The Applications of Attachment Theory to Psychotherapy

Setting this presentation in the context of the attachment research of John Bowlby and Mary Main, Christopher Clulow offers a detailed explication of the application of attachment theory to couple psychotherapy. Working on the premise that attachment can be activated in dyadic relationships throughout life, he asks three key questions: How can we conceptualise adult couple relationships in attachment terms? What is the function of attachment for couples? What implications for therapeutic practice follow from this? In answering these, Christopher Clulow examines patterns of approach and avoidance, reciprocity and flexibility, caregiving, sexuality, mutual affect-regulation and other markers of secure or insecurely attached couples. Finally, he considers the implications for therapeutic practice, examining the role of therapist as a secure base, as a mirror, decoder and regulator of the ‘couple as the patient’.

Video lecture with captions and transcript – 20 mins

Attachment and Intimacy in Adulthood – Part II

Video lecture with captions and transcript – 28 mins

Attachment and Intimacy in Adulthood – Part III

Video lecture with captions and transcript – 28 mins

Every baby is born into a unique relational environment of attachments and interpersonal histories. This talk considers the power of the inter-generationally transmitted narrative to shape the self. Before we are even conceived, Linda Cundy suggests, we are conceived of. The predictive projections placed on a new infant will bear the hallmarks of the parents’ attachment history, and these narratives, in the minds of both parents, are later enacted in explicit and subtle ways in interaction with the child. Holding in mind that the level of narrative coherence is a measurement of the individual’s attachment security, Linda Cundy skilfully connects the concept of the attachment script that the patient brings into therapy with the potential for revising this. She offers an approach to evoking secure attachment via specific therapeutic techniques that combine object relational insights and psychodynamic psychotherapy with a cognitive or mentalizing task.

Video lecture with captions and slides – 35 mins

The extent to which psychotherapy can bring about transformation from insecure to genuinely secure internal working models is frequently debated in the clinical and research literature. Our working models of attachment are complex and deep-rooted structures but are nevertheless subject to change given certain therapeutic conditions. In this presentation, Sarah Daniel draws on case material from psychotherapy to illustrate how we can apply knowledge of attachment patterns in guiding therapeutic interactions and in the organisation of the treatment process.

Video lecture with captions and slides – 59 mins

The concept of an internal working model is central in the conceptualisation of developmental continuity and inter-generational transmission of patterns of attachment. Attachment theory has tended to make two basic assumptions about the ways these internal working models work: first, they are believed to arise in early development in response to variations in the quality of care and in that sense they are initially highly plastic and environmentally-driven. Second, these working models, though presumed to be open to change, are expected to be quite stable over time and come to influence attachment-related functioning across the lifespan. In this talk, Pasco Fearon presents two lines of evidence that seem to confirm some aspects of this theory and question others. In particular, he outlines the results of behavioural-genetic studies of attachment and long-term longitudinal follow-up studies of attachment from infancy to adulthood, which suggest marked discontinuity between early and later attachments. The findings prompt us to question what precisely is measured when we measure attachment through narrative-based interviews.

Video lecture with captions and slides – 47 mins

John Bowlby and Colin Murray Parkes realised that identifying the differing patterns of attachment manifested by different people who had suffered loss, and adapting psychotherapy accordingly, better helped them to deal with the bereavement. Similarly, using this approach provides a tool to examine how attachment patterns may change in psychotherapy. Starting from examples of the various types of insecure attachment style, and their origins in corresponding early failures of caregiver responsiveness, this talk will suggest how appropriately responsive psychotherapy, that takes account of these differences, can help the “earning” of attachment security by the client.

Audio lecture with captions, slides and transcript – 58 mins

This lecture outlines the qualities of an attachment-informed psychodynamic psychotherapy, focusing on points of overlap and difference with ‘Independent’ psychoanalytic or relational approaches. 10 key tenets for the application of attachment theory to psychotherapy are proposed: intimacy, the attachment dynamic, loss and separation, the attachment typology, sensitivity, attachment across the life cycle, affect regulation, discourse style, reflexive function, mind-mindedness, mentalizing, rupture and repair. Professor Holmes argues that however secure ones therapeutic ‘secure base’, change entails experiencing, facing and surviving moments of utter vulnerability and helplessness. He elaborates the therapeutic processes that are involved in the move from insecure to more secure patterns of relating – to oneself and others. These include psychotherapy as ‘soft power’, acting as a catalyst (but not as a reagent) and offering sufficient stability until new equilibrium achieved.

Video lecture with captions and transcript – 1 hr 4 mins

The presentation describes the continuum of attachment from a protective factor to enhance optimal development to a risk factor for psychopathology. The safety that emerges from attachment security facilitates intersubjective experience between parent and child and is crucial for the organization of the self – physically, neurologically, emotionally, cognitively, and socially. When the attachment is disorganized so too is the developing self: the child (or adult) is left with insufficient skills and intentions to rely on others and to learn from others, and his resilience in confronting future stress and trauma is greatly impaired. We consider how.

Video lecture with captions – 51 mins

Safe Relationships: The road to secure attachment from trauma in troubled children when we are confronted by the children’s behaviour

This presentation describes the crucial role of the foster carer and adoptive parent in facilitating their child’s movement toward attachment security and the development of a coherent life story and integrated sense of self. The importance of the carer/parents own attachment histories will be explored as well as their need to adopt a nurturing and healing attitude that is characterized by playfulness, acceptance, curiosity, and empathy (PACE).

Video lecture with captions – 1 hr 2 mins

In this lecture, Dr Frank Lachmann elaborates and distinguishes between two streams of empirical infant research: one, a dyadic systems view of mother-infant communication using video microanalysis. The other, study of attachment styles based on the baby’s response to the strange situation test. He summarizes the differences between these two streams and then reports on how they can flow together in longitudinal research that predicts dissociation and borderline pathology in young adults from disorganized attachment at 1 year. Finally, he discusses some of the implications of these longitudinal findings for the psychotherapeutic treatment of adult patients.

