Last updated on 12th October 2009
I wrote earlier this month on "Attachment, compassion & relationships". I've been aware of John Bowlby's work on adult-child attachment for many years but, when I've approached it for insights that might help in my work as a psychotherapist, I've been put off by the complexity of assessment methods and variety of reported attachment styles, as well as by the rapidly growing size of the relevant academic literature. As Jude Cassidy and Phillip Shaver write in their preface to the 2008 meister work "Handbook of attachment (2nd ed)" - see more details at the end of this blog post - "Anybody who conducts a literature search on the topic of 'attachment' will turn up more than 10,000 entries since 1975, and the entries will be spread across scores of physiological, clinical, developmental, and social psychology journals, will include numerous anthologies, and will deal with every stage of life from infancy to old age."
Sharon Begley's easily digestible chapter "Blaming mom? Rewired for compassion" introduced me to Professor Phillip Shaver's deeply fascinating work and linked it to understanding and working better with self (and other) criticism and kindness. This led me on to searching for relevant academic websites and research papers and then, to the two major books detailed below - "Handbook of attachment" and "Attachment theory and research in clinical work with adults". The Handbook is immense. Its 40 multi-authored chapters span the field from overviews of attachment theory, biological perspectives, and attachment in infancy & childhood, to attachment in adolescence & adulthood, psychopathology & clinical applications of attachment theory & research, and systems, culture, and context (which looks at diverse subjects including caregiving, divorce, religion and child care policy). This 1,000 plus paged textbook is not a quick read, and I jumped quickly to Arietta Slade's chapter "The implications of attachment theory and research for adult psychotherapy, research and clinical perspectives". Encouragingly and interestingly she writes " ... attachment theory and research have the potential to enrich (rather than dictate) a therapist's understanding of particular patients. Attachment theory does not dictate a particular form of treatment; rather, understanding the nature and dynamics of attachment and of mentalization informs rather than defines intervention and clinical thinking. Attachment theory offers a broad and far-reaching view of human functioning that has the potential to change the way clinicians think about and respond to their patients, and the way they understand the dynamics of the therapeutic relationship. This perspective provides yet another template with which a therapist can understand and make meaning of the patient's experience, without needing to jettison other, equally important and valid kinds of clinical understanding."
The other book that immediately appealed to me as I relooked at the possible relevance of attachment theory to my work was Joseph Obegi and Ety Berant's "Attachment theory and research in clinical work with adults". Again this is a multi-authored work (details at the end of this blog posting), but this time "only" 500 or so pages. The book is arranged into five main sections - theoretical foundations, assessing attachment, clinical utility, integration with clinical approaches, and future directions. Examples of interesting chapters from each of these five sections include Farber & Metzger's "The therapist as secure base", Fraley & Phillips's "Self-report measures of adult attachment in clinical practice", Mallinckrodt et al's "An attachment approach to adult psychotherapy", McBride & Atkinson's "Attachment theory and cognitive-behavioral therapy", and Holmes's "From attachment research to clinical practice: getting it together".
As a busy psychotherapist, with strong roots in cognitive-behavioural therapy, I finally feel that I can use ideas from attachment theory to help me be more useful for my clients. There are now relatively straightforward self-report methods for assessing and monitoring changes in clients' attachment - particularly in the key areas of relationship anxiety and avoidance. The relevance of attachment concepts such as "safe haven" and "secure base" also make much more practical sense to me and are obviously applicable to the therapeutic relationship. As McBride & Atkinson wrote " ... attachment theory can be easily integrated into the CBT approach ... knowledge of a client's attachment style is extremely useful ... CBT is already a powerful treatment with proven efficacy for several different disorders. Our hope is that what we have presented here can be used to supplement this therapeutic approach, and to assist the CBT therapist in preparing a case formulation and treatment plan informed by theory and research in close relationships." Good, fascinating and encouraging.
Next week I'll write on "Some great attachment websites".