Talking Bodies

How do we Integrate Working with the Body in Psychotherapy from an Attachment and Relational Perspective?

Kate White

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429919817
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This monograph brings together the presentations from the nineteenth John Bowlby Memorial Conference in 2012, organised by The Bowlby Centre.It explored the growing role of the body in relational psychotherapy over the last decade, and to bring us up to date in thinking about the relationship between attachment, the body and trauma. Questions addressed included: How do we anchor the new understandings we are gaining within the framework of attachment? How might the integration of these ideas about the body change what we do in the consulting room? What impact might this have on the therapy relationship? Can we maintain and respect the place of a secure, attuned attachment between therapist and client, and its healing potential, at the centre of our therapeutic work?

CHAPTER ONE

Attachment theory and the John Bowlby Memorial Lecture 2012: a short history

Kate White

(Based on an original article by Bernice Laschinger)

This year marks nineteen years since the first John Bowlby Memorial Lecture was given by Colin Murray Parkes on the theme of mourning and loss. That was a fitting recognition of Bowlby’s great contribution to the understanding of human grief and sadness, while his clinical observations of separation and loss laid down the foundations of attachment theory. This year’s lecturer is Pat Ogden, a pioneer in the field of somatic psychology and the founder/director of the Sensorimotor Psychotherapy Institute, an internationally recognised school specialising in somatic-cognitive approaches for the treatment of post-traumatic stress and attachment disturbances.

In the years which have followed that first conference, attachment theory, in the words of Cassidy and Shaver (2008, p. xi), has produced “one of the broadest, most profound and most creative lines of research in 20th-century (and now 21st-century) psychology”. Nevertheless, given the hostility of the psychoanalytic establishment to Bowlby’s ideas, it has only been in the last two decades, during which there have been dramatic advances in the congruent disciplines of infancy research and relational psychoanalysis, that the clinical relevance of attachment theory has been unquestionably established.

Indeed, it has been the development of its clinical applications—in tandem with its evolving convergence with psychoanalysis and trauma theory—that has been central to our practice at The Bowlby Centre. Looking back, our very early links with Bowlby’s work were forged by one of our founders John Southgate, who had clinical supervision with John Bowlby. Bowlby’s understanding of the nature of human relatedness became primary in our theoretical framework and practice. It contributed directly to our emergence as an attachment-based psychoanalytic centre in 1992.

In 2007 the John Bowlby Memorial Conference marked the centenary of John Bowlby’s birth in 1907. One of the outstanding psychoanalysts of the twentieth century, as a theory builder and reformer, his societal impact and influence on social policy have been greater than that of any other. He has been described by Diana Diamond as “the Dickens of psychoanalytic theory”: he illuminated the human experiences of attachment and loss as vividly as Dickens represented those of poverty and deprivation.

The origins of Bowlby’s work lay in his early work with children displaced through war or institutionalisation. This led him to the conviction that at the heart of traumatic experience lay parental loss and prolonged separation from parents. His landmark report for the World Health Organization, Maternal Care and Mental Health, enabled him to establish definitively the primary link between environmental trauma and the disturbed development of children (1952).

With these understandings, he entered the public arena to bring about change in the way childhood suffering was addressed by the adult world. Bowlby’s work created a bridge over the chasm between individual and social experience, and hence between the personal and the political.

There is congruence between the social and therapeutic perspectives of John Bowlby and those of the John Bowlby Memorial Lecturer in 2008 Judith Herman, author of Father Daughter Incest (2000) and Trauma and Recovery (1992). She, too, has directed her life’s work to the “restoring of connections” between the private and public worlds in which traumatic experience takes place; but her focus has been on the traumatic experiences that take place in adulthood. She has shown the parallels between private terrors such as rape and domestic violence, and public traumas such as political terrorism. Her conceptual framework for psychotherapy with traumatised people points to the major importance of attachment in the empowerment of the survivor. She writes: “Recovery can take place only within the context of relationships; it cannot occur in isolation” (1992, p. 133).

Bowlby had also sought to bridge the chasm between clinician and researcher. His preparedness to leave the closed world of psychoanalysis of his time in order to make links with other disciplines such as animal studies and academic psychology was vital in the building up of attachment theory. The documented and filmed sequence of children’s responses to separation in terms of protest, detachment, and despair, as researched by James Robertson, provided evidence of separation anxiety. The impact of these ideas on the development of care of children in hospital has been enormous. The 2001 John Bowlby Memorial Lecturer, Michael Rutter, discussed institutional care and the role of the state in promoting recovery from neglect and abuse. His lecture was a testament to the continuing relevance of Bowlby’s thinking to contemporary social issues.

