THROWBACK: Attachment Theory, just hanging in there (Season 1 Episode 2)

[00:00:00] Welcome back to How to Be Patient. This is a throwback episode where we will be delving into attachment theory. It's, like, our second one ever. Yeah. You know, I feel I'm securely attached to that episode, and we thought we'd bring it back because we felt like it was a good one. And I think I was tired of avoiding the episode.

So it was about time to challenge that avoidance and come back around. I think that this was kind of a chance for us to figure out how to find our rhythm a little bit as a pod. Like, we explored the, you know, secure attachment, anxious, preoccupied attachment, and then the, the avoidant attachment styles, and I think we, like, went into some anecdotes.

So I hope you all enjoy the episode. It's kind of fun to see how far we've gone just in, in our cadence and how we, put together the podcast as a whole. But I think this is one that is a banger. I feel like since we made [00:01:00] that one, like, that was in my, like, beginning of fourth year when we made it, and now I'm at the end of first year of child.

And I just continue to think obviously the field of science around attachment, but especially when it was emerging in terms of, like, what we understood about therapy. I feel like attachment science gave a language to what was being described in, like, psychodynamic or psychoanalytic therapy- Mm-hmm ... and has given us a thread to follow.

And yeah, I just think that episode, and honestly reviewing for that episode and understanding some of these things that are now brought up in common everyday language, especially in child, but also in adult therapy, is a good foundation for anyone to have. Yeah. I- if you're gonna start somewhere, start with attachment theory.

And it keeps... it's like a string, it follows you. I remember when I was prepping for the existential therapy, episodes much later, everything just started, like, boiling down to analogies for attachment. You know? And when you're dealing with your death avoidance and you think that, you know, you're either personally infallible or there's gonna [00:02:00] be some great rescuer, like, those two death avoidant denial techniques, they really start to express themselves as either avoidant attachment or, like, anxious attachment.

So it, I like, you could argue, like, a lot of roads come back to attachment, but it's a really good foundation to have. This is just making me think of the thing I- we may have talked about in the attachment episode. But, like, when you're at, like, the eye doctor, and they're like, "Okay, this lens. Now this lens."

And it's like, "Which is clearer?" It's just like this is what we're doing. We're like, "Existential therapy? No. This DBT? No." One- "Attachment? Oh" ... or two. One, attachment. DBT. Well, without further ado, we hope you enjoy the episode, and don't get too attached. How to Be Patient So Margaret, how's it going? I have gotten a lot more famous in, since we last spoke, Preston.

Oh, okay. Tell me more about that. have you ever heard of Strega Nona? [00:03:00] no. Well, you're about to hear a lot about it. there is a New York Times article about how we're having a Strega Nona fall after brat summer. So I don't... did you celebrate brat summer? Okay, so you mentioned the thing about Taylor Tomlinson.

Yes. Is she the one talking about Strega Nona fall? She also was. She's, organically coming up on my for you page now. Strega Nona fall. And you're welcome to that. And, all, this Strega Nona stuff that I'm- Is now there ... hearing about indirectly, yeah, all over the group chat. I'm like, "Oh my God, Margaret's everywhere."

I'm e- I'm everywhere. So I'm in, the Strega Nona-ssance, as I have named it. So can, you explain to me what is Strega Nona? so the start of the book, which is a children's book from the '70s, is that she is Strega Nona, although I've learned online that it's maybe spelled incorrectly in Italian, and so it's doesn't translate as it says in the book.

Hm. But is grandma witch. And the primary story most people read when we were younger was she makes a ton of pasta and she has magic in which she can [00:04:00] make pasta for the whole town, and she hires this gu- She gets older and she hires this guy named Big Anthony, that's the name in the book for him. Big Anthony?

It's literally every time he's in the book, it's Big Anthony, and he's supposed to do chores, but he sees her one day doing the magic that makes the pasta and thinks that he can do it. So when she leaves to go out and visit her friend, he tries to make pasta, but he doesn't know the secret to make the pot stop making pasta, and then it overruns the town.

Oh. But then she stops it and she saves the day, and his punishment is that he has to eat all the pasta that filled the town. What a punishment. Oh, man. Which is, you know, I think something, for everyone to think about. So is, so as everyone Strega Nona fall, are they just making pasta- Well, now they are

as a way to celebrate this I- Italian witch? The... Well, yeah, that's what I'm trying to get them to do. Okay. Okay, and you said that The New York Times published this? Yeah. So I was like reached out to on my like Gmail that was like N- NYT inquiry ?Strega Nona?. [00:05:00] That's incredible. So the most famous person that's ever reached out to me was someone for BuzzFeed.

BuzzFeed still exists? It d- it does, and they're in my DMs, and they were like- ... "I'm doing this story on craziest things medical creators have ever experienced. What are like some crazy things from your DMs that are like super crazy we can include in this wild article?" And I was like, "Stop. Finally some real journalism."

And did you, what was the craziest thing? I mean, I talked about like all these like unsolicited sexual passes that I get, and I was not expecting that at all. Have you talked about that? I, and I don't really discuss it, 'cause I don't- Right ... consider my content to be grotesque in any way, but people say some- That'd be fun

wild stuff. And it was just like a video about me like taking care of my plants or petting Magnolia. So that was my contribution to it How many times have you been offered to be a sugar baby? about half as many as been, I've been solicited for feet pictures, unfortunately People want [00:06:00] what they want

Yeah. They want what they want. You know, I, try not to think about... I don't shame it. You know, if, you like feet, if that's your thing, that's awesome. Oh. Cat sighting. Yeah. Speaking of- Magnolia- ... what were you doing? Magnolia had her own little feast Why give you a recent update? So me? Yeah. I got a new cat.

Her name is Lilac, and I'm been, like, doing the whole introduction with Magnolia and then this week, and it's been going pretty well. I was like... You, hear- She's tuning in, actually. I was pretty nervous at first 'cause Magnolia's, like, super antisocial and she's, like... So back in my old neighborhood, she was known as, like, the villain cat.

Like, she has a split face and, she's tortoiseshell so she l- she looks like a little spice jar so people would call her Spice. And I'd be, like, out with Maggie in the front yard and someone would walk by and be like, "Oh my God, it's Spice." And I'm like, "Who's that?" And they're like, "This is the cat that antagonizes my cat every night."

She, like, goes out into the- She's a bad girl. She goes out into the night. She like, she's so Strega Nona fall. And she's, [00:07:00] like, she's got her, little, whiskers pressed against the screen- ... and she's just staring at these poor domestic house cats, and they're like, "Oh my God, you know, she's the villain in our lives."

And so I kinda realized that Maggie isn't the sweetest cat, so I was worried about, like, having another cat because, you know. But turns out they're doing okay. Like, Maggie just kinda likes to watch, and then they bump- they bumped noses yesterday, and they didn't smack each other. Is that a good thing or a bad thing in cat world?

I, you know, you'll have to ask them. Oh. I didn't grow up with cats or, 'cause my parents are aller- or my mom's allergic and so I have no idea. When you were like, "I, they can't be in the same room at the same time," I was like, what is this? Yeah. What is this? S- so going into this segment, I want to talk about your hot takes based on your rotation right now.

So do you wanna go first or do you want me to go first? I want... You can go first. Okay. So my hot take is that [00:08:00] psychiatrists should spend an entire rotation with the radiologists. Okay, say more. So I did a month on neuro rads, and I'm also doing, a neuropsych rotation, and the amount of, like, psych stuff that we actually end up seeing on MRI that just gets, like, thrown under the blanket of, like, no acute intracranial abnormality is kind of a lot, and the stuff that they pick up on is really unique.

So, like, for example, they were looking, I was looking at a MRI with Lewy body dementia versus- Alzheimer's, and there's a- distinct pattern- in the way that it atrophies. So in Lewy body dementia, bilateral temporal lobes are preserved relatively. Mm-hmm. The anterior temporal lobes go. Medial frontal lobes start to go, and then also the atrophy of the ventricles is, like, an inside out- coring the apple from, or rotting from the inside. Whereas in Alzheimer's- Being- ... the temporal lobes go first, and the whole thing atrophies ... Brat summer mention, sorry. So, yeah, so yeah, I think the apple's rotten to the core, except it's your [00:09:00] MRI and y- I'm sorry, you have dementia. But I was like, "Oh my gosh."

