Integration in psychoanalytic psychotherapy – an attachment meta-perspective

Abstract

Effective therapists need guiding models, but, paradoxically, the benefits of psychoanalytic psychotherapy may not flow from its espoused theories. Using an attachment framework, it is argued that psychoanalytic psychotherapy in common with all therapies, has three principal components: an attachment relationship; meaning-making; and change-promotion. Secure and insecure models of attachment help us to understand how therapists guide the therapeutic relationship in helpful or unhelpful directions. Freedom of meaning-making is a mark of secure attachment. Change is promoted by placing clients in a ‘benign bind’ characterized by: close engagement; discrepancy between client transferential expectations and therapist response; exploration and verbal descriptions of the feelings arising from these discrepancies. An attachment meta-perspective helps to reconcile apparent differences between psychoanalytic philosophies, and is inherently integrative.

Keywords:

• psychotherapy integration
• attachment
• change processes

Acknowledgements

I am grateful to James Johnston for organizing the conference where this paper was first presented, and for his heroic transcript of my chaotic lecture. Some of the material in it appears, in expanded and clinically illustrated form, in Holmes (2009).