(2000).

Journal of the American Psychoanalytic Association, 48:1147-1174

The Development and Organization of Attachment: Implications for Psychoanalysis

Arietta Slade
As a result of John Bowlby's breach with the British Psychoanalytic Society nearly forty years ago, his work, specifically the development of attachmenttheory, was until recently largely expunged from the psychoanalytic record. However, thanks to developments in both psychoanalytic and attachmenttheories, a rapprochement has been forged, and a number of scholars are now seeking to integrate these two complementary perspectives. In this paper, the fundamental premises of attachment theory are discussed in light of their relation to psychoanalytic theory. In addition, their application to the clinical situation in both adult and child treatment is discussed. Attachment theory was first conceptualized in the 1950s by John Bowlby, a psychoanalyst and a member of the British Psychoanalytic Society. It began as a clinical theory, and followed Bowlby's (1944) observation that the delinquent boys with whom he was working had all suffered early losses or traumatic abandonments. His curiosity about the long-term effects of such early disruptions led him to investigate many of the overlapping dimensions of development and biology, and to establish critical dialogues with pioneers in the study of early separation, evolutionary biology, ethology, congnitive

The author wishes to thank Susan Coates, Shelley Doctors, Karen Gilmore, and Mary Main for their clarifying and helpful comments. A version of this paper was presented at the panel on attachment, Fall Meeting of the American Psychoanalytic Association, New York, December 20, 1997. Submitted for publication April 9, 1998.
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science, and information processing theory. Together, these rich and multifaceted investigations led to the formulation of a fundamental premise of attachment theory: that children are born with a predisposition to become attached to their caregivers, and that early disturbances in primary attachment relationships can lead to lifelong feelings of insecurity and to distortions in the capacity to develop and sustain meaningful relationships (Bowlby 1969, 1973, 1980). These ideas are absolutely acceptable, if not banal, today; indeed, they seem typical of mainstream psychoanalytic beliefs, particularly those of the relational and self psychological schools (Aron 1995; Kohut 1969;Mitchell 1988, 1993). Indeed, Bowlby himself saw attachment theory as intrinsically psychoanalytic, and he saw himself as a psychoanalyst throughout his long career. As compatible as the fundamental premises of attachment theory are with present-day psychoanalytic thought, however, Bowlby's ideas led to his virtual expulsion from the British Psychoanalytic Society. Despite the fact that he has been described by Storr (1992) as one of the three or four finest psychiatrists of the twentieth century, Bowlby, along with his theory and its vast clinical ramifications, was, as Holmes put it, for decades virtually airbrushed out of the psychoanalytic recordrather like some dissident in Stalinist times (Holmes 1995, p. 20). Grostein has called Bowlby's extrusion one of the most dreadful, shameful and regrettable chapters in the history of psychoanalysis (1990, p. 62). The myriad theoretical, historical, and political reasons underlying this breach have been well described elsewhere (Holmes 1993; Karen 1998; van Dijken 1996). In any case, its principal effects were straightforward: from the standpoint of psychoanalysis, psychiatry, and clinical psychology, attachment theory all but ceased to exist for at least three decades. Not until research in attachment began to provide empirical evidence of the most essential tenets of psychoanalysis did analysts began to consider that attachment theory might be applicable to developmental theory and clinical work (Coates 1998; Diamond and Blatt 1994; Eagle 1995, 1997; Fonagy 1999,Fonagy et al. 1995; Holmes 1993, 1995, 1996; Minde and Hesse 1996; Mitchell, 1999; Sable 1992, 1994; Silverman 1991; Slade 1999a, 1999b; Slade and Aber 1992). As unfortunate as this breach was for psychoanalysis, and for Bowlby personally, it led him toward academic psychology, and specifically into a collaboration of nearly thirty years with clinician and
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research psychologist Mary Ainsworth. Their collaboration eventually ensured attachment theory's rightful place in academic developmental psychology. However, it also reified the distance

between attachment theory and psychoanalysis. By the time he met Ainsworth, Bowlby had become very interested in biology and in cognitive control theory, but it was her work on the development and stability of empirically derived patterns of attachment (Ainsworth et al. 1978) that shifted the focus of attachmenttheory from clinical inquiry to empirical research and the study of normal development. As a consequence, attachment research developed along a completely different trajectory than it would likely have followed had it remained clinically grounded. In recent years, however, the concerns of attachment research and clinical psychoanalysis have begun to converge, as a consequence both of advances inattachment research, and of the increasing breadth of psychoanalytic inquiry and metapsychology. I intend to consider here some of the clinical implications of attachmenttheory: specifically its broad implications for clinical listening, the direct relevance of attachment classification for the clinical process, and the relevance of attachmenttheory to child analytic work. These are obviously complex issues whose clinical relevance can best be made clear by direct application to case material. I offer here, therefore, a set of reflections that I hope will set the stage for direct clinical application and inquiry. As a way of laying the groundwork for such inquiry, I will first sketch out the basic assumptions and findings of attachment theory and research.

