This is a chapter excerpt from Guilford Publications.

Attachment in Psychotherapy, by David J. Wallin

Copyright © 2007

Attachment and Change

CHAPTER 1

Attachment and Change

. . . the therapist’s role is analogous to that of a mother who

provides her child with a secure base from which to explore the
world.
—JOHN BOWLBY (1988, p. 140)

I
n the world according to Bowlby, our lives, from the cradle to the
grave, revolve around intimate attachments. Although our stance toward
such attachments is shaped most influentially by our first relationships, we
are also malleable. If our early involvements have been problematic, then
subsequent relationships can offer second chances, perhaps affording us the
potential to love, feel, and reflect with the freedom that flows from secure
attachment. Psychotherapy, at its best, provides just such a healing relation­
ship.
Precisely how as psychotherapists we can enable our patients to grow
beyond the limits imposed by their history is a question that attachment
theory does not directly address. Yet the ongoing research inspired by
Bowlby’s original insights has enormous clinical value, offering us a pro­
gressively clearer view of the development of the self in a specifically rela­
tional context.
In attempting to harness the power of this research, I have identified
three findings that appear to have the most profound and fertile implica­
tions for psychotherapy: first, that co-created relationships of attachment
are the key context for development; second, that preverbal experience
makes up the core of the developing self; and third, that the stance of the
self toward experience predicts attachment security better than the facts of
personal history themselves.

1
2 Attachment and Change

In drawing out the clinical implications of these three core conclusions,

I reach into the attachment literature, of course. But I also reach beyond it,
not only to intersubjective and relational theory but also to affective neuro­
science—which Allan Schore (2004) calls the “neurobiology of attachment”—
as well as cognitive science, trauma studies, and explorations of conscious­
ness. The present chapter plumbs the three core findings regarding the
developmental centrality of attachment relationships, preverbal experience,
and the reflective function. And it distills their clinical yield in a model of
psychotherapy that involves the transformation of the self through relation­
ship. My aim here is to convey the orientation to emotional healing—the
clinical philosophy derived from reviewing research, theory, and personal
experience—that underlies all the various approaches I take in order to be
of help to my patients.
As I will explain, the proposed model of psychotherapy as transforma­
tion through relationship describes a trajectory that parallels the unfolding
story of attachment theory itself. Bowlby (1969/1982) began by recogniz­
ing that attachment is a biological imperative rooted in evolutionary neces­
sity: The attachment relationship to the caregiver(s) is critical to the infant’s
physical and emotional survival and development. Given the requirement
to attach, the infant must adapt to the caregiver, defensively excluding
whatever behavior threatens the attachment bond. Mary Ainsworth’s re­
search (Ainsworth, Blehar, Waters, & Wall, 1978) then clarified that it is
the quality of the nonverbal communication in the attachment relationship
that determines the infant’s security or insecurity—and along with it, the in­
fant’s approach to his or her own feelings. Mary Main’s investigations
(Main, Kaplan, & Cassidy, 1985) illuminated the ways in which these early
biologically mandated nonverbal interactions register in the infant as men­
tal representations and rules for processing information that influence, in
turn, how freely the older child, adolescent, and adult is able to think, feel,
remember, and act. Finally, Main (1991) and Peter Fonagy (Fonagy, Steele,
& Steele, 1991a) highlighted the crucial importance of the stance of the self
in relation to its own experience. They showed that security of attachment,
resilience, and the ability to raise secure children all are correlated with the
individual’s capacity to adopt a reflective stance toward experience. Thus,
from Bowlby to Ainsworth, Main, and Fonagy, the evolving narrative of at­
tachment theory has unfolded through a focus on intimate bonds, the non­
verbal realm, and the relation of the self to experience.
The same three themes organize the model of therapy as transforma­
tion through relationship. In this model, the patient’s attachment relation­
ship to the therapist is foundational and primary. It supplies the secure base
that is the sine qua non for exploration, development, and change. This
sense of a secure base arises from the attuned therapist’s effectiveness in
helping the patient to tolerate, modulate, and communicate difficult feel­
Attachment and Change 3

ings. By virtue of the felt security generated through such affect-regulating

interactions, the therapeutic relationship can provide a context for access­
ing disavowed or dissociated experiences within the patient that have not—
and perhaps cannot—be put into words. The relationship is also a context
within which the therapist and patient, having made room for these experi­
ences, can attempt to make sense of them. Accessing, articulating, and re­
flecting upon dissociated and unverbalized feelings, thoughts, and impulses
strengthen the patient’s “narrative competence” (Holmes, 1996) and help
to shift in a more reflective direction the patient’s stance toward experience.
Overall, the relational/emotional/reflective process at the heart of an attach-
ment-focused therapy facilitates the integration of disowned experience,
thus fostering in the patient a more coherent and secure sense of self.

