The menopause: is psychology doing enough?

We may be talking a lot about the menopause, but, asks Deputy Editor Jennifer Gledhill, can psychologists offer more support during this transitional time?

07 October 2025

We've all received the 'menopause memo'. Davina McCall is showing us how she applies her oestrogen gel on YouTube, Michelle Obama is podcasting about hot flushes and weight gain, and Gwyneth Paltrow is on TikTok, talking about how she feels 'sudden fury for no reason'.

Like many of us, I've been on mandatory workplace menopause awareness training, but it left me feeling no better. I was told to go easy on myself. I'm too busy feeling the shame of brain fog and the weight of anxiety – just a couple of the 30+ symptoms of menopause – to figure out how I do this.

My Instagram algorithm is pushing me to spend a month's salary on menopause supplements, which promise to help me sleep and find more energy and clarity. Yet it all feels more about money than science – the global market for menopause products is reportedly worth nearly 17 billion dollars.

So, what will help? Thankfully, we now know that the benefits outweigh the risks for many symptomatic women when taking hormone replacement therapy. That's a turnaround from the early 2000s when the Women's Health Initiative suggested a substantially increased risk of breast cancer. HRT can help to relieve symptoms including hot flushes, sleep problems and low mood. However, many women, including me, are advised not to take it due to medical family history and other risk factors. Can psychology offer us more options? And, more importantly, do they work?
'We need other options'

I speak with Aimee Spector, Professor of Clinical Psychology of Ageing and one of the psychologists at University College London's Menopause Mind Lab – dedicated to understanding more about the impact of menopause transition on cognition, mental health and wellbeing. When I tell her that the only thing I was offered when I reported heightened anxiety and low mood to my GP was antidepressants, she expresses disappointment.

'This shouldn't be the only option,' says Spector, who believes psychology can now play a huge role in making the transition a more positive one. 'I have firsthand experience of navigating this journey for myself. It's hard. There often seems to be a lot of focus on the biological changes our bodies go through, but there are lots of psychological and cognitive symptoms as well. For me, HRT was helpful at first, but then I got breast cancer, and the recommendation was to come off it. We need other options as well.'

Spector and her team have evaluated the effectiveness of psychosocial interventions, including Mindfulness-Based Interventions and Cognitive Behavioural Therapy, on non-physiological symptoms of menopause, including mood, cognition and quality of life, combining data from 3,500 women. 'CBT can help with the psychological thoughts about the physiological feelings,' she says. 'And the combination of CBT and HRT works well together. Take hot flushes that are disrupting sleep, for example. Someone may take HRT to help with the physiological symptoms, but they may well have also got into a negative thought pattern too, something I think we can all identify with – waking up in the night and not being able to drift back off because you are worrying that you are going to be awake all night. Or, we can worry about having a hot flush at work and being judged by our colleagues. CBT can be helpful when we are stuck in a negative pattern of thought, which may be hard to come out of, even when symptoms start to get better. It can help us to find strategies and techniques to help.'
One size doesn't fit all

But like with anything, there is no 'one-size fits all' and menopause support is no exception. 'For example, some neurodiverse people don't like CBT because something telling you to change the way that you think about things can be very challenging,' says Spector. 'One of the projects that we're doing now is looking at the results of Compassionate Mind Training (CMT) on women going through menopause transition; we're getting really promising results from it and hoping to expand it into a trial. CMT is a 'third wave CBT' that aims to reduce feelings of self-criticism and shame. It focuses on helping individuals to take better care of themselves and learn strategies to manage their symptoms.'

King's College London's Emeritus Professor of Clinical Health Psychology, Myra Hunter, who has worked in women's health for over 35 years, has been instrumental in creating a CBT programme that, in 2024, for the first time, was recommended by NICE as an intervention for the main menopausal symptoms – hot flushes and night sweats.

'This was good news,' she tells me. 'In the first menopause NICE Guideline in 2015, the only symptom CBT was recommended for was depression in menopause. We have now carried out six successful clinical trials and have enough evidence that CBT can help reduce the impact of hot flushes and night sweats, and help to reduce depressed mood and sleep problems. This offers a choice for women who prefer not to use HRT or for whom HRT is contraindicated. It can be used either in conjunction with HRT or on its own, and is available in self-help, group and online formats.'

Hunter explains that it is helpful to use a biopsychosocial approach to understand the range of factors that can affect a woman's experience of menopause. 'Although there are typical symptoms, we will all have our own experience, and an important need for people in perimenopause or menopause is to feel understood. As psychologists, how do we explore this? We can start by being informed and aware of what might happen during menopause, but not to judge or make assumptions. On average, about 25% of women have symptoms that impact quality of life. As well as biological factors, such as general health and menstrual changes, it makes sense to explore psychosocial factors, such as mood, beliefs about menopause and ageing, workplace environment, shame and stigma, and social support. There are bi-directional relationships between hot flushes and depressed mood, and this is important because mid-life is a time of higher reports of depressive symptoms for both men and women. There are many interactions between experience of symptoms and psychological stressors – children leaving home perhaps, older relatives needing more care – as well as expectations of how we should age and the social meanings and beliefs around women ageing.'

Hunter tells me that's where CBT and working in groups can really help. 'I think it's important with menopause awareness to remind people we're not treating an illness but offering evidence-based information and useful tools to navigate the menopause journey. We offer CBT in groups and individually, and it's manualised for psychologists and other health professionals. The course is 8 hours in total and involves psychoeducation around how to reduce stress and how lifestyle, thoughts and behaviours can impact our wellbeing. We use diaphragmatic breathing to help calm stress reactions and hot flushes. We then move on to use cognitive therapy to challenge overly negative beliefs about ageing and menopause, and coping strategies for hot flushes, sleep and night sweats. We encourage self-compassion and use CBT to help reduce the stigma and shame that we can often feel around having them. In group settings, we look at how to talk about menopause, grow our confidence and not feel the need to apologise for it.'
Menopause not illness

However, when the NICE guidelines were initially published in a consultation document, there was an immediate backlash, with the media and some advocacy groups expressing outrage that psychological interventions were being recommended for their debilitating symptoms. A quick Google points to some early reactions: 'Rubbish. How is mindfulness going to help you when you wake again at 3am drenched in sweat?' and, 'Try being in a responsible job with long hours and making time for this. HRT got me through without fuss.'

Both Hunter and Spector remember the reactions well. 'Opinions can be very divided,' says Spector, 'but saying that CBT might help doesn't mean that HRT won't. It certainly helped me, but I was told to stop taking it! Many people would benefit from both, and some may want choices in terms of treatment options.'

'The wording of the final guidance, published in 2024, was changed to be clear that CBT is recommended as an option – not instead of HRT ', says Hunter. 'However, given that women's experience varies such a lot, it makes sense to wait to find out if you need to have HRT, rather than viewing it as something you should be doing. There have been people on social media talking about menopause as if it's a disease that you must take medication to treat. What we can do is not say that the menopause is automatically a disaster for everybody.'