Attachment Theory and Research: Basic Assumptions

It is helpful to think of attachment theory and research as organized around four basic assumptions or guiding principles (for summaries of the history of attachmenttheory and research, see Belsky and Cassidy 1994; Bretherton 1985; Cassidy 1999; and Karen 1998). The first basic assumption of attachment theory and research is that a baby is highly motivated to form, maintain, and preserve his primary relationships, because his emotional and physical survival depend upon his doing so. It is this motivation to sustain his primary attachments that ensures that he will adapt to his caregiver's actions and his caregiver's mind, even when doing so requires distortion of his most inherent responses. Behaviors, feelings, and thoughts that would
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disrupt vital attachments are excluded from consciousness, and thus remain unelaborated, unintegrated, and split off from self-experience. Like Winnicott (1965, 1971), Bowlby believed that children would comply with the needs and desires of their caregivers even if this meant adopting a false and distorted self. But unlike Winnicott, Bowlby placed particular emphasis upon the survival value of such compliance. This view of motivation led to the unfortunate rift between Bowlby and the British Psychoanalytic Society, in part because in Bowlby's view the need to develop and preserve attachments necessarily supplanted the importance of libidinal and aggressive drives. As radical as that notion seemed forty years ago, a wealth of evidencedevelopmental (Brazelton and Cramer 1990), clinical, and neuroscience-based (Hofer 1995; Kandel, Schwartz, and Jessel 1991) now supports Bowlby's view: the infant has a basic and biologically determined propensity to sustain his attachments to those who provide vital regulation of physiological, behavioral, neural, and affective systems. And several psychoanalytic writers, notably Lichtenberg (1989) and Silverman (1991), have provided powerful arguments for the integration of Bowlby's notion of motivation into psychoanalytic metapsychology. The second basic assumption of attachment theory is that because the infant will do what is necessary emotionally, cognitively, and otherwise to maintain his primaryattachment relationships, disruptions in these relationships will often create vulnerability in his sense of himself and of others, and in his capacity to regulate, contain, and modulate his affective experience. This premise is fundamental to much latterday psychoanalytic thinking, but what is particular to attachment theory is the view that there is a specifiable and observable relationship between actual lived experience as it is manifested both in the mother's behavior with the infant and in her capacity to represent his mind and reflect upon his experienceand the development of structures for thinking, feeling, remembering, and knowing (Coates 1998; Fonagy and Target 1998; Fonagy et al. 1995). To understand the fundamental organization of the child's mind and his sense of wholeness, security, and reality, it is imperative to understand how affects are regulated within the child's primary relationships, and how experiences are made real, known, and mentalized within the relationship and within the childhimself. In a multitude of explicit, empirically derived investigations, attachment theorists have emphasizedin terms that are
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complementary to the work of Stern (1985, 1995), Beebe (Beebe and Stern 1977; Beebe, Lachmann, and Jaffe 1997), Tronick (Tronick and Weinberg 1997), and otherinfant researchersthat it is

the real relationship that serves as the bedrock of psychic structure, that gives shape to inherent biology, and that provides organization to interior life, fantasy, and object representations.1 The third basic assumption of attachment theory and research concerns the development of attachment patterns; it was initially outlined by Bowlby, and later substantially elaborated by Mary Ainsworth and Mary Main. In this view, the child's biologically driven adaptations to the caregiver's actions and to the caregiver's mind lead to the development of regularly occurring and stable patterns of defense and affect regulation. Infants live in relationships that have specified boundaries and expectations; they quickly perceive and learn these boundaries, and develop patterned ways of responding to their caregivers. These patterned responses are slowly interiorized, becoming internal representations that determine access to thoughts, feelings, and memories relevant to attachment (Main, Kaplan, and Cassidy 1985). Research suggests that such representations in fact become neurologically based structures for affect regulation and for knowing (Schore 1994). Thoughts and feelings that threaten to disrupt primary relationships are defended against and excluded from consciousness, resulting in the fragmented, distorted, and multiple representational models of insecure individuals (Main 1991). Thus cognitive as well as emotional access to attachment-relevant information emerges as a function of thehistory of the mother-child relationship; in essence, the structure and functioning of the child's mind is determined by the types of feelings that are recognized and allowed expression within the dyad. Attachment classification is essentially the empirical codification and description of such patterns, both in infant behavior and in adult speech. Although Bowlby's interest in cognitive psychology (particularly the dynamics of information processing and representational models) set the stage for the notion ofattachment classification, these

