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Clinical Implications of Current Attachment Theory
... A vast literature on this topic includes (although is not limited to) contributions by the following: Ainsworth (e.g. Ainsworth et al. 1978), Beebe and Lachmann (2013), the Boston Change Process Study Group (BCPSG 2010), Bowlby (1958), Coates (2004Coates ( , 2012Coates ( , 2016, Fonagy (1999a), Hesse (1999), Holmes (1996Holmes ( , 2001, Lyons-Ruth (2002, 2003, Main and Solomon (1986), Seligman (2000), Schechter (2017) and Slade (2014). ...
The impact of intergenerational transmissions of trauma and the dissociative states of mind that cross from parents to their children has become an important expansion of psychoanalytic theory. Clinical material will be discussed showing how an early death of a mother haunted the lives of many generations of mothers and daughters. Considerations of attachment rupture, trauma, envy, deadly and deadening aggression and shame are discussed as part of transgenerational transmission phenomena and how they are worked on in the analytic relationship. Envious attacks, though painful to tolerate, nonetheless need to be processed in order to transform transmissions from the past.
... What I came to understand was that attachment functions as the mode of transmission in most if not all transgenerational transmission circumstances. A vast literature on this topic includes (although not limited to) contributions by the following: Ainsworth (e.g., Ainsworth et al. 1978), Beebe and Lachmann (2013), The Boston Change Process Study Group (2010), Bowlby (e.g., 1958), Coates (2004aCoates ( , 2004bCoates ( , 2012 in press), Fonagy and Fonagy (1999), Hesse (1999), Holmes (1999), Lyons-Ruth (2002, 2003, Main and Solomon (1986), Seligman (2000), Slade (2014), and Tronick (1989). The violence of trauma fractures someone's experience of being in the world and pulls at the fabric of attachment, our intrinsic way of feeling safe. ...
This discussion works to situate intergenerational transmission of Holocaust trauma literature within psychoanalysis and trauma studies, arguing that it is timely for a new appraisal of our psychoanalytic theories regarding these transmissions. I find Gomolin’s re-interpretation narrow and unpersuasive, and her focus tends to disregard current literature in psychoanalysis. I make a case for a reappraisal that is saturated with theories and research from attachment theory, affect regulation, intersubjectivity, field theories, epi-genetics, and new evaluations of testimonial research. This interpenetration will offer us greater understanding to the complexity of trauma transmissions across many generations, cultures, traumas, and their historical context.
... What seemed to me the most rewarding statements regarding understanding appeared instead in a text by Stephen Seligman (2000) who wrote: "Understanding is not exactly about experience, it is itself an experience" (p. 1193). ...
The aim of the thesis was to examine different aspects of the role of intersubjectivity in metacognitive development and in social understanding. More specifically, it investigates how different theoretical frameworks, such as mentalization theory, the theory of primary intersubjectivity, and interaction theory describe the developmental role of intersubjectivity. The suggestions these theories make in regard to this is also studied. Common to all three papers included in the dissertation is the conviction that intersubjectivity actually is central for, and affects in a basic way, social and cognitive development from the very beginning of life.
The methods employed are theoretical and concern the analysis of empirical studies in developmental psychology, as well as the analysis of, and comparison between, theories concerning different aspects of social understanding.
In the first paper, metacognition is interpreted as a way of managing cognitive resources that does not necessitate algorithmic strategies or metarepresentation. When pragmatic, world-directed actions cannot reduce the distance to a particular goal, the agents involved may engage in epistemic action directed at cognition. Such actions are often physical and involve other people, and thus are open to observation. Taking a dynamic systems approach to development, it is suggested that implicit and perceptual metacognition emerges from dyadic reciprocal interaction. Early intersubjectivity allows infants to internalize and construct rudimentary strategies for monitoring and control of their own and of others’ cognitions by means of emotion and attention. The functions of initiating, maintaining and achieving turns make proto-conversation a productive platform for developing metacognition. It enables the caregiver and the infant to create shared routines for epistemic actions that permit training of metacognitive skills. The adult is of double epistemic use to the infant—as a teacher who comments on and corrects the infant’s efforts, and as a cognitive resource for the infant.
