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|The Attuned Therapist|
The Attuned Therapist
Does attachment theory really matter?
by Mary Sykes Wylie and Lynn Turner
Five hundred people sat in a packed workshop at the Networker Symposium last March, listening to eminent developmental psychologist and researcher Jerome Kagan draw on more than four decades of research he's conducted as he discussed the clinical relevance of inborn temperament. Midway through the session, responding to a question from the audience, he tried to clarify an earlier, seemingly disparaging, comment he'd made about attachment theory. But he soon removed any possible doubt about where he stood. "I'm glad that attachment theory is dead," he said. "I never thought it would go anywhere."
There was a moment of stunned silence, followed by a low hum as people shifted in their seats and murmured to each other. Whatever their imperfect understanding of the voluminous research literature of attachment theory, for most therapists in the room, the idea that the early emotional attunement of a mother/caregiver (or lack of it) profoundly affects the child's psychological development was as self-evident as the worthiness of therapy itself. Indeed, during the last 15 to 20 years, attachment theory has exerted more influence in the field of psychotherapy than just about any other model, approach, or movement. Though not a clinical methodology, it has justified a whole range of therapeutic perspectives and practices. Among them are a particular sensitivity to the role of traumatic or neglectful ties with early caregivers; the fundamental importance of affect regulation to successful therapy; the importance of establishing relationships with clients characterized by close, intense, emotional, and physical attunement; and the ultimate goal of recreating in therapy an attachment experience that makes up, at least to some degree, for what the client missed the first time around. That attachment theory itself has amassed a vast body of empirical evidence (see p.34) is often taken, by extension, to cast a glow of scientific credibility on attachment-based therapy. So when Kagan delivered his offhand rebuke, he was raising fundamental questions about the evidence supporting findings that most therapists there considered not just theory, but well-established fact.
Suddenly, in the wordless void that followed Kagan's bombshell, psychiatrist, brain researcher, and staunch attachment theory proponent Daniel Siegel popped out of his seat, looked for a floor microphone to respond, and, finding none, strode up the center aisle and bounded onto the stage. As a startled Kagan looked on and the entire ballroom audience sat dumbfounded, Siegel, the conference keynote speaker from that morning, asked for a microphone and announced: "I can't let this audience listen to your argument without hearing the other side. Have you actually read the attachment research?" he demanded of his colleague.
There followed a heated, impromptu debate between the two men that later became the talk of the conference. Part of the buzz was because it was a disagreement between two stars—Jerome Kagan, arguably the most revered developmental psychologist in the world, and Daniel Siegel, one of the most influential thinkers and teachers in the field of psychotherapy today. Each brought to bear both an impressive resume and passionately held convictions on the age-old question about human development: which counts more—nature or nurture? Beyond its sheer drama, two things stood out about this spontaneous encounter—the surprise that a discussion of research findings could generate such intellectual fervor at a psychotherapy conference and, for the majority of the audience, the shock that there was any debate at all about the role of early experience in human development. It was as if a leading biologist had gotten up at a professional conference to denounce germ theory.
In the world of psychotherapy, few models of human development have attracted more acceptance and respect in recent years than the centrality of early bonding experiences to adult psychological well-being. Nevertheless, the Kagan–Siegel encounter brought to the surface a barely visible fault line between true believers in attachment and its doubters, who not only question the idea that the quality of the mother-child attachment always and permanently affects a child's psychological development, but whether attachment theory itself has had a positive or negative influence on the practice of psychotherapy. It raised the question of whether the growing centrality of attachment theory has begun to blind the field to other vital influences on a person's development—inborn temperament, individuation needs, family dynamics, even class and culture—which all lie outside the mother–child dyad.
But what on earth could ever be wrong with emphasizing early bonding, connection, and relationship as the foundation of all good therapy? Are there ever times when too much "attunement" and "empathy" can constrict a therapist's clinical repertoire and obfuscate the issues with which clients should deal? For those for whom this debate focuses on a theory that wasn't even on their grad-school curriculum, what's all the fuss about, and what exactly does attachment theory tell us that we haven't known since the days of Freudian analysis?