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Attachment as a Sensorimotor Experience:

The Use of Sensorimotor Psychotherapy

Janina Fisher

I
n the first few minutes after birth, newborn and mother generally meet
heart against heart as the baby is laid across the mother’’s chest. These and
other early experiences of attachment are body-to-body experiences: hold-
ing, rocking, feeding, stroking, gaze-to-gaze contact. Rather than using words,
we communicate to infants with coos, mmmms and terms of endearment that
evoke a lilt in the voice of the speaker. Preverbal children take in the warm
gaze, the smile, the softness or playfulness and respond with smiles, vocaliza-
tions, and chuckles of delight, relaxing or soothing or brightening in a dyadic
dance with their care-givers (Schore, 2001). But infants and young children
equally take in the body tension of the care-giver, the still face (Tronick, 2007),
the irritable tone of voice or rough movements. Their immature nervous
systems are easily alarmed by intense emotional reactions, loud voices, sudden
movements or manifest anxiety in the mother (Lyons-Ruth, Dutra, Schuder, &
Bianchi, 2006). Whether care-giving promotes secure attachment or is ‘‘fright-
ened or frightening’’ (ibid.), these ‘‘right brain to right brain’’, body-to-body
experiences are later remembered not as visual or verbal narratives but in the
form of ‘‘body memories’’, procedurally learnt emotional, autonomic, motoric,
visceral, and meaning-making states (Ogden, Minton, & Pain, 2006; Tronick,
2007).
If attachment styles reflect an adaptation to a particular care-giving environ-
ment and a given care-taker, then we might do well to think of them as proce-
durally learnt, held in the non-verbal memory system for procedures: that is,
actions and responses. Grigsby and Stevens (2002) describe procedural learn-
ing as mediating ‘‘what we do with one another’’ while declarative memory
captures ‘‘what we know about one another’’ and emotional memory how our
emotional state is altered in relationship to one another. The infant’’s muscle
memories of tensing in response to care-givers who were unpredictable and
alarming may remain encoded in the body as a lifelong tendency in attachment

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relationships. Insecure––avoidant tendencies to orientate internally or towards

inanimate objects, away from care-givers, is as much a body experience as
anxious arousal and inability to orientate other than to the care-giver in inse-
cure––ambivalent tendencies. Autonomic memories of alarm or shutdown in
response to frightening behaviour might also be encoded as automatic reac-
tions to attachment stimuli and re-evoked in later relationships or contribute to
preoccupied, dismissing, or disorganized/unresolved attachment patterns
(Lyons-Ruth, Dutra, Schuder, & Bianchi, 2006) in adulthood.
As research increasingly attests, early childhood attachment experiences
play a crucial role in the development of affect regulation (Schore, 2003). Affect
tolerance in adulthood appears to be directly tied to procedural learning of the
autonomic nervous system (Ogden, Minton, & Pain, 2006) and optimal develop-
ment of the right orbital prefrontal cortex (Schore, 2001), the brain’’s self-sooth-
ing centre. In order for children to develop a ‘‘window of tolerance’’ (Siegel, 1999)
for emotions and arousal, they require the repeated emotional––somatic experi-
ence of ‘‘interactive regulation’’, that is, soothing or down-regulating when sym-
pathetically aroused and distressed, up-regulating in the context of para-
sympathetically mediated low responsiveness. Each attachment pattern reflects
a different autonomic adaptation to the relational environment: the high
sympathetic arousal found in insecure––ambivalent patterns, parasympathetic,
dorsal vagal tendencies of insecure––avoidant babies, and the bi-phasic alterna-
tions observed in disorganized attachment reflect adaptation to a particular
kind of care-giver or care-giving environment.
Mariela, a young woman in her early twenties, came with her mother to
consult about difficulties with intense emotional reactivity to disappointment
or misattunement in her relationships with men. ‘‘I don’’t think it has anything
to do with trauma, though. My only trauma,’’ she said, ‘‘was that I spent my first
nine months of life in a Romanian orphanage –– but that can’’t be a trauma
because I don’’t remember it.’’ After hearing about Mariela’’s intense swings of
approach and avoidance in intimate relationships and difficulties with affect
regulation resulting in both anxiety and depression, I felt comfortable explain-
ing to both mother and daughter that her behavioural and emotional responses
were often found in unresolved attachment patterns secondary to ‘‘frightened
and frightening’’ care-giving (Main & Hesse, 1990, Lyons-Ruth, Dutra, Schuder,
& Bianchi, 2006). The concurrent experiences of profound neglect and fear, well
documented in studies of Romanian orphans and orphanages, have been found
to leave significant functional, intellectual, emotional, and autonomic effects
(Chugani et al., 2001). Although she had no visual or declarative memories of
her first nine months, I assured them, she was ‘‘remembering’’ it emotionally
and behaviourally. Hearing this, her mother tearfully recalled the signs of
Mariela’’s traumatic experiences: ‘‘I know this is right. When you came to us,
I remember that you kept arching your back and pulling away from me

