Clinical Child Psychology
and Psychiatry
2014, Vol. 19(4) 494­–502
© The Author(s) 2014
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DOI: 10.1177/1359104514550556
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Systemic therapy and attachment
narratives: Attachment Narrative
Therapy
Rudi Dallos1 and Arlene Vetere2
1University of Plymouth, Plymouth, UK
2Diakonhjemmet University College, Oslo, Norway
Abstract
This article outlines an integration of attachment theory with narrative theory and systemic theory
and practice: Attachment Narrative Therapy (ANT). This integration offers a more powerful
explanatory formulation of the development and maintenance of human distress in relationships,
families and communities, and gives direction to psychotherapeutic intervention.
Keywords
Attachment theory, narrative theory, systemic theory, systemic practice, integrative
formulation, attachment narrative therapy
Attachment theory is a developmental theory of the social regulation of emotion in families. It was
originally developed by John Bowlby (1969) to offer an understanding of the formation of psychological
problems in children and adults. He was convinced that early experiences of separation and
emotional deprivation could have long-term negative consequences for children’s development. It
seems that his interest in this was not simply a ‘scientific’one. It was also an attempt to understand
his own experience of the separation he had from his parents who sent him away at the age of 7 to
boarding school and who generally believed that showing affection to or spending time with their
children was unnecessary. In many ways, Bowlby followed Freud in noting that negative events in
childhood, such as separation, trauma and abuse, were at the core of later mental health problems
– neuroses and pathologies, as they were called. However, Bowlby was interested to develop an
understanding of the mechanisms whereby such negative effects could occur, and thus, he turned
to a wide range of theoretical perspectives. In effect, attachment ‘theory’ is best described as an
umbrella term for a set of inter-related theories. Central to his thinking was the idea that we possess
a fundamental survival instinct to seek protection from our parents (or carers) when we experience
dangers. This instinct is shared with other mammals and serves to foster the survival of each species.
The seeking of safety leads to a long-term connection and relationship, and primates, like
humans, will show a preference for and continue to spend time with their parents/carers even as
Corresponding author:
Arlene Vetere, 55 The Avenue, Mortimer, Berkshire RG7 3QU, UK.
Email: drarlenevetere@hotmail.com
550556CCP0010.1177/1359104514550556Clinical Child Psychology and PsychiatryDallos andVetere
research-article2014
Article
Dallos and Vetere	 495
adults. Bowlby’s theory argues that in human beings, this fundamental need to seek protection
from danger develops to form a generalised sense of how we expect others to act towards us and
also how they see us. In childhood, the most significant others are usually our family members, and
hence, attachment theory encapsulates these early relationships particularly in how the child develops
a sense of being able to trust others to help resolve their fears and anxieties. Hence, attachment
theory embraces the family as an emotional system in terms of how they respond to help each other
in situations of actual danger and in relation to anxiety and threat. On the other side of this coin,
the sense of safety, protection and care we can experience produces not just relief of anxiety but the
positive emotions of trust, affection and love.
Bowlby’s initial intention was to persuade the psychiatric community that preventative efforts
were necessary to offset the risk of long-term damage done by the separation of children from the
adults that they needed to protect and nurture them emotionally. His theory provides an elegant
development model of how different kinds of insecurities and problems may develop, but he did
not have time to develop the full implications of the attachment model for therapy. Importantly
though, he suggested that analogous to security in a family, therapy needed to create a secure base
for the family members in which the therapist is experienced as a transitional attachment figure:
For not only young children, it is now clear, but human beings of all ages are found to be at their happiest
and to be able to deploy their talents to best advantage when they are confident that, standing behind them
are one or more trusted persons who will come to their aid should difficulties arise. The person trusted
provides a secure base from which his (or her) companion can operate. (Bowlby, 1973: 407)
Bowlby argued that many families have not been able to provide an experience of security for
their children and will find the positive attachment offered by a therapist a new and possibly daunting
experience, for example, ‘can I trust this person when I have grown to think I must only ever
rely on myself’?
Following Bowlby’s pioneering work, there have been a number of thoughtful, empirical
attempts to articulate the theory–practice links between attachment theory and psychotherapeutic
practice with children, adults, couples and families (e.g. see the work of Crittenden, 2006; Flaskas
& Pocock, 2009; Holmes, 2001; Johnson, 2002). We have a similar purpose in our Attachment
Narrative Therapy (ANT) project. We integrate three major systems of thought that offer explanatory
power for understanding the development and maintenance of human distress with systemic
psychotherapy practice: family systems theory, attachment theory and narrative theory. Both
authors are clinical psychologists and family systemic psychotherapists. A.V. works therapeutically
with couples, with substance mis-use and with family violence. R.D. works therapeutically
with children and families, eating distress, social services, adoption and fostering.
