Treating Attachment Disorders: From Theory to Therapy

By Keith, Charles | American Journal of Psychotherapy, January 1, 2003 | Go to article overview

Treating Attachment Disorders: From Theory to Therapy


Keith, Charles, American Journal of Psychotherapy


KARL HEINZ BRISCH: Treating Attachment Disorders: From Theory to Therapy. Guilford Press, New York, 2002, 294 pp., $36.90, ISBN 1-57230-681-5.

The author, a German psychoanalyst, attempts to demonstrate the applicability and efficacy of attachment-theory concepts in a wide variety of clinical situations. Brisch discusses consultation in hospitals, schools, social welfare agencies, and in psychoanalytic psychotherapeutic encounters with pregnant mothers about to miscarry, parents of premature infants, children with school phobias, addicted and conduct-disordered adolescents, and adults with various emotional problems.

Only some of the patients suffered from what are typically considered attachment disorders, thus the book's title is something of a misnomer.

The first third of the book provides the reader with an excellent overview of attachment theory. Along the way, the author integrates other developmental theories, particularly psychoanalytic ones, with attachment concepts, demonstrating how they often overlap to enrich one another. The "strange situation" and "adult attachment interview," two of attachment theory's principal research tools, are described in detail along with the rich postdictive and predictive research findings that have emerged over the years. These introductory chapters are worth the price of the book and would in themselves be useful for teaching developmental theory to residents, candidates, and graduate students.

However, these theoretical chapters are to provide an introductory framework for the treatment chapters in which Brisch briefly describes 26 clinical situations in which he highlights his use of attachment concepts. He warns the reader that the focus on attachment concepts in his discussion of these highly complex clinical encounters may at times seem strained and awkward. Indeed, this is so. Perhaps if there were fewer clinical cases, this could have allowed more in-depth discussion of each, which in turn could have ameliorated some of the awkwardness. But, perhaps, there is some inherent awkwardness when attempting to translate well-researched, meticulously defined attachment concepts and configurations into the subtle complexities of the therapist-patient interaction.

The author is clearly a sensitive psychoanalytic clinician. Thus, it is surprising when he uses psychoanalytic clinical theory as a "strawman" to highlight an attachment concept. For instance, one of his case studies involves a 17-year-old promiscuous, addicted girl who was neglected and abandoned by her parents. …

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