Attachment Theory, just hanging in there

[00:00:00] 

Preston: So, Margaret, how's it going? 

Margaret: Um, I have gotten a lot more famous since we last spoke, Preston. 

Preston: Oh, okay. Tell me more about that. 

Margaret: Um, have you ever heard of Stregonona? 

Preston: Uh, no. 

Margaret: Well, you're about to hear a lot about it, uh, there is a New York Times article about how we're having a Streganona fall after Bratt summer, so I don't, did you celebrate Bratt summer?

Okay, so 

Preston: you mentioned the thing about Taylor Tomlinson, is she the one talking about Streganona fall? She also was. She's organically coming up on my For You page now. Streganona fall. And you're welcome for that. And all this Streganona stuff. That I'm hearing about indirectly. Yeah. All over the group chat.

I'm like, oh my God. Margaret's everywhere. 

Margaret: I'm [00:01:00] at. I'm everywhere. So I'm in, I'm in the Stre songs as I have named it. 

Preston: So, can can you explain to me what, what is Regan? 

Margaret: Um, so the start of the book, which is a children's book from the seventies, uh, is that she is stre, although I've learned online that it's maybe spelled incorrectly in Italian, and so it doesn't translate as it says in the book.

But is Grandma witch. And the primary story most people read when we were younger was, she makes a ton of pasta, and she has magic in which she can make pasta for the whole town, and she hires this guy, she gets older, and she hires this guy named Big Anthony, and that's the name in the book for him. 

Preston: Big Anthony?

Margaret: It's literally, every time he's in the book it's Big Anthony, and he's supposed to do chores, but he sees her one day doing the magic that makes the pasta, and thinks that he can do it, so when she leaves to go out and visit her friend, he tries to make pasta, but he doesn't know the secret to make the pasta.

The pot stop making pasta and then it overruns the town. Oh. But then she stops it and she saves the day. And his punishment is that he has to eat all of the [00:02:00] pasta that fills the town. . 

Preston: What a punishment. Which is, you know, I 

Margaret: think something, something for everyone to think about. . 

Preston: So is, so is everyone struggling on a fall?

Are they just making pasta? That's a way to celebrate this Italian witch. 

Margaret: Well, yeah, that's what I'm trying to get them to do. 

Preston: Okay. Okay, and you said that the New York Times published this? 

Margaret: Yeah, so I was like reached out to on my like gmail that was like, NYT inquiry question mark streganona. 

Preston: That is incredible.

So the most famous person that's ever reached out to me was someone for BuzzFeed. 

Margaret: BuzzFeed still exists? 

Preston: It does. And they're in my DMs and they were like, I'm doing a story on craziest things medical creators have ever experienced. What are like some crazy things from your DMs that are like super crazy that we can include in this wild article?

And I was like, stop. Finally, some real journalism. What was the craziest thing? Um, I mean, I talked about like all these like unsolicited sexual passes that I get and I was not expecting that at all. And I don't really discuss it because I [00:03:00] don't consider my content to be grotesque. In any way, but people say some wild stuff, and it was just like a video about me like taking care of my plants or petting Magnolia.

That was my contribution to it. How many 

Margaret: been offered to be a sugar baby? 

Preston: Um, about half as many as I've been solicited for feat pictures, unfortunately. 

Margaret: People want what they want. Yeah, 

Preston: you know, I try not to think about it, I don't shame it. You know, if, if you like feed, if that's your thing, that's awesome.

Margaret: Oh, 

Preston: um, 

Margaret: cat sighting. Speaking of, what were you doing? What were you a recent update? 

Preston: So me, I got a new cat. Her name is Lilac and I've been like doing the whole introduction with Magnolia and them this week and it's been going pretty well. I was like, she's tuning in actually, I was pretty nervous at first cause Magnolia's like super anti social and she's like, so back in my old neighborhood she was known as like the [00:04:00] villain cat, like she, she has a split face and um, she's tortoiseshell, she looks like a little spice jar, some people would call her spice, and I'd be like out with Maggie in the front yard and someone would walk by and be like, oh my god, it's Spice, and I'm like, who's that?

And they're like, this is the cat that antagonizes my cat every night, she, she like goes out into the 

Margaret: She goes out into the night. She's so stragononafal. 

Preston: And she's like, she's got her her little her little whiskers pressed against the screen and she's just staring at these poor domestic house cats and they're like, oh my god, you know, she's the villain in our lives.

And so I kind of realized that Maggie isn't the sweetest cat so I was worried about like having another cat because You know, but turns out they're doing okay. Like Maggie just kind of likes to watch and then they bumped, they bumped noses yesterday and they didn't smack each other. Is that a 

Margaret: bad thing in cat world?

Preston: You know, you don't have to ask them. 

Margaret: I didn't grow up with cats or, cause my parents are allergic, or my mom's allergic and so I have no idea. When you were [00:05:00] like, they can't be in the same room at the same time, I was like, what is this? What is this? 

Preston: So, going into this segment, um, I want to talk about your hot takes based on your rotation right now.

So, do you want to go first? Do you want me to go first? 

Margaret: I want, you can go first. 

Preston: Okay, so my hot take is that psychiatrists should spend an entire rotation with the radiologists. 

Margaret: Okay, say more. 

Preston: So I did, I did a month on neurorads and I'm also doing um, a neuropsych rotation and the amount of like psych stuff that we actually end up seeing on MRI that just gets like thrown under the blanket of like no acute intracranial abnormality is kind of a lot.

And the stuff that they pick up on is really unique. So like, for example, they were looking, I was looking at a MRI with Lewy body dementia versus Alzheimer's, and there's a distinct pattern in the way that it atrophies. So in Lewy body dementia, bilateral temporal lobes are preserved relatively, the anterior [00:06:00] temporal lobes go, medial frontal lobes start to go.

And then also the atrophy of the ventricles is like an inside out. Kind of like coring the apple from rotting from the inside. Whereas in Alzheimer's, the temporal lobes go first and the whole thing atrophies. 

Margaret: Brat summer mentioned. Sorry. 

Preston: Yeah. So yeah, I think the apple's rotten to the core, except it's your MRI and I'm sorry, you have dementia, but I was like, Oh my gosh.

So we go look at this person clinically and let's say they have A temporal lobe dysfunction, so memory stored in your temporal lobe, right, and they can't recall details semantically, and I'm like, oh, that fits with Alzheimer's, but then you ask, and then you go and look and you see the atrophy on the hippocampus, and I'm like, the amount of times that I, as a consult liaison psych resident or something, have asked these recall questions.

and gotten nothing from it in an inpatient setting and then looked at the MRI and knew nothing about what was going on or the CT. But then there's like more to it. So if I ask someone a question, [00:07:00] remember this word cloud, for example, and I asked them in five minutes if they remember it and they go, no idea.

If I say like, hey, the word has something to do with the sky, that's called a semantic cue. So I'm giving like a part of that schema, giving them a detail. And if they can recall that, that means the white matter tracks are intact and they're consolidating it. If they can't recall it from that, if I give them multiple choices and they can't recall it, that means the memory never got stored.

And so if you, if you correlate that with hippocampal atrophy, you can diagnose dementia or you can get pretty close. And so I was like, wait, why are the neurologists doing this? This is like, this is straight up psych stuff. 

Margaret: Well, I mean, I feel like that my, I feel like that distinction historically between psych and neuro is becoming more and more tenuous as each year and research advances.

