ART OF ATTUNEMENT

For all beginning therapists one of the hardest things to come to terms with is that less is more. It is easy to feel pressured to ‘do’ something to help our client’s suffering. Over the years I have come to appreciate the importance of the skill of attunement and how it is central to a transformative experience.

During the first few years of life the ability of a mother to be attuned to the needs of her infant is crucial to their development. This attunement is important to a child’s ability to learn to regulate their nervous system and deal with distressing events. When a mother consistently fails to be attuned different types of insecure attachment result. One could say that a mother’s attunement is the building block to how one learns to be connected to others, build relationships, and feel safe in the world. This article discusses how the skill of attunement in therapy has similar effects.

Definition of Atunement

A definition of attunement ‘is a kinesthetic and emotional sensing of others knowing their rhythm, affect and experience by metaphorically being in their skin, and going beyond empathy to create a two-person experience of unbroken feeling connectedness by providing a reciprocal affect and/or resonating response’. (Erksine 1998). One could say it is our ability to be present to, and with, another’s expression of their experience. I view attunement as the meta skill of therapy which might have subheadings, such as; empathy, mindfulness, immediacy, active listening, presence, experience and knowledge, and cognitive understanding. Any of these skills on their own is not attunement, but at times come into ‘tuning into’ our clients and sometimes work in tandem as we grapple with understanding and connecting to them. The ability to be attuned really comes down to how connected to our clients we are in the moment to moment process of therapy, and how successfully we can communicate that to them. Our responses and interventions are then a result of this attunement.

Goal of Therapy

Simply, we could say that the goal of therapy is to facilitate people’s ability to deal with emotional pain. This requires clients to be comfortable with experiencing themselves. When people walk through my door, they do not come in saying that they want a more intimate relationship with themselves. More often it is a result of a crisis, where their life is not working in some way and they are in pain, and they want some way of stopping the pain. It is understandable that people do not want to feel pain. What is ironic is that as we guide our clients to experience and tolerate their emotional pain, they discover that they can withstand and recover from anything that life throws at them. Through this process one acquires the strength and resilience to mourn and grieve these losses. If one tries to defend against pain they will remain powerless and fearful of life. Without the opportunity to process emotional pain in a safe environment it becomes ‘stuck’ in one’s nervous system and body. When this happens we have little choice but to find ways to detach from the emotional pain.

As clients begin to talk about their lives it becomes clear that the emotional pain they carry has come from those relationships with significant others who have betrayed them. Betrayal occurs along a continuum from intrusive to neglectful behaviours. Extensive betrayal is traumatic and leaves the individual with a deep sense that they were not important to those around them, relationships are unsafe, and the build up of emotional pain is too overwhelming to experience or process. As a result individuals adapt by developing behaviors and ‘symptoms’ to deal with the impact. These include depression, anxiety, somatization, relationship difficulties, perfectionism, to name a few. These adaptations restrict self awareness and can leave people afraid of their own experience.

The basic contract in the therapeutic relationship is that the focus of attention is on the client’s experience. Self awareness is an important attribute for clinicians which helps them to remain focused on their clients, and be able to use their internal reactions to understand their client’s re-enactment of their world. A commitment to their own personal work is therefore crucial to a therapist’s development of being deeply connected to their clients.

Attunement and Transformative Moments

The following example of a transformative moment examines the role of attunement in therapy. A young woman I am working with at one point in the session was talking about how she trusted me and felt safe in response to an inquiry I made. My inquiry came from an ongoing feeling that she was anxious to give me responses that would please me. As she was talking her hands were fidgeting. As I brought awareness to her hands she was able to identify anxiety and the contradiction this brought up. She was able to voice her need to respond to me and people in her life with what she anticipates they want, and to identify feelings of being unsafe in relationships.

Let’s examine how attunement was important in this transformative moment. Firstly, it helps us to mirror back that our client’s experience matters to us, and that we take them seriously. Secondly, when this is mirrored back a space is created that the person can relax into and give voice to their experience. By doing so they take themselves seriously. Thirdly, it creates a foundation of safety within the therapeutic relationship so that emotional risks can be experienced. And finally, attunement highlights the interpersonal enactments of the client’s trauma as it emerges in therapy.

