The move from categories to process: Attachment phenomena and clinical evaluation

Despite the degree to which attachment theory and research have been embraced by clinicians in recent years, many remain unsure as to what this perspective adds to clinical understanding and psychodynamic thinking about the clinical process. In this article, I outline some ways that developments in the study of attachment have the potential to enrich our clinical work with children and families, and may be particularly illuminating with respect to certain aspects of evaluation, formulation, and diagnosis. This added value comes not from formally assessing patients' attachment classification but from sensitizing clinicians to observing the functioning of the attachment system and to the internal and interpersonal functions of attachment processes. Such awareness on the part of the therapist makes it possible for these dynamic regulatory, defense, and motivational systems to be addressed within the context of evaluation and ongoing psychotherapeutic work. Thinking about attachment processes within the clinical situation does not supplant other aspects of dynamically oriented assessment and evaluation, but rather is theoretically consistent with psychoanalytic models of development and offers new levels of richness and understanding to formulations and treatment planning.