It's like, what do you, like, why does neuro do it? Like, I mean, like, we know that like post stroke depression is a thing and It's not just like, oh, psychologically, someone's not coping with it, but probably is related, and like, we know this with any of these, so it's like, well, when, [00:08:00] shouldn't, in the future, are all psychiatrists and all neurologists going to be neuropsychiatrists, like?

Preston: I mean, I think that's where it's going, but unfortunately, I think people are pretty attached to these labels. 

Margaret: Which makes sense. I mean, I think it makes sense to be attached because, like, there's such different kind of worlds that you go, I mean, both of us are not neurologists. Like, I know you thought about it.

I did not. Uh, and I was like, I want to do psych because I want to do this, this, and this. I will say I've, like, really enjoyed actually, like, being taught how to incorporate it into psychiatry. But I feel like the set of things and the set of people that you interact with when we like are in med school of like, what does a neurologist do and what does a psychiatrist do are so, so different for some reason.

Preston: And while we are attached to these different titles, I think now's a good time to move into our topic for today, which is attachment theory. Let's do it. So what, what do you know about attachment theory? What does this mean to you? 

Margaret: So I want to, before we even say any of this, I want to [00:09:00] give my first of many caveats, which is Uh, that we are both trainees, I know people know this, but that this is our first discussion of kind of like content and so both Preston and I are going to be reading and are in training.

We're also still learning, which I think makes the conversation interesting and also kind of like closer to the point where people are where they might be listening to this. We will cite things we will include at the end, but listen to what we're saying, take it as you will, and then look into things yourself.

Preston: And this is meant to be a dialectic discussion, I'm not approaching this as a clinician, it's really just Preston and Margaret talking about the things that are relevant to our education and also interacting with people as humans or anyone who has to interact with a person I guess. 

Margaret: Yeah. 

Preston: So if you're on Mars and you don't interact with people then uh, go ahead and turn the pot off, it's not for you.

Margaret: So I think in terms of attachment, like the first thing I think of when I think of that All the Tik Toks I'll see about people being like, I have anxious attachment or like when you're dating like avoid and attach [00:10:00] blah blah blah. That is like the first topical thing that comes to my mind. And 

Preston: they add no context to it.

I remember watching those and being like, okay, 

Margaret: what is this label? Well, and it's like, here's five signs that you have this. And it's like, I love pathologizing normal emotions. I think that's awesome. What do you think about it? What is your first 

Preston: thought? Besides you have anxious attachment, it's like when you get broken up with, you're sad.

And everyone's like, oh my god, me, that's so me coded. Is there a way to 

Margaret: fix this? 

Preston: And then the next one is like, you miss your parents, and they're all like, 

Margaret: whoa! 

Preston: Yeah, so iPic, when I picture attachment, I don't know why I don't go to those tiktoks. I just picture a monkey clinging to its mother as she's climbing through the trees.

Margaret: Hmm. I feel like that's like a good image to start with. Attachment 

Preston: theory. Yeah. You know, like, ah, 

Margaret: yeah, like, 

Preston: or, or like when you know, you're like a toddler and you'd wrap your arms around your mom's pant leg. Mm-hmm . She try to walk and you just turn yourself into this cumbersome ankle weight. 

Margaret: Mm-hmm . Yeah.

I think like. [00:11:00] I think that's a good place to start and I think in contrast to what I was like, thinking of in terms of like the TikTok stuff is I don't know how much people actually know. I don't know that I've been taught about it actually yet in terms of outside of my own reading in like residency.

Preston: Yeah, I think everyone that I've talked about it with just kind of acts like they know what it is. And then they're like, Oh, yeah, you know, I've been on attachment theory. And then you ask them about a detail of it. And they're just like, Oh, you know. The one where, the one where you're attached and you don't like being unattached.

You're like, oh, okay. When you 

Margaret: do things funkily. I think it's also like, there's so much even in psychiatry, which is a specialized field, right, compared to like primary care, in that there's so many different lenses you can look through and you could read forever on like each of them and ask questions and like never fully understand it.

And I feel like attachment is kind of. Something that is now sort of foundational both to like development as well as like how we think about therapy or how we think about like [00:12:00] relational health, but how do we actually kind of go with a critical lens and look at like, where did this come from? Why did it emerge like historically?

And also what can we say it actually is helpful for or not? Because like any diagnosis or tool. If it's like, not correct, like people can use it and it can be helpful in their lives or it can feel like a box that they're trapped in. 

Preston: Yeah, I think how I approach all these different theories is they're just Ways of organizing.

Mm-hmm. The complexity of human interaction and attachment theory captures part of the self, it captures part of the interpersonal interaction, but it's just like you said, is one lens. We're all trying to use these different theories to categorize the same basic thing, and we're just looking at it from different angles.

So Sounds like you have some hot takes about. When this theory first started, I don't actually know that much about the origins of attachment theory. 

Margaret: Yeah. So I think that I always think this is actually an important place to start, even when I'm talking with my patients about it, just because I think so much information and misinformation [00:13:00] is out there.

So attachment theory is the kind of parents of attachment theory are a guy named John Bowlby and then Mary Ainsworth. Um, John Bowlby was a psychiatrist, I think, or he was a psychologist. In like the like 1930s and 40s. And onwards, who was trained as so many people were at that time, the primary model of understanding people's like mental health and responding was psychoanalysis, like that was kind of the only game in town.

And he was under this, what I read is like, he was under the study at one point of Melanie Klein, who is a famous, famous like, Psychoanalysis, psychoanalyst after Freud, um, and he, this is 

Preston: like the 20 years after Freud's come to fame and everyone's just psychoanalyzing, paying half a grand to sit on a couch and talk about their dreams.

So the scene is set. 

Margaret: The scene is set. So he had a lot of really kind of new theories at the time that [00:14:00] were somewhat divergent from what the main like psychoanalytic thinkers were saying. Um, but he was more of a theorist than he was like someone doing empirical clinical research until he started working with Mary Ainsworth, who was more of like a behaviorist clinical researcher.

Um, Mary Ainsworth is the one who did the thing that probably all of us who have read anything or ever had a lecture on attachment have gotten, which is the, um. Like, strange situation experiment. 

Preston: Oh my god, I remember the strange situation. Yeah, yeah, what do you remember about it? Is that the one with the baby?

So they like, they put the baby in the room, and then they run away from it, and then they come back and see what it did. Right? Yeah. Oh no no no, they have a stranger come look at it too. 

Margaret: Yes. 

Preston: So there's a child in the room. 

Margaret: Mmhmm. 

Preston: And he's playing with toys and mom's like, Oh, hey, how's it going? And then mom leaves and a stranger shows up and just like stares at the kid.

Margaret: Yeah. 

Preston: And then the stranger leaves and the mom comes back. And they see what the see what the kid does. So like, sometimes the kid is [00:15:00] like, Oh, thank God you're back, mom. And they stuck on her. Or sometimes they're like, pretend mom never left. Right? That's, that's that one. Okay, sorry. Keep going. 

Margaret: No, no, that's it.

Um, yeah. And so there's all sorts of things we could say about those studies, but in the interest of time, the kind of, there is some importance in terms of like, how does the infant, it's like an infant that can like crawl and point and interact, so it's like, You know, get up in the months, up, you know, in that kind of, think of that age range, and they would exactly what you're saying.

