Some Clinical Issues in the Light of Attachment Research and Theory

I think of my primary role at this conference as a sort of moderator and summarizer of ideas and issues raised by the other participants. However, I do want to raise four issues that are generated by a psychoanalytic perspective and that perhaps can be profitably addressed by attachment research and theory. The main issue I will address is the nature of change in psychotherapy, particularly as it relates to change in attachment status. I will then only briefly refer to the questions of the kind of interventions that may facilitate the infant's secure attachment; the relationship between oedipal resolution and attachment status; the question of multiple attachment styles within the same individual; and finally, the issue of intensity of attachment style.

There seems to be wide agreement that repetitive early experiences with the caregiver are encoded, not simply as discrete episodes but in terms of the invariant features that are common to these experiences. Stern's (1985) Representations of Interactions Generalized (RIGs), Beebe and Lachmann's (1988) “interactional structures,” and Bowlby's (1973) “internal working model” are examples of concepts that attempt to capture this aspect of experience. Kernberg's (1976) self-object-affect unit is still another example of such a concept, and it also reminds us that these interactional units are not simply cognitive representations, but are suffused with strong affects.

A question I want to raise is how susceptible to change are these early representations and their accompanying affects. There is wide agreement that much like an overlearned habit, they are often automatic, recalcitrant, and difficult to change. As is suggested by Fonagy et al. (1995), it may be that much successful change in therapy consists, not in significantly altering early procedural reactions, but in one's ability to become aware of and reflect on them—which may, in turn, modulate their impact on one's affects and behavior.