in the
diagnosis
and treatment of emotionally disturbed patients and families, its usage hitherto has been mainly to promote research in develop- mental psychology.
A-Secure-Base-Bowlby-Johnf
A Secure Base
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John Bowlby
A Secure Base
Clinical Applications of Attachment Theory
? First published 1988 by Routeldge
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(C) 1988 R. P. L. Bowlby, R. J. M. Bowlby and A. Gaitling Preface to Routledge Classics Edition (C) 2005 Jeremy Holmes
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? ? ? British Library Cataloguing in Publication Data
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To
Mary D. S. Ainsworth who introduced the concept of a secure base
1 2 3 4 5 6
7 8
Caring for Children
The Origins of Attachment Theory Psychoanalysis as Art and Science Psychoanalysis as a Natural Science Violence in the Family
On Knowing What you are Not Supposed to Know and Feeling What you are Not Sup- posed to Feel
The Role of Attachment in Personality Development
Attachment, Communication, and the Therapeutic Process
REFERENCES NAME INDEX SUBJECT INDEX
CONTENTS
PREFACE
ACKNOWLEDGEMENTS
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
PREFACE
In 1979, under the title of The Making and Breaking of Affectional Bonds, I published a small collection of lectures that I had given to a variety of audiences during the two preceding decades. In this volume I present a further selec- tion of the lectures given since then. Each of the first five was delivered to a particular audience on a particular occasion; details of each are de- scribed in a brief preamble. The remaining three are extended versions of lectures given in extem- pore form to audiences made up of mental health professionals in countries of Europe and Amer- ica. As in the earlier collection, I have thought it best to print each lecture in a form close to that in which it was originally published.
Since the theory of attachment provides the basis for every lecture some deletions have been necessary to avoid an excess of repetition. It is hoped that such as remains will, by presenting the same ideas in different contexts, clarify and emphasize distinctive features of the theory.
It is a little unexpected that, whereas attach- ment theory was formulated by a clinician for use
10/362
? ? ? in the diagnosis and treatment of emotionally disturbed patients and families, its usage hitherto has been mainly to promote research in develop- mental psychology. Whilst I welcome the findings of this research as enormously extending our un- derstanding of personality development and psy- chopathology, and thus as of the greatest clinical relevance, it has none the less been disappointing that clinicians have been so slow to test the the- ory's uses. There are probably many reasons for this. One is that initially the data drawn on ap- peared to be unduly behavioural. Another is that clinicians are very busy people who are naturally reluctant to spend time trying to master a new and strange conceptual framework until they have strong reasons for believing that to do so will improve their clinical understanding and therapeutic skills. For those who have decided the time has come to sample what this new per- spective has to offer I hope the lectures gathered here may provide a convenient introduction.
ACKNOWLEDGEMENTS
During the past ten years I have had the great be- nefit of frequent communication with staff and students at the Tavistock Clinic and also with a number of colleagues engaged in pioneering studies of how patterns of attachment develop during infancy and childhood. To all of them I owe a deep debt of gratitude, often for useful sug- gestions, sometimes for necessary corrections, and always for stimulation and encouragement. To my secretary, Dorothy Southern, I also owe a deep debt of gratitude for many years of devoted service during which she has made my interests her own.
For editorial assistance in preparing these lec- tures for publication and for constructing the in- dex my thanks are due to Molly Townsend.
The first six lectures in this book have ap- peared in other publications and I am grateful to the publishers concerned for permission to repro- duce them here. Lecture 1 was chapter 18 in Par- enthood: A Psychodynamic Perspective edited by Rebecca S. Cohen, Bertram J. Cohler, and Sidney H. Weissman, the Guilford Press, New York
12/362
? ? ? (1984); Lecture 2 was 'Attachment and loss: ret- rospect and prospect', American Journal of Orthopsychiatry 52: 664-78 (1982); Lecture 3 was 'Psychoanalysis as art and science', Interna- tional Review of Psychoanalysis 6: 3-14 (1979); Lecture 4 was 'Psychoanalysis as a natural sci- ence', International Review of Psychoanalysis 8: 243-56 (1981); Lecture 5 was 'Violence in the family as a disorder of the attachment and care- giving systems', The American Journal of Psy- choanalysis 44: 9-27 (1984); Lecture 6 was chapter 6 in Cognition and Psychotherapy edited by Michael J. Mahoney and Arthur Freeman, Plenum Publishing Corporation, New York and London (1985), expanded from 'On knowing what you are not supposed to know and feeling what you are not supposed to feel', Canadian Journal of Psychiatry 24: 403-8 (1979).
JOHN BOWLBY
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
A Secure Base first appeared in 1988 when John Bowlby was in his 81st year. Although there was, amazingly, one more book to come--the Darwin biography--it is his final contribution to Attach- ment Theory, the discipline which he, with Mary Ainsworth's help, founded nearly half a century earlier. Thus A Secure Base has a valedictory feel to it--a summation of a life's work, but also a tribute and a handing over to the next generation of attachment researchers and clinicians.
In it are to be found all the familiar Bowlbian themes--theoretical, etiological, methodological, clinical, and political. He restates the conceptual foundation stones of his ideas: the primacy of the attachment behavioural response and its role in protection from predation; sensitive care-giving as a foundation for psychological health; the con- tinuing importance of attachment throughout the life cycle. He argues powerfully for the role of real-life adversity--emotional deprivation, un- mourned bereavement, rejection, obfuscation, neglect, physical and sexual abuse--as the origin of subsequent psychopathology, as opposed to
14/362
? ? ? putative endo-psychic entities such as 'death instinct'.
Methodologically he emphasizes the import- ance of systematic scientific observation of chil- dren and parents, as opposed to speculative re- constructions from the couch. Clinically he sees the therapist as providing a secure base for her patients, a springboard from which they can be- gin to develop the free flowing discourse of emo- tion that is characteristic of those who are se- curely attached.
Finally, there is the figured base of Bowlby's social philosophy lying at the heart of his work: 'man and woman power devoted to the produc- tion of happy, healthy, and self-reliant children . . . does not count at all. We have created a topsy- turvy world' (p. 2).
The past 25 years has seen an explosion of in- terest in attachment theory, culminating in the landmark volume Handbook of Attachment (Cassidy & Shaver, 1999), an exhilarating sum- mation of how Bowlby and Ainsworth's acorn, nurtured by them into a sturdy sapling, has seeded a whole forest of developments, applica- tions, and ideas. In this brief introduction I shall pick out three of these growth points, or 'recent
15/362
? ? ? advances' in attachment theory, hinted at by Bowlby, but greatly expanded since A Secure Base was first published: the role of fathers in creating secure attachments; mentalization and 'theory of mind' as a developmental achievement; and psychotherapy as an interpersonal enterprise.
Attachment to Fathers. As implied in the quo- tation above, Bowlby was always insistent that mothers and fathers mattered when it came to providing a secure base. One of the crucial planks in the argument that security of attachment is an interpersonal, interactive phenomenon, and not simply a matter of the child's inborn tempera- ment, is that one and the same child can be clas- sified in the Strange Situation as secure with one parent and insecure with another. Nevertheless, attachment theory, both in its research and clin- ical guises, has tended to be a somewhat mater- nocentric enterprise and it has not been easy to pin down precisely what the father's contribution to security of attachment comprises.
Recent work (Grossman, Grossman, & Zim- merman, 1999; Grossman, Grossman, & Zindler, 2005) has begun to throw light on this topic. When Bowlby was writing the essays and lectures
16/362
? ? ? that make up this book in the 1980s, longitudinal studies of attachment phenomena were them- selves in their infancy. We now have 20-year pro- spective studies that look at measures of attach- ment security, parental sensitivity, exploration, relational competence, and their mental repres- entations throughout childhood. These can now be correlated with attachment disposition in young adulthood as manifested in attitudes to- wards romantic relationships and the Adult At- tachment Interview.
These studies show that paternal contributions are indeed vital to secure, stable, exploratory, balanced, verbally fluent attachment dispositions in adulthood. However, this contribution to psy- chological health is not predominantly mediated via security of attachment as measured in the Strange Situation. The role of fathers, rather, makes itself felt via the exploratory dimension of the attachment/exploration dichotomy and is eli- cited in the 'SCIP' (Sensitive and Challenging In- teractive Play) measure (Grossman, Grossman, & Zindler, 2005), which observes and rates parents interacting with their children in a 10-minute play session.
