Brief Reviews, VOLUME 4

Brief Review: The Impact of Attachment By Susan Hart [Vol. 4, #2]

A Brief Review of

The Impact of Attachment.
Susan Hart.
Hardback:  W.W. Norton, 2010.
Buy now:  [ Amazon ]

Reviewed by Josh Morgan.


Attachment theory is one of the most well-respected psychological theories in the mental health fields. Focusing on the effect of relationships on people’s behaviors, moods, attitudes, thoughts, etc., attachment theory has influenced many professions and subsequent treatment modalities. Rooted in psychoanalytic theory’s history, attachment work tends to be longer-term and less concrete than managed care-friendly modalities, like cognitive-behavioral therapy.

Increasing neuroscience research has focused more efforts on understanding the role of the brain, its structures, neurotransmitters, and hormones on thoughts, moods, and behaviors. With the rising medicalization of mental health and improving psychotropic medications, longer-term and more transformative (rather than symptom-focused) therapies have faced greater challenges and less respect.

Susan Hart, a Danish psychologist, attempts to tackle many of these in her ambitious volume, The Impact of Attachment. This thick text is a comprehensive explanation of attachment theory, particularly connecting it with modern neuroscientific findings. The fundamental thesis of her work is that “a dichotomy of brain/mind, biology/experience, nature/nurture is not very productive, chiefly because it hampers the development of a theory that is capable of fully embracing the complexity that characterizes human psychological development” (xi). As a psychologist, I can attest to the fact that the increasing debate that polarizes qualitative and quantitative like modern American politics is creating more conflict with the mental health fields. Such conflict does not help build better treatments if we were all to work together to bring our unique areas of expertise to elucidate the shadows of the mind.

As Hart states in the foreword, “Currently, there is no integrated theory about the human mind, and it will probably take a great deal of additional interdisciplinary bridge building to arrive at a theory that enables us to understand both subjective and objective reality” (xii). Again, as a psychologist, I can validate this. I tend to prefer the more subjective methodologies and philosophies in contrast to the “hard science” of the increasingly neurology-based field of psychiatry. Managed care and the ways people treat their psychological orientations like religions has not helped anyone try to resolve strong evidence both the subjective/qualitative and the objective/quantitative.

Hart is the first person I have seen who has extensively reconciled both sides. Attachment theory is one of the more subjective theories that has been the subject of many quantitative (rather than qualitative) research studies. Hart has done an excellent job compiling these studies and effectively linking them with every level of attachment theory.

She effectively validates that both the quantitative and qualitative are vital to therapy. This book provides people who want to appreciate and utilize both sides of the theoretical divide a way to do so without being disingenuous to either side. Hart does not dilute the potency of neurobiological evidence nor the strength of traditional attachment theory. She achieves her ambitious task phenomenally.

For those who are already familiar with attachment theory, this book may not provide a lot of new information, unless they do not know about the neurobiological correlates of their work. This can still be useful to those people to help provide evidence that psychotherapy affects and changes people’s brain structures and chemistry in a more effective and lasting way than medications alone. There is no evidence that this book was translated to English from Danish except for the copyright page. It is a smooth read, but does use technical language that is aimed at mental health providers rather than a general audience.

The Impact of Attachment
is a text that will remain on my most easily-accessible bookshelf for years to come.


Josh Morgan is a clinical psychologist, who has a passion for the integration of psychology and spirituality, particularly under the umbrella of spiritual formation.

C. Christopher Smith is the founding editor of The Englewood Review of Books. He is also author of a number of books, including most recently How the Body of Christ Talks: Recovering the Practice of Conversation in the Church (Brazos Press, 2019). Connect with him online at:

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