Attachment Theory

Working Towards Learned Security

Rhona M. Fear

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429911057
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book covers the groundbreaking concepts in attachment theory, as promulgated by Bowlby himself and during the years post Bowlby. It sets out to develop the seminal concept of 'learned security': the provision of a reparative experience of a secure base by the therapist so that the client can imbibe what he missed out on during his formative years. Rhona M. Fear points out that the idea of learned security has developed from the concept of earned security but is distinctly different. In Part I, Fear outlines the origins and progress of attachment theory and the concepts of earned and learned security. In Part II, she uses a process of dialectical thinking to put forward an integration of Kohut's self psychology, Bowlby's attachment theory, and Stolorow, Atwood and Brandchaft's intersubjective perspective. The unifying concept that binds these three theories together is that of empathy, but she puts forward a particular intersubjective, collaborative view of empathic attunement.

Part I
Attachment Theory as the Underlying Basis of the Theory of Learned Security

CHAPTER ONE
Origins of attachment theory

Introduction

Attachment theory, as first developed by John Bowlby, is at the very heart of this book. It is to John Bowlby that I owe the nascent ideas that led me to develop an integration of three psychoanalytic theories (described in Chapter Eleven) which, when employed in concert, I believe to be more effective in enabling the healing process of my clients to take place than if one employs a single theoretical model. I undertook to write this book in order to share with a wider audience of practising psychotherapists and counsellors this integrative approach to psychotherapy. I hope that it may encourage further debate that will lead to further development.

This book is an attempt to present the underlying ideology that has been born over many years as a practising psychoanalytic psychotherapist. Above all, the theory of learned security represents a summation of the way in which I think psychotherapy can best function as an effective instrument, carefully crafted by the therapist and used with skill to assist her client to develop a clearer sense of “auto-biographical competence” (Holmes, 2010, p. 49) and a stronger and more sustainable sense of self by the time he ends long-term therapy. These two aims—autobiographical competence and the ability to feel secure within oneself—are, to my mind, the most important gains of long-term therapy. They are frequently not the stated, conscious aims of the client, who might often actually present with more pressing concerns about external environmental factors which are troubling him.

It is my contention that it is one of the foremost aims of many therapists, though perhaps not always consciously recognised, to help the client move from a fractured, conflictual approach to relationships to a more satisfying way of relating. The conflictual mode of relating is almost always evidenced in the very first few sessions of therapy, embroiled in the issues with which the client presents. In my experience of over twenty-seven years in practice, the presenting problem is nearly always due to difficulties in relationships, whether these relationships concern a core partnership, interactions with a child or another family member, or, alternatively, with individuals at work or within the social milieu. Thus, I believe that one needs to tackle the way in which the client relates to others, and, of course, this will be revealed in the “here and now” of the transference and countertransference, and by the growth of the real relationship which underpins the working alliance.

Attachment theory: the precedence of external traumata

I am concentrating here upon attachment theory, so it seems expedient to talk about John Bowlby’s life from a psychodynamic perspective, in order to provide some insight into the reasons that Bowlby perhaps devoted his time to the invention and development of attachment theory and its clinical applications. In so doing, Bowlby’s career involved him in a grand schism with the majority of the psychoanalytic world, including The Psychoanalytical Society and its main proponents. The inevitability of the schism essentially lay in the fact that Bowlby believed that environmental failures were pre-eminent in adversely influencing the mental health of individuals, rather than a person’s intrapsychic phantasies and motivations being at odds with his expressed conscious intentions and stated aims. In short, the client is understood by traditional psychoanalysts to be suffering from intrapsychic conflict rather than the result of environmental failure. In addition, Bowlby also believed that psychoanalysis, by the mid twentieth century, had lost its scientific basis, as put forward by Freud, and had been replaced by the intuitive and hermeneutic approach of Melanie Klein and Anna Freud.