After falling down a rabbit hole reading the responses to the NICE guidelines around CBT, I wonder if part of it is fuelled by the ongoing legacy of women not feeling heard by the health system. After all, a 2025 study funded by the Department of Health and analysed by The London School of Hygiene and Tropical Medicine has found that one in four women in England have suffered with serious reproductive health issues, with 'systemic, operational, structural and cultural issues' preventing them from accessing care.' Overall, 74 per cent of women reported experiencing some form of reproductive health problem relating to menstruation, menopause, pregnancy and diseases such as endometriosis and polycystic ovary syndrome.

If we haven't experienced personalised, compassionate care from our health care provider (and how much can we expect in a brief appointment?), and menopause-training has, for the first time, only just become mandatory for medical students, can we really expect our reproductive and menopausal health needs to be met when we ask for support? Do we need to stay on the defensive until we can be assured that professional caregivers have caught up?
Researching psychiatric disorders

'Progress is always too slow and too frustrating,' says Professor Arianna Di Florio, Professor of Psychological Medicine and Clinical Neuroscience at Cardiff University. Di Florio's recent 2024 study has highlighted just how much we need to question research methods that study the experience of perimenopausal people.

Her team looked at incidence rates of psychiatric disorders during the perimenopause (classed as four years around the final menstrual period – FMP) and found that, compared with the pre-menopausal period (6-10 years before FMP) incidence rates of psychiatric disorders significantly increased (0.59% to 0.88%), mainly due to small increases in new onset major depression and mania. However, these prevalence rates returned to premenopausal levels during postmenopause (0.50%).

The study was the first of its kind in the UK to include over 120,000 participants and use 'age at menopause' rather than simply 'age' as a variable. 'In my clinic, I found that some women, previously living lives without any experience of severe mental health issues, developed severe mental illness around the time of the menopause,' says Di Florio.

'Psychiatric disorders associated with the menstrual cycle, childbirth and menopause are very complex, very heterogeneous conditions. The crucial point to me is that, clinically, we cannot make any strong assumption based on averages. By using age at menopause rather than simply age, we found that participants without a previous history of mania were over twice as likely to develop mania for the first time in the perimenopause than in the late reproductive stage (6 – 10 years before FMP).'

'So, in practical terms,' says Di Florio, 'if a perimenopausal woman presents to the doctor for the first time with symptoms of bipolar disorder, the doctor should take her seriously and not, as sometimes happens, confuse a severe mental illness with another condition, such as major depression or, even worse, with an existential crisis or a stereotype such as the "empty nest syndrome" or, even, dismiss this as "only menopause". HRT is not enough to treat mania.'
'Why did nobody ever teach me about this?'

I'm fully aware I'm at the 'lucky' end of the scale in terms of my menopausal symptoms. I wasn't offered any psychological interventions when I asked for help, but I am a privileged, healthy, white woman, a psychotherapist who has access to experts and information at hand. For many women, it's not that simple, something Diane Danzebrink, founder of Menopause Support, a not-for-profit community interest company that campaigns for better menopause information, knows all too well.

As founder of the #MakeMenopauseMatter campaign – which calls for mandatory menopause education for doctors, a public health menopause information project, greater support in the workplace and for menopause to be added to the curriculum in secondary school education – Danzebrink knows that having a 'menopause policy' in the workplace isn't enough.

'The problem with awareness is that if you raise it, and more people recognise there might be options for their symptoms, then they are disappointed when the infrastructure isn't there to support them. It may take three or four weeks to see a GP. That appointment is probably going to be for about eight minutes. Unless they see someone who specialises in menopause, which is unlikely, they may come away no better off.'

Danzebrink says that despite working with lots of menopause specialists over the years, it feels like it's only now that there's more understanding about hormones. 'Often women have been experiencing premenstrual dysphoric disorder, which causes significant distress in some menstruating women, and they have been misdiagnosed as bipolar. There may be neurodiverse people who haven't had a diagnosis but perhaps have been masking throughout their lives, who then enter perimenopause, and all their coping strategies go out the window.'

Danzebrink's own experience of enduring years of painful periods, horrific pain and being fobbed off by doctors eventually resulted in a diagnosis of grade four endometriosis and adenomyosis following a total hysterectomy for suspected ovarian cancer in 2012, at the age of 44. Three months after surgery, her mental health plummeted. 'I came very close to taking my own life', she tells me.

'Not one doctor gave me information about the menopause, nobody mentioned HRT to me, not until I hit rock bottom. After I recovered, I thought, "Why did nobody ever teach me about this? Why didn't I hear about menopause when I learned about periods and pregnancy at school? And why is there no kind of national campaign to bring about public awareness?"'

Despite never campaigning before, with Menopause Support, Danzebrink has managed to bring menopause to the curriculum in schools, and mandatory menopause training for all medical students has just started. 'We are still campaigning for a government public health campaign, and we want to have menopause guidance and support in every workplace, regardless of the number of people you employ. We don't want it to be simply a tickbox exercise. We want to ensure that the entire workforce is educated about what menopause is, when it happens, why it happens, what people can do to support themselves, and what your role is in supporting your colleagues. I think the benefit would be enormous for the health and wellbeing of the whole population, but I think there would be a huge financial benefit too. However, not many women hold the purse strings when it comes to these decisions', says Danzebrink.

She's right. UK grant-making charity, The Rosa Foundation, announced in 2023 that from a total of £4.1 billion worth of grants awarded to charities, the women and girls sector received just 1.8 per cent.
Making a difference

In addition to educating the workplace and the next generation of GPs, should there be plans to educate more psychologists? Professor Spector informs me that plans are afoot as we speak: 'We are about to launch a half-day online course called 'Introduction to Menopause for Psychological Therapists' from the Menopause Mind Lab. This is because most psychological therapists in the UK haven't had any menopause teaching. The course not only provides a background and biopsychosocial perspective but also encourages people to formulate using case vignettes and discuss if, when and how to bring menopause into a discussion with the client. I have just run a session for our second year Clinical Psychology Doctorate trainees at UCL,' says Spector, 'and most were amazed that this was the first time menopause had been introduced to our curriculum. Thankfully, this will now be an annual session at UCL, but I believe that all psychology training courses should be covering it.'

Perhaps the best way psychologists can make a difference to the menopause experience is by creating interventions that can reach the largest number of people. Professor Hunter is working on that right now.

'With the British Menopause Society, Drs Melanie Smith and Janet Balabanovic are training health professionals to use the manualised group CBT program and the therapy is being implemented in NHS trusts and cancer charities. With colleagues – Prof Amanda Griffiths and Dr Claire Hardy – we have developed an online package for organisations to use called Menokit that's got something for everybody – for employers, for menopause champions and with CBT for those who need it. We aim to make it available to organisations as soon as possible. It is important to consider the work environment as well as the individual. And important not to forget that menopause is a process and most symptoms are time-limited. When we have done qualitative studies with women who have come through it, they talk about feeling stronger, with a renewed sense of themselves and their identity. Maybe that's through shaking off some of those negative gender stereotypes and taking the opportunity to reflect on who we are, and what we need to look after ourselves.'