1 There continues to be a great deal of controversy within psychoanalysis concerning the degree to which the real

relationship (as opposed to the child's inherent drive development andother biological factors) shapes the emergence of the mind. Indeed, this is an issue that has divided psychoanalysts for generations. Nevertheless, most contemporary psychoanalysts and developmental psychologists (Mayes and Cohen 1996; Mitchell 1988) view the interaction of these factors as intrinsic to any complete view of development, either normal or compromised.
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constructs were brought to life and substantially elaborated first in the work of Mary Ainsworth and then in the work of Mary Main. Ainsworth embarked on her research with the explicit aim of confirming what I have called the first and second basic assumptions of attachment theory: namely, that the child is motivated to learn, from early on, which of his responses will elicit care from the mother, and which will not, and that those that elicit or assure at least limited security become preferred and safe ways of interacting with those who care for him. Her research provided what many consider to be indisputable support of these hypotheses, and also explicit proof that the history of the mother-child relationship (and, as later research documented, the father-child relationship [Belsky 1996; Fonagy and Target 1995; Main and Weston 1981]) sets the stage for the infant's developing capacity to engage in satisfying, mutual, and adaptive object relationships. Even more important, however, Ainsworth's system for classifying infantmother attachment provided strong support for Bowlby's belief that regularly occurring interactive experiences lead to the development of stable patterns of behaving and thinking in relation to primary attachment figures. Her classification of infantile attachmentpatterns as secure or insecure dramatically altered the course of attachment studies and of academic developmental psychology, largely because it allowed her to reconceptualize radically the meaning and context of the behavior of infants. A decade later, Mary Main extended Ainsworth's thinking about behavioral patterns to the level of representation; once again, the path of attachment research changed dramatically. Whereas Ainsworth studied attachment behavior in infants, Main studied attachment representations in adults. And just as Ainsworth discovered patterns in the behavior of infants, so did Main discover that patterns of representation could be discerned in adult attachment narratives (Main, Kaplan, and Cassidy 1985). The hour-long Adult Attachment Interview (George, Kaplan, and Main 1985) is a deceptively straightforward semistructured interview in which adults are asked to describe and reflect upon their relationships with both parents, as well as their experiences of loss, rejection, and separation during early childhood. In this context, Main observed differences in the way parents represented early attachment experiences. Analysis of the patterns of thought, memory, and affectivity inherent in their narratives (Main and Goldwyn 1984, 1998) revealed
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that some parents appeared to have open and ready access to their thoughts, feelings, and memories about early attachment; Main described these parents' representations of attachment as secure or autonomous. Other parents' descriptions of their early relationships were fragmented, incoherent, or somehow compromised; these parents' representations of attachment were described as dismissing or preoccupied. Subjects whose interviews suggested a failure to resolve mourning or traumawere classified as unresolved/disorganized with respect to mourning or trauma (Main and Hesse 1990); such subjects manifested the effects of trauma in cognitive or affective disorientation and confusion, in dissociation, and in lapses in reasoning or discourse. Main found that individuals who reported difficult childhoods were not necessarily insecure. Patterns of representation appeared to reflect not simply the facts of early childhood, but also the quality of the representation of early experiences. Thus the security inherent in an adult narrative was not assessed on the basis of real life experiences, but on the basis of the organization and integration inherent in therepresentation of such experiences. Main also discovered that sixty-eight percent of the time, the organization of maternal attachment narratives predicted the quality of infant attachment.2 Mothers who were able to remember openly and describe early attachment experiences, even if such experiences were negative, had children who were open and clear in the expression of their need for comfort and nurture in the experimental situation. Dismissing mothers were likely to have avoidant children, and preoccupied mothers were likely to have resistant children. Main was later able to document a link between a mother's unresolved/disorganized status and disorganization and disorientation in the child. These findings have been replicated in fourteen further samples (see van Ijzendoorn 1995 for a review), and provide evidence for the intergenerational transmission of attachment. I consider this the fourth basic assumption of attachment theory and research: namely, that the quality of a mother's organization of attachment (and to some extent the father's) will profoundly influence the child's ultimate representation of attachment, as well as the behaviors that flow from such developing representations.

2 In her original study (Main, Kaplan, and Cassidy 1985 ), Main also found that the child's status as secure or

insecure could be predicted seventy-five percent of the time. Thus, the explicit type of infant insecurity is less readily predicted by the explicit type of maternal insecurity than the fact of the child's insecurity per se.
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Main focused her attention upon language, and upon patterns of narrative, in a very specific and important way. She made an explicit distinction between coherence and incoherence in narrative, and between organized and disorganized narratives. She made explicit the importance of listening closely to moment-to-moment changes in linguistic fluency, to shifts in voice, to lapses in meaning and coherence, and to fragmentation of narrative, as these for her are the indicators of insecurity in adult patterns of speech. This is the aspect of her work that is particularly relevant to the clinical process, and I will return to it in later sections of this paper. Main's groundbreaking study raised a number of important questions, this chief among them: how does the structure of narrative in the mother relate to the infant's capacity to seek comfort and proximity? Her findings suggested that the capacity to acknowledge, access, and evaluate openly and coherently her own affects in relationto attachment allows a mother to respond to her child's attachment needs in a sensitive and nurturing way, because they evoke feelings within her that are familiar, known, and therefore unthereatening. Because she can acknowledge these experiences in relation to her own attachment figures, she does not need to deny, distort, or obliterate them in her child (see Main 1995). And because she has been able to bind, organize, and make meaning of these feelings in herself, she can bind, organize, and make meaning of them in her child (Slade 1996). By contrast, the mother who has distorted, forgotten, repressed, or remained overwhelmed by the affects inherent in her own early childhood attachment experiences will find her child's needs and feelings intolerable and painful, and will turn away from these feelings as she has turned away from her own. In the late 1980s, Main's work on representational processes began to attract the attention of psychoanalysts, in particular Peter Fonagy. Fonagy, with Miriam and Howard Steele, was the first to replicate Main's original study (Fonagy, Steele, and Steele 1991). More important, however, was the description that he and his colleagues provided of the reflective function, which they saw as intrinsic to the intergenerational transmission of attachment (Fonagy et al. 1995). He proposed that narrative cohernece, in the AAI or in treatment, is a manifestation of the adult's capacity to reflect upon and contemplate internal affective experience: to understand his emotional life, its dynamics, its temporality,

