The Significance of Attachment Theory for Work in Outpatient Practice

The attachment theory was first formulated by the British psychiatrist and psychoanalyst John Bowlby and has since been the subject of continuous research and further development. It states that humans possess a subconscious and independent motivation for attachment. Accordingly, so-called attachment systems are activated when the subject is in danger. Attachment serves to protect the subject from various dangers that may come both from within and from without. Already in the first year of life a child develops patterns of attachment that are stored as attachment styles and subconsciously activated: Four different attachment styles are distinguished: secure, secure, anxious-avoidant, anxious-ambivalent, and disorganized. These styles are also found in adults. Secure attachments represent a major resource for the development of a mature personality structure; this is valid not only for the development of a child but also for patients undergoing therapeutic interventions. Attachment theory envisages the sensitivity of the reference person as a major prerequisite for the formation of a secure attachment. Sensitivity is considered as the ability and behaviour of the reference person to react attentively, spontaneously and appropriately to the signals of another (child or patient) without dropping into an over-precautionary behaviour. In his review, Klopper describes the characteristics of the various attachment styles as well as the peculiarities of patients who possess these patterns. For one example, among others, he shows how relevant an understanding of attachment theory is for daily routine. He also shows where it can take its place within the framework of the pluralismus of contemporary pyschoanalytical theories.