My Personal Integrative Approach

“What lies before us and what lies behind us are small matters compared to what lies within us. When we bring what is within us out into the world, miracles happen”. (Henry Thoreau, 1817-62).

What follows is one possible explanation of how emotional difficulties may develop as a result of misattunements in our early relationships. However, often it is not so clear cut and it is not the only explanation. Other circumstances, such as trauma or abuse may also give rise to emotional and other difficulties. It should also be kept in mind that even if the explanation below resonates with you on a personal level, there may be reasons why your carers attunement to you as you developed was not quite what you needed - their work commitments, their own upbringing, large families and your birth order within it, or even other siblings with difficulties etc that may have left your carers with insufficient emotional energy to devote to you as you needed it. What I am suggesting is that it is the quality of our own "felt" experience that sets the tone for our expectations of how our future relationships with others will be. We learn and adapt from our experiences, sometimes in healthy ways, but sometimes we learned to behave in unhelpful ways that brought us the love or attention we wanted, or helped us avoid intrusive or unwanted attention, and these unhelpful ways of thinking, feeling and behaving become fixed and entrenched, hence why we keep doing the same things in different relationships leading us to get the same unsatisfactory results.

I believe our personality and emotional development, both healthy and unhealthy, develop from the interaction between what we instinctually need and whether the environment’s we live in, and especially the significant people in our lives, are able to respond to us in an attuned, or at least “good enough” (Winnicott, 1965) manner.

From the very beginning, our lives revolve around intimate attachments to significant others, with our first relationships being a key context for our development. As infants, our very survival depends upon us bonding/attaching to our primary carers, usually but not always our parents, and we adapt ourselves to maintain this physical proximity, making sure that our various instinctual needs such as food and protection are met. The quality of these early experiences shapes our expectations of future interactions.

When our needs are not met we may try to control our environment - think of the infant crying for food. This may only be partly successful, depending upon a range of factors such as the availability of our carers, for example. If we can't control and change our environments response to us, then instead we will adapt ourselves to the demands of our environment: “If parents cannot adapt themselves to the changing needs of their developing child, then the child will adapt itself to what is available to maintain the required ties (Stolorow et al., 1987: 90).

In line with Trevarthen’s (1979) theory of Primary Intersubjectivity, I believe we are born “hardwired” to relate to other people, and it is this felt quality of our early relationships, especially with our primary carers that is a key factor in our early emotional development, healthy or otherwise. Our first few months, and years, become a developmental crucible for us, where we and our primary carers co-create between us a world where each interaction between us influences how we think, feel and relate to each other, both now and going forward. In these relationships we learn not only about ourselves and others, but also about the world around us (Stern, 2003). Stern suggests there are a number of developmental possibilities here:

Overstimulation can occur where the our carers constantly play or interact with us, even when we don't want to, perhaps out of their need for closeness or affection. As a result, we may develop a view that interactions with others are too demanding, and in turn we may either avoid interpersonal contact or become overly compliant. If our parents are overbearing and dominate the space in our interactions together then we may not fully develop our capacity to communicate and interact with others. At the extreme, we may fear being overwhelmed by others and consequently learn to fear and dread closeness and intimacy.

Alternatively, we may find interactions with others insufficiently stimulating, perhaps because our carer(s) are emotionally distant, unresponsive, absent or depressed, for example. This may lead us to develop a view that relationships are unrewarding and rejecting, and we may avoid interpersonal contact because we get little from it. However, it may also be the case that we become a "performer" as a means of gaining the attention and closeness we desire. As adults we may then struggle to receive others in relationships as we are desperate to get our own needs met first.

Thirdly, the carers may attune to selective behaviours in us, for instance rewarding the bright, bubbly aspects of our characters but leaving us to our own devices when we are sad or grumpy. Here, we may learn that it is only rewarding to interact with others in a good mood, disavowing our negative emotions, potentially leaving them difficult to access in the future, and leading to the development of a rather narrow sense of self.

Fourthly, Stern suggests that the carers may misattune to our needs. For example, the father who responds to the squeals of delight of his daughter with a smile, only to follow this with an instruction to her of not to get too excited. This can be particularly difficult, as we don't not know where we stand, and where the carer actually enters the our world before undermining and distorting it. The frustration and confusion that may ensue can in turn lead us to withhold our actual felt experiences from others in the future.

Finally there are unauthentic attunements based upon deceitful communication, which may be powerfully disorientating to us, where others overt expressions just don't ring true with what they seem to be conveying at a covert level, such as their body language. Such confusion may lead us to withdraw from interactions with others.