They would have mom there, they would have the mom leave, it was in a lab, um, and that, so it's also like a strange environment, and then they would have stranger there, stranger would leave, mom would come back. Um, one of the interesting things I was reading was that it's, it ended up sort of being, in their view at least, more important to what the reunion was like.

Um, than anything else. Like, there is some importance in, like, if they leave, how they react, but, like, how is kind of the connection reestablished when there's been, like, a small breach? [00:16:00] Um, and so, 

Preston: Can, can you heal, like, like an airplane? If you knock, if it hits turbulence, can it restabilize? 

Margaret: Mm, yeah, yeah, exactly.

And I, I mean, if we think about adult relationships, like, if you have a fight with someone, can that deepen the connection rather than rupture it? So, That is kind of the foundational research that showed like there's sort of three styles of response that the infants responded in. Um, in those studies, they called it ambivalence, which I think we think about as anxious sort of, uh, avoidant and then secure.

And then eventually after that, when there was more studies later on, there was kind of this question of like disorganized or a sort of mixture of styles. So was this only 

Preston: where I get kind of confused is that attachment theory is. Between adults when we talk about interpersonal relationships, but all of these studies back in the 70s were between like infant and mother.

Did they make all these like big jumps assuming that your ideal relationship with your caregiver was like established as an infant and then you just [00:17:00] carry that through the rest of your life? 

Margaret: So, those jumps are still, in my reading, my understanding, are still up in the air. Um, so I think that it's interesting in that like, I think we can say things about adult attachment and like adult relationship forming in the literature, but I think one of the things that my, I don't know if it's a hot take, but it's like, how sure are we that this totally applies in the way that it's like now commonplace to talk about in terms Attachment.

And I think it, I think it does, but I think sometimes, like, like many, like, things are many, like, good, much good science. We get, like, some stuff right, but then we want it to all be one cohesive answer, and the science in there. The golden bullet. Yeah, exactly. 

Preston: Oh my gosh. Yeah. 

Margaret: So, that's kind of, like, the history, and then there's been, like, different things of how to apply it to adults that came through in, like, the 80s and 90s.

Like, don't get me wrong. I think there's a lot there that is kind of proven and known, but I think these kind of, like, bullet points, [00:18:00] oversimplified sort of archetypes. And the finality of them is the thing I like take issue with because I think it's oversimplified and can trap people. 

Preston: Yeah, I think in a lot of ways we Myers Briggsified attachment theory and just kind of turned it into this like pop psych almost corporate jargon that people can use.

Yeah. Um, but there is, I think, utility to it outside of even like the love language, um, concept of stuff. So the way I think about it now is that there's a couple different types of attachment, right? I guess. So can we start with the, the stable kind? The kind where if you go through the turbulence as an airplane, you can correct back to normal.

What's, what's that one called? 

Margaret: Yeah. So like talking about secure attachment. Yeah. And I think it helps to ground us in like what is a secure infant attachment and then talk about what that might look like in adulthood based on like the literature, but also based on like how that kind of relates. So, the 

Preston: kind of secure The comfortable infant, that was fine.

Margaret: Yeah, [00:19:00] so like the secure infant would One of the kind of key concepts in attachment at that time, like during Mary Ainsworth and John Bowlby's work was This sort of idea of like a secure base so that like the parent when they come into the room and they're there and they're establishing like before the mom has left in the settings, which also obviously that's a caveat because men are also parents and can form attachments with their kids, but um, this is in the early studies, their ability to kind of like come back to the parent and see that they're there and from an evolutionary perspective, Like to know that they are within like the reach of their care caregiver to be able to survive.

Um, but then when that's there, then an ability to explore. So this balance of safety and being able to explore and discover. 

Preston: So I'm safe on my own to take this risk. And also I know I can depend on mom to come get me, 

Margaret: right? Yes. If I 

Preston: need her. 

Margaret: Yeah. And I know that she's there. [00:20:00] 

Preston: And I have, I have that, that ultimate trust in mom and I have that trust in myself.

And that's my, that's how I, my framework of the world. 

Margaret: Yeah. 

Preston: It's okay. And so 

Margaret: when the mom would come back after the strangeness. There would be kind of, it would be quicker for the infant, like the infant would reach back towards her, the infant would be generally like more consolable and interactive and like snuggling, but then eventually would be feel safe again to go explore and not like cling, uh, too much, like, to the, the parents.

Preston: Okay, so just like we talked about, you return to mom, they're consoled, and they're like ready to explore again. Right. Okay. Well that sounds pretty secure to me. Uh huh, yeah. Alright, stable. Stable. So now what does it look like when they're not stable? 

Margaret: Yeah, so the terms used at the time, I'm going to switch to just saying anxious attachment, but it was like, the term was ambivalent at that time in the earlier literature.

Preston: And so all of these just fall under the insecure attachment? 

Margaret: Yeah, the two non secure, yeah, 

Preston: yeah, [00:21:00] yeah. 

Margaret: Okay. So The anxious attachment or the ambivalent attachment, same thing, uh, would, sort of, when the parent would leave, and then would come back, there was more of this, like, inconsolability, as well as, like, the, like, clinging on, not able to go explore, kind of more, like, difficult to repair, the kind of But not betrayals too strong a word, but like to repair like, okay, I am safe and we knew that sense.

The 

Preston: abandonment caused an injury and the return of mom isn't enough to close that wound. 

Margaret: It was interesting because on the avoidant infants in some of these studies, it was like, it looked on the surface, like they were kind of just calm, you know, like a duck, like calm on the surface and then underneath they're like kicking their legs like crazy.

And their blood pressure, heart rate, and like cortisol would be rising when mom was outside the room, despite the kind of stone face. And when mom would come back, they wouldn't, like, rush to her, they wouldn't kind of reattach, they wouldn't show upset. Wait, 

Preston: so I'm confused. This is the anxious attachment?

This is [00:22:00] avoidant. This is not the avoidant. Okay. So they're, they're pretending, I don't care, but they really, deep down, they probably care based on us measuring their sympathetic response. 

Margaret: Yeah. Or they've, right, they've learned kind of, like, reseeking attachment doesn't get me Okay. What I want like it doesn't get me a further sense of safety.

So why would I waste so I'm still distressed that that caretaker is not here But there's a little bit of like a learning probably in terms of like why pursue that 

Preston: So it's like the this makes me think about operant conditioning when you're like modifying someone's behavior So these avoidant kids Or I think avoiding people in general have kind of learned that their caregiver can be, is reliably unreliable.

And if they can count on mom for anything, it's to never show up. So I have to rely on myself and that trusting, like other people are bad. And I'm good, basically. Like, the only person that, who's gonna look out for me is me, [00:23:00] even though it still stresses me out. And then I guess the, the anxious attachment one is how I understand it's this variable interval reinforcement.

So you know how, like, with a rat in a Skinner box, if you give it the, like, The cocaine laced water every fourth hit, it will constantly go every fourth hit and then eventually give up. But if you randomize when the cocaine laced water goes through, it will, it will tap the Skinner box relentlessly until it passes out.

And so when mom is disorganized and she's not responding, like maybe she has her own stuff going on, she's on the phone, she's busy, who knows, she has her own traumas, then the kid is getting that variable reinforcement that when they seek. Attachment or they seek help from mom. They get it randomly. So they are just asking for it constantly, just like the rat, but they're saying like, Hey, I need you.

Please help me. 

