Attachment-Based Psychoanalytic Psychotherapy

What is Attachment theory?

I did my Psychoanalytic training at the Bowlby Centre in London.  This training organisation was set up to provide a Psychoanalytic training which is heavily influenced by the work of John Bowlby, who was the originator of ‘Attachment theory’.  In the 1950s, Bowlby did pioneering work and research with children and young people, looking at the importance of the nature of our earliest relationships or ‘attachments’. In a nutshell, what he discovered was that a strong and secure attachment, or ‘secure base’ with our caregivers in childhood is vital for every aspect of life. This includes our sense of ourselves, our physical and psychological development, our self- worth, and our ability to build and maintain secure and healthy relationships with other people. It is also the key to our creativity, and to our ability to reach our potential as individuals. Since then Bowlby’s ideas have been expanded upon by the work of many other psychological theorists, researchers, and therapists, and we now understand that secure attachments are vital, not just in infancy and childhood, but throughout life.

What is Attachment-Based Psychoanalytic Psychotherapy?

Attachment-Based Psychotherapy is based upon this understanding that people come into the world with both the need, and the ability, to make strong and secure relationships with others.   When people suffer the pain of loss, neglect or abuse; or they have generally felt unsupported by the people they expect and need to love and care for them, this can lead to many psychological difficulties.  These difficulties include low self-esteem and feelings of shame, feeling unhappy, lonely, depressed, anxious, and problems in making and maintaining healthy and reciprocal relationships with others.

Like other psychoanalytic approaches, Attachment- Based therapy is designed to address and remedy these issues at a deep level.  It does this by providing a secure, confidential and understanding ‘attachment relationship’ in therapy in which people have the opportunity to share their thoughts and feelings. I see therapy as a joint venture, in which the therapist and the ‘client’ or ‘patient’, work to identify and to understand the nature of the ‘unconscious’ and repeated patterns of thinking, feeling and behaviour which have contributed to, and perpetuated their difficulties.  An example of this would be that someone has the ‘conscious’ agenda and belief that they want, and deserve, to be treated well by others, but find themselves ‘stuck’ in a cycle of abusive and distressing patterns of relating. This may then have served to perpetuate their low self-worth, and their lack of trust in themselves and others.  These patterns often stem from having suffered abuse or neglect, or simply just not having felt secure and loved enough in childhood; but not having fully understood or accepted what the impact of this has been at a deeper level.  Revisiting this experience, and the suffering it caused, and feeling understood and supported in therapy, provides the opportunity for a reparative and healing experience.  People can then begin to understand why and how they have ‘unconsciously’ repeated certain patterns, to  grieve over what they have suffered, to feel more understanding and  forgiving towards themselves,  and consequently, to feel freed up to make better choices.   

One of the things I really like about Attachment-based therapy is that it puts a strong emphasis on the understanding that patterns/dynamics which seem to be unhelpful, were once vital in helping people to feel more secure and connected with their caregivers as children; It also recognizes and honours our longing, and our ability, to recover from trauma and neglect, and to go on to make a better relationship with ourselves and with others.  

Working at this depth takes time and commitment on the part of both the patient and the therapist.  This being the case, it is necessary to meet at least once a week, and sometimes more often than this if someone’s difficulties are very deep-seated and complex, in order for the therapy to be safe and effective. This regularity of meeting helps people to feel secure and contained psychologically, and that there is a sense of continuity to the work.   Even when someone misses an appointment, this needs to be thought about in the context of the therapy, and whether or not there is an ‘unconscious’ meaning attached to it. This being the case, the fee for the appointment is payable for any missed appointments. This serves to keep the therapy in place, and to protect the ongoing work in the therapy. This is common practice for most Psychoanalytic psychotherapists.