Although Bowlby joined the British Psychoanalytical Society in the 1930s and received his training from Joan Riviere and Melanie Klein, he became increasingly sceptical of their focus on the inner fantasy life of the child rather than real life experience, and tended towards what would now be termed a relational approach. Thus, in searching for a theory that could explain the anger and distress of separated young children, Bowlby turned to disciplines outside psychoanalysis such as ethology. He became convinced of the relevance of animal, and particularly primate, behaviour to our understanding of the normal process of attachment. These relational concepts presented a serious challenge to the closed world of psychoanalysis in the 1940s, and earned Bowlby the hostility of his erstwhile colleagues for several decades.

The maintenance of physical proximity by a young animal to a preferred adult is found in a number of animal species. This suggested to Bowlby that attachment behaviour has a survival value, the most likely function of which is that of care and protection, particularly from predators. It is activated by conditions such as sickness, fear, and fatigue. Threat of loss leads to anxiety and anger; actual loss leads to anger and sorrow. When efforts to restore the bond fail, attachment behaviour may diminish, but will persist at an unconscious level and may become reactivated by reminders of the lost adult, or new experiences of loss.

Attachment theory’s basic premise is that, from the beginning of life, the baby human has a primary need to establish an emotional bond with a caregiving adult. Attachment is seen as a source of human motivation as fundamental as those of food and sex. Bowlby (1979, p. 129) postulated that “Attachment behaviour is any form of behaviour that results in a person attaining or maintaining proximity to some other preferred and differentiated individual … While especially evident during early childhood, attachment behaviour is held to characterise human beings from the cradle to the grave.”

Attachment theory highlights the importance of mourning in relation to trauma and loss. An understanding of the relevance of this to therapeutic practice was a vital element in the foundation of The Bowlby Centre. The consequences of disturbed and unresolved mourning processes was a theme taken up by Colin Murray Parkes when he gave the first John Bowlby Memorial Lecture in 1993.

Mary Ainsworth, an American psychologist who became Bowlby’s lifelong collaborator, established the interconnectedness between attachment behaviour, caregiving in the adult, and exploration in the child. While the child’s need to explore and the need for proximity might seem contradictory, they are in fact complementary. It is the mother’s provision of a secure base, to which the child can return after exploration, which enables the development of self-reliance and autonomy. Ainsworth developed the Strange Situation Procedure for studying individual differences in the attachment patterns of young children. She was able to correlate these to their mother’s availability and responsiveness. Her work provided both attachment theory and psychoanalysis with empirical support for some basic premises. This provided the necessary link between attachment concepts and their application to individual experience in a clinical setting.

Over the last two decades the perspective of attachment theory has been greatly extended by the work of Mary Main, who was another John Bowlby Memorial Lecturer. She developed the Adult Attachment Interview in order to study the unconscious processes that underlie the behavioural pattern of attachment identified by Mary Ainsworth. Further support came from the perspective of infant observation and developmental psychology developed by yet another John Bowlby Memorial Lecturer, Daniel Stern. The John Bowlby Memorial Lecturer for 2000, Allan Schore, presented important developments in the new field of neuro-psychoanalysis, describing emerging theories of how attachment experiences in early life shape the developing brain.

The links between attachment theory and psychoanalysis have also been developed. Jo Klein, a great supporter of The Bowlby Centre and also a former contributor to the John Bowlby Memorial Conference, has explored these links in psychotherapeutic practice. In particular, the 1998 Bowlby Lecturer, the late Stephen Mitchell, identified a paradigm shift away from drive theory within psychoanalysis. His proposed “relational matrix” links attachment theory to other relational psychoanalytic theories, which find so much resonance in the current social and cultural climate. Within this area of convergence, between attachment research and developmental psychoanalysis, the 1999 John Bowlby Memorial Lecturer Peter Fonagy has developed the concept of “mentalization”, extending our understanding of the importance of the reflective function, particularly in adversity.

In a similar vein, the work of Beatrice Beebe, the 2001 John Bowlby Memorial Lecturer, represents another highly creative development in the unfolding relational narrative of the researcher-clinician dialogue. Her unique research has demonstrated how the parent–infant interaction creates a distinct system organised by mutual influence and regulation, which is reproduced in the adult therapeutic relationship.

In the movement to bring the body into the forefront of relational theory and practice, the 2003 John Bowlby Memorial Lecturer Susie Orbach has been a leading pioneer. It was the publication of her groundbreaking books, Fat is a Feminist Issue (1978) and Hunger Strike (1986) that introduced a powerful and influential approach to the study of the body in its social context. Over the last decade, one of her major interests has been the construction of sexuality and bodily experience in the therapeutic relationship.