17/362
? ? ? In general, combined mother-father scores along multiple dimensions of attachment in childhood are far more predictive of security or insecurity of attachment representation in adult- hood than those of either parent alone. However, the preoccupied dimension--adults who give confused, affect-laden, unstructured responses to probes--is strongly correlated with father rejec- tion and insensitivity in mid-childhood, with the maternal contribution being relatively weak. Thus it seems that good-enough fathers help their children to develop clarity of thought and to be able to face up to negative emotions without feeling overwhelmed.
Like mothers, fathers need to be sensitive, but this takes the form of praise, encouragement, and the capacity to sustain positive affect in their off- spring. As they help their children to cope with curiosity-wariness conflicts, this protective, chal- lenging, 'you can do it' father diverges markedly from the castrating picture of classical psycho- analytic theory, which might apply more accur- ately to insensitive fathers who fail intuitively to grasp the basic message of attachment: that achievement is always predicated on security.
18/362
? ? ? Mentalization and theory of mind. Bowlby lived long enough to appreciate the enormous significance of Mary Main's contribution to At- tachment Theory and in particular the possibilit- ies represented by her development of the Adult Attachment Interview (AAI) (Hesse, 1999). He quotes her finding, confirmed by others, that mothers who showed insecurity on the AAI were more likely to have insecure children as meas- ured in the Strange Situation. He saw insecure at- tachment in terms of psychological defences--ne- cessary for emotional survival (and in the envir- onment of evolutionary adaptiveness in which our species evolved, physical survival)--but also as a constricting factor that excludes the insecure individual from the possibility of processing ad- verse experience.
A crucial finding in this early work was that 're- flexive function' (Fonagy et al. , 2002) as meas- ured in the AAI, appears to be a protective factor that despite adverse childhood experience such as parental separation, bereavement or even neg- lect and abuse, enables individuals to remain se- cure themselves and to provide security for their offspring. Put simply, the ability to 'talk about it' mitigates the long-term negative consequences of
19/362
? ? ? childhood trauma. 'Reflexive function' can be seen as tapping into internal speech, or mental representation of experience that underlies this capacity for external interactive story-telling.
Fonagy and his co-workers (Fonagy, Gergely, Jurist, & Target, 2002; Bateman & Fonagy, 2004) have extended these early findings with their new concept of 'mentalization'. Drawing on the philo- sophical tradition of 'theory of mind' they suggest that there are crucial developmental processes which enable infants to begin to appreciate the fact that they themselves, and those around them, have 'minds'--i. e. the ability to represent the world and to have projects, beliefs, and de- sires. Mentalization enables us to differentiate between 'reality' and our perspective or appreci- ation of reality, and also to grasp the fact that dif- ferent people view the world in differing ways. Thus mentalization, which could be seen as an extension of Bowlby's notion of internal working models, is anti-narcissistic and, so Fonagy et al. argue, a vital component of the ability to interact socially, including the ability to survive the vicis- situdes of mis-attunement, alliance ruptures, and the minor failures that are a normal part of
20/362
? ? ? 'good-enough parenting', or even 'not-good- enough' parenting.
This set of ideas leads to a rather different take on the evolutionary significance of attachment, which Bowlby, drawing on an ethological per- spective, always insisted was that of protection from predation. Fonagy et al. (2002) suggest that the emotional and physical proximity which at- tachment ensures also equips infants with the ca- pacity to understand themselves and those around them. Secure attachment enables us to 'read' people--including ourselves. Recent work in developmental psychopathology has begun to look at the developmental processes which lead to successful mentalization--'mirroring' between mother and child, 'marking' clear boundaries between 'pretence' and reality--and the ways in which these can break down. These studies sug- gest that insecure attachment, especially disor- ganised attachment (Holmes, 2004), is a likely predisposing factor for the subsequent develop- ment of personality difficulties in adult life (Bate- man & Fonagy, 2004), especially Borderline Per- sonality Disorder (described in this volume by Bowlby in traditional psychoanalytic terms as
21/362
? ? ? cases of 'false self', schizoid personality or patho- logical narcissism).
Interpersonal aspects of psychotherapy. Bowlby regularly emphasized the parallels between secure parenting and good psychother- apy (see Chapter 8). Just as he rehabilitated the role of real trauma, as opposed to phantasy, as the pathogenic factor in psychological difficulties, so he called for 'greater emphasis [to be] placed on the contribution of the therapist's role as a companion for his patient in the latter's explora- tion of himself and his experiences, and less on the therapist interpreting things to the patient' (p. 151).
Bowlby himself clearly was able to provide a secure base for his patients, co-workers, and stu- dents, inspiring a huge amount of affection and admiration amongst them. His writings, and life- story, are imbued with his capacity to balance the 'maternal' qualities of sensitivity and responsive- ness with 'paternal' challenge and support (note that I am here utterly repudiating my earlier in- accurate and impertinent description of him as 'dismissing', Holmes, 1993). He may perhaps not have appreciated, however, just how hard won these qualities are for some therapists. Recent
22/362
? ? ? work has begun to tease out the separate contri- butions of therapist and patient to the therapeut- ic dyad and to suggest that the quality of the ther- apy, and probably ultimately its outcome, is a function not of each alone, but of the interaction or 'fit' that exists between them. Dozier et al. (1999) looked at the attachment classification of therapists and their clients, and found that insec- ure therapists tend to reinforce the insecure at- tachment patterns of their clients, in avoidant cli- ents resulting in yet more hypoactivation of at- tachment behaviours, and in their preoccupied counterparts greater clinging and affective dys- regulation. Secure therapists by contrast tend to redress the balance between avoidance and pre- occupation and to push their clients towards more secure patterns of relating.
With the introduction of the Patient-Therapist Adult Attachment Interview (PT-AAI) Diamond and her co-workers (Diamond et al. , 2003) have taken this line of investigation one step further. Here the Adult Attachment Interview procedure is applied to the therapeutic relationship it- self--both therapist and patient are asked to provide adjectives to describe one another, to- gether with supporting anecdotes, and are asked
23/362
? ? ? speculate about why they think their patient/ therapist behaves in a particular way. The inter- view is then transcribed and rated in a similar way to the AAI, generating attachment categories and also measures of Reflexive Function in rela- tion to the therapeutic process. A number of in- teresting findings are beginning to emerge.
First, as might be hoped and expected, Reflex- ive Function improves in the course of therapy. Second, good outcomes seem to be associated with therapists who are neither too far behind nor too far ahead of their clients in the PT-AAI scores. A degree of distance between therapist and client is needed, but it must not be too far--for effectiveness therapy should not be too cosy, nor too astringent. Third, the therapist's ca- pacity for Reflexive Function varies from patient to patient. Each therapist-patient pair appears to generate its own particular attachment atmo- sphere and capacity for mentalization, or the lack of it.
All this implies a much more complex and dy- namic relational culture between caregiver and care-receiver (whether parent and child, or ther- apist and patient) than perhaps Bowlby's sugges- tions in the last chapter in this volume suggest.
24/362
? ? ? Tracking the vicissitudes of this relationship is a huge challenge for developmentalists, psycho- therapy researchers, and clinicians wishing to practice and teach their craft. Bowlby was an ec- lecticist par excellence. He had a remarkable ca- pacity to bring together differing discip- lines--psychoanalysis, cognitive science, child de- velopment, ethology, cybernetics--and to weld them into a coherent story.
This eclecticism makes attachment theory hugely attractive to some, but also off-putting to clinicians in search of truths deriving from but one 'God' alone. For our discipline to advance further, another effort of synthesis will be needed, bringing together ideas from neurobio- logy, neuroimaging, linguistics, ecology, and the mathematics of complex systems such as chaos theory. Forging such creative links is a task for the future--one which Bowlby would surely have happily endorsed and be sad to have missed.
JEREMY HOLMES
REFERENCES
Bateman, A. & Fonagy, P. (2004) Psychotherapy for Borderline Personality Disorder. Oxford: Oxford University Press.
25/362
? ? ? Cassidy, J. & Shaver, P. (1999) Handbook of Attach- ment. London: Guilford.
Diamond, D. , Stovall-McClough, C. , Clarkin, J. , & Levy, K. (2003) Patient-therapist attachment in the treatment of Borderline Personality Disorder. Bul- letin of the Menninger Clinic 76, 227-259.