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whenever I tried to hold you. I didn’’t understand why you didn’’t want to be
held.’’ Mother and daughter shared a moment of sadness and gratitude that this
mother had patiently persisted in helping her daughter to bond through those
difficult early years rather than becoming dysregulated herself.
As Grigsby and Stevens (2002) point out, procedural and emotional memory
systems are both largely unconscious and generally experienced as action
tendencies and emotional reactions independent of the events that shaped
them:
The neural substrate for procedural learning . . . appears to develop prior to the
capacity for declarative learning. This means templates for habitual behaviors
may be acquired, and the behaviours may become relatively automatic and
routine, before the child has an episodic memory system capable of remembering
the events that produced these behaviors. In situations involving both fear condi-
tioning and procedural learning, very young children are likely to experience a
kind of learning (habits, conditioned responses) that is dissociated from the
context. In other words, because of the relative independence of these systems, it
may be impossible to recall the events that led to the acquisition of certain types
of behavior. (pp. 17––18)
Mariela had no declarative memory of her first nine months in the orphan-
age, but procedural and emotional memories of that experience affected not
only her ability to attach to her adoptive parents but also her adult intimate
relationships. Without declarative memories, psychodynamic treatment had
not successfully helped her to gain insight into these patterns because, as she
kept saying, ‘‘How could I have been affected by an experience that I don’’t
remember?’’ If we expand our understanding of ‘‘memory’’ to include emotional
and procedural memory systems, then Mariela had many memories: her body
remembered that closeness is dangerous, leading her to reject boy friends if
they were kind or if the relationship grew closer. As romantic relationships
endured despite her reactions to the closeness, she typically became increas-
ingly hypervigilant, suspicious, and reactive to any failure of attunement or
attention. Next, she would find herself erupting in anger and threatening to
leave. Over and over, fight/flight responses alternated with proximity-seeking.
These body-centred, autonomically driven patterns of reaction were inaccessi-
ble to verbal dialogue, requiring a therapeutic approach that could reach below
the level of conscious experience and declarative memory to subcortical
emotional memory and body memory for automatic tendencies.
Sensorimotor psychotherapy (Ogden, Minton, & Pain, 2006) offers just such
an avenue for addressing attachment patterns at a subcortical procedural level.
Developed in the 1980s by Dr Ogden, as a body-centred talking therapy, senso-
rimotor psychotherapy is designed to specifically address the bodily and auto-
nomic symptoms of trauma and attachment-related disorders, as well as the

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cognitive––emotional aspects, without requiring the use of hands-on interven-

tions. Consequently, it is easily integrated into traditional inpatient and out-
patient treatments, often so seamlessly that the patient is not aware that a
different modality is being introduced. Sensorimotor psychotherapy incor-
porates interventions drawn from psychodynamic psychotherapy, gestalt ther-
apy, cognitive––behavioural approaches, and the Hakomi method of body
psychotherapy (Kurtz, 1990).
Its theoretical principles stem from neuroscience research findings on the
effects of both attachment and traumatic experiences on the brain and body, so
that the moment-to-moment therapeutic experience reflects an understanding
not only of the patient’’s verbalizations, but also the language of the brain and
body. A typical session begins, as would most psychotherapy sessions, with a
client’’s narrative. However, rather than engaging in a conversation ‘‘about’’ the
experience, the sensorimotor psychotherapist focuses instead on noticing the
sequence of emotional, bodily, and cognitive responses to the narrative. Brain
scan research on traumatic memory demonstrates that, when traumatic experi-
ences are recalled, subcortical, non-verbal areas in the right hemisphere of the
brain are activated rather than declarative memory centres in the prefrontal
cortex (van der Kolk & Fisler 1995). As the client narrates historical events or
describes present crises, the therapist not only attends closely to the narrative,
but also ‘‘tracks’’ the signs of subcortical remembering and procedural learning:
postural patterns, repeated phrases, affect tolerance and intolerance.
As Mariela described angrily attacking her nurturing boyfriend, then beg-
ging him tearfully to forgive her, her body curled up slightly and she leaned for-
ward, her tear-filled eyes not leaving my face and gaze. Then, her demeanour
began to shift in rhythm with her account of the ‘‘little things’’ that activated her
nervous system and mobilized a fight response: her boyfriend arriving late,
being overly solicitous (‘‘too nice’’), failing to remember things important to her,
being kind when she was angry. The memories of what tended to provoke her
fight/flight responses were followed by her voice deepening and spine length-
ening as she sat up straight, looked me strongly in the eyes, and spoke in a tone
of anger and sarcasm. Mariela’’s body was telling me the story. All of the cues
that evoked these shifts in affect and body experience were attachment-related:
all involved behaviour on the part of the other inviting ‘‘too much’’ closeness or
creating ‘‘too much’’ distance. Too much closeness, I noticed, evoked fight or
flight reactions, while too much distance evoked panic, sadness, and collapse in
her body. Her body literally became unable to support her at those times, while
in the fight/flight state, her body posture and muscle tension supported a
strong, solid stance both physically and emotionally. In the latter, she felt as if
she did not need anyone; in the former, she felt lost and afraid.
Narrative retelling of events can cause these subcortical neural networks to
fire, but does not necessarily contribute to changing those firing patterns so