So we go look at this person clinically- Mm-hmm ... and let's say they have a temporal lobe dysfunction, so memory is stored in th- your temporal lobe, right? And they can't recall details semantically. And like, oh, that fits with Alzheimer's. But then you ask, and then you go and look and you see the atrophy in the hippocampus.

Mm-hmm. And I'm like, the amount of times that I as a consult liaison psych resident or something have- Mm-hmm ... asked these recall questions and gotten nothing from it in- Yeah ... in an inpatient setting, and then looked at the MRI and knew nothing about what was going on- Right ... or with the CT. Right. But then there's, like, more to it.

So if I ask someone a question, like, remember this word cloud, for example. Mm-hmm. And I ask them in five minutes do they remember it, and they go, "No idea." Mm-hmm. If I say like, "Hey, the word has something to do with the sky," that's called a semantic cue. Mm-hmm. So I'm giving, like, a part of that schema. I'm giving them a detail.

And if they can recall that- that means the white matter tracts are intact and they're [00:10:00] consolidating it. Mm-hmm. If they can't recall it from that, if I give them multiple choice and they can't recall it, that means the memory never got stored. Yeah. And y- so if you, correlate that with hippocampal atrophy, you can diagnose dementia- Right

or you can get pretty close. Right. And so I was like, wait, why are the neurologists doing this? This is like, this is straight up psych stuff. Well, I mean- You know? ... I feel like the my, I feel like the distinction historically between psych and neuro is becoming more and more tenuous as each year and research advances.

It's like, what do you, like, why does neuro do it? Like, I mean, like, we know that, like, post-stroke depression is a thing, and is not just like, oh, psychologically someone's not coping with it, but probably is relate- And like we know this with any of these, so it's like, well, when shouldn't... In the future, are all psychiatrists and all neurologists going to be neuropsychiatrists?

Like... I mean, I, think that's where it's going, but unfortunately, I think people are pretty attached to these labels. Which makes sense. I mean, it ma- I think it makes sense to be attached because, like, they're [00:11:00] such different kind of worlds that you go... I mean, both of us are not neurologists. Like- Right ... I know you thought about it.

I did not. And I was like, "I wanna do psych 'cause I wanna do this, and this." I will say I've, like, really enjoyed actually, like, being taught how to incorporate it into psychiatry. Mm-hmm. But I feel like the set of things and the set of people that you interact with when we, like, are in med school of like what does a neurologist do and what does a psychiatrist do are so, so different for some reason.

Yeah. and while we are attached to these different titles, I think now's a good time to move into our topic for today, which is attachment theory. Let's do it. So what, do you know about attachment theory? What, does this mean to you? So I wanna, before we even say any of this, I wanna give my first of many caveats, which is, that we are both trainees.

I know people know this. But that this is our first discussion of kind of like content, and so both Preston and I are gonna be reading and are in training. We're also still [00:12:00] learning, which I think makes the conversation interesting and also kind of, like, closer to the point where people are where they might be listening to this.

We will cite things. We will include it at the end. But listen to what we're saying, take it as you will, and then look into things yourself. Yeah. and this is meant to be a dialectic discussion. Yeah. I'm not approaching this as a clinician. It's really just Preston and Margaret talking about the things- Yeah

that are relevant to our education and also interacting with people as humans, or anyone who has to interact with a person, I guess. Yeah. So, so if you're on Mars and you don't interact with people, then, go ahead and turn the pod off. It's not for you. Turn it off. So I think in terms of attachment, like the first thing I think of when I think of that is, like, all the TikToks I'll see about people being like, "I have anxious attachment," or, like, when you're dating, like avoidant attached, blah, blah, blah.

That is like the first topical thing that comes to mind. Yeah. And they add no context to it. Yeah. I remember watching those and being like, "Okay." Yeah. Yeah. And it's- Like, what is this label? Well, and it's like, "Here's five signs that you have this." And it's like I love [00:13:00] pathologizing normal emotions. Mm-hmm.

I think that's awesome. It- it's like- What do you think about atta- what is your first response? Five signs you have anxious attachment, and it's like when you get broken up with, you're sad. And everyone's like, "Oh my God, me. That's so me coded." Me. Whoa. Me. Is there a way to fix this? And then the next one is like you miss your parents, and they're all like, "Whoa."

Whoa. Yeah. Yeah. So I pic- when I picture attachment, I don't know why, I don't go to those TikToks, I just picture a monkey clinging to its mother as she's climbing through the trees. I feel like that's like a good image to start with. Attachment theory. Yeah. You know? I'm like, "Ah." Yeah. Like, or like when, you know, you're like a toddler and you'd wrap your arms around your mom's pant leg- Mm-hmm

as you try to walk, and you just turn yourself into this cumbersome ankle weight. Mm-hmm. Yeah. I think like, I think that's a good place to start, and I think in contrast to what I was like thinking of in terms of like the TikTok stuff is I don't know how much people actually know. I s- I don't know that I've been taught about it actually yet in [00:14:00] terms of outside of my own reading in like residency.

Yeah, I think everyone that I've talked about it with just kind of acts like they know what it is. Yeah. And then they're like, "Oh yeah, you know, I've been on attachment theory." And then you ask them about a detail of it, and they're just like, "Oh, you know the one where you're attached and you don't like- Right

being unattached. And you're like, "Oh, okay." When you do things unhealthily. I think it's also, like, there's so much even in psychiatry, which is a specialized field, right, compared to, like, primary care, in that there's so many different lenses you can look through, and you could read forever on, like, each of them, and ask questions, and, like, never fully understand it.

And I feel like attachment is kind of something that is now sort of foundational both to, like, development as well as, like, how we think about therapy or how we think about, like, relational health. But how do we actually kind of go with a critical lens and look at, like, where did this come from? Why did it emerge, like, historically?

And [00:15:00] also, what can we say it actually is helpful for or not? Because, like any diagnosis or tool, if it's, like, not correct... Like, people can use it and it can be helpful in their lives, or it can feel like a box that they're trapped in. Yeah. I think how I approach all these different theories is they're just ways of organizing the- Mm-hmm

complexity of human interaction. And attachment theory captures part of the self, it captures part of the interpersonal interaction, but it's just, like you said, is one lens. We're all trying to use these different theories to categorize the same basic thing, and we're just looking at it from different angles.

So sounds like you have some hot takes about when this theory first started. I don't actually know that much about the origins of attachment theory. Yeah. So I think that, I always think this is actually an important place to start, even when I'm talking with my patients about it, just because I think so much information and misinformation is out there.

So attachment theory is, the kind of parents of attachment theory are a guy [00:16:00] named John Bowlby and then Mary Ainsworth. John Bowlby was a psychiatrist, I think, or he was a psychologist, in, like, the, like, 1930s and '40s and onwards, who was trained, as so many people were at that time, the primary model of understanding people's, like, mental health and responding was psychoanalysis.

Like, that was kind of the only game in town. And he was under this... What I read is, like, he was under the study at one point of Melanie Klein, who is a famo- famous, like, psychoanalysis af- ps- psychoanalyst after Freud. and he- This is, like, the 20 years after Freud's come to fame- Yeah ... and everyone's just- Correct

psychoanalyzing, paying half a grand to sit on a couch and talk- Yeah ... about their dreams. Yeah. Okay. So- the scene is set The scene is set. So he had a lot of really kind of- New theories at the time that were somewhat divergent from what the main, like, psychoanalytic thinkers [00:17:00] were saying. but he was more of a theorist than he was, like, someone doing empirical clinical research until he started working with Mary Ainsworth, who was more of, like, a behaviorist clinical researcher.

Mary Ainsworth is the one who did the thing that probably all of us who have read anything or ever had a lecture on attachment have gotten, which is the, like, strange situation experiment. Oh my God, I remember the strange situation. Yeah, What do you remember about it? Is that, the one with the baby?

