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Exploring in Security: Towards an Attachment-Informed Psychoanalytic Psychotherapy
Winner of the 2010 Goethe Award for Psychoanalytic and Psychodynamic Scholarship! This book builds a key clinical bridge between attachment theory and psychoanalysis, deploying Holmes' unique capacity to weld empirical evidence, psychoanalytic theory and consulting room experience into a coherent and convincing whole. Starting from the theory–practice gap in psychoanalytic psychotherapy, the book demonstrates how attachment theory can help practitioners better understand what they intuitively do in the consulting room, how this benefits clients, and informs evidence-based practice. Divided into two sections, theory and practice, Exploring in Security discusses the concept of mentalising and considers three components of effective therapy – the therapeutic relationship, meaning making and change promotion – from both attachment and psychoanalytic perspectives. The second part of the book applies attachment theory to a number of clinical situations Throughout the book theoretical discussion is vividly illustrated with clinical material, personal experience and examples from literature and film, making this an accessible yet authoritative text for psychotherapy practitioners at all levels, including psychoanalysts, psychiatrists, clinical psychologists, mental health nurses and counsellors.
- GenresPsychologyNonfiction
216 pages, Paperback
First published January 1, 2009
8 people are currently reading
73 people want to read
About the author
Jeremy Holmes
41 books17 followersJeremy Holmes is a British psychiatrist, born in London in 1943.
https://en.wikipedia.org/wiki/Jeremy_...
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https://en.wikipedia.org/wiki/Jeremy_...
Librarian Note:
There is more than one author in the Goodreads database with this name.
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Displaying 1 - 3 of 3 reviews
February 12, 2013
Just some points I made for discussion at a local book club:
Now, re Jeremy Holmes’s book, here is a list of the main points I got, and they are very general:
1.Patients come to us in distress and confusion, and are looking to make sense of this confusion hence easing (maybe) some of this distress
2.As Jeremy Holmes put it: our job is to assist in MEANING MAKING, then making GRADED CHALLENGES as an action orientated plan to patient
3.The above can only occur if patient feels safe, and trusting of the therapist and the setting. Hence the importance of the THERAPEUTIC RELATIONSHIP
4.The patient and therapist carry their own relational templates based on past experience with parental and other caregivers, and here is where ATTACHMENT THEORY comes in. Here we can maybe talk about the 4 different attachment styles and how they may differ in different contexts
5.Within a SECURE attachment, the possibility of MENTALIZATION can occur: a combination of theory of mind, empathic understanding of the intentional stance of the other, affect regulation, and the ability hence to engage in SAFE internal/external exploration, leading to the potential for perspective taking, reflective functioning (rather than pretend or equivalence mode) and creativity leading to a ‘simple complexity’ in the development of self in relation to other
6.Attachment and mentalization that are the collaborative vehicles for the PROCESS of meaning making, the CONTENT of which can be ‘polysemic’: here the co-creation depends on the therapists knowledge of various psychoanalytic theories, and also patients preferences etc. COLLABORATIVE hypothesis testing within a safe, secure relationship is paramount.
7.A big difference between mentalization/attachment theory and more ‘traditional’ psychoanalytic ones is that the former describes the process and how the relational field (Ogden’s ‘analytic third’, or Winnicott’s ‘transitional space’) contributes to this, whereas the others (especially Freudian) are more mechanistic and ‘atomistic’, but still potentially relevant.
Now, re Jeremy Holmes’s book, here is a list of the main points I got, and they are very general:
1.Patients come to us in distress and confusion, and are looking to make sense of this confusion hence easing (maybe) some of this distress
2.As Jeremy Holmes put it: our job is to assist in MEANING MAKING, then making GRADED CHALLENGES as an action orientated plan to patient
3.The above can only occur if patient feels safe, and trusting of the therapist and the setting. Hence the importance of the THERAPEUTIC RELATIONSHIP
4.The patient and therapist carry their own relational templates based on past experience with parental and other caregivers, and here is where ATTACHMENT THEORY comes in. Here we can maybe talk about the 4 different attachment styles and how they may differ in different contexts
5.Within a SECURE attachment, the possibility of MENTALIZATION can occur: a combination of theory of mind, empathic understanding of the intentional stance of the other, affect regulation, and the ability hence to engage in SAFE internal/external exploration, leading to the potential for perspective taking, reflective functioning (rather than pretend or equivalence mode) and creativity leading to a ‘simple complexity’ in the development of self in relation to other
6.Attachment and mentalization that are the collaborative vehicles for the PROCESS of meaning making, the CONTENT of which can be ‘polysemic’: here the co-creation depends on the therapists knowledge of various psychoanalytic theories, and also patients preferences etc. COLLABORATIVE hypothesis testing within a safe, secure relationship is paramount.