and its effect upon others. The reflective function underlies coherence, as it allows the individual to make sense of his own and others'
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psychological experience. It allows him to enter into another's experience, to read another's mind, and thus to perceive the behavior of others as meaningful and predictable. Most important of all, it may provide protection against the damaging effects of abuse and trauma (Fonagy et al. 1995). Fonagy suggests that it is the mother's capacity to understand her child's mental states, and her readiness to contemplate these in a coherent manner (1995, p. 249), that creates the context for a secure relationship (see also Coates 1998). The mother who is able to reflect upon her own inner experience as well as her infant's forms a representation of the infant as intentional: as mentalizing, desiring, believing. In short, the mother recognizes the child as having a mind of his own. And in Fonagy's view, the experience of the self as real, known, and intentional is central to the experience of security. Main and Fonagy, then, view attachment security in the child as intrinsically related to the quality and organization of the caregivers' representation of their own earlyattachment relationships: that is, how they have understood and integrated the minds of their own parents. Recently a number of researchers have begun studying what might be considered a second, but equally important, vehicle for the intergenerational transmission of attachment: the development and function of parental representations of the child (George and Solomon 1996; Slade et al. 1999; Zeanah et al. 1995). This work evolved from the notion that just as parents develop representations of their own parents, so do they develop representations of their children, which begin to form long before conception, and evolve substantially during pregnancy (Benedek 1959; Fraiberg 1980; Ogden 1986; Slade and Cohen 1996; Solomon and George 1996). While such representations are undoubtedly affected by prior representations of attachment, the experience of actually mothering or fathering a particular child may well have an effect on prior representations of attachment, transforming or elaborating them (Slade and Cohen 1996; Slade et al. 1999). Although we know that parental attachment narratives predict child attachment during the first year of life, this newly developing research suggests that parental empathy, sensitivity, and reflective capacity must be understood as emerging not simply as a function of parents' representations of their relationships with their own parents, but also as a function of developing, ongoing, and potentially changing representations of the child. Thus, both prior representations of caregiving and the ongoing relationship with the actual representations of
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the child may well over the course of development play a role in the transmission of attachment organization from one generation to the next (Slade et al. 1999).

Some Clinical Implications of Attachment Theory and Research

There are a variety of ways to think about the meaning of this body of theory and research for psychoanalytic theory and process. I will consider: the importance of listening for attachment themes in the clinical situation; the clinical utility of the concept of attachment patterns; and the general implications of attachment theory and research for psychoanalytic work with children. Two especially important areas that I will not discuss here warrant specific mention. One is the body of rapidly developing research into the utility of the AAI for assessing treatment outcome, for charting changes from less to more secure organization, and for monitoring the level of reflective functioning over the course of psychoanalytic treatment. This work is being carried out at various research and clinical sites by Ammaniti, Blatt, Diamond, Fonagy, Muschetta, and others. A second critical body of emerging research examines the relationship between attachment classification and various psychiatric diagnoses (Blatt, Auerbach, and Levy 1997; Dozier, Stovall, and Albus 1999; Rosenstein and Horowitz 1996).

Listening for Attachment in the Clinical Situation

Historically, psychoanalytic listening has meant the process of listening for content, for themes, for symbolic, underlying, or distorted meaning, and for metaphor. However, some analytic writers have also focused upon the meaning that is inherent in the structure and organization of language itself (Pizer 1996; Schafer 1958,1992). The work of Main and Fonagy has essentially operationalized and systematized this approach to psychoanalytic listening, placing the kinds of listening analysts do all the time within a theoretical and empirical context. As such, it represents a substantial advance in analytic thinking about the meaning and organization of discourseand narrative.

Main's work, applied to a psychoanalytic theory of language and representation, suggests that the structure of language, syntax, and discourse may be understood to represent unconsciously the dynamics of an individual's early object relationships, and, specifically, the individual's
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experience of seeking comfort and care within the context of that relationship. Main suggests that the infant's experience of his parents' response to his fear, proximity-seeking, anger, and satisfaction is encoded first in an action sequence (Main, Kaplan, and Cassidy 1985); slowly, interiorized action sequences become working internal models of attachment. Thus, I would suggest that the structure of the child's generalized representation of careseeking is embedded in the structure of his representations (see also Bruner 1990). Encoded in the very organization of attachment narratives, or in the capacity to describe and reflect upon some experiences and not others, is arepresentation, at a structural level, of what experiences could be held and understood by the caregiver and which could not. Also embedded in the structure ofattachment-related discourse is the degree to which the individual felt it necessary to distort and obliterate his own needs in the service of maintaining his primaryrelationships. Main distinguishes between language that is collaborative and coherent, and which can therefore convey meaning in a clear and unambguous way, and language that is incoherent, distorted, or vague; the latter makes it necessary for the listener to infer linkages of which the speaker is unconscious, to create organization, and to deduce the real or underlying meaning in the story being told. Both Main and Fonagy imply that secure or highly reflective patterns of language and thought indicate thepresence of an internalized other who can contemplate and contain the breadth and complexity of the child's needs and feelings. By contrast, the incoherence, disruptions, inconsistencies, contradictions, lapses, shifts in person, and irrelevances of insecure language and thought imply breaks in the caregiver's capacity to respond to thechild's needs for care, comfort, and containment. In essence, the distortions of language reflect the child's efforts to maintain his connection to the caregiver, even if this requires fragmentation of his feeling and knowing. This way of hearing language and understanding the organization of thought has several direct clinical implications. First, it implies that experiences of seeking comfort and care constitute nodal, organizing events in early development, and that the consideration of these events as they are conveyed in language within the analytic context may be a critical part of analytic work with some patients. Second, listening for attachment necessarily affects the way the analyst imagines the patient's early experience and thinks about how such early experiences
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have been translated into the patient's relationship to people, feelings, and inner experience. Listening at the level of the structure of discourse helps the analyst to imagine the dynamic patterns that evolved around the regulation of comfort-seeking and care in early childhood, to understand early empathic breaks with caregivers, and to identify islands of dissociated, unintegrated affective experience. It allows the analyst to understand the function of the particular patterns of thought and feeling that both protect the patient from intolerable experiences, and elicit care from others. Finally, such listening necessarily affects what the analyst speaks to in the analytic situation. It allows the analyst to imagine what it was like for the patient to need the parent and be rebuffed, to feel fearful and be turned away, to feel longing and be left alone; thus, it allows her to speak to the patient about these experiences in direct and immediate ways. It allows the analyst to speak to what it must have been like to need, long for, and hope for care that did not come, or that came only in destructive and terrifying ways. For patients whose early attachment experiences can be characterized by the failure to establish a sense of security and safety in primaryrelationships, such understanding on the part of the analyst can have a powerful and transforming effect. As both Bowlby (1988) and Fonagy (Fonagy et al. 1995) have noted, it is the analyst's capacity to reflect upon and mentalize these aspects of the patient's story, and to provide a secure base for the patient's mind, that leads to healing and internal consolidation.