Margaret: Right, right. Yeah, I think that's exactly right. And I think also in the, like [00:24:00] with Mary Ainsworth, like the history, I think from her work and just in general was like this, the strand of the behaviorists like Skinner of like, how is this, um, Like, a ways of understanding more observable behavior versus like psychoanalysis was sort of like these invisible desires and what was driving people, both of which I think have validity, but yeah, you're exactly right.

I think that's the way they started to make sense of it too. 

Preston: So Now, like, in adults, we have this, this kind of same idea. So the securely attached adult, I imagine, has a positive view of themselves and a positive view of other people. Like, I'm okay on my own, and I'm okay with another person. Like other humans are safety, and I am safety.

Is there, is there anything else to like the securely attached adult? 

Margaret: Yeah, I mean, I think in my view, and this is sort of anecdotal now, like there's also this similar to with like the infant that like one of the main things was how does repair happen and can repair happen. To me, a secure [00:25:00] adult, you know, in terms of attachment is exactly what you said, as well as like, when like knows that.

Relationships won't be perfect and there'll be fights and misunderstandings and is it able to tolerate that and has skills to be able to repair and have enough kind of space without feeling Really really scared or like overwhelmed to build closeness over time, which includes conflict and repair 

Preston: So I am I'm not afraid of conflict and I can be consoled with conflict I think one thing that strikes me in well adjusted and secure individuals is This thing called object constancy 

Margaret: Yeah, 

Preston: it's it's so it's like object permanence where you play peekaboo with a kid when you when you cover up your eyes So if something's visually obstructed, can I still comprehend that it exists behind the curtain right and object constancy is like that But just for emotions, so if [00:26:00] I'm feeling an emotion towards you Can I comprehend that my other emotions also exist towards you so like Margaret am I capable of being mad at you right now?

but also know Deep down, I like you. Or, or maybe I'm feel, feel skeptical of you, but I appreciate this gesture you did for me right now. It's like a stranger on the bus or something. And I think some people have trouble holding those emotions in tandem. And so it kind of leads them to either I'm going to reject this person completely or I'm going to attach to them 

Margaret: solely.

Preston: And, and also one thing I guess I work with a lot of my patients on in therapy is being able to see The complexity of emotions 

Margaret: in 

Preston: a situation. So if something happened, 

Margaret: it's 

Preston: not all bad or it's not all good. And if you can almost like they're, they're vectors, I guess, like arrows. So if the only, if the only arrow I have is just like, bad when, when something happens, then like the situation is a crisis, you know, it's not just, Oh, you know, they were mad at me.

It's [00:27:00] like, we're going to break up right now. But then if, if you have, Oh, well, like, at least she's, it feels comfortable expressing herself in front of me. But also I feel sad that the thing she brought up was that she didn't like an action I did. Now, like you have one arrow pointing up and one arrow pointing down and you're neutral.

Right. That also kind of tempers. how much these, this conflict like destabilizes them. So I think securely attached individuals, they can, they, they're secure at the beginning, but also it's almost like they have shock absorbers 

Margaret: in the 

Preston: way they interpret the situation. It doesn't just go zero to a hundred.

Margaret: Yeah. I always like ask my patients when my therapy patients in particular ask them like, what, when we're talking about how they handle emotions or how they deal with like things that are making them anxious in relationships, I always ask like, Hey, what was your role model of what to do with hard emotions or what to do with conflict?

Those are two separate things I'll ask. But like, I think similarly with attachment, it's like, how are you taught how [00:28:00] to deal with, like our parents teach us how we deal with these like hard parts of life and you know, are you taught? So one of the things that they talk about in the studies, the earlier studies was kind of like the attunement, um, and the, the other term.

What 

Preston: is attunement? 

Margaret: So, attunement in this case, but also actually I think in most cases, so I will, attunement is, uh, kind of the ability for another person in the studies, like for the mother, to read and respond to the infant's speech. Needs and emotions and distress. So like 

Preston: how calibrated is the mom to the kids cues?

Margaret: Yeah So one of their emotional or 

Preston: physical cues, okay 

Margaret: one of the things that is talked about a lot in therapy in different ways is like the idea that of like the good enough mother Which was kind of a pushback against like our parents do all these things and it messes up and duh duh duh duh duh Like especially on mothers Historically, but one of the things in the attachment studies that they have, they started to think about was like, not the quantity of [00:29:00] attachment kind of actions, but the quality of the attunement in them.

Um, and so attunement, when we practice it as like therapists to talk about like adult attachment style, but also to talk about like, how does this come up in therapy is. It is important that we are reading our therapy patients like correctly and responding to them in a way that is like attuned to what they need and is not like shutting them down or like exacerbating it.

Preston: So like, cause if I express something to my therapist, I want them to have an idea that my emotion is being shown. So like, like if, if I guess if I'm crying. It even just as simple as a statement of like, Hey, I noticed that some tears came out when you discussed that this is important to you. Or like, I noticed that this seems to make you upset.

I think when I'm in situations where I've expressed myself and I don't think Any emotions or like my emotions are acknowledged by other people. It's almost [00:30:00] like my emotions don't matter. Right. And, and I think that there are some kids that grew up in households where their emotions were almost never acknowledged.

It's funny you should say that. I think I remember seeing a study that looked at the latency between when a kid would express something and how quickly the mom would react to it and if she reacted appropriately. So like, yeah, Let's say a kid was crying. How long does it take mom to go and say like, oh, are you sad?

Like, let me acknowledge that you're sad. Or if kid's happy, are they happy? But if it's like disorganized, like if you're crying and mom starts laughing at you or something, then you're like, wait, if I'm expressing distress, why is this amusing to this other person? And so you kind of, you're trying to calibrate how does, how do my personal feelings relate to other people?

And this, this is like my starting block. This makes no sense. 

Margaret: Right. Right. 

Preston: So. So to kind of like reattune people in therapy, you have to show them like, no, I'm, I'm noticing this emotion. This is how I respond to it. I'm noticing that you're [00:31:00] excited or I'm noticing you're angry or frustrated or sad or despaired.

Margaret: And I think that that's like. Right, like emotional experiences in relationships, despite like what kind of pop culturally I think we think we say and are taught, at least in like the U. S., are still things that are learned. Um, one of the things that, uh, Bowlby would talk about is like the internal working model is like the kind of way he would phrase, What we learn from attachment as kids and what we take into older childhood and adulthood is like this model of how the world, how relationships work, what emotions mean in us, and which touches on a lot of the things, right, that, that you were taught, that you, we've talked about already, um, I think with that, maybe talking about like what What do you think about when you think about like an adult with like a quote unquote anxious attachment style in a way that isn't, you know, like five bullet points, but is like, how might that show up?

Preston: I think about someone who's this serial monogamist. They almost [00:32:00] have to be in a relationship and they have this kind of codependent organization. Like I was just like uncertainty of making a decision and you're met the type of person and I think this was me for a lot of my life. They can't make any, any kind of decision without having the endorsement of like everyone around them.

Like, Hey, does anyone want to like go out to this amusement park this weekend? Or like, I'm thinking about going to this college. Like, what do you think about it? What do you think about it? What are my parents think about it? And then there are other kids in high school that were like, I'm going to this university and I don't care what anyone says.

Margaret: Yeah. 

