John Holmes’ book serves as a guide to John Bowlby’s research in attachment theory, contextualising it in the history of psychodynamic psychotherapy, and tracing its influences on child development and adult outcome research. Bowlby’s influence extends far beyond psychoanalysis and this volume serves as a concise overview of its importance within psychology, social work and social policy. Holmes vividly contextualises psychoanalysis’s rejection of Bowlby, as arising from a conflict between introspection and empiricism, and between warring factions in the post Freudian analytic world. Yet, this is very much a psychoanalytic reassessment of Bowlby’s work on attachment, trauma and loss, and seeks to place him within the context of the psychoanalytic tradition and contemporary practise.
Bowlby’s work emphasised the importance of infant experience and loss (learning), over the developmental patterns hypothesised by Freud and Klien alike (rooted in instinct). In doing so he demonstrated the importance of real trauma in diagnosis and treatment. Bowlby’s willingness to integrate scientific research findings and methodologies into his theories and practice, remind us of the importance of interdisciplinary awareness. Attachment is one of the best evidenced and most productive theories within psychology (Carlson & Sroufe, 1995), in part due to its relative absence of introspective speculation. Integrative psychotherapy could benefit from connecting to findings from other fields, for example the cognitive biases and heuristics discovered by behavioural economists, and the relational insights identified by social psychologists. Holmes commentary on the history of object relations ideas since the time of Klien, is a useful guide to how their predictions have been supported in the scientific literature (pp7); and he works hard to integrate psychodynamic theories with attachment and loss.
In common with Patrick Casement (Casement, 1990), Holmes argues that interpretations are much less important that the real / working relationship in psychotherapy outcomes (pp8). The difficulty of forming this relationship is determined by client attachment style (moderated by real world trauma), and the therapists attunement to the client’s attachment style and level of emotional and cognitive functioning, as well as their ability to contain the transference (pp154). For Bowlby transference is the employment of outmoded models / assumptions of treatment, learned in childhood, in the new attachment relationship of therapy (pp170). Attachment requires no speculative conception of infant experience, in stark contrast to Klienian and Winnicottian conceptions of early object relations (Winnicott, 1971). Bowlby’s model sees love as a distinct adaptive instinct for physical closeness, separate from the satisfaction of other infant physiological needs and psychological drives (pp64).
The maternal deprivation Bowlby identified as so destructive of children’s capacity to form relationships and healthy object relations, helps us understand the roots of severe behavioural disorder (pp39). It should be kept in mind when dealing with family conflict, especially in an institutional context. He leaves us with an understanding of the necessity for children of some parental contact – even in the most disturbed families (pp43), and the grave consequences of total maternal depravation (pp51). However, Holmes sites Michael Rutter – whose research demonstrates that Bowlby exaggerated the intellectual and physiological damage of one-trial separation, and the specific contribution maternal deprivation makes to the multifactorial causes of delinquency (pp50). On the other hand, evolutionary psychology research has evidenced much greater attentiveness of care on the part of direct relations (Webster, 2004), as well as much higher levels of neglect and violence against non-blood related children (Archer, 2013) – demonstrating the very real danger maternal absence creates, adaptively reacted to by the developing child.
The stages of grief, as described by Bowlby – numbing / denial, yearning for the lost object / anger, despair and reorganisation (of relationship with the inner object representations of the lost external object); provide a vivid template for understanding in adaptive object relations terms, how death and relationship failure can be experienced by clients (pp90), and how this is sensitized by their attachment style and history (pp95). The necessity of experiencing and expressing grief and negative emotions in general, ties into the idea that avoided anxiety perpetuates pathology (Marzillier, 2010). Holmes makes the point that frozen grief can be reignited by further bereavement (pp97), especially in avoidant clients (pp183), something we often see arising in client work. I found Parks’ typology of pathological grief (Parks, 1975, cited in Holmes 1993) extremely useful in understanding varieties of presenting grief in clinical work.
As previously noted, Holmes situates Bowlby and attachment theory squarely in the history and theoretical structures of psychoanalysis (pp128). The book provides a fascinating portrait of the early years of post-Freudian psychoanalysis; helping in the process to explain the differences between Klienian, object relations and classical analysis, and between these schools and attachment’s emphasis on the environmental trauma and empirical investigation (pp130). At the same times Holmes (not always convincingly) attempts to reunite attachment and psychoanalysis – with attachment as cause of dysfunction, and analysis as phenomenology. Holmes comparison of Bowlby’s work with that of Winnicott illuminates their shared emphasis on the practical and emotional need meeting aspects of the primary parental bond (pp138); while clarifying their differences – sexual vs attachment drives, explanation vs understanding, and so on (pp140). Attachment theory provides a new way of thinking about defences – as methods of attempting to ensure the persistence of attachment objects or repress the pain of their absence (pp150).
