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I am grateful to the British Journal of Psychotherapy for asking me to discuss this fascinating case. I write as a psychodynamically trained individual and group therapist with a longstanding interest in attachment theory applied to psychopathology and clinical practice.
I want to begin with an impossibly brief discussion of how attachment theory is a helpful paradigm for psychodynamic psychotherapists and why it represents a 21st
century update on classical psychoanalysis. Research based on attachment theory has provided evidence that supports Freudian claims (both Sigmund and Anna) that early parent-child attachments have a long-term influence on adult attachments, and provides an understanding of how those attachments may be repeated in adulthood, including with therapists. I think many early 20th century analysts would have been excited by the evidence from linguistic studies of attachment focused interviews that find that how people speak of themselves and others (not just the content of what they say), unconsciously reveals their state of mind with respect to relationships and vulnerability.
Applying attachment theory psychodynamically to S.'s history, we note an immediate sense of detachment and isolation from others, which must raise questions about who and how S. related to his parents. S. describes being a little boy whose father was away a great deal; and whose relationship with his mother is ‘normal but lacks intimacy’, as if that makes sense. S. describes feeling frightened of his father, (also described as aggressive and hostile to S.'s mother), which reminded me that chronic fear is a disorganiser of the developing mind leading to the use of dissociation and numbness as defences, which, in turn, make disorganised attachment and the use of psychotic thinking likely in adulthood. I also note the note of idealisation and minimisation of fear when S. reassures his therapist that his father was ‘not violent’.
So far, from an attachment p