TRANSFORMATIVE RELATIONSHIPS

Very much as the original attachment relationship(s) allowed the child to

develop, it is ultimately the new relationship of attachment with the thera­
pist that allows the patient to change. To paraphrase Bowlby (1988), such a
relationship provides a secure base that enables the patient to take the risk
of feeling what he is not supposed to feel and knowing what he is not sup­
posed to know. The therapist’s role here is to help the patient both to
deconstruct the attachment patterns of the past and to construct new ones
in the present. As we have seen, the patterns played out in our first attach­
ments are reflected subsequently not only in the ways we relate to others,
but also in our habits of feeling and thinking. Correspondingly, the pa­
tient’s relationship with the therapist has the potential to generate fresh
patterns of affect regulation and thought, as well as attachment. Put differ­
ently, the therapeutic relationship is a developmental crucible within which
the patient’s relation to his own experience of internal and external reality
can be fundamentally transformed.

THE UNTHOUGHT KNOWN

Given the prelinguistic roots of the patient’s original attachment patterns,

and the disavowals and dissociations they may have demanded, the thera­
pist must tune in to the nonverbal expressions of experience for which the
patient has as yet no words. That is, the therapist must find ways to con­
nect with what Christopher Bollas (1987) has called the patient’s “un­
thought known.” Grasping the unspoken (or unthinkable) subtext of the
therapeutic conversation requires what several writers (Bateson, 1979;
Bion, 1959) have referred to as the clinician’s “binocular vision” that
4 Attachment and Change

tracks the subjectivity of both the patient and the therapist. The underlying
assumption here is that the patient who cannot (or will not) articulate his
own dissociated or disavowed experience will evoke it in others, enact it
with others, or embody it. The clinical implication is that the therapist must
pay particular attention to her own subjective experience, to the transfer­
ence–countertransference enactments jointly created by patient and thera­
pist, and to the nonverbal language of emotion and the body—for all these
are routes to accessing and eventually integrating what the patient has had
to deny or disown.

THE STANCE TOWARD EXPERIENCE:

REPRESENTATION, REFLECTION, AND MINDFULNESS

Along with its emphasis on the centrality of relational and nonverbal expe­
rience, attachment research underscores the salience of the reflective func­
tion and metacognition. More broadly, this research reveals the decisive
impact of the stance of the self toward its own experience.
Secure attachment is clearly associated with a reflective stance toward
experience. In Main’s (1991) account, this stance rests on the metacog­
nitive capacity to recognize the “merely representational nature” of our
own beliefs and feelings (p. 128). With such a stance, we can step back
from the immediate “reality” of experience and respond in light of the
mental states that might underlie it—to use Fonagy’s term, we can “mental­
ize.” With greater freedom to mentalize, we are less likely to be inescapably
gripped by emotional reflexes laid down in the course of our first relation­
ships. As research using Main’s Adult Attachment Interview has revealed,
the reflective stance toward experience is entirely different from that found
in insecure individuals who tend either to minimize and deny the impact of
their experience (in the dismissing state of mind) or to be overwhelmed by
it (in the preoccupied state of mind). As a rule, the more we are able to mo­
bilize a reflective stance the more resilient we will be, and the more capable
of raising secure children.
By the same token, to “raise” secure patients, we must cultivate in our­
selves this capability for reflection in psychological depth. And, of course,
we must nurture it in those who come to us for help. As therapists, our ef­
forts to foster or disinhibit our patients’ mentalizing capacities are an essen­
tial feature of the help we offer. To the extent that we make it possible for
patients to mentalize, we strengthen their ability to regulate their affects, to
integrate experiences that have been dissociated, and to feel a more solid,
coherent sense of self.
Beyond the capacity for a reflective stance, I would argue that there ex­
ists the potential for a stance toward internal and external experience that
Attachment and Change 5