ANT grew out of our disquiet with single model explanations of behaviour and a diagnostic
system that categorised symptomatic behaviour, and out of our dis-satisfaction with therapeutic
practice that did not theorise love in our close relationships. Ultimately, we want an integrative
framework to formulate the development and maintenance of individual and relational distress in
a way that offers road maps for effective and compassionate intervention. We call these road maps
‘formats for exploration’, and we shall outline a few in this article.
Why the three theories need each other
Bowlby was both integrative and systemic in his approach to understanding the life-long significance
of attachment processes. However, much of the early research work has focused on dyadic
relationships, such as mother–child dyads and couple relationships, with a later interest in fathers
496	 Clinical Child Psychology and Psychiatry 19(4)
and siblings. We argue that systemic theory helps enlarge the traditional focus to an appreciation of
triangular relationships and triangulation processes in families. For example, in the original strange
situation paradigm, what might have been observed had fathers or brothers and sisters been present
when the mother left and returned? In systemic thought, the triangle is the basic human relationship,
that is, when any two people are together, their relationship is influenced by their separate
relationships with a common third person.
Systemic theory and practice focus on pattern and process in relationships over time, on intergenerational
learning in families, on meaning in communication and on the social context that both
influences families and is influenced by families. However, it does not explicitly theorise love in
family relationships, nor sexuality in couple relationships. Many of the early family therapists were
psychodynamically trained, and theories of emotion regulation were implicit in their early work,
for example, Minuchin’s (1974) description of the impact of unacknowledged anxiety in couple
and family relationships, or Bowen’s (1978) description of enmeshment. Thus, attachment theory
helps explicate the meaning of emotional safety, comfort and reassurance in relationships, and
what happens when we struggle to understand and manage our emotional responses.
Narrative therapies are interested in how we story our experience and live time through narrative
constructions and in particular how certain narratives about ourselves and others become dominant,
and other possible constructions become marginalised. In the elegant descriptions of narrative
practice, we miss the theory of narrative as skill development (e.g. Bruner, 1986; Vygotsky, 1978).
For example, how does a child learn to construct a narrative of their experience? What makes it
safe for children to contemplate all aspects of their lives, and in particular if they live with fear and
danger on a daily basis, what happens if it is not safe to contemplate others’ intentions towards
them? It is in this latter question that we see the fit between attachment theory, systemic theory of
relational process and narrative theory.
In summary, we have found that a systemic perspective offers elegant descriptions of problemmaintaining
interactions in families but tells us less about how and why these have evolved in the
first place. Family therapy appears to have become shy of suggesting causal developmental explanations
for fear of appearing to ‘blame’ parents for causing problems in their children. Attachment
theory does offer a developmental and causal model but has been too dyadic in its focus and arguably
too much orientated as a deficit model evident in its frequent use in social service contexts to
assess ‘risk’. Both models can be complemented by narrative approaches which emphasise meaning-making
and choice as central to family life. In particular, we draw on Byng-Hall’s (1995) idea
of corrective and replicative scripts to capture how parents make choices, albeit not always conscious
ones, about how to act as parents and relational partners and how they want their families to
be similar or different to what they themselves experienced as children.
Representational systems: The layers of attachment
In our view, probably one of the most helpful theoretical developments has been in working with
implicit relational knowing (Stern et al., 1998) and the recognition that our representations of our
attachment relationships and experiences are held in different memory systems: procedural, sensory,
semantic, episodic and integrative (Tulving, 1983). Procedural memory is memory for how
we do things, for example, riding a bicycle, making a cake, looking after someone who is sick or
having an argument with our nearest and dearest. Sensory memory is memory for sensation, feelings
and emotion. It is often implicit memory and is sometimes referred to as embodied memory,
with the potential to trigger trauma responses, for example, the look on the face of a loved one (or
a feared one), the smell of a baby, the sound of anger, a comforting touch and so on. Semantic
memory is thought to be that collection of thoughts, beliefs, values and assumptions about
Dallos and Vetere	 497
ourselves, others and ‘the world’ that is available for conscious processing. Episodic memory is
sometimes referred to as autobiographical memory. It is our capacity to link our experiences in
subjective time to form a coherent narrative that others, when listening, can follow. At times of
duress and distress, when we are highly physiologically aroused, much of our spare mental capacity
might be devoted to a preoccupation with managing our emotion such that our ability to narrate
experience coherently is constrained. Integrative memory is our capacity to integrate all our memory
resources, rather than relying on one predominant memory system to describe and explain
experience, and importantly to reflect on what we are thinking, feeling and doing. This capacity has
been called meta-communication, meta-cognition and reflective self-functioning within the major
theories of psychotherapy.
