Attachment Theory and Psychoanalysis (review)

Since its birth, psychoanalysis has demonstrated an unfortunate pattern of ignoring, marginalizing, or disparaging differing viewpoints. The classic criticism is that these theories are not "psychoanalytic" (and therefore irrelevant). In the current culture, with the ascendance of managed care, psychoanalysis is no longer valued as it once was, and it has been criticized for lacking scientific evidence demonstrating its validity. Unfortunately, after many decades, there has been only minimal progress in integrating psychoanalysis with general psychologies, particularly those grounded in empirical research.

There are, of course, exceptions to these generalizations, e.g., the increasing attention being paid to infant research, neurobiology, and cognitive science. However, the primary thrust of analysts has always been on clinical data. Complicating matters further, psychoanalysis is not a homogenous entity, but is rather composed of various orientations with attendant theories and clinical practices. Thus, in addition to a tendency to ignore other psychologies, there are conflicts among the orientations. It is rare for analysts within one orientation to have substantive knowledge of others. More common is polemical divisiveness, based on superficial knowledge of alternative views, often resulting in fights with straw men.

Peter Fonagy's Attachment Theory and Psychoanalysis is remarkable in that it not only demonstrates superior scholarship, but also compares and contrasts attachment theory with a wide range of psychoanalytic orientations in a sophisticated and incisive manner. This book is an integrative study of the subtle and complex areas of overlap between the two fields. Fonagy reviews the history and current state of attachment theory and evenhandedly notes its strengths and weaknesses as well as those of psychoanalysis.

The relevance of attachment theory has become particularly acute given the "relational turn" in psychoanalysis. The past fifteen years or so, psychoanalysts have become increasingly interested in interpersonal and internalized relations. Bowlby's primary contribution was to emphasize the importance of the infant's need for a secure attachment to the mother. The large body of resultant research has explored many issues of concern to relational analysts, e.g., the effects of the mother-child relationship on the child's behavior, cognitive development, and character. Rather than relying exclusively on retrospective speculation about the analysand's early experiences, analysts have a rich body of research to explore.

The first two chapters of Fonagy's book outline the development of attachment theory and its key findings. This includes a discussion of the course of Bowlby's work and his conflict with psychoanalysis, as well as a review of various researchers, including Mary Salter Ainsworth and Mary Main. In chapters three through ten, a host of psychoanalytic theories and theorists are summarized and points of contact with and divergence from attachment theory are outlined. Fonagy begins with Freud and includes ego psychology, the British school, Daniel Stern's work, the interpersonal model, and psychoanalytic attachment theorists. He concludes with two chapters discussing what psychoanalysis and attachment theory have in common and how each can benefit from the other.

In Fonagy's phrase, there has been a long history of "bad blood" between psychoanalysis and attachment theory. Since Bowlby published "Grief and Mourning in Infancy and Early Childhood" (1960) in Psychoanalytic Study of the Child, analysts have criticized attachment theory for being mechanistic and reductive, for focusing on the surface and ignoring the unconscious, and for minimizing fantasy at the expense of reality. Bowlby strongly disagreed with Kleinian analysts who privileged fantasy over actual early experience in determining development. Unfortunately, Bowlby's disillusionment with psychoanalysis, and his interest in "the representation of the real rather than the reality of the representation" (4), led to the diversion of attachment theory into a line of experimental research with a largely behavioral emphasis. To date there continue to be some analysts who disparage attachment theory.

However, on closer inspection, these incompatibilities are not as self-evident as previously thought. As Stephen Mitchell argued in Relationality: From Attachment to Intersubjectivity (2000), in contemporary psychoanalysis the boundary between reality...