Attachment 19th Nov 2010 Dr Helen Brotherton 19th Nov 2010 Dr Helen Brotherton

AttachmentAttachment

19th Nov 2010

Dr Helen Brotherton

19th Nov 2010

Dr Helen Brotherton

Session OutlineSession Outline

Historical perspectives on Attachment Theory- the work of Bowlby & others

Importance of ‘Bonding’ and Infant Mental Health Update on Contemporary Attachment Theory Disruptions in Childhood Attachment Research on links between early attachment and

later mental health difficulties DVD- Clinic illustrations of attachment &

bonding

Historical perspectives on Attachment Theory- the work of Bowlby & others

Importance of ‘Bonding’ and Infant Mental Health Update on Contemporary Attachment Theory Disruptions in Childhood Attachment Research on links between early attachment and

later mental health difficulties DVD- Clinic illustrations of attachment &

bonding

How Attachment theory fits inHow Attachment theory fits in

Initial Group Exercise

"What does the term attachment mean to people? What words, phrases, concepts, understandings etc .......”

“What’s your understanding of Attachment Theory? ….”

Initial Group Exercise

"What does the term attachment mean to people? What words, phrases, concepts, understandings etc .......”

“What’s your understanding of Attachment Theory? ….”

Historical Perspectives on Attachment Theory

Historical Perspectives on Attachment Theory

From 1910 onwards, 2 theories were dominant in understanding a child’s tie to its mother:- Psychoanalytic theory; and Social learning theory

These theories both emphasized that a relationship developed when the mother feeds the infant -> leading to a pleasurable relationship when hunger is satisfied

These theories were described as ‘secondary drive dependency theories’ by Bowlby

From 1910 onwards, 2 theories were dominant in understanding a child’s tie to its mother:- Psychoanalytic theory; and Social learning theory

These theories both emphasized that a relationship developed when the mother feeds the infant -> leading to a pleasurable relationship when hunger is satisfied

These theories were described as ‘secondary drive dependency theories’ by Bowlby

‘Secondary drive dependency’ Theories of Attachment

‘Secondary drive dependency’ Theories of Attachment

Cupboard love theories, as they became known, were therefore dominant

The rationale being:- we attach to our mother because she feeds us (Dollard, Millar, Freud etc).

Primary drive is food -> leading to a Secondary drive for attachment.

Cupboard love theories, as they became known, were therefore dominant

The rationale being:- we attach to our mother because she feeds us (Dollard, Millar, Freud etc).

Primary drive is food -> leading to a Secondary drive for attachment.

Evidence against ‘Cupboard Love Theories’


Bowlby noticed evidence from animal studies challenged previously held notions

Lorenz noted infant geese attached to parents who did not feed them:- therefore, imprinting seemed to occur during a critical period due to exposure

Bowlby noticed evidence from animal studies challenged previously held notions

Lorenz noted infant geese attached to parents who did not feed them:- therefore, imprinting seemed to occur during a critical period due to exposure



Harlow observed infant rhesus monkeys The studies found that, in times of stress, monkeys

preferred a more comforting cloth-covered ‘mother’ figure to feed them, rather than the wire-mesh ‘mother

Evidence also grew to show that human infants became attached to people who did not feed them

So Bowlby (1980) noted:-“if the secondary drive dependency theory was inadequate, what was the alternative?”

Harlow observed infant rhesus monkeys The studies found that, in times of stress, monkeys

preferred a more comforting cloth-covered ‘mother’ figure to feed them, rather than the wire-mesh ‘mother

Evidence also grew to show that human infants became attached to people who did not feed them

So Bowlby (1980) noted:-“if the secondary drive dependency theory was inadequate, what was the alternative?”

Attachment Theory - the contribution of BowlbyAttachment Theory - the contribution of Bowlby

Bowlby - British child psychiatrist, part of the psychoanalytic community, training when object-relations (Kleinian) theories were dominant

Supervised and analyzed by Melanie Klein, but differences began emerging between him and others in the psychodynamic community

Bowlby’s view led his to be ignored by the psychoanalytic community & only considered relevant in recent years (ie Fonagy, Holmes etc)

Bowlby - British child psychiatrist, part of the psychoanalytic community, training when object-relations (Kleinian) theories were dominant

Supervised and analyzed by Melanie Klein, but differences began emerging between him and others in the psychodynamic community

Bowlby’s view led his to be ignored by the psychoanalytic community & only considered relevant in recent years (ie Fonagy, Holmes etc)

Attachment Theory - Differences between Bowlby & Analysts

Attachment Theory - Differences between Bowlby & Analysts

Bowlby’s work evolved from observing the impact of WWII & working in a home for maladjusted boys - the impact of separations, losses and disruptions in close relationships