is, in some sense, “deeper” and closer to the subjective center of ourselves. I
am thinking here about a stance that involves deliberate nonjudgmental at­
tention to experience in the present moment—that is, a stance of mindful­
ness (Germer, Siegel, & Fulton, 2005; Kabat-Zinn, 2005). While mindful­
ness is not part of the vocabulary of attachment, this construct from
Buddhist psychology seems a natural outgrowth of attachment theory and
research. In fact, Phillip Shaver, coeditor of the Handbook of Attachment,
told me that recently, in preparing a scientific presentation for the Dalai
Lama, he had occasion to read nearly a dozen books on Buddhism. To his
surprise, he found the psychology there to be not only consistent with but
in many respects virtually identical to the psychology of attachment theory
(Shaver, personal communication, 2005).
To clarify what is meant by a stance of mindfulness, imagine four con­
centric rings each of which represents an element that contributes to the
moment-to-moment experience of being a “mindful self.”
The outermost ring stands for external reality. The world of external
reality includes not only the events that happen to us and the situations we
co-create but also, perhaps most importantly, the people with whom we are
involved.
Moving inward there is a second ring that stands for the representa­
tional world: that is, the mental models of previous experience that relieve
us of the necessity to reinvent the wheel with every new moment. These
representational models orient us, shaping our interpretations of past and
present, and establishing our expectations for the future.
Within the second ring is a third, standing for that part of ourselves
that is capable of a reflective stance toward experience—in shorthand, the
“reflective self.” Here our representations, including our internal working
models, are understood to mediate or filter our experience of external real­
ity. We neither equate the subjective world of representations with the ob­
jective world of external reality nor deny the impact of external reality
upon our subjective experience. With such a stance we can reflect, con­
sciously and unconsciously, on the meaning of our experience rather than
simply take that experience at face value. This affords us a significant mea­
sure of internal freedom.
Attachment theory deals explicitly only with the elements represented
by these first three rings: external reality, the representational world, and
the reflective self. It seems to me, however, that there is a trajectory to the
evolving narrative of attachment theory that points like an arrow to a
fourth ring inside the other three. This fourth ring represents what I am
calling the mindful self.
To put it somewhat cryptically, this self is the answer to the question,
Who (or what) is it that actually reflects on experience? For if a reflective
stance involves metacognition—thinking about thinking—then it seems
6 Attachment and Change

natural to ask who is it that is thinking the thoughts about thinking. You
might try, as I did, to close your eyes and pose this question to yourself. My
own (experientially derived) response to the question took me by surprise.
It was: no one. Dovetailing with a fundamental tenet of Buddhist psychol­
ogy, this elusive understanding reflects the paradox that the mindful self
can be at once a secure self and no (personal) self at all, but only awareness
(see Goldstein & Kornfield, 1987; Kornfield, 1993; Engler, 2003).
Jeremy Holmes (1996), who writes eloquently about attachment,
touches on the same paradox when he acknowledges borrowing from Bud­
dhism the term nonattachment to describe an “equidistant position” that
includes awareness both of the depth and breadth of the self’s experience
and of the fact that the self is “ultimately a fiction” (p. 30).
Another angle on this matter of mindfulness: While the reflective
stance toward experience entails metacognition, a mindful stance involves
meta-awareness—that is, awareness of awareness. Put differently, the self
that reflects on experience attends to the contents of experience while the
self that is mindful attends to the process of experiencing. Such mindful at­
tention illuminates the process by which experience is constructed (Engler,
2003).
Fonagy alludes to research highlighting the clinical potential of mind­
fulness meditation as an adjunct to psychotherapy. He notes that “what we
would call ‘mentalizing’ is directly enhanced by meditation practice” (Allen
& Fonagy, 2002, p. 35). Fonagy’s point is undoubtedly well taken. Yet
mindfulness involves more than formal meditation. And meditation sup­
ports more than mentalizing.
The regular exercise of mindful awareness seems to promote the same
benefits—bodily and affective self-regulation, attuned communication with
others, insight, empathy, and the like—that research has found to be associ­
ated with childhood histories of secure attachment (Siegel, 2005, 2006).
Although there may be other explanations for these parallel outcomes, I
would suggest that they arise from the fact that mindfulness and secure at­
tachment alike are capable of generating—though by very different routes—
the same invaluable psychological resource, namely, an internalized secure
base.
Secure attachment relationships in childhood and psychotherapy help
develop this reassuring internal presence by providing us with experiences
of being recognized, understood, and cared for that can subsequently be in­
ternalized. Mindfulness practice can potentially develop a comparably reas­
suring internal presence by offering us (glimpsed or sustained) experiences
of the selfless, or universal, self that is simply awareness. Such experiences
are often marked by profound feelings of security, acceptance, and connec­
tion, in relation as much to others as to ourselves (Linda Graham, personal
communication, 2006).
Attachment and Change 7