The second paper deals with the question of how primary engagement and interaction relate to social understanding, most notably mentalization. The basic hypothesis considered is that primary intersubjectivity and mentalization are complementary and that the latter depends on the former, but the converse to this is not the case. Primary intersubjectivity is the sharing of experiences. It involves emotional engagement in second-person relations that are meaningful to the infant already from the start, whereas the theory of affect mirroring provides an explanation of how mentalization and representational abilities develop from dyadic interaction and contingency detection. A comparison of the theories suggests that, despite of their differences, they can fruitfully be combined. This paves the way for developing an alternative interpretation of affect mirroring, one based on the idea of young infants’ understanding the experiential dimension of emotion and using this to understand others. This makes it possible to trace the continuous development of social understanding based on emotion experience and affect sharing, and in addition to elaborate on the role of second-person engagement in attachment.
The third paper concerns the concept of mentalization as it was introduced into psychological science by Fonagy and his associates. The study describes some fundamental aspects of how the development of mentalization is viewed within the framework of this theoretical approach, enabling certain issues that seem difficult to explain in terms of mentalization theory to be more readily understood. A critical discussion of the theory is then undertaken, comparing and contrasting it with the theory of primary intersubjectivity. A suggestion is made concerning the development of mentalization that connects it with the notion of primary intersubjectivity. More specifically, it is argued that mentalization develops originally within the context of primary intersubjectivity, and that primary intersubjectivity is a basic prerequisite for the development of mentalization and in addition that there is a partial overlap between the concepts of primary intersubjectivity and implicit mentalization.
... As early as 1971, Matte-Blanco (1971, p. 198), when reviewing Bowlby's fi rst volume of Attachment and loss, felt that its impact upon ideas regarding the psychobiological foundations of psychoanalysis was bound to be signifi cant, and, 16 years afterwards, Emde (1997, quoted in Bernardi, 1998) opened a panel discussion on 'Attachment' with the remark that recent attachment research, based on the theories of Bowlby and the research of Mary Ainsworth, had exerted considerable infl uence on psychoanalysis. Three years later, Seligman (2000) offered support for this view, stating that psychoanalysis had renewed itself in all areas via integration of attachment theory, a development which-if one follows Mitchell (1999, p. 85)-was due to the fact that Bowlby 'was several steps ahead of his own time'. ...
Bowlbys Bindungstheorie und ihre neueren Versionen werden sowohl in epistemologischer Hinsicht als auch unter der Frage untersucht, inwieweit sich psychoanalytische Konzepte in ihnen wiederfinden lassen. Es wird argumentiert, dass Bowlbys Fundierung der Bindungstheorie, die auch in den spteren Konzepten nicht ernsthaft problematisiert wurde, wissenschaftlichen Ansprchen nicht gengen kann, und dass die in der Psychoanalyse zentral stehenden Konzepte — wie z.B. das dynamisch Unbewusste, innere Konflikte, das Zusammenspiel von Triebwnschen und Abwehr in der Herstellung von Ersatzbildungen — entweder ignoriert oder nicht ausreichend diskutiert wurden bzw. werden. In diesem Licht gesehen, verkehrt sich die Feststellung, dass die psychoanalytische Kritik an der Bindungstheorie auf wechselseitigen Missverstndnissen beruhte und in der Zwischenzeit substanzlos geworden ist, in ihr Gegenteil: Die psychoanalytische Kritik kann nur als berholt angesehen werden, wenn entweder die Psychoanalyse, die Bindungstheorie oder beide missverstanden werden.Bowlbys attachment theory and more recent versions of it are examined from an epistemological viewpoint and subjected to questioning on whether they are in line with central psychoanalytic concepts. It is argued that Bowlbys basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientific standards, and that psychoanalytic issues such as the dynamic unconscious, internal conflicts, the interaction between drive wishes and defence in establishing substitutive formations are either ignored or not treated in sufficient depth. In the light of this, the assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and is outdated nowadays stands the matter on its head: psychoanalytic criticism can only be regarded as outdated if either psychoanalysis, or attachment theory or both are misunderstood.
