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I noted with interest Jill Brown's (1997) response to my paper ‘An attachment-based approach to working with clients affected by HIV and AIDS’ (Purnell 1996). There are a number of points which she raises to which I feel it would be helpful to respond.
I do agree with Brown that the paper which I presented made psychotherapy with HIV-affected clients ‘sound like extremely hard work’. It can be, but to suggest that this work was ‘driven by anxiety and, possibly, a need to counter the negative transference’ is plainly inaccurate. What it reflects is the complexity of issues - biological, psychological and social - which need to be addressed when working with this particular client group. It is not collective anxiety which has led to the development of the ‘new model of counselling’ which she questions the need for, but a recognition that old paradigms do not adequately meet the challenge which HIV and AIDS present.
Perhaps this is also where some of Brown's difficulty with what I am saying lies. The attachment model which I present does not fit neatly into older and more established paradigms. There is no reason why it should, and the fact that it doesn't does not make it any less valid - there is a rich and exciting body of attachment research which continues to grow out of Bowlby's original formulations, and which becomes increasingly difficult to ignore. The temptation is to try and assimilate this into more traditional paradigms rather than develop something new, drawing only, where appropriate, upon psychoanalytic theory.
It may be, as Brown quotes, that practitioners who work within a psychoanalytic framework ‘do not need to alter that framework unduly for these patients’, but what also needs to be recognized is that some clients who are living with HIV do not readily find the traditional psychoanalytic framework conducive to their needs for psychological support.
Very often for those affected the difficulties lie not simply within their own internal processes in de