Yearning and Contact – An integrative, relational approach to therapy

Carl Webster is a relational, integrative, psychotherapist and Registered Psychologist working in Private Practice in Sydney and

I was having an extended family dinner the other day, three generations and we all get on.  The family comic was in fine form and at one
point as us oldies were laughing and reminiscing about school milk, I had a recovered memory pop up of playing with the silver foil milk
bottle tops at primary school (flicking them between two fingers if anyone is old enough to remember).  After, we went to the park and I
had fun playing kick-a-ball with the son and his family.  Everyone left and my wife and I did the washing up.  I should have felt good after
having a pretty good get together, but instead I felt a bit grumpy, a bit sad and had an urge to isolate myself without really knowing why.
It wasn’t really until the next morning that I understood my ‘moodiness’ had to do with the trigger of the recovered memory and its
historically, potent emotional associations with my own early family experiences as a young child.   
As a psychologist working in private practise, I often see clients whose current problems, be they classified as anxiety, depression,
addiction, anger or relationship issues, relate closely to problems they experienced in early childhood with their parents or primary
carers.  While cognitive and behavioural therapies, mindfulness, acceptance and commitment strategies are all valid approaches to
psycho-social-emotional issues, I have learnt how important it is to take account of and allow some reprocessing of those early
childhood memories in order for therapy to be truly effective.  
I have a relational focus in therapy, both in terms of how well attuned I am to the client but also how their current level of distress is
reflected in their current relationships (or lack of them) and how their distress may also be related to disruptions in their early childhood
experiences of relationship.  I also take an integrative approach to therapy, believing it is important to work with the all of a client’s
experiences on cognitive, affective, somatic, behavioural and interpersonal levels.  How aware the client is of their own thoughts,
feelings, behaviour and relationships is also about how well are they relating to themselves and others – what are they noticing, not
noticing, where are they getting stuck and where do they want to go.  
The more distressed the client, the more it often seems related to a history of chronic, repeated conflict, neglect, abuse and other
relational disruptions that they experienced as a child.  As in my own case, a relatively peaceful relational experience can trigger off
emotional/relational memories which can then negatively affect our experience/relationship with ourself and others.  A common-sense
view might be that we can never change what happened in the past and we should just learn to cheer up and get on with it.  
Unfortunately knowing what we should do does not necessarily make it easy to do it.  A relational, Integrative therapy does offer the
possibility of increasing awareness of triggers and associated cognitive, emotional and behavioural reactions, It also assists in
allowing us to learn skills of deep self soothing, accessing and re-processing of cognitive, emotional, somatic and behavioural
responses.  It also gives us empathic insight into our own reactions and the reactions of others and the courage to become more
assertive and self disclosing in our current relationships with partners, family and friends.
In this article I want to take a brief but integral look at what does happen for a young child who experiences relational problems early in
life and how consequences can play out on a number of personal and interpersonal levels as an adult.   I also want to suggest what a
relational and integral therapy can offer.
All children and adults are unique and their experiences differ, but there are patterns which are often shared.  Infants and young children
are highly dependent on their carers and from an early stage are acutely aware of how their carers are responding or not responding to
them.  An infant is a bundle of needs, wanting food and warmth, but also needing to feel safe and secure in a bonded, emotionally and
physically attached relationship or relationships.  The infant’s experience of relationship is precisely how the infant develops a sense of
identity, a growing sensory awareness of body together with slowly growing understanding and recognition of feeling states such as
love, safety and security, as well as fear, hunger, anger and sadness.  The infant and child takes its cues from its primary carer(s) and
any repeated lack of consistency or lack of genuineness  in the relationship with the carer is going to produce confusion and distress on
physical, emotional, cognitive and behavioural levels.  All carers will fail at some time, but it is repeated failures over time which can
create lasting problems.  Each time there is a disruption or break in the attachment relationship the child experiences a mini trauma
(though it may well be terrifying to a very young child) and if such disruptions occur regularly over a long time, then the child will suffer
some chronic distress and has to learn some way of dealing with the distress internally and externally.