The 2004 John Bowlby Memorial Lecturer Jody Messler Davies has made major contributions to the development of the relational model. Her integration of trauma theory and relational psychoanalysis led to new understandings of the transference-countertransference as a vehicle for expressing traumatic experience (Davies & Frawley, 1994).

Kimberlyn Leary, our John Bowlby Memorial Lecturer in 2005, illuminated the impact of racism on the clinical process. The importance of her contribution lay in her understanding of the transformative potential inherent in the collision of two “racialised subjectivities” in the therapeutic process. She showed the possibility for reparation when both therapist and client break the silence surrounding their difference.

The contribution of the 2006 John Bowlby Memorial Lecturer Bessel van der Kolk to the understanding of post-traumatic stress as a developmental trauma disorder has been seminal (2005). His book Psychological Trauma was the first to consider the impact of trauma on the entire person, integrating neurobiological, interpersonal and social perspectives (1987).

Within this tradition of great trauma theorists, the contribution of John Bowlby Memorial Lecturer 2007 Judith Herman, a collaborator of Bessel van der Kolk, has been outstanding. As a teacher, researcher, and clinician, her life’s work has been directed to survivors of trauma. Her landmark book Trauma and Recovery (1992) is considered to have changed the way we think about trauma. Bridging the world of war veterans, prisoners of war, and survivors of domestic and sexual abuse, she has shown that psychological trauma can only be understood in a social context.

In 2008 our John Bowlby Memorial Lecturer was Arietta Slade, a widely published clinician, researcher, and teacher. Her work has been enormously significant in the movement to link attachment theory with clinical ideas (1999b, 2008). She has pioneered attachment-based approaches to clinical work with both adults and children, including the development of parental reflective functioning and the relational contexts of play and early symbolisation. There is also a congruence between her current work and the spirit of Bowlby’s early clinical observations. She has shifted the therapeutic focus away from the formal categorisation of attachment patterns, to questions about how the attachment system functions to regulate fear and distress within the therapeutic process, significantly where there are “dynamic disruptions”.

Arietta Slade’s work represents a highly significant development in the application of attachment theory to clinical work (1999a). Following on the work of Main (1994) and Fonagy (1999) she has demonstrated how an attachment-based understanding of the development of representation and affect regulation in the child and his or her mother offers us potentially transformative insights into the nature of the therapeutic process and change.

In 2009 we were honoured to welcome Amanda Jones to give the John Bowlby Memorial Lecture. She presented her work with troubled parents and their children—highlighted in the television series Help Me Love My Baby. Her work has been acclaimed for its capacity to demonstrate the effectiveness of interventions where the parent is offered a long-term compassionate attachment relationship in which their own story of trauma is shared. This provides a possibility for reflectiveness and intergenerational change.

Our John Bowlby Memorial Lecturer in 2010 was Jude Cassidy, a pioneer in the attachment tradition of research with clinical applications. She was a student of Bowlby’s primary collaborator Mary Ainsworth and has extended attachment theory’s reach in both the fields of childhood and adolescence. As an author and editor she has had a prominent role in the publication of attachment theory, research findings and their clinical application. Jude Cassidy is Professor of Psychology at the University of Maryland, and director of the Maryland Child and Family Development Laboratory. She received her PhD in 1986 from the University of Virginia where her mentor was Mary Ainsworth. Jude Cassidy’s research includes a focus on early intervention. Her concerns are wide ranging, focusing on attachment, social and emotional development in children and adolescents, social information-processing, peer relations, and longitudinal prediction of adolescent risk behaviour. These were all areas that were pertinent to our theme in 2009 of “Attachment in the 21st Century; Where Next?”

In 2012 the John Bowlby Memorial Lecturer was Dr Sandra L. Bloom, who has a long association with The Bowlby Centre as she has been our consultant on trauma for many years. Sandy Bloom is a psychiatrist, currently Associate Professor of Health Management and Policy and Co-Director of the Center for Nonviolence and Social Justice at the School of Public Health of Drexel University in Philadelphia. She is best known to us through her imaginative and pioneering work for twenty-one years as director of The Sanctuary Programmes, an inpatient mental health intervention for adults maltreated as children. Here she developed a humane and compassionate centre caring for those traumatised in early life, using the work of John Bowlby as its central conceptual framework. An account of this work is to be found in her publications, Bloom (2013) and Bloom and Farragher, (2010, 2013).

This year we welcome Pat Ogden to deliver the nineteenth John Bowlby Memorial Lecture on the theme of the links between attachment, trauma, and...