Attachment, Psychoanalysis, and the Search for a 21st-Century Psychotherapy Practice

ABSTRACT

Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics, and evolutionary theory. Although it was initially rejected by the psychoanalytic establishment, there has been a gradual rapprochement. This article attempts to accelerate this process by laying out the points of overlap and distinction between attachment and psychoanalytic perspectives on clinical treatment. It summarizes the main tenets of attachment theory and then looks in detail at the therapeutic alliance, classification, transference/countertransference, and interpretation and mentalizing from an attachment perspective. A clinical example illustrates how insecure and secure attachment play out in the consulting room, and the article ends by suggesting that attachment provides a suitable evidence base for the Relational/Independent Psychoanalytic approach.

Notes

¹ Although the ease of e-mail contact, texting, etc., means that this has increasingly become a feature of on-going therapy.

² C.f. the we-go as opposed to the ego.

³ How illustrative cases are chosen is an interesting topic in its own right. It is possible that I have unconsciously selected a difficult and transgender-related case because it resonates with the overall theme of the article—the miscegenation between two seemingly irreconcilable models, psychoanalytic and attachment.

⁴ Published in Psychoanalytic Dialogues, a relational journal, an approach that can be seen as the U.S. equivalent of independent analysis.

Additional information

Notes on contributors

Jeremy Holmes

Jeremy Holmes, M.D., FRCPsych, is a psychiatrist, psychoanalytic psychotherapist and attachment theorist. He is Visiting Professor at the University of Exeter UK.