To take the example of hunger.  If the child experiences hunger which is unsatisfied, the child will cry for food.  If the food is not
forthcoming the child will continue to cry but eventually is likely to become tired from the effort of crying and learn to accommodate or
deny the feeling and modify or adapt their behaviour (ie stop crying) in an attempt to mitigate their need (eg widen the search) or
prolong survival (eg shut down).  In order to repress the distress-causing pain of hunger, the child may learn to dissociate from its own
pain and compromise its own awareness of self.    From an evolutionary perspective, this skill of denying/repressing pain may well have
proved invaluable in humans learning to persist and survive in harsh, hostile environments, but there can be a cost to pay in personal
and relationship terms for such self denial.
On an emotional level, the child who experiences neglect, abuse or a lack of emotional contact in relationship will similarly feel distress,
since they are looking for safety, security and reassurance.  Instead they will experience emotional confusion (often a mix of fear,
shame and anger) as they experience confusing, ambivalent, blaming. shaming or guilt-laden messages.  The child then has to
accommodate their internal emotional and physical stress and learn to adapt their behaviour in order to sustain whatever contact is
available and survive.  Accommodating ongoing (dis)stress is likely to create chronic, underlying muscular tension for the child, often
buried, but experienced as tension and pain in external muscles (eg shoulders, back, arms and legs)  as well as internal tension often
buried in the chest and abdomen.   They may well also feel disconnected from their body or parts of it and only have a superficial
awareness of their own physical self.  Helping an adult who experienced such stress focus on their body, while therapeutically
(relationally, genuinely and tenderly) discussing early childhood experiences (often in the context of current issues), will often result in
feedback such as tingling in hands or feet, a weightiness or tightness in the chest, a churning, empty or knotted feeling at the level of the
diaphragm or abdomen.
On a relational, behavioural, level the developing child is dependent upon the carer(s) and will seek to modify their behaviour and the
way they relate in order to maximise opportunities to get their needs met.  If simple protest does not elicit a positive, nurturing
response, the child is likely to then escalate its protest (witness the toddler temper tantrum).  Failing any positive response the child
may seek out others to fulfil their needs and/or will be eventually forced to repress and internalise their response of confusion, self
doubt, anger and anxiety about not having their needs met.  Behaviours such as sulking, isolating, apathy, or  the other extreme of
acting out, aggressiveness towards self and others may become evident.  If parents and carers are experiencing their own relational
difficulties, such as conflict, domestic violence, interpersonal emotional distance, anxiety and depression, the child will also be affected
in a variety of ways depending on each situation.  Faced with conflict and aggression in others the child may well seek to hide out of
fear, or try to come between the protagonists and soothe the situation (or one parent) – an enormous adult-like burden for a young child,
forcing them into an inappropriate and adult-like role of rescuer or compliant pleaser which is likely to continue into adulthood.  When a
child has to repress, internalise and adapt their physical, emotional, verbal and behavioural responses over time, they are likely to be
deeply affected.  They may feel out of touch with themselves and others and suffer from confusion, self doubt, insecurity, anxiety and
depression and their resultant behaviour and relationships may also suffer from a range of dysfunctionality such as addiction,
dissociation, anger and cynicism.  
Two clinical examples may be useful here.  Sam came for therapy as a middle aged man who was facing relationship difficulties with
his partner.  His family history revealed being brought up in a family where the father was largely physically and emotionally absent for
much of the time, while his mother was always very busy with three young children and did her best to please her children, pacify her
husband and keep up appearances.  His father would drink quite regularly which sometimes caused conflict and aggression between
the father and mother.  Sam was experiencing conflict in his own relationship over lack of communication, sex and parenting.  His
behavioural style as a husband was to try to please his wife superficially, while harbouring resentment about their lack of sexual
relations.  His anger would also erupt from time to time with his partner and his children.  Despite him initially saying he had had a
good, loving childhood, further discussion and empathic attunement with his early memories revealed to him that he had often felt lonely
and distant from his parents and sisters and had adopted a strong and silent persona.  While he was generally socially pleasant he did
not have many friends of his own and tended to be unassertive about his own feelings and needs.  He felt angry about the lack of sex in
his relationship and tended to blame his partner for nagging him and for being what he saw as emotionally and sexually unavailable.  At
the same time, he sometimes suffered a low sense of self worth and found it difficult to access and talk about his own feelings.  He had
also increased his level of alcohol intake over the past year and was on the verge of having an affair.
