equilibrium has been restored and the physiology calms down.

Parents soothe new-borns, but soon start teaching their children to tolerate higher levels of arousal. Learning how to manage arousal is a key life skill, and parents must do it for babies before babies can do it for themselves. Securely attached children learn what makes them and others feel good and bad; they acquire a sense that their actions can change how they feel and how others respond. They learn the difference between situations they can control and situations where they need help and that they can play an active role when faced with difficult situations. In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. The way a mother holds her child underlies their ability to feel their body as the place where the psyche lives. This deep inward bodily sensation lays the foundation for what they experience as real. Things can go wrong when mothers are unable to tune in to their baby’s physical reality: the baby learns to become the mother’s idea of what the baby is. Having to discount its inner sensations, and trying to adjust to its caregiver’s needs, means the child perceives that something is wrong with the way it is.

Most children are securely attached. When they grow up, their history of reliable, responsive caregiving will help to keep fear and anxiety at bay. Barring exposure to some overwhelming trauma that breaks down their self-regulatory system, they will maintain a fundamental state of emotional security throughout their lives. Secure attachment also forms a template for children’s relationships: they pick up what others are feeling, learn to tell a game from reality and develop a good sense for false situations or dangerous people. Securely attached children become pleasant playmates and have lots of friends. Having learned to be in tune with other people, they tend to notice subtle changes in voices and faces and to adjust their behaviour accordingly. This can, however, be reversed by abuse or neglect.

Children who overreact to their peers’ aggression, who don’t pick up on other children’s needs, who easily shut down or lose control of their impulses, are likely to be shunned and left out. Eventually, they may learn to cover up their fear by putting up a tough front. Or they may spend more and more time alone, watching TV or playing computer games, falling even further behind on interpersonal skills and emotional self-regulation. The need for attachment never lessens. Most human beings cannot tolerate being disengaged from others for any length of time, so people who cannot connect through work, friendships, or family usually find other ways of bonding, through illnesses, legal battles, or family feuds. Anything is preferable to a sense of unconnectedness, so they will go to almost any length to feel connected.

Children have a biological instinct to attach, they have no choice. Whether their caregivers are loving and caring, or distant and insensitive, or rejecting and abusive, children will develop a coping style based on their attempt to get at least some of their needs met. Securely attached infants are distressed when their mother leaves them, but show delight when she returns, and after a brief check-in for reassurance, they settle down and resume their play. Children whose mother is unresponsive or rejecting learn to deal with their anxiety in two distinct ways: some get chronically upset and demanding, while others are more passive and withdrawn. In both cases, contact with the mother fails to settle them down and they don’t return to play contentedly. Avoidantly attached infants look like nothing really bothers them, don’t cry when their mother goes away, and ignore her when she comes back. However, this does not mean that they are unaffected. In fact, their chronically increased heart rates show that they are in a constant state of hyperarousal. Most mothers of avoidant infants seem to dislike touching their children. They have trouble snuggling and holding them, and they don’t use their facial expressions and voices to create pleasurable back-and-forth rhythms with them. With anxious attachment, infants constantly draw attention to themselves by crying, clinging or screaming. They become very upset when they do not know where their mother is but show little comfort when she returns, and even though they don’t seem to enjoy her company, they stay passively or angrily focused on her, even in situations when other children would rather play.

These three “organised” attachment strategies (secure, avoidant, and anxious) work because they elicit the best care that their caregiver can provide. Unfortunately, that does not mean that there are no problems as attachment patterns often persist into adulthood. Anxious toddlers tend to grow into anxious adults, while avoidant toddlers are likely to become adults who are out of touch with their own feelings and those of others. There is another group that is less stably adapted as they are unable to figure out how to engage with their caregivers as the caregivers themselves are a source of distress or terror. Children suffering from “disorganised” attachment are faced with an unsolvable dilemma: their caregivers are simultaneously necessary for survival and a source of fear. Parental abuse is not the only cause of disorganised attachment: parents who are preoccupied with their own trauma, such as domestic abuse or the recent death of a parent or sibling, may also be too emotionally unstable and inconsistent to offer adequate comfort and protection. Disorganised attachment can manifest in two different ways. Some mothers who seem to be too preoccupied with their own issues to attend to their infants can be intrusive, hostile and rejecting. Others seem helpless and fearful, often coming across as sweet or fragile, but they don’t know how to be the adult in the relationship and seem to want their children to comfort them.

Conscientious parents often become alarmed when they discover attachment theory research, worrying that their occasional impatience or their ordinary lapses in attunement may permanently damage their children. In real life, there are bound to be misunderstandings and failures of communication. Because parents miss cues or are simply preoccupied with other matters, infants are frequently left to their own devices to discover how they can calm themselves down. Within limits this is not a problem, children need to learn to handle frustrations and disappointments. With “good enough” caregivers, children learn that broken connections can be repaired. The critical issue is whether they can incorporate a feeling of being safe with their caregivers. Children who don’t feel safe in infancy have trouble regulating their moods and emotional responses as they grow older.

Emotional withdrawal by caregivers has the most profound and long-lasting impact on their children and is the most powerful predictor of mental instability in their adult children. Emotional distance and role reversal (in which mothers expect their children to look after them) are linked to aggressive behaviour against self and others in adolescence and there is a striking relationship between maternal misattunement during the first two years of life and dissociative symptoms in the child in adolescence. If your caregivers ignore your needs or resent your existence, you learn to anticipate rejection and withdrawal. You cope as well as you can by blocking out your mother’s hostility or neglect and act as if it doesn’t matter, but your body is likely to remain in a state of high alert. Dissociation means simultaneously knowing and not knowing. If you cannot tolerate knowing what you know or feeling what you feel, the only option is denial and dissociation. Dissociation is learned early: later abuse and trauma account for many other problems, but not for chronic dissociation or aggression against self. These individuals don’t know how to feel safe and suffer an impaired sense of inner reality. This does not imply that child abuse is irrelevant, but that the quality of early caregiving is critically important in preventing mental health problems. For that reason, therapy needs to address not only the imprints of specific traumatic events but also the consequences of not having been mirrored, attuned to, and given consistent care and affection. It’s not important for me to know every detail of a client’s trauma. What is critical is that the client learns to tolerate feeling what they feel and knowing what they know.

I do not tell my clients that they should not feel the way they do or that they should see the world in a more positive, flexible way. My responsibility goes much deeper: I must help them reconstruct their inner map of the world. Adults who were abused or neglected as children can still learn the beauty of intimacy and mutual trust in attuned relationships whether these occur in daily life or in therapy.

I offer a free initial telephone conversation, giving you as much time and space as you need to consider whether you’d like to come and meet me.