Do We Still Need Attachment Theory?

Five hundred people sat in a packed workshop at the 2010 Networker Symposium, 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. 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.

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. 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?

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?

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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."

The Emotional Revolution

Whether or not attachment-based approaches improve the effectiveness of psychotherapy, they do seem to have already gone a long way to transforming our notions of what constitutes the real McCoy for clinical practitioners. It's a long way from the coolly analytical, talky, left-brain therapeutic ideal of decades past to the far more intuitive, nonverbally adept, emotionally tuned-in therapist envisioned within the emerging attachment-based paradigm. After decades of cognitive and behavioral scientists purposely seeking "to put emotions out of sight and out of mind," says neuroscientist Jaak Panksepp, they're being forced to "relearn that ancient emotional systems have a power that is quite independent of neocortical processes." In our increasingly technological world, therapy seems to be directing our attention to the very core of our primeval being, the "ancient emotional systems" that are the source of love, hatred, rage, desire, compassion, of our unquenchable need for connection with others of our own species.

From our very first mother–infant bond, we experience relationships in this same, still mysterious, primarily physical way as did our primitive hominid ancestors. Like them, we look into each other's eyes, we smile and gesture, touch and stroke each other, make soft, friendly sounds, breathe in each other. Through these ancient signs and signals, we come, as they did, to know each other and by knowing each other we come to know ourselves.

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