Attachment Classification and the Clinical Process

Attachment research has extended psychoanalytic thinking about language, affect regulation, and the self, but up until now I have considered it in terms that are not in any sense antithetical to latter-day psychoanalytic thinking about language, psychic organization, or clinical process. But what about the notion of attachmentclassification? To return to the third basic assumption of attachment theory, what can we make clinically of the notion that representations, or narratives, take certain formsor patterns? Is attachment classification a useful clinical construct? Might it affect how we think about patients and

how we work with them? In other words, what relevance do the third and fourth basic assumptions of attachment theory and research have for thinking about clinical process?
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Both the third and fourth assumptions of attachment theory and researchthat there exists relative stability of attachment across generations, and that attachmentorganization is patternedhave been greeted with skepticism by many psychoanalysts. Specifically, attachment research is often criticized as advocating a kind of simplistic and overly detrministic way of thinking that is anathema to many clinicians, particularly psychoanalytically oriented ones. And many of the notions underlying the construct of attachment patterns actually do violate some of the basic assumptions of psychoanalytic theory. For instance, the idea that development from parent tochild is necessarily or typically continuous isfrom an analytic perspectivereductionistic. Attachment research has been aimed, to a large extent, at documenting continuities in attachment classification from mother to child; by contrast, the notion that development is necessarily understood as multiply and variously determined is intrinsic to psychoanalytic thinking (Coates 1997; Fischer, Shaver, and Carnochan 1990; Mayes and Cohen 1996; Pine 1990; Waelder 1936). From this perspective any simple notion of developmental linearity is simplistic and developmentally naive. But perhaps most troubling for clinicians is the notion that attachment categories are mutually exclusive, and reflect distinct mental structures or modes for the processing of attachment-relevant experience. Indeed, until it became clear that the concepts of narrative coherence (Main et al. 1985) and of reflective functioning (Fonagy et al. 1995) avoid the problem of type, attachment research was largely ignored by psychoanalysts. From the standpoint of attachment research, however, an individual's state of mind with regard to attachment can be characterized at a structural and perhaps even neurological level in terms of a dominant, singular, mode of affectand self-regulation. Thus, for example, an individual is either dismissing or preoccupied with regard to attachment, but cannot be classified as manifesting both patterns concurrently. Indeed, as Hesse (1996) has noted in his recent work on the cannot classify category, dual classification is typically associated with high levels of psychopathology. The majority of psychoanalytically oriented clinicians would likely be quite uncomfortable with this kind of categorization; psychic functioning, and particularly defensive functioning, are thought to be too fluid and complex to be described by such a simple typology, particularly in the therapeutic situation. This is of course a variant of
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the problem psychoanalysts have long had with the notion of psychiatric diagnosis. These are legitimate concerns. Nevertheless, I would like to suggest that it is possible to develop an ear for attachment themes and attachment patterns without necessarily falling prey to categorical ways of thinking thatas valuable as they may be in researchare too narrow for the clinical situation. The four major attachment classifications delineated by Main describe explicitly different responses to seeking care, and to acknowledging one's affects in primaryrelationships. Each of the four classifications implies differences in the structures that regulate internal experience and guide the development and maintenance of object relationships. Clinically speaking, it is important to recognize that such categories reflect relative, as opposed to absolute, differences in internal organization and psychological structure, and that they describe predominant but not necessarily singular modes of affect regulation (Blatt 1995; Lichtenberg 1989). They are, in effect, metaphors for qualities of psychological organization and internalized object representations. Indeed, Main has noted (personal communication) that inherent in each of the insecure categories are aspects and components of the other insecure categories. For instance, dismissing persons may be seen as actively preoccupied with their parents' unavailability, but cleaving to a veneer of distance and detachment as a defense. Preoccupied people may well be grappling with their identification with their own mothers' coldness, and yet be manifesting a desire for warmth in overt preoccupation and entanglement. Thus, although individuals learn a specific conscious strategy that dictates attachment behavior, there is another unconscious representation that exists outside of ordinary awareness but may well be accessible in the clinical situation. Subtle shifts in levels of conscious and unconscious modes of function may indeed help explain incidents of discordance between mother and child with regard to their styles of attachment organization (Slade and Cohen 1996). For these reasons, thinking about some patientsparticularly those whose early history has been marked by rejection, abandonment, loss, or trauma, or whosepreoedipal development was compromised by disruptions in primary relationshipsin terms of the dynamics and function of particular attachment classifications can directly affect both how the clinician understands the dynamics