We cannot underestimate the transformative effect of communicating to our client’s that their experience matters. This is fundamental to their ability to deal with emotional pain. One of the core beliefs that develops as a result of early childhood betrayal and trauma is that we do not matter, and other’s are not interested in our experience. For my client she had developed a hyper-vigilant sensitivity to what others wanted from her and tried to give it to them. This was an adaptation to protect her from others disapproval, but any approval she may have received was based on her inauthenticity. This served to re-enact the core belief that her experience didn’t matter. By being present to her process and ‘tuning in’ to this split I communicated that I was interested in the unexpressed emotional self, the part of her most connected to the pain of feeling unsafe. This was the client’s experience that I was taking seriously and was connected to her authentic self.

My client had learned to split what she expressed to the world from her emotional self. The degree to which this split is dissociated depends on the extent of early betrayal and degree of dependency on attachment figures. Expressions of self-doubt and confusion over ones desires and feelings are common signs that the person has detached from their body and emotional life. My client expressed herself often in this way. By mirroring back to her the incongruence of her words and actions, I gave her the opportunity to give voice to a part of her that was unexpressed. In this way she connected with her feelings and risked more of herself in the relationship. This process of connecting with ones experience is the heart of therapy.

Now that doesn’t mean it is easy for people. Many have great difficulty focusing on their experience, and for good reason. The experiences that cause a person to constrict are painful and contain fear. So as they focus on their internal, physical, and emotional self, their emotional pain will be encountered. Creating safety to experience this pain in a way that is manageable, is fundamental to transformative moments. When one is emotionally overwhelmed their internal world feels out of control, and therefore unsafe. If this happens we tend to constrict our experience again to gain control.

How Attunement relates to Safety

We need safety to develop this relationship to ourselves. Safety is experienced, or not, from birth. As one begins to move, crawl, walk, touch and taste we explore more and more of ourselves through the interaction between the world and how it feels. When one is intruded upon or neglected then the environment is not safe, and it is not safe to express our emotional self. For one’s personality to develop one needs to increasingly integrate internal and external realities, but when there is little safety this process is interrupted and one’s curiosity is curtailed. Over protection is a form of intrusion that communicates to the child that they should be afraid of the world, and that their desire to explore is bad. To provide an environment that is safe requires a parent to be mindful of when the child is going too far and might hurt themselves, and when they may be holding back and need encouragement. So the space in between, is one where the child can relax into their experience and explore the world. This space becomes more constricted as the child feels unsafe.

Four Tasks of Creating safety

  1. Assessing how big each client’s exploratory space is and establish a relationship within it. It is through being attuned to a client’s contact boundaries that we can assess how big that space is, and the kind of material that the client is comfortable with. Clients express their comfort and discomfort in many ways, including through cognitive, somatic, behaviour, verbal, and emotional cues.
  2. Maintain safety as you process uncomfortable material. This requires a therapist to attune to the signs that the process may be too fast and the client becomes overwhelmed, or too slow that nothing happens. When either of these happen we can reinforce a fear of life and living. Safety is maintained as the therapist makes adjustments to this container. Perhaps there is a need for more space around an experience, or a little push to move out of too much comfort and protection. When an individual begins to feel overwhelmed then it is important to pause, slow it down, put our feet on the ground and feel supported before proceeding.
  3. Communicating that we are with our client in their experience provides safety. We feel safe in the world by our connection to others, and attunement is the ‘skill of connection’. Through being safe clients gain confidence to experience life, and deal with what comes their way.
  4. Connecting to one’s experience as well as the client’s, we enter into the client’s enactment of their world. Therapy provides a picture of the clients interpersonal trauma as it emerges in the relationship. The picture that was created from my own feelings of discomfort along with what I was tuned into about my client’s expression informed my intervention regarding her fidgeting.

Any one of these four tasks may take on more importance depending on what is happening in the moment. Being attuned to our clients enables us to continually make adjustments that respond to what is needed. For my client the most important aspect of this moment was taking her unexpressed feelings seriously, and how this began to change the enactment of her trauma. For another client expressing her anxiety and awareness of her need to please me may be too threatening, and safety becomes important in finding ways to support that expression.

The therapy process is full of these transformative moments that are a result of any or all of the four tasks outlined in this article. The skill of attunement is central to all of these tasks and the goal of helping clients move towards a greater ease with their emotional self. I hope that this article has gone some way to highlight how when we pay attention and focus on being attuned to our clients, we are in fact ‘doing’ a great deal.

R. G. Erksine, (1998) Attunement and involvement: therapeutic responses to relational needs. International Journal of Psychotherapy, Vol. 3 No. 3,