Becoming Secure: The Science of Healthy Relationships

Attachment is a hot-button issue these days, and Dr. Amir Levine is at the forefront of psychiatrists who are widening the definition of what a healthy relationship looks like. In his bestselling 2010 book, Attached: The New Science of Adult Attachment and How it Can Help You Find and Keep Love (recently released in paperback), he argues that "healthy is whatever works," and that we should not be too quick to label relationships that exhibit extreme attachment as immature, faulty, or codependent.

An Associate Professor in the Department of Psychiatry at Columbia University, Dr. Levine is among a handful of child psychiatrists who are trained both in clinical as well as molecular and biochemical approaches to study normal and pathological human development. His research focuses on the molecular processes that are unique to the developing brain, and how changes in the brain during adolescence pose a greater risk for the development of addiction and mood disorders.

Born in Israel, he worked with Nobel Prize Laureate Dr. Eric Kandel (and his wife, Dr. Denise Kandel) on a National Institute of Health-sponsored research project, and continues his investigation of adolescent brain development in the Division of Child and Adolescent Psychiatry.

We recently spoke over Zoom about why attachment matters, how to create more attachment not less, and why the biology of loneliness is important to our self-understanding.

Mark Matousek: Due to the pandemic, a lot of people are more awake to the need for connection, yet attachment can get a bad rap in our culture.

Dr. Amir Levine: It's true. But being independent and relying on ourselves doesn’t coalesce well with our biology. We’re built to be intricately involved with other people, and if you think about it, we hardly do anything alone. Humans are not particularly a strong species physically, yet we are able to inhabit even the harshest parts of this planet because we collaborate with other people and find ways to protect ourselves.

One of the most powerful ways of regulating emotional distress is by forming a connection with someone we’re securely attached to. At the same time, one of the most powerful generators of emotional distress is insecure relationships. So attachment is the basis of both suffering and healing from suffering.

MM: You say that half of the population is securely attached and the rest split between anxious and avoidant attachment styles. Also that these styles can evolve with age. Why is that?

AL: Attachment styles have to do with your level of desire for intimacy and closeness and your sensitivity to potential threats to that closeness. If you love intimacy but have a sensitive radar, then you have an anxious attachment style. If you love intimacy but don’t have a sensitive radar, a lot of the potential threat may go over your head. If you want intimacy but too much closeness makes you uneasy, and you push the person away, then you have an avoidant attachment style.

With attachment, think in terms of effective versus ineffective behavior. What works and what doesn't? My patients engage with me by texting in real-time while they are in the midst of a powerful experience with their spouse or significant other. I can teach them a small but significant way to interact that can take things on a different trajectory and move things toward becoming more secure. Given the right surroundings, and finding a way to appreciate what the secure stance is, we can produce changes that translate to different interactions in the world outside. With age and experience, you learn more about how this works.

MM: Can you give me an example?

AL: One patient resented the fact that his significant other refused to get needed treatment. When he texted me, I told him it took him almost a year to follow my recommendations, so why would he expect her to immediately listen to what he had to say? He was then able to tell her that because he’d had a hard time following through on other people’s recommendations, he now understood her reluctance. That changed everything because his girlfriend felt understood and heard, which fosters secure attachment.

MM: Is a person's attachment style established in childhood?

AL: Some of it certainly may be, and some it comes from experiences later in life. Even having your heart broken in your first adolescent romance can unsettle your faith in human beings.

From an evolutionary perspective, there’s an advantage to a portion of the population liking more closeness and some liking less. Simple organisms have two types of feeding behaviors, the aggregate behavior, and the solitary behavior. If there’s a lot of food, aggregates tell everybody, but if there’s a predator, the solitary eater won’t get eaten. This variation principle runs throughout biology and phylogeny.

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MM: This seems to fly in the face of the traditional attachment theory.

AL: Research suggests we are born with a certain temperament or genetic predisposition. I’m not going to say that the mother-child connection is wrong [as the primary factor], just that it’s more complex. The environment in utero can also have an effect. We’re just starting to understand some of the complexities.

MM: Is it true that the same person can be insecurely attached to one person and anxious or avoidant with someone else?