7.A big difference between mentalization/attachment theory and more ‘traditional’ psychoanalytic ones is that the former describes the process and how the relational field (Ogden’s ‘analytic third’, or Winnicott’s ‘transitional space’) contributes to this, whereas the others (especially Freudian) are more mechanistic and ‘atomistic’, but still potentially relevant.
July 13, 2024
A perfectly adequate resource, though I found Russell Meares' Intimacy and Alienation, Jessica Fern's Polysecure, and Susan M. Johnson's Attachment Theory in Practice to be deeper engagements with attachment theory on the level of theory and praxis.
To give a small rundown, attachment theory argues that we develop different styles of attachment depending on our primary caretaker: 1) secure, with a good enough caretaker who is attuned to our needs and capable of repairing dyadic ruptures, 2) avoidant, if the caretaker persistently fails to respond to our needs, 3) ambivalent, if the caretaker is unpredictable in fulfilling our needs, and 4) disorganised, if the caretaker is abusive.
Secure children will show distress when a caretaker leaves, but be comforted when they return. Avoidant children will mask their distress when a caretaker leaves, and show little emotion when they return. Ambivalent children will show heightened distress when a caretaker leaves, and react with rage or listlessness on their return. And disorganised children will exhibit confusing, contradictory behaviour, like fleeing and freezing, self-harming, and dissociating (because the caretaker is the source of both care and trauma).
Holmes argues that traditional psychoanalysis has focused on the exploration of meaning, but such explorations can only take place in conditions of security. If you're not secure in your attachment (to the therapist, at the very least), you won't feel comfortable exploring your lifeworld. Though Holmes seems unaware of dissociation-based treatments , he mirrors a lot of their thoughts (which build off Pierre Janet, rather than Freud).
The first thing to do in psychotherapy then, is to alleviate symptoms, through goal-corrected empathic attunement, which involves 1) affect expression, 2) empathic resonance, 3) affect regulation, 4) mutual pleasure/playfulness, and 5) exploratory play/companionable interaction.
In other words, first, you mirror the other. You validate their emotions and show that their perspective is worth considering. Second, you regulate affect, soothing or exciting them, so they can continue with a line of thought previously overwhelming. Third, you connect affect to meaning (Holmes calls this "mastery"), weaving a sense of selfhood and continuity into their existence.
These are the same ways a "good enough" caretaker with interact with their child: 1) they'll exaggerate the child's emotional expressions so they form mental representations of their inner world, 2) comfort them in times of distress so they learn how to comfort themselves and others, and 3) create narratives of their behavioural patterns so they gain an awareness of their capacity to affect the world.
This leads to Holmes' main contribution to psychoanalysis: the introduction of the concept mentalisation from developmental psychology—essentially a more rigorous definition of empathy. Mentalisation comes in degrees. It begins with the capacity to think about thinking, and to see oneself in perspective. It ends with the capacity to speculate on the thoughts of others, to see their minds as perspectival. In other words, mentalisation is a self-reflexive, cybernetic form of empathy, that is distinctly other-oriented. It is not "what would I do if I were in their shoes," but "what would they do in the shoes they are in." It is thinking about the conditions that generate thought itself. It is empathy as otherness, rather than self-imposition.
Holmes argues that anxiety and stress are the enemy of mentalisation. The point of therapy then, is to provide the security necessary for mentalisation to develop in the client, and therefore, for new object relations to emerge. This is the space of play, where transferences (old patterns of relating) can be investigated and dismantled. Mentalisation gets us out of earlier modes of thinking such as 1) teleology, which understands the world through cause and effect, and object functions, 2) equivalence, which operates through transferences, projections, and overgeneralisations, and 3) pretend, the fantasy of the inner world.
To put it in critical theory/poststructuralist terms, mentalisation is the counter to instrumentalisation; it is a form of intersubjective fantasy based on iteration (difference), rather than repetition (sameness).
If you're wondering why I've only given this book two-stars, it's because I feel like I should have just read a book on mentalisation. The rest of the book is standard psychoanalysis material, affirming deep psychology in the face of CBT, etc. I really liked Holmes' development of mentalisation as the bridge between insecurity and security, a depathologising process that challenges our maladapted behaviours and thoughts. However, it felt a bit handwavy. One of the reasons I moved away from psychoanalysis and into embodied cognition, trauma studies, and posthumanism, was because of the psychoanalysis's tendency to reify meaning and narrative as the site of transformation. It all feels a bit too idealist.
There was a great burst of frenetic energy when catharsis models came into vogue in the 2oth century, but the issue with catharsis is that once it's over and you've joyously expended your energy, you just go back to work. It's the carnival of the imaginary. It doesn't necessarily bring about structural change.
