Affect and attachment in the family

Although there is widespread agreement among clinicians that family environment influences the course of psychiatric disorder, existing treatment approaches emphasize psychoeducation and symptom management while minimizing the impact of more entrenched and enduring family characteristics. By exploring the muitigenerational patterns of attachment and ways of expressing affect in families of severely disturbed patients Jeri A. Doane and Diana Diamond advance the theoretical and clinical understanding of the treatment of major psychiatric disorder. Based on empirical findings from the Yale Psychiatric Institute Family Study, a longitudinal research project, the book describes a family typology (low intensity, high intensity, and disconnected) that reflects intergenerational patterns of attachment bonds and styles of expressing affect in the family. In order to work effectively with families who have a member with a major psychiatric disorder, it is crucial to understand how the history of each family member's attachments and primary relationships becomes reprojected and reenacted in the next generation. Using rich clinical case studies, the authors detail a family therapy model in which attachment dysfunction is addressed as the first critical step in treatment. Equipped with insights into the family's attachment history, the clinician is then able to formulate interventions that address the complexity of the underlying patterns of disturbed family functioning. The authors' approach is aimed not only at relapse prevention but at improving the quality of relating among family members beyond periods of acute stress. Although the research study focused on severely disturbed patients, this treatment approach can be helpful for clinicians treating a wide range of family dysfunction.