Exploring the relevance of attachment theory to therapeutic communities for addictions: a critical review of the literature
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This research project assesses the relevance of attachment theory to the work of therapeutic communities for addictions. It critically reviews the literature on attachment theory and addictions, and on therapeutic communities for addictions, and builds bridges between the two areas. Associations between insecure attachment and addictions have been demonstrated and progress has been made in clarifying which attachment styles are most associated with addiction and why. However, attachment theory has not been comprehensively applied to therapeutic communities for addictions despite the likelihood that most, if not all, their residents are insecurely attached. Six clinical guidelines have been developed on the basis of the findings of this review to summarise how a therapeutic community could encourage the development of secure attachment: • Respond flexibly to residents in recognition of their attachment needs, for example, negative feedback and sanctions are tailored to be therapeutic for each individual. • Support senior residents and staff to recognise and respond to attachment needs. • Create an experience of at least some aspects of a secure base for staff and residents, for example, senior colleagues/residents should be available and reliable. • Create rules and boundaries to provide containment but ensure they are not so rigid as to be overly controlling or protective. • Enhance mentalization by ensuring residents are provided with clear information on the values, norms, and standards of the therapeutic community. • Leaven the intensity of the therapeutic community to help residents and staff maintain mentalization, for example, through humour, games, creative expression, celebrations, etc.