This post covers the relevance of attachment theory to clinical counselling practice. Attachment theory is the brain child of John Bowlby, a British psycho-analytically trained psychiatrist.  Between 1969 and 1980 Bowlby published a three volume series on human behavior related to how and why affectional bonds are formed and what happens when these bonds are effected adversely.  This trilogy establishes the theoretical foundation of attachment theory.  In this post, I review several constructs which are central to attachment theory and explain how these constructs are relevant to the therapeutic process.

Attachment theory explains how and why infants and caregivers bond, how such bonds are developed ideally, how the bonding process can go awry and the implications of this on a persons development including their psychological well being throughout the lifespan.  It is only in more recent years that attachment theory, essentially a theory of human development, has been used as a touchstone for clinical psychotherapy practice.

What is a relationship of attachment?  According to attachment theory, a relationship of attachment is characterized by several factors including the need to maintain proximity, distress upon separation, joy upon reunion, and grief at loss.  Another thing that distinguishes attachment relationships is that an attachment figure is used preferentially as a secure base from which to explore the world and to retreat to at times of distress.

A construct central to attachment theory is that of a “secure” vs. an “insecure” attachment between an infant (child) and his or her caregiver.  Secure attachments are thought to develop in a care giving environment where in attachment figures are sufficiently available and responsive to the attachment needs of their infants.  Conversely, insecure attachments develop in caregiving environments wherein caregivers are not consistently available or responsive.  Insecure attachment in childhood is generally thought to take the form of one of three identifiable patterns: the “avoidant”, the “resistant” or the “disorganized” pattern.

It is thought that people develop consistent patterns of behavior for the purpose of defending against the feelings associated with disruptions in care in such a way that allows them to maintain contact with and proximity to their caregiver(s) to ensure ongoing care and thus survival. These childhood patterns translate into adult patterns of behavior which are referred to as “dismissing”, “preoccupied”, and “unresolved” respectively.  In adult terms, a secure pattern is referred to as “secure-autonomous”.

One of the key differences between the secure and the insecure patterns in adulthood is considered to be the capacity to engage in what is called meta-cognitive reflection.  This refers to a persons ability to think in terms of mental states, both ones own and that of others, and to use this awareness to understand one’s own and others behavior and intentions in light of those mental states.  This ability allows a person to take into account both the interpersonal and intrapersonal implications of the states of mind which are relevant to any interaction.  It is thought that the more a person is able to envision mental states in self and in other, the more he is able to engage in sustained, intimate, productive, and satisfying relationships with others.

The relationship between the therapist and the client can be seen as a relationship of attachment.  From the perspective of attachment theory, one of the aims of the psychotherapeutic process is that this relationship have the qualities of a “secure” attachment.  A secure therapeutic attachment can be thought of as safe container or a place of refuge wherein the client is able to process life experiences in such a way that s/he is able to grow and develop in potential beyond what would be possible were it not for the solidity of this relationship.  This developmental potential is co-created through the interactions between the client and the counsellor.

In attachment theory, secure attachment is seen as a precondition to a person’s ability to thoroughly and effectively explore their environment (including their interpersonal environment) and to experience him/herself as a fully active agent and self-effective individual.  When there is a safe and consistent enough base from which to explore and to which to return as needed, a person can afford to take the risks associated with exploring the various dimensions of life.

In order for the therapeutic relationship to be secure the therapist has to be able to effectively attune to the needs of the client in many of the same ways that a parent would attune to the needs of a child.   This involves the therapist being able to identify, name and reflect on the core emotions that the client is experiencing.  The therapist needs to be emotionally accessible and responsive to the clients needs. In these ways a therapy process is akin to a process of being parented, but by someone who is ideally trained know what constitutes a secure attachment as well as how to ensure that the therapeutic relationship is secure for the client.