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Title

Attachment in the consulting room: towards a theory of therapeutic change

Abstract

Effective therapists need guiding models, but, paradoxically, the benefits of psychoanalytic psychotherapy may not flow from its espoused theories. Using an attachment framework, it is argued that psychoanalytic psychotherapy in common with all therapies has three principal components: an attachment relationship; meaning-making; and change-promotion. Secure and insecure models of attachment help understand how therapists guide the therapeutic relationship in helpful or unhelpful directions. Freedom of meaning-making is a mark of secure attachment. Change is promoted by placing clients in a ‘benign bind’ characterised by: close engagement; discrepancy between client transferential expectations and therapist response; and exploration and verbal descriptions of the feelings arising from these discrepancies. An attachment meta-perspective helps reconcile apparent differences between differing psychoanalytic and non-psychoanalytic theoretical perspectives.

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