Preston: And I think. Classically, I think of the, for the avoidant kid or the adult, I think of that like person in the back of the class with like the alpha wolf. Lone Wolf t-shirt, you know, well, I want, can we, me? They're like, they're like inside either there are two wolves merch 

Margaret: for the podcast, 

Preston: and neither of them we got the wve inside of everyone.

The support of a relationship. . No, seriously, like I, like, I've talked to people and they're like, I really like my independence. I couldn't [00:33:00] imagine being tied down in a relationship. They use all these, this negative language to describe mm-hmm . A romantic bond between people as, as though it's something unsafe.

And the other thing that I find interesting, so when I read about it in adults, there's this. I guess a fourth type of unstable attachment and that's, that's mixed or I think disorganized or fearful avoidant are all terms I use. And that's where You're basically the best of both worlds. So I think about, yeah, I think about 60 percent of people are securely attached and then you have 20 percent are anxious, another 20 percent are avoidant, and then the scraps.

So the 50, so 55 percent ish are secure. The last couple of percents, like one to 2%, those are your feel for avoidance. It's less common. And because it's kind of hard to develop that. Organized view of relationships. So someone who's fearful avoidant, [00:34:00] because they're both, they have this anxious codependence, but then the second they get close to a relationship, they're afraid of it and they push it away.

So you crave emotional intimacy, but you fear losing your independence, which sounds like a nightmare to be stuck. Like, I feel like you are almost like never satisfied. I guess we've kind of seen how these exist on, on different lines and, and everything is on a spectrum, I guess. So 

Margaret: I think one caveat to mention though, is that like, these are ways of relating that people learn and therefore they don't silo quite as neatly as how we're talking about them.

I think they're super helpful and valid frames to think about, but I also think like the mixture of styles or that people. Act differently in different relationships. I think one of the things that bothers me the most about like attachment style stuff talked about online is when we [00:35:00] give people this as like a framework and we talk about like the emotional, like emotional, physical, or any other like abuse, um, world.

It becomes 

Preston: the prison that they view everything in their life. 

Margaret: Well, and it becomes like if you feel anxious and you're not sure about the person, like If there's gaslighting, and there's emotional manipulation, and there's like infidelity or abuse, anyone would feel uncertain, right? Anyone would feel that.

So, just to say that these don't happen in a vacuum when you're an infant, and they don't, they're in a dyad always, or they're in a, in a, they're the thing you create together. And so, while people may tend towards relating in a certain way over and over again, it's also like people will get into, one of the papers I was reading was talking about like, people with anxious attachment styles.

If they get in a relationship where they feel sufficiently attuned to, can have really good relationship outcomes, and so just that you don't, it's not just one person playing at any time, and that also this is a [00:36:00] different conversation if like abuse or emotion, just any sort of abuse is on the table. 

Preston: I think we, as a society, especially in pop psych, struggle drawing the line of pathology.

Like if, and I think I always use physic, I always like fall back on physical pain as my metaphor for this. If I step on a nail, it's going to hurt really bad. But that doesn't mean I have chronic pain syndrome or someone that experiences like unrelenting chronic pain every day. And I think we do the equivalent in psychiatry of I step on a nail one time, I'm like, Oh my God, I have chronic pain syndrome because my foot hurts so bad.

Right. And I was like, well, it's like kind of, you know. This is reasonable, but it's not disrupting your ability to, like, engage meaningfully with your life. And I think it's just so hard for people that, like, once they identify this emotion to say, like, oh, it has to be pathology. 

Margaret: Well, and I think similarly, like, with acute and chronic pain, one of the things that we know in the chronic pain world is, like, there are [00:37:00] certain things in the way you view and relate to pain that, like, if you have acute pain, And you have, you're really anxious in general, and you're like, oh no, what if this turns into chronic pain?

Is this chronic pain? You are in some ways more likely to develop a chronic pain syndrome. Similarly with attachment, or with emotion, I think, in a lot of ways, if you are really fearful that it means something big and bad is wrong with you and your life is like effed forever. This is my soulmate 

Preston: or I'm doomed for the rest of my life.

Margaret: Or this is my attachment style because some of it resonates with me. When in reality, is it your attachment style or are you just normally anxious because you're like going on a first date? Yeah, does it have to be pathology or can it be human experience and can we not be emotion phobic which our 

Preston: society also is Exactly like a CrossFitters.

They say pain is weakness leaving the body Uh huh, you know, like can we get a reframe on my anxious attachment like oh, this is

This is just this is my [00:38:00] insecurity leaving the body. Yeah, there's like this whole community like Embrace your insecurity. 

Margaret: CrossFit Matt mentioned. 

Preston: I just yeah No, it's funny because I think, like, I've seen people that, like, they love CrossFit and the way they appraise pain, they, like, lean into it. You know, where the other people are like, uh, pain's the worst thing ever, I'm trying to avoid it.

And they're like, if, if I don't hurt, I'm not having a good workout. So, it, and like, ideally they have, people are experiencing the same sensation, but they have a very different relationship with it. And I think even, like, I'm the same way with grief. There's one thing I'm trying to do is like, I know people that they will like lean into grief and be like, I'm so sad and I feel this and other, other people like me will be like, I never want to experience grief, I'm going to find a way to replace this emotion or avoid it or do something.

I'm going to delete this emotion. Yeah, so I don't know how to be that crossfitter who's like, oh, this is like strength entering my body or weakness leaving my body. 

Margaret: I also want to say like, that the. The CrossFit are also like, right, the person who does that [00:39:00] also is more likely to have, there's like, is an issue with injuries in CrossFit and pushing yourself in that way that our brains really like, Be 

Preston: toxically positive.

Margaret: Yeah, or like, it can be that there's, there's too far in both directions. And our human minds love to be like, I have one rule and I apply it to everything and now I can turn off in some ways because my, I don't have to make complex decisions anymore. I 

Preston: critically think because it's who I am. I hate critically 

Margaret: thinking.

Yeah, let's get rid of that. That's our, that's my hot take. 

Preston: That's good. I'm glad we got around to your hot takes. So, um, when we come back, we can go over this attachment quiz that I took and the results kind of, they, they surprised me because I didn't think that my childhood was that bad, but I guess we'll find out.

And, and, and I also kind of got to see that continuum of how it scored me in multiple Regions rather than just being like, here's your single label. Here's your gold star. He's like, no, you actually, you know, I got my little like equivalent of like ENTJ, which that's my Myers Briggs is ENTJ [00:40:00] or I think it's INTJ.

I'm like somewhere in the middle. Okay. So we'll take a quick break and then when we come back, we'll talk about our own attachment problems. 

Margaret: Well, 

Preston: or mine.

I have my results. 

Margaret: Let's hear them. 

Preston: I was, I was kind of surprised. I thought that I was this paragon of human emotion and interacting with people. And then it said I was 60 percent fearful of avoidant or the, or like the mixed disorganized. You're a unicorn. I know. I was like, I'm, I got the rare one. And then.

Um, my next one was secure. So I was like, okay, we're in the bag there. 

Margaret: What do you mean your next one? So it kind of ranked me. Yeah. So, so my 

Preston: highest one was fearful avoidant, then it went secure. Then after that was anxious. And then the last one was avoidant. So, I think what's interesting about that is it kind of implies that I have [00:41:00] this almost negative view of myself and a negative view of other people.

So it's like I don't trust myself to be quite on my own, but I'm also like, don't trust myself to be in a relationship with someone. And I was kind of like, I was like, how does this actually manifest? Like, like, does this make sense with like kind of how I was raised? I don't know. And so I was, I was debriefing this in therapy and.