In Band 18 der Internationalen Psychoanalyse liegt ein Schwerpunkt auf der frühen Beziehung zwischen Mutter und Kind: Wie ist diese zu denken und was folgt daraus für die psychoanalytische Theorie und Praxis? Die Autor*innen untersuchen die transgenerationale Weitergabe früher Verluste über den mütterlichen Neid, den Ursprung von Kunst in der Zwischenleiblichkeit von Mutter und Ungeborenem sowie die Bedeutung der Wahrnehmung von Sinneseindrücken für die Psyche. Außerdem zeigen sie, wie Teleanalyse ein Fenster für frühe Formen des Begehrens öffnen kann, und konzeptualisieren ein mütterliches Bündnis, das die Gewalt unter Geschwistern begrenzen soll. Der zweite Schwerpunkt fokussiert die feldtheoretischen Entwicklungen in der Psychoanalyse von Lewin bis Civitarese. Ein Essay zum Film First Reformed, in dem die Regression auf primitivste Mechanismen in der Auseinandersetzung mit der Klimakatastrophe herausgearbeitet wird, beschließt den Band. Das International Journal of Psychoanalysis gilt als weltweit wichtigste Fachzeitschrift der Psychoanalyse. Aus diesem reichen Fundus versammelt Internationale Psychoanalyse jährlich ausgewählte Beiträge in deutscher Übersetzung. Mit Beiträgen von Lionel Bailly, Danielle Bazzi, Avner Bergstein, Giuseppe Civitarese, Lindsay L. Clarkson, Siri Hustvedt, Jorge Luis Maldonado, Christopher W.T. Miller, Rosine Jozef Perelberg, Donald R. Ross, Jill Salberg und Stefanie Sedlacek
L’impact des transmissions intergénérationnelles de traumatismes et les états psychiques dissociatifs qui passent des parents à leurs enfants, ont connu un développement important dans la théorie psychanalytique. Un cas clinique sera discuté, montrant comment la mort précoce d’une mère hanta les vies de plusieurs générations de mères et de filles. Des considérations sur la rupture d’attachement, le traumatisme, l’envie, l’agression mortelle et anesthésiante et la honte sont discutées en tant que phénomènes de transmission transgénérationnelle, et nous verrons comment ces différentes composantes sont perlaborées dans la relation analytique. Les attaques envieuses, bien que douloureuses à tolérer, doivent néanmoins être traitées afin de transformer les transmissions du passé.
Psychoanalysts of various persuasions share a commitment to reflection and recognition as core values in everyday clinical work. This suggests convergences between analytic perspectives that might otherwise be underestimated. With other analytic approaches in the background, this article emphasizes parallels between the attachment researchers’ emphasis on reflection and psychological coherence and the Bionian conceptualization of thinking as a special developmental achievement. With regard to clinical analysis, specific discussions of the value of attention to variations in the quality of reflective thinking, with analysands with varied psychopathology, are offered. In addition, an aspect of transference is clarified as a state of mind without “metacognition.”
Throughout this book, I have attempted to describe various aspects of emotional experience related to the process of aging and illness. Although the patients whose case histories I have discussed portray varied levels of psychological functioning, different personalities, character structures and defenses, there is one major theme that is common to all of them: the difficulty in accessing an emotional language due to the concrete demands of bodily illness or concrete focus on the body.
While I have described how ageism, and the fear of illness or death on the part of therapists may explain the hesitation of traditional psychoanalysts in addressing the needs of medically ill and older patients, the challenges that these patients bring to the therapeutic setting in talking about their internal and mental experiences creates unique difficulties for working with this population. In this chapter, we will revisit the concept of alexithymia; I will suggest that this idea can be expanded and applied to our work as clinicians, but without the pejorative connotations that are often associated with the dilemma of lacking the right words to describe feelings, or the assumption that illness is psychosomatic. I have argued that traditional approaches are not useful for many medical and aging patients; I will also describe how we might understand aspects of the therapeutic encounter with this population. Finally, I will contextualize the hope and grief our patients face, with a focus on the resilience of the elderly and medical patients, as these individuals often want to learn ways they can expand their emotional landscape towards a more nuanced and developed internal dialogue. The quest for meaning and insight in these patients implores us to continue to find ways to connect with and help this growing population.