So they, like- Yes ... they put the baby in the room, and then they run away from it, and then they come back and see what it did, right? Yeah. Or no, they have a stranger come look at it too. Yes. So there's a child in a room- Mm-hmm ... and he's playing with toys, and mom's like, "Oh, hey, how's it going?" And then Mom leaves, and a stranger shows up and just, like, stares at the kid.

Yeah. And then the stran- and then the stranger leaves, and the mom comes back. Yes. And then they see what the, kid does. So, like, sometimes the kid is like, "Oh, Mo- thank God you're back, Mom," and they- Mm-hmm ... like stuck on [00:18:00] her. Mm-hmm. Or sometimes they're, they, like, pretend Mom never left, right?

Mm-hmm. That's, that one? Okay. Sorry. Keep- Yes ... keep going. no. That's- Just wanna make sure I did it ... no, that's it. and so there's all sorts of things we could say about those studies, but in the interest of time, the kind of... There is some importance in terms of, like, how does the infant... It's, like, an infant that can, like, crawl and point and interact, so it's, like, you know, get up in the months up, you know, in that kind of...

Think of that age range. And they would exactly what you're saying, they would have the mom there, they would have the mom leave. It was in a lab. and that, so it's also, like, a strange environment, and then they would have a stranger there. Stranger would leave. Mom would come back. one of the interesting things I was reading was that it's wh- it ended up sort of being, in their view at least, more important to what the reunion was like, than anything else.

Like, there is some importance in, like, if they leave, how they react, but, like, how is kind of the connection reestablished when there's been, like, a small breach? and so- [00:19:00] Like, can you heal? Like, like an airplane, if you knock, it hits turbulence, can it restabilize? Hm. yeah, exactly, and I, mean, if we think about adult relationships, like, if you have a fight with someone, can that deepen the connection rather than rupture it?

So- That is kind of the foundational research that showed, like, there's sort of three styles of respon- that the infants responded in. in those studies, they called it ambivalence, which I think we think about as anxious, sort of, avoidant, and then secure. And then eventually after that, when there was more studies later on, there was kind of this question of, like, disorganized or, like, a sort of mixture of styles.

So was this only s- where I get kinda confused is that attachment theory is between adults- Yes ... when we talk about interpersonal relationships. But all of these studies back in the '70s were between, like, infant and mother. Did they make all these, like, big jumps assuming that your ideal relationship with your caregiver was, like, established as an infant, [00:20:00] and then you just carry that through the rest of your life?

So those jumps are still, I th- in my reading, my understanding, are still up in the air. so I think that it's interesting in that, like, I think we can say things about adult attachment and, like, adult relationship forming in the literature, but I think one of the things that my, I don't know if it's a hot take, but it's like, how sure are we that this totally applies in the way that it's, like, now commonplace to talk about in terms of attachment?

And I think it, does, but I think somet- like, like many, like, things or many, like, good s- much good science, we get, like, some stuff, right? But then we want it to all be one cohesive answer, and the science isn't there. The, golden bullet. We're like- Yeah, exactly. Oh my gosh, yeah. So that's kinda like the history, and then there's been, like, different things of how to apply it to adults that came through in, like, the '80s and '90s.

Like, don't get me wrong. I think there's a lot there that is kind of proven and known, [00:21:00] but I think these kind of, like, bullet points, oversimplified sort of archetypes, and the finality of them is the thing I, like, take issue with because I think it's oversimplified and can trap people. Yeah. I think in a lot of ways, we, Myers-Briggs-ified- Yeah.

attachment theory, and just kind of turned it into this, like, pop psych, almost corporate jargon that people can use. Yeah. but there is, I think, utility to it outside of even- Totally ... like, the love language, concept of stuff. So the way I think about it now is that there's a couple different types of attachment, right?

I guess- Mm-hmm ... so can we start with the stable kind, the kind where if you go through the turbulence as an airplane, you can correct back to normal? what's that one called? Yeah. Yeah, so, like, talking about secure attachment, and I think it helps to ground us in, like, what is a secure infant attachment, and then talk about what that might look like in adulthood based on, like, the literature, but also based on, like- [00:22:00] how that kind of relates.

So- Okay ... the kind of secure- The comfortable infant that was fine. Yeah. So, like, the secure infant would... One of the, kind of key concepts in attachment at that ti- like during, Mary Ainsworth and, John Bowlby's work was this sort of idea of, like, a secure base so that, like, the parent, when they come into the room, and they're there, and they're establishing, like, before the mom has left in the settings, which also, obviously, that's a caveat because m- men are also parents and can form- Mm-hmm

attachments with their kids. But, this is in ear- the early studies. Their ability to kind of, like, come back to the parent and see that they're there, and from an evolutionary perspective, right? Like, to know that they are within, like, the reach of their care ta- caregiver to be able to survive. but then when that's there, the, an ability to explore.

So this balance of safety and being able to explore and discover. So [00:23:00] I'm safe on my own to take this risk. Mm-hmm. And also, I know I can depend on Mom- Right ... to come get me- Right, yes ... if I need her. Yeah. And I know- And- ... that she's there. And I have, that, ultimate trust in Mom, and I have that trust in myself.

Yes. And that's my, that's how I f- my framework of the world. Yeah. It's- Yeah ... okay. And so when the mom would come back after the strangeness, there would be kind of m- it would be quicker for the infant, like the infant would reach back towards her. The i- the infant would be generally, like, more consolable and interactive- and, like, snuggling, but then eventually would be feel safe again to go explore and not, like, cling, too much, like, to the parent. Okay. So just like we talked about, return to Mom, she's c- they're consoled- and they're, like, ready to explore again. Right. Okay. Well, that, that sounds pretty secure to me.

Yeah. All right. Stable. Stable. so, so now what does it look like when they're not stable? Yeah. So the terms used at the time, I'm gonna switch to just saying anxious attachment, [00:24:00] but it was, like, it, the term was ambivalent that, at that time in the earlier literature. And so all of these just fall under the insecure attachment?

Yeah. So this is- The two non-secure ... okay, it's two big- Yeah. Y- yeah, okay. yeah. so the anxious attachment or the ambivalent attachment, same thing, would sort of re- when the, parent would leave, and then would come back, there was more of this, like, inconsolability as well as, like, the, like, clinging on, not able to go explore, kind of more, like, a difficult to repair the kind of- But not b- betrayal's too strong a word, but like to repair like, "Okay, I am safe."

Yeah And re- renew that sense. The abandonment caused an injury and the return of mom isn't enough- Right ... to, close that wound. It was interesting 'cause the, on the avoidant infants in some of these studies, it was like it looked on the surface like they were kind of just calm. You know, like a duck, like calm on the surface and then underneath they're like- Mm-hmm

kicking their legs like crazy. And their blood pressure, heart [00:25:00] rate, and like cortisol would be rising when mom was outside the room despite the kind of stone face. Mm-hmm. And then when mom would come back, they wouldn't like rush to her. They wouldn't kind of reattach. They wouldn't show- Wait, so I'm a-

upset ... I'm confused. This is the anxious attachment? Or is this the avoidant? This is avoidant. This is now the avoidant. Okay. Yeah. So they're, pretending, "I don't care," but they really deep down, they probably care based on us- Yeah ... measuring their sympathetic response. Yeah. Or they've, right, they've learned kind of like reseeking attachment doesn't get me what I want.