As therapists, our own capacity to be mindful may be critical to our

efforts to be of help to our patients. First, and perhaps most crucially, a
mindful stance fosters the experience of being firmly lodged in the present
moment. The British psychoanalyst Wilfrid Bion (1970) captures this state
of open presence as well as any Buddhist philosopher when he extols the
advantages of approaching the patient “without memory, desire, or under­
standing” (pp. 51–52). Thus rooted in the here and now—rather than the
remembered past, the wished-for future, or the abstractions of theory—we
are less vulnerable to our own tendencies to be either dismissing or preoccu­
pied. A mindful stance allows us to be more fully present, open, and capable
of responding—like the “good enough” attuned parent—to the require­
ments of the moment as these emerge in our interaction with the patient.
Second, a mindful and present-centered stance fosters an experience of
being inside, and aware of, the body. The resulting attunement to our own
somatic responses amplifies the signals that allow us to tune in to the non­
verbal expressions of the patient’s internal state. Thus, mindfulness can
potentially enhance accurate empathy as well as our ability to connect with
the patient’s unarticulated, and perhaps dissociated, experience. Third,
mindfulness (like a secure state of mind with respect to attachment) fosters
an attitude of acceptance—a nondefensive openness and receptivity to
experience as it is that can help us make room for the full spectrum of the
patient’s feelings, thoughts, and desires. In this way, mindfulness in the
therapist may facilitate a relationship with the patient that fosters the pro­
cess of integration.
Such integration may be not only a primary goal of psychotherapy but
also (as previously suggested) a consequence both of secure attachment and
of the practice of mindful awareness. As part of what makes the therapeutic
relationship a transformative one, the therapist’s mindful stance may have a
“contagious” quality—kindling the patient’s own experience of mindful­
ness very much as expressions of the therapist’s reflective stance help to
kindle the patient’s ability to mentalize. With some patients, in addition, it
may be helpful for the therapist to encourage the formal practice of medita­
tion.

I trust I have made it clear that, viewed through the lens of attachment
theory and research, the healing power of psychotherapy derives primarily
from the therapeutic interaction. The new relationship of attachment that
the patient forms with the therapist can potentially function as a develop­
mental crucible. In the chapters to follow, I delve more deeply into the three
key themes—the relationship, the nonverbal dimension, and the stance of
the self toward experience—that orient my work with every patient. The
chapters in Part I summarize the story of attachment theory and research,
establishing in the process the book’s conceptual foundation. Part II de­
 8 Attachment and Change

scribes the impact of attachment relationships on the developing self. Part

III makes the first bridges from attachment theory to the practice of psy­
chotherapy. Part IV explains the clinical implications that follow from iden­
tifying the patient’s prevailing pattern(s) of attachment. Part V details
further the nature of therapeutic work in the nonverbal realm as well as the
ways in which we can attempt to both cultivate in ourselves and elicit in
our patients a more reflective and mindful stance toward experience.

Guilford Publications
Copyright © 2007 The Guilford Press. All rights reserved under International Copyright 72 Spring Street
Convention. No part of this text may be reproduced, transmitted, downloaded, or stored in New York, NY 10012
or introduced into any information storage or retrieval system, in any form or by any 212-431-9800
means, whether electronic or mechanical, now known or hereinafter invented, without the 800-365-7006
written permission of The Guilford Press. www.guilford.com