underlying the patient's psychic organization, and how she speaks to such dynamics in the clinical situation. One has only to be frozen out by a patient's detachment,
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ensnared in a patient's enmeshment, or lost in a patient's disorientation to appreciate the implications of these patterns for understanding aspects of clinical process. Let me elaborate briefly by describing some of the ways that clinical work can be affected by the dynamics of a patient's attachment organization, specifically the dismissing and preoccupied patterns (see also Dozier 1990; Korfmacher et al. 1997; Holmes 1996, 1998; Sable 1992, 1994). Due to space constraints, this section will necessarily refer to such individuals in a general sense; the complex interplay between attachment types and the subtleties inherent in each of the individual classifications requires the discussion of specific case material (see Slade in press). Some patients are easily recognized as falling into Main's dismissing category of attachment; often they can also be characterized as schizoid, obsessional, or narcissistic. Indeed, thinking about such disturbances in terms of attachment organization and dynamics may be critical to making sense of the patient's primary affective and relational difficulties. Generally speaking, these are individuals who, even though they may develop stable and long-lasting relationships, have enormous difficulty trusting or establishing truly intimate connections with others; they find it terribly difficult to acknowledge the importance of either early or current attachments. Within the clinical situation, their need to defend against intensity of affect, whether it be anger, anxiety, or joy, can be striking, and they are well described as detached, and as minimizing or denying of emotional experience. Interestingly, sexual feelings and indeed sexuality in general are disavowed and unintegrated aspects of functioning, and may actually function as split-off ways of obtaining care and/or expressing aggression. Individuals who are dismissing with regard to attachment might well be described as overly differentiated and separate in relation to others and in relation to their inner lives. Dismissing adults often report, usually without affect, evidence of early disruptions in care: parental unavailability, early rejection and abandonment, or changes in caregivers. However, the emotional impact or meaning of such failures in care cannot be acknowledged; rather, they are frozen out of memory and experience. The inability to integrate such experiences into an overall representation of attachment may be reflected in the patient's need to idealize or normalize his childhood. Alternatively, painful memories or feelings may be denied altogether,
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although they are typically enacted at some other, less conscious levelusually in behavior and relationships. Frequently, such denial and inability to acknowledge the effects of early neglect and rejection has a direct effect on discourse processes, leading to shifts in person or topic, or to overt disavowals and contradictions. Such patients seem to have particularly closed (Bretherton 1990) representational systems, in the sense that their stories and self-experience do not appear open to change; presumably this is because the openness that would lead to change necessarily involves the retrieval and re-experiencing of painful emotions. Instead, they cleave to what Holmes (1998) refers to as nodal memories: rigid, inflexible versions of their early relationships and inner reality. Their stories are, as it were, fixed, and they lack the capacity to reflect upon, monitor, or evaluate the meaning of the stories they tell. The development of a therapeutic alliance with such patients is often thwarted by the patient's inability to experience or acknowledge the analyst's importance to him. The denial of longing, need, sadness, and anger vis--vis the caregiver is central to his psychological and self organization, and the evocation of such feelings within thetransference can be powerfully distressing and threatening. Individuals who are dismissing of attachment will disparage the analyst's efforts to speak to their inner experience, and they seem overtly unperturbed by vacations or other breaks in the treatment; they themselves may miss sessions without apparent reaction. Transferencereactions are characterized by the need to keep the analyst at bay, and such patients may respond angrily to the analyst's efforts to get to know them or understand their experience. Countertransference reactions in these circumstances can be quite intense, as the analyst often feels shut out, ridiculed, and inconsequential, as the patient himself must once have felt in relation to his primary caregivers (Dozier 1990; Sroufe and Fleeson 1986). It is critical, in working with patients who dismiss attachments and detach themselves from inner experience, to understand their disavowal of emotion not asresistance but as a vital and long-honed protective device; they have learned that to express longing, need, desire, or fear is to open themselves up to the painful realitythat they will not be comforted, and to leave themselves vulnerable to feelings that they cannot manage alone. They disavow and distort their needs in order to obtain whatever care is