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K.
in the diagnosis and treatment of emotionally disturbed patients and families, its usage hitherto has been mainly to promote research in develop- mental psychology. Whilst I welcome the findings of this research as enormously extending our un- derstanding of personality development and psy- chopathology, and thus as of the greatest clinical relevance, it has none the less been disappointing that clinicians have been so slow to test the the- ory's uses. There are probably many reasons for this. One is that initially the data drawn on ap- peared to be unduly behavioural. Another is that clinicians are very busy people who are naturally reluctant to spend time trying to master a new and strange conceptual framework until they have strong reasons for believing that to do so will improve their clinical understanding and therapeutic skills. For those who have decided the time has come to sample what this new per- spective has to offer I hope the lectures gathered here may provide a convenient introduction.
ACKNOWLEDGEMENTS
During the past ten years I have had the great be- nefit of frequent communication with staff and students at the Tavistock Clinic and also with a number of colleagues engaged in pioneering studies of how patterns of attachment develop during infancy and childhood. To all of them I owe a deep debt of gratitude, often for useful sug- gestions, sometimes for necessary corrections, and always for stimulation and encouragement. To my secretary, Dorothy Southern, I also owe a deep debt of gratitude for many years of devoted service during which she has made my interests her own.
For editorial assistance in preparing these lec- tures for publication and for constructing the in- dex my thanks are due to Molly Townsend.
The first six lectures in this book have ap- peared in other publications and I am grateful to the publishers concerned for permission to repro- duce them here. Lecture 1 was chapter 18 in Par- enthood: A Psychodynamic Perspective edited by Rebecca S. Cohen, Bertram J. Cohler, and Sidney H. Weissman, the Guilford Press, New York
12/362
? ? ? (1984); Lecture 2 was 'Attachment and loss: ret- rospect and prospect', American Journal of Orthopsychiatry 52: 664-78 (1982); Lecture 3 was 'Psychoanalysis as art and science', Interna- tional Review of Psychoanalysis 6: 3-14 (1979); Lecture 4 was 'Psychoanalysis as a natural sci- ence', International Review of Psychoanalysis 8: 243-56 (1981); Lecture 5 was 'Violence in the family as a disorder of the attachment and care- giving systems', The American Journal of Psy- choanalysis 44: 9-27 (1984); Lecture 6 was chapter 6 in Cognition and Psychotherapy edited by Michael J. Mahoney and Arthur Freeman, Plenum Publishing Corporation, New York and London (1985), expanded from 'On knowing what you are not supposed to know and feeling what you are not supposed to feel', Canadian Journal of Psychiatry 24: 403-8 (1979).
JOHN BOWLBY
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
A Secure Base first appeared in 1988 when John Bowlby was in his 81st year. Although there was, amazingly, one more book to come--the Darwin biography--it is his final contribution to Attach- ment Theory, the discipline which he, with Mary Ainsworth's help, founded nearly half a century earlier. Thus A Secure Base has a valedictory feel to it--a summation of a life's work, but also a tribute and a handing over to the next generation of attachment researchers and clinicians.
In it are to be found all the familiar Bowlbian themes--theoretical, etiological, methodological, clinical, and political. He restates the conceptual foundation stones of his ideas: the primacy of the attachment behavioural response and its role in protection from predation; sensitive care-giving as a foundation for psychological health; the con- tinuing importance of attachment throughout the life cycle. He argues powerfully for the role of real-life adversity--emotional deprivation, un- mourned bereavement, rejection, obfuscation, neglect, physical and sexual abuse--as the origin of subsequent psychopathology, as opposed to
14/362
? ? ? putative endo-psychic entities such as 'death instinct'.
Methodologically he emphasizes the import- ance of systematic scientific observation of chil- dren and parents, as opposed to speculative re- constructions from the couch. Clinically he sees the therapist as providing a secure base for her patients, a springboard from which they can be- gin to develop the free flowing discourse of emo- tion that is characteristic of those who are se- curely attached.
Finally, there is the figured base of Bowlby's social philosophy lying at the heart of his work: 'man and woman power devoted to the produc- tion of happy, healthy, and self-reliant children . . . does not count at all. We have created a topsy- turvy world' (p. 2).
The past 25 years has seen an explosion of in- terest in attachment theory, culminating in the landmark volume Handbook of Attachment (Cassidy & Shaver, 1999), an exhilarating sum- mation of how Bowlby and Ainsworth's acorn, nurtured by them into a sturdy sapling, has seeded a whole forest of developments, applica- tions, and ideas. In this brief introduction I shall pick out three of these growth points, or 'recent
15/362
? ? ? advances' in attachment theory, hinted at by Bowlby, but greatly expanded since A Secure Base was first published: the role of fathers in creating secure attachments; mentalization and 'theory of mind' as a developmental achievement; and psychotherapy as an interpersonal enterprise.
Attachment to Fathers. As implied in the quo- tation above, Bowlby was always insistent that mothers and fathers mattered when it came to providing a secure base. One of the crucial planks in the argument that security of attachment is an interpersonal, interactive phenomenon, and not simply a matter of the child's inborn tempera- ment, is that one and the same child can be clas- sified in the Strange Situation as secure with one parent and insecure with another. Nevertheless, attachment theory, both in its research and clin- ical guises, has tended to be a somewhat mater- nocentric enterprise and it has not been easy to pin down precisely what the father's contribution to security of attachment comprises.
Recent work (Grossman, Grossman, & Zim- merman, 1999; Grossman, Grossman, & Zindler, 2005) has begun to throw light on this topic. When Bowlby was writing the essays and lectures
16/362
? ? ? that make up this book in the 1980s, longitudinal studies of attachment phenomena were them- selves in their infancy. We now have 20-year pro- spective studies that look at measures of attach- ment security, parental sensitivity, exploration, relational competence, and their mental repres- entations throughout childhood. These can now be correlated with attachment disposition in young adulthood as manifested in attitudes to- wards romantic relationships and the Adult At- tachment Interview.
These studies show that paternal contributions are indeed vital to secure, stable, exploratory, balanced, verbally fluent attachment dispositions in adulthood. However, this contribution to psy- chological health is not predominantly mediated via security of attachment as measured in the Strange Situation. The role of fathers, rather, makes itself felt via the exploratory dimension of the attachment/exploration dichotomy and is eli- cited in the 'SCIP' (Sensitive and Challenging In- teractive Play) measure (Grossman, Grossman, & Zindler, 2005), which observes and rates parents interacting with their children in a 10-minute play session.
17/362
? ? ? In general, combined mother-father scores along multiple dimensions of attachment in childhood are far more predictive of security or insecurity of attachment representation in adult- hood than those of either parent alone. However, the preoccupied dimension--adults who give confused, affect-laden, unstructured responses to probes--is strongly correlated with father rejec- tion and insensitivity in mid-childhood, with the maternal contribution being relatively weak. Thus it seems that good-enough fathers help their children to develop clarity of thought and to be able to face up to negative emotions without feeling overwhelmed.
Like mothers, fathers need to be sensitive, but this takes the form of praise, encouragement, and the capacity to sustain positive affect in their off- spring. As they help their children to cope with curiosity-wariness conflicts, this protective, chal- lenging, 'you can do it' father diverges markedly from the castrating picture of classical psycho- analytic theory, which might apply more accur- ately to insensitive fathers who fail intuitively to grasp the basic message of attachment: that achievement is always predicated on security.
18/362
? ? ? Mentalization and theory of mind. Bowlby lived long enough to appreciate the enormous significance of Mary Main's contribution to At- tachment Theory and in particular the possibilit- ies represented by her development of the Adult Attachment Interview (AAI) (Hesse, 1999). He quotes her finding, confirmed by others, that mothers who showed insecurity on the AAI were more likely to have insecure children as meas- ured in the Strange Situation. He saw insecure at- tachment in terms of psychological defences--ne- cessary for emotional survival (and in the envir- onment of evolutionary adaptiveness in which our species evolved, physical survival)--but also as a constricting factor that excludes the insecure individual from the possibility of processing ad- verse experience.
A crucial finding in this early work was that 're- flexive function' (Fonagy et al. , 2002) as meas- ured in the AAI, appears to be a protective factor that despite adverse childhood experience such as parental separation, bereavement or even neg- lect and abuse, enables individuals to remain se- cure themselves and to provide security for their offspring. Put simply, the ability to 'talk about it' mitigates the long-term negative consequences of
19/362
? ? ? childhood trauma. 'Reflexive function' can be seen as tapping into internal speech, or mental representation of experience that underlies this capacity for external interactive story-telling.
