This book rectifies a much neglected area in the conceptualization and treatment of attachment disorders. The interface between attachment, psychic structure, and character pathology has been largely ignored in the clinical literature until recent years, and when discussed, it has been generally relegated to the domain of child psychopathology. Because human attachment is such a basic aspect to motivation and adjustment, attachment disruptions in childhood color psychic development and often leave deep and enduring deficits in personality and adaptive functioning. The author shows that patients with attachment deficiencies and associated characterological vulnerabilities have fundamental structural deficits in personality organization that lie at the heart of our current understanding of disorders of the self.
Offering the first comprehensive paradigm on the psychoanalytic treatment of adult and adolescent attachment disorders, Jon Mills argues that attachment pathology is a disorder of the self based on developmental trauma that predisposes patients toward a future trajectory marked by structural deficits, character pathology, and interpersonal discord that fuel and sustain myriad forms of clinical symptomatology. This pivotal work constitutes a treatise on the governing psychic processes of attachment on self-organization, adaptation, and conflicted intersubjective dynamics in non-childhood populations, and on the intervening relational parameters in treating their emergent clinical pathologies.
Through conceptually astute technical strategies grounded in sold clinical practice, the author offers one of the most extensive and original frameworks in the psychoanalytic treatment of attachment disorders.
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Table of Contents
Part I: Theoretical and Diagnostic Considerations
1 Conceptualizing Attachment Pathology
2 The Attachment Disordered Self
3 Borderline Organization, Trauma, and Attachment
Part II: Treatment Perspectives
4 Beginning the Treatment
5 The Fragile Nature of Therapeutic Alliance
6 Managing Primitive Defenses
7 Embracing Countertransference
8 Reaching the Affect
Part III: Extended Case Studies
Engaging Alexithymia in a Depressed, Eating Disordered, Body Dysmorphic Adolescent Female
Feeling Closeted: Der Todestrieb, Guilt, and Self-Punishment in a Bipolar Gay Man
Homo Homini Lupus: Treating a Case of Systemic Ritualistic Abuse
Postscript from the Unconscious
"Under the author's highly knowledgeable and skillful guidance, attachment theory once the pariah of psychoanalysis, is demonstrated by him to be central to understanding human development, and errors in attachment to be central to the development of psychopathology. Thus, attachment has now become a major player in psychoanalytic theory and clinical application. Dr. Mills ably demonstrates the role of attachment disorder in adult dysfunctional ways of being. It is the immediacy of the importance of attachment in the clinical situation which clearly distinguishes this worthy book. Attachment is no longer simply a feature of infancy in childhood. It is a matter for a lifetime and is a major player in adult psychopathology. I urge all mental health workers to read it."—James S. Grotstein, M.D., David Geffen School of Medicine, UCLA; Training and Supervising analyst at the Los Angeles Psychoanalytic Society/Institute and the at the Psychoanalytic Center of California Los Angeles.
"It is a rare treat indeed and one that is increasingly uncommon to have the richest, most detailed clinical material presented alongside tightly organized and coherent clinical theory. This book is of immense practical value. In teaching simple but effective therapeutic techniques, the book succeeds in identifying a previously frequently overlooked set of clinical problems and in meeting these in the most powerful way that modern analytic technique is able to muster. This book is an absolute gem!"—Peter Fonagy, Ph.D., University College of London, Director of the Sub-Department of Clinical Health Psychology
About the Author
Jon Mills, Psy.D., Ph.D., ABPP, is a psychologist, philosopher, and psychoanalyst in private practice in Ajax, Ontario, Canada. He is a diplomate in psychoanalysis and clinical psychology with the American Board of Professional Psychology and is currently president of the Section on Psychoanalysis of the Canadian Psychological Association.