Like it doesn't get me a further sense of safety, so why would I waste... So I'm still distressed that caretaker is not here, but there's a little bit- of like a learning probably in terms of like Why pursue that? Gotcha. So it's like the... This makes me think about operant conditioning when you're like- Mm-hmm

modifying someone's behavior. Mm-hmm. So these avoidant kids, or I think avoidant people in general, have kind of learned that their caregiver can [00:26:00] be r- is reliably unreliable. Mm-hmm. And if they can count on mom for anything, it's to never show up, so I have to rely on myself. Mm-hmm. And that trusting, like, other people are bad- Mm-hmm

and I'm good, basically. Like, the only person that, who's gonna look out for me is me. Right. Even though it still stresses me out. And then I guess the anxious attachment one's, how I understand, it's this variable interval reinforcement. Mm-hmm. Yes. So you know how like with a rat in a Skinner box- Mm-hmm

if you give it the, like, the cocaine-laced water every fourth hit- Mm-hmm ... it will constantly go there every fourth hit, then eventually give up, but if you randomize when the cocaine-laced water goes through, it will s- it will tap the Skinner box relentlessly- Mm-hmm ... until it passes out. Mm-hmm. And so when mom is disorganized and she's not responding- Mm-hmm

like maybe she has her own stuff going on, she's on the phone, she's busy, who kn- she has her own traumas- Mm-hmm ... then the kid is getting that variable [00:27:00] reinforcement that- Right ... when they seek attachment or they seek help from mom, they get it randomly. Yes. So they are just asking for it constantly- Right

just like the rat, but they're saying like, "Hey, I need you. Please help me." Right. Right. Yeah, I think that's exactly right, and I think also in the, like, with Mary Ainsworth, like, the history, I think, from her work and just in general was, like, this, the strand of the behaviorists like Skinner of like how is this, like, a ways of understanding more observable behavior versus, like, psychoanalysis was sort of like these invisible desires and, what was driving people, both of which I think have validity, but yeah, you're exactly right.

I think that's the way they started to make sense of it too. So now, like, in adults, we have this s- this kinda same idea. So, the, securely attached adult, I imagine, has a positive view of themselves and a positive view of other people. Like, I'm okay on my own- And I'm okay with another [00:28:00] person. Like, other humans are safety.

Yeah. And I am safety. Yeah. I think there's also- is there anything else to the securely attached adult? Yeah. I mean, I think in my view, and this is sort of anecdotal now, like, there's also this similar to with, like, the infant that, like, one of the main things was how does repair happen? And can- Mm-hmm

repair happen? To me, a secure adult, you know, in terms of attachment, is exactly what you said, as well as, like, when, like, knows that relationships won't be perfect and there'll be fights and misunderstandings, and is able to tolerate that and has skills to be able to repair and have enough kind of space without feeling really, scared or, like, overwhelmed to- Mm-hmm

build closeness over time, which includes conflict and repair. Mm-hmm. So I am, I'm not afraid of conflict and I can be consoled with conflict. Yeah. I think one thing that strikes me in [00:29:00] well-adjusted and secure individuals is this thing called object constancy. Yeah. It's, So it's like object permanence, where you play peekaboo with a kid.

when you cover up your eyes, so if something's visually obstructed, can I still comprehend that it exists behind the curtain? Right. And object constancy is like that, but just for emotions. So- if I'm feeling an emotion towards you, can I comprehend that my other emotions also exist towards you?

So like, Margaret, am I capable of being mad at you right now, but also- Mm-hmm ... know deep down I like you? Mm-hmm. Or, maybe I'm feel skeptical of you, but I appreciate this gesture you did for me right now, to like a stranger on the bus or something. Mm-hmm. And I think some people have trouble holding those emotions in tandem.

Yeah. And so it kind of leads them to either I'm gonna reject this person completely, or I'm gonna attach to them- Yeah ... solely. Yeah. and also one thing I, guess I work with a lot of my patients on in therapy is being able to see- [00:30:00] The complexity of emotions Mm-hmm ... in a situation. So if something happened- Love that

it's not all bad or it's not all good. Yeah. And if you can almost like they're, vectors I guess- Mm-hmm ... like arrows. So if the only, arrow I have is just like bad when- Right ... when something happens, then like- Right ... the situation is a crisis. You know? It's not just, "Oh, you know, they were mad at me."

It's like, "We're gonna break up- Right ... right now." Right. But then if, you have, "Oh, well like at least she's, it feels comfortable expressing herself in front of me, but also I feel sad that the thing she brought up was that she didn't like an action I did," now like you have one arrow pointing up and one arrow pointing down and- Mm-hmm

you're neutral. Right. Right. So that also kind of tempers how much these c- this conflict like destabilizes them. Yeah. So I think securely attached individuals, they can, they s- they're secure at the beginning, but also it's almost like they have shock absorbers- Mm-hmm. Yeah ... in the way they interpret the situation.

it doesn't just go zero to 100. Yeah. I always [00:31:00] like ask my patients, when my therapy patients in particular, ask them like d- what... When we're talking about how they handle emotions or how they deal with like things that are making them anxious in relationships, I always ask like, "Hey, what was your role model of what to do with hard emotions or what to do with conflict?"

Those are two separate things I'll ask. But like I think similarly with attachment, it's like how are you taught how to deal with... Like our parents teach us how we deal with these like hard parts of life. And, you know, are you taught... So one of the things that they talk about in the studies, the earlier studies, was kind of like the attunement, and the, other term that- What, is attunement?

So attunement in this case, but also actually I think in most cases, so I will... Attunement is, kind of the ability for another person, in the studies like for the mother, to read and respond to the infant's needs and emotions and distress. Mm-hmm. [00:32:00] So- So like how calibrated is the mom to the kid's- Yeah

cues. Yeah. So one of the things- Their, emotional or physical cues. Okay. One of the things that is talked about a lot in therapy in different ways is like the idea that, of like the good enough mother, which was kind of a pushback against like our parents do all these things and they mess us up and da.

Mm-hmm. And like especially on mothers historically. But one of the things in the attachment studies that they have st- they started to think about was like not the quantity of attachment kind of actions, but the quality of the attunement in them. Mm-hmm. and so attunement when we practice it as like therapists to talk about like adult attachment style, but also to talk about like how does this come up in therapy is- It is important that we are reading our, therapy patients, like, correctly and responding to them in a way that is, like, attuned to what they need and is not, like, shutting them down or, like, exacerbating it So, like, 'cause if I express something- Mm-hmm

to my [00:33:00] therapist- Mm-hmm ... I want them to have an idea that my emotion is being shown. Yeah. So, like if I guess if I'm crying- Yeah ... it even just as simple as a statement of like, "Hey, I noticed that some tears came out when you discussed that this is important to you." Yeah. Or like, "I notice that this seems to make you upset."

I think, and when I'm in situations where I've expressed myself and I don't think any emotions or, like, my emotions are acknowledged by other people, it's almost like my emotions don't matter. Right. And, I think that there are some kids that grew up in households where their emotions were almost never acknowledged.

Mm-hmm, mm-hmm. it's funny you should say that. I think I, I remember seeing a study that looked at the latency between- when a kid would express something and how quickly the mom would react to it and if she reacted appropriately. So like- Yeah ... let's say a kid was crying. How long does it take mom to go and say like, "Oh, are you sad?"

Like, "Let me acknowledge that [00:34:00] you're sad." Or if the kid's happy, "Are they happy?" But if it's, like, disorganized, like if you're crying and mom starts laughing at you or something- Mm-hmm ... then you're like, "Wait, if I'm expressing distress, why is this amusing to this other person?" And so you kind of, you're trying to calibrate how does, how do my personal feelings relate to other people?

And this is like my starting block. This makes no sense. Right, right. So, so to kind of like re-attune people in therapy, you have to show them like, "No, I'm, noticing this emotion. This is how I respond to it." Right. I'm noticing that you're excited or I'm noticing you're angry or frustrated- Yeah ... or sad or despaired.

And I think that's like, right, like emotional experiences and relationships despite, like, what kind of pop culturally we, I think we s- we think we say and are taught, at least in like the US, are still things that are learned. one of the things that, Bowlby would talk about is like the internal working model is like the kind of way he would phrase what we learn from [00:35:00] attachment as kids and what we take into older childhood and adulthood is like this model of how the wor- how relationships work, what emotions mean in us and which touches on a lot of the things, right, that, you were taught, that you, we've talked about already.

Mm-hmm. I think with that- Maybe talking about what do you think about when you think about like an adult with like a quote-unquote anxious attachment style in a way that isn't, you know, like five bullet points, but is like how might that show up? I, think about someone who's this serial monogamist.

They almost have to be in a relationship. Mm-hmm. And they have this kind of codependent organization. Like I... It's almost this like uncertainty of making a decision. Yeah. You're, not the type of person, and I think this was me for a lot of my life, they can't make any, kind of decision without having the endorsement of like everyone around them.