While I have described how ageism and the fear of illness or death on the part of therapists may explain the hesitation of some clinicians in addressing the needs of some medically ill and older patients, the challenges that many patients bring to the therapeutic setting in talking about their internal and emotional experiences create unique difficulties for working with this population. In this chapter, I will revisit the concept of alexithymia; I will suggest that this idea can be expanded and applied to our work as clinicians, but without the pejorative connotations that are often associated with the dilemma of lacking the right words to describe feelings, or the assumption that illness is psychosomatic. I will challenge the idea that people with illness are unconsciously recruiting their disease, which is an idea espoused in some psychoanalytic writing. One of the most remarkable things about many of us as we age and/or become ill is that we constantly adapt. I think of people I have met who tell me they will definitely end their lives if they live to be 90 and are still in emotional or physical pain. Yet these women and men have greeted 90 and gone on to live for several more years. Keep in mind that the average life expectancy in 1920 was around 54 years of age. As I have described elsewhere, there is a sense of shock for many, and disappointment for some, about living such a long life and then having the last part of it be with a compromised body (Greenberg, 2012). Most people I have treated figure out ways to adapt to the inherent shock and at times dismay of living such a long life. I will discuss the research on posttraumatic growth and how this body of evidence shows us that some people can fight through the frightening and traumatic aspects of illness and go on to lead better, more gratifying lives. I will contextualize the hope and grief our patients face, with a focus on the resilience of the elderly and medical patients, as these individuals often want to learn ways they can expand their emotional landscape towards a more nuanced and developed internal dialogue. And indeed, it is rarely the case that I meet an elder person, even who is severely depressed, who does not eventually see the benefit of how better relationships can make life more meaningful. The quest for meaning, closeness, and insight in these patients implores us to continue to find ways to connect with and help this growing population.
In this article I track three ways of confronting the question of whiteness and its attendant problematic of racism. I look at two personal episodes one involving inheritances from white explorer forebearers and the place of racism in fetishized objects and second in the institutional difficulties within psychoanalysis in finding ways to speak about race and the dilemma of being a beneficiary of racism. Finally I look at the hidden racism in a much lauded psychoanalytic article, Joan Riviere's (192956.
Riviere , J. ( 1929 ). Womanliness as a masquerade . International Journal of Psychoanalysis , 9 , 303 – 313 . View all references) “Womanliness as a Masquerade,” and in the light of these three problems speculate on “whiteness.” I argue that the intergenerational transmissions of guilt and disavowal together leave a blank psychic space that makes an authentic expression of racial consciousness and genuine reparation currently difficult and certainly, even if well intentioned, partially compromised.
Work on the transgenerational transmission of trauma refers to unspoken stories across generations, but the actual mode of transmission has remained somewhat mysterious. Utilizing examples from her own life, the author illustrates how attachment patterns are a primary mode of transmission of trauma. When trauma revisits a person transgenerationally through dysregulated and disrupted attachment patterns, it is within the child's empathic attunement and search for a parental bond that the mode of transmission can be found. This will become the texture of traumatic attachment: how it feels to this child to feel connected to the parent.
© 2015 The Psychoanalytic Quarterly, Inc.
This article considers the influence of infant research on psychodynamic theory and practice. Infant research highlights the dramatic effects of the early caregiving relationship on development throughout the life span. It also provides important perspectives on psychotherapeutic processes. This article highlights such elements as empathy, mutual recognition and attachment, along with elaborating the intersubjective and transactional systems perspectives. In addition, it stresses the powerful role of nonverbal, implicit communication and meaning-making, which play a greater role in human relational experience-and therefore in the therapeutic process-than previously understood. In addition to clarifying these general orientations, the article describes specific therapeutic strategies based on the expanded developmental knowledge.
The author sets out to locate Bion's model of the mind within the developmental history of psychoanalysis, from Freud to Klein to Bion, using biographical material and clinical case examples, to illustrate Bion's concepts of container/contained, his understanding and use of projective identification, his extension of the use of the countertransference, and his differentiation between the psychotic and non-psychotic aspects of the mind. Links, and attacks against linking are discussed, as well as Bion's thoughts about learning versus knowing, being versus becoming and his emphasis on the essential importance of the development of the capacity to think.
This article gathers diverse attachment specialists in a far reaching conversation about the utility of attachment assessment and theory for complex family law decision making, and reflections on the thorny question, “If I were the judge . . .?” Inge Bretherton, Professor Emerita, Developmental Psychology at Wisconsin University, is one of a few attachment researchers in the Bowlby/Ainsworth tradition to have completed studies in the divorce field. Seligman, a psychoanalyst and clinical psychologist, Solomon, a clinical psychologist and researcher, and Crowell, professor of psychiatry and psychology, take on some large controversies, and offer well over 100 years combined experience of applying attachment knowledge in complex family matters.
