The Role of Attachment Theory in Healing: Exploring the Psychotherapeutic Relationship

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Why therapy work is still an on-going discussion, but when it does work - it often mirrors the attachment dynamics found in good parenting. 

Attachment theory, initially developed by John Bowlby and Mary Ainsworth in the mid-20th century, has had a profound influence on psychotherapy. This theory posits that the bonds formed between babies and their primary caregivers have a lasting impact on an individual's emotional and relational patterns throughout their life. In the context of psychotherapy, understanding attachment styles can greatly enhance the therapeutic process and outcome, especially when it comes to healing from emotional distress or trauma.

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​According to neurologist Dr. Allan Schore, attachment trauma—which includes the effects of neglect and abuse during early neurological development in infancy—results from a failed attachment relationship between a mother and her baby, leading to damage. 

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In this blog, I want to write why our defence mechanisms are so persistent, and why true, substantial change is both difficult and uncommon, but is possible. I would like to offer my personal perspective on how genuine change can occur, how this early damage can be somewhat healed, and what conditions are necessary for this healing to take place. While I don’t have scientific evidence to support these views, I can draw from my own experiences, having been a client in therapy for nearly 10 years and from my experiences working with my own clients in my practice. 

In simple term, a successful and healing psychotherapy relationship involves several key elements. First, the therapist needs to be able to understand and share the client's feelings, endure the client's pain and confusion long enough to make sense of it, and then communicate their insights in a way that makes the client feel understood. One simple sentence encapsulates numerous elements. This requires a therapist who is comfortable handling various emotions, including anger, envy, and hatred, and who can cope with the client’s often deep-seated pain.​ 

In dealing with challenges in mental health issues such as borderline personality disorder, therapists need significant emotional and psychological resilience. They must be able to handle intense feelings of terror, rage, and chaos without feeling overwhelmed. It's also essential for therapists to have undergone extensive psychotherapy themselves. Beyond this, they need skills to interpret these complex emotions and communicate their insights effectively. These skills are developed through quality training, supervision, and years of experience in therapy as well as practical experience.  In my early years of practice, I understood quite a lot, but my explanations often seemed forced. I was overly focused on maintaining the ideal psychoanalytic stance, which sometimes made my clients feel "analysed" rather than understood. Over time, I learned how to communicate in a more empathetic manner. 

Empathy, not sympathy, is crucial for effective healing interpretation. I've always been skilled at recognising unconscious rage and envy, but it took years for me to truly appreciate how painful those feelings can be. As transference develops, a therapist may become the target of intense and destructive attacks, such as enraged accusations or possessive expressions of "love". In such moments, it's challenging to remember the intense pain the client is experiencing. If a therapist cannot cope with these emotions themselves, it becomes difficult to make the client feel understood, safe, and accepted. However, if we can endure these painful emotions and provide empathic insights, we will gradually help our clients learn to tolerate these feelings within themselves, little by little, over time.

In this way, the therapist offers a type of emotional support similar to what a good mother would provide. In the secure attachment, caregivers are consistently available and responsive, in another words, it's the mother's role to accept the baby's projected feelings; like terror and anger, which the baby cannot understand or handle on its own. In a "good enough" attachment relationship, the mother responds properly to these projections, helping her baby learn to cope with them. 

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Dr. Allan Schore suggests this helps the brain develop more or less "normally," forming complex neural connections and building structure so that the child learns to understand and manage its own experiences. Years later, a therapist can attempt to compensate for a failed attachment relationship. The therapist can endure the client’s projections, try to understand their meanings, and respond appropriately. Gradually, over time, we can help our clients develop the mental capacity to understand and cope with their own experiences. It’s not the same as having had a "good enough" mother, and it won’t return our clients’ brains to a pre-damage state, but it can make a significant difference. 

Some probably agree with what I have said so far. My views are based on the psychodynamic/psychoanalytic theory I studied during my training at Exeter university, the excellent supervision I received, and my years of therapy with an analyst who fully faced my pain, rage, hatred, and envy. She had a profound ability to hold me through my confusion, loss, and trying to finding my self and identity. 

Without her help and patience, I wouldn't have developed the mental and emotional capacity I have today. I was lucky to find her, I wouldn't be where I am today without her assistance. I know she deeply cared about my wellbeing and emotionally invested in ways that were meaningful to her as well. It was within the context of this relationship — this new attachment relationship — that the healing occurred. 

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I believe in that a truly healing relationship involves a kind of love and commitment from both sides. When I accept a new client, especially someone facing serious issues, I take it very seriously; our relationship may last short or for many years and involve significant emotional demands. If our work is effective, my clients will form a strong attachment to me. Although the psychotherapy relationship means something different to each of us — it's primarily about the client’s life, not mine — we both need to care deeply about it. Over time, we will come to love each other. It makes me feel extremely vulnerable to say this. 

While the love in therapy is different from the love between a mother and a baby, and it can't replace what was missing, it is still important and powerful. I believe that this kind of love in therapy offers the best chance for healing. Even if the brain didn't develop normally because the child lacked what it needed during a critical period, love and understanding in a later therapy relationship can still repair a lot of that damage. Perhaps my clients and I will never be "native speakers" of emotional language because we didn't get what we needed as infants, but that doesn't mean we can't become proficient in it.