Fonagy and his co-workers (Fonagy, Gergely, Jurist, & Target, 2002; Bateman & Fonagy, 2004) have extended these early findings with their new concept of 'mentalization'. Drawing on the philo- sophical tradition of 'theory of mind' they suggest that there are crucial developmental processes which enable infants to begin to appreciate the fact that they themselves, and those around them, have 'minds'--i. e. the ability to represent the world and to have projects, beliefs, and de- sires. Mentalization enables us to differentiate between 'reality' and our perspective or appreci- ation of reality, and also to grasp the fact that dif- ferent people view the world in differing ways. Thus mentalization, which could be seen as an extension of Bowlby's notion of internal working models, is anti-narcissistic and, so Fonagy et al. argue, a vital component of the ability to interact socially, including the ability to survive the vicis- situdes of mis-attunement, alliance ruptures, and the minor failures that are a normal part of
20/362
? ? ? 'good-enough parenting', or even 'not-good- enough' parenting.
This set of ideas leads to a rather different take on the evolutionary significance of attachment, which Bowlby, drawing on an ethological per- spective, always insisted was that of protection from predation. Fonagy et al. (2002) suggest that the emotional and physical proximity which at- tachment ensures also equips infants with the ca- pacity to understand themselves and those around them. Secure attachment enables us to 'read' people--including ourselves. Recent work in developmental psychopathology has begun to look at the developmental processes which lead to successful mentalization--'mirroring' between mother and child, 'marking' clear boundaries between 'pretence' and reality--and the ways in which these can break down. These studies sug- gest that insecure attachment, especially disor- ganised attachment (Holmes, 2004), is a likely predisposing factor for the subsequent develop- ment of personality difficulties in adult life (Bate- man & Fonagy, 2004), especially Borderline Per- sonality Disorder (described in this volume by Bowlby in traditional psychoanalytic terms as
21/362
? ? ? cases of 'false self', schizoid personality or patho- logical narcissism).
Interpersonal aspects of psychotherapy. Bowlby regularly emphasized the parallels between secure parenting and good psychother- apy (see Chapter 8). Just as he rehabilitated the role of real trauma, as opposed to phantasy, as the pathogenic factor in psychological difficulties, so he called for 'greater emphasis [to be] placed on the contribution of the therapist's role as a companion for his patient in the latter's explora- tion of himself and his experiences, and less on the therapist interpreting things to the patient' (p. 151).
Bowlby himself clearly was able to provide a secure base for his patients, co-workers, and stu- dents, inspiring a huge amount of affection and admiration amongst them. His writings, and life- story, are imbued with his capacity to balance the 'maternal' qualities of sensitivity and responsive- ness with 'paternal' challenge and support (note that I am here utterly repudiating my earlier in- accurate and impertinent description of him as 'dismissing', Holmes, 1993). He may perhaps not have appreciated, however, just how hard won these qualities are for some therapists. Recent
22/362
? ? ? work has begun to tease out the separate contri- butions of therapist and patient to the therapeut- ic dyad and to suggest that the quality of the ther- apy, and probably ultimately its outcome, is a function not of each alone, but of the interaction or 'fit' that exists between them. Dozier et al. (1999) looked at the attachment classification of therapists and their clients, and found that insec- ure therapists tend to reinforce the insecure at- tachment patterns of their clients, in avoidant cli- ents resulting in yet more hypoactivation of at- tachment behaviours, and in their preoccupied counterparts greater clinging and affective dys- regulation. Secure therapists by contrast tend to redress the balance between avoidance and pre- occupation and to push their clients towards more secure patterns of relating.
With the introduction of the Patient-Therapist Adult Attachment Interview (PT-AAI) Diamond and her co-workers (Diamond et al. , 2003) have taken this line of investigation one step further. Here the Adult Attachment Interview procedure is applied to the therapeutic relationship it- self--both therapist and patient are asked to provide adjectives to describe one another, to- gether with supporting anecdotes, and are asked
23/362
? ? ? speculate about why they think their patient/ therapist behaves in a particular way. The inter- view is then transcribed and rated in a similar way to the AAI, generating attachment categories and also measures of Reflexive Function in rela- tion to the therapeutic process. A number of in- teresting findings are beginning to emerge.
First, as might be hoped and expected, Reflex- ive Function improves in the course of therapy. Second, good outcomes seem to be associated with therapists who are neither too far behind nor too far ahead of their clients in the PT-AAI scores. A degree of distance between therapist and client is needed, but it must not be too far--for effectiveness therapy should not be too cosy, nor too astringent. Third, the therapist's ca- pacity for Reflexive Function varies from patient to patient. Each therapist-patient pair appears to generate its own particular attachment atmo- sphere and capacity for mentalization, or the lack of it.
All this implies a much more complex and dy- namic relational culture between caregiver and care-receiver (whether parent and child, or ther- apist and patient) than perhaps Bowlby's sugges- tions in the last chapter in this volume suggest.
24/362
? ? ? Tracking the vicissitudes of this relationship is a huge challenge for developmentalists, psycho- therapy researchers, and clinicians wishing to practice and teach their craft. Bowlby was an ec- lecticist par excellence. He had a remarkable ca- pacity to bring together differing discip- lines--psychoanalysis, cognitive science, child de- velopment, ethology, cybernetics--and to weld them into a coherent story.
This eclecticism makes attachment theory hugely attractive to some, but also off-putting to clinicians in search of truths deriving from but one 'God' alone. For our discipline to advance further, another effort of synthesis will be needed, bringing together ideas from neurobio- logy, neuroimaging, linguistics, ecology, and the mathematics of complex systems such as chaos theory. Forging such creative links is a task for the future--one which Bowlby would surely have happily endorsed and be sad to have missed.
JEREMY HOLMES
REFERENCES
Bateman, A. & Fonagy, P. (2004) Psychotherapy for Borderline Personality Disorder. Oxford: Oxford University Press.
25/362
? ? ? Cassidy, J. & Shaver, P. (1999) Handbook of Attach- ment. London: Guilford.
Diamond, D. , Stovall-McClough, C. , Clarkin, J. , & Levy, K. (2003) Patient-therapist attachment in the treatment of Borderline Personality Disorder. Bul- letin of the Menninger Clinic 76, 227-259.
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K. , & Zimmerman, P. (1999) A Wider view of attachment and exploration: sta- bility and change during the years of immaturity. In Handbook of Attachment (Eds J. Cassidy & P.
Shaver). London: Guilford.
Grossman, K. , Grossman, K. , & Kindler, H. (2005)
Early care and the roots of attachment and part- nership representation in the Bielefeld and Re- gensburg longitudinal studies. In Attachment from infancy to adulthood: the major longitudin- al studies. New York: Guilford.
Hesse, E. (1999) The Adult Attachment Interview: His- torical and Current Developments. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). Lon- don: Guilford.
26/362
? ? ? Holmes, J. (1993) John Bowlby and Attachment The- ory. London: Routlege.
Holmes, J. (2004) Disorganised attachment and Borderline Personality Disorder: a clinical per- spective. Attachment and Human Development 6, 181-190.
1
CARING FOR CHILDREN
During the early months of 1980 I was giving lectures in the United States. Amongst invita- tions reaching me was one from the psychiatric staff of the Michael Reese Hospital in Chicago to address a conference on parenting.
AN INDISPENSABLE SOCIAL ROLE
At some time of their lives, I believe, most human beings desire to have children and desire also that their children should grow up to be healthy, happy, and self-reliant. For those who succeed the rewards are great; but for those who have children but fail to rear them to be healthy, happy, and self-reliant the penalties in anxiety, frustration, friction, and perhaps shame or guilt, may be severe. Engaging in parenthood therefore is playing for high stakes. Furthermore, because successful parenting is a principal key to the mental health of the next generation, we need to know all we can both about its nature and about
? 28/362
? ?
