In line with this description, I have demonstrated that implicit attachment communications are expressed within the therapeutic alliance, and that they are expressed in ultra-rapid transactions of nonverbal facial expressions, gestures, and prosody between the patient’s and therapist’s right brains (Schore, 2005). Furthermore, with intimations of failed manualized treatment attempts, the APA Task Force reports that “Research suggests that sensitivity and flexibility in the administration of therapeutic interventions produces better outcomes than rigid application of . . . principles” (p. 278, my italics).
The concept of sensitivity is, of course, also important in the developmental attachment literature, where Ainsworth (1978) referred to the importance of the mother’s “sensitive responsiveness to infant signals and communications.” According to Van den Boom (1997) the sensitive caregiver packages her social interactive behavior in such a way in the interaction flow that it promotes rather than interrupts the exchange. These authors then expanded the concept, stating, “It would be more fruitful to think of sensitivity not as a parenting dimension that exists apart from other dimensions, but rather, as permeating all interactive behavior” (p. 593).
This surely includes the sensitive clinician’s interactive behavior within the attachment bond co-created within therapeutic alliance.
In more recent attachment research Schachner, Shaver, and Mikulincer (2005) propose that sensitivity to a relationship partner’s nonverbal behavior directly influences the quality of interpersonal interactions and relationships, including all forms of attachment relationships. These authors point out that “adult attachment researchers have not paid much attention to patterns of nonverbal behavior and sensitivity” (pp. 147-147, my italics).
Indeed, the findings of Roter et al.
(2005) on the central role of the expression of emotion through nonverbal behavior in the physician-patient relationship
applies directly to the therapist-patient relationship: “Highcontext communication depends on sensitivity to nonverbal
behaviors and environmental cues to decipher meaning, while low-context exchanges are more verbally explicit, with little reliance on the unstated or nuanced” (p. S28).
In writings on “the art of psychotherapy” Bugental (1987) asserts,