Attachment-informed psychoanalysis

Domain I · Psychodynamic & depth psychology · Bowlby, Holmes, Wallin · 1988

What it is

This is mainly a theoretical framework applied to psychoanalytic psychotherapy, not a manualised therapy. Bowlby set out five tasks and a therapist stance but no session protocol. Holmes and Wallin describe clinical practice in illustrative, non-manualised form. Everything below that turns this…

Format

• Format. This is individual psychodynamic or psychoanalytic psychotherapy, usually face to face (Wallin's focus on nonverbal and bodily experience presupposes it). It is typically once or twice weekly, either open-ended or time-limited (often 6–24 months in public services). Bowlby and the later…
• Version followed: Bowlby, A Secure Base (1988), chapter 8 (the five therapeutic tasks, pp. 138–140) and chapter 6 (on knowing what you are not supposed to know), read through Jeremy Holmes's operationalisations (John Bowlby and Attachment Theory 1993; The Search for the Secure Base 2001; Exploring…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The same impasses recurring with different patients. It is working when you can predict and step out of your own pulls.
• Imposing your own story on the patient. It is working when the patient retells the story themselves with more detail and feeling.
• Sounding like you are cross-examining. Keep the tone curious. It is working when more episodic memories emerge, along with feeling.
• Over-apologising, which can burden the patient. It is working when the relationship recovers and the patient says repair is new for them.
• Blaming the patient for the enactment. It is working when the patient can co-observe the pattern and the relationship feels more alive afterwards.

Problems the guide addresses

• Stuck: flat, intellectual, “nothing to talk about” (often dismissing)
• Resistance: avoidance of particular topics or memories
• Overwhelm and flooding (often preoccupied or unresolved)
• Non-attendance, lateness and between-session tasks not done
• Ruptures, hostility and devaluation
• Idealisation, dependency and requests for contact between sessions
• Crises around breaks and endings
• Therapist pulled into a complementary pattern
• Parent-blaming, or uncertain memories of abuse
• Suicidality and self-harm

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.