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Bowlby originally explained this by analogy with the phenomenon of imprinting, in which in prosocial species, young birds will follow any mobile figure to which they are exposed at the ‘sensitive period’ in their development. Of those who had been traumatised in this way under the age of six, the figures were 57 per cent for BPD and 13 per cent for other diagnoses. Psychoanalysts working with these patients have emphasised the extensive use of projective identification that arises in the transference–countertransference matrix. For the inexperienced, (and not infrequently the experienced!) all this can be unexpected and difficult to tolerate.
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Today the focus has shifted away from gross disruptions of care such as bereavement, which do not in themselves necessarily result in psychopathology if conditions are otherwise favourable. The contemporary emphasis is much more on the subtleties of parent–child interaction contributing to the qualitative features of the attachment bond. Maternal responsiveness and the ability to attune to her child are now seen as key features in determining the security or otherwise of attachment bonds.
As a child the patient had lacked a secure base with this mother, whom she felt neglected her in favour of two younger sisters, one of whom had been chronically ill with kidney disease, while the other was epileptic, and to whom she had devoted all her attention. In an initial phase of individual therapy she was able to link her fears of harming the baby with aggressive feelings towards her younger sisters and her angry dependency on her mother, but her symptoms persisted. At the first session she proudly announced that her husband – unlike herself – was afraid of nothing. He accepted the compliment rather diffidently, but confirmed that he had been more or less self-reliant since the age of ten, when his parents had divorced and he and his younger brother had been left to fend for themselves on the rough estate where they lived. When asked if it was true, as his wife believed, that he was frightened of nothing, he confessed that he had slipped on a plank that morning and had been very scared, and that since the birth of the baby he had been much less of a daredevil. His wife seemed surprised at this revelation, but visibly relaxed and perked up.
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Sarah would start each session in a bright and breezy way, referring to the weather or to current events as she entered the consulting room. The therapist instinctively did not respond in kind – in a way that would, from the point of view of affiliation, seem almost rude. It was clear from her history that she had always managed to avoid intimacy through group living, and by making sure she was the ‘life-and-soul’ in any gathering, but always keeping her real self well hidden.
In a moving epilogue to their monograph they show how social cohesion is promoted by secure attachment, and how more caring and coherent societies foster families’ capacity for altruism. Crowell, like Hazan and Shaver, examined attachment in adult romantic relationships (Crowell et al., 2002). Rather than rely on selfreport measures, she and her colleagues developed the Current Relationship Interview that assesses representations of attachment, classifying the subject as secure, dismissing, or preoccupied in relation to their current partner. Those classified as secure on the CRI reported greater levels of satisfaction and commitment overall; when both partners were insecure, a number of markers of aggression were elevated and partners reported lower levels of marital satisfaction and closeness.
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The basic attachment credo vis-à-vis psychoanalysis can be summarised as follows. For Bowlby the important issue is not, as the orthodox Freudians thought, sex, but security. The organism is not an isolated drive-driven creature in search of an object on whom to discharge his accumulated tension, but a whole person relating to other whole persons. Homeostatic and other cybernetic control systems govern his behaviour, just as they do that of other mammals. His relationship to the world is determined not just by unconscious phantasy but also by internal working models which include affective, cognitive and behavioural components, whose lineaments reflect the real-life experiences of their possessors.
Mr P was asked to take the phone off the hook for that half hour each evening. With much misgiving and a horrible feeling that he was rejecting his son, he agreed, without disastrous results, and with a general lightening of the relationship between Richard and his parents. Through this small change the family seemed to have come to accept that a firm boundary can be a mark of loving attachment rather than rejection. The continuing physiological need for an environment containing oxygen. It is a relatively silent need of which one becomes aware sharply only when it is not being met, when a harsh world compels one to draw one’s breath in pain. Brazelton and Cramer’s synchrony, symmetry, contingency and ‘entrainment’, from which mutual play and infant autonomy begin to emerge, are likewise applicable to therapist–patient interactions.
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He now felt able to provide a secure base for his children – leaving his therapist as abruptly as his wife had ‘left’ him. Suggested, the period from six months to four years may be critical for the capacity to form stable relationships, since children who had been adopted after four, despite forming close and loving bonds with their adoptive parents, remained antisocial in their behaviour at school. The Romanian orphan studies came to similar conclusions (Rutter et al., 2007).
Today, many companies are now exploring new underwriting models that return to core principles – assessing ability to repay without attempting to use outside information to model a consumer’s presumed ability to repay. Third, there would be more switching and incentives for better service. In an open and competitive market, it is easy for individuals to fire, or walk away from, their financial provider for whatever reason.
Importantly, the quality of parenting also plays a role in mediating the relationship between time spent in non-maternal care and insecure attachment – poor quality of parental care combined with long periods of non-maternal care bodes ill for the child. Highly politicized, this issue continues to divide academics and parents. Although still in print, it is more than half a century since Child Care and the Growth of Maternal Love was first published. The terms of the debate have changed, so that, with less physical absence, but with everincreasing difficulties in managing their lives, mothers are subject to enormous social pressures and their children are often the first casualties of this. For a more detailed examination of maternal deprivation from a contemporary perspective, and for a discussion of how children may be helped to escape, or may remain ever more deeply trapped in deprivation, we turn now to the work of Michael Rutter. Be found within psychoanalysis and psychotherapy in response to the difficulties – dogmatism, obsolete meta-psychology and anti-empiricism – with which Bowlby was struggling.
Conversely some BPD sufferers flee at the merest whiff of an attachment relationship, fearful of a repetition of the abuse and control it signifies in their own history. Effective therapeutic strategies need to accommodate to these centripetal and centrifugal patterns. A second, conceptualisation of the borderline predicament was originally proposed by Fonagy and has led to an established and effective modality of treatment. He suggested that the borderline experience can be understood in terms of a deficiency in these patients of what he calls a ‘mentalising capacity’.
Yet, by contrast, the principal feature of the innovative technique for treating patients that Freud introduced is to focus attention on the relationships patients make with their therapist. From the start, therefore, there was a yawning gulf between the phenomena with which the therapist was confronted, and the theory that had been advanced to account for them. The establishment of a secure internal base, a sense that conflict can be negotiated and resolved, the avoidance of the necessity for primitive defences – all this depends on parental handling of the interplay between attachment and loss that is the leitmotiv of the Bowlbian message. Print our ready-made 10th grade math worksheets written by expert teachers!
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