Dependency is not the same thing as Attachment

Inexperienced therapists --- and some patients, too --- often worry that patients will become ”dependent” on the therapist and unable to, one day, leave therapy. This worry may be confusing dependency with attachment. Bowlby, according to Sable, distinguishes the two by their observable, distinct behaviors. For example, babies are dependent on others for food, but eventually grow to be able to feed themselves; and the other who provides the bottle may be substituted. Attachment needs, however, are life long and are not related to immaturity. The attachment bond/attachment figure is not so easily interchangeable. Development of attachment bonds is an achievement, not something to be outgrown.

Furthermore, Bowlby thought that fears [on the part of the therapist] about dependency could obfuscate awareness of the universal human need for attachment [in their patients]. Therapists provide an attachment bond and a secure base [through affect regulation/attunement, through timely and consistent repair of ruptures, and through shared affective experience- per Beebe and Lachmann; and through a ‘moving along’ toward a shared intention- per Boston Change Process Study Group; by being emotionally present and honest, yes, and by being punctual]. This secure base allows the patient to explore novel, and ‘safe surprises’ [Bromberg], such as previously disavowed affective states.

Just as with children viz a viz the caregiver, secure attachment develops in patients an increased psychological self sufficiency from which to explore their inner and outer worlds, and, in relationship with the therapist, reconfigures ‘internal working models’ [Bowlby] --- internal working models being a kind of ‘implicit relational knowing’ [Lyons-Ruth] or relational paradigm [Herzog] encoded in the brain as a pattern of behavior or way of ‘being with’ another. While it may take years in the treatment for a secure attachment to develop, the existence of this secure attachment decreases, not increases, dependency. (Is it counterintuitive to learn that increased secure attachment decreases dependency?) The therapist, through self reflection and supervision, and through being attuned to patients’ needs, comes to terms with discomfort regarding being depended upon and being intimately, authentically related to the other.

Sable, P. (1994). Anxious Attachment in Adulthood: Therapeutic Implications. Psychoanal. Soc. Work, 2(1):5-24.