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that the mind and body can have an experience of relief (van der Kolk, 2006).
In sensorimotor psychotherapy, the therapist attempts to help the client ‘‘trans-
form’’ procedurally learnt patterns from the ‘‘bottom up’’ (Ogden, Minton, &
Pain, 2006). This process involves a simple but precise series of steps: as the
therapist begins to note the unfolding psychophysiological patterns, he or she
gently draws the client’’s attention to those patterns. Rather than interpreting
what is noticed, the therapist mirrors it in simple words (‘‘I notice when you
talk about your boyfriend being nice, your tears dry, you sit straight up, your
voice deepens –– things really shift, don’’t they?’’), inviting the client to ‘‘notice’’
or ‘‘study’’ the internal and body experience. These simple mirroring statements
are carefully chosen and ‘‘pitched’’ so that they evoke mindful noticing without
dysregulating or shaming the client. Attention to attunement is expressed
through the therapist’’s body: perhaps the face softens, and the tone becomes
one of curiosity and fascination, or the therapist leans forward or back in
rhythm with the client. Interpersonal neurobiological regulation in psycho-
therapy requires ‘‘right brain to right brain’’ communication, the therapist pays
equal or greater attention to the client’’s nervous system and bodily communi-
cation than to language and meaning-making. The right brain monitors the
impact of words and body language on the client’’s nervous system and somatic
experience, then adjusts breathing, tone of voice, energy level, facial expression
accordingly. In secure attachment contexts, care-givers intuitively use right
brain communication, experimenting with language and body language until
the child’’s emotional and autonomic state is within the window of tolerance.
‘‘Making contact’’, as this type of communication is termed in sensorimotor
psychotherapy, has two purposes: to foster ‘‘dyadic dancing’’ and a felt sense of
the therapist’’s attunement moment to moment, but also to direct mindful atten-
tion to the unfolding body experience. Directed mindfulness capitalizes on
neuroscience findings that mindfulness meditation increases activity in the
medial prefrontal cortex (thought to be an integrative centre as well as respon-
sible for internal awareness) and decreases activity in the amygdala, thus facil-
itating regulation of autonomic arousal (Lazar et al., 2000; Creswell, Way,
Eisenberger, & Lieberman, 2007).
As Mariela was helped to ‘‘notice rather than draw conclusions’’ about these
patterns, she became aware of the physical sensations of ‘‘opening’’ in the chest
and heart area when she recalled the first weeks of being in love with a
boyfriend, how warm she felt inside during those early stages. Mariela’’s
intense yearning for the physical and emotional sensation of contact with
another (perhaps a body memory of her attachment need in the orphanage) left
her body open and exposed, which she expressed by opening her arms wide to
show her therapist the extent of her vulnerability at these times. Without an
ability to open by degrees as a relationship deepened, she was left vulnerable
to the inevitable misattunements found in any relationship. Describing what

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happened next as a boyfriend might arrive late or forget something important