SOURCE:

https://www.bps.org.uk/psychologist/menopause-psychology-doing-enough(accessed 15.10.25)

Γιατί κανείς δε μιλάει για την ψυχολογία του ζευγαριού σε διαδικασία εξωσωματικής; Πώς να διαχειριστούμε το άγχος

Ένα από τα πλέον ευαίσθητα θέματα που μπορεί να απασχολεί αρκετά ζευγάρια αφορά την εξωσωματική διαδικασία. Οι ερωτήσεις που πρέπει να απαντήσουν μεταξύ τους τα ζευγάρια και οι συμβουλές της ψυχολόγου.

ΓΡΑΦΕΙ: The Mamagers Team - 04 ΣΕΠΤΕΜΒΡΙΟΥ, 2025



Η σύγχρονη καθημερινότητα ενδεχομένως οδηγεί αρκετά ζευγάρια στο να καταφύγουν στην εξωσωματική για διάφορους λόγους, μια διαδικασία η οποία εμπεριέχει έντονη ψυχολογική φθορά. Αυτή η ψυχολογική φθορά σχετίζεται με τις έντονες προσδοκίες του ζευγαριού για την απόκτηση παιδιού (αυτές οι προσδοκίες ενισχύονται κάποιες φορές ακόμη περισσότερο και από τις προσδοκίες του οικογενειακού ή φιλικού περίγυρου).
Τα 2 ερωτήματα που πρέπει να απαντήσουν τα ζευγάρια πριν από την απόφαση


Έτσι λοιπόν είναι αναγκαίο να έχουμε στο νου μας ότι η εξωσωματική είναι μια ιδιαίτερη και συνάμα πολύ ευαίσθητη διαδικασία όπου χρειάζεται να εστιάσουμε στο τι σημαίνει για το κάθε ζευγάρι η απόκτηση παιδιού και για ποιο λόγο είναι σημαντική η απόκτηση παιδιού. Αυτά τα δύο ερωτήματα είναι απαραίτητο να απαντηθούν πριν ξεκινήσει κανείς τη διαδικασία.

Σε σχέση με τα παραπάνω ερωτήματα είναι κάποιες φορές ενσταλαγμένη η πεποίθηση ότι οικογένεια σημαίνει απόκτηση παιδιού. Αντιστοιχεί όμως αυτή η πεποίθηση στην πραγματικότητα; Η απάντηση είναι αρνητική καθώς κάθε ζευγάρι χρειάζεται να έχει στο νου του ότι είναι ήδη οικογένεια και ότι η απόκτηση παιδιού σημαίνει την επέκταση της οικογένειας.




Παρόλα αυτά αρκετές φορές παρατηρούμε ότι η παραπάνω πεποίθηση μπορεί να υπερισχύει στο νου αρκετών ζευγαριών λόγω κάποιων κοινωνικών πιέσεων π.χ. επίμονες ερωτήσεις ή πεποιθήσεις "πότε θα κάνετε παιδί;”, "ακόμη να κάνετε παιδί;”, "χωρίς παιδιά δεν έχει νόημα η ζωή”, "τα παιδιά είναι ευτυχία” οι οποίες επιβαρύνουν ψυχολογικά το ζευγάρι.

Βάσει των παραπάνω κατανοεί κανείς ότι η ερμηνεία του όρου οικογένεια είναι πολύ σημαντική σε σχέση με το πώς τα ζευγάρια αντιλαμβάνονται τη διαδικασία της εξωσωματικής την οποία ξεκινούν. Σε αυτό το σημείο χρειάζεται να προστεθεί η σημαντική αναπλαισίωση της πεποίθησης ότι η εξωσωματική γίνεται όχι "σε μένα” αλλά "για μένα” ως μια ευκαιρία, δυνατότητα να αποκτήσει κανείς παιδί.

Έτσι λοιπόν τα ζευγάρια που ξεκινούν αυτό το ιδιαίτερο ταξίδι της απόκτησης παιδιού είναι αναγκαίο να λειτουργούν ως ομάδα. Το ομαδικό πνεύμα σε συνάρτηση με τον κοινό στόχο, το κοινό όραμα, την αλληλοϋποστήριξη, την αλληλοκατανόηση, τον αλληλοσεβασμό είναι σημαντικά στοιχεία τα οποία θα βοηθήσουν στη διαχείριση των κάθε είδους δυσκολιών που μπορεί να εμφανιστούν κατά τη διάρκεια αυτής της διαδρομής. Ταυτόχρονα η διάθεση ουσιαστικής επικοινωνίας στο ζευγάρι μέσα από το μοίρασμα των ευκολιών καθώς και των δυσκολιών είναι ο ακρογωνιαίος λίθος για μια γόνιμη ζωή.
Ένα ταξίδι με έντονα συναισθήματα και διακυμάνσεις

Επιπλέον χρειάζεται να δώσουμε έμφαση στα ποικίλα συναισθήματα που εμπεριέχει αυτό το ταξίδι για την απόκτηση παιδιού π.χ. αγωνίας (αν η προσπάθεια θα είναι επιτυχής), ανησυχίας (αν κάνουμε ό,τι χρειάζεται με τον πιο κατάλληλο τρόπο), άγχους (αν η κάθε απόφαση που λαμβάνουμε είναι η πιο κατάλληλη), απογοήτευσης (τι δεν πήγε καλά), θυμού και θλίψης (κανείς δε μπορεί να καταλάβει όσα βιώνουμε), χαράς (δίνουμε την ευκαιρία σε εμάς να προσπαθήσουμε να αποκτήσουμε παιδί), ηρεμίας (κάνουμε το καλύτερο που μπορούμε), ικανοποίησης (βρισκόμαστε ολοένα και πιο κοντά στην απόκτηση παιδιού) καθώς είναι ένα ταξίδι στο άγνωστο με τελικό προορισμό το θαύμα της απόκτησης παιδιού.

Όπως γίνεται αντιληπτό ένα ζευγάρι μπορεί να βιώσει διάφορες συναισθηματικές διακυμάνσεις λόγω των εναλλαγών στα παραπάνω συναισθήματα. Για αυτό χρειάζεται να τεθούν όρια (π.χ. πόσες φορές αντέχει το ζευγάρι να κάνει την εξωσωματική διαδικασία χωρίς να καταρρεύσει ψυχικά), δικλείδες ασφαλείας στις επιλογές που θα γίνουν (αν νιώθει το ζευγάρι ασφάλεια στη συνεργασία με τους επαγγελματίες υγείας), στα βήματα που θα ακολουθηθούν (αν λαμβάνονται υπόψη τα δεδομένα και οι συνθήκες που επικρατούν στη ζωή του ζευγαριού) ώστε να υπάρχει αυτοπροστασία του για να μη διακυβευθεί η ψυχική ηρεμία του.

Και αν κάποια στιγμή λυγίσετε σε αυτή τη διαδρομή να έχετε στο νου σας ότι είναι εντάξει και ότι είστε οι ήρωες στη δική σας ζωή! Η όποια πιθανή αδυναμία σας γίνεται η δύναμή σας! Να εμπιστεύεστε τη διαίσθησή σας και να κρατάτε στο νου σας πώς ό,τι συμβαίνει γίνεται για κάποιο λόγο, για να οδηγηθείτε σε εκείνο το μονοπάτι που είναι το πιο κατάλληλο για εσάς! Έτσι μονάχα έρχονται και τα θαύματα στη ζωή σας!

