Book Review
Psychotherapy 
Attachment Processes in Couple and Family Therapy Susan M Johnson, Valerie E Whiffen, editors. New York: The Guilford Press; 2003. 411 p. US$42.00.
Reviewer
rating*: Excellent
Review by: Natasha Demidenko, MA
Ottawa, Ontario
Attachment theory was developed by John Bowlby as a theoretical framework to understand enduring emotional bonds that individuals develop in relation to certain people. It is only within the past 15 years or so that attachment theory has been recognized as a clinically valuable way of understanding significant adult relationships. From this understanding came research that demonstrated the meaningful link between attachment security or insecurity and well-being or distress.
This edited text presents a broad look at the benefits and relevance of using an attachment-based framework when working with couples and families, regardless of the clients’ ages. Its chapters are self-contained articles written by experts regarded as leaders in the areas of couples therapy, family therapy, and attachment theory. The text has 5 clear sections. Section 1 addresses the issue of why (and how) attachment theory is relevant for clinical practice with couples and families. Here, the authors point out the universal and evolutionary basis of attachment. They provide readers with a solid foundation in the assumptions underlying attachment theory, offering key definitions outlining secure and insecure forms of attachment, as well as a discussion of the nature of attachment and pair bonding in adults. Further, they put attachment theory into a context that challenges readers to think about the variations in human attachment that may occur over one’s lifespan and across cultures.
Section 2 introduces readers to clinical interventions that incorporate attachment theory into their model of treatment. Specifically, the authors discuss emotion-focused therapy (EFT) for distressed couples; the value of attachment theory in behavioural interventions; and the use of attachment theory in interventions with children, in adolescents suffering from depression, and in adoptive families.
In Sections 3 and 4, the authors expand on the discussion of clinical interventions, using an attachment-based framework. Separate chapters cover intervention with infants and mothers, adolescents and parents, heterosexual and same-sex couples, and older adults. The authors cohesively incorporate the research and theory components of their chapters with clinical illustrations such as case examples, session-specific therapist–client dialogue, and specific interventions. This allows readers to consolidate what they have learned theoretically with what they may see in their daily clinical practice. The authors demonstrate that attachment theory may serve as a valuable guide to clinicians when working with specific clients such as sexual abuse survivors and their partners, individuals with chronic pain and their partners, and women suffering from postpartum depression. Perhaps one of the most important points illustrated in the text’s final section is the systemic nature of attachment-based interventions. These interventions are aimed at treating individuals, families, and couples in the very context in which they live and interact with others. By definition, these interventions take the focus off the “identified patient” and his or her disorder and put the emphasis on underlying attachment insecurity in clients’ interpersonal networks.
EFT for couples and families is emphasized throughout this text as an empirically validated and effective treatment for distressed couple and family relationships. In comparison with other couple and family therapies practised today, EFT distinguishes itself. Because EFT is heavily guided by attachment theory, clinicians using EFT may better understand the links between current individual or couple distress; past family relationships; and individuals’ vulnerabilities, needs, and fears. Combining systemic and experiential approaches, this approach primarily focuses on affect and cyclical, self-reinforcing interactional response patterns. The process of EFT facilitates the expression of core emotions involved in relationship distress and urges each individual to become aware of how his or her negative affect is an extension of unmet attachment needs that maintain the negative interactional cycle. Central to EFT is the recognition that attachment and security within close relationships is a universal human need. This recognition normalizes dependency as an adaptive and healthy response, particularly in times of crisis or transition. With attachment needs and longings normalized, clients may experience a therapy that validates the very obstacles they are struggling to reconcile—fears of abandonment, desires for closeness, and needs for security. In its approach, the book challenges other, more traditional, Western therapeutic approaches that have emphasized separation and individuation while simultaneously pathologizing dependency.
Overall, this is a comprehensive, well-written, and highly readable text for clinicians who may be new to attachment-based interventions for couples and families. It is an equally valuable addition to the library of clinicians who are well-seasoned in attachment-based interventions and wish to better understand the applicability of attachment theory and related interventions to various populations. This is an ideal text for clinicians who would like to better understand how to treat many common mental health problems as well as relationship distress, taking into consideration the complexity of their clients’ interpersonal contexts.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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