Holmes points out the contribution of risk and resilience factors in moderating the effects of neglect and deprivation (pp53). He also emphasises the importance of current functioning and the protective utility of contemporary relationships, which can be neglected in psychodynamic therapy (pp54). The effect of loss in triggering and creating vulnerability to psychological disorders, is similarly moderated by (perception of, in other words internalised representations of) relationships that serve as resilience factors (pp182).
Insecure attachment, whether ambivalent, avoidant, or disorganised (pp105) seems to underlie many of the relational difficulties which isolate and make vulnerable to psychological illness, clients in therapy (pp68). Understanding how the real or perceived threat of abandonment or betrayal by attachment figures can provoke rejection, hostility and alienation, can help to understand clients in severe distress – and develop interventions which protect them. This is further clarified by the concept of ‘dissuagement’, relating to the use of defences and compulsive behaviours to sooth the anxiety created by the lack of a secure attachment base (pp71); while at the same time evidencing the utility of therapist providing re-parenting graduated failure, as pioneered by Winnicott and Rogers alike (Winnicott, 1971) – especially the necessity of providing containment while the client projects hostile envious transference (pp88). In common with Karen Maroda (Maroda, 2010), Holmes’ suggests a reflexive approach, where Winnicottian graduated failure is facilitated by openly admitting mistakes in the therapy (pp155). Maternal responsiveness (pp85) shares much in common with Winnicott’s idea of the ‘good enough mother’ scaffolding the child’s emotional and intellectual needs (Winnicott, 1971).
Understanding avoidant and ambivalent attachment in terms of distorted adaptations to chronically inadequate / absent parenting, helps to provide a context for insecurely attached client’s distrustful and aggressive projections (pp79). Seeing attachment as underlying relationship difficulties, can help to justify and shape therapeutic strategies focused around the therapeutic alliance (in Bowblian terms, serving the role of the responsive, secure base) (pp153); as well as providing a theoretical basis for more instructive psychoeducative approaches (pp83).
I found Holmes poststructural justification of the healing powers of psychoanalysis’s hermeneutic approach, supportive of my own developing conviction that psychotherapy is a productive meaning making process, rather than an uncovering of a hidden ‘authentic self’. The utility of psychoanalysis is not in the accuracy of its model of mind, so much as the space it offers for the development of the clients psychical reality in the interpersonal containment of the analytic encounter. In other words – ‘aesthetic’ (p144) self discovery is the goal, rather than ‘scientific’ self understanding. There appears sufficient flexibility within object relations to provide a useful model for clients to employ in the understanding of their developmental conflicts and unresolved ambivalences. Viewing therapy in this way respects the client’s own truth, in all its ambiguity and contradictions. It also acknowledges the inarguable evidence for the impact of demand characteristics / suggestion on the client’s discourse and understanding in therapy. Helping the client to construct a meaningful narrative with which to frame their life, and rebuild the ‘narrative incompetence’ wrought by insecure attachment (pp146), by explicitly revising pathological semantic cognitions (pp158), might well be a useful therapeutic technique. I would distinguish this from the avoidant storytelling that client’s can engage in, with a comparison to Bion’s concept of +K learning / experience (Waddel, 2002), lived and felt rather than merely related and symbolically configured. Holmes’ relates that Bowlby’s later theory emphasises the expression of feelings around loss is as important as the loss itself in developing (and healing) trauma (pp162).
Bowbly’s application of ‘feedback loops’ to psychotherapy, fits into behavioural psychotherapeutic approaches which can be preferred by clients who want a more responsive (though not necessarily prescriptive) approach (pp79).
Bowlby’s great contribution is his emphasis on the importance of nature and intimacy of the early connection between the infant and primary care giver (pp21), and the devastating effects of its disruption. I would endeavour to keep this in awareness, as a tool to both predict and understand adult trauma and attachment difficulties.
Bowlby’s ideas about the roots of attachment style, and the intergenerational transmission of attachment were new to me. Holmes describes specific attachment styles, environmentally learned, distinct to either parent (pp106), emerging within the earliest months of life, from the dyadic interaction of child temperament and parent attachment expressed through consistency of responsiveness to infant needs (attunement – which can be understood as an example of projective identification). Holmes cites research indicating the overwhelming contribution of maternal adult attachment style to this dynamic (pp114). This can help to understand not only development – but the necessity of a client centred dynamic in the therapeutic encounter. It also argues for the efficacy of educative approaches which teach parenting and empathic sensitivity (Lukens & McFarlen, 2004) as well as ‘containment’ and reintegration (pp122).
