Community Health & Counseling Services

The nature of the drive toward forming and maintaining intense attachments with other human beings has been examined in the light of case material from the play therapy sessions of a ten-year-old boy. The primary question addressed concerns the relationship of the attachment drive to other drive systems. Freudian theory, object relations theory, and attachment theory present competing paradigms for understanding the relationship between the drives. The Freudian paradigm sees human attachment as derivative from other drives, especially the sexual drive. In developing his attachment theory, Bowlby broke from the classical Freudian view. He postulated attachment as a primary and autonomous drive. Object relations theory, by contrast, sees sexuality as one manifestation of a more fundamental drive that is intrinsically relationship seeking. Each of these traditions has contributed to our understanding of human reality. A careful examination of the clinical material, however, strongly suggests that a drive toward relationship is intrinsic to libidinal energy. It is therefore concluded that the understanding of the relationship between the drives based on object relations theory provides us with the most adequate framework within which to understand the clinical material.

Explicates a medical-pastoral paradigm in terms of eight “polar unities”: natural science/theology; person/organism; efficient/teleological causality; multivocal/univocal language; quantitative/qualitative concerns; meaning/technical interventions; description/value; validation of intervention effectiveness. Suggests that these varieties of approaches may be illustrated in the ancient Oriental Yin-Yang symbol which includes the kind of “polar unity” implicit in a modern medical center.

The importance of a counselor's philosophical point of departure is emphasized. Viewing the self as "a conscious, free, and responsible decision-making actor in a world of substantial and self-transcendent meanings and purposes" is suggested as the core of a definition that uses an existentialist point of departure. In the light of this definition, four specific inadequacies of counseling that uses a natural-scientific point of departure are identified and discussed: 1) it is overreductionistic; 2) it reinforces the view of self as "helpless victim"; 3) it disregards the importance of transpersonal concerns; 4) it ignores the importance of conflicting world views between therapist and client.