Julie came for therapy to address her anxiety and depression.  She had a tendency to isolate herself socially and generally felt tired and
stressed with two teenage children and a husband who was preoccupied running his own business.  She occasionally binged on junk
food and was overweight.  She often felt anxious and resentful about her relationship, scared that her husband might leave her, while at
the same time resenting his demands for sex. She described her father as kind, loving and unnassertive, while her mother was vain,
self obsessed and regularly complained about her husband and the work generated by her two children.  Julie’s mother still expected to
be called regularly and listened to at length, while she rarely, if ever enquired as to her daughter’s life, health or well being.
Both Julie and Sam had their relational needs for a secure attachment compromised at an early age and both show the effects as an
adult. They both have issues with their own identity – how to access their own feelings to decide what they need and then assert
themselves to get their needs met.  Both have internalised negative self images and beliefs that in some way they are not ok, taking
refuge in alcohol (Sam) and food (Julie) as a way of seeking comfort and escape from their own unhappiness and anxiety.    Both have
relational issues insofar as they both tend to not look after their social and friendship needs and feel unhappy, frustrated and resentful
with their partners, while not being able to understand, articulate and assert their own feelings and needs.
Both Julie and Sam’s relational and developmental experiences with their parents as children had left them feeling insecure with
resultant confusion, anxiety and resentment.  Very young children are necessarily egocentric since they are trying to build their sense of
self via their relationships with others.  Insecure, anxious and angry children know they are unhappy but cannot objectify the reasons why
they are.  In order to try to make sense of their unhappiness and insecurity they are forced to the erroneous conclusion that there must
be something wrong with them and will generally form an unconscious ‘script' or self belief around a version of “i am not OK” . Both Sam
and Julie internalised their self doubt from them not having their emotions understood, validated and accepted by their parents.  Their
anxiety, frustration and difficulties in their current adult relationships reinforced their own insecurity and self doubt and led them towards
negative behaviours.
The authoritarianism of Sam’s mother and the occasional aggression from his father were both introjected by Sam on a cognitive level
in that he often found himself identifying with a negative and self critical train of thought (or critical ‘voice’) in his mind which further
added to his distress. The same introjection led him to blame his partner for his distress.  Similarly Julie had also internalised a
negative ‘voice’ which tended to criticise herself as being unworthy, unloveable and hopeless – all messages which she heard in
various indirect and direct ways from her own self-obsessed mother and which were not directly challenged by her unnassertive father
who tended to defend her mother.
In the same way that hunger produces stomach pains, and emotional pain can produce tension on a somatic and mental level, the
emotionally deprived child will continue to experience a yearning and desire to be loved and a desire to feel safe enough in themselves
to relax and feel fully accepted in relationship.   If the child can find an actual congruent, emotionally safe relationship with another adult
this may go some considerable way in meeting their needs.  Grandparents, aunts, uncles and even neighbours sometimes fulfil this
need and offer some positive parenting, emotionally rewarding relationships and models of such relationships that can sustain the child
into adulthood.   However if the emotional deficit has been chronic for the child, the adult is likely to continue to experience intense
yearning for an ‘other’ who can offer comfort and security.  They may well project such yearning onto another,  in seeing them as an
idealized figure representing the fulfilment of their hopes and dreams.   Partners may suffer from such projections when they get
messages of never being good enough, constant criticism or constant demands for attention and sex.  Such yearning together with an
undeveloped sense of personal boundary and empathic insight (into the feelings of self and other) may also lead into inappropriate
affairs and even abusive relationships causing damage to both oneself and those with who one is in relationship.
The child who has experienced unmet relational needs will need to develop a personality that functions in the adult world and they are
likely (as with all children) to copy the personality styles of their parents.  So Sam became superficially pleasant (mother), while
reserved emotionally (father).  Julie became a little self-obsessed and self critical like her mother but kind, loving and passive like her
father.  With the confusion and emotional deficits they had endured as children, both Sam and Julie often felt quite disconnected from
their own feelings and sense of self with some resultant self doubt, self critical thinking and anxiety which affected their ability to nurture
and sustain close relationships.  Both sometimes found themselves caught up in a sense of disappointment, sadness and
hopelessness, especially when they were unable to connect with their core feelings and express their core needs.  Such a sense of
sadness could be triggered off by a range of ‘normal’ interactions. {Such as reported by myself at the start of this article).