'One of the most influential forces in child psychiatry and psychology, Dr. Bowlby challenged basic tenets of psy- choanalysis and pioneered methods of investigating the emotional life of children. '
The New York Times
'John Bowlby was a towering figure in general psychiatry, child psychiatry and psychoanalysis. More than anyone else he demonstrated the importance of real- life childhood events for the develop- ment of later psychopathology. '
The Independent
? Routledge Classics contains the very best of Routledge publishing over the past century or so, books that have, by popular consent, be- come established as classics in their field. Drawing on a fantastic heritage of innovative writing published by Routledge and its associ- ated imprints, this series makes available in attractive, affordable form some of the most important works of modern times.
For a complete list of titles visit
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John Bowlby
A Secure Base
Clinical Applications of Attachment Theory
? First published 1988 by Routeldge
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First published in Routledge Classics 2005 By Routledge
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(C) 1988 R. P. L. Bowlby, R. J. M. Bowlby and A. Gaitling Preface to Routledge Classics Edition (C) 2005 Jeremy Holmes
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? ? ? British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
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A catalog record for this book has been requested ISBN 0-415-35527-3
To
Mary D. S. Ainsworth who introduced the concept of a secure base
1 2 3 4 5 6
7 8
Caring for Children
The Origins of Attachment Theory Psychoanalysis as Art and Science Psychoanalysis as a Natural Science Violence in the Family
On Knowing What you are Not Supposed to Know and Feeling What you are Not Sup- posed to Feel
The Role of Attachment in Personality Development
Attachment, Communication, and the Therapeutic Process
REFERENCES NAME INDEX SUBJECT INDEX
CONTENTS
PREFACE
ACKNOWLEDGEMENTS
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
PREFACE
In 1979, under the title of The Making and Breaking of Affectional Bonds, I published a small collection of lectures that I had given to a variety of audiences during the two preceding decades. In this volume I present a further selec- tion of the lectures given since then. Each of the first five was delivered to a particular audience on a particular occasion; details of each are de- scribed in a brief preamble. The remaining three are extended versions of lectures given in extem- pore form to audiences made up of mental health professionals in countries of Europe and Amer- ica. As in the earlier collection, I have thought it best to print each lecture in a form close to that in which it was originally published.
Since the theory of attachment provides the basis for every lecture some deletions have been necessary to avoid an excess of repetition. It is hoped that such as remains will, by presenting the same ideas in different contexts, clarify and emphasize distinctive features of the theory.
It is a little unexpected that, whereas attach- ment theory was formulated by a clinician for use
10/362
? ? ? in the diagnosis and treatment of emotionally disturbed patients and families, its usage hitherto has been mainly to promote research in develop- mental psychology. Whilst I welcome the findings of this research as enormously extending our un- derstanding of personality development and psy- chopathology, and thus as of the greatest clinical relevance, it has none the less been disappointing that clinicians have been so slow to test the the- ory's uses. There are probably many reasons for this. One is that initially the data drawn on ap- peared to be unduly behavioural. Another is that clinicians are very busy people who are naturally reluctant to spend time trying to master a new and strange conceptual framework until they have strong reasons for believing that to do so will improve their clinical understanding and therapeutic skills. For those who have decided the time has come to sample what this new per- spective has to offer I hope the lectures gathered here may provide a convenient introduction.
ACKNOWLEDGEMENTS
During the past ten years I have had the great be- nefit of frequent communication with staff and students at the Tavistock Clinic and also with a number of colleagues engaged in pioneering studies of how patterns of attachment develop during infancy and childhood. To all of them I owe a deep debt of gratitude, often for useful sug- gestions, sometimes for necessary corrections, and always for stimulation and encouragement. To my secretary, Dorothy Southern, I also owe a deep debt of gratitude for many years of devoted service during which she has made my interests her own.
For editorial assistance in preparing these lec- tures for publication and for constructing the in- dex my thanks are due to Molly Townsend.
The first six lectures in this book have ap- peared in other publications and I am grateful to the publishers concerned for permission to repro- duce them here. Lecture 1 was chapter 18 in Par- enthood: A Psychodynamic Perspective edited by Rebecca S. Cohen, Bertram J. Cohler, and Sidney H. Weissman, the Guilford Press, New York
12/362
? ? ? (1984); Lecture 2 was 'Attachment and loss: ret- rospect and prospect', American Journal of Orthopsychiatry 52: 664-78 (1982); Lecture 3 was 'Psychoanalysis as art and science', Interna- tional Review of Psychoanalysis 6: 3-14 (1979); Lecture 4 was 'Psychoanalysis as a natural sci- ence', International Review of Psychoanalysis 8: 243-56 (1981); Lecture 5 was 'Violence in the family as a disorder of the attachment and care- giving systems', The American Journal of Psy- choanalysis 44: 9-27 (1984); Lecture 6 was chapter 6 in Cognition and Psychotherapy edited by Michael J. Mahoney and Arthur Freeman, Plenum Publishing Corporation, New York and London (1985), expanded from 'On knowing what you are not supposed to know and feeling what you are not supposed to feel', Canadian Journal of Psychiatry 24: 403-8 (1979).
JOHN BOWLBY
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
A Secure Base first appeared in 1988 when John Bowlby was in his 81st year. Although there was, amazingly, one more book to come--the Darwin biography--it is his final contribution to Attach- ment Theory, the discipline which he, with Mary Ainsworth's help, founded nearly half a century earlier. Thus A Secure Base has a valedictory feel to it--a summation of a life's work, but also a tribute and a handing over to the next generation of attachment researchers and clinicians.
In it are to be found all the familiar Bowlbian themes--theoretical, etiological, methodological, clinical, and political. He restates the conceptual foundation stones of his ideas: the primacy of the attachment behavioural response and its role in protection from predation; sensitive care-giving as a foundation for psychological health; the con- tinuing importance of attachment throughout the life cycle. He argues powerfully for the role of real-life adversity--emotional deprivation, un- mourned bereavement, rejection, obfuscation, neglect, physical and sexual abuse--as the origin of subsequent psychopathology, as opposed to
14/362
? ? ? putative endo-psychic entities such as 'death instinct'.
Methodologically he emphasizes the import- ance of systematic scientific observation of chil- dren and parents, as opposed to speculative re- constructions from the couch. Clinically he sees the therapist as providing a secure base for her patients, a springboard from which they can be- gin to develop the free flowing discourse of emo- tion that is characteristic of those who are se- curely attached.
Finally, there is the figured base of Bowlby's social philosophy lying at the heart of his work: 'man and woman power devoted to the produc- tion of happy, healthy, and self-reliant children . . . does not count at all. We have created a topsy- turvy world' (p. 2).
The past 25 years has seen an explosion of in- terest in attachment theory, culminating in the landmark volume Handbook of Attachment (Cassidy & Shaver, 1999), an exhilarating sum- mation of how Bowlby and Ainsworth's acorn, nurtured by them into a sturdy sapling, has seeded a whole forest of developments, applica- tions, and ideas. In this brief introduction I shall pick out three of these growth points, or 'recent
15/362
? ? ? advances' in attachment theory, hinted at by Bowlby, but greatly expanded since A Secure Base was first published: the role of fathers in creating secure attachments; mentalization and 'theory of mind' as a developmental achievement; and psychotherapy as an interpersonal enterprise.
Attachment to Fathers. As implied in the quo- tation above, Bowlby was always insistent that mothers and fathers mattered when it came to providing a secure base. One of the crucial planks in the argument that security of attachment is an interpersonal, interactive phenomenon, and not simply a matter of the child's inborn tempera- ment, is that one and the same child can be clas- sified in the Strange Situation as secure with one parent and insecure with another. Nevertheless, attachment theory, both in its research and clin- ical guises, has tended to be a somewhat mater- nocentric enterprise and it has not been easy to pin down precisely what the father's contribution to security of attachment comprises.
Recent work (Grossman, Grossman, & Zim- merman, 1999; Grossman, Grossman, & Zindler, 2005) has begun to throw light on this topic. When Bowlby was writing the essays and lectures
16/362
? ? ? that make up this book in the 1980s, longitudinal studies of attachment phenomena were them- selves in their infancy. We now have 20-year pro- spective studies that look at measures of attach- ment security, parental sensitivity, exploration, relational competence, and their mental repres- entations throughout childhood. These can now be correlated with attachment disposition in young adulthood as manifested in attitudes to- wards romantic relationships and the Adult At- tachment Interview.
