Treating Attachment Pathology

Article excerpt

JON MILLS Treating Attachment Pathology Lanham, MD: Jason Aronson, 2005, 388 pages (ISBN 0-7657-0132-4, CDN$40.02 Paper, 0-7657-0130-8, CDN$89.31 Cloth) Reviewed by TREVOR R. OLSON and MICHAEL Wm. MACGREGOR

Many books written on attachment pathology focus on the assessment and treatment of children, and provide very little information on attachment difficulties found in adults and adolescents. Jon Mills' Treating Attachment Pathology addresses this neglected area by exploring attachment disorders and psychopathology in adults. As such, Mills' work is a welcome addition to the literature. It goes beyond simply linking adult psychopathology to early attachment difficulties. Mills' work provides a theoretical framework for understanding attachment from a psychodynamic/psychoanalytic perspective and then uses this theoretical framework to discuss the aetiology and treatment of adult disorders.

Mills aims to make Treating Attachment Pathology accessible to the expert and novice alike. He does this by extensively reviewing the literature for the expert (e.g., conceptualizations of the self, borderline conditions, etc.), and by making the literature accessible to the novice by providing case examples. Mills himself, however, acknowledges that at times the literature and language is "dense and esoteric." To counteract this Mills makes extensive use of case examples and thereby makes complex and theoretically dense concepts accessible. This is one of the real strengths of Mills' book and it is done with great skill.

Mills divides Treating Attachment Pathology into three sections: "Theoretical and Diagnostic Considerations," where he introduces psychodynamic, psychoanalytic, and attachment theory and research (pp. 3-92); "Treatment Perspectives" where he examines specific aspects of psychodynamic/psychoanalytic psychotherapy for attachment disordered patients (pp. 95-276); and "Extended Case Studies," where the reader is given an opportunity to consider the previously presented information in lengthy case examples (pp. 279-339).

The first section of Treating Attachment Pathology begins with an exploration of the unconscious and prelanguage origins of attachment. Mills also explores issues such as early attachment classification, biological and emotional components of attachment, relationality, and intersubjectivity. Mills' philosophical background is clearly evident in Chapter One as he takes the reader through a review of past and present attachment conceptualizations and classifications. Although the material is at times philosophical and "dense," this chapter provides a foundation upon which Mills builds his conceptualization of attachment pathology and how it relates to adult psychopathology. For example, Mills discusses how attachment pathology results in structural deficit of the self due to the incorporation of toxic introjects. Mills continues to lay the foundation for his understanding of attachment pathology in Chapter Two, where he discusses his theory of the infantile mind. In this chapter, Mills provides an excellent summary of his theory of the infantile mind (pp. 42-43). He also addresses the defensive evolvement of the infant and highlights the works of Object Relations psychologists such as Klein, Bion, and Fairbairn. Through the use of case examples, Mills helps the reader better understand the material presented. This is one of the strengths found throughout Mills' book and as indicated above, helps makes the material accessible to the novice.

In the third chapter, Mills cogently argues that attachment pathology often results in personality organization at the borderline level. He further goes on to argue that this borderline organization helps account for the polysymptomatic presentation seen in patients with attachment pathology (i.e., dysregulated affect, complaints directed towards others, interpersonal difficulties, disturbed self-representations, impulsive behaviours, confusion over interpreting inner experiential states, developmental histories marked by absence and loss). …