AN ATTACHMENT THEORY APPROACH TO TREATMENT OF THE DIFFICULT PATIENT

This article reviews the role of attachment in difficult-to-treat pati ents. It is suggested that difficulty often arises in the treatment of these patients because of their inadequate understanding of mental fu nctioning in themselves and in others. The capacity to mentalize is se en as a function of early attachment relationships. Vulnerability intr oduced by insecure attachment is frequently compounded by a history of intense trauma, leading these patients to defensively inhibit their c apacity to think about mental states in their abusers, which then gene ralizes to other attachment relationships. The clinical implications o f this model are discussed.