In contradicting the underlying philosophical assumptions of traditional psychoanalysis, Bowlby attacked the basic tenet of psychoanalysis, and has never been forgiven. Some rapprochement has been seen over the past sixty years, but it is my guess that even this book, which adheres to the Bowlbian principle that environmental failure is more important than, or at least as important as, intrapsychic conflict will be poorly received in some circles. It has been my own experience, during my training as a psychoanalytic psychotherapist in the 1990s, to find the theoretical ideas of Bowlby dismissed as banal and bland. I had intended to write my second year extended theory essay on attachment theory, and was told in no uncertain terms that this would not be well received and I should consider another subject.

Furthermore, when I was undertaking an assessment during my training, I presented a patient who had suffered from extreme environmental traumata, through the horrific death of both of his parents when he was a teenager. Following this trauma, my patient was later affected directly by two close friends’ attempted suicides. During the presentation of the case at my interview, I recalled that he cried for the first time ever during this session with me, believing it to be an important moment of emotional cathexis. I believe that when a client starts to feel safe and securely held in therapy, then he starts to be able to voice his deepest anxieties and hurts. For this reason, I believed that my client being able to cry, for the first time ever, represented a defining moment in his therapy. However, the assessor did not agree with me, probably because she gave no credence to attachment theory or the growth of an affective relationship between client and therapist. She focused entirely upon the negative transference, saying that my client was simply seeking to satisfy me by acting out a show of being upset. I was told that I should have tackled the negative transference and not have been taken in by my client’s distress. I am speaking about the reality, prevalent in the 1980s and 1990s when I trained, when clients were referred to with a very superior and arrogant tone of voice; clients seen as being intrinsically less “knowing” than our selves as psychoanalytic psychotherapists. I am not alone in this view; Gerhardt (who also trained in the 1990s) speaks similarly in her chapter in Odgers’ (2014) book, where she describes a supervisor instructing her very clearly “to destroy her client’s masochism” (my emphasis).

In fact, research shows that there is an inverse correlation between repeated insistence on interpreting the negative transference and drop out in therapy because the client experiences therapy as punitive. Personally, I am not surprised by this summation. The use of unkind language, which has been used on some courses (which also tend to give apostolic power to senior analysts) by the reference to their clients as “babies” and “victims” has a knock-on punitive effect upon the actual therapy relationship in the consulting room. If we refer to our clients privately in such negative terms, and with a superior demeanour, we cannot hope to enable the client to gain a sense of “learned security”. The real power of the therapist lies not in being the only one who “knows” the “unthought known” (Bollas, 1987), but in the fact that she is the supplier of the “secure base” (Holmes, 2010, p. 6). Unless the client can gain a sense of security, their accompanying anxiety will be such that they are unable to voice the true feelings and beliefs that will enable them to work through their neurosis, assisted by the making of the unconscious conscious.

It was my contention, at that assessment, that my client had formed an internal working model of relationships in that he believed there was intrinsically something so abhorrent about him that each individual with whom he became involved took it upon themselves to leave him. It was this interpretation, rather than some deep Kleinian transference interpretation, that I thought more applicable at that point in the therapy. I believed that by this interpretation, I gave to my client the power that comes with knowledge: having started to make the unconscious conscious, he would then have the choice to continue to think that way about his life, or the choice to reassess and continue from thenceforward differently.

In The Oedipus Complex: Solutions or Resolutions? (Fear, 2015), it will be seen that I give due credence to intrapsychic conflict. An Oedipus complex manifests itself in the transference as well as in the client’s everyday life, and is the result of intrapsychic conflict. Six case studies therein provide detailed analysis of how the work in the transference led to a more permanent resolution of oedipal conflict for each of these clients with whom I worked.