Mentalisation is emphatically different from catharsis, because while it can be cathartic, it is other-oriented, rather than self-expressive. However, I'm skeptical of consciousness-raising, on its own, as a mode of change. I mean, how many people have dropped a tab of acid, discovered newfound depths to themselves and the world, and then fallen back into older patterns of relating out of habit? Or taken a deep dive into climate change literature and then felt even more politically hopeless? Dissociation-based treatments, on the other hand, go beyond the formulation of new meaning to the enactment of new relations. More than thinking otherness, it is performing otherness, in concert with others. As with the family therapies that preceded it, it is about systemic shifts in being.
Another aspect that Holmes fails to consider is the more performance-based side of psychotherapy, such as with psychodrama—therapeutic modalities that bring unformulated experiences into the immediacy of the body so that they may be experienced again as living processes—modalities that have been used to develop tactics for class struggle , as well as trauma recovery. These are implicitly anti-idealist, connecting psychological wellbeing and growth to social engagements with material bodies, rather than (just) inner objects.
Lastly, I find the ontology of psychoanalysis deeply problematic. Many philosophers have used psychoanalysis as a critique of Enlightenment humanism, citing the unconscious as a site that ruptures conceptions of the self as fully knowable. Yet, many feminists have pointed out that the unconscious has been used to victim-blame survivors of sexual abuse and assault. Under psychoanalysis, an emphatic "no" can be spun into a secret "yes," shifting focus from the perpetrator to the victim, who is excised from the social field, isolated to their mind (much like the Enlightenment subject)—and a mind discoverable only by the analyst.
Throughout the book, Holmes repeatedly argues that his patients bring about their own suffering. It's repugnant, because while yes we reproduce behaviours from our past that prime others into treating us a certain way, to say that we desire that is fucking ridiculous, especially in the context of abuse. Critical victimologists have investigated this point with far defter hands than Holmes: people who have been abused fall back into abusive relations because abuse isn't merely negative, it contains moments of care and nourishment, and it is those elements that are sought for, not the abuse itself. I'm quite sick of psychoanalysts, who have never experienced abuse, repeating the mantras of Freud without thought.
One more thing. There are hidden dimensions of power in using mentalisation as a rehumanising tool. Isn't mentalising a form of emotional labour? Like, all good to those who have never done it and are finally receiving and returning the empathy they need, but what about the mentalisation of mothers, caretakers, and so forth? There's something incredibly reductive about Holmes' binary of anxiety-mentalisation, as if mentalisation can't produce anxiety and stress, especially to those whose role is to mentalise. David Graeber argues that throughout history, it's been slaves and women who've had to develop empathic capacities to survive. Mentalisation can be a form of entrapment, as much as one of emancipation.
To give a small rundown, attachment theory argues that we develop different styles of attachment depending on our primary caretaker: 1) secure, with a good enough caretaker who is attuned to our needs and capable of repairing dyadic ruptures, 2) avoidant, if the caretaker persistently fails to respond to our needs, 3) ambivalent, if the caretaker is unpredictable in fulfilling our needs, and 4) disorganised, if the caretaker is abusive.
Secure children will show distress when a caretaker leaves, but be comforted when they return. Avoidant children will mask their distress when a caretaker leaves, and show little emotion when they return. Ambivalent children will show heightened distress when a caretaker leaves, and react with rage or listlessness on their return. And disorganised children will exhibit confusing, contradictory behaviour, like fleeing and freezing, self-harming, and dissociating (because the caretaker is the source of both care and trauma).
Holmes argues that traditional psychoanalysis has focused on the exploration of meaning, but such explorations can only take place in conditions of security. If you're not secure in your attachment (to the therapist, at the very least), you won't feel comfortable exploring your lifeworld. Though Holmes seems unaware of dissociation-based treatments , he mirrors a lot of their thoughts (which build off Pierre Janet, rather than Freud).
The first thing to do in psychotherapy then, is to alleviate symptoms, through goal-corrected empathic attunement, which involves 1) affect expression, 2) empathic resonance, 3) affect regulation, 4) mutual pleasure/playfulness, and 5) exploratory play/companionable interaction.
In other words, first, you mirror the other. You validate their emotions and show that their perspective is worth considering. Second, you regulate affect, soothing or exciting them, so they can continue with a line of thought previously overwhelming. Third, you connect affect to meaning (Holmes calls this "mastery"), weaving a sense of selfhood and continuity into their existence.
These are the same ways a "good enough" caretaker with interact with their child: 1) they'll exaggerate the child's emotional expressions so they form mental representations of their inner world, 2) comfort them in times of distress so they learn how to comfort themselves and others, and 3) create narratives of their behavioural patterns so they gain an awareness of their capacity to affect the world.