Like, "Hey, does anyone wanna like go out to this amusement park this weekend?" Or [00:36:00] like, "I'm thinking about going to this college." Like, "What do you think about it? What do you think about it? what do my parents think about it?" And then there are other kids in high school that were like, "I'm going to this university and I don't care what anyone says."

Yeah. And I think, classically I think of the, for the avoidant kid or the adult, I think of that like person in the back of the class with like the alpha wolf, alpha lone wolf T-shirt, you know? Well, I want... Can we- they're like inside neither- ... merge our T-shirts? There are two wolves- Merge for the podcast

and neither of them needs- We have the two wolves inside of everyone ... the support of a relationship. No, seriously. I, like I've talked to people and they're like- Yeah ... "I really like my independence. I couldn't imagine- Mm-hmm ... being tied down in a relationship." They use all these, this negative language to describe- Mm-hmm

a romantic bond between people as though- Mm-hmm ... it's something unsafe. And the other thing that I find interesting, so when I read about it in adults, there's this, I guess a fourth type of unstable attachment. Mm-hmm. Yeah. And that's, mixed or I think [00:37:00] disorganized- Yeah ... or fearful avoidant are- Yeah

are all terms I use. And that's where you're basically the best of both worlds. So I think about- Hannah Montana mentioned. Yeah. I think about 60% of people are securely attached. And then you have 20% are anxious, another 20% are avoidant. Mm-hmm. And then the scraps. The scraps. So, the 55, so 55%-ish are secure.

The last l- couple percents, like 1% to 2%, those are your fearful avoidants. it's less common and because it's kind of hard to develop that organized view of relationships. So someone who's fearful avoidant, because they're both, they have this anxious codependence, but then the second they get close to a relationship, they're afraid- Mm-hmm

of it and they push it away. Mm-hmm. So you crave emotional intimacy, but you fear losing your independence. Mm-hmm. Which sounds like a nightmare- Yeah ... to be stuck. Like, I feel like you are [00:38:00] almost, like, never satisfied. Yeah. I guess we, we've kind of seen how these exist on, different lines. Mm-hmm. And, everything's on a spectrum, I guess.

So- I think one caveat to mention, though, is that, like, these are ways of relating that people learn, and therefore, they don't silo quite as neatly as how we're talking about them. I think they're super helpful and valid frames to think about, but I also think a- like, the mixture of styles or that people can act differently in different relationships.

I think one of the things that bothers me the most about, like, attachment style stuff talked about online is when we give people this as, like, a framework and we talk about, like, the emotional, like, a b- emotional, physical, or any other, like, abuse, world, that- It becomes the prism that they view everything in their life.

Yeah. Well, and it becomes like, if you feel [00:39:00] anxious and you're not sure about the person, like, if there's gaslighting and there's emotional manipulation and there's, like, infidelity or abuse-

Anyone would feel uncertain, right? Anyone would feel- Mm-hmm ... that. So just to say that these don't happen in a vacuum when you're an infant, and they don't, they're in a dyad always, or they're in a, They're the thing you create together. And so while people may tend towards relating in a certain way over and over again, it's also, like, people will get into...

One of the papers I was reading was talking about, like, people with anxious attachment styles, if they get in a relationship where they feel sufficiently attuned to, can have really good relationship outcomes. And so just that you don't, it's not just one person playing at any time, and that also this is a different conversation if, like, abuse or emotion- a- just any sort of abuse is on the table.

Yeah. I think we in, as a society, especially in pop psych, struggle drawing the line of pathology. Like, if... Like, [00:40:00] and I think I always use physi- I always, like, fall back on physical pain as my metaphor- Mm-hmm ... for this. If I step on a nail, it's gonna hurt really bad. But that doesn't mean I have chronic pain syndrome- Right

or someone that experiences, like, unrelenting chronic pain every day. Mm-hmm. And I think we do the equivalent in psychiatry of I step on a nail one time, I'm like, "Oh my God, I have chronic pain syndrome"- Mm-hmm ... 'cause my foot hurts so bad. Right. And then- And everyone's like, "Well, it's, like, kinda, you know...

This is reasonable, but it's not disrupting your ability to in- like, engage meaningfully- Right ... with your life." And I think it's just so hard for people that, like, once they identify this emotion to say, like, "Oh, it has to be pathology." Right. Well, and I think similarly, like, with c- with acute and chronic pain, one of the things that we know in the chronic pain world is, like, there are certain things in the way you view and relate to pain that, like, if you have acute pain and you have, you're really anxious in general, and you're like, "Oh, no, what if this turns into chronic pain?

Is this chronic pain?" You are in some ways more- Mm-hmm ... [00:41:00] likely to develop a chronic pain syndrome. Similarly with attachment or with emotion, I think, in a lot of ways- If you are really fearful that it's means something big and bad is wrong with you and your life is, like, F'd forever- Mm-hmm ... that makes it hard to change this is my soulmate or I'm doomed for the rest of my life.

Right. Or this is my attachment style because some of it resonates with me, when in reality, is it your attachment style or are you just normally anxious because you're, like, going on a first date? Yeah. Does it have to be pathology or can it be human experience, and can we not be emotion phobic- Yeah

which our society also is. Exactly like, like CrossFitters. They say pain is weakness leaving the body. You know? Like- Yeah ... can we get a reframe on my anxious attachment? Like, oh, this is Can we get a reframe please? This is just, this is my insecurity leaving the body. Spoilers. Yeah. And there's, like, this whole community like, "Ugh, embrace your insecurity."

CrossFit Matt mentioned. I just... Yeah. No, it's funny 'cause [00:42:00] I think, like, I've seen people that, like, they love CrossFit and the way they appraise pain, they like lean into it. Mm-hmm. You know, where the other people are like, pain's the worst thing ever. I'm trying to avoid it." And they're like, if I don't hurt, I'm not having a good workout."

So it... And, like, ideally they have... People are experiencing the same sensation, but they have a very different relationship with it. And I think even, like, I'm the same way with grief is one thing I'm trying to do, is, like, I know people that they will, like, lean into grief and be like, "I'm so sad and I feel this."

And other t- people like me will be like, "Oh, I never wanna experience grief. I've gotta find a way to replace this emotion or avoid it or do something." I'm gonna delete this emotion. And yeah, so I don't know how to be that CrossFitter who's like, "Oh, this is, like, strength enter my body or weakness leaving my body."

It's- I also wanna say, like, that the, CrossFitter also, like, right, the person who does that also is more likely to ha- There's, like, is an issue with injuries in CrossFit and in pushing yourself in that way that our brain's really, like- Be toxically positive. Yeah. Or, [00:43:00] like, it can be... That there's, too far in both directions, and our human minds love to be like, "I have one rule and I apply it to everything, and now I can turn off in some ways because my- Mm-hmm

I don't have to make complex decisions anymore." I don't have to critically think because it's who I am. Yeah. I hate critically thinking. Yeah. Who doesn't? Let's get rid of that. That's our, that's my hot take. That's good. I'm glad we got around to your hot takes. So, when we come back, we can go over this attachment quiz that I took and- Oh, yeah.

Be sure tell us. The results kinda, they, surprise me because I didn't think that my childhood was that bad. Oh. But I guess we'll find out. and I also kind of got to see that continuum of how- Mm-hmm ... it scored me in multiple regions rather than them just being like, "Here's your single label.

Here's your gold star." Yeah. It's like, no, you actually, you know... I got my little, like, equivalent of, like, ENTJ, which that's my Myers-Briggs is ENTJ. Ooh. Or I think it's INTJ. INTJ, so. I'm, like, somewhere in the middle. Okay. So we'll take a quick break, and then, when we come back, we'll talk about our own attachment problems.[00:44:00] 

Well. Or mine.

I have my results. Let's hear 'em. I was, kinda surprised. I, thought that I was this paragon of human emotion and interacting with people, and then it said I was 60% fearful avoidant, or the, or like the mixed disorganized. You're a unicorn. I know. I was like, "I'm... I got the rare one?" And then, my next one was secure, so I was like, "Okay, we're in the bag there."