This development that links attachment theory and theory of memory functioning with trauma
theory helps us as practitioners both to develop the therapeutic alliance and fit our responses and
possible interventions with our clients’ dominant attachment strategies when in distress and under
threat. Attachment threat can arise when we fear rejection and abandonment, and fear that we are
a disappointment to ourselves and others. This can be accompanied by deep and unprocessed feelings
of shame, which if not attended to can continue to implicitly direct our defensive and selfprotective
strategies.
Implications of attachment theory for therapeutic practice:
Working within and between
Attachment theory is representational and is about care-giving and affection, and in adult relationships
about sexuality. We like attachment theory because it does not pathologise dependency in our
close relationships. Rather, dependency and autonomy are seen as both sides of the same attachment
coin. It is when we feel safe and secure in our relationships that we are most likely to reach
out to others for help with problem solving, and for comfort and reassurance. Such a sense of safety
arises from knowing that close others are more or less predictable in their accessibility and responsiveness
to us. These are the building blocks of trust in our close relationships.
Thus, in therapy with children and families, attachment theory emphasises the importance of
helping people name, understand, illuminate and process their emotional responses. It emphasises
the importance of both listening and feeling heard and deeply understood. This has the ability to
help soothe and calm when unhelpfully aroused, and in therapy highlights the importance of helping
family members stay present, attuned and listening to each other when one or more are upset.
Comfort is central to attachment theory, and in therapeutic work, this translates into practice that
affirms and actively supports the giving of comfort, seeking of comfort and receiving of comfort
with others and the developing of capacity to soothe and comfort ourselves. When we are unhelpfully
physiologically aroused and upset, we may become preoccupied with our own emotional
state and our attempts to regulate ourselves such that our ability to process negatively laden material
slows down, our empathic curiosity about others may be reduced in a difficult moment and our
ability to read relational cues might be constrained. Thus, therapy promotes compassion for self
and others and helps family members both feel affirmed and understood, before moving to promote
relational understanding and action. Attachment theory is focused on safety and protection in our
close relationships and thus emphasises the therapeutic importance of slowing down our work during
these difficult moments to help and support people with their understanding and emotional
processing. Finally, attachment theory in its later development has emphasised transformations in
our representational systems. Thus, if we tend to rely on a de-activating strategy to down-regulate
unhelpful physiological arousal, we may emphasise semantic representational systems in
498	 Clinical Child Psychology and Psychiatry 19(4)
our dialogue with ourselves and others. This may express itself as a tendency to rely on ‘facts’, to
minimise our descriptions and to persuade ourselves we are alright. Similarly, if we become easily
overwhelmed when under attachment threat and become preoccupied with our struggle to regulate
our arousal, we may tend to over-simplify explanations and become emotionally reactive. A more
balanced response involves both the above strategies, with a wider repertoire of coping responses,
and some capacity to stay reflective while upset. In our view, all psychotherapies are trying to help
people develop their reflective and integrative capacities, to think about what they and others are
thinking, feeling and doing, while developing curiosity, empathy and compassion, for self and others.
A systemic focus will also include relational esteem, that is, that capacity to hold our relationships
in focus, and esteem them as much as we hold ourselves and others in mind.
ANT
A broad framework for utilising systemic attachment and narrative ideas – ANT (Dallos, 2006;
Dallos & Vetere, 2009, 2010) – is illustrated below. This employs four key stages in the intervention
process,
Creating a secure base. In this stage, it is recognised that coming for therapy can be an extremely
anxiety-provoking experience for many families. The first session emphasises safety and validation
and invites families to comment on the pacing of the work and how comfortable they
feel. It indirectly invites attention to their feelings and how these are communicated and conveys
a message that negative or distressing feelings in the session can be commented on and
they will be responded to.
Exploration. In this stage, the materials for subsequent emotional and interactional changes are
gathered through a variety of forms of exploration, such as genograms, sculpts with objects,
tracking circularities, enactments, identifying attachment threats and dilemmas, their explanations
of the problems and trans-generational patterns of attachment and comforting. It recognises
that such exploration can also provoke anxieties, and the above emphasis on pacing and
commenting on their experience of reflecting on the work is maintained.