I think a lot of it came from how I got a lot of mixed messages from both of my parents. So my dad, I always joke that my dad's love was like an electron. You know, like you're pretty sure it exists, but you can't like see it, feel it, touch it, taste it. You know, you're like, you're like, ah, who knows, you know, but like, I, I believe in like quantum mechanics and I know it's there and he must express it, but I'm not experiencing that.

So that was kind of like one relationship I had where I almost, I knew not to trust someone else. And I was like, okay, like I have to be on my own. And then my mom would give me a lot of, um, [00:42:00] support and would be very intimate in the kind of like, Emotionally, like lovey dovey, but then would also kind of flip the switch and Um, yell at us a lot.

Like, like one time I had, um, like a, a relationship over for Thanksgiving and she was, she like screamed from the top of the, top of the stairs. She was like, Preston, like, get your laundry. And dude, like, I'm a medical student, like, I'm, I'm like, 25, home visiting, and then the girl I was with was like, your mom yells at you like that?

And I was like, yeah, I'm used to it. And she was like, my parents never yell. And I was like, oh, well, this is nothing compared to what it used to be. 

Margaret: Like, this is actually the good edit right now. This is not the behind the scenes cut. I'm like, I'm chilling, 

Preston: yeah. And so, so she was like, Preston, I think, like, you kind of had a more toxic childhood than you thought.

And I was like, oh, okay. So then I, I took one of those like ACEs, Adverse Childhood Experiences, and I was like, oh, okay, whoa, there's a significant [00:43:00] amount of these. Yeah. And I guess it kind of started to make sense that I, I was like, I don't know if I should be able to express myself. And funnily enough, humor is like one of the ways that I learned to like avoid those situations.

So I would always like defuse situations in the household by making a joke or being funny. Or I would like, I almost view like shame or like being silly like a vacuum like all the eyes can be on me so the conflict will have to stop you know what I mean so like if I had if I had a campfire going and I lit a bonfire next to it the Oxygen is going to snuff out the campfire because it's all going to get taken up into the bonfire.

So I would kind of view it like that in my household, like if my parents are fighting or if there's all a conflict between my sisters or something's directed at me. If I make someone laugh, I can disarm them and I can avoid that like conflicting situation. 

Margaret: And there's also something to that of, there's kind of an [00:44:00] implicit, like, I'm okay.

Like I'm laughing. I'm happy. I'm whatever. I'm whatever. That is when used at certain times that call for like disclosure or vulnerability or sadness a way of protecting ourselves in the situations where we learn it like what you're saying of like having to do it and then though we get into adulthood and maybe hopefully like away from those situations and we push away people who want to know the other parts of us because it's like why would you do that also you might just like yell at me if I tell you.

Preston: Exactly. And I think in a lot of ways I use humor almost as my like fearful avoidant tool sometimes. Like jokes, like laughing together with someone can make you feel close, but also you can use humor to not let someone get too close. Like everything, everything is a joke. I'm not going to let this be serious right now.

So it's like simultaneously an icebreaker and it's an ice wall, I guess, if that makes sense. [00:45:00] And, and I think I, like, I feel safe in it. that environment so it's been kind of interesting to reflect on that and that's one thing i'm actually working on in therapy right now is that i use humor as like an avoidant technique and i always like framed it as positive like oh if i'm making a joke then i've succeeded i've diffused the situation and then my therapist is like 

Margaret: i'm sad 

Preston: she's like do you ever think you humor to avoid emotions and i was like Oh!

Margaret: Not that you say that. 

Preston: I was like, this conversation's over. This is done. We're done now. And then she laughed, yeah. And I was like, see, I made you laugh. And she was like, yeah, I see what you're trying to do. You're trying to avoid talking about this. So she's kind of got my number, unfortunately, um, and I've been trying to kind of like appraise when I use that.

So I think that's like kind of a, a driving factor in how I developed this. So, I'm not going to go into any of the TMI relationships, but I think it's been helpful to kind of reflect on [00:46:00] understanding that you can be okay on your own and also, like, be stable in a relationship with someone. And I think, like, the awareness of that is really helpful.

Margaret: There's this, like, conversation on TikTok right now that is sort of, it's not necessarily about this, but I think it's really related. related in some ways, in that there's this conversation, at least on my side of TikTok and in kind of like girl world to some extent, uh, of people asking different, different people asking this kind of question of how do you be more confident and like a response generally being like, I think you just need, like, I think you're thinking about yourself too much.

And to me, like C. S. Lewis has a quote that he said, like, humility is not thinking less of yourself, but thinking of yourself less. And to me, that applies to like the attachment stuff too, because it's not like thinking more of them or thinking more of yourself. It's actually like, I'm, I will care and I will grieve if I lose this person, but I will still be me.

And that's such like a [00:47:00] beautiful stance to have in the world. And that like, people can become more that way, even if you don't have that attachment style or that experience before. I 

Preston: think especially, it's funny you should say that, when I was In my adolescence and I felt like really unstable in these relationships, you know, when you ask that person, you're like, they're like, do you like pancakes?

And you're like, it's, is Sarah going to like me more or less if I say I like pancakes, you know, and so that, that overthinking about trivial preferences, like thinking too much about yourself, but if you just kind of answer like, yeah, I do, or I don't like whatever, and knowing that that's who you are and that will either be accepted or rejected and that's okay.

Margaret: Right. 

Preston: It's really interesting to me. 

Margaret: And that no one can love you if, no one can really know you intimately and closely if you, if they feel like you're kind of shifting under their gaze to be something that they want. Like that there's some kind of [00:48:00] inherent edge that is attractive of 

Preston: being You're trying to filter yourself for their approval.

Yes, 

Margaret: because then they're like, well, but who are you? And how can I know you? And how can I trust you that I can be myself with you if you won't be yourself with me? 

Preston: Mm 

Margaret: hmm. But, man, it's tough. It's tough stuff. And just because, 

Preston: you know, worried that, and I think that person is worried that their true self is not good enough.

Margaret: Yeah. 

Preston: That if I reveal my true self to this person, they'll find it wanting. Yeah. So, I need to recalibrate or I need to kind of almost like mold myself in a presentable way and be the version that they might accept. So, like, like what C. S. Lewis said, think less of yourself, think less about yourself to think more of yourself.

It's almost like. You don't have to think about yourself at all. You just have to accept who you are. 

Margaret: I think you also have to practice. And this moves us into this, the thing we'll end on, which is kind of what you were, I like the word you used of like recalibrate of like, what do you think about for you from anecdotes, like outside of clinic or in [00:49:00] clinics of how to make this concept, not just a diagnosis, but a workable tool.

So I think one of the things is like, I'll often ask my patients, even when we're talking about all these other things, well, what are you? What did you like to do when you were a kid and can you do that for 30 minutes this week and not have it be for performance or not for anything else but just like re explore like what, what do I like and what does it feel like and what are the experiences that I can focus on rather than focusing on If I'm good enough, if they're good enough, if this is working.

Preston: Yeah, I think there's a lot of beauty in practicing. So, one thing we're learning in CBT right now is that if there's ever this discrepancy between how you want to feel about a situation and how you react to that situation, A behavioral experiment or practice is the best way to resolve that. So if you're like, well, I want to accept myself, but whenever I feel like I'm being vulnerable in front of someone, I get nervous and I filter it out.