The answer came when Bowlby considered the child’s actual experience with its primary attachment figures - he considered this to be the “bedrock of psychic structure” (Lemma, 2003)

Bowlby’s work evolved from observing the impact of WWII & working in a home for maladjusted boys - the impact of separations, losses and disruptions in close relationships

The answer came when Bowlby considered the child’s actual experience with its primary attachment figures - he considered this to be the “bedrock of psychic structure” (Lemma, 2003)

Bowlby’s Theory of AttachmentBowlby’s Theory of Attachment

Bowlby developed an ethological theory, which suggested that:-“the infant attachment bond is an instinctually guided

behavioural system that has functioned throughout

human evolution to protect the infant from danger”

With this evolutionary based theory, fear of strangers and other threats to survival is innate

Bowlby developed an ethological theory, which suggested that:-“the infant attachment bond is an instinctually guided

behavioural system that has functioned throughout

human evolution to protect the infant from danger”

With this evolutionary based theory, fear of strangers and other threats to survival is innate


Bowlby considered that infants preferred a principal attachment figure for comfort and security = ‘monotropy’

This monotropy theory has gained support, but some researchers remain critical

Some writers report ‘attached’ and ‘unattached’ infants and Bowlby thought that without attachment, we get affectionless psychopathy

Others have considered there to be no such thing as ‘no attachment’

Bowlby considered that infants preferred a principal attachment figure for comfort and security = ‘monotropy’

This monotropy theory has gained support, but some researchers remain critical

Some writers report ‘attached’ and ‘unattached’ infants and Bowlby thought that without attachment, we get affectionless psychopathy

Others have considered there to be no such thing as ‘no attachment’


Attachment behaviours, such as smiling & vocalizing, are signalling behaviours which alert mother to child’s interest & bring her to the child

Others, ie crying, are aversive, but bring mother->child and signal something needs terminating

Bowlby believed the attachment process is assisted by Fixed Action Patterns, which are instinctive and biological

Fixed Action Patterns are complex behaviours which can aid attachment formation, including grasping, crying and smiling (Ainsworth)

Attachment behaviours, such as smiling & vocalizing, are signalling behaviours which alert mother to child’s interest & bring her to the child

Others, ie crying, are aversive, but bring mother->child and signal something needs terminating

Bowlby believed the attachment process is assisted by Fixed Action Patterns, which are instinctive and biological

Fixed Action Patterns are complex behaviours which can aid attachment formation, including grasping, crying and smiling (Ainsworth)

Bowlby (cont)Bowlby (cont)

Attachment behaviours clinging using mother as a secure base to explore signalling to mother to ensure her proximity different behaviours are used with different

types of attachment

Attachment behaviours clinging using mother as a secure base to explore signalling to mother to ensure her proximity different behaviours are used with different

types of attachment

So Attachment is about….So Attachment is about…. …the ability of individuals to use attachment

figures as a secure base from which to explore and

…a safe haven in times of fear, distress or danger

…the extent to which caregiver responses are: Reciprocal Sensitive (accurate interpretation of signal) Consistent Offer comfort, calm & enable feelings of safety

…the ability of individuals to use attachment figures as a secure base from which to explore and

…a safe haven in times of fear, distress or danger

…the extent to which caregiver responses are: Reciprocal Sensitive (accurate interpretation of signal) Consistent Offer comfort, calm & enable feelings of safety

Schafter’s Theory of Attachment: Separation Anxiety

Schafter’s Theory of Attachment: Separation Anxiety

Shafter’s work particularly looked at attachment and separation reactions

Three stages of attachment, generally presented as:- 6/52-3/12 - attach to anyone 3-8/12 - knows strangers are different but not scared of

them 8+/12 - separation and stranger anxiety From 3 years, develop trust in mother’s permanence

and can move away from them

Shafter’s work particularly looked at attachment and separation reactions

Three stages of attachment, generally presented as:- 6/52-3/12 - attach to anyone 3-8/12 - knows strangers are different but not scared of

them 8+/12 - separation and stranger anxiety From 3 years, develop trust in mother’s permanence

and can move away from them

Ainsworth: Separation Anxiety/Protest


Ainsworth, colleague of Bowlby, did pioneering naturalistic observations of mothers and infants

She developed the ‘Strange Situation’ assessment, studying parent-infant reactions

Study = parents in lab setting are separated then reunited with their 12-14month-olds

Ainsworth, colleague of Bowlby, did pioneering naturalistic observations of mothers and infants

