This paper is an attempt to look at the impact of early traumatic attachment and disorganized attachment system in the evolution and maintenance of phobic response. It will explore the way in which the therapeutic attachment relationship plays a core role in facilitating development that was obstructed in infancy, childhood and adolescence involving the integration of developmental issues and the undoing of the need for phobic response. The tenacity of the need for a good enough primary attachment figure and the impact of the search for one on development are starkly revealed in the therapeutic work.

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Facilitating the development of Family Centred Care in a large Moscow children's hospital is described. The two-and-one-half-year period of work demonstrated many obstacles to change such as alien culture, language barriers, extreme poverty, and political problems. The techniques used to work with and overcome these difficulties are described. Clinical examples are given.

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