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This erudite but accessible guide to “attachment in clinical practice” is a book that I—and no doubt other attachment-oriented therapists—have long been waiting for. It is a rich repository of diverse experience and knowledge gleaned by “an international roster of expert clinician-researchers” (p. xix). They include psychologists, psychiatrists, nurses and psychotherapists using psychoanalytic/psychodynamic, cognitive-behavioural, systemic, and more integrative approaches. The contributors have skilfully built on and updated John Bowlby's seminal work to make attachment theory even more relevant in the twenty-first century by applying it to a wide range of clinical issues and contexts. As Brent Mallinckrodt suggests in the Foreword (p. xx): attachment theory itself “has now become an established ‘secure base’ for the application of clinical practice”.
The book explores the centrality of the therapeutic relationship through assessing the adult attachment styles and needs of not only the client, but the “concordant” or “complementary” responses of the individual therapist and, indeed, of the organisational culture, and their helpfulness or otherwise in dealing with various clinical issues. These include depression, anxiety, psychosis, dissociative disorders, so called “personality disorders”, eating difficulties, and medically unexplained symptoms (MUS). The relevance of attachment theory to working therapeutically with difference in gender, culture, and ageing and in institutions is also explored.
Drawing on post-Bowlby and current attachment research, Jeremy Holmes (p. 17) provides a very helpful theoretical overview and reminds us that “threattriggered attachment behaviours and exploration are mutually exclusive”, and that “the basic interpersonal architecture of therapy is: a) a person in distress seeking a safe haven, in search of a secure base; b) a caregiver with the capacity to offer security, soothing and exploratory companionship; and, c) the resulting relatio