She developed the ‘Strange Situation’ assessment, studying parent-infant reactions

Study = parents in lab setting are separated then reunited with their 12-14month-olds



Ainsworth (& Main later) developed three main types of attachment A, B & C (plus later type D- disorganised)

Intra and cross cultural differences and children can move between groups

Key is mother’s sensitivity to needs

Ainsworth (& Main later) developed three main types of attachment A, B & C (plus later type D- disorganised)

Intra and cross cultural differences and children can move between groups

Key is mother’s sensitivity to needs

‘Strange Situation’ results - Responses to Separation

‘Strange Situation’ results - Responses to Separation

Type A- Insecure Avoidant (20%)- little bond with mother, not too upset by separation, but hates being alone so comforted by stranger, whilst actively avoids seeking contact with parent

Type B- Securely attached (60%)- distressed by parent leaving but seeks parent and can easily be consoled on return

Type C- Insecure Ambivalent (20%)- little security in bond initially, when separated becomes very distressed, difficulty being soothed on reunion

Type A- Insecure Avoidant (20%)- little bond with mother, not too upset by separation, but hates being alone so comforted by stranger, whilst actively avoids seeking contact with parent

Type B- Securely attached (60%)- distressed by parent leaving but seeks parent and can easily be consoled on return

Type C- Insecure Ambivalent (20%)- little security in bond initially, when separated becomes very distressed, difficulty being soothed on reunion

The Importance of the Very Early Life - Infant Mental Health

The Importance of the Very Early Life - Infant Mental Health Attachment theorists emphasize the impact

of very early bonding experiences, as well as later childhood events

In terms of development, Bowlby considered that the 1st year is a ‘sensitive period’, but the critical period for attachment may be up to 3 years

Attachment theorists emphasize the impact of very early bonding experiences, as well as later childhood events

In terms of development, Bowlby considered that the 1st year is a ‘sensitive period’, but the critical period for attachment may be up to 3 years

The Importance of Infant Mental Health 0-12 months

The Importance of Infant Mental Health 0-12 months

Pregnancy, birth and ‘bonding’- during these processes, parents experience

negative & positive feelings, from distress and anxiety to intense happiness

- when baby is born, he/she is also at the mercy of such extreme feelings

- ‘bonding’ is the development of a deep relationship, through painful experiences as well as good times

Pregnancy, birth and ‘bonding’- during these processes, parents experience

negative & positive feelings, from distress and anxiety to intense happiness

- when baby is born, he/she is also at the mercy of such extreme feelings

- ‘bonding’ is the development of a deep relationship, through painful experiences as well as good times

Infant Mental Health 0-12 months


First few days- babies have distinct personalities and

different responses to the trauma of birth- early stages can feel ‘messy’ both

emotionally & physically for parents- parents can be struggling to live up to ideals- getting to know the baby and developing a

relationship is the primary task

First few days- babies have distinct personalities and

different responses to the trauma of birth- early stages can feel ‘messy’ both

emotionally & physically for parents- parents can be struggling to live up to ideals- getting to know the baby and developing a

relationship is the primary task



Tavistock Case material“A central belief … is that a baby cannot be understood in isolation. She is born into a complex relationship with her primary carers ….”“things will not be broken beyond repair: recovering from difficulties … for both baby and parents, is an essential part of getting to know and love each other.”

(Boswell, 2004; p.9)

Tavistock Case material“A central belief … is that a baby cannot be understood in isolation. She is born into a complex relationship with her primary carers ….”“things will not be broken beyond repair: recovering from difficulties … for both baby and parents, is an essential part of getting to know and love each other.”

(Boswell, 2004; p.9)



The first 6 weeks- both parents and babies can feel at their

most vulnerable and terrified- babies will be feeling bewildered and lost,

and life feels chaotic, frightening and without boundaries

- the parents’ moods affect the baby and the baby’s moods affects the parents

The first 6 weeks- both parents and babies can feel at their

most vulnerable and terrified- babies will be feeling bewildered and lost,

and life feels chaotic, frightening and without boundaries

- the parents’ moods affect the baby and the baby’s moods affects the parents



Tavistock Case material

* Matt, becoming a father for the 1st time….

“I’d never known my own father, and suddenly here I was being a father to Thomas. One day … I was washing up and suddenly I was in floods of tears. I never remember missing my father when I was growing up, but I suddenly felt I was missing him now.” [p.30]


* Matt, becoming a father for the 1st time….