What do you mean your next one? So it, it kind of ranked- Oh, the second most high n- answers. Yeah ... me, yeah, so, so my highest one was fearful avoidant, then it went secure, then after that was anxious, and then the last one was avoidant. Mm-hmm. So I think what's interesting about that is it kind of implies that I have this almost negative view of myself- Mm-hmm

and negative view of other people. So it's like I don't trust [00:45:00] myself to be quiet on my own, but I'm also like, don't trust myself to be in a relationship with someone. Mm-hmm. And I was kinda like, I was like, how does this actually, like, manifest? Like, like does this, like, make sense- with, like, kinda how I was raised?

I don't know. And, and so I was, debriefing this in therapy, and I think a lot of it came from how I got a lot of mixed messages from both of my parents. Mm-hmm. So my dad, I always joke that my dad's love was like an electron. Mm-hmm. You know? Like, you're pretty sure it exists, but you can't, like, see it, feel it, touch it, taste it.

You know, you're like, "Ah, who knows?" You know? But like, I, believe in, like, quantum mechanics and I know it's there, and he must express it, but like I'm not experiencing that. So that was like kinda like one relationship I had where almost I knew not to trust someone else, and I was like, "Okay," like, "I have to be on my own."

And then my mom would give me a lot of, support and would be very intimate and kinda like emotionally like [00:46:00] lovey-dovey, but then would also kind of flip a switch- Mm-hmm ... and, yell at us a lot. Like- Hm ... like one time I had, like a, relationship over- Mm-hmm ... for Thanksgiving, and she w- she like screamed from the, top of the stairs.

She was like, "Preston," like, "Get your laundry." And, dude, like I'm a medical student. Like, I'm like 25, home visiting. And then the girl I was with was like, "Your mom yells at you like that?" And I was like, "Yeah, I'm used to it." And she was like, "My parents never yell." And I was like, "Oh, well this is nothing compared to what it used to be."

I'm like, this is actually the good edit right now. Yeah, I'm like- This is not the behind-the-scenes cut ... I'm like, I'm chilling. Yeah. And so, so she was like, "Preston, I think, like, you kinda had a more toxic childhood than you thought." And I was like, "Oh, okay." So then I took one of those like ACES, Adverse Childhood Experiences- and I was like, "Oh, okay, whoa." "There's a significant-" Not funny. I'm sorry ... am- amount of these." Yeah. [00:47:00] And I guess it kinda started to make sense that I was like, I don't know if I should be able to express myself. Mm-hmm. Funnily enough, humor is like one of the ways that I learned to, like, avoid those situations.

So I would always, like, defuse situations in the household by making a joke or being funny. Or I would like... I almost view, like, shame- or like being silly like a vacuum. Like, all the, eyes can be on me so the conflict will have to stop. You know what I mean? So, like, if I had, a fi- a campfire going and I lit a bonfire next to it- Mm-hmm

the oxygen's gonna snuff out the campfire- Mm-hmm ... because it's all gonna get taken up into the bonfire. So I would kind of view it like that in my household. Like, if my parents are fighting or if there's a lot of conflict between my sisters or something's directed at me- if I make someone laugh, I can disarm them.

Right. And I can avoid that, like, conflicting situation. Right. So- And there's also something to that of there's kind of an implicit, like, "I'm [00:48:00] okay," like, "I'm laughing, I'm happy, I'm whatever" that is, when used at certain times, that call for, like, disclosure of vulnerability or sadness- Mm-hmm ... a way of protecting ourselves.

In the situations where we learn it, like what you're saying, of, like, having to do it, and then, though, we get into adulthood and maybe hopefully, like, away from those situations. And we push away people who want to know the other parts of us. Yeah. Because it's like, "Why would you do that? Also, you might just, like, yell at me if I tell you."

Exactly. And, I think in a lot of ways, I use humor almost as my, like, fearful voidant tool sometimes. Mm-hmm. Like, jokes, like laughing together with someone can make you feel close. You can use humor to not let someone get too close. Like, everything's a joke. I'm not gonna let this be serious right now.

Yeah. So y- it's, like, simultaneously an icebreaker and it's an ice wall- Right ... I [00:49:00] guess, if that makes sense. Right. Yeah. and I think I... Like, I feel s- I feel safe in that, environment. So it's, been kinda interesting to reflect on that, and that's one thing I'm actually working on in therapy right now is that I use humor as, like, an avoidant technique.

Mm-hmm. And I always, like, frame this positive. Relatable. I'm like, "Oh, if I'm making a joke, then I've succeeded. I've defused the situation." And then my therapist is like- Are you not entertained? I'm sad. She's like, "Do you ever think you use humor to avoid emotions?" And I was like, "Oh, Now that you say that.

I was like, "This conversation's over." This is done. and then she laughed. We're done now. Yeah. And I w- I was like, "See, I made you laugh," and she was like, "Yeah, I see what you're trying to do. You're trying to avoid talking about this." Yeah. So she's kinda got my number unfortunately, and I've been trying to kinda, like, appraise when I use that.

So I think that's, like, a driving factor in how I developed this fearful avoidant organization. So- Mm-hmm ... I'm not gonna go into the, any of the TMI relationships, [00:50:00] but I think it's been helpful to kinda re- reflect on understanding that you can be okay on your own and also, like, be stable in a relationship with someone.

Mm-hmm. And I think, like, the awareness of that is really helpful. Yeah. There's this, like, conversation on TikTok right now that is sort of... It's not necessarily about this, but I think it's really related, in some ways, in that there's this conversation, at least on my side of TikTok and in kind of, like, girl world to some extent of, like, people asking different people asking this kind of question of how do you be more confident?

And, like, a response generally being like, "I think you just need, like, I think you're thinking about yourself too much." And to me, like, C.S. Lewis has a quote that he said, like, "Humility is not thinking less of yourself, but thinking of yourself less." And to me- that applies to, like, the attachment stuff, too, because it's not, like, thinking more of them or thinking more of yourself.

It's actually, like- I'm, I will care and I will grieve if I [00:51:00] lose this person, but I will still be me. And that's such, like, a beautiful stance to have in the world. And that, like, people can become more that way even if you don't have that attachment style or that experience before. Mm-hmm. I think especially, it's funny you should say that.

When I was, like, in my adolescence and I felt, like, really unstable in these relationships, you know, and you ask that person, you're like... They're like, "Do you like pancakes?" And you're like, does, is Sara gonna like me more or less if I say I like pancakes?" Mm-hmm. You know, and so that overthinking about trivial preferences.

Mm-hmm. Like, thinking too much about yourself. But if you just, kinda answer like, "Yeah, I do," or, "I don't," like- Right ... whatever. Any, and knowing that's who you are and that, that will either be accepted or rejected and that's okay. Right. Right. Right. Is, really interesting to me. And that no one can love you if...

Like, no one can really know you intimately and closely if [00:52:00] you, if they feel like you're kind of shifting under their gaze to be something that they want. Mm-hmm. Like, that there's some kind of inherent edge that is attractive of being, like- You're, trying to filter yourself for their approval Yes.

'Cause then they're like, "Well, but who are you and how can I know you, and how can I trust you that I can be myself with you if you won't be yourself with me?" Mm-hmm. But, man, it's tough. And, it's because, you know- It's tough. ... worried that, and I think that person is worried that their true self is not good enough.

Yeah. That if I reveal my true self to this person, they'll find it wanting. Yeah. So I need to recalibrate, or I need to kind of almost, like, mold myself- Yeah ... in a presentable way and be the version that they might accept. So like, like what C.S. Lewis said, think less of yourself. Think less about yourself to think more of yourself.

It's almost like- You don't have to think about yourself at all. You just have to accept who you are. Mm-hmm. Mm-hmm. Like, they- I think you also [00:53:00] have to practice, and this, moves us into this, the, thing we'll end on, which is kind of what you were- I like the word you used of, like, recalibrate, of, like, what do you think about, for you, from anecdotes, like, outside of clinic or in clinics, of how to make this concept not just a diagnosis, but a workable tool?