It is through these close early relationships that we develop internal models of our relationships with others (Bowlby, 1988). These models help us predict how we expect others to behave based on our past experience of relating to them and in doing so shape our future interactions and relationships, and our expectations of them. Much of this early development is before we can speak, which explains the importance of the infant’s "felt" security. As the saying goes: "Actions speak louder than words". What is important is that we lay down these representations, not just in terms of specific people but in terms of how we expect interactions with others to play out, based upon our experiences. This is why it is so easy for us to transfer not just our experiences from one person to another, and one situation to another, but we also transfer and employ the same early, rigid ways of behaving: it is not so much a "so and so is like this", but more of a "when I engage in certain ways then these particular things tend to happen". How many of us end up unconsciously choosing a partner, even marrying them sometimes, who when we really step back and truly reflect on things, reminds us of either our mother or father. Perhaps they behave in ways we are familiar with, and understand, making the relationship feel safer as we know what to expect. Perhaps it is because we are searching to recreate old relationships and model them anew, receiving the kind of attention and love we never quite received, but wished we had. Whatever the reasons, our early relationships have a significant impact on our lives.

Not all is lost, though. There is always the opportunity for these relationship ruptures to be repaired, allowing us to learn that failures in communication are manageable, in the same way that differences in how people feel and respond are also manageable. It should also be noted that these models or representations of how we expect others to interact or respond are not cast in stone or irreversible. Future attuned interactions offer the opportunity for the individual to challenge and update their internal models/representations. Working through our outdated ways of viewing the world and our relationships in therapy can offer insight and the opportunity for change.

Many of the people I have worked with experience an exhausting roller coaster ride trying to manage and contain their emotions. The neuroscientist Alan Schore (2012) sees this as often arising from early relational difficulties, where our primary carers acted as less than ideal role models in how to regulate our emotions. Our expressions and behaviour as children that received an attuned response from our primary carers become integrated into our internal working model, whilst those which received unsatisfactory or negative responses led us to develop defensive strategies, possibly resulting in an emotional and/or relational aspect that may be underdeveloped us. For example, if my expressions of sadness are not met with an appropriate response then I may avoid this emotion in future for fear of getting the same negative response. I may then repress feelings of sadness in future leading to difficulties accessing or expressing this emotion in future relationships and the possible development of what Winnicott (1965) calls the “false self”, where we adapt to our environment and others by striving to meet others values and demands, overriding what we may actually need (Rogers, 1951). In this way we adopt defensive strategies to manage the emotional difficulties we experience in order to maintain closeness with significant others. However, the strategies and ways of being we adopt both restrict and distort these relationships, and create tension and anxiety within us.

Our previous relationship experiences with others give us predetermined expectations of how relationships and communications with others are likely to be in the future. We then deploy the defensive strategies we have learned in other relationships to new ones, based upon these expectations, repeating old ways of being with predictable results. Into this heady mix we must also add our own temperament and the tussle between our innate physical and intellectual qualities and the ability within the different environments we inhabit during our lifespan to either help or hinder our development. This is the tension between nature and nurture.

Much of my work is devoted to helping you understand how these processes may have developed for you, and to understand what their impact has been on your own life, by identifying the patterns of relating or defensive strategies you may use. I look for these patterns as your life story unfolds during our work together and will gently offer them up to you to think about and explore with me. Gaining insight this way, allows you to recognise your fixed, and sometimes unhelpful, ways of relating, thinking or behaving, offering you the chance to question if you wish to continue with them and to consider and explore other, more fluid, ways of relating that may offer different results. As part of this process it is vital to recognise the importance of these early strategies to you, and respect the protective benefits, in terms of avoiding emotional pain, that they gave you at the time. They literally helped you to survive.

Recent neuroscience findings (Siegel et al, 2006; Le Doux, 1996; Schore, 2005) suggest that what we feel and sense can dominate what we think and say, so how you feel and your non-verbal experience is also an important focus of our work. This allows you to observe your own experience and feelings rather than try to suppress them, or be overwhelmed by them. This research also supports the suggestion that our earliest experiences and relationships are crucial in our emotional development, as much of this experience is before we can speak. It is, therefore, the felt quality of attunement, or otherwise, to others is what appears to be key.

I always try to explain where I am heading with our work and why, as I see it as a joint venture. You are the expert on yourself, but I may be able to shed light on troublesome patterns of relating or thinking, linking them to past experiences so you can see how they may have developed, and giving you the chance to break free from them.

Person centred principles (Rogers, 1980) influence how I am with you in our sessions. They are the foundations that underpin the development of the therapeutic relationship. I will try to gain a real understanding of your world as you see it. I will be open and honest with you, and encourage you to be so with me. I will not judge you, hopefully enabling you to air deeply held fears and concerns, so that we can explore them together safely, and so you no longer need to be held prisoner by them. I believe the therapeutic relationship is key to facilitating change (Horvarth & Symonds, 1991) and a warm, open and honest way of working together in a safe and confidential environment is vitally important.

I will try to build as full a picture as possible of you during the course of our work, reflecting on how you relate to others and they to you, your current and past environments and experiences, as well as the thinking, feeling, behaving and embodied aspects of your life experiences, both past and present. Just like the fluid, responsive ways of relating I hope you will develop or regain, I don’t have a specific format I follow, as this would be too restrictive. I feel our work together needs to be alive, and to respond and adapt to your own specific needs as our efforts together unfold. As individuals in the world we weave together and integrate different aspects of different relationships and it is the same with psychotherapy.


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My Integrative Approach