The phenomenon of dual diagnosis in the light of attachment theory - a case study
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Arch Psych Psych 2009;11(4):57–62
A key precept of Bowlby's attachment theory is that every human being has a biologically and genetically imprinted need to develop relationships with other people. The relationship, which develops between a child and mother, constitutes the starting point for the development of ensuing emotional ties with people ever more distant than the mother - both within the family, as well as outside of it. Emotional disorders in adulthood are due to disturbed early development of attachment. Fulfilment of the need for successful relationships in later life is the key for building and sustaining one's mental health. M. Ainsworth has assessed the quality of attachment styles from infanthood onward. In the course of her research, she defined three categories of attachment styles: secure, avoidant, fearful- ambivalent. Regardless of attachment style, it is of utmost importance that the adult person's need for relationships during the whole life comes to fruition on various levels of social interaction. The patient's psychological representation of the object of attachment may also influence his/ her compliance in treatment. The therapeutic relationship in the psychiatric setting can thus be viewed in the light of Attachment Theory. This point of view seems particularly relevant, when one considers the problems encountered in the treatment of dual diagnosis patients. Clinical experience shows that dual diagnosis (psychiatric disorder with concomitant substance dependency) patients are particularly difficult in terms of compliance. This case report describes a 32-old man suffering from schizophrenia, addicted to alcohol, with incident abuse of amphetamines, coming from a dysfunctional family background. Close scrutiny of the patient's life from the perspective of Attachment Theory reveals a thorough lack of secure relationships from early childhood, through to his adult life, including failed marriage and parenthood. Every addiction therapy, he has hitherto undertaken, has failed, concurrent with psychotic relapse. For the therapist, he is a constant source of frustration.