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The Attuned Therapist - Page 7

What's Wrong with This Picture?

It's easy to see why attachment-based therapy appeals to so many therapists. Unlike many clinical approaches, it derives from an apparently robust scientific theory of human development and seems compatible with findings from neuroscience about the way the brain processes emotion. At the same time, it seems to restore not only "deepness" to therapy, but its heart and soul—feelings!—all of which many have felt had gone missing from many years of formulaic, highly technical cognitive and behavioral approaches. Emotion, depth, an awareness of psychobiology, scientific respectability—what's not to like in attachment-based therapy?

Quite a lot, according to some critics. Family therapy pioneer Salvador Minuchin suggests that in focusing so intensely on the early mother-child bond, attachment-based therapy neglects a vast range of important human influences and experiences "The entire family—not just the mother or primary caretaker—including father, siblings, grandparents, often cousins, aunts and uncles, are extremely significant in the experience of the child," says Minuchin. "And yet, when I hear attachment theorists talk, I don't hear anything about these other important figures in a child's life."

It's not just the family that vanishes in this kind of therapy, according to Minuchin. "Certainly a stable early environment is important, but focusing so much attention on attachment issues can make compelling social and racial issues simply disappear. It can take us back to the heyday of psychoanalysis and deny the full familial and social reality of children's lives, as well as obscure our understanding of the context in which they grew up."

Minuchin also wonders whether the therapist in attachment-based work can become too important as the central, perhaps only, reparative figure in the client's life. "The therapist selects the qualities of affect, cognition, and mood regulation that the patient needs," he says. "Systemic therapists, on the other hand, don't believe that the therapist should play such a central role, but try to use the person's present relationships—the full range of them—to renegotiate problems arising from past experience."

Finally, attachment-based therapy for children or adults, in Minuchin's view, too often seems to implicitly assume that attachment "wounds" are the result of childhood trauma. "These days therapists too often talk as if child therapy is the same thing as 'trauma therapy,'" he says. "But, the danger of focusing so much on trauma is that you develop the view that trauma is somehow the human condition, rather than occasionally a part of it. It is always tempting to make an entire psychotherapy theory from cases of the most extreme pathology."

If Minuchin doesn't think attachment-based therapists fully recognize the role of family and society in the making of the young human being, psychologist and sex therapist David Schnarch suggests that it can keep adult couples stuck in the role of perpetually needy children. Author of the bestselling Passionate Marriage and several other books, and founder of a tough-minded, differentiation-based approach to couples' counseling, Schnarch believes that relationship failure stems not from lack of emotional connection between partners—the focus of attachment-based therapy—but too much of the wrong kind. Partners become enmeshed, lose a sense of selfhood, and depend on positive reinforcement and reassurance from each other because they can't soothe their own anxieties, and then have relationship difficulties when both demand validation from the other but neither will give it. Each partner needs, in effect, to grow up, learn to tolerate anxiety, and take charge of him- or herself before they can fully connect with the other.

Schnarch says that couples come to see him on the brink of divorce, whose own therapists told them not to see him, since they needed to attach before they could differentiate. This is exactly backward, he says. "Adults don't need to go back and attach—that is not the right approach and just reinforces weakness, fragility, and dependency—characteristics of the emotional fusion, connection in the absence of differentiation, that is causing the problems in the first place. The solution is not to get them even closer together. Attachment-based therapy plugs together troubled couples only as long as they mutually validate and stroke each other, move in lock step, and keep on doing it. It encourages co-dependency, which will organize functioning, but that doesn't mean it's good."

What Schnarch calls "attachment hegemony" is also out of sync with ongoing social and cultural evolution, he argues. "Attachment is an adaptation for when we lived as small, tribal, hunter-gatherer societies, in small, intact clan groups—it was designed by evolution to keep couples together four to eight years, just long enough to get kids born, weaned, and surviving. Now, marriage has fundamentally changed—it's no longer physically necessary for survival. What keeps couples together now long-term is their marital happiness and things like desire, intimacy, and good sex. But genuine intimacy and desire in committed relationships are driven by differentiation—the emergence of the adult human self—which attachment-based therapy doesn't address."

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