Attachment in Psychotherapy

in Psychotherapy David J Wallin. New York (NY): Guilford Press; 2007.366 p. US$38.00 Reviewer rating: Excellent Review by Paul I Steinberg, MD, FRCPC, and Carolyn R Steinberg, MSc, MD Vancouver, British Columbia This book is clearly written, despite concentration of material it offers. The author appears very knowledgeable about subject. The book is quite readable. It is an excellent review of contemporary psychoanalytic thought, including relational and intersubjective approaches, and incorporates consideration of mentalization and mindfulness. David J Wallin offers a model of psychotherapy that involves transformation of self through relationship.p 2 In comparing psychotherapy with early development, he notes that cocreated relationships of attachment are key context for development, that preverbal experience makes up core of developing self, and that stance of self toward experience predicts attachment security better than facts of personal history themselves. Wallin emphasizes that the patient who cannot (or will not) articulate his own dissociated or disavowed experience will evoke it in others, enact it in others, or embody it, adding that, therapist must pay particular attention to her own subjective experience, to transference-countertransference enactments jointly created by patient and therapist, and to nonverbal language of emotion in body... for all these are roots to accessing and eventually integrating what patient has had to deny ordisown.p4 An introductory chapter expands on attachment and change. Part 1, and Beyond, describes foundations of attachment theory and contributions of Bowlby, Main, Ainsworth, and Fonagy, with an emphasis on mentalization, affect regulation, and intersubjectivity. Wallin provides an excellent review of foundations of attachment theory and work of Bowlby and Ainsworth. He provides a well organized historical basis and sequence of attachment research, guiding reader through in a helpful manner. Wallin has a remarkable ability for summarizing research in a readable format. His chapters are short and punchy, with a pleasing writing style. In Part 2, Attachment Relations and Development of Self, Wallin describes multiple dimensions of self that are first shaped and can be reshaped in an attachment context. He summarizes research documenting varieties of attachment experience, which provides an evocative basis for grasping origin, meaning, and impact of each of 4 primary states of mind with respect to attachment. He builds bridges between attachment research and clinical practice, focusing on affect regulation, cocreated attachment relationship, and qualities of collaborative communication fostering security both in childhood and in psychotherapy. Wallin includes an excellent summary of impact of neurobiology on attachment experience. He makes repeated reference to Bollas' known without explicitly discussing Bollas' contribution beyond a passing reference, although he bases a whole chapter on unthought known. Part 2 deals with multiple dimensions of self, varieties of attachment experience, and how attachment relationships shape themselves. …

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