Outlining the connections between upbringing and later psycho-physical-emotional-relational problems might be seen as taking a
somewhat fatalistic and deterministic approach. By assigning importance to early childhood experiences and recognising their
developmental significance can one ever hope to escape one’s early limitations?  What is the role and effectiveness of therapy and
what makes an integrated, relational approach a good choice?
As children, we all have had the need  (and still have a current need) to feel unconditionally loved and accepted, forgiven when we
made mistakes, reassured when we felt doubt or fear, encouraged to pursue our dreams and respected as being someone worth
listening to.  If this has not happened, or not happened enough, then we have had to repress our needs for contact-in-relationship  and
have been left with an unmet sense of need or yearning.  Since our need was and is relational, it can only be met on a relational basis,
via a relationship or relationships where there is contact that is safe, respectful, nurturing and emotionally intimate.  Hence we all look
for contact-full relationships and seek out partners who can meet our needs.  To the extent that our unmet needs have caused us to
variously internalise chronic patterns such as tension,  shame, self criticism and disgust, chronic anger and resentment, anxiety, a
sense of worthlessness, hopelessness and lack of entitlement; any partner that we choose may find it difficult to live up to our desires
and unconscious expectations.  They may also be limited in their ability to be present and contact-full  due to their own developmental,
relational experiences. When partners do not fully meet, yearning is left unsatisfied and emotional distance, conflict and frustration may
occur, along with an emotional  roller coaster of highs and lows that are preoccupying but ultimately unsustaining.   Both the child's and
adult's needs are fundamentally about consistency and safety to allow the internalisation of feeling a core sense of security, belonging
and self value.   
Where a partner or partners can fail, a therapist capable of being empathic, fully attuned to a client's needs and emotionally real in
relationship, can make a difference, by consistently  acknowledging and accepting the unmet yearning (needs) and offering support,
reassurance and encouragement for the client to both accept and value their own needs, behave in ways that are self sustaining and
work on defining and achieving relationships that are mutually beneficial.   As years of research has shown, it is the quality of
relationship that exists between therapist and client that is a defining factor in the success of therapy, and it is only over time (and
numbers of sessions) that qualities of safety, consistency, acceptance and reassurance can be experienced and newly internalised.  
Therapy for deeply affected clients must be essentially relational, in that contact, connection, empathy, attunement and authenticity can
be experienced  and is experienced both by client and therapist.  (Profound empathy and attunement is experienced relationally and as
a client experiences contact, so will the self-aware therapist. )
Contact in relationship needs also to be experienced integrally so that there is a felt sense of congruence in experiencing sensation,
emotion, behaviour and cognition.  Such a felt sense can only be internalised relationally via empathic attunement, though it may be
expressed behaviourally and verbally.  Eye contact, occasional and appropriate physical contact, intellectual discourse, role play,
gestalt-style two chair dialogue, bodywork, laughter, visualization, script work and mindfulness approaches allow the unmet needs to be
expressed, heard, accepted, validated and pursued, while being freed from guilt, shame, resentment, anger, projection, defensiveness,
avoidance, anxiety and depression.
With consistency and persistance, a distressed client can be helped to acknowledge, accept and work creatively with their maladaptive
somatic, affective, behavioural, cognitive and relational responses. We may not always get our needs met in the way we would like, but
we can choose to validate, express, negotiate and find ways of meeting them in some form.

Selected Bibliography

Beyond Empathy  A Therapy of Contact-in Relationships Richard G Erskine Janet Moursund 1999
Bioenergetics        Alexander Lowen 1994
Your Body Speaks its Mind Stanley Keleman (1989)
Gestalt Therapy Verbatim Frederick S  Perls 1992
Games People Play Eric Berne 2010
Attachment  John Bowlby 1983
The Family and Individual Development Winnicott
The Search for the Self Heinz Kohut
Shame and Pride: Affect Sex and the Birth of the Self Donald L  Nathanson 19994