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).

See also

The four key themes of Melanie Klein and Object Relations Theory

This week’s lecture was on the second part of the ideas of Melanie Klein and Object Relations Theory.

In Kleinian therapy the analyst would link your present behaviour to childhood to determine what age you were then.  The link to memories and stories is very important.  The therapist would seek to offer the client reparative experiences. 

Envy: Someone else has got something you want.  This can be seen as an attack on the breast.  The unconscious phantasy relates to intolerance and frustration and the child’s need for instant gratification.  The first hurdle for a child is to develop a healthy ego.  If un-negotiated then powerful feelings get stirred.

Jealousy: This is the same principle as envy but two or more people need to be involved.  Jealousy is wanting a person in particular rather than just wanting a relationship, for instance. There is a deep terror that the good breast is not available.  This has links to the Adlerian birth order. It relates to a triangular (oedipal) relationship – it is whole-object oriented

Greed: Impetuous and insatiable craving in excess of what is needed and what can be realistically given.  Greed is manifested when one desires to possess all of the good that is available regardless of the consequences.  Greed can be caught up with introjection, while envy with projection. Indiscriminate idealization can be fuelled by greed, since the need to get the best from everywhere interferes with the capacity for selection and discrimination.

Guilt: This arises from feeling too much of a burden and from realising that bad object that has been broken could have been the good object all along.  This can manifest in
therapy as negative transference. A client wasn’t rejected so kept attacking the therapist.  The therapist becomes a very important person in the client’s world and needs to absorb the attacks.

Gratitude allows the love object to be assimilated.  What is split becomes whole.  The ego becomes strong enough to contain and manage the conflicted feelings.  The destructive forces of envy are overcome by love. Reparation is the healing of the paranoid schizoid split. For Klein it was all about forming a healthy ego, just like for Jung, it was all about the integration of the shadow.      The  constancy of therapy can mirror the good parent.      

Qualities to be observed

Envy:
persecution, frustration, guilt, self pity, idealization, acting out, ambition, disapproving, aggression, manic defences, intolerance, hatred, destructiveness, self-destructiveness, sabotaging, discounting, etc.

Jealousy:
rivalry, rejection, suspicion, exclusivity, possessiveness, tense relationships, immaturity, grievance, hostility, etc.

Greed:
craving, selfishness, insensitivity, poor discrimination, self-denial, dissatisfaction, demanding, insistent, (or, as a defence: emptiness, low self-confidence, over-adaptation, etc.)

Gratitude:
acceptance of limitation, generosity, sharing, healthy relationships, grace, tolerance, creativeness, repressed guilt, etc.

Resources

Developments in Kleinian thought
Klein revisited
Melanie Klein – a history
Melanie Klein – Beyond Freud

 

 

 

 

 

The ideas of Melanie Klein and Object Relations Theory

Last week’s lecture was on the ideas of Melanie Klein and Object Relations Theory.

The ideas of Melanie Klein are not easy and it is difficult to get your
head around them. But her ideas provide useful material when seeing clients, especially for experiential learners.  By all accounts she was an unpleasant woman, if you believe what her daughter said about her. Apparently she would not even say hello to her clients as they entered her therapeutic room.  Klein is known as the mother of object relations theory.  She was a contemporary of Freud but was laughed out of the room at the time by Freudians. Whereas for Freudians it was all about sexual drives, for Klein it was all about the breast. Klein believed psycho sexual development rested on the relationship the baby had with its mother and the breast.  It was not about intrapsychic conflicts as Freud would argue but the relationships between young child and the objects in its environment.  Therefore, mother and father is an object as breast is an object, not libidinal drives, as,for Klein, it was the drives of aggression.

Essential core human drives are aggressive and destructive in nature. Klein worked mainly with young children and with mothers and with young babies.  She took lots of meticulous notes.  She had a strong interest in the possible early causes of psychosis. For Klein the origins of early months in life was the priority, not like Freud, who emphasised the first 7 years.

According to Klein there is no sense of self, no ego, as babies.  Many will argue with this. Others believe babies do have a sense of self.  But for Klein the baby is utterly dependent on the primary carer for its sense of self. Psychologically, the mother is the baby’s ego.  The implication is that if you have had a great and caring mother then great, but you are doomed if you have had a bad mother.  The earlier the wounding the greater the damage and the greater psychosis and early trauma can be the roots of schizophrenia. ( bi polar depression could be seen as later stages of development).

How do these ideas get played out in therapy? With young children there is no rational mind, as the feelings are immense and unmediated.  There is no language for these feelings. The work in therapy is to identify what the feelings are about, what in your younger life is being triggered.  Freud constancy principle, outcome of lots of conflict. For Klein it is not internal conflicts but the outcome of environmental factors.

Objects can be part objects, as full objects are too big for a young child.
Good and bad breasts,(mother could be out at shops but child just experiences the absence of mother),  light and dark, Internal experiences (hunger)

Between 0-3 months the paranoid schizoid position takes place. Baby is not distinguishing between itself and other.  As we grow up, we get a sense of other.  Enormous swings in mood, if an adult was doing it you might think that the behaviour is weird. For a baby it is normal. It is only later that a self is formed.

Objects relations therapy will look at the relationships between all your objects. If you don’t resolve the early problems then they are carried forward. Who are you when you are out in the world, outer and inner relationships.

Child gets message that its not okay to be angry.

Idea of phantasy big part of objection relations theory (unconscious).  Unconscious going on all the time.  Instinctual drives going on before thought. Phantasies about hunger, hence the focus on breast.

Major themes: Envy (someone else has what I want), greed (I want it
all), jealousy (its not fair, they have got what I want), destructiveness, gratitude,

Phantasies are very live, very immediate (but not in a conscious way) angry
biting the breast.  An attack, such a  strong feeling of frustration then the baby is seeking to destroy. Phantasy could be fear and anxiety of showing anger and we worry about the consequences  so we then try to please and make it better.

In therapy: Parents, reality check to accept that things may not have  been perfect. If my parents are not okay then it is because I am not lovable.  Okay to be angry.

Two stages:
Paranoid schizoid (0-3 months) Child trying to make sense of the world.
Depressive (3-6 months)

For Klein we are shuttling between two positions. Bits that can’t be tolerated get split off.

1) Could be dissociated when drunk
2)  Or projected onto others

Schizoid manoeuvre to split off. Paranoid bit is that it will come back and bite me. (Someone is doing the anger for us, they will realise that and will get angry with us). Or punishment for biting the breast.  Dared to be bad, disowning and fear of comeback

Depressive position gets arrived at, provided that the child adequately  deals with the paranoid schizoid position.  Good and bad object can be good and bad.  Object can be whole.  Struggle not  to be nice all the time.  Accept that this range of feelings can exist in whole object.

The work in therapy is to accept that parents tried their best, and  that has no reflection on me. Still a bit depressing, but better than blaming others (or parents) for our lot.

Co-dependent circles: rescuers all want to be rescued. Objects can be careers, food, alcohol, can be objects. Klein was not using nice language, but was describing something  real.  Pessimistic view: like Freud. Klein has had a great influence but her views were inherently pathological.  (no soul qualities). Focus  on dysfunction and psychiatry.

We can have reparative experiences as we get older. Getting to know the
parents of a friend who were good parents. (Winnicott and Bowlby develop this)

The real work in therapy is making conscious what is in the relationship, just beneath the surface,  being aware of transference and counter transference, just be aware of it,  regardless of how creative and clever we can be with techniques.

From Classical to Contemporary Psychoanalysis: A Critique and Integration (Book Review)

More soon….