Audio lecture with captions and transcript – 28 mins

Attachment, disorganized attachment and aggression – PART II

Audio lecture with captions and transcript – 17 mins

Some psychotherapists and psychoanalysts may conduct therapy in a way that causes harm to the patient. We need to identify and classify iatrogenic (unintended but damaging) interventions in order to avert them. Many negative interventions result from a complex set of factors, including strict adherence to certain theoretical and technical dictums. However, it is here proposed, these primarily result from the analyst’s enactment of their own internal working models of dysfunctional attachments in their family of origin, which have not been adequately resolved in their own analysis. We will consider types of unhelpful psychotherapeutic intervention such as false neutrality, derogation, probing, invalidating experience, persecutory spirals, intrusive interpretations, and how these can evoke attachment re-traumatization in the patient.

Video lecture with captions and slides – 46 mins

Research in the fields of developmental psychology, neurobiology and cognitive neuroscience are helping to deepen our understanding of the therapeutic relationship and the process of change. In this paper, Paul Renn illuminates the way in which attachment theory and research can be integrated with data from related disciplines and applied to our clinical work. He argues that a key aspect of therapeutic action consists in the modification of implicit memories that motivate the procedures underpinning habitual ways of experiencing self with other. He illustrates this therapeutic process with a clinical vignette.

Video lecture with captions and transcript – 55 mins

One of Bowlby’s paradigm-changing insights was to realise that to understand attachment we need to be aware of the evolutionary forces that have shaped human bodies and minds. However when Bowlby was formulating attachment theory, evolutionary studies of behaviour were in their infancy so he had limited research on which to draw. During the last half century, research pertaining to the evolution of attachment dynamics has blossomed. This presentation draws on that research to address questions such as: is maternal love automatic and unconditional or is it shaped by a mother’s physical and social environment? Why are human infants so exquisitely tuned-in to the emotional world of others and so sensitive to possible abandonment? Why does the quality of maternal care effect how infants come to see the world? Why do different attachment patterns exist? Might insecure attachment patterns be evolutionarily adaptive? One aim of this presentation is to show ways in which psychotherapeutic work can be enriched by understanding our species’ evolutionary heritage.

Video lecture with captions – 50 mins

This talk, by one of the leading attachment researchers, summarises other intervention work that has achieved changes in attachment classifications or increases in coherence and reflective functioning via therapy.

Video lecture with captions – 40 mins

Working on the premise that therapy heals through the creation of a new relationship of attachment, this talk explores how we can identify our attachment own patterns as they play out in our relationship with our patients. David Wallin considers how it might inform our theoretical understanding and therapeutic interventions to recognize that in the interaction with the patient we are constantly in a state of mind that is secure, insecure, or unresolved. He asks how the therapist’s attachment history shapes his/her efforts to be of help to the patient. What are the particulars of personal history and patterning that shape your own conduct as a therapist? How do your own experiences of trauma and shame affect your work with your patients?

Participants at David Wallin’s 2014 seminar were invited to assess their attachment patterns through the ECR-Experiences in Close Relationships self reporting system. For more information about that process visit internal.psychology.illinois.edu

Video lecture with captions and slides – 1 hr 8 mins

How the attachment patterns of therapist and patient interlock: from collusion and collision to collaboration

Considering enactments as the inter-personalization of internal conflict, David Wallin here describes the matrix of enactments that can arise depending on the attachment pattern of the therapist as it intersects with that of the patient. He proposes that focusing on ways in which therapist and patient act-out in their relationship allows us to recognize how our own attachment patterns may be compromising our efforts to create for the patient a new and healing attachment relationship. Such a focus can also open a “royal road” to dissociated experience, the access to which is a precondition for its integration. Through identifying some common collusions and collisions, the goal of this talk is to identify some of the enactments in which therapists are regularly vulnerable to becoming ensnared.

Video lecture with captions and slides – 57 mins

What is to be done? Mindfulness and mentalizing in action: exploring interacting attachment patterns as they unfold

In this final session, David Wallin begins by focusing on enactments that play out around the boundaries of treatment, suggesting that our attachment history shapes all aspects of our relationships, including our relationship to money, time keeping and other therapy transactions. He juxtaposes to the patient’s emotional dependence upon the therapist with the therapist’s economic dependence upon the patient, proposing that the traumatized or insecure therapist is vulnerable to experiencing care-giving and fee-taking as contradictory processes. He proposes that mindfulness enables us to become aware of and to explore what we are doing with the patient while we’re doing it and suggests that we hold three questions in mind as we work: What am I actually doing with this patient? What are the implicit relational meanings of what I’m doing? What might be my motivations for doing what I’m doing? David conveys how mindfulness and mentalizing must be enlisted to identify and understand enactments, and to transform treatment impasses into opportunities for insight and new experience, not only for the patient but for the therapist as well.

Video lecture with captions and slides – 28 mins

In this presentation, Kate White will give an overview of the centrality of separation and loss, the vital importance of mourning and Bowlby’s contribution to our understanding of what facilitates and what impedes this experience in therapeutic relationships. She will focus on how these impact on the body, on our sense of belonging and the ways in which our attachment patterns are embodied in the struggle to protect us against attachment, loss and disappointment, past and present and future. She will explore therapeutic approaches which enable both client and therapist to understand and engage in the painful process of mourning loss. The talk will be concluded with a discussion of how mourning needs to emerge into the context of the wider community with consideration of ways to reconnect. Mourning is both personal and political.

Video lecture with captions and slides – 35 mins