Ευχαριστούμε την Φωστηρία Αμανατίδου, Ψυχολόγο, Ειδικό στη Γνωστική-Συμπεριφορική Θεραπεία-NLP Master Coach, www.amanatidou.com

ΠΗΓΗ:

https://www.themamagers.gr/egimosuni/501590/pos-diaxeirizomai-to-agxos-stin-exosomatiki(accessed 8.10.25)

Dominant and submissive relationships

by Meg-John Barker



Welcome to my website! You’ve found my most popular post, and in a second you can read more about Dominant/submissive relationships. If you want to find out more, check out my books and zines which cover this topic in more depth. If you like this, please do consider supporting my Patreon.

Why do people sometimes prefer Dom/sub relationships?

D/s is one aspect of the wider category of BDSM (Bondage and Discipline, Dominance and Submission, and Sadomasochism), sometimes also known as kink. Some people are into all of the things listed under BDSM, and some only some of them. D/s is generally distinguished from SM because it is more about power than about physical sensation (although some use these terms more interchangeably).

In D/s activities one person generally dominates the other, or has power over them, therefore people tend to prefer D/s if they find a power dynamic to be exciting in some way. Of course it is pretty common for sex and power to be mixed together in our culture. For example, a lot of romance fiction involves people being rescued from peril or being swept away by somebody more powerful, and a lot of people fantasise about having the power of being utterly desirable to their partner.

What is involved in a Dom/sub relationship?

If somebody identifies as being into D/s, or having a D/s relationship, then they probably include power play in their sex life, and perhaps in other aspects of their relationship. People can identify as dominant, submissive, or switch (which means that they are sometimes dominant and sometimes submissive). It might be that people stick to the same roles each time they play together, or that they take different roles on different occasions.

For most people, being D/s will be something that they only do some of the time (for example, just in pre-arranged scenes – often, but not always, involving sex). Such scenes could involve any kind of exchange of power. For example, the submissive person might serve the dominant one food, or give them a massage; the dominant person might order the submissive one around or restrain them or punish them in some way; people might act out particular power-based role-plays such as teacher and student, cop and robber, or pirate and captive.

Some people who are into D/s might have longer periods, such as a holiday, where they maintain their power dynamic. And a few have lifestyle or 24/7 arrangements, where one person always takes the dominant, and the other the submissive, role. However, even in such cases much of their everyday life will probably not seem that different to anybody else’s.
How does it differ to the traditional ‘vanilla’ relationship?

This depends very much on how important it is in the lives of those involved. Some D/s relationships would look very much like a vanilla relationship but just with a bit more power-play involved when people have sex. Others would have something of the D/s dynamic in other parts of the relationship. However, it should be remembered that most vanilla relationships have specific roles (e.g. one person takes more responsibility for the finances, one person is more outgoing socially, one person does more of the looking after, one person takes the lead in sex). In D/s relationships those things tend to be more explicit, but perhaps not hugely different.

So perhaps the main difference is in the amount of communication. Most people involved in BDSM stress the importance of everything being ‘consensual‘ so there will probably be much negotiation at the start about the things people do and do not enjoy, and the ways in which the relationship will be D/s. Checklists and contracts can be useful ways of clarifying this. So, for example, there may be limits about the kinds of activities and sensations people like, whether they enjoy role-play or not, and which aspects of the relationship will have a D/s element.

Why do so many people have misconceptions of this type of relationship?

The media portrayal of BDSM has tended to be very negative, often associating it with violence, danger, abuse, madness and criminality. Research has shown that actually people who are into BDSM are no different from others in terms of emotional well-being or upbringing, and that they are no more likely to get serious injuries from their sex lives, or to be criminal, than anybody else.

Often the media also focuses on the most extreme examples, such as very heavy and/or 24/7 D/s arrangements, rather than the more common relationships where there are elements of D/s. For these reasons people may well have misconceptions about D/s relationships. This is why it is useful to get a range of experiences out there in the media – so people can have more awareness of the diversity of things involved and the continuum (e.g. from light bondage and love bites to more scripted scenes and specifically designed toys).
How do couples go about beginning a relationship like this?

A good idea for all people in relationships, whether or not they are interested in D/s, is to communicate about what they like sexually early on, and more broadly about what roles they like to take in the relationship. Often people just assume what they other person will enjoy or how they would like the relationship to be.

For example, one good activity from sex therapy and from the BDSM community is to create a list as a couple of all of the sexual practices that either of you is aware of, and then to go down it writing ‘yes’, ‘no’, or ‘maybe’ about whether it is something that interests you, and sharing your thoughts. It can also be good to share sexual fantasies or favourite images/stories and to talk about whether (and, if so, how) they might be incorporated into your sex life (the Nancy Friday and Emily Dubberley collections of sexual fantasies can be helpful with this). It is very important that people only do things that they really want to try (rather than feeling coerced into certain activities) and that it is accepted that there will likely to be areas which aren’t compatible as well as those that are.

BDSM communities and websites are a great place to look for more information from those who have been involved in these kinds of practices and relationships. Also local fetish fairs and kink events often include demonstrations and workshops. There is more in my books Enjoy Sex and Rewriting the Rules about communicating about sex and relationships.
Some people have a BDSM relationship outside of an existing ‘vanilla’ relationship. What effect can this have on a marriage or couple relationship?

Again this varies. Although it isn’t always out in the open, many couples have arrangements where they are open to some extent (e.g. monogamish couples, the ‘new monogamy’, open relationships, swinging, polyamory, and ‘don’t ask don’t tell’ agreements).

Having different sexual desires is one reason why some couples open up their relationship to one or both of them being sexual with another person. If this is communicated about clearly, kindly and thoughtfully, it can work perfectly well. The important thing again is kindness and communication.

In regards to the hit book 50 Shades of Grey, many husbands have bought this for their wives and girlfriends. What does this say to them, and how would you help a couple who want to get more involved in this sort of lifestyle but don’t know how, or they are too shy to approach it?

The kinds of conversations and activities mentioned above are a great idea. One of the good things about 50 Shades of Grey is that it has opened up this kind of conversation for many people. However, it is important not to assume that the only form of BDSM is the one described in the book. In a heterosexual couple it may well be that the woman is more dominant, for example, or that both people switch roles, and the things that they enjoy may well be different to the ones which Ana and Christian engage in in the book.

If you want to read more about different practices and how to do them, then there are lots of good books available about BDSM. Dossie Easton and Janet Hardy’s books The New Topping Book and The New Bottoming Book are great places to start, as is Tristan Taormino’s The Ultimate Guide to Kink.

For couples who are really struggling to communicate about sex, or who have very different desires and are finding it hard to reconcile this, it might well be useful to see a sex and relationship therapist for a few sessions. The Pink Therapy website includes many kink-friendly therapists.

SOURCE:

https://www.rewriting-the-rules.com/sex/dominant-and-submissive-relationships/(accessed 6.10.25)

Considering digital change alongside planetary health

Sarah Lake and Dr Penny Trayner argue they are two sides of the same coin.

