Attachment in Psychotherapy, by D. J. Wallin

Attachment in Psychotherapy, by D. J. Wallin

In Attachment in Psychotherapy, David J. Wallin has composed an innovative psychological and neurobiological treatise that integrates the core elements of an attachment perspective into the reader's clinical thinking and day-to-day work with patients. Wallin, a seasoned psychoanalyst and scholar of attachment theory, emphasizes relational moves, nonverbal experience, and healing through human bonds as vital to self-development in a relational context.

Wallin's central thesis contends that emotional growth occurs through the transformation of the self through relationship. He engages the reader with three findings from attachment research with fertile implications for psychotherapy: (c) Cocreated relationships of attachment are the key context for development, (b) preverbal experience makes up the core of the developing self, and (c) the stance of the self toward experience predicts attachment security better than the facts of personal history themselves.

Wallin grounds contemporary attachment theory in Bowlby's two major discoveries: First, attachment is identified as a distinct, biologically based behavioral/motivational system; and second, individual differences in the functioning of the attachment system are linked inextricably to the individuals' “internal working models” of self and other (Bretherton, as cited on p. 26). Mary Main (1991, 1995) made empirical study of Bowlby's (1973) original internal working model concept possible by shifting attention from the external world of interpersonal interactions to the internal world of mental representations. This led her to metacognition, or cognition about cognition, “involv[ing] the ability … to appreciate the ‘merely representational nature’ of our own (or others') “mental representations” (Main, 1991 cited in Wallin, 2007, p. 40). Main, a psycholinguistics researcher, considered that an individual's working model of attachment is observable in characteristic patterns of narrative. Her Adult Attachment Interview (AAI) protocol enabled her to study the inner world of adult caregivers (and their children) through narrative analysis.

Figuring prominently are the clinical implications of Main's discovery of two statistically significant correlations between early experience and the development of internal representational structures. The first was between the child's Strange Situation behavior with the primary parent at 12 months and the structure of the inner world of that child 5 years later. The second was between the child's Strange Situation behavior and the parent's “state of mind with respect to attachment” (Wallin, 2007, p. 30) (as measured on the AAI); this revealed an intergenerational transmission of attachment involving the quality and influence of infant–caregiver interactions on adult attachment. Researchers and therapists were now able to “imagine” their subjects' or patients' early infant–caregiver relationships. This is the heart and soul of Wallin's model.

These correlations are the core applications of prior theory building and psycholinguistic research of Wallin's model. Wallin takes these empirically validated linkages and incorporates them into a new view of transference and countertransference, bridging attachment research and clinical practice. Transference and countertransference have come to include the attachment between patient and therapist as a biological imperative rooted in evolutionary necessity. To preserve the outdated working models, adult patients actively bolster their adherence to the old “rules of attachment.”

Wallin provides a subtle study and deft blending of Fonagy's mentalization and reflective function (Allen & Fonagy, 2002; Fonagy, Gergeley, Jurist, & Target, 2002) into his methodology. He elucidates the subjective modes of experience (psychic equivalence, pretense/pretend), their developmental relationship to psychopathology, enactments, mentalization, and developing the patient's mentalizing capacity.

For Wallin, enactments are the therapeutic action, and working experientially within an enactment is the therapy. Therapeutic work with(in) enactment(s) requires a strikingly different approach, array of assumptions, techniques, and innovations that address the asymmetries in the more conventional drive model. Wallin questions the assumption that patients are more subject to the influence of their unconscious than we are. He believes that rather than concentrating initially on the meaning of the patient's behavior, therapists would do better by focusing first on their own because preverbal experience is not accessible as it is but only as the patient evokes it in us, enacts it with us, or embodies it.

The nonverbal domain contains the lion's share of Wallin's innovations concerning enactments and what we attune to in ourselves and our patients. Wallin applies Main's AAI questions to the clinical situation as a full panoply of techniques to track manifestations of insecure attachment(s). Immediately discernible in the narrative are such markers as dysfluent or incoherent speech, changes in voice, contradictions, lapses, irrelevancies, and breakdowns in meaning during discussions of past familial experiences.

The three chapters covering each adult attachment pattern are rich gems illustrating their respective fundamental dynamics with a host of potent clinical examples. Wallin is interested in the kind of relationship(s) we might foster to integrate disowned or dissociated experience(s). The final chapter, titled “Mentalizing and Mindfulness,” eloquently explores these two concepts and their kinship with Buddhism. This is a wonderfully inspiring and fitting concluding chapter.

Attachment in Psychotherapy is a vastly integrative work. Wallin compels the reader to develop a therapeutic stance that represents a genuine embodiment of his or her subjectivity. This scholarly work warrants serious study and a wide readership.

Robert M. Greenfield, PhD

Private Practice

Staten Island, NY 10301