However, it is my contention that we must work towards an integration of theories, where we accept that the anguish that individuals suffer is a mix of both intrapsychic and interpersonal conflict. I have written previously (Fear & Woolfe, 1996, 1999, 2000) of my determination and my wishes to pursue a philosophical path via a process of dialectical thinking. It is through thinking dialectically that one can look for a common range of concepts that, employed together, marry up seemingly irreconcilable differences. I voyaged some way down the path of dialectical thinking in an earlier paper (Fear & Woolfe, 1996), as I mentioned in the Introduction.

I have remained, throughout the intervening twenty years, a staunch believer in the centrality of attachment theory, and in John Bowlby’s ideas. But, first of all, it is to John Bowlby’s life story that I turn, in order to explore his own psychodynamic history. I hope that, in so doing, we will be better able to appreciate why this enigmatic man, so sensitive to the emotional needs of others and yet so unable to share his own feelings with his contemporaries, devoted his life to the pursuit of a world in which privation of emotional nurturance from one’s mother would become a thing of the past.

A psychodynamic approach to John Bowlby's history

John Mostyn Bowlby was born on 26 February 1907 to May Mostyn and Major-General Sir Anthony Bowlby (1855–1929), who had been rewarded with a knighthood for his appointments as Royal Surgeon to King Edward VII and King George V. Sir Anthony had only felt himself free to look for a wife following the death of his widowed mother. He had appointed himself as the latter’s carer, after the murder of his father in Peking in 1861 when he was a small boy.

John was one of six children, his parents being middle-aged when he was born: his mother being forty when she gave birth to him, his father fifty-two. As so many parents of their class and generation, they left the care and upbringing of their children mainly to a succession of trusted nannies, servants, and the rigid discipline of boarding schools. As a consequence, it might well be appropriate to surmise that John Bowlby suffered the maternal deprivation that he found so abhorrent and which motivated him to campaign for radical change to the circumstances in which children were brought up. In 1944, he wrote “Forty-four juvenile thieves: their characters and home life”, a paper about the way in which ten of the twelve of those whom he termed “affectionless psychopaths” had been subjected to the protracted loss of maternal care during their childhoods. Admittedly, in contrast, John had a physically available mother. (His mother was available for an hour from 5.00 p.m. to 6.00 p.m. each evening after nursery tea, so, at times, she was physically available!) It is questionable, however, whether she was really emotionally available to him. Father, too, was an unavailable, distant object, having given most of his time to his vocation. John’s upbringing meant, in reality, that while he remained a devoted campaigner for the rights of the child, sensitive and with “an inner calm” (Phelps Brown, 1992), he would allow few people to get close to him. It is possible that if he had undertaken Mary Ains worth’s strange situation test, he would have been categorised as insecure–avoidant (I define this typology later in this chapter). This is as a result of having a carer who was only available on her terms. He was, thus, unsure, I surmise, whether he was ever going to get the attention he desired. Again, had he submitted to Main’s adult attachment interview (AAI), he might well have been analysed as distant and unemotional, and not very responsive or attuned as a parent himself. This could well be because it would have been too embarrassing to admit to any level of vulnerability. One can also surmise that he felt very severely the lack of a close emotional bond with either his mother or father, and, undoubtedly, it was this that partially motivated him to pursue the innovative and unique path that he trod, resulting in a silver lining to the cloud for all of us in the psychoanalytic world.

John grew up alongside one particular brother, Tony, and a very competitive relationship developed. This affected him significantly. Tony was thirteen months older than he, but the two were often treated as twins. In consequence, John was forever caught up in a struggle to be “equal” or “better than”. Tony was destined to follow his father into medicine, but chose not to, in order to perhaps avoid feelings of failure in comparison to his father’s prowess. This left the path to a career in medicine open to John, and, following a false start in a naval career at Dartmouth, he went up to Trinity College, Cam bridge. There, he read for a first class honours degree in pre-clinical sciences and psychology.

