The GP surgery as a secure base? Patterns of attachment in primary care

Abstract

This paper explores the notion of a GP practice as a ‘secure base’, suggesting that greater attention could usefully be paid to the importance of attachment relationships in primary care. If professionals feel secure and respected within ‘the practice’ then ‘the practice’ itself is more likely to be able to function as a ‘secure base’ for its patients. It is suggested that this concept could be developed further to provide a conceptual framework for practices to examine their function as therapeutic organizations. A short resumé of John Bowlby's attachment theory is outlined. Illustrations are given of how different attachment styles – secure, avoidant, ambivalent or disorganized – might affect patient care. A case of a mother (with postnatal depression) and her infant is considered in detail to illustrate the value of early intervention in a mother-infant relationship. Professionals are also attached to the practices where they work and the author reflects on his own retirement from being a GP (after 35 years). Finally, the paper describes another case – of a patient who was able to relive, and possibly repair, some of her earlier traumatic childhood separations through her relationship and parting from her GP as retirement approached.