Considering alternatives. This stage utilises the material from the exploration and extends these
to consider exceptions and unique outcomes, to support emotional risk-taking in relationships,
processing and clarifying intentions and meanings, and also focuses on the parents’ corrective
and replicative scripts. Particularly important here is a consideration of what they have attempted
to change and whether this has worked. Frequently, family members here mention that they
have wanted to be more emotionally available than their own parents had been, but have experienced
a sense of failure in not being able to achieve this. Healing past hurts in relationships
and repairing relationships is crucial to this stage.
Maintaining the therapeutic base. In this stage, it is recognised that for many families, developing
a sense of trust with the therapist has been a new and powerful experience. Discussions take
place about how the relationship can continue in terms of what ideas and feelings family member
will take away and also what we will remember about our work with them. Healing, understanding
and empathic appreciation of self and others give people confidence for the future.
This also recognises the need to consider future problems that may arise and to offer further
session if required to maintain a sense of continuing support. In our experience, for many
Dallos and Vetere	 499
families, the potential of future support is sufficient and they do not in fact need to take up further
sessions.
These four domains of relational therapy are not simply distinct or a linear progression but
overlap, and we may return to exploration from attempting change. However, throughout we pay
close attention to attempting to foster a secure base.
In addition to these four over-arching stages of ANT, we may progress in a spiralling way
through a focus on family interactional patterns to a consideration of the attachment significance
and attachment dynamics which are shaping these (see Figure 1).
Initially, the focus can be on an analysis of the current patterns of actions, emotions and beliefs
maintaining the distress and the problems. Through the exploration and illumination of these patterns,
a sense of containment is fostered along with a reduction in the unhelpful arousal associated
with the problems. For example, a mother may complain that the problem is that her son is being
disrespectful and aggressive towards her. The exploration takes her concerns seriously but also
focuses on what happens between her and the child and other family members when the problematic
process is occurring. In some cases, the reduction in anxiety and anger fostered by such exploration,
for example, by drawing out a circularity of the meaning, emotion and behaviours underlying
the problems, can be adequate to facilitate change. This exploration, however, may also reveal
failures to understand each other’s actions in terms of attachment requests and attachment
responses. For example, when the parent complains that her child is being disrespectful and angry,
she may find it harder to recognise that aspects of these behaviours may be related to the child’s
attempts to gain an attachment response and that his ‘angry’ protest behaviours may represent
anger and sadness (or fear of rejection) at not having his attachment requests recognised and
attended to. Moving to this level of exploration requires the family to develop a sense of safety
with the therapist and the team in order not to feel ‘blamed’ by these considerations of how they
are responding. This analysis also considers what the parents’ attachment needs are in general, as
well as in the patterns under consideration. This in turn can trigger an exploration of the transgenerational
attachment dynamics in the family’s recent history. For example, this can involve a
consideration of the parents’ experiences of the attachment dynamics in their own families, how
their attachment needs were responded to and what corrective or replicative scripts they have
brought into their current family. For example, the mother above may have felt that her parents
were emotionally unavailable and consequently she had developed an attachment strategy of selfreliance
and of attempting to minimise her needs. However, it may also reveal that she developed
a corrective script of wanting to be more emotionally available as a parent and of wanting a closer
relationship with her son. Consequently, she may be especially sensitive to feeling that he is angry
with her and that she failed to be the sort of parent she would have wanted herself. These explorations
can facilitate a softening of the emotions, an enhanced appreciation of their intentions and
greater attunement to understanding each other’s attachment needs and contemplating and risking
different ways of responding.
This progress through the levels is flexible, and in some cases, work with a family need not
involve all of these levels. It is also often the case that the parents need to build trust with the therapist
in order not to feel that they are being blamed for their attachment ‘inadequacies’. Consequently,
considering changes at the initial interactional level, for example, some changes in how they
respond to each other, and tactics for ‘managing’ the anger may be adequate or at least a pre-requisite
for agreeing to consider attachment dynamics. However, in our experience, a vital component
is a consideration of the trans-generational ‘corrective’ and ‘replicative’ scripts. This allows a
framing of the parents’ intentions as positive in either trying to do things differently and better or
to repeat aspects of what they experienced as good in their childhoods. This then frames
500	 Clinical Child Psychology and Psychiatry 19(4)
the discussions of attachment and relationships in the family in positive terms as opposed to
‘attachment deficits’. The latter can be a considerable risk in employing attachment frameworks
which can inadvertently lead parents to feel that they are being told that the problems are predominantly
caused by their attachment ‘insensitivities’.