These studies show that paternal contributions are indeed vital to secure, stable, exploratory, balanced, verbally fluent attachment dispositions in adulthood. However, this contribution to psy- chological health is not predominantly mediated via security of attachment as measured in the Strange Situation. The role of fathers, rather, makes itself felt via the exploratory dimension of the attachment/exploration dichotomy and is eli- cited in the 'SCIP' (Sensitive and Challenging In- teractive Play) measure (Grossman, Grossman, & Zindler, 2005), which observes and rates parents interacting with their children in a 10-minute play session.
17/362
? ? ? In general, combined mother-father scores along multiple dimensions of attachment in childhood are far more predictive of security or insecurity of attachment representation in adult- hood than those of either parent alone. However, the preoccupied dimension--adults who give confused, affect-laden, unstructured responses to probes--is strongly correlated with father rejec- tion and insensitivity in mid-childhood, with the maternal contribution being relatively weak. Thus it seems that good-enough fathers help their children to develop clarity of thought and to be able to face up to negative emotions without feeling overwhelmed.
Like mothers, fathers need to be sensitive, but this takes the form of praise, encouragement, and the capacity to sustain positive affect in their off- spring. As they help their children to cope with curiosity-wariness conflicts, this protective, chal- lenging, 'you can do it' father diverges markedly from the castrating picture of classical psycho- analytic theory, which might apply more accur- ately to insensitive fathers who fail intuitively to grasp the basic message of attachment: that achievement is always predicated on security.
18/362
? ? ? Mentalization and theory of mind. Bowlby lived long enough to appreciate the enormous significance of Mary Main's contribution to At- tachment Theory and in particular the possibilit- ies represented by her development of the Adult Attachment Interview (AAI) (Hesse, 1999). He quotes her finding, confirmed by others, that mothers who showed insecurity on the AAI were more likely to have insecure children as meas- ured in the Strange Situation. He saw insecure at- tachment in terms of psychological defences--ne- cessary for emotional survival (and in the envir- onment of evolutionary adaptiveness in which our species evolved, physical survival)--but also as a constricting factor that excludes the insecure individual from the possibility of processing ad- verse experience.
A crucial finding in this early work was that 're- flexive function' (Fonagy et al. , 2002) as meas- ured in the AAI, appears to be a protective factor that despite adverse childhood experience such as parental separation, bereavement or even neg- lect and abuse, enables individuals to remain se- cure themselves and to provide security for their offspring. Put simply, the ability to 'talk about it' mitigates the long-term negative consequences of
19/362
? ? ? childhood trauma. 'Reflexive function' can be seen as tapping into internal speech, or mental representation of experience that underlies this capacity for external interactive story-telling.
Fonagy and his co-workers (Fonagy, Gergely, Jurist, & Target, 2002; Bateman & Fonagy, 2004) have extended these early findings with their new concept of 'mentalization'. Drawing on the philo- sophical tradition of 'theory of mind' they suggest that there are crucial developmental processes which enable infants to begin to appreciate the fact that they themselves, and those around them, have 'minds'--i. e. the ability to represent the world and to have projects, beliefs, and de- sires. Mentalization enables us to differentiate between 'reality' and our perspective or appreci- ation of reality, and also to grasp the fact that dif- ferent people view the world in differing ways. Thus mentalization, which could be seen as an extension of Bowlby's notion of internal working models, is anti-narcissistic and, so Fonagy et al. argue, a vital component of the ability to interact socially, including the ability to survive the vicis- situdes of mis-attunement, alliance ruptures, and the minor failures that are a normal part of
20/362
? ? ? 'good-enough parenting', or even 'not-good- enough' parenting.
This set of ideas leads to a rather different take on the evolutionary significance of attachment, which Bowlby, drawing on an ethological per- spective, always insisted was that of protection from predation. Fonagy et al. (2002) suggest that the emotional and physical proximity which at- tachment ensures also equips infants with the ca- pacity to understand themselves and those around them. Secure attachment enables us to 'read' people--including ourselves. Recent work in developmental psychopathology has begun to look at the developmental processes which lead to successful mentalization--'mirroring' between mother and child, 'marking' clear boundaries between 'pretence' and reality--and the ways in which these can break down. These studies sug- gest that insecure attachment, especially disor- ganised attachment (Holmes, 2004), is a likely predisposing factor for the subsequent develop- ment of personality difficulties in adult life (Bate- man & Fonagy, 2004), especially Borderline Per- sonality Disorder (described in this volume by Bowlby in traditional psychoanalytic terms as
21/362
? ? ? cases of 'false self', schizoid personality or patho- logical narcissism).
Interpersonal aspects of psychotherapy. Bowlby regularly emphasized the parallels between secure parenting and good psychother- apy (see Chapter 8). Just as he rehabilitated the role of real trauma, as opposed to phantasy, as the pathogenic factor in psychological difficulties, so he called for 'greater emphasis [to be] placed on the contribution of the therapist's role as a companion for his patient in the latter's explora- tion of himself and his experiences, and less on the therapist interpreting things to the patient' (p. 151).
Bowlby himself clearly was able to provide a secure base for his patients, co-workers, and stu- dents, inspiring a huge amount of affection and admiration amongst them. His writings, and life- story, are imbued with his capacity to balance the 'maternal' qualities of sensitivity and responsive- ness with 'paternal' challenge and support (note that I am here utterly repudiating my earlier in- accurate and impertinent description of him as 'dismissing', Holmes, 1993). He may perhaps not have appreciated, however, just how hard won these qualities are for some therapists. Recent
22/362
? ? ? work has begun to tease out the separate contri- butions of therapist and patient to the therapeut- ic dyad and to suggest that the quality of the ther- apy, and probably ultimately its outcome, is a function not of each alone, but of the interaction or 'fit' that exists between them. Dozier et al. (1999) looked at the attachment classification of therapists and their clients, and found that insec- ure therapists tend to reinforce the insecure at- tachment patterns of their clients, in avoidant cli- ents resulting in yet more hypoactivation of at- tachment behaviours, and in their preoccupied counterparts greater clinging and affective dys- regulation. Secure therapists by contrast tend to redress the balance between avoidance and pre- occupation and to push their clients towards more secure patterns of relating.
With the introduction of the Patient-Therapist Adult Attachment Interview (PT-AAI) Diamond and her co-workers (Diamond et al. , 2003) have taken this line of investigation one step further. Here the Adult Attachment Interview procedure is applied to the therapeutic relationship it- self--both therapist and patient are asked to provide adjectives to describe one another, to- gether with supporting anecdotes, and are asked
23/362
? ? ? speculate about why they think their patient/ therapist behaves in a particular way. The inter- view is then transcribed and rated in a similar way to the AAI, generating attachment categories and also measures of Reflexive Function in rela- tion to the therapeutic process. A number of in- teresting findings are beginning to emerge.
First, as might be hoped and expected, Reflex- ive Function improves in the course of therapy. Second, good outcomes seem to be associated with therapists who are neither too far behind nor too far ahead of their clients in the PT-AAI scores. A degree of distance between therapist and client is needed, but it must not be too far--for effectiveness therapy should not be too cosy, nor too astringent. Third, the therapist's ca- pacity for Reflexive Function varies from patient to patient. Each therapist-patient pair appears to generate its own particular attachment atmo- sphere and capacity for mentalization, or the lack of it.
All this implies a much more complex and dy- namic relational culture between caregiver and care-receiver (whether parent and child, or ther- apist and patient) than perhaps Bowlby's sugges- tions in the last chapter in this volume suggest.
24/362
? ? ? Tracking the vicissitudes of this relationship is a huge challenge for developmentalists, psycho- therapy researchers, and clinicians wishing to practice and teach their craft. Bowlby was an ec- lecticist par excellence. He had a remarkable ca- pacity to bring together differing discip- lines--psychoanalysis, cognitive science, child de- velopment, ethology, cybernetics--and to weld them into a coherent story.
This eclecticism makes attachment theory hugely attractive to some, but also off-putting to clinicians in search of truths deriving from but one 'God' alone. For our discipline to advance further, another effort of synthesis will be needed, bringing together ideas from neurobio- logy, neuroimaging, linguistics, ecology, and the mathematics of complex systems such as chaos theory. Forging such creative links is a task for the future--one which Bowlby would surely have happily endorsed and be sad to have missed.
JEREMY HOLMES
REFERENCES
Bateman, A. & Fonagy, P. (2004) Psychotherapy for Borderline Personality Disorder. Oxford: Oxford University Press.