The books interlinking of problematic child behaviours with attachment style (pp122), has important implications for child psychotherapeutic treatment. Although attachment therapies have been distorted to fit directive, abusive psychotherapeutic approaches (Chaffin et al, 2006).
Holmes interlinking of avoidant-attachment and borderline personality helps expand on the conception of borderline as a learned behaviour involving damaged core self-believes / internalised object relations (Lawson, 2004).
Holmes notes “The relentless interpretation of the transference may hypnotically open the patient up to layers of regression and dependency which make such interpretations self fulfilling prophecies” (pp131). A powerful argument for the tentative, client directed interpretation advocated by Patrick Casement (Casement, 1990, 1995).
I found Holmes’ consideration of the differences between Bowlby and Winnicott in relation to reassurance of client re-experiencing trauma in therapy illuminating. I found Patrick Casement’s Winnicottian approach to a client reliving an extreme childhood trauma (Casement, 1995), worrying and unsafe. Casement explains that this approach is an effort to maintain the ‘omnipotence’ illusion of experience as it was, however from an attachment perspective the degree of physical holding requested by the client was reasonable, and not (in this case) a sexual transference.
Holmes makes a useful distinction between psychoanalysis’s concern with sensation and cognitive psychologies preoccupation with perception (pp170).
Holmes addresses the concerns of the modern reader regarding the primacy and ‘monotropism’ of the maternal bond (pp45), and the potential misuse of Bowlby’s institutional critique to justify austerity (pp46), and paternal absence. However Holmes’ revision of Bowlby’s work and influence fails to address the issues raised by gay parenting, single parent and alternative family structures (pp69). Essentially the particularly of the maternal bond is never elaborated on, and Holmes provides little evidence of the effectiveness or ineffectiveness of its replacement in non-nuclear family structures. It would have been interesting to read about the supportive impact (or its lack) in alloparenting cultures (Ahnert, 2005) – or potential connections between ADHD and avoidant attachment (Ladnier & Massanari, 2000).
I found Holmes contention that narrative coherence is a facet of secure attachment unconvincing (pp110). While the research cited shows clearly that autobiography is more well developed in securely attached children; I’d speculate that novel creativity is frequently higher in insecurely attached individuals, arising from the necessity to create a multiplicity of deep, vivid compensatory narratives to avoid the pain of internal experiences of separation. Little research has been done in this area – but literature has been show to stimulate greater emotional impacts in adults with avoidant attachment (Djikic et al, 2009).
It would have been interesting to read about the ways in which insecurely attached children seek to mollify their attachment difficulties in adolescence through participation in close knit friendship groups / subcultures of like minded teens, and the effect of these strategies (or their absence) in life outcomes. As with Inside Lives (Waddell, 2002), I found Holmes forays into literature, in search of support for attachment / grief (pp98), added little to the book.
While Bowlby’s pioneering family therapy, and the application of attachment to family systems work is fascinating (pp176), I don’t find concepts linking individual / family dysfunction and wider social cultural functioning convincing or predictive. The idea that social problems are the result of subgroups of poorly attached individuals failing to follow the prevailing social agenda (pp202), is both anodyne and paternalistic – ignoring the very real inequalities mentioned by Marris (Marris, 1991, cited in Holmes, 1993) in the ‘competition for security’ underlying class and ethnic conflicts.
Holmes’ book is a marvellously succinct synopsis, not only of Bowlby’s enormous body of research, but also its influence and antecedents. Moreover, the book is coherent, clearly written and above all entertaining (especially when describing Bowlby’s eccentric and rarefied upbringing). Like many great psychotherapists, from Sigmund Freud to Albert Ellis, Bowlby’s theories were influenced as much by his personal experiences as his intellectual influences. Holmes does a good job of showing the roots of insecure attachment and grief in Bowlby’s own life and maternal relations (pp23, 26). He also gives reasonable space to research which has critiqued and refined Bowbly’s ideas, and the impact of those ideas on our management of children. Holmes’ detailed investigation of the implications of attachment theory for psychoanalysis, especially in relation to the real / working relationship, are invaluable. He addresses the most productive interventions and relating style when working with clients across a range of levels of attachment difficulty and environmental insult (pp154). The detail and variety of references and observations in the book make it one to which I will inevitably return.
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