To assist the process of exploration in ANT, we have developed a number of ‘formats for exploration’,
elaborated further elsewhere, for example, Dallos and Vetere (2009). These formats can be
woven into the therapeutic work with families at the various stages of exploration.
Format for exploration: Patterns of comforting and self-soothing
The capacity to give, to seek and to receive comfort and reassurance, for ourselves and others, is at
the heart of attachment theory. This is a poignant matter. The ANT perspective organises our therapeutic
work with comfort in two ways: (a) by emphasising inter-generational patterns of comforting
in family relationships and the opportunities for inter-generational learning and change and (b)
by using our capacity to compare and contrast by emphasising and drawing out what we observe
and experience as similar or different in patterns of comforting across the generations.
We may use the following prompt questions:
When you were upset or frightened as a child, what happened? Who did you turn to?
How did you get to feel better? Who helped you to feel better? How did they do this? What else
happened?
What have you learnt from this for your own family?
What do you want to do the same? What do you want to do differently?
How do people comfort each other in your own family/relationships?
How do you comfort your children?
Current RelaƟonal
PaƩerns and aƩachments
AƩachment strategies
shaping family
dynamics
Trans – generaƟonal
aƩachment paƩerns
Figure 1.  Reciprocal and historical influences on attachment strategies and attachment significance of
family relationships.
Dallos and Vetere	 501
How do they comfort you?
What do you want your children to learn about comforting? If your children were to have children,
what would you hope their children would learn about comforting?
Formats for exploration: Corrective and replicative scripts
This format for exploration utilises ideas from John Byng-Hall (1995) that families make comparisons
across the generations in terms of similarities or differences between how our parents were
with each other and with us (their children) and how this might be repeated or altered in the next
generation and for the future of the next generation. Importantly, it allows us to work in a positive
frame with the family in that we may construe the intentions of the parents positively, that is, they
have tried to repeat what was good or correct what they felt was bad about their own experiences
of being looked after. This can lead to an exploration of whether these attempts have been successful
or not, including unanticipated consequences, and possibly how they might be altered, strengthened
and/or elaborated. Prompt questions might include the following:
What are your thoughts about how similar or different your relationship with each other and
with your children is to your parents’ relationships and in turn with their parents?
What have you tried to make similar or different to these relationships?
What do you value versus feel critical about in either of your parents’ relationships (or grandparents’
relationship)?
Does what you have tried to repeat and/or change work? Is there anything you want to alter,
strengthen, abandon about what you have been trying to repeat/change?
Thinking into the future, when your children have grown up and might be parents in their own
right, what do you want them to learn from you about these experiences?
Conclusion
Attachment theory has clear implications for our therapeutic work with children and their families:
(a) in naming emotions, expanding understanding and helping with emotional regulation; (b) in
exploring the significance of comfort, safety and protection in relationships; (c) in developing
empathy and compassionate appreciation of the self and of the other; (d) in facilitating information
processing of negatively laden material; and (e) in facilitating transformations in our representational
systems of attachment. In particular, this enables a focus on the attachment significance in
our disappointing moments, when we feel hurt and fear rejection and abandonment. If these difficult
moments in our close relationships are not attended to and resolved, we risk carrying forward
into the future a trail of ‘small’everyday relational traumas, that is, losses and hurts that impair our
wish to and our ability to trust others. Understanding of the wish to connect with others is at the
heart of attachment theory and the ways in which we can heal and repair our close relationships.
Narrative theory helps us understand the necessary conditions of emotional safety within which
children learn to narrate and integrate their relational experiences into clear and straight forward
accounts. Thus, can we support children and families in developing a shared narrative of how they
healed, recovered and resolved their relationship difficulties.
502	 Clinical Child Psychology and Psychiatry 19(4)
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit
sectors.
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Author biographies
Rudi Dallos is Professor of Clinical Psychology at Plymouth University, UK, and Research Director of the
Doctorate in Clinical Psychology, Plymouth University, UK.
Arlene Vetere is Professor of Family Therapy and Systemic Practice at Diakonhjemmet University College,
Oslo, Norway; Affiliate Professor of Family Studies at Malta University, Malta; and Visiting Professor of
Clinical Psychology at Universita degli Studi, Bergamo, Italy.