25/362
? ? ? Cassidy, J. & Shaver, P. (1999) Handbook of Attach- ment. London: Guilford.
Diamond, D. , Stovall-McClough, C. , Clarkin, J. , & Levy, K. (2003) Patient-therapist attachment in the treatment of Borderline Personality Disorder. Bul- letin of the Menninger Clinic 76, 227-259.
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K.
in the diagnosis and treatment of emotionally disturbed patients and families, its usage hitherto has been mainly to promote research in develop- mental psychology. Whilst I welcome the findings of this research as enormously extending our un- derstanding of personality development and psy- chopathology, and thus as of the greatest clinical relevance, it has none the less been disappointing that clinicians have been so slow to test the the- ory's uses. There are probably many reasons for this. One is that initially the data drawn on ap- peared to be unduly behavioural. Another is that clinicians are very busy people who are naturally reluctant to spend time trying to master a new and strange conceptual framework until they have strong reasons for believing that to do so will improve their clinical understanding and therapeutic skills. For those who have decided the time has come to sample what this new per- spective has to offer I hope the lectures gathered here may provide a convenient introduction.
ACKNOWLEDGEMENTS
During the past ten years I have had the great be- nefit of frequent communication with staff and students at the Tavistock Clinic and also with a number of colleagues engaged in pioneering studies of how patterns of attachment develop during infancy and childhood. To all of them I owe a deep debt of gratitude, often for useful sug- gestions, sometimes for necessary corrections, and always for stimulation and encouragement. To my secretary, Dorothy Southern, I also owe a deep debt of gratitude for many years of devoted service during which she has made my interests her own.
For editorial assistance in preparing these lec- tures for publication and for constructing the in- dex my thanks are due to Molly Townsend.
The first six lectures in this book have ap- peared in other publications and I am grateful to the publishers concerned for permission to repro- duce them here. Lecture 1 was chapter 18 in Par- enthood: A Psychodynamic Perspective edited by Rebecca S. Cohen, Bertram J. Cohler, and Sidney H. Weissman, the Guilford Press, New York
12/362
? ? ? (1984); Lecture 2 was 'Attachment and loss: ret- rospect and prospect', American Journal of Orthopsychiatry 52: 664-78 (1982); Lecture 3 was 'Psychoanalysis as art and science', Interna- tional Review of Psychoanalysis 6: 3-14 (1979); Lecture 4 was 'Psychoanalysis as a natural sci- ence', International Review of Psychoanalysis 8: 243-56 (1981); Lecture 5 was 'Violence in the family as a disorder of the attachment and care- giving systems', The American Journal of Psy- choanalysis 44: 9-27 (1984); Lecture 6 was chapter 6 in Cognition and Psychotherapy edited by Michael J. Mahoney and Arthur Freeman, Plenum Publishing Corporation, New York and London (1985), expanded from 'On knowing what you are not supposed to know and feeling what you are not supposed to feel', Canadian Journal of Psychiatry 24: 403-8 (1979).
JOHN BOWLBY
PREFACE TO THE ROUTLEDGE CLASSICS EDITION
A Secure Base first appeared in 1988 when John Bowlby was in his 81st year. Although there was, amazingly, one more book to come--the Darwin biography--it is his final contribution to Attach- ment Theory, the discipline which he, with Mary Ainsworth's help, founded nearly half a century earlier. Thus A Secure Base has a valedictory feel to it--a summation of a life's work, but also a tribute and a handing over to the next generation of attachment researchers and clinicians.
In it are to be found all the familiar Bowlbian themes--theoretical, etiological, methodological, clinical, and political. He restates the conceptual foundation stones of his ideas: the primacy of the attachment behavioural response and its role in protection from predation; sensitive care-giving as a foundation for psychological health; the con- tinuing importance of attachment throughout the life cycle. He argues powerfully for the role of real-life adversity--emotional deprivation, un- mourned bereavement, rejection, obfuscation, neglect, physical and sexual abuse--as the origin of subsequent psychopathology, as opposed to
14/362
? ? ? putative endo-psychic entities such as 'death instinct'.
Methodologically he emphasizes the import- ance of systematic scientific observation of chil- dren and parents, as opposed to speculative re- constructions from the couch. Clinically he sees the therapist as providing a secure base for her patients, a springboard from which they can be- gin to develop the free flowing discourse of emo- tion that is characteristic of those who are se- curely attached.
Finally, there is the figured base of Bowlby's social philosophy lying at the heart of his work: 'man and woman power devoted to the produc- tion of happy, healthy, and self-reliant children . . . does not count at all. We have created a topsy- turvy world' (p. 2).
The past 25 years has seen an explosion of in- terest in attachment theory, culminating in the landmark volume Handbook of Attachment (Cassidy & Shaver, 1999), an exhilarating sum- mation of how Bowlby and Ainsworth's acorn, nurtured by them into a sturdy sapling, has seeded a whole forest of developments, applica- tions, and ideas. In this brief introduction I shall pick out three of these growth points, or 'recent
15/362
? ? ? advances' in attachment theory, hinted at by Bowlby, but greatly expanded since A Secure Base was first published: the role of fathers in creating secure attachments; mentalization and 'theory of mind' as a developmental achievement; and psychotherapy as an interpersonal enterprise.
Attachment to Fathers. As implied in the quo- tation above, Bowlby was always insistent that mothers and fathers mattered when it came to providing a secure base. One of the crucial planks in the argument that security of attachment is an interpersonal, interactive phenomenon, and not simply a matter of the child's inborn tempera- ment, is that one and the same child can be clas- sified in the Strange Situation as secure with one parent and insecure with another. Nevertheless, attachment theory, both in its research and clin- ical guises, has tended to be a somewhat mater- nocentric enterprise and it has not been easy to pin down precisely what the father's contribution to security of attachment comprises.
Recent work (Grossman, Grossman, & Zim- merman, 1999; Grossman, Grossman, & Zindler, 2005) has begun to throw light on this topic. When Bowlby was writing the essays and lectures
16/362
? ? ? that make up this book in the 1980s, longitudinal studies of attachment phenomena were them- selves in their infancy. We now have 20-year pro- spective studies that look at measures of attach- ment security, parental sensitivity, exploration, relational competence, and their mental repres- entations throughout childhood. These can now be correlated with attachment disposition in young adulthood as manifested in attitudes to- wards romantic relationships and the Adult At- tachment Interview.
These studies show that paternal contributions are indeed vital to secure, stable, exploratory, balanced, verbally fluent attachment dispositions in adulthood. However, this contribution to psy- chological health is not predominantly mediated via security of attachment as measured in the Strange Situation. The role of fathers, rather, makes itself felt via the exploratory dimension of the attachment/exploration dichotomy and is eli- cited in the 'SCIP' (Sensitive and Challenging In- teractive Play) measure (Grossman, Grossman, & Zindler, 2005), which observes and rates parents interacting with their children in a 10-minute play session.
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? ? ? In general, combined mother-father scores along multiple dimensions of attachment in childhood are far more predictive of security or insecurity of attachment representation in adult- hood than those of either parent alone. However, the preoccupied dimension--adults who give confused, affect-laden, unstructured responses to probes--is strongly correlated with father rejec- tion and insensitivity in mid-childhood, with the maternal contribution being relatively weak. Thus it seems that good-enough fathers help their children to develop clarity of thought and to be able to face up to negative emotions without feeling overwhelmed.
Like mothers, fathers need to be sensitive, but this takes the form of praise, encouragement, and the capacity to sustain positive affect in their off- spring. As they help their children to cope with curiosity-wariness conflicts, this protective, chal- lenging, 'you can do it' father diverges markedly from the castrating picture of classical psycho- analytic theory, which might apply more accur- ately to insensitive fathers who fail intuitively to grasp the basic message of attachment: that achievement is always predicated on security.
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? ? ? Mentalization and theory of mind. Bowlby lived long enough to appreciate the enormous significance of Mary Main's contribution to At- tachment Theory and in particular the possibilit- ies represented by her development of the Adult Attachment Interview (AAI) (Hesse, 1999). He quotes her finding, confirmed by others, that mothers who showed insecurity on the AAI were more likely to have insecure children as meas- ured in the Strange Situation. He saw insecure at- tachment in terms of psychological defences--ne- cessary for emotional survival (and in the envir- onment of evolutionary adaptiveness in which our species evolved, physical survival)--but also as a constricting factor that excludes the insecure individual from the possibility of processing ad- verse experience.