01 October 2025


The next generation of applied psychologists have a dual inheritance: a planet in crisis, with its profound psychological impacts, and a healthcare system in the midst of digital change. Against this background, the British Psychological Society (BPS) recently approved new standards for the accreditation of doctoral programmes in clinical psychology, with some notable updates reflecting contemporary clinical practice in these two areas.

The publication of 'Clinical psychology and planetary health: Changing course in the storm' (BPS, 2004b) is both a call to action and a resource for psychologists. It positions planetary health as fundamental to psychological wellbeing, offering evidence and direction for clinicians while urging the profession to take an active role in both mitigating and adapting to climate change.

As an aspiring Clinical Psychologist (Sarah) and a Clinical Psychologist and Paediatric Clinical Neuropsychologist, and Academic Director on the Liverpool Doctorate (Penny), these new competencies are highly relevant to us. We are involved in digital change through Kompass Health, a rehabilitation data platform that tracks patient assessments, goals, activities, and outcomes to support personalised recovery and service evaluation. To us, planetary health is intrinsically connected to digital change. Technologies have a material footprint, including energy use and data centre demands. This lens makes a response to the climate emergency feel immediate and practical: it is not only a matter of advocacy; it is about how we design, procure, and use the systems that underpin everyday healthcare.

Here, we summarise the BPS's position on planetary health, explore digital change and investigate the climate effects of different aspects of it.
Planetary health

We live in an era of unprecedented human-driven environmental change. Global temperatures have already risen ~1.1°C above pre-industrial levels, fuelling more frequent extreme weather events and posing threats to both physical and mental health. Whether that is the direct psychological impact of climate disasters such as hurricanes or wildfires, or the indirect effects of the changing climate on socioeconomic and political status and climate anxiety, the mental health impacts are both ranging and growing with the issue itself.

Growing awareness of climate change, though valuable for public knowledge and campaigning, is also driving climate anxiety, fear and hopelessness about the future shaped by the climate crisis (Boluda-Verdú et al., 2022). Younger generations are disproportionately affected, as those who will most directly face its consequences. Surveys report sadness, anxiety, and powerlessness, with 45 per cent stating these feelings negatively impact daily life (Hickman et al., 2021). Distress is compounded by a perception that governments are not doing enough. The BPS (2024a) recognises this anxiety as a rational response to an existential threat, but warns that without support it can become debilitating (Clayton & Karazsia, 2020). Without activism and change, which foster agency and social support (Schwartz et al., 2023; Stanley et al., 2021), young people are left with their rational worries, to see little being done about it.

The BPS publication also emphasises that the climate emergency's mental health effects are starkly unequal. Those in the poorest communities, who contribute least to emissions, experience the greatest burdens (Lobell et al., 2008; Pourmotabed et al., 2020). In lower-income countries, repeated trauma from climate-exacerbated disasters combines with limited recovery resources. In wealthier nations, disadvantaged groups, including low-income families, indigenous peoples, and individuals with disabilities, face higher risks due to barriers in adapting to heatwaves, evacuating from storms, or accessing mental health care (World Health Organization, 2023). Thus, climate change intertwines with social injustice: those least responsible bear the heaviest toll.

Underscoring the whole publication is the reality that human well-being is inseparable from the health of our planet. This is the principle of planetary health – the idea that human health depends on natural systems doing well. Clean air, safe drinking water, stable climates, and biodiverse ecosystems form the foundation for healthy communities. Their degradation directly harms mental health, whether through increased disaster trauma, food and water insecurity leading to chronic stress, or the loss of green spaces that normally support psychological well-being. Thus, the climate emergency calls psychology to broaden our scope to consider the larger ecosystems that support our collective health.

Consequently, the Standards for the Accreditation of Doctoral Programmes in Clinical Psychology (BPS, 2024a) frame sustainability and planetary health as integral to training. It is considered as both a moral and professional responsibility, tightly linked to sustainability, social justice, and health equity – and thus extremely important to future clinical psychologists.
Digital change

With the use of technology in healthcare steadily increasing across services worldwide (Rittenhouse et al., 2017), such innovations are set to play a pivotal role in advancing planetary health, simultaneously reducing the sector's ecological impact and promoting high-quality, effective care. This expansion reflects the broader reality that healthcare is constantly transformed by technological innovation, a trend set to continue at pace in coming years (Thimbleby, 2013). The regulatory landscape recognises this, with the Health and Care Professions Council's updated Standards of Proficiency (September 2023) requiring practitioner psychologists to 'use information, communication and digital technologies appropriate to their practice' (Standard 7.7) and to adopt digital record-keeping tools where required (Standard 9.3).

In clinical practice more broadly, emerging technologies are advancing far faster than is often appreciated, requiring clinicians and policymakers to think 'exponentially' and 'expansively' about how to integrate them into both pre-clinical and clinical interventions (Hategan et al., 2019). This growth has also been driven by significant financial investment in health technology (Chandra & Skinner, 2012), and was further accelerated by the Covid-19 pandemic, which exposed the need for rapid digital transformation (Clipper, 2020; Hammers et al., 2020). However, the pandedmic also revealed enduring gaps in digital skills and confidence, often due to limited time and structured support amidst competing clinical demands.

In rehabilitation, technological developments have expanded the scope and effectiveness of the discipline (Anderson et al., 2019; Schreyögg et al., 2006), while adoption of such tools has been linked to policy initiatives aimed at tackling healthcare inequalities (Chishtie et al., 2022; Joynt et al., 2017). Policy mandates, such as the forthcoming NICE 2025 rehabilitation guidelines, reinforce this shift by embedding digital care pathways into best practice, aligning with the UK government's aim to achieve full digital maturity within the NHS by 2025 (UK Parliament, 2023). At the same time, digital tools are increasingly recognised for their role in empowering patients (Fitzpatrick, 2023).

The Standards for the Accreditation of Doctoral Programmes in Clinical Psychology (BPS, 2024a) therefore recognise the need for psychologists to adapt and lead digital change, being able to understand and utilise digital platforms and methods within their work. Digital competency is embedded not just as a practical skillset but as a fundamental shift in clinical governance, communication, education, and research.
Technology and its effect on planetary health

The Health and Care Act 2022 made the NHS in England the world's first health system to legislate for a net zero strategy. This sets two milestones: achieving net zero by 2040 for directly controlled emissions (with an 80 per cent reduction by 2028–2032), and by 2045 for supply chain emissions (with an 80 per cent reduction by 2036–2039). Operationally, this embeds net zero into procurement, infrastructure, care delivery, and travel. Suppliers are now required to consider carbon footprints in the tendering process, cascading an environmental responsibility across the entire supply chain.

This shows how planetary health and digital change also represent two sides of the same coin. Operationally, they have to be considered in tandem. And the workforce are open to this: conversations with clinical psychologists and rehabilitation professionals highlight a strong openness to innovation, underscoring the broader shift toward digital solutions (Hategan et al., 2019; Trayner et al., 2023).

Here are some areas that need to be considered as part of that shift.

Electronic patient records

Electronic patient records (EPRs) are replacing paper systems in contemporary practice, offering environmental benefits such as reduced paper use, less physical storage, and more efficient information sharing (Clarke et al., 2018; Kwon et al., 2024; Turley et al., 2011). Cloud back-ups also strengthen disaster resilience, ensuring data is preserved during events such as floods or fires.