[00:50:00] So just like someone who's afraid of a spider, they're like, I know I shouldn't be afraid of this small tarantula or this bunny. I have bunny phobia, but my heart rate's at 150 every time I pet a bunny, and it doesn't make any sense to me. And I rationally know I shouldn't be afraid of bunnies, but here we are.

The solution to that We're going to go pet a bunny. 

Margaret: Yeah. 

Preston: And we're going to sit with it. We're doing 

Margaret: bunny yoga. 

Preston: Exactly. You're going to test out the, the depth of the pool with both your feet. Just kidding. We can do a toe in my office. We'll just look at videos of bunnies. We're 

Margaret: just going to watch bunny videos.

This is for the patient or for Preston. 

Preston: I'm like, I'm like another day of watching bunny videos in my office. I'm like, I'm like, this is another. You know, the patient comes in to talk about their divorce, and I'm like, another classic case of bunny phobia. Guess we'll have to watch more bunny videos.

And the guy's like, oh, I'm not mad about it. Like, okay. 

Margaret: You're like, well, you know, Easter's coming up pretty soon, so we gotta, we gotta get to work. 

Preston: This is giving me serious bunny [00:51:00] phobia vibes. Man, we need to work on that. So the same thing with expressing yourself emotionally. You just small at first trivial stuff, you know, what's your favorite flavor of ice cream?

What's your favorite color? And then how do you feel about your place in the world? What do you want your career to look like? Like, what do you want another person like those are really strong, vulnerable things to share. And you kind of just kind of get used to be like, well, you know, Oh, I shared this, this thing about me.

And then you open the blast doors and you're like, wait, you still like me? 

Margaret: You still accept 

Preston: me? I can accept me. Look at that. So I think. One thing that's helpful, like you said, using attachment theory to interact with your patients is to take this as a framework and say, okay, how do, how do you, this complex nuanced person at this moment in time fit into this framework?

And then how does it guide us to help close the gap you have between how your life is and how you want your life to be? Because that's ultimately the goal [00:52:00] of therapy. It's the goal of psychiatry, really. 

Margaret: Well, and that's one of the roles too, of therapy and psychiatry, like even, One of my favorite, like, papers that we have to read every year at my residency is, like, how not what to prescribe, which is kind of on, like, the meaning of medications and the therapeutic relationship and all sorts of things, but, like, That the therapy itself is practice as well, and it's a practice of like connecting and hopefully connecting with someone who you feel like is understanding you, is listening to you, that if you know they do something that annoys you or you feel misunderstood, that there's enough space there to have them reattune to you and to do the kind of small things Like breakage and repair in a way that's different than your internal kind of working model that you've had before 

Preston: Yeah I see it almost like I You're always gonna see me going back to the physical pain analogy if I broke my arm and I know how to like cope with It I kind of just like hobble around and maybe I I only grip my pencil with my like middle finger and part of my Thumb, [00:53:00] but then when I go into the physical therapist's office or the the surgeon's office It's gonna be really painful to try to like do a closed reduction You But that's a safe, sterile environment to do it.

I'm not trying to reduce my arm in a Wendy's parking lot with my whole family around. You know what I mean? 

Margaret: I 

Preston: don't know. Like Wendy's, if you 

Margaret: want to sponsor us, I love a frosty. That's all I'll say. 

Preston: Maybe your hands were full of, of frosties and you trip over the curb. Next thing you know, your arm's broken.

Now your whole family's around and you're like, Oh my gosh, how do I handle this? Yeah. So. You have to kind of find the right environments to do emotional surgery the same way you do physical surgery. And, and, and otherwise it might be too painful and you might just reject it and be like, you're never touching me again.

Like, don't touch my arm. 

Margaret: And like, again, similar to like physical therapy, um, that thing, that takes a long time to make you feel better. And it works, but it's like, Okay, I guess I'm going to the physical therapist's office twice a week and I'm going to be doing my set of bridges and the kid [00:54:00] next to me who's like eight is going to be better at it than I am.

This is not a specific experience at all of mine. But, uh,

Similarly, it's going to take time to kind of reshape the way of relating. But the really hopeful thing is that it's possible. Because I think often there's this message of like, it's either this or that and then you're done. where there's actually a way of changing what feels safe and what feels like good connection and But you're totally right where it has to be done in a way Especially if there's any history of like trauma abuse like that makes people feel That they cannot trust their internal system and that they don't have good intuition.

And even sometimes when we give people a diagnosis, we can diagnose them with anxiety when it's like, is it anxiety and there's like a pathology there or is it something else? Like, I often will see like people be like, oh, I'm just an anxious person and that's why I feel this way and like the medication will solve it.

And the medication can really help, but sometimes it's like, have you been through ways of relating that can That are not, [00:55:00] you're just an anxious person and this is how you are and you're broken in the world. It's like, no, you have And you have an ability over time to have experiences of secure relationships, it just takes some kind of re doing.

Preston: Yeah, and you're using the medication to treat this constant anxious response to a disorganized attachment. Right. Yeah. Right. So, I guess the way, I view this and I know everyone loves the, in medicine we love to say lens, but it's really like that. So when we're at the optometrist and I'm like, what looks better?

One or two? One or two? Attachment theory is one and CBT is two. We're really looking at the maladaptive core beliefs someone has, their concept of self, their personhood, and how they relate to other people. And we're just picking the right one. What focal length do you want to look at it with? 

Margaret: Yes. 

Preston: And some of it's capturable in attachment theory, some of it's capturable in CBT, some of it in psychodynamic.

And so the adept psychiatrist is someone who can, or a psychologist can navigate those [00:56:00] lenses well to find one that fits both their and their patient's understanding the best. 

Margaret: Right. And sometimes you're going to see the same thing in different lenses. Um. 

Preston: Well, I think a lot of time you do. 

Margaret: Right, right. I think a question for us to end on positively, uh.

Preston: Actually I, I have something I wanted to talk about, which is, I want to, I used these lenses and I applied them to movies that I'd watched. And I think I gave you homework, too, to find some characters that you think show attachment styles. Yes. And how they play out. Yes. So, um, why don't you go first? I want to, I want to see what you brought up.

Margaret: Okay, so mine is Meg in Hercules and, and Hercules, uh, so Meg in Hercules, as the, the Disney version, as those of you who know, has a song called I Won't Say I'm in Love. She's also like, for a number of reasons, a servant to Hades and is trying to like, is supposed to like, go mess up [00:57:00] Hercules and like, fool him and make him not a hero and da da da da da, and then accidentally falls in love with him and sings this song in the, you know, middle of the movie, like If there's a prize for Rotten Judgment, I guess I've already, like, I've paid it or I've already, if there's a prize for Rotten Judgment, I guess I've already won that.

Um, no man is worth the aggravation. That's ancient history. Been there, done that. So, um, first of all, bar. Second of all, 

Preston: I think she reminded me of my first animated crush. 

Margaret: Wait, I thought you said you hadn't seen this movie. 

Preston: No, I, I've, I'm looking it up right now. I have seen this movie. 

Margaret: Yeah, yeah. Um, so I would say that she's avoidant attachment.

Yeah, 

Preston: so no man's gonna hold her down. No man's gonna, 

Margaret: well, avoidant and also like, no one's gonna be good. Um, I will not be dependent on anyone. I will not, like, need anyone. They're only gonna disappoint me. I've had this experience of no one being attuned to me and abandonment. I'm not doing this. That's my my pick of like, okay, it's a funny 

Preston: metaphor because the strongest [00:58:00] male figure in her life is literally Hades 

Margaret: It's literally 

Preston: like, are other people safe or are other people evil?