A crucial finding in this early work was that 're- flexive function' (Fonagy et al. , 2002) as meas- ured in the AAI, appears to be a protective factor that despite adverse childhood experience such as parental separation, bereavement or even neg- lect and abuse, enables individuals to remain se- cure themselves and to provide security for their offspring. Put simply, the ability to 'talk about it' mitigates the long-term negative consequences of
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? ? ? childhood trauma. 'Reflexive function' can be seen as tapping into internal speech, or mental representation of experience that underlies this capacity for external interactive story-telling.
Fonagy and his co-workers (Fonagy, Gergely, Jurist, & Target, 2002; Bateman & Fonagy, 2004) have extended these early findings with their new concept of 'mentalization'. Drawing on the philo- sophical tradition of 'theory of mind' they suggest that there are crucial developmental processes which enable infants to begin to appreciate the fact that they themselves, and those around them, have 'minds'--i. e. the ability to represent the world and to have projects, beliefs, and de- sires. Mentalization enables us to differentiate between 'reality' and our perspective or appreci- ation of reality, and also to grasp the fact that dif- ferent people view the world in differing ways. Thus mentalization, which could be seen as an extension of Bowlby's notion of internal working models, is anti-narcissistic and, so Fonagy et al. argue, a vital component of the ability to interact socially, including the ability to survive the vicis- situdes of mis-attunement, alliance ruptures, and the minor failures that are a normal part of
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? ? ? 'good-enough parenting', or even 'not-good- enough' parenting.
This set of ideas leads to a rather different take on the evolutionary significance of attachment, which Bowlby, drawing on an ethological per- spective, always insisted was that of protection from predation. Fonagy et al. (2002) suggest that the emotional and physical proximity which at- tachment ensures also equips infants with the ca- pacity to understand themselves and those around them. Secure attachment enables us to 'read' people--including ourselves. Recent work in developmental psychopathology has begun to look at the developmental processes which lead to successful mentalization--'mirroring' between mother and child, 'marking' clear boundaries between 'pretence' and reality--and the ways in which these can break down. These studies sug- gest that insecure attachment, especially disor- ganised attachment (Holmes, 2004), is a likely predisposing factor for the subsequent develop- ment of personality difficulties in adult life (Bate- man & Fonagy, 2004), especially Borderline Per- sonality Disorder (described in this volume by Bowlby in traditional psychoanalytic terms as
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? ? ? cases of 'false self', schizoid personality or patho- logical narcissism).
Interpersonal aspects of psychotherapy. Bowlby regularly emphasized the parallels between secure parenting and good psychother- apy (see Chapter 8). Just as he rehabilitated the role of real trauma, as opposed to phantasy, as the pathogenic factor in psychological difficulties, so he called for 'greater emphasis [to be] placed on the contribution of the therapist's role as a companion for his patient in the latter's explora- tion of himself and his experiences, and less on the therapist interpreting things to the patient' (p. 151).
Bowlby himself clearly was able to provide a secure base for his patients, co-workers, and stu- dents, inspiring a huge amount of affection and admiration amongst them. His writings, and life- story, are imbued with his capacity to balance the 'maternal' qualities of sensitivity and responsive- ness with 'paternal' challenge and support (note that I am here utterly repudiating my earlier in- accurate and impertinent description of him as 'dismissing', Holmes, 1993). He may perhaps not have appreciated, however, just how hard won these qualities are for some therapists. Recent
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? ? ? work has begun to tease out the separate contri- butions of therapist and patient to the therapeut- ic dyad and to suggest that the quality of the ther- apy, and probably ultimately its outcome, is a function not of each alone, but of the interaction or 'fit' that exists between them. Dozier et al. (1999) looked at the attachment classification of therapists and their clients, and found that insec- ure therapists tend to reinforce the insecure at- tachment patterns of their clients, in avoidant cli- ents resulting in yet more hypoactivation of at- tachment behaviours, and in their preoccupied counterparts greater clinging and affective dys- regulation. Secure therapists by contrast tend to redress the balance between avoidance and pre- occupation and to push their clients towards more secure patterns of relating.
With the introduction of the Patient-Therapist Adult Attachment Interview (PT-AAI) Diamond and her co-workers (Diamond et al. , 2003) have taken this line of investigation one step further. Here the Adult Attachment Interview procedure is applied to the therapeutic relationship it- self--both therapist and patient are asked to provide adjectives to describe one another, to- gether with supporting anecdotes, and are asked
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? ? ? speculate about why they think their patient/ therapist behaves in a particular way. The inter- view is then transcribed and rated in a similar way to the AAI, generating attachment categories and also measures of Reflexive Function in rela- tion to the therapeutic process. A number of in- teresting findings are beginning to emerge.
First, as might be hoped and expected, Reflex- ive Function improves in the course of therapy. Second, good outcomes seem to be associated with therapists who are neither too far behind nor too far ahead of their clients in the PT-AAI scores. A degree of distance between therapist and client is needed, but it must not be too far--for effectiveness therapy should not be too cosy, nor too astringent. Third, the therapist's ca- pacity for Reflexive Function varies from patient to patient. Each therapist-patient pair appears to generate its own particular attachment atmo- sphere and capacity for mentalization, or the lack of it.
All this implies a much more complex and dy- namic relational culture between caregiver and care-receiver (whether parent and child, or ther- apist and patient) than perhaps Bowlby's sugges- tions in the last chapter in this volume suggest.
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? ? ? Tracking the vicissitudes of this relationship is a huge challenge for developmentalists, psycho- therapy researchers, and clinicians wishing to practice and teach their craft. Bowlby was an ec- lecticist par excellence. He had a remarkable ca- pacity to bring together differing discip- lines--psychoanalysis, cognitive science, child de- velopment, ethology, cybernetics--and to weld them into a coherent story.
This eclecticism makes attachment theory hugely attractive to some, but also off-putting to clinicians in search of truths deriving from but one 'God' alone. For our discipline to advance further, another effort of synthesis will be needed, bringing together ideas from neurobio- logy, neuroimaging, linguistics, ecology, and the mathematics of complex systems such as chaos theory. Forging such creative links is a task for the future--one which Bowlby would surely have happily endorsed and be sad to have missed.
JEREMY HOLMES
REFERENCES
Bateman, A. & Fonagy, P. (2004) Psychotherapy for Borderline Personality Disorder. Oxford: Oxford University Press.
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? ? ? Cassidy, J. & Shaver, P. (1999) Handbook of Attach- ment. London: Guilford.
Diamond, D. , Stovall-McClough, C. , Clarkin, J. , & Levy, K. (2003) Patient-therapist attachment in the treatment of Borderline Personality Disorder. Bul- letin of the Menninger Clinic 76, 227-259.
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K. , & Zimmerman, P. (1999) A Wider view of attachment and exploration: sta- bility and change during the years of immaturity. In Handbook of Attachment (Eds J. Cassidy & P.
Shaver). London: Guilford.
Grossman, K. , Grossman, K. , & Kindler, H. (2005)
Early care and the roots of attachment and part- nership representation in the Bielefeld and Re- gensburg longitudinal studies. In Attachment from infancy to adulthood: the major longitudin- al studies. New York: Guilford.
Hesse, E. (1999) The Adult Attachment Interview: His- torical and Current Developments. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). Lon- don: Guilford.
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? ? ? Holmes, J. (1993) John Bowlby and Attachment The- ory. London: Routlege.
Holmes, J. (2004) Disorganised attachment and Borderline Personality Disorder: a clinical per- spective. Attachment and Human Development 6, 181-190.
1
CARING FOR CHILDREN
During the early months of 1980 I was giving lectures in the United States. Amongst invita- tions reaching me was one from the psychiatric staff of the Michael Reese Hospital in Chicago to address a conference on parenting.
AN INDISPENSABLE SOCIAL ROLE
At some time of their lives, I believe, most human beings desire to have children and desire also that their children should grow up to be healthy, happy, and self-reliant. For those who succeed the rewards are great; but for those who have children but fail to rear them to be healthy, happy, and self-reliant the penalties in anxiety, frustration, friction, and perhaps shame or guilt, may be severe. Engaging in parenthood therefore is playing for high stakes. Furthermore, because successful parenting is a principal key to the mental health of the next generation, we need to know all we can both about its nature and about
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