AL: Yes. Let’s say you’re more anxious, but then you meet someone who calls when they say, shows up when they say, and always replies to texts and emails. Someone who’s secure has radar, has a talent for what the other person needs, and then meets those needs. It’s about the small things, less than the huge gestures. It doesn’t mean you can’t have insecure people in your life; it’s just a matter of turning down the volume on insecurity and turning up the volume on security. People that are secure don’t see the danger and as long as the environment isn’t actually dangerous, they learn how nice it is to have someone around who loves to be close without getting riled up over little things. That type of radar exists in all our relationships, including the workplace. I had a colleague who called so often that I wanted to ignore her, but I learned to preemptively call her and be attuned to what she might need. That caused everything to flow more smoothly.

MM: Yet different relationships have different protocols or structures.

AL: Yes, but certain principles cut through all of them. One is that we need to feel included. Suppose you find out that your boss held a meeting and didn’t invite you. If you’re anxious, you might think the boss is trying to exclude you or take credit for your work. If you have a secure relationship with the boss, you might think they simply know how much you hate meetings and know you don’t really need to be there. These are such different ways of looking at the world.

MM: Speaking of general principles, how would you articulate the difference between healthy attachment and unhealthy codependent attachment?

AL: Effective or ineffective? Again, look at it from that perspective. My two mentors were this power couple of professors at the university. They arrived together and left together. The wife would call her husband every two hours, as well as making sure that his assistant had allowed a slot of time for him to go swimming. Some might see this as being codependent, but they were very close and it worked for them.

Relationships and feeling connected are a safety mechanism. We don’t feel safe because we have a lot of money in the bank or an expensive car. Feeling that someone has our back allows us to be brave and try new things. When we have that, we can achieve a lot. That’s the function of effective relationships.

MM: The need to love yourself before you can love someone else is such a cliché, and you don’t seem to go along with that.

AL: That idea of learning to love yourself before you can have someone else love you is misguided. If you teach patients how to change their milieu, then you’re setting them up for success because they begin to have secure people around them. For some patients who are only used to insecure interactions, it’s like being in a foreign terrain. After a while they say, “Maybe there isn’t danger here. This actually feels comfortable.” You see the transformation and healing.

MM: So taking care of your neediness before love is possible is not necessary?

AL: When you go to therapy, you’re working with someone; you have a relationship with someone. Perhaps you can learn to love yourself on your own through sitting and meditating, but eventually, you’re going to have to interact with someone.

Part of what I’m trying to teach people in my book is that you don’t need a lot to feel safe, to deal with your neediness. You want to identify needs and take care of them before they get out of control, but a lot of people in our society don’t realize that.

Once we become a dyad, once we form an attachment with someone, our autonomic nervous system becomes dependent on them. The quality of a relationship can affect people’s blood pressure and breathing and heart rate, their sleep, their immune system.

MM: What's the difference between being "coupled and apart" versus being alone?

AL: Being alone and being apart physiologically for the brain is not the same. When we attach to someone, our whole physiology changes. Neurotransmitters and hormones in the brain change their level of expression. With distress, the stress signal that culminates in the production of cortisol goes up, but the rest of the cascade doesn’t until you separate from them and then that cascade goes right through. Chemically, you become much more sensitive to the separation. But when you know that someone is there and attuned to you, then being alone or being together doesn’t really matter.

If you’re not attached to someone, you aren’t suffering distress physiologically, so the stress signal that culminates in the production of cortisol stays down.

MM: Is trusting one's feelings always a good idea?

AL: The book I’m writing now will give you a blueprint of knowing which feelings to trust. It’s like the prequel to my first book because it’s about what happens when we meet people, especially when there’s a romantic spark. How do you know if that is going to lead to a good match? There are certain things that you need to trust and other things you need to test. Whether or not to trust your feelings does not have a simple answer.

MM: Feelings run amok can be disastrous, of course.

AL: What I think can ruin your connection is not understanding the function of the relationship. That function is there to regulate a person’s emotions and yet, most people don’t consider that. When there are a lot of hurtful feelings in a relationship, something is off in the dyad because secure relationships are not about that. There’s a misalignment in the bond that doesn’t allow this mutual help in regulating feelings to happen.

MM: If you could give readers seeking healthy relationships one piece of advice, what would it be?

AL: Learn to appreciate the secure people in your life and find a way to give them more attention.