She's like, well, the only person to know is actually the devil. Yeah, or the Greek I mean Hades isn't really the devil, but the Greek interpretation of the the overseer of the underworld So, sorry Hades, I know, I know he probably hates getting compared to, um, Unfortunately, I think he was my first, 

Margaret: uh, childhood crush, so sadly.

What does that say about me? 

Preston: Yeah, that's so funny. No, I can see that, um, her being avoidant attachment, I wasn't picturing you having a crush on the animated version of Hades with the blue hair. She's got a good 

Margaret: personality, that's all I'll say. 

Preston: Now I'm going to segue into what I brought to the table, which is, so first I'm going to do anxious attachment.

And I have Jerry Smith from Rick and Morty. So 

Margaret: this is we're outside of my sphere of pop culture right now. Okay, 

Preston: so I'd love to explain this to you. So [00:59:00] Rick and Morty is a lovely show about interdimensional travel. So they actually probably started the whole like interdimensional plot scene, plot sequence that's been like pretty overused at this point.

But there's infinite number of realities. And Rick is this super genius who's the smartest in all versions. And he's the only person who's discovered a way to travel in between. These are the verses. And he lives with his daughter and his and her lame duck husband, Jerry, who cannot do anything on his own.

He just had, he has to be stuck with either his, his like scared son or his husband or his wife, Beth, or with Rick and all this time. So it's kind of a running joke that Jerry can't do anything. to support himself. And there's like, there's one time at the dinner table where he's like toasting at Thanksgiving and he's like, to my lovely family, who I'm so grateful for.

And if I didn't have you around, I think I would actually perish. [01:00:00] And then it's like, quiet for a second at the table. And he goes, at my own hand. I'm, so I'm gonna be honest, like, Beth, if you left me, I think I might end mine. And then the, like, just cuts off. And I was like, wow, that's great job, Rick and Morty, like, you identified some anxious attachment there.

Margaret: Okay, I see it. Yeah, I see it. 

Preston: And, and it's, it's, like, funny how it plays out. But then, like how we were talking, he gets the chance to redeem himself. And so there's a lot of times where, you know, He is abandoned and then Jerry has to learn to depend on himself and have self efficacy So they leave him behind in this universe where basically it's like an apocalyptics Apocalyptic end to earth and that that dimension they left it They come back years later and Jerry has survived on his own and he's like I learned to depend on myself He's he's like in all this caveman garb He's got like a hide of a buffalo on you know stoke in a fire with a spear that he made himself Yeah He's like That's old [01:01:00] Jerry.

Like, new Jerry has secure attachment. He can do his own thing. 

Margaret: That's like your dream, is like, like, that there's gonna be, like, I just, I just need to be in a different dimension. Jerry has a great redemption 

Preston: arc. 

Margaret: Honestly, yeah, that does sound like good, like, he's getting secure. Well, 

Preston: at least, so the problem is, then you go to the next episode and they're in a new dimension, we're back to lame duck Jerry.

But that one Jerry in that one universe, Kudos, man. I'm glad you did it. 

Margaret: That's how some people feel in therapy, though. Like they like reach a breakthrough and they like, or they have like one victory that week and they're like, look, and then it's like next week, new episode. We like, we're back to the usual.

Preston: Yeah, yeah, exactly. So my second character, I just want to squeeze this in because I have a hot take on this, but it's, uh, Goodwill Hunting. So, Will Hunting is your classic avoidant attachment, but you could use an antisocial lens to view him as well if you wanted to, because a lot of what he does Um, makes almost no sense.

Like, Will's like, time to, time to drive in [01:02:00] my car. I'm, I'm a, this like, super genius that can solve these math problems. I'm being hired by the university to solve math problems. And he's like, better get in a bar fight or start conflict for, for, for seemingly no reason. And I think when I first watched it, I was like, Oh, this doesn't make any sense.

But he doesn't want to be in a situation where he's dependent on anyone. 

Margaret: Right. 

Preston: And he, he almost to. Like an absurd hyperbole views himself as so great that he can get himself out of any kind of trouble out of jail. Like he's talked himself off the stand several times at the start of the movie. And then every time he like finds himself getting close to the Stanford girl, I forget her name.

Sorry, the Harvard girl who's going to med school at Stanford. He like pushes her away. And the conclusion to the movie is he has to go see about a girl and he kind of realizes that he can trust other people, kind of correct his attachment. So 

Margaret: And [01:03:00] then there are no issues ever. It's happily ever after. No, everything's 

Preston: perfect.

Yeah. So thanks Ben Affleck for creating this wonderful film. Actually, I don't like Good Will Hunting though, so I feel like I've been glazing it by just by kind of giving Will Hunting's character more nuance than he deserves because at the end of the day I like the movie. 

Margaret: I like it. 

Preston: I know. And we'll discuss this in a different episode.

Margaret: It's going to be on the Patreon. 

Preston: But it's, it's Oscar bait that is essentially just three monologues from Woburn Williams and the rest of it is filler, screen filler. So it works really well on these digestible bites. Thanks for watching. I'll see you Watch it this weekend. We'll talk about it later. I 

Margaret: live it.

Preston: Okay. Thank you so much for listening. If you guys want to learn more, please reach out to our socials. You can contact us and give us any of your feedback, things that you want to see differently about the show, any of my jokes that landed. didn't land. If you want to hear Margaret talk more, if you want to hear me talk more, we're open to all those things.

I know everyone kind of wants to have their [01:04:00] voice heard and our inbox is open. So this is, this is a conversation we want to have with y'all. If you want to reach out on Instagram or TikTok, you can find us at human content pods, or you can contact the team directly on our website. How to be patient pod.

com. And remember, this is a new show. It's an experiment for me and Margaret. We're trying our best to make this thing work for us, but also, also for you. You're the audience, you know, this is, this is kind of a three way conversation. So if there's stuff that you want to hear in the conversation, Please write in, we'd love to hear about it, or if there are things that you're not comfortable with, or just anything you have feedback on, we want to hear it all.

Margaret: We're learning how to be psychiatrists, and your guys feedback on this is part of us becoming better at doing that. 

Preston: Yeah, we need to have a secure relationship with the feedback we get from y'all. If you want to see full episodes, they're available on the YouTube channel each week at It's Presro. Thank you for listening.

We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, [01:05:00] Preston Roche, also Margaret Duncan, Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke. Our editor and engineer is Tracy Barnett. Our music is by Omer Ben Zvi. If you want to learn about our program disclaimer or ethics possible, so to learn about our program disclaimer and ethics possible, Policy submission verification and licensing terms or HIPAA release terms.

Just go to our website and check out how to be patient at human content. com and bring up any questions or concerns there. So just remember, we do this as learners. We do this as physicians in training. And as fellow humans that are just trying to bring these discussions to light. So we appreciate any feedback on it, but the goal is ultimately that this isn't medical advice and that also we're not trying to stand on our pedestal and preach to you, well, a little bit.

Margaret: I am about stregonoma, but that's neither here nor there. 

Preston: And I will about goodwill hunting. 

Margaret: How to 

Preston: be patient is a human content [01:06:00] production. Thank you guys for listening.