R. D. Laing opened one of his less enduring works with the warning: ‘Few books today are forgivable’. Well, here's one to celebrate. If you practice psychotherapy and you read it, your patients stand to benefit. And, as an impressive synthesis of research and practice, it joins a handful of books that truly belong to this century rather than the previous one. Wallin has recognised that the techniques relationally minded therapists have been discovering may be out of step with some traditional clinical teaching, but can be usefully reconciled with findings from cognitive science and neuroscience as well as developmental psychology. Implications include the way therapeutic approaches are tailored throughout to an individual patient's attachment history and responses, the importance of non-verbal communications and how awareness of feelings in the body is fostered in therapy.
In the model Wallin develops, patients are helped to overcome the ways they have become, as a consequence of insecure early attachments, either embedded in or dissociated from their experience. They do this by developing the capacities to reflect, to mentalise and to be mindful. The therapist models and teaches these capacities within a therapeutic process whose aim is to bring about a lasting and liberating adjustment in patients' relationship to their experience. Minute attention is paid to the particulars of what is happening and how it is being understood, rather than relying on more abstract forms of interpretation. To work effectively, providing optimal conditions within a therapeutic relationship, therapists need the personal capacity to offer not only secure attachment but a very receptive and accepting attentiveness towards their patients. Well-chosen examples are provided of these in practice.
Like many good books, Attachment in Psychotherapy provides a snapshot of work in evolution. Its bland title belies its actual range. Its current organisation, which reveals progressive levels of subtlety of the author's model, rather than a sequence of therapeutic operations, may not be final. Perhaps two apparent omissions will be addressed in the next version. One is the role that eye movement desensitisation and reprocessing (EMDR) is finding, in other hands, in potentiating the sort of therapeutic operations that Wallin recommends. The other is the potential of therapeutic groups to afford an arena in which feelings not only emerge through what he terms evocations and enactments, but can also be understood and modulated within a rich but stable set of relationships. For now, we can be grateful that this book has arrived. It is much more than forgivable. It seems indispensable.
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