possible. Fundamentally, self-organization revolves around not expressing emotions that would disrupt critical ties. Thus
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what they unconsciously convey to the analyst, and to those who try to get close to them, is that intimacy is dangerous and threatening. What effect does thinking about a patient as dismissing have upon how we think about the work, and what we say? In work with such people, we are aiming to soften defenses, and to create flexibility in structures that have become hardened and inflexible. It is critical to find a way in to the patient's story, much of which has been long buried and uncoupled from affect and meaning. Holmes (1998) calls this unpacking, reworking, and reassembling of rigid stories story breaking; the patient's singular view of life's events is recast in light of new information. This necessarily comes about when the patient is allowed to experience, within the therapeutic relationship, an other who can tolerate intense affect and who will not leave in the face of need, anger, or fear. Often this requires great tolerance for rejection and ridicule on the part of the analyst. In contrast to patients who are dismissing of attachment, and who provide evidence of early rejection in only the most oblique, bland, and emotionally watered-down ways, individuals who are preoccupied in relation to attachment often present direct evidence of early disruption and trauma, and manifest few stable structures for the regulation and containment of affect; this is particularly true of those whom Main classifies as E2 and E3 (Main and Goldwyn 1984, 1998). The former (E2) category is comprised of individuals whose story is one of over-whelmingly negative experience that cannot be contained and organized, whereas the latter (E3) refers to people who seem afraid to remember early attachment, and cannot easily keep talking about relationships. Some of these individuals could well be described as having borderline or primitive hysterical personality disorders (Adam, Keller, and West 1995; Ainsworth and Eichberg 1991; Allen, Hauser, and Borman-Spruell 1996; Fonagy et al. 1995); importantly, they are often also classified as unresolved/disorganized in relation to attachment. Many patients who are preoccupied in this way seem overwhelmed and tormented by feeling; indeed, the constant and ongoing evaporation of structuremost often manifested in narrative incoherenceposes a major impediment to therapeutic work. Feelings from the past are still live and present in everyday experience; hence Main's original use of the term enmeshed (Main, Kaplan, and Cassidy 1985). Their personal relationships are predictably disrupted by intrusive rage, anxiety, desperation, and need; the capacity to reflect upon inner experience, or
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to maintain perspective, is slight. Clinically speaking, these patients are poorly differentiated, and they struggle in many aspects of their lives to develop a sense of themselves as separate and whole. The capacity to develop stable representations of self and of others is highly compromised in preoccupied adults; indeed, structures for the regulation of experience and of affect are all but absent. As a consequence of the relative paucity of internal structures, such patients may well become dependent and demanding within the treatment situation, although dependency may initially be expressed in oblique and indirect ways. They are far more likely than dismissing individuals to call therapists between sessions or to demand extra appointments, along with advice, support, and direct approval. They are also far more likely to challenge the parameters ofpsychotherapy and endeavor to turn the treatment situation into a relationship more reminiscent of a parent-child relationship. Their intense needs for structure and containment, and their experience of being treated as uncontainable and unmanageable, can often leave the analyst feeling sapped, overwhelmed, and ineffectual. The analyst can feel much the way the patient once did as a child: swamped, angry, helpless, confused, and dysregulated. It is important to understand that the patient who is preoccupied in relation to attachment has the fantasy, likely rooted in early experience, of his caregivers as unable to regulate or soothe him, and therefore of himself as uncontainable; this experience is enacted in the transference again and again. And, as a function of the trauma and negativity that likely typified his early history, he may well define intimacy in terms of heightened negative emotion; for him, closeness came through rage, need, and fear; without such intensity, those closest to him might not respond. What this means, concretely, is that the analyst working with a patient who is preoccupied in relation toattachment necessarily defines her work as the creation of structures for the containment of affect. This is accomplished through the process, as Holmes (1998) describes it, of making stories that somehow capture the confusion and vagaries of overwhelming feelings. The analyst must walk the difficult line between remaining present and available, yet not entering into the rage and anxiety that is the patient's primary way of attaining closeness. Indeed, whereas the dismissing individual requires tangible but unthreatening evidence of the

analyst's availability, the preoccupied individual requires the analyst's separately held belief that there is structure, differentiation, andautonomy (Holmes 1996) to be had in the
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patient's own untangling of meaning and of feeling. The analyst's natural inclination to create stories for the patient will only increase the patient's dependency and thus increase his feeling of being mired in chaos and confusion. As has been noted by Fonagy and his colleagues, these patients are often very difficult to treat (Fonagy et al. 1996). These complexities are exacerbated when the characteristic entanglement and enmeshment become intertwined with what Main terms the lack of resolution ofmourning or trauma (Main and Hesse 1996). Here the relative absence of regulatory structures is compounded by cognitive dysregulation. This can manifest itself in a number of ways, principally among them dissociation, disorientation, and transient thought disorganization. It is with these patients that the effects of attachmentorganization upon psychological structure and integration are most apparent. Liotti (1993, 1995) has written about the complexity and pace of working with such traumatized patients. Coates ( Coates and Moore 1997; Coates and Wolfe 1997) has linked maternal lack of resolution of mourning and early trauma to breakdowns inmother-infant attachment, and suggests that it may be a primary factor in the onset of childhood gender identity disorder. The foregoing discussion of the dynamic impact of attachment organization upon analytic work has necessarily simplified what is in fact a complex and textured process, in which the clarity of a classification system gives way to a nuanced, layered, and changing set of clinical conceptualizations. Nevertheless, my intentional simplification of these issues is meant to highlight what I think is one of the most potent implications of attachment research for understanding of analytic process: work proceeds differently at the process level, the technical level, the dynamic level, and the relational level, as a function of attachment organization. Andin patients whose early attachment experiences have truncated the normal development of flexible regulatory structuresanalytic progress reflects change in the capacity to remember, make sense, and make meaning of early experience. The analytic process forges change in basic representational processes. Attachment issues are not necessarily less salient for analysts than for patients ( Dozier, Cue, and Barnett 1994; Slade 1999a). Many analysts have suffered early losses as well as covert and overt forms of abandonment; naturally, they will vary in the degree to which they have reconciled and come to terms with these experiences. And different patients will engage the analyst and her attachment drams in different
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ways. Clearly, the dynamic interplay between an analyst's attachment organization and that of her patient is often complex, and may be central to progress and stalemates in treatment.

