Clinical Social Work Journal, Vol. 34, No. 3, Fall 2006 (Ó 2006) DOI: 10.1007/s10615-006-0048-2

BOOK REVIEW

SEEING THROUGH TEARS: CRYING AND ATTACHMENT. Nelson, J.K. New York: Routledge, 2005, 241 pp., $29.95. ‘‘The act of shedding tears has as much depth, symbolism, and meaning as a poem or a dream, and as much magic and mystery as sex. Crying, too, touches all the themes that bind us together with the totality of human experience’’ (Nelson, p. xi). The subject of crying gets little focus in the clinical literature despite its ubiquity in psychotherapy and in everyday life. A curiosity about crying led Judith K. Nelson to devote her scholarship and clinical work to deepening her understanding about it. In Seeing Through Tears: Crying and Attachment, a concise yet in-depth volume, she provides an exploration of crying in its multi-layered origins and expressions. Creatively connecting her ideas to attachment theory—especially the work of John Bowlby—she presents her theory of what it means to cry and the caregiving response it usually elicits. Her major argument—and contribution—is her inclusion of crying among the attachment behaviors. The book is well-organized into four sections, beginning with ‘‘A Theory of Crying.’’ Why, she asks, do people cry? Unlike other expressions of emotion, crying often falls outside exclusive conscious control. Nelson asserts that, as one of several attachment behaviors, crying helps to establish and maintain a bond between infant and caregiver; throughout life and across cultures it is also a response to the possibility that bond may be ruptured. That these behaviors endure is what led Nelson ‘‘to use attachment to understand crying throughout the life cycle’’ (p. 12). With repeated experiences of crying and responsive caregiving, the capacity to self-soothe gradually increases. The experience of solitary crying, therefore, may be understood as intersubjective. This construction sheds light on why some clients can cry alone and feel better, while others cannot seem to find emotional equilibrium. In the book’s second section, ‘‘The Clinical Assessment of Crying and Caregiving,’’ Nelson applies her theory of crying to the assessment of adult crying and caregiving in both healthy and problematic versions. She tells us that secure caregiving is ‘‘the mirror image of secure attachment’’ (p. 101). For Nelson, the ‘‘hallmark of secure attachment’’ is ‘‘the experience of an available and accessible internal caregiver’’ (p. 108). Moreover, even those who are securely attached may experience grief in response to personal loss without necessarily crying. She credits Dr. Saul Rosenberg with the term ‘‘inhibited crying’’ to identify this non-pathologic situation. I find this concept to be somewhat confusing since, in the aforementioned situation, the absence of crying is not problematic. Perhaps there is no need to label it. 391

Ó 2006 Springer Science+Business Media, Inc.

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Nelson includes a classification of attachment styles first identified by Ainsworth in infants but elaborated by others to apply to adults. These styles tend to be reflected in the ability to cry (an attachment behavior) and also in the expectation of a soothing caregiving response. ‘‘Crying and caregiving are intertwined’’ (p. 105). Assessing crying in the clinical situation entails, in part, listening carefully to accounts of crying and caregiving, historically and currently. Assessment also involves the examination of crying and caregiving responses in the therapy relationship. The latter requires that the therapist put aside the notion that crying only serves to discharge painful affect (p. 107). The securely attached client who cries in our presence tends to invites us ‘‘in’’ to respond. An insecurely attached client may also do this selectively; Nelson cites Hesse’s term ‘‘earned secure’’ to describe the selective experience of trust (p. 109). A chapter that focuses on more ‘‘symptomatic crying and inhibited crying’’ in adults includes an assessment tool for identifying ‘‘maladaptive, dysfunctional or immature’’ crying (p. 117), or psychiatric or medical problems that may account for these symptomatic presentations of crying. For example, protest crying sometimes affects us in a way that triggers annoyance or even an absence of any feeling response at all. This is one marker of symptomatic crying. When protest crying continues and has not led to a resolution of despair (and neurological causes have been ruled out), we need to consider an unresolved grief reaction. Nelson tells us that it can be helpful to think about protest crying being ‘‘a hallmark of the anxious-ambivalent attachment style’’ (p. 120), in which our efforts to soothe and comfort cannot be accepted by the client. When it is characteristic for a person to intentionally hold back tears and also detach from caregivers in the face of loss, this is likely a symptomatic form of inhibited crying. It is not ‘‘merely...a temporary defense or soothing strategy’’ (p. 129). On the other hand, ‘‘symptomatic inhibited crying’’ might sometimes be situational and not a characteristic reaction for an individual. If crying is in response to death or other permanent ruptures to a relationship, and if ambivalence or anger toward the lost person is prominent, the result may be an inhibition of crying. In those who have an extreme need for control—as in obsessive-compulsive personality disorder—crying rarely is a tolerable option. This is also frequently the case with those with avoidant attachment styles. What may substitute instead is a compulsive use of alcohol or food or other driven behavior. Nelson offers a continuum along which to place any episode of crying, from the ‘‘somatic’’ to the ‘‘emotional.’’ The continuum is part of her effort to present crying more holistically, taking into account a range of factors, and may be another helpful tool for understanding crying as a complex phenomenon. Section Three, ‘‘Crying and Inhibited Crying in the Therapy Relationship,’’ builds on the prior two sections. As a therapist who identifies with the more contemporary intersubjective reading of psychoanalytic theory, Nelson tells us that she has ‘‘come to see attachment behavior and its corresponding system—caregiving—as synonymous with intersubjectivity’’ (p. 153). Attachment and caregiving behaviors in both the patient and the therapist interact. The patient’s crying can provide a key to understanding her past parent–child bond and the current bond with the therapist. For those patients whose attachment experiences have not offered enough security and consistency, an anxious-ambivalent, avoidant or disorganized attachment style will often impede the ability to accept caretaking. Over time, with sufficient experiences of attachment and caregiving with the therapist,

