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The Attuned Therapist - Page 2

The Ascent of Attachment Theory

In the 1970s and early '80s, the groundbreaking innovations influencing clinical practice came not from the attachment literature, but from the iconoclastic rebels promulgating the gospel of family systems theory. Figures like Salvador Minuchin, Murray Bowen, Jay Haley, Virginia Satir, and Carl Whitaker became the role models for a generation of clinicians, followed during the '80s by more schematic, minimalist, and pragmatic therapies, like brief solution-focused therapy and Cognitive-Behavioral Therapy. As the quiet, blank-screen demeanor of psychoanalysts eternally waiting for their clients to gain insight became passé, what united the new generation of innovators, whether the whirling dervishes of family therapy or the mild-mannered, systematic interviewers of solution-oriented work, was a focus, not on the ancient past, but on what they could make happen in sessions right then.

In those days, attachment theorist John Bowlby's name or work was seldom mentioned in clinical circles; much less did it appear on any training curriculum. Nevertheless, Bowlby had been developing his theory for decades. Even before training as a psychiatrist, he did volunteer work at a residential school for maladjusted and delinquent children, concluding that the complex behavior of these children—not only their delinquency, but their anger, unpredictability, and rejection even of those who tried to befriend them—was directly related to their early emotional deprivation. As a young psychiatrist, he believed that psychoanalysis emphasized the child's fantasy world too much and what actually transpired in the child's everyday life too little. The prevailing assumption, for example, was that the child's bond with the mother was based on the association of mom with food—kids missed the breast, not the breast's owner. It was what Bowlby waggishly referred to as the "cupboard love theory of infant love."

In 1944, he prepared what would become a classic paper, "Forty-Four Juvenile Thieves, Their Characters and Home Lives," based on case notes made during a stint at the London's Child Guidance Clinic, in which he determined that the children who habitually stole had suffered the most maternal deprivation—most of them institutionalized or hospitalized for much of their early years and rarely visited by family. Emotionally damaged and undemonstrative, they felt no affection for anybody, demonstrated no sense of shame or responsibility, and were, in effect, young psychopaths. After the war, he went to work at the Tavistock Clinic to head the Children's Department, which he promptly renamed The Department for Children and Parents—to highlight his belief that parent–child interactions were critical to the child's development.

His work on delinquents brought him to the attention of the World Health Organization, which asked him to prepare a report on the mental health of the hundreds of thousands of children rendered homeless by World War II. Titled Maternal Care and Mental Health, it drew on interviews with child psychiatrists, pediatricians, and social workers in Europe and America who actually worked with homeless children (unlike the methodology of most analysts or learning theory researchers, who largely rejected Bowlby's conclusions). Through the preparation of this report, Bowlby came up with what would be his lifetime thesis: the loss of a mother figure at a vulnerable age was far more distressing and potentially psychologically damaging than previously recognized. "The young child's hunger for his mother's love and presence," Bowlby and his colleagues suggested, "is as great as his hunger for food." Its absence "generates a powerful sense of loss and anger." Furthermore, Bowlby, et al., continued, the "responses and processes" seen in these children deprived of their primary caregivers "are the very same as are known to be active in older individuals who are still disturbed by separations that they suffered in early life."

By this time, Bowlby's research was convincing him that humans developed not as individual monads, struggling against their own aggressive impulses toward civilization—the psychoanalytic view—but as members of interacting systems. The human infant didn't, in fact, yearn for "the breast," as child psychologist Melanie Klein had it, but for the one and only human being whose breast it was. "This profound attachment to a particular person," wrote Bowlby in 1956, "is both as strong as, and often as irrational as, falling in love, and the very similarity of these two processes suggest strongly that they may have something in common." Finally, the source of psychopathology wasn't to be found in internalized Oedipal conflicts, but in failed or unavailable infant and early childhood attachments.

Bowlby's work was greeted by his psychoanalytic colleagues with a mix of indifference and hostility, which would last until roughly 1980. Even Bowlby's own analyst opposed his ideas. "Psychoanalysis," she wrote, "is not concerned with the real world. . . . It is concerned simply and solely with the imaginings of the childish mind." Psychoanalyst Anna Freud reacted similarly, arguing that psychoanalysis doesn't "deal with the happenings in the external world as such but with their repercussions in the mind." Even pediatrician and psychoanalyst D. W. Winnicott, with his "holding environment" and the "good enough mother"—concepts that seemed to have affinity with Bowlby's ideas—said once, "I can't quite make out why it is that Bowlby's papers are building up in me a kind of revulsion." Actually, the reason for Winnicott's "revulsion" seems obvious: Bowlby's ideas threatened the whole edifice of orthodox psychoanalysis. Winnicott himself admitted in his comments about one of Bowlby's papers that "It was certainly a difficult paper to appreciate without giving away everything that has been fought for by Freud."

Meanwhile, supported or not by the establishment, Bowlby was gathering his own troops together to develop a full-fledged theory of attachment and loss. He wanted to know what the process of normal and abnormal attachment looked like—what actually happened, moment by moment, between mother and child—so he could explore how it affected emotional development. Probably his most famous colleague was American developmental psychologist Mary Ainsworth, who studied with him at Tavistock, then spent two years in Uganda researching mother–child interactions. Returning to America, and taking a teaching job at Johns Hopkins University, she documented thousands of hours of home observations of mother–child behavior.

As a long-distance colleague of Bowlby's, during the 1960s, she devised the Strange Situation experiments, based on his principles, which documented a series of separations and reunions between mothers and their very young children in a controlled setting (see p. 31). Drawing inferences about the quality of mother–child attachment from these experiments, Ainsworth concluded that there were three types of attachment relationships: secure, insecure-avoidant, and insecure-ambivalent.

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