This leads to Holmes' main contribution to psychoanalysis: the introduction of the concept mentalisation from developmental psychology—essentially a more rigorous definition of empathy. Mentalisation comes in degrees. It begins with the capacity to think about thinking, and to see oneself in perspective. It ends with the capacity to speculate on the thoughts of others, to see their minds as perspectival. In other words, mentalisation is a self-reflexive, cybernetic form of empathy, that is distinctly other-oriented. It is not "what would I do if I were in their shoes," but "what would they do in the shoes they are in." It is thinking about the conditions that generate thought itself. It is empathy as otherness, rather than self-imposition.
Holmes argues that anxiety and stress are the enemy of mentalisation. The point of therapy then, is to provide the security necessary for mentalisation to develop in the client, and therefore, for new object relations to emerge. This is the space of play, where transferences (old patterns of relating) can be investigated and dismantled. Mentalisation gets us out of earlier modes of thinking such as 1) teleology, which understands the world through cause and effect, and object functions, 2) equivalence, which operates through transferences, projections, and overgeneralisations, and 3) pretend, the fantasy of the inner world.
To put it in critical theory/poststructuralist terms, mentalisation is the counter to instrumentalisation; it is a form of intersubjective fantasy based on iteration (difference), rather than repetition (sameness).
If you're wondering why I've only given this book two-stars, it's because I feel like I should have just read a book on mentalisation. The rest of the book is standard psychoanalysis material, affirming deep psychology in the face of CBT, etc. I really liked Holmes' development of mentalisation as the bridge between insecurity and security, a depathologising process that challenges our maladapted behaviours and thoughts. However, it felt a bit handwavy. One of the reasons I moved away from psychoanalysis and into embodied cognition, trauma studies, and posthumanism, was because of the psychoanalysis's tendency to reify meaning and narrative as the site of transformation. It all feels a bit too idealist.
There was a great burst of frenetic energy when catharsis models came into vogue in the 2oth century, but the issue with catharsis is that once it's over and you've joyously expended your energy, you just go back to work. It's the carnival of the imaginary. It doesn't necessarily bring about structural change.
Mentalisation is emphatically different from catharsis, because while it can be cathartic, it is other-oriented, rather than self-expressive. However, I'm skeptical of consciousness-raising, on its own, as a mode of change. I mean, how many people have dropped a tab of acid, discovered newfound depths to themselves and the world, and then fallen back into older patterns of relating out of habit? Or taken a deep dive into climate change literature and then felt even more politically hopeless? Dissociation-based treatments, on the other hand, go beyond the formulation of new meaning to the enactment of new relations. More than thinking otherness, it is performing otherness, in concert with others. As with the family therapies that preceded it, it is about systemic shifts in being.
Another aspect that Holmes fails to consider is the more performance-based side of psychotherapy, such as with psychodrama—therapeutic modalities that bring unformulated experiences into the immediacy of the body so that they may be experienced again as living processes—modalities that have been used to develop tactics for class struggle , as well as trauma recovery. These are implicitly anti-idealist, connecting psychological wellbeing and growth to social engagements with material bodies, rather than (just) inner objects.
Lastly, I find the ontology of psychoanalysis deeply problematic. Many philosophers have used psychoanalysis as a critique of Enlightenment humanism, citing the unconscious as a site that ruptures conceptions of the self as fully knowable. Yet, many feminists have pointed out that the unconscious has been used to victim-blame survivors of sexual abuse and assault. Under psychoanalysis, an emphatic "no" can be spun into a secret "yes," shifting focus from the perpetrator to the victim, who is excised from the social field, isolated to their mind (much like the Enlightenment subject)—and a mind discoverable only by the analyst.
Throughout the book, Holmes repeatedly argues that his patients bring about their own suffering. It's repugnant, because while yes we reproduce behaviours from our past that prime others into treating us a certain way, to say that we desire that is fucking ridiculous, especially in the context of abuse. Critical victimologists have investigated this point with far defter hands than Holmes: people who have been abused fall back into abusive relations because abuse isn't merely negative, it contains moments of care and nourishment, and it is those elements that are sought for, not the abuse itself. I'm quite sick of psychoanalysts, who have never experienced abuse, repeating the mantras of Freud without thought.
One more thing. There are hidden dimensions of power in using mentalisation as a rehumanising tool. Isn't mentalising a form of emotional labour? Like, all good to those who have never done it and are finally receiving and returning the empathy they need, but what about the mentalisation of mothers, caretakers, and so forth? There's something incredibly reductive about Holmes' binary of anxiety-mentalisation, as if mentalisation can't produce anxiety and stress, especially to those whose role is to mentalise. David Graeber argues that throughout history, it's been slaves and women who've had to develop empathic capacities to survive. Mentalisation can be a form of entrapment, as much as one of emancipation.
December 9, 2021
Lots of long words in this one so progress was slower at the start but found the material thought provoking and interesting when I apply to my work as a counsellor. Recommended read
Displaying 1 - 3 of 3 reviews