to her, she folded her arms across her chest and set her chin. As the therapist
interrupted the narrative of these empathic failures to help her notice the
posture, she laughed. ‘‘I guess I just close up and my body decides never, ever
to open again.’’
In sensorimotor psychotherapy, the body is used both as a source of infor-
mation about procedurally learnt tendencies and also as a vehicle for interven-
tion (Ogden, Minton, & Pain, 2006). Therapist and client shift the focus of
attention back and forth from narrative to body experience to meaning-making,
then back to the body. For Mariela, the newfound awareness of her body’’s role
in these relational impasses led to a discussion of, and somatic education about,
attachment and the body. Using her arms, the therapist demonstrated how a
child in a secure attachment-promoting family might learn to tolerate separa-
tions by closing her chest a little and refusing to say goodbye, then open phys-
ically and emotionally just a little to the care-taker who came to mind her, then
close a little if tired or feeling some separation anxiety, then open again on
reunion with the parent, while still able to close again to screen out any over-
stimulating or distressing interaction.
This embodied explanation encouraged Mariela to take the next step in a
sensorimotor treatment: to see how movement and action might contribute to
changing the attachment ‘‘memories’’ in her body. Young children in secure
attachment-promoting environments learn early on to execute ‘‘acts of triumph’’,
to use their bodies to say ‘‘go away’’, or ‘‘come closer’’, or ‘‘I can do it myself’’.
Successful execution of these actions generally increases the ability to auto-
regulate in the face of the inevitable disruptions and separations of childhood.
In Mariela’’s case, it was adaptive for her body to retain the capacity for wide-
open receptivity in the orphanage environment to maximize any relational
contact, but also to develop an equally strong capacity for ‘‘armouring’’ in the
context of neglect and danger.
After demonstrating with her arms how a child might develop healthy flex-
ible somatic boundaries, the therapist invited Mariela to use her arms in the
same way and ‘‘notice what happens’’. In a mindfulness-based therapeutic
modality, attention is repeatedly directed away from the past to the present
moment: ‘‘Right here now, how does it feel to close your chest just a little? What
do you notice? Is it comfortable or uncomfortable?’’ Mariela explored how it felt
in her chest and heart area as she moved her arms out from her body in a wide-
open posture, then slowly brought her arms in as if making a circle. She was
aware of feeling more solid and less exposed as her arms closed the circle and
noticed that it was a different and more comfortable feeling than the arms-
across-the-chest posture procedurally evoked by misattunements and disap-
pointments. A thought came up that she would miss the ecstatic sense of
closeness that went with the early weeks of a relationship, but that was quickly

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followed by her awareness of the price she paid for that euphoria. The thera-
pist again demonstrated how the arms might open wider as she got to know
someone well enough to develop trust or at least be able to anticipate what
disappointments would ensue in a particular relationship.
In subsequent weeks of therapy sessions, Mariela worked on a number of
movements related either to regulating her affect and arousal or developing
new procedural tendencies in relationship. As she experimented with reaching
out towards someone with her arm and hand, she could feel her body tense and
an impulse to pull her hand back, but she also observed the same reaction
when the therapist reached out towards her. With the yearning for closeness
that had dominated her consciousness since her teenage years came automatic
defence responses: tensing, bracing, autonomic arousal. Observing these
tendencies allowed Mariela to practise relaxing her body as she reached out or
as the therapist reached out to her. Experimenting with a gesture of reaching
out with one hand and making a stop gesture with the other afforded her the
opportunity to experience without words how healthy boundaries allow close-
ness to others to feel safer.
In the words of Solomon (2011), ‘‘Attachment is the infant’’s need to be safe
from danger. We are not born securely attached. To the infant, the world is not
a safe place’’. Attachment relationships are the body’’s way of ensuring infant
safety, and when safe attachments are not available, the body must adapt.
Autonomic, muscular, perceptual, and movement tendencies are available even
to infants as a source of support and regulation, as demonstrated in Beebe and
colleagues’’ research (2009). Early on, the baby’’s body must make an adaptation
to the quality of the attachment field, laughing and smiling while crying or
collapsing and shutting down emotionally and autonomically. Sensorimotor
psychotherapy allows client and therapist to work with these very early prever-
bal interactions at the level of muscle and autonomic memory. The experience
of being able to explore empowering actions in the context of attuned interac-
tive psychobiological regulation is not unlike the experience of securely
attached young children. In sensorimotor work, though, the client is encour-
aged to become a mindful witness as the process unfolds and inner experience
is mentalized and verbalized.
As Mariela was able to notice her bodily and emotional reactions as they
unfolded, rather than retrospectively, she was able to inhibit explosive
responses and relax the body in relationships. Practising her new movements
and somatic resources inside as well as outside of therapy helped her to have
alternatives when dysregulated by attachment hopes and fears. Finally, her
ability to stay present in the context of emotion allowed her to witness being
witnessed by her therapist and by those she loved. ‘‘Hijacked’’ by the body
memories of abandonment and threat, Mariela had not ever been able to take
in the experience of being ‘‘seen’’ and valued by others in her life. Witnessing

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their witnessing began to challenge her shame and sense of defectiveness.

Mariela has discovered that the experience of safety in relationship is as much
a body experience as it is an emotional one. When arousal is within the window
of tolerance, when the body feels both solid and relaxed, when we can mental-
ize, and when we can tolerate a gamut of emotions without feeling either over-
whelmed or numb, we know we are finally ‘‘safe’’.

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Attachment as a Sensorimotor Experience: The Use of Sensorimotor Psychotherapy