The Use of Attachment Theory in the Clinical Dialogue with Patients

Abstract

Attachment theory specifically addresses the ability to use an attachment figure as a haven of safety and base of exploration. While many other relational issues are important during development, a foundation of trust based on having positive expectations that others will be available when needed is clearly relevant in the practice of psychotherapy. Yet many patients come in with histories of insecure or even disorganized attachment and have suffered different forms of maltreatment. Understanding affect-regulating strategies, defensive processes, and transference and countertransference patterns associated with insecure or disorganized patterns is enormously useful during the clinical exchange. In addition to paying attention to affect regulation strategies, it is important to note that two other motivational systems may become coopted for defensive purposes in order to cope with disorganized attachment: the caregiving system and the ranking system (the latter being the legacy of dominance hierarchies we observe in primates). The other theme in this article is the importance of paying attention to a cooperative and social engagement motivational system (sometimes referred sometimes to as a social or affiliative motive) in building a therapeutic alliance. This prosocial motive is not about safety (attachment) but about sharing and developing positive social relations with others (Cortina & Liotti, 2010). The article explores the significance of building on this cooperative and social engagement system when there is not a foundation of trust based on a secure attachment history.

Fundamentos del psicoanálisis relacional: Filogenia y ontogenia

“…• La enorme importancia que los vínculos de apego durante el desarrollo en crear una base segura y de confianza para la exploración del mundo material y social (Ainsworth, Blehar, Waters, & Wall, 1978;Bowlby, 1988;Cortina, 2013;L. A. Sroufe, Egeland, Carlson, & Collins, 2005) CeIR Vol.…”

Representações dos cuidadores por crianças institucionalizadas: um modelo grounded

“…Numa relação de vinculação segura, a criança pode expressar-se emocionalmente (Ferreira, 2014), apresentando, também, sentimentos mais elevados de reciprocidade afetiva e de empatia (Cortina, 2013;Oliveira, 2011;Sroufe, 2005), o que se verifica nas afirmações das crianças entrevistadas.…”

“…As crianças seguras apresentam, também, uma maior autoestima (Cortina, 2013;Sroufe, 2005 (2000), a positividade da relação estabelecida entre as crianças e os seus cuidadores. É, ainda, percetível a preocupação dos cuidadores institucionais relativamente ao estado emocional das crianças.…”

“…As crianças seguras evidenciam, também, comportamentos de obediência às regras (Cortina, 2013;Sroufe, 2005).…”

“…Constatou-se, ainda, o desenvolvimento de competências empáticas e o incentivo à expressão emocional e ao reconhecimento dos seus defeitos, pois os cuidadores institucionais proporcionam às crianças um ambiente de segurança e confiança. Estes aspetos confirmam a positividade do relacionamento crianças-cuidadores institucionais (Bretherton & Munholland, 1999;Clark & Symons, 2000;Sroufe, 2005;Cortina, 2013;).…”