The Role of Attachment Theory in Psychotherapy

Although attachment theory has its origins in the research of infant development and is not a model for how to conduct psychotherapy, I have found it increasingly useful as a therapist to consider attachment style when sitting with a patient. In a healthy development children develop a secure attachment with their primary caretaker, usually the mother. More often than not an insecure attachment develops. John Bowlby outlines three types of insecure attachments. An avoidant attachment style is one in which the child adopts the attitude that he/she is fine without the caretaker and maintains this “I don’t need you” stance throughout life. An individual with an ambivalent attachment style responds to an unpredictable parent by either becoming angry or exhibiting helplessness. And an individual with a disorganized attachment style can present as scattered and disoriented, especially when the attachment figure is unavailable.

These attachment styles originate in infancy and persist through adolescence and adulthood. We find that these are transmuted generationally, with children often mirroring the attachment style of their caretaker. It is imperative for a clinician to be aware of one’s own attachment style as well as to attend to one’s patient’s unique attachment style, as these will emerge in the treatment as the relationship between the therapist and patient evolves. It may well inform the clinician and patient about what is being enacted in the therapy, and if a clinician is not paying close enough attention, the danger is that things get acted out in the therapeutic relationship without being addressed.

Attachment styles are not set in stone. Through the work of therapy, someone who previously had an insecure attachment style can learn to develop healthy attachments in their closest relationships. It may not replicate the experience of one who was born with secure attachments, but it is still possible for the individual to establish and maintain close, meaningful interpersonal relationships. As a therapist who works relationally, I view the therapeutic relationship as the primary agent of change. By focusing directly on attending to what occurs in the relationship between therapist and patient, we can afford the patient the opportunity to experience a healthy attachment, possibly for the first time. The real relationship between therapist and patient offers the patient the chance to learn and practice developing true closeness with a nonjudgmental parental figure with whom one can reveal their authentic self without repercussion of rejection, abandonment, or wrath. Over time, the hope is that by modeling a healthy relationship between therapist and patient, this experience will transfer to other close relationships outside of this dyadic relationship. In this way, the bulk of therapy happens in the room by addressing the ever-changing landscape of the real relationship between therapist and patient. The therapeutic relationship thus presents a unique opportunity for emotional intimacy that may endure as one of the closest and healthiest relationships the patient has known.

The Plight of the Performing Artist

The gratification of a standing ovation, uproarious laughter when you land your joke just right, the sense of mastery you can experience at reaping the rewards of your hard work and preparation…these are just some of the allures of being a performing artist. Inherently, nothing is wrong with basking in the limelight for a job well done. But when the measure of one’s sense of self-worth is determined by external validation as opposed to internal validation, it may drive that individual into a nonending chase after that all too temporal adoration.

Children develop self-worth by the age of five. In a healthy development, the child learns an intrinsic sense of self-worth and is internally validated. Such a child comes to believe that he is a valuable individual merely because of his existence on this planet, as opposed to because of how good his grades are, how popular he is, how attractive he is, or any other of the numerous false markers of “worthiness” that may be prescribed at a young age. Often when one is seeking elusive validation of their self-worth, that individual may feel incredibly insecure and “less than” on the inside. If that person then pursues a career which is so closely intertwined with the response of an audience, as would be the case of a performing artist, then often the need for external validation becomes the thing that drives the artist’s performance above all else. When one’s primary motivation for one’s art hinges on the accolades of an audience, it is likely that this individual at his core has a depreciated sense of self.

In addition to seeking constant adulation, performing artists may attempt to compensate for a lack that is at their core. Numerous behaviors may be employed to this end: substance abuse, eating disorders, anger outbursts, depression, anxiety, self-harm, and sexual acting out, to name a few. Such behaviors often are attempts to manage underlying feelings of low self-worth.

Psychotherapy can help a performing artist uncover the previously hidden unconscious motivations that have been operating, thereby assisting her in increasing her awareness of underlying relational patterns that get repeated if not addressed. By becoming aware of how one has exhausted herself with this constant drive for validation, one may be better positioned to shift things so that one can learn to derive satisfaction from one’s intrinsic sense of self-worth. Such a person will still have ups and downs, losses and successes, like any individual, but one’s identity can remain solid and intact even during times of hardship because one’s sense of self-worth is no longer dictated by some outside validation over which we have no power.