Prologue: Creative Attachments: Clinical Practice Through an Attachment Theory Lens

On being invited to edit an issue of Psychoanalytic Inquiry, the topic that immediately sprang to mind was the use of attachment theory and research in clinical practice. Why did I settle so quickly on this particular theme, when there is a plethora of other clinically relevant subjects that I might well have chosen instead? My decision was influenced, at least in part, by the fact that my clinical practice with adults (individuals and couples) is centrally informed by attachment theory and research. This, in turn, reflects the fact that attachment ideas and empirical findings inform many new ways of thinking about clinical issues and the therapeutic process: for example, the Boston Change Process Study Group (BCPSG)’s work on the nonverbal implicit/procedural domain of being and relating, Beebe and Lachmann’s adult treatment model, Allan Schore’s neurobiological approach to affect regulation and cumulative developmental trauma, Bateman and Fonagy’s mentalizationbased treatment of borderline personality disorder, Joseph Lichtenberg’s thinking about motivational systems and adult sexuality and sensuality, Giovanni Liotti’s understanding of the cognitive-developmental and motivational basis of dissociation and multiple self-representations, Alicia Lieberman’s development of psychoanalytic infant-parent psychotherapy, Arietta Slade’s emphasis on reflective functioning in conjoint work with parents and children and focus on narrative in work with adults, Susan Johnson’s and Christopher Clulow’s approaches to working with couples, and Hazan and Shaver’s research into the quality of adult romantic relationships. Perhaps I should say that it is not always appreciated that research in the field of attachment encompasses two main lines of investigation. Research utilizing the strange situation procedure (Ainsworth et al., 1978) and the Adult Attachment Interview (George, Kaplan, and Main, 1996) tends to focus on the intergenerational transmission of patterns of attachment organization between caregiver and child. By contrast, research employing the Relationship Questionnaire (Bartholomew and Horowitz, 1991) and the Self-Report Measure of Adult Attachment Styles (Brennan, Clark, and Shaver, 1998) is designed to reveal the social-cognitive dynamics affecting thoughts, feelings, and behavior in adult romantic relationships. Proponents of this line of investigation argue that their research methodologies identify and classify the individual’s adult attachment style on a dimensional continuum. Discomfort with closeness and emotional intimacy lie at one end of the continuum, anxiety about abandonment and rejection lie at the other end. I have found these ideas and findings particularly helpful in working clinically with the attachment dynamics that motivate violence and abuse in intimate relationships (Renn, 2003, 2006, 2008, 2012). More generally, I think it important to emphasize that attachment classifications used for research purposes are simply ways of describing and organizing implicitly encoded attachment phenomena. These silent phenomena and the invisible processes and relational procedures they represent are the focus of clinical work, not the classifications per se (Slade, 2004; Renn, 2012; Clulow, 2017, this issue;Wachtel, 2017, this issue). Also, that attachment is relationship specific, with representational models of mother, father, and other significant attachment figures developing separately, rather than there being one overarching model of attachment (Steel and Steele, 2008). This empirical finding would seem to support the contemporary psychoanalytic concept of multiple self-states (Davies and Frawley, 1994; Bromberg, 1998). But the main factor that led me to choose this particular theme is that, despite the extensive literature on attachment, and the broad acknowledgement of the clinical relevance of this body of knowledge, many practitioners seem to be at something of a loss when it comes to actually using