Unfortunately, EPRs are not impact-free. Their footprint lies in energy use: powering servers, data centres, and networks requires significant electricity, while the manufacture of hardware involves resource-intensive mining and processing, contributing to pollution and depletion. In some cases, EPRs may even produce higher greenhouse gas emissions per patient than paper records, largely due to server demands (Eyesustain, 2025; Kwon et al., 2024). However, if powered by renewable energy, digital records retain their eco-efficiency.

Telerehabilitation

The Covid-19 pandemic rapidly accelerated telehealth across medicine and psychology, with video consultations, app-based condition management, and online appointment systems becoming routine. This shift came with a compelling climate benefit, the lack of transportation required. Studies show that the small emissions from data use are negligible compared to the savings from reduced journeys (Hantel et al., 2024; Nordtug et al., 2022; Rahimi-Ardabili et al., 2022; Vidal-Alaball et al., 2021). At scale, widespread telehealth adoption could reduce national healthcare travel emissions by nearly one-third, preventing tens of millions of kilograms of CO₂ annually (Nordtug et al., 2022; Vidal-Alaball et al., 2021). With this climate benefit, comes accessibility benefits too.

Digital care does, however, carry an energy cost: running video calls, transmitting data, and powering servers all consume electricity. While per-appointment use is minimal, system-wide adoption increases demand on data centres, and if coal-powered, some travel savings are offset. Encouragingly, many centres are transitioning to renewable energy, and streaming efficiency continues to improve. This positions telehealth as a strong example of digital change that advances planetary health.

Artificial intelligence

AI is increasingly integrated into clinical psychology, from clinical decision-making and conversational tools to administrative tasks like minute taking and record management. However, unlike telehealth, the environmental cost of AI is substantial, particularly in the training of models (Strubell et al., 2019; Truhn et al., 2024). While deployment has relatively low emissions, training is energy-intensive (Truhn et al., 2024), and as AI applications expand and become more complex, training demands and their climate burden will grow (Morand et al., 2024). At the same time, AI could mitigate healthcare's environmental impact by streamlining processes, reducing waste, and enabling low-carbon alternatives such as virtual care (Ueda et al., 2024). This duality highlights AI as both a potential climate solution and a significant environmental risk.

Moving forward, the focus must be on sustainable AI: reducing the energy required for training, using renewable power, and demanding transparency from vendors about carbon footprints and offsetting practices. For psychology and rehabilitation, aligning AI adoption with planetary health is essential.
Practice points

Considering the effects, both positive and negative, that digital change can have on our planet, the discipline must act. Consequently, psychologists must embrace digital innovation in ways that actively protect and promote planetary health, ensuring technology is a tool for sustainability, not a new source of harm.

Some practical ideas of how to do this include:Adopt sustainable digital systems: Choose electronic patient record (EPR) platforms hosted on renewable-powered servers, implement device recycling schemes, and extend hardware lifespans through repair and refurbishment rather than replacement. Evaluate platforms not only for clinical utility and usability, but also for energy efficiency and supplier alignment to NHS carbon targets.
Align with policy: Prepare for NICE's digital maturity targets (2025) by embedding environmental criteria into procurement, service design, and commissioning. Psychologists should advocate for sustainability to be built into the digital standards their services adopt.
Embed equity and climate justice: Ensure digital health solutions do not widen inequalities (such as by perpetuating digital exclusion) and design interventions that specifically support vulnerable populations affected by climate-related crises.
Teach sustainable digital literacy: Incorporate training for psychologists to critically assess the environmental costs and benefits of digital tools, helping the workforce see sustainability as integral to clinical effectiveness. Build in protected time for digital upskilling and reflective discussion within teams.
Make positive everyday digital choices: Reduce the hidden carbon footprint of digital work by sharing files via cloud links instead of email attachments, regularly deleting old emails and clearing spam, avoiding unnecessary printing, and using digital notepads and secure recording systems. Where clinically appropriate, use low carbon defaults such as remote supervision and paper-light workflows. Even small changes, such as streamlining email habits, can have measurable impact. Using a carbon calculator can make these savings visible, motivating behaviour change across services.
Far-reaching transitions

The challenges of climate change demand that clinical psychology 'change course', rethinking our practices, priorities, and use of technology in light of the planetary emergency. Both digital change and planetary health are key changes affecting our discipline, and should not be considered as isolated factors, especially as they both directly contribute to the discipline that future professionals will inherit.

Technology will undoubtedly be a part of the path forward in tackling the climate emergency. Its potential to shrink healthcare's carbon footprint, whilst present, must be tackled thoughtfully to avoid unintended environmental consequences. Thus, a mindset of sustainable innovation is required, embracing digital change whilst considering the full lifecycle environmental impact and ways to mitigate any climate downsides of developments. This is why the two considerations are two sides of the same coin, as they must be acted on concurrently. Psychologists are well positioned to advocate for this, bringing a human-centric lens to ensure that technology best serves human well-being without undermining environmental health.

Finally, a tone of advocacy and reflection is fitting. There is no denying that both the climate crisis, and the rate of digital change can feel overwhelming, and it is easy for healthcare providers to feel that their individual actions are a mere drop in the ocean. Yet, as the BPS (2024a) paper emphasises, collective action and leadership from professionals are indispensable for the 'far-reaching transitions' required, and digital change is no different.Sarah Lake is a Research Assistant working with Kompass Health. Sarahlake@kompass.health
Dr Penny Trayner is a Clinical Psychologist and Paediatric Clinical Neuropsychologist, and the Founder of Kompass Health, a rehabilitation data platform that tracks patient assessments, goals, activities, and outcomes to support personalised recovery and service evaluation. Penny is also joint Academic Director of the DClinPsy at the University of Liverpool.

Inspired by:

British Psychological Society. (2024b). Clinical psychology and planetary health: Changing course in the storm. Leicester, UK: British Psychological Society.

See also the 'Climate and the environment' collection.
References

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‘Attachment research gave some indication where we could start in trying to parent our seriously unwell daughter’

Robbie Duschinsky (University of Cambridge) reflects on parenting a profoundly unwell and disabled child whilst undertaking research and writing about attachment.

01 August 2025


Ibegan conducting research addressing child-caregiver attachment relationships in 2012. A few years later, things settled down for my wife Sophie and I in our jobs, and we felt it was time to start a family. I felt positive about becoming a dad, and reassured by what I had learnt from attachment theory and research. I understood about the importance of being available to offer support for a child when they wanted to explore (a 'secure base'); and to offer them help and comfort when they were distressed (a 'safe haven'). This is what attachment researchers called a 'secure attachment'. I doubted I'd be anything like a perfect parent, but that did not seem to be especially the point. Someone my child could trust – I thought that sounded possible.

The next few years were hard. Sophie and I celebrated the start of three pregnancies, only for each to end in miscarriage. Miscarriage is not so uncommon, and I remained hopeful, though these losses weighed on both of us.