This paper illustrates the clinical application of current theorizing about mentalization and reflective functioning and shows how it can synergize with established analytic concepts. The paper presents a single case, that of a mid-dle-aged woman patient with a moderate but significant history of trauma and presenting with narcissistic/borderline and masochistic dynamics. Un-like some applications of the new concepts, however, this paper does not fo-cus the case presentation around them but instead shows how a number of processes contribute to the development of mentalization. These include corrective engagement in enacted repetitions of the patient's past mistreat-ment, the development of a central metaphor that allows for proto-reflection and playing with painful affects, and a mourning process precipitated by the death of a family member to whom she is ambivalently attached. In the course of the presentation, then, a variety of psychoanalytic concepts are applied, such that the paper works as a synthesis of mentalization theory with them. Specifically, transference–countertransference dynamics are tracked, projective identifications and containment processes are described, interactions and interpretations lead to progressive change, and fantasies, conflicts, and internal object relations are observed and analyzed. Such di-rect and detailed clinical application of the concept also makes it more vivid, lucid, and experience near.
The concept of transference has broadened to a recognition that patients often express enduring relational patterns in the therapeutic relationship.
To examine the structure of patient relational patterns in psychotherapy and their relation with DSM-IV personality disorder symptoms.
A random sample of psychologists and psychiatrists (n=181) completed a battery of instruments on a randomly selected patient in their care.
Exploratory factor analysis identified five transference dimensions: angry/entitled, anxious/preoccupied, avoidant/counterdependent, secure/engaged and sexualised. These were associated in predictable ways with Axis II pathology; four mapped on to adult attachment styles. An aggregated portrait of transference patterns in narcissistic patients provided a clinically rich, empirically based description of transference processes that strongly resembled clinical theories.
The ways patients interact with their therapists can provide important data about their personality, attachment patterns and interpersonal functioning. These processes can be measured in clinically sophisticated and psychometrically sound ways. Such processes are relatively independent of clinicians' theoretical orientation.
The development of the capacity to reflect on mental states has its origins in the mother's function of accepting the infant's projections of unbearable states of mind and re-presenting them in a more tolerable form. During the oedipal period, the continued availability of a parent who can take in the child's mental states and represent them from a different perspective results in the emergence within the child of a reflective mode of mental functioning. This mental capacity allows the child entering latency to begin to be able to recognize that her experience is but one perspective among many. Reflection on mental states takes place within an intermediate area of experience that belongs neither to the inner world nor to external reality, but partakes of both. In latency, the capacity to reflect on mental states remains a vulnerable capacity that is dependent on the reflective function of a parent at times of crisis. When a parent who can contain and transform the child's experience is not available, the child's potential space for reflection can collapse, leaving the child unable to differentiate inner from outer reality. The mother's relationship to a loved object other than the child is necessary for her continuing ability to support the child's reflective function. The child's awareness of a parental relationship from which she is excluded is also essential to the child's internalization of the capacity to reflect on mental states because it creates a vantage point from which the child can imagine herself being observed from the outside. These points are illustrated with material from a first psychotherapy session with a latency age boy.
The author examines Bowlby's attachment theory and more recent versions of it from an epistemological viewpoint and subjects it to questioning on whether they are in line with central concepts of Freudian psychoanalysis. He argues that Bowlby's basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientific standards, and that psychoanalytic issues such as the dynamic unconscious, internal conflicts, interaction of drive wishes and the role of defence in establishing substitutive formations are either ignored or not treated in sufficient depth. In the light of this, Fonagy's assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and ought nowadays to be seen as outdated is reversed: psychoanalytic criticism can only be regarded as outdated if either basic tenets of Freudian psychoanalysis, or attachment theory or both are misunderstood.
This article presents a model of therapeutic action that takes into account both intrapsychic and intersubjective dimensions of analysis and the necessity of their mutual interaction in the development of self-reflexivity. Reflexive self-awareness is both an intellectual and emotional process; involves conscious and unconscious mentation; draws on symbolic, iconic, and enactive representations; and involves the mediation of the self-as-subject with self-as-object, the "I" and the "me," the verbal and the bodily selves, the other-as-subject, and the other-as-object. Self-reflexivity is not the achievement of an isolated mind in private contemplation, as the traditional concepts of insight and self-analysis may have implied; rather, self-reflexivity always involves an affective engagement, a meeting of minds. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discourse, prediction, and studies in attachment: Implications for psychoanalysis
- M Main