Reality matters: attachment, the real relationship, and change in psychotherapy

Early attachment relationships and their inherent emotional regulation formatively effect psychoneurobiologic development. Implicitly learned relational interactions begin within the context of such relationships, and as habitual responses to strong emotions, such as fear, ultimately define character. The psychotherapeutic attachment relationship can positively affect change in developmental processes compromised in earlier relationships, influencing character change. The early attachment relationship is evaluated for features that become relevant as the therapeutic attachment relationship and real relationship--the realistic and genuine elements of the therapeutic relationship, affect psychoneurobiologic change in the patient. This paper asserts that the real relationship deepens therapeutic attachment relationships, improves emotional regulation processes, and stimulates further development of processes such as mentalization. Current research studies are considered regarding areas of the brain potentially affected in psychotherapeutic processes.