Book of the Month October 2020 - The Little Book of Attachment

The Little Book of Attachment: 
Theory to Practice in Child Mental Health With Dyadic Developmental Psychotherapy 
​by Daniel Hughes and Ben Gurney-Smith

In ‘The little book of attachment’, Dan Hughes and Ben Gurney-Smith carefully consider the relevance of attachment theory and research for practitioners working in child mental health. 

They notice how understanding attachment theory and the importance of relationships can bring an extra dimension to formulation, diagnosis, and treatment of mental health difficulties within children. They emphasise that this goes beyond recognising children with difficulties of attachment and finding interventions that can reduce these difficulties. It is a recognition that children who do not experience security of attachment can be left with core difficulties in trusting and feeling safe in relationships, regulating emotions and reflecting on experience. These developmental areas, associated with attachment, are critical for emotional well-being and development and therefore can usefully inform how we intervene to help children who present with mental health difficulties. 

Much research, described in this book, has highlighted therapist variables as a more accurate predictor of outcome than mode of intervention. Here Dan and Ben present a powerful discussion of why this might be so. Therapist qualities such as building a therapeutic alliance, empathy, recognising and repairing ruptures, affirmation and holding clients with positive regard are the very same relational qualities that parents bring to parenting a child with a secure attachment. Dan and Ben propose that ‘if we utilize the qualities of human relationships, found in secure attachment, we might begin to enhance the developmental outcomes attachment theory would predict as being important to mental health; named here as the developmental triad of safety and trust, regulation and reflection.’

Dan and Ben are clinicians and they bring all their clinical experience into helping us to translate these ideas into practice. They draw upon Dyadic Developmental Psychotherapy as one example of a therapy that has a relational approach central to the intervention and which actively uses principles derived from Attachment Theory in the therapy. This approach helps families to work towards developing their child’s trust in reciprocal relationships which in turn can help them to develop the emotional and reflective skills needed to both experience attachment security and to move towards improved mental health and emotional well-being. The book is illustrated with many examples of DDP interventions, providing a very practical focus to understanding the ideas being discussed.

This book is called ‘The little book of attachment’. I think it is misnamed. Although the book is little, the ideas within it are huge and have profound implications for the practice of child mental health. All clinicians working with children and families will recognise the importance of understanding the attachment relationship. As one clinician once told me: ‘it always comes down to the attachment stories in the end.’ Our early attachment relationships impact on us in many ways developing both our resilience and our vulnerabilities. By attending to these relational qualities in the therapy room, and within the families, we can only enhance the interventions we use, from whichever model we are comfortable working within. As a DDP practitioner myself, I am persuaded of the benefits of DDP as a relational model of therapy which is helpful for children who have experienced developmental trauma in their lives. Within this book we are invited to broaden our thinking to consider how this, or similar approaches to therapy, can enhance our interventions for all children and families who have been touched by poor mental health and reduced emotional well-being. In doing this there is no ‘throwing the baby out with the bath water’, such an approach to intervention can add an extra dimension to the therapies currently on offer.

I recommend this book to all practitioners interested in improving children’s mental health. It will not necessarily change your practice, but it will enhance it. In bringing relationship to the fore, our interventions will be more successful. We are relational beings, living in a relational world. Attending to relationships within our therapy has to make sense.
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As I ‘tweeted’ when I first read this book: ‘Thanks to Dan and Ben for this gem of a ‘little’ book. Like a Tardis it is bigger on the inside!’

Kim Golding, Clinical Psychologist, DDP trainer and author
August 2020

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