It was expected that he would then go to London and study clinical medicine, but, ever the renegade (if quietly so), he sought a position in a progressive school for maladjusted children. While there, two experiences radically affected his entire professional career thereafter. First, he found that he could communicate with the disturbed children at the school, and found, moreover, that their psychological problems seemed to be linked to their unhappy and disrupted childhoods. This factor was to direct his course, like a compass, for the remainder of his professional days. Second, he met and became friends with John Alford, who himself had enjoyed some personal therapy, and who advised John to undertake training as a psychoanalyst. Again, per haps because of both his level of interpersonal and intrapsychic conflict, John found the path to analysis inviting at a personal level.

While at University College London (1929) during his clinical medical training, he entered the Psychoanalytic Society and undertook analysis with Joan Riviere, a friend and follower of Melanie Klein. After medical qualification in 1933, he went to the Maudsley, where he started training as an adult psychiatrist. He qualified as an analyst in 1937, and immediately commenced training in child analysis with Melanie Klein. While he believed in the practical efficacy of analysis, he questioned its theoretical underpinnings for two reasons. First, he felt that, under the directions of Anna Freud and Melanie Klein, analysis had become a discipline removed from the rigours of science, relying far more on intuition and intellectual premise. Second, he disagreed (as I have stated before) with the primacy given to intra psychic conflict and phantasy, and to Freud’s “homuncular” model (that is, that each developmental stage is predetermined and succeeds the previous one in a pre-existing planned order). Instead, he felt that each individual develops in his or her own particular way, at a varying rate (an epigenetic model), and that environment rather than the internal world of phantasy is of paramount importance to the development of the human being.

Despite his misgivings concerning the Psychoanalytic Society, and his continuous disquietude with the prevailing attitudes, Bowlby was elected as Training Secretary in 1944, although he was not an appoin ted training analyst. He disliked the fact that the Society dissociated itself from the beginnings of the National Health Service (NHS, which was clearly going to come into being (as it did in 1948) following the Second World War, and it seems to me that, in consequence of this, psychoanalysis did itself a grave disservice.

We have all suffered the legacy of the arrogance of this attitude, for, as a result, psychoanalysis and psychoanalytic psychotherapy (by association) have never been politically accepted by government, whatever party may be in power. Contrast this with the profession of psychology, which aligned itself to the NHS, in consequence of which it is an accepted part now of NHS provision in the field of mental health, especially since the implementation of the Improving Access to Psychological Therapies (IAPT) programme. Concomitantly, psychologists in NHS practice or private practice can charge far higher fees than qualified analysts or psychoanalytic psychotherapists, despite the latter groups’ difficult, equally arduous and expensive training. This, it seems to me, is the political rationale for this discrepancy, which clearly exists, despite the evidential fact that neither psychologists nor psychoanalysts are qualified to prescribe medicine, or, de rigueur, receive a medical training.

In 1944, Bowlby had to read a paper to the Psychoanalytic Society in order to achieve full voting rights. He prepared and then read his seminal paper, “Forty-four juvenile thieves: their characters and home life” (Bowlby, 1944). In this paper, he made the point that of twelve “affectionless psychopaths”, ten had suffered maternal loss under the age of ten. In similar vein, forty per cent of them had suffered severe maternal deprivation and, as a result of this (he believed), there was a correlation between deprivation and alienation and anomie regarding societal norms. While such small sample numbers, without any con trol groups, would not be accepted as statistically significant nowadays, the evidence was convincing enough to have an impact in the 1940s. However, the Society disliked Bowlby’s emphasis on the effect of environment rather than intrapsychic conflict as the cause of neurosis, and he was noticeably shunned and marginalised.

Further papers, presented between 1957 and 1959, led to debate but little enthusiasm, and downright hostility from the Kleinian con tingent. Note that I was in receipt of the same hostility in the 1990s during my training. It makes me wonder whether the prevailing ide ology in psychoanalysis has really changed. Jeremy Holmes is a little more optimistic than me. He writes, in John Bowlby and Attachment Theory,

But times have changed. The old certainties no longer hold. Psycho analysis has lost its dogmatism and is much more open to empirical evidence and to c...