SynopsisIn a 2-year study of conjugal bereavement, 26 of 99 women remained highly distressed throughout the course of the study. Of the remaining 73 women, 30 never gave evidence of ‘high distress’. Deficits in social support, health and financial problems correlate with enduring ‘high distress’. Personality traits consonant with a socially acceptable and expected ‘widow role’ were found to differentiate the women with enduring ‘low distress’.

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Recent advances in attachment research provide a framework for defining the content and process of brief psychotherapy with adults. Attachment theory emphasizes a number of issues crucial to therapeutic work. Specifically, attachment relationships are enduring components of a individual's pattern of interpersonal behaviours. Functionally, attachment relationships address security needs. Insecure attachment arises from a representational model based on feared loss of the attachment figure, which predisposes the individual to have little confidence in the attachment figure's availability, responsiveness, and permanence. Behavioural responses to insecure attachment can lead to specific patterns of interpersonal relationships which, in turn, strengthen the representational model. Thus, a relatively stable, self-reinforcing system evolves and results in a consistent inability to experience security within attachment relationships. In this article, the authors describe the current framework for understanding adult attachment relationships and present clinical vignettes illustrating the saliency of attachment theory to common clinical presentations. The goal of the clinical intervention is defined as increasing the "permeability" of the individual's working model of attachment through affective and cognitive re-assessment of attachment experiences and expectations. Finally, the utility of this approach in evaluating the outcome and effectiveness of psychotherapy is highlighted.