Attachment Theory and Child Therapy

Let me close by turning briefly to the applicability of attachment theory and research to clinical child psychotherapy and psychoanalysis. I would like to make two interrelated points: first, that thinking about a child's attachment classification can provide an important perspective upon the nature of internal organization and structure, just as it does in adult work; and second, that addressing a parent's representation of the child is an important aspect of child therapy. By the time children are a year old, they can be reliably classified as secure, avoidant, resistant, or disorganized. These classifications describe the degree to which the infant's expression of his need for closeness, comfort, and security are: overregulated and minimized, as in the avoidant pattern; undercontrolled or dysergulated, as in either the resistant and disorganized patterns; or openly experienced and flexibly expressed, as is characteristic of the secure pattern. This way of thinking about modes ofaffect regulation is buttressed by recent evidence from neurobiology, which indicates that what we might term dispositions and tendencies with regard to affect expression and regulation are well in place by the end of the first year, and appear to emerge as a function of the infant's interaction with his primary caregivers (Schore 1994; see also Hofer 1995 for a discussion of similar phenomena in rat pups). The psychoanalytic perspective typically associates emotional flexibility and a range of higher-order defenses with a successful move through the preoedipal period and with relative success in the resolution of the oedipal crisis, whereas lower-order defenses are associated with varying degrees of fixation, regression, and failure to resolve the issues of the preoedipal period. Attachment theorists offer us a different map for early development, however, for they suggest that the roots of affective

flexibility, balance, and emotional openness can be traced to the first year of life, and to the dynamics of the mother-child relationship. Thus, the dynamics of a secure relationship predispose the child toward more differentiated, coherent, and flexible functioning ( Diamond and Blatt 1994).
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Presumbly such emergent representational structures will exert a profound influence on the development of internal subjective experience as well as on the capacity to engage in and sustain basic relationships. They will shape the child's experience of his sexuality, his aggression, and his autonomy. They will also determine the nature and quality of his fantasy life in relation to these aspects of his development. For instance, an avoidant child's move through separation-individuation might well be characterized by flattened pleasure in autonomy and a diminished capacity to grapple with and integrate the sense of loss that is part of the rapprochement subphase. We have much to learn about how these processes play out developmentally. What impact does attachment quality have upon the emergence and negotiation of triadic relationships? How does it affect the development of sexuality? Young children's capacity to enter into and truly experience the complexity of the oedipal triangle may well be profoundly affected by the quality of their attachment; under certain circumstances, a child's continuing entanglement in the struggle to obtain his mother's care and attention will preclude his internalizing a sustaining and comforting image of her. This will make it more difficult for him to move beyond his attachment to his mother and toward his father, and toward more complex triadic oedipal functioning. Clearly it is important to note that attachment processes may well be modified and influenced by temperament. Extremes of temperamental vulnerability, even in an essentially positive relationship, can derail the development of attachment security. For some highly reactive, hypersensitive, and vulnerable children, forming an internal image of the mother can be very difficult, even when the attachment relationship is solid and sustaining. Finally, I would like to consider from an attachment perspective the function of the work we do with the parents of our child patients. Attachment experiences are represented in the adult patient. For the child patient, however, although internal representations of the parents are forming continuously, actual attachments and their vicissitudes are a real and lively part of experience. The child is living in real relationships that are contributing continuously to the development of internal structures. Parents respond to their children, in part, as a function of their experience with their own parents; at the same time, they respond to their children as a function of their representations of them, representations that are formed over the course of pregnancy and parenthood (Slade et al. 1999; Slade and Cohen 1996). When we work with the
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parents of the children we treat, we are often working directly upon the actual attachment relationship, and specifically upon the parent's capacity to understand and make sense of the child's emotional life. Often this involves direct work with the parent's representation of the child; that is, we work to modify, temper, expand, or contextualize the parent's representation of the child, his biological rhythms, his moods, his intentions, and his desires (Slade 1999b). Addressing such representations in a direct way allows the parent to respond to the child more freely and sensitively, and allows the child an enhanced experience of the parent as a present, mentalizing, secure base. Even in our work with adult patients, we work with what is being carried forward from the past as well as what is being carried forward into the future. We often talk to our adult patients about their children, and about the ways their children's fears and anxieties recall their own. As we learned years ago from Selma Fraiberg (1980), suchremembering allows adults to empathize and identify with their children; we hope that it makes them more sensitive and responsive parents. Helping adults provide a safe and comfortable haven for their children, perhaps protecting them to some extent from what they suffered at the hands of their own parents, is no small part of our work. Let me close by reiterating what I said earlier: the language of attachment theory complements the thinking of many current analytic thinkers (Mitchell 1993; Ogden 1986). And, as I hope I have made clear here, it provides ways of thinking and speaking that are likely experience-near for our patients, and that address experiences that are nodal in most of our lives. It provides a language of loss, of need, of sorrow, and of longing, and it allows us to imagine and make sense of experiences that have transformed us by their poignancy, their immediacy, and their meaning.

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Article Citation [Who Cited This?]

Slade, A. (2000). The Development and Organization of Attachment. J. Amer. Psychoanal. Assn., 48:1147-1174