In 2019, following a fourth pregnancy, our daughter A was born. However, it soon became clear that she was seriously unwell. We received news of our daughter's diagnosis of a very rare and serious genetic condition over the phone the day that lockdown began. The severity of the condition can vary. For A it has meant profound intellectual disability, long-term struggles with nutrition, and impairments in communication and mobility. Most immediately, she was in pain 16-20 hours a day for her first few years. Coinciding with the pandemic, lockdowns and huge healthcare backlogs, Sophie and I were largely on our own with our sick daughter, with limited access to help.

In 2021, A began having seizures, which did not respond well to medication, and since that time she has needed continuous monitoring day and night. At that time, she lost the ability to vocalise, eat, drink, walk, play with toys, smile, or even routinely recognise us. Now, heading towards her sixth birthday, some of these skills have returned, such as her smile and increasingly her ability to recognise us. Many skills remain partially or wholly lost.

Through A's early years, and still today to an extent, I faced a daily battle with feelings of hopelessness and heartbreak. In this context, something that made a profound difference was my work on attachment theory and research. Thinking about, researching and writing about attachment helped me retain a sense that whilst the situation could feel impossible, it did not mean that it actually was impossible. Sophie and I couldn't stop A being ill. But attachment research gave some indications of where we could start in trying to parent our daughter.

A lot of well-meaning nonsense and hazy generalities are circulated about attachment. Inaccurate information is so much easier to come by than accurate information – it's wild. But attachment theory and research has also generated some recommendations for parents, supported by researcher consensus as well as experimental evidence from attachment-based interventions. My experiences have given me an urgent sense of the value of some of these key messages. I have tried to make these accessible in my books, and especially in one for students and general readers called The Psychology of Attachment, written with my friends and colleagues Pehr Granqvist and Tommie Forslund.

The challenges A faced were extreme and rare. But the recommendations of attachment theory and research still had bearing for Sophie and I, maybe even more so given our daughter's suffering and need for comfort. The focus of this article is on the ideas I found helpful in giving some sense of how to proceed with A's care. I close by bringing the reader up to the present, thinking about what I have learnt from these experiences, and how these lessons have shaped me as a parent to A's little sister, as a co-parent with my wife Sophie, and also as a researcher.
Providing a safe haven

An early and important source of help for Sophie and I as parents was the idea of the caregiver as a 'safe haven'. By this attachment researchers mean that when a child is distressed, they are disposed to seek a familiar caregiver with the expectation of help and protection. Touch and comfort from a familiar adult, these basic things, help an infant to re-find equilibrium. Older children can get the same reassurance by other indications of the caregiver's availability. Even as adults we are still disposed to look for comfort when we are distressed, unless we have learnt that this will backfire.

In being available when a child is distressed, a caregiver gradually helps the child learn to trust, and to cope with difficult feelings (Ainsworth, 1985). The extent of security of each close relationship makes an additional contribution to a child's development in these regards, highlighting the importance of caregivers supporting one another in their provision of safe haven availability to a child (Dagan et al., 2021).

Sophie and I could not protect our daughter from pain. However, we could remain with her through it, holding her, and walking her up and down our little flat for unending hours. We could reassure her that she was not alone. We could try to teach her the expectation that when she was distressed, her mum or I would be completely there with her, even if, to our sorrow, we didn't know how to make things better. We could try to support one another with the grief we were feeling.

Attachment theory suggests that caregivers are most readily able to offer a safe haven to their child when they feel themselves supported by their family, community and society (Supkoff et al., 2013). Due to the pandemic and the severity of A's illness, at times we have felt quite abandoned by community and society, with exceptions. We have found it tremendously difficult to access support from health and social care services, who have often been hell-bent on reducing costs or trying to pass responsibility to other services regardless of what this means for A's safety or our family's ability to cope. Some professionals have gone above and beyond to help us. There's been almost no middle ground. Likewise many friends from before we became parents ran in horror at A's suffering and what our lives looked like. But some friends really stepped up to try to look after us, acting towards A like extended family. And since 2024 A has started attending a specialist primary school, which she absolutely loves, and which has reduced pressure on us too.
Attending to our child's signals

Attachment research has a premise that a lot goes on at the level of behaviour that mostly does not get noticed. On this basis, a second recommendation made by the attachment literature was the idea that caregivers can consider their child's actions as having 'signal value' for their experiences and needs (Ainsworth, 1977). The caregiver can be on the look-out for behaviours and vocalisations that might give relevant clues. This will allow the caregiver to accurately identify the child's motivations, and respond to them appropriately and in a timely way. For instance, being able to distinguish signals of tiredness from hunger or pain can be helpful in ensuring that the caregiver is available as a safe haven when needed.

It was very hard to discern A's experiences and needs. For her first years, other signals were often drowned out by pain. Then, with the seizures, she lost much of what capacity she had to communicate her experiences and needs. At times it felt that A was inaccessible to us, for all that she was physically present and required care.

Yet the idea of the child's actions as having 'signal value' suggested that signal might still be found, even if most of A's means of communicating her experiences and needs had been overloaded, blocked or damaged. We began keeping a moment-to-moment diary of everything we thought might have signal value, day and night: what A seemed to pay attention to, when she was capable of attention; bowel movements; coughs; when she fell asleep and woke up; changes in her breathing. Sophie and I worked together to try to interpret these signals.

This level of attention was, and remains, costly. It is exhausting, and comes at the expense of other things. But over time it has helped build our understanding of A's experiences and needs, allowing us to respond to them. We searched for A in these small signals, and in this way, over time, began to identify critical factors for her care, including triggers for pain and for seizures, and other indicators associated with better days for her. We discovered, for instance, that she loved cheesy '90s pop music (e.g. Spice Girls, Aqua), and given the lack of access to medical care, this was what we had available as pain relief for A for her early years.

Sophie and I feel that A acts like someone who believes that we are trying to interpret her signals and to help. On her better days she reaches out for contact, she smiles, and she rarely resists her medical care; she readily forms new relationships with people who are responsive to her cues. A knows we are listening out for her signals; and Sophie and I know that A's signals can be found and trusted. Despite all that we have to bridge in order to achieve this understanding, this sense of mutual trust makes a huge practical and emotional difference to every day of interaction and care.
Avoidance and Emotional Defence

A third point raised by attachment theory and research is that a child's signals of their experiences and needs can be obstructed by the caregiver's own defences (Main & Hesse, 1992), or when a caregiver feels chronically overwhelmed (Cyr et al., 2010). So when a child signals to us, our defences or feelings of overwhelm can hinder us from recognising or responding to these signals.

Attachment theory is sometimes perceived as about categories, putting people into boxes. That's a stereotype and simplification. In reality, we all have tendencies towards particular kinds of defence or dysregulation, tendencies that will be elicited particularly when we are under stress, and shaped and reshaped by the training our life continues to give us in how to cope. Parents, including those of children with additional needs, have our own histories. For me, A's additional needs have confronted me with the limits of my defences, not least from watching them buckle at times from the pressure placed on them.

A's quality of life is frequently not good. But with the passing years it has been generally getting better, and when she is not in pain or dazed by seizures she is a remarkably happy and resilient little person. Even so, perhaps the hardest challenge for me as a parent, my most pervasive defence, has been to bear to try to see things from A's point of view. Whilst able to cognitively attend minutely to signals of her experience and needs, I nonetheless find it aversive to imagine what A's life might be like for her. To go beyond A's signals and what they mean for what I need to do, and try to fully imagine her mind behind those signals.