So I think one of the things is, like, prac- Like, I'll often ask my patients even when we're talking about all these other things is, like, "Well, what do you... What did you like to do when you were a kid? And can you do that for 30 minutes this week and not have it be for performance or not for anything else, but just, like- Mm-hmm

re-explore, like, what do I like, and what does it feel like, and what are the experiences that I can focus on rather than focusing on if I'm good enough, if they're good enough, if this is working?" Yeah. I think there's a lot of beauty in practicing. So and one thing we're learning in CBT right now is that if there's ever this discrepancy between how you want to feel about a [00:54:00] situation and how you react to that situation- a behavioral experiment or practice is the best way to resolve that. So if you're like, "Well, I want to accept myself, but whenever I feel like I'm being vulnerable in front of someone- Mm-hmm ... I get nervous and I, filter it out." So just like someone who's afraid of a spider- Mm-hmm ... they're like, "I know I shouldn't be afraid of this small tarantula or this bunny.

I have bunny phobia." Okay. "But my heart rate's at 150 every time I pet a bunny." Yeah. "And that doesn't make any sense to me, and I rationally know I shouldn't be afraid of bunnies, but here we are." Mm-hmm. The solution to that would be we're gonna go pet a bunny. Yeah. And you're gonna sit with it. So- Doing bunny yoga.

Exactly. You're gonna test out the, depth of the pool with both your feet. Mm-hmm. Just kidding. We can do a toe in my office. We'll just look at videos of bunnies. We're just gonna watch bunny videos. This is for the patient or for us. Yeah. This is... And then I'm like, "Another day of watching bunny videos in my office."

I'm like, "This is another..." You know, the patient comes in to talk about their divorce, and I'm [00:55:00] like, "Another classic case of bunny phobia." this is all- "Guess we'll have to watch more bunny videos" ... symbolic. And the guy's like, I'm not mad about it." Like, "Okay." And you're like, "Well, you know, Easter's coming up pretty soon, so we gotta get to work."

this is giving me serious bunny phobia vibes, man. We need to work on that. So the same thing with expressing yourself emotionally. Mm-hmm. You just- Talking about practice ... small, at first, trivial stuff. You know, "What's your favorite flavor of ice cream? What's your favorite color?" And then- How do you feel about your place in the world?

What do you want your career to look like? Yeah. Yeah. Like, what do you want another person? Like, those are really strong, vulnerable things to share. Mm-hmm. And you kinda just kinda get used to be like, "Well, you know, oh, I shared this thing about me," and then you open the blast doors and you're like, "Wait, you still like me?"

Mm-hmm. Mm-hmm. "You still accept me? I can accept me? Look at that." So I think one thing that's helpful, like you said, using attachment theory to interact with your [00:56:00] patients is to take this as a framework and say, "Okay, how do, you, this complex, nuanced person- Mm-hmm ... at this moment in time fit into this framework?"

Mm-hmm. And then how does it guide us to help close the gap you have between how your life is and how you want your life to be? 'Cause that's ultimately the goal of therapy, is ul- the goal of psychiatry, really. Well, and that's one of the roles, too, of therapy and psychiatry. Like, even one of my favorite, like, papers that we have to read every year in, at my residency is, like, how not what to prescribe, which is kind of on, like, the meaning of medications and the therapeutic relationship and all sorts of things.

But, like, the, therapy itself is practice as well, and it's a practice of, like, connecting and hopefully connecting with someone who you feel like is understanding you, is listening to you, that if, you know, they do something that annoys you or you feel misunderstood, that there's enough space there to have them re-attune to you and to do the kind of small, like, breakage and [00:57:00] repair in a way that's- Mm-hmm

different than your internal kind of working model that you've had before. Yeah. I, see it almost like- I, you're always gonna see me going back to the, physical pain analogy. if I broke my arm and I know how to, like, cope with it- Mm-hmm ... I kinda just, like, hobble around and maybe I only grip my pencil with my, like, middle finger and- Mm-hmm

part of my thumb. But then when I go into the physical therapist's office or the, surgeon's office, it's gonna be really painful to try to- Yes ... like, do a closed reduction, but that's a safe, sterile environment to do it. I'm not trying to reduce my arm in a Wendy's parking lot with my whole family around.

You know what I mean? In a Wendy's parking lot. I don't know. Like, maybe- Wendy, if you wanna sponsor us, I love a Frosty. That's all I'll say. Maybe your hands were full of Frosties and- Oh full of Frosties ... and you trip over the curb. Next thing you know your arm's broken, now your whole family's around, and you're like, "Oh my gosh."

And you drop all the Frosties. "How do I handle this?" Yeah. So you have to kind of find the right environments to do [00:58:00] emotional surgery the same way you do physical surgery. and otherwise it might be too painful and you might just reject it and be like, "You're never touching me again." Like, "Don't touch my arm."

And like, again, similar to, like, physical therapy, that tak- that takes a long time to make you feel better, and it works, but it's like, okay, I guess I'm going to the physical therapist's office twice a week and I'm gonna be doing my set of bridges, and the kid next to me who's, like, eight is gonna be better at th- than I am.

This is not a specific experience at all of mine. Mm-hmm. But, similarly it's gonna take time to kind of reshape the way of relating. But the really hopeful thing is that it's possible, 'cause I think often there's this message of, like, it's either this or that and then you're done, where there's actually a way of changing what feels safe and what feels like good connection.

And, but you're totally right, where it has to be done in a way, especially if there's any history of, like, trauma, abuse, like, that makes people- feel that they cannot trust their internal system and that [00:59:00] they don't have good intuition. And even sometimes when we give people a diagnosis, we can diagnose them with anxiety when it's like, is it anxiety and there's, like, a pathology there?

Or is it something else? Like- Mm-hmm ... I often will see, like, people be like, "Oh, I'm just an anxious person, and that's why I feel this way. And, like, the medication'll solve it." And the medication can really help, but sometimes it's like, have you been through ways of relating that can, that are not you're just an anxious person and this is how you are, and you're broken in the world?

It's like, no, you have an, ability over time to- Have experiences of secure relationships. It just takes some kind of redoing Yeah. And you're using the medication to treat this constant anxious response- Right ... to a disorganized attachment. Right. Yeah. Right. So I guess the way I view this, and I know everyone loves the, in medicine we love to say lens, but it's really like that.

Yeah. So when we're at the optometrist and I'm like, "What l- what looks better, one or two?" Yeah. One or two? Attachment theory is one [01:00:00] and CBT is two. W- we're really looking at- Yes ... the maladaptive core belief someone has, their, concept of self, their personhood, and how they relate to other people.

Mm-hmm. And we're just picking what focal length we wanna look at it with. Yes. And some of it's captured well in attachment theory, some of it's captured well in CBT, some of it in psychodynamic. Yeah. And so the adept psychiatrist is someone who can, or psychologist, can navigate those lenses well- Mm-hmm.

Mm-hmm ... to find one that fits both their and their patient's understanding the best. Right. And sometimes you're gonna see the same thing in different lenses. Well, I think a l- a lot of the time you do. Right. Right. I think th- a question for us to end on positively, Oh, actually, I have something I wanted to talk about- Okay, go on

which is w- I wanna... I use these lenses and I applied them to movies that I'd watched, and I think I gave you homework too, to find- You did give me homework. ... find some characters that you think show attachment [01:01:00] styles- Yes ... and how they play out. Yes. So, why don't you go first? I wanna, see what you brought up.

Okay. So mine is M- Meg in Hercules and in Hercules. so Meg in Hercules, as the, Disney version, as those of you who know, has a song called I Want to Say I'm In Love. She's also, like, for a number of reasons, a servant to Hades, and is trying to, like... is supposed to, like, go mess up Hercules and, like, fool him and make him not a hero and da, And then accidentally falls in love with him and sings this song in the, you know, middle of the movie like If there's a price for rotten judgment, I guess I've already, like, I've paid it or I've already... If there's a prize for rotten judgment, I guess I've already wo- run, won that. no man is worth the aggravation.

That's ancient history. Been there, done that. So, first of all, bar. Second of all I- I think she might've been my first animated crush. Wait, I thought you said you hadn't seen this movie. No, I've, I'm [01:02:00] looking it up right now. I have seen this movie. yeah. so I would say that she's avoidant attachment.

