Linking Attachment Issues & Addiction Issues: An Interview with Dr. Susan Johnson
In 2008, my much admired colleague, Dr. Susan Johnson, published her groundbreaking book, Hold Me Tight, bringing the concept of Emotionally Focused Therapy (EFT), a treatment approach she’d been developing for more than 20 years, to the masses. For me, this was a was an “our world has shifted” moment, as it crystallized and codified a methodology for couples and family therapy that made perfect sense to me and worked beautifully with my clients.
As my practice has always focused on intimacy issues and addictions (which I view as intimacy issues), learning about Sue’s approach to healing within relationships – an approach that does not push partners and addicts into the self-reliance trap, and asks them instead to work together for the betterment of all concerned – was a welcome relief. Recently, as part of my research for a new book of my own, I was able to converse with Sue about EFT, its development, and its role in the treatment of addictions. I have decided to share a portion of that discussion below, in Q&A format, as other clinicians (and laypeople) are likely to find it both interesting and enlightening.
Can you talk in a general way about EFT, including the basics of what it is and how/why you developed this approach?
Emotionally Focused Couple and Family Therapy is a treatment methodology that shows the best outcomes of any intervention for troubled relationships. And these outcomes appear to last! You can look on the EFT website, www.iceeft.com, for a summary of the many research studies and articles showing the efficacy of this approach.
EFT does not teach communication skills or give advice. It basically sets out clearly how partners trigger each other, lose their emotional balance, and pull each other into an escalating dance of emotional disconnection. EFT therapists understand the dynamics of distress and, because we have learned how to work with emotional signals, we know how to help troubled couples change their emotions – the music of their dance. When the emotional music changes, they can move together in new ways.
EFT is also the only approach to couple and family therapy based on a clear and scientific understanding of adult love – why it matters so much, and what is needed to make it work and last. EFT understands that love is not just about sentiment and sex. It is an ancient, wired-in survival code designed to keep a few people you can really count on close so they are there when you are vulnerable and need support. This longing for connection is wired into our nervous system, and when partners can be attuned and emotionally responsive to each other in what we call “Hold Me Tight conversations,” they can deal with almost any personal differences and stressors. This scientific approach to love allows us to be on target and to help people actively shape their love relationships.
In Hold Me Tight, you write about resistance within the treatment field to the idea of EFT, in particular the belief that only dysfunctional people need or depend on others (leading to terms like enmeshed, codependent, merged, and fused). Has the field come around in recent years, or do you still encounter this resistance?
One of the blocks to the acceptance of EFT was the belief that adults should NOT need each other, that they should be self-sufficient, that it is a weakness to need others, so we should not be helping people learn how to reach for each other and pull each other close. However, the new science lays out just what constructive dependency looks like and how secure emotional connection makes us stronger, more resilient, and more confident, and creates a stronger sense of self within us. When we are valued by and can count on others, we move out into the world with more assurance. We can explore with confidence.
People now understand more about healthy attachment, so there is not that much resistance. Still, there are some folks who persist in believing that we must always stand on our own two feet and we should deal with difficulties by ourselves, despite all sorts of evidence to the contrary. What they see as pathological neediness, I see as people desperately trying to get others to respond to them but not knowing how to reach out effectively.
In my experience, most addicts (and maybe most people in general) would rather eat dirt than ask for help, even after they’ve repeatedly tried and failed to stay sober on their own. When you face this type of resistance with your clients, how do you handle it?
Unfortunately, our society has taught people to be ashamed of their need for the support and care of others. When this comes up with clients, we validate that someone taught them this, that someone taught them to deny their wired-in natural need for others. We help them access their fear of this need and their expectations about what will happen if they let others see their soft places. We normalize this need. We let them know that the human nervous system was designed reflecting the fact that we are born and remain oh so vulnerable, and we stay this way for much longer than other species. We are not designed for splendid isolation but for connection with others. To counter this shame and fear, clients need a direct and real experience of allowing themselves to be vulnerable and showing this to another human being who then responds with caring. We try to create this experience with EFT.
Traditionally, partners of people who struggle with addiction (or some other disorder) are told they should “detach with love.” Your EFT approach is very different. Instead of labeling loved ones as enmeshed or codependent and urging them to detach, you encourage them to become more emotionally connected, but to do so productively. Can you describe this, also talking about why it is so much more successful than the traditional approach?
Teaching people to detach and face the dragon of addiction alone is a mistake. The natural place for us to deal with our hurts, fears, and vulnerability – all of which lie at the heart of most addictions – is WITH responsive others. Safe connection with another tranquilizes our nervous system. The fear here is that non-addicted partners might, to keep the relationship with the addict intact, encourage the addiction rather than confront it. And in some relationships this can happen. But the answer to this is NOT to promote what we call avoidant attachment, thereby insisting that addicts face the hurts that turned them to addiction without support.
In a sense, addiction is a desperate replacement for the natural way we have of dealing with difficult feelings – by turning to others. Instead of becoming vulnerable in that way, addicts get high as a way of avoiding that very natural need. When people learn to stand together, however, they help each other keep their emotional balance. As a result, they are much more effective in problem solving and dealing with painful issues.
This sense of secure attachment, where individuals can turn to others as a safe haven and to provide a secure base that allows for resilient coping in the world, is the ultimate goal of EFT. This kind of bond makes people stronger and less vulnerable to becoming caught in the web of addictive substances and activities. Essentially, secure attachment fosters a positive and functional way of dealing with our hunger for comfort, positive emotions and sensations, soothing and relief from pain, and a sense of ourselves as valuable and strong. As such, it could perhaps be thought of as an antidote to addiction.
In my experience, and as you mention above, some partners of addicts truly mean well, but they try to do too much, which helps neither the addict nor the loved one (which is probably why so many partners are labeled as codependent). In your work, how do you help these individuals define, set, and stick to appropriate, useful boundaries that support but don’t enable? And how do you help their addicted partners respect these new boundaries?
You are talking here about how we help partners who, in their anxiety and caring, end up rescuing the addict in ways that prevent the addict from growing beyond the addiction. If we see this, we do what we always do in EFT: We reflect this dance, we help them deal with their anxiety about setting limits, and we let them know that they and the addict can learn constructive dependency habits rather than simply living in the addiction. We guide them from negative patterns of blaming and withdrawing into more secure connection, where the addict and the partner can respond to each other in ways that make the addiction or the partner’s indirect support of the addiction – a protection that has become a prison – irrelevant.
As one addict told his wife in a final session, “I never knew how to be close, how to show anyone what I need, or that what I needed was okay. Now that we can do this, I never want to let it go. I am not going to let a bottle come between me and you, between me and what we have. I don’t need the bottle when I have you. You were right to tell me to choose between my affair with booze and you. I choose you.”
Put another way, people become addicted when there is no safe haven with others on offer. They have to find an alternative way to calm their panic and pain and bring themselves into the light for a moment. Once you have this kind of habit – alcohol, drugs, sex, gambling, or any other addiction – you will not let go unless there is a better way, a way that answers your need for connection with others. So trying to change addiction without building the addict’s attachment relationships is like trying to drive a car that has no wheels. Difficult. We are social bonding animals, and the best remedies for our struggles acknowledge this and use the power of relationships to help us heal.
Weiss LCSW, R. (2017). Linking Attachment Issues & Addiction Issues: An Interview with Dr. Susan Johnson . Psych Central. Retrieved on April 26, 2018, from https://blogs.psychcentral.com/blog/2017/04/hold-me-tight-sue-johnson-interview/