Can Attachment Theory form part of an integrative model of psychotherapy

John BowlbyJonathan Bowlby (pictured, left) has been described by Storr as “one of the three or four most important psychiatrists of the twentieth century.”  For the purposes of this post, I intend to focus on his work on Attachment Theory. Bowlby was troubled by the dogmatism and cultism of the psychoanalytic world and argued strongly for open scientific debate and inquiry.  He felt that psychoanalysis neglected the role of real environmental trauma in the genesis of neurosis and emphasised instead the part played by infantile fantasy.

Bowlby’s papers that launched the theory (later developed by others including Mary Ainsworth) made a simple but, in the context of prevailing Kleinian orthodoxy in psychoanalytic thinking, revolutionary point. First, there was a primary attachment bond between mother and child, which did not depend on “oral drive” or reward by feeding and whose evolutionary function was protection from predation. At the time this point was incendiary in the psychoanalytic community but actually it could be viewed as no more than an extension of ideas already in the object relations school (Balint’s “primary clinging”, Winnicott’s concept of an “environment mother” as well as “object mother”, and Fairbairn’s views that drives are “signposts of the object” rather than vice versa).  Second, the idea that separated or bereaved infants and small children could experience grief and mourning no less intensely than could adults, was rejected by the psychoanalytic community wedded to the idea that mental pain had its origins in the internal, rather than the external, world. Third, Bowlby’s ideas on separation anxiety were closely related to Freud’s mature view of anxiety, which he saw as an affective response to threat (castration) but also as the threat of separation from a loved one (Freud 1926).

In contrast to the Freudian theories of his training, which centred on drive theory and incomplete sexual development as being responsible for neurosis, Bowlby developed his own theories on attachment, separation and loss and the effect of maternal deprivation on children.

 therapy should concentrate not so much on conflict as on deficiency

Attachment Theory met with strong resistance in the psychoanalytical world because it was viewed as an interpersonal, rather than an intrapersonal, theory. It implied an essentially harmonious, rather than conflictual, model of mother-infant interaction, unless the interaction is disturbed by external difficulty. The implication of this is that therapy should concentrate not so much on conflict as on deficiency. Also, the role of sexuality in infant life is downplayed as pleasure is related to proximity, play and nurturance rather than orgasmic discharge. The key issue in infantile experience becomes not so much power (power of the phallus, the breast, the logos) but space. Attachment theory has been described by Holmes as essentially “a spatial theory: when I am close to my loved one I feel good, when I am far away I am anxious, sad or lonely”

There are four styles of attachment that have been identified in adults: secure, anxious-preoccupied, dismissive-avoidant and fearful-avoidant. These roughly correspond to infant classifications: secure, insecure-ambivalent, insecure-avoidant and disorganized/disoriented.

Internal working models can be very evident in the therapeutic relationship.  Clients may become fearful of abandonment when told that the therapist is taking leave. Averil Earnshaw notes that family time is the time that rules our internal world (Earnshaw, 1995 Time will tell). She was specifically referring to the effect of critical dates in transgenerational links with family background. In history taking, an investigation of any potential critical date phenomena can illuminate areas of family malfunction/perversity/trauma and conflict.   The therapist may experience some counter transference, reminiscent of Winnicott’s article on “Hate in the Counter Transference” (1947). However, it is important that therapists don’t allow these feelings to impact in the rule of neutrality. These feelings should be explored in group supervision in order to stay focused on client material.

missing the heart of the psychoanalytic project

It can be argued that Attachment Theory and attachment-based psychotherapy is not simply another therapeutic approach, it is a core concept that is at the heart of many therapeutic relationships. However, Bowlby has been accused of neglecting the inner world and, therefore, missing the heart of the psychoanalytic project. Indeed, the psychoanalytic reader will find little in his trilogy about free association, dreams, fantasies, the Oedipus Complex or other staple psychoanalytic fare.

Bowlby believed in monotropy but it can be argued that children can develop multiple attachments. Children can have a number of attachment figures. As well as attaching to mothers, children can, for example,  bond with fathers, grandparents and paid staff e.g. nannies, babysitters or child minders.

Furthermore, Bowlby believed that there was a critical period for forming attachments but it could be argued that this is too extreme. It can be argued, for example, that there may be a sensitive period for attachment rather than a critical period. This means that the first 3 years may be the best time to form an attachment but it doesn’t follow that it’s the only time.  Children can form healthy attachments with others after the age of 3 as this can be seen by the positive impact of adoptive parents on a child’s life.

Bowlby believed that the effects of deprivation were irreversible but it can be argued that they can be reversed. For example, there is a famous case of two Czech twins who spent early years of their lives locked in a basement after their mother had died. They were cruelly treated by their father and stepmother to the point of suffering deprivation. However, when they were taken into care. they gradually got over their abuse and neglect. They formed strong bonds with the family who fostered them and both twins went on to have successful marriages.

Whilst a lot of research on Attachment Theory has focused on infants, Bowlby considered attachment to be a life-span construct. The challenge for Attachment Theorists was to demonstrate the need for measures of attachment beyond infancy. Main helped in this with the development of the Adult Attachment Interview (AAI) which is commonly used in psychotherapy nowadays.

So, can Attachment Theory form part of an integrative model of psychotherapy? A major part of assessing a new client is to take a thorough early history and seek to build a picture about early bonds. An initial assessment would not be complete without finding out about the client’s relationship with each parent and family member during childhood and significant childhood events. The manner in which a person forms (or fails to form) a therapeutic alliance and the nature of transference, resistance, and dependency within therapy can be viewed as reflecting attachment history (i.e. pattern).

Indeed, Transpersonalists would take heed of what Bowlby had to say. In Wilber’s Spectrum of Consciousness it is necessary to embrace psychodynamic tools and techniques in order to deal with pre-personal client material. Further, Robert Sardello maintains there is a great risk in embracing the spirit before sufficient time is spent on dealing with the personal baggage of one’s material life. (Love and the World: A Guide to Conscious Soul Practice (Google eBook).

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