Attachment theory and research teaches that avoidance is a strategy, one that can be protective when the alternative would be getting overwhelmed and dysregulated. It isn't bad. But avoidant behaviour by carers is penalised by the contemporary health and social care system: our experience has been that unless you are telling professionals repeatedly that you are not coping, help gets stripped away, even when this is manifestly unsafe. Additionally, attachment research regards avoidance as emotionally impoverishing when it is stuck in place. When we barricade ourselves off from the experience of others, this can help us cope, but also risks leaving us feeling empty (Slade et al., 2023).

Over the years I've given this challenge a lot of thought; I've talked about it with Sophie; I've had counselling through our local children's hospice. Though it is hard, I am learning how to use avoidance more flexibly, and try, where I can, to feel out what A's experience might be. The more I do, the more pleasure and pain I receive in being A's parent. As I do, the more A seems to respond to me and engage, even if her forms of engagement remain limited. This would be in line with the idea from attachment theory that exploration is facilitated when a child feels their caregiver's engagement with their experiences (Fonagy & Target, 1997).
The present

In 2022, Sophie and I had another little girl, L, who has been healthy and hilarious. The weight of past experience and day-to-day pressures of A's care has certainly affected me as a parent. As someone who generally thought of himself as quite silly, I can at times barely recognise myself in my parenting behaviour, which can sometimes be flat and exhausted, lacking playfulness.

I struggle especially with the rough play L enjoys, and requests most days: even faced with our firework of a toddler, my hands expect A's vulnerability, and it requires intense concentration to adjust. But Sophie and I also have an intensified sense of the preciousness of L's communications, and confidence in our capacity for teamwork as parents.

I continue to try to learn from attachment theory and research to inform me as a parent. Indeed, I sometimes talk in my head to the attachment researchers I have read or know about my caregiving responsibilities for A; I find this can help with making sense of it all.

In turn, my experiences as a parent have shaped how I have interpreted and undertaken attachment theory and research, and informed my writing about the topic. This has included a sense of wonder at the power of some of the levers available to caregivers: touch, noticing signals, provision of a secure base. I've also gained greater tenderness in considering the challenges caregivers may face in thinking about the mind of their child.

Experiences as A's parent have also given me additional questions. For instance, whereas attachment researchers generally treat 'safe haven availability' as a single thing, I've been brought to think about its different aspects, such as a caregiver's response to indications of pain, distress, fear and incomprehension. I have also become more critical of the limited way that attachment theory and research have addressed the wider context of family life, even when the data was available to do so. I cannot unlearn what I have learnt as a parent about the power of social isolation and failures of health and social care systems, and this has left a decisive mark on me as a researcher.

In Cornerstones of Attachment Research, written before A was born, I wrote of a sense of affection for attachment theory and its 'genuine insights into the strange, drunk-dialling human heart'. For all that I am more critical of attachment theory and research now, I couldn't have possibly known then how precious some of those insights would prove to me when I became a parent.Dr Robbie Duschinsky is Professor of Social Science and Health and Head of the Applied Social Science Group within the Primary Care Unit.
See also our 'parenting' collection.
Key sources and further reading

Ainsworth, M.D.S. (1977) Social development in the first year of life: Maternal influences on infant-mother attachment. In: J. M. Tanner (Ed.) Developments in Psychiatric Research (pp.1-20). London: Hodder & Stoughton

Ainsworth, M. D. (1985). Attachments across the life span. Bulletin of the New York Academy of Medicine, 61(9), 792-812; Goldberg, S. (2000) Attachment and Development, London: Routledge.

Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2025). Attachment in pediatrics: No such thing as a child. In M. H. Bornstein & P. E. Shah (Eds.), APA Handbook of Pediatric Psychology, Developmental-Behavioral Pediatrics, and Developmental Science (pp. 205–226). American Psychological Association.

Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development & Psychopathology, 22(1), 87-108.

Dagan, O., Schuengel, C., Verhage, M. L., et al. (2021). Configurations of mother‐child and father‐child attachment as predictors of internalizing and externalizing behavioral problems: An individual participant data (IPD) meta‐analysis. New Directions for Child and Adolescent Development, 2021(180), 67-94.

Doodeman, T. W., Schuengel, C., & Sterkenburg, P. S. (2023). Effects of the Attune & Stimulate‐checklist for caregivers of people with severe and profound intellectual disabilities: A randomised controlled trial. Journal of Applied Research in Intellectual Disabilities, 36(5), 1136-1149

Dozier, M., & Bernard, K. (2019). Coaching Parents of Vulnerable Infants: The attachment and biobehavioral catch-up approach. New York: Guilford Publications

Duschinsky, R. (2020) Cornerstones of Attachment Research, Oxford: Oxford University Press – free to download from the Oxford University Press website

Duschinsky, R., Granqvist, P., & Forslund, T. (2023). The Psychology of Attachment. London: Routledge.

Duschinsky, R. (2025) Developments in Attachment Research, Oxford: Oxford University Press – free to download from the Oxford University Press website

Fonagy, P. & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and psychopathology, 9(4), 679-700

Foster, S.L., Schofield, G., Geoghegan, L., Hood, R., Sagi-Schwartz, A … Duschinsky, R. (2025) Attachment theory and research: What should be on the core curriculum for child and family social workers?. Social Work Education, forthcoming.

Main, M. & Hesse, E. ([1992] 2021). Disorganized/disoriented infant behaviour in the Strange Situation, lapses in the monitoring of reasoning and discourse during the parent's Adult Attachment Interview, and dissociative states. In Tommie Forslund & Robbie Duschinsky (Eds.) Attachment Theory and Research: A Reader (pp.108-132), NY: Wiley.

Mucha, L. (2025). Please Find Attached: How Attachment Theory Explains Our Relationships, London: Bloomsbury

Schuengel, C., & Oosterman, M. (2019). Parenting self-efficacy. In Bornstein M. H. (Ed.), Handbook of parenting: Being and becoming a parent (654–680). London: Routledge

Slade, A (2009). Mentalizing the unmentalizable: Parenting children on the spectrum. Journal of Infant, Child, and Adolescent Psychotherapy, 8(1), 7-21.

Slade, A, Sadler, L. S., Eaves, T., & Webb, D. L. (2023). Enhancing attachment and reflective parenting in clinical practice. Guilford Publications.

Supkoff, L., Puig, J., & Sroufe, L.A (2013). Situating resilience in developmental context. In M. Ungar, The Social Ecology of Resilience. (pp. 127-142). New York: Springer

Berástegui, A, & Pitillas, C. (2024). The family keyworker as a critical element for attachment resilience in the face of adversity. Journal of Family Theory & Review, 16(1), 106-123.

Vandesande, S., Bosmans, G., & Maes, B. (2019). Can I be your safe haven and secure base? A parental perspective on parent-child attachment in young children with a severe or profound intellectual disability. Research in developmental disabilities, 93, 103452.

SOURCE:

https://www.bps.org.uk/psychologist/attachment-research-gave-some-indication-where-we-could-start-trying-parent-our(accessed 30.9.25)