Yeah, so no man's gonna hold her down. But- No man's, well, avoidant and also, like, no one's gonna be good. Mm-hmm ... I will not be dependent on anyone. I will not, like, need anyone. They're only gonna disappoint me. I've had this experience of no one being attuned to me and abandonment. I'm not doing this.

That's my- Yeah. ... my pick of, like, okay, here's the- I think it's a funny metaphor because the strongest male figure in her life is literally Hades. Is literally the, devil. it's like, are, other people safe, are other people evil? She's like, "Well, the only person I know is actually the devil."

Yeah. Or, the, Greek- So- I mean, Hades isn't really the devil- Yeah ... but the Greek interpretation of the, Yada, we know ... the overseer of the underworld. Sor- sorry, Hades, I know, he probably hates getting compared to, Unfortunately, I think he was my first- ... Beel- Beelzebub and- ... childhood crush

Behemoth all the time So sadly. What does that say about me? Yeah. That's so [01:03:00] funny. No, I can see that. it, her being avoidant attachment, no, I, wasn't picturing you having a crush on the animated version of Hades with the blue hair. So- He's got no personality. That's all I'll say. Now, I'm gonna segue to w- what I brought to the table- Yeah, who are yours?

which is, so first, I'm gonna do anxious attachment. Okay. And I have Jerry Smith from Rick and Morty. So if you- This is, we're outside of my sphere of pop culture right now. Okay, so I'd love to explain this to you. I would love you to explain this to me. So Ri- Rick and Morty is a lovely show about, interdimensional travel.

So they actually probably started the whole, like, interdimensional plot scene, plot sequence- Mm-hmm ... that's been, like, pretty overused at this point. But there's infinite number of realities, and Rick is this super genius who's the smartest in all versions, and he's the only person who's discovered a way to travel between these universes.

Okay. And he lives with his daughter and his, and her lame duck husband, Jerry, [01:04:00] who cannot do- Oh ... anything on his own. He just ha- he has to be stuck with either his s- his, like, scared son or his husband or his wife, Beth, or with, Rick, and all this time. So it's kind of a running joke that Jerry can't do anything to support himself.

And there's like, I think there's one time at the dinner table where he's, like, toasting at Thanksgiving, and he's like, "To my lovely family, who I am so grateful for, and if I didn't have you around, I think I would actually perish." And then it's, like, quiet for a second at the table, and he goes at my own hand I'm, so I'm gonna be hon- like, "Beth, if you left me, I think I might end my..."

And then it like just cuts off. And I was like, "Wow, that's great job, Rick and Morty. Like, you, you identified some anxious attachment there." Okay, I see it. Yeah, I see it. And, it's like funny how it plays out, but then, like how we were [01:05:00] talking, he gets the chance to redeem himself. And so there's a lot of times where- Mm-hmm

he is abandoned, and then Jerry has to learn to depend on himself and have- Mm-hmm ... self-efficacy. So they leave him behind in this universe where basically it's like an apocalyptics, apoc- apocalyptic end to Earth in that dimension they left it. they come back years later, and Jerry has survived on his own.

And he's like, "I learned to depend on myself." he's like in all this caveman garb. He's got like a hide of a buffalo on, you know, stoking a fire with a spear that he made himself. Yeah. He's like, "That's old Jerry. Like, new, Jerry has secure attachment. He can do his own thing." That's like your dream is like, like the me.

Like, I just- Yeah, that's my redem- I just need to be in a different dimension ... Jerry has a great redemption arc. I see. So- Yeah, that does sound like good, like he's getting secure. Well, at least, so the problem is then you go to the next episode and they're in a new dimension. We're back to lame duck Jerry.

Mm-hmm. But that one Jerry in that one universe, kudos man. I'm glad you did it. That's how some people [01:06:00] feel in therapy though. Like, they like reach a breakthrough and they like, or they have like one victory that week and they're like, "Look." And then it's like next week, new episode. We, like we're back to the usual.

Yeah. Yeah, exactly. So my second character, I just wanted to squeeze this in because I have a hot take on this but is, Good Will Hunting. So Will Hunting is your classic avoidant attachment, but you could use an antisocial lens to view him as well if you wanted to. Sure. Because a lot of what he does, makes almost no sense.

Like, Will's like, time to drive in my car. I'm, a, this like super genius that can solve these math problems. I'm being hired by the university- Mm-hmm ... to solve math problems," and he's like, "Better get in a bar fight or start conflict for, seemingly no reason." And I think- Yeah ... when I first watched it, I was like, "Oh, this is, doesn't make any sense."

But- Mm-hmm ... he doesn't wanna be in a situation where he's dependent on anyone. Right. And he pro- he almost to [01:07:00] like an absurd hyperbole views himself as so great that he can get himself out of any kind of trouble, out of jail. Like, he's talked himself off the stand several times- Mm-hmm ... at the start of the movie.

Mm-hmm. And then every time he like finds himself getting close to the, Stanford girl, I forget her name. Mm-hmm. Or sorry, the Harvard girl who's going to med school at Stanford. Yes. He like pushes her away. Yeah. And the conclusion to the movie is he has to go see About a Girl, and he kind of- realizes that he can trust other people. Yeah. Kinda correct his attachment. So- And then there are no issues ever. No everything- It's happily ever after ... everything's perfect, yeah. So thanks, Ben Affleck, for creating this wonderful film. Actually, I don't like Good Will Hunting, though. I know you don't. So I feel like I've been glazing it by dis- by kinda giving Will Hunting's character more nuance than he deserves.

Because at, the end of the day- I like the movie. I like it. I know, and we'll, discuss this at a different [01:08:00] episode. it's gonna be on the Patreon. But it's, Oscar bait that is essentially just three monologues from Rob- Robin Williams, and the rest of it is filler, screen filler. So it's- I liked the film

it works really well in these digestible bites. Watch it this weekend. we'll talk about it later. I live it. Okay. Thank you so much for listening. If you guys wanna learn more, please reach out to our socials. You can contact us and give us any of your feedback, things that you wanna see differently about the show, any of my jokes that landed, didn't land, if you wanna hear Margaret talk more, if you wanna hear me talk more.

We're open to all of those things. I know everyone kinda wants to have their voice heard, and our inbox is open, so this is a conversation we wanna have with y'all. If you wanna reach out on Instagram or TikTok, you can find us @humancontentpods, or you can contact the d- the team directly on our website, howtobepatientpod.com.

And remember, this is a new show. It's an experiment for me and Margaret. We're trying our best to [01:09:00] make this thing work for us- We are scientists ... but also for you. You're the audience, you know? this is kind of a three-way conversation, so if there's stuff that you wanna hear in the conversation, please write in.

We'd love to hear about it. Or if there are things that you're not comfortable with or just anything you have feedback on- Mm-hmm ... we wanna hear it all. We're learning how to be psychiatrists, and your guys' feedback on this is part of us becoming better at doing that. Yeah. Yeah, we need to have a secure relationship with the feedback we get from y'all.

Yeah. If you wanna see full episodes, they're available on the YouTube channel each week at It's Presro. Thank you for listening. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, Preston Roche; also Margaret Duncan; Will Flanary; Kristin Flanary; Aron Korney; Rob Goldman; and Shahnti Brooke.

Our editor and engineer is Tracy Barnett. Our music is by Omer Ben-Zvi. If you want to learn about our program disclaimer or ethics pos- So to learn about our- We have no ethics ... program disclaimer and ethics policy, submission verification and licensing terms, [01:10:00] or HIPAA release terms, just go to our website and check out howtobepatient@human-content.com and bring up any questions or concerns there.

So just remember, we do this as learners, we do this as physicians in training, and as fellow humans that are just trying to bring these discussions to light. So we appreciate any feedback on it, but the goal is ultimately that this isn't medical advice and that also- It's like the helpful conversation

we're not trying to stand on our pedestal and preach to you. Yeah. Well, a, little bit. I am about Strega Nona, but that's neither here nor there. And, I will about Good Will Hunting. Ugh. How to Be Patient is a Human content production. Thank you guys for listening[01:11:00] 

Thank you for watching. If you wanna see more of us, or if you wanna see... This is Lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac, point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They pr- they probably exist for real.

But in the meantime, I'm just gonna pet Lilac, and then I'm gonna go dance in the background