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the internal ‘‘attachment organization’’ can change, with the result that the patient can better tolerate caregiving, and better modulate affect with self-soothing behaviors (p. 158). Nelson regards physical touch as ‘‘the most powerful affect regulator,’’ (p. 170) but cautions against its actual use in psychotherapy. Instead, she tells us, we need to use our expressions, tone of voice, choice of words and other nontouching techniques to metaphorically ‘‘touch.’’ It can be a powerful metaphor and Nelson puts it to use to provide a caring response that can ‘‘touch’’ a client’s core. As the client’s core is touched, so too may the therapist’s, sometimes accompanied by her own shedding of tears. In this regard, Nelson’s attachment and caregiving framework can be a tool to understand each episode of a therapist’s crying, just as with episodes of a patient’s crying. Clear, concrete suggestions are provided for those therapists who have suffered losses and are finding it hard to manage their grief in sessions. The book’s final section, ‘‘Attachment and Caregiving: Beyond the Personal,’’ is as ambitious as it is absorbing. In this relatively brief section Nelson endeavors to integrate crying in its psychological, social and physical aspects with the symbolic, spiritual and aesthetic realms—using attachment theory to weave them together. When ‘‘transcendent tears’’ (p. 195) flow, they may be less about loss and more about connection with art or music or nature or other experiences that touch us particularly deeply. She tells us that Freud believed that an ‘‘oceanic feeling’’ (a concept named by Romain Rolland, a friend of Freud and a Nobel laureate) derives from the original bond between mother and infant (p. 196). Nelson’s incorporation of composers’, writers’ and poets’ versions of the oceanic experience is quite interesting, as are her descriptions of oceanic responses to nature, dance, film and art. The weeping that may come in response to a poem, a novel or any form of creative expression, Nelson tells us, flows from feelings of deep connection to something larger than ourselves—that oceanic oneness—rather than being an expression of loss. I wonder, though, if oceanic feelings, because of their origins in the earliest parent–child bond, may actually encapsulate feelings of loss that may not necessarily be conscious. Further examples come from the visual arts and film, where deep feelings and tears may be provoked. These responses may accompany the experience of becoming involved in someone’s world (as in photography) or feeing part of a communal sharing of tears (as in viewing a film in a theatre). I find it interesting to speculate on the different experience so many people now have viewing films at home, without being part of an audience. I think that there is something lost in that experience and that the loss is about sharing a communal experience of crying (or laughing or other responses, for that matter). Nelson has packed this part of her book with numerous examples from each of the arts, giving us a rich ending to a unique, stimulating and very useful book. Laura Reiter, L.C.S.W. Trinity College Counseling Center Hartford, CT 06106, USA [email protected]