Attachment disorganization and severe psychopathology: a possible dialogue between attachment theory and control-mastery theory

A good enough theory of psychological functioning and development, and of how psychotherapy works, should take into account recent scientific developments about emotional, motivational, and cognitive functioning. They show how human beings are "wired" to adapt to reality and share a set of evolutionarybased emotions, motivations and skills that are shaped by the cognitive-affective structures (schemas) developed on the basis of the emotionally relevant experiences, in particular of the first years of life. Attachment theory (Bowlby, 1969, 1973, 1980) represents the first real attempt in this direction, although the clinical implications of this theory are still fragmented and not specific enough. We think that control mastery theory (CMT; Weiss, 1993) could be useful for integrating attachment, psychodynamic, and cognitive-evolutionary thinking. Such an integrated model is based on the centrality of adaptation, sense of safety, and real experiences; on the central role of inner representations/beliefs/schemas in linking adverse developmental experiences and attentional strategies, perception organization, emotional reactions, behavior, and psychopathology; and on the necessity to modify this relational knowledge in order to help patients get better. To explore the possible integration between attachment theory and CMT, we will focus on a specific topic, the disorganization of attachment and its psychopathological consequences, and we will illustrate the implications of this integration with a brief clinical example. We chose to focus on attachment disorganization because it is the attachment category more consistently related to psychopathology.