“I’d never known my own father, and suddenly here I was being a father to Thomas. One day … I was washing up and suddenly I was in floods of tears. I never remember missing my father when I was growing up, but I suddenly felt I was missing him now.” [p.30]



Three to six months- importance of feeding -> highlights babies’

individual temperaments & personalities- baby begins to separate from mother &

already uses play to make sense of feelings- parents’ and baby’s emotions are closely

entwined- each is intensely affected by the other

Three to six months- importance of feeding -> highlights babies’

individual temperaments & personalities- baby begins to separate from mother &

already uses play to make sense of feelings- parents’ and baby’s emotions are closely

entwined- each is intensely affected by the other




“A baby of 6 months is much more aware of her feelings.. No longer so bewildered by the newness of life, no longer at the mercy of chaotic feelings or happenings which spring out from nowhere, she has a secure base around her, and growing resources inside.” [p.48]


“A baby of 6 months is much more aware of her feelings.. No longer so bewildered by the newness of life, no longer at the mercy of chaotic feelings or happenings which spring out from nowhere, she has a secure base around her, and growing resources inside.” [p.48]



Six to Twelve months- baby begins to integrate his/her feelings and

thoughts, creating a more coherent view of the self and others

- life is full of emotional extremes for baby- baby’s emotional development depends on his/her

parents’ ability to bear frustration and to allow themselves & baby to be human

Six to Twelve months- baby begins to integrate his/her feelings and

thoughts, creating a more coherent view of the self and others

- life is full of emotional extremes for baby- baby’s emotional development depends on his/her

parents’ ability to bear frustration and to allow themselves & baby to be human



Tavistock Case material Seeing himself in a new light

“Feeling less passive,more in control and more of an individual, he will gradually join the rest of humanity” [p.50]

Seeing his mother in a new light“now, the baby is discovering that his mother is a

whole, separate person, someone who … can… fail to understand his needs” [p.50]

Tavistock Case material Seeing himself in a new light

“Feeling less passive,more in control and more of an individual, he will gradually join the rest of humanity” [p.50]

Seeing his mother in a new light“now, the baby is discovering that his mother is a

whole, separate person, someone who … can… fail to understand his needs” [p.50]

Infant Mental Health -> Attachment theory and Bonding

Infant Mental Health -> Attachment theory and Bonding

Attachment theory focuses on …- how loss and separation need to be continually,

and frequently, negotiated in the 1st year of life, with weaning, parental return to work etc

- how babies need to experience being fully known and ‘held in mind’ for the child to feel integrated, secure and understood

- the impact of normal disruptions and the importance of 'good enough' parenting ….

Attachment theory focuses on …- how loss and separation need to be continually,

and frequently, negotiated in the 1st year of life, with weaning, parental return to work etc

- how babies need to experience being fully known and ‘held in mind’ for the child to feel integrated, secure and understood

- the impact of normal disruptions and the importance of 'good enough' parenting ….

Contemporary Attachment Theory


Four main findings from Attachment Theory:-1) Universality hypothesis- in all cultures, human

infants become attached to 1+ specific caregivers2) Normality hypothesis- secure attachment is

numerically & physiologically normal (70%)3) Sensitivity hypothesis- attachment security is

dependent on sensitive & responsive caregiving4) Competence hypothesis- differences in

attachment security lead to differences in social competence [Van Ijzendoorm & Sagi, 1999]

Four main findings from Attachment Theory:-1) Universality hypothesis- in all cultures, human

infants become attached to 1+ specific caregivers2) Normality hypothesis- secure attachment is

numerically & physiologically normal (70%)3) Sensitivity hypothesis- attachment security is

dependent on sensitive & responsive caregiving4) Competence hypothesis- differences in

attachment security lead to differences in social competence [Van Ijzendoorm & Sagi, 1999]



Holmes (2001) added three further hypotheses:-5) Continuity hypothesis- childhood attachment

patterns significant impact on relationship skills & mental representations in adulthood

6) Mentalization hypothesis- secure attachment leads to capacity to reflect on self & others’ states of mind (mentalization)

7) Narrative competence hypothesis- childhood secure attachment is reflected in how adults’ talk about their lives, past, relationships & related pain

Holmes (2001) added three further hypotheses:-5) Continuity hypothesis- childhood attachment

patterns significant impact on relationship skills & mental representations in adulthood

6) Mentalization hypothesis- secure attachment leads to capacity to reflect on self & others’ states of mind (mentalization)

7) Narrative competence hypothesis- childhood secure attachment is reflected in how adults’ talk about their lives, past, relationships & related pain



Attachment Relationship can be defined by: i) proximity seeking to preferred figure; ii) the secure-base effect; and iii) separation protest (Weiss, 1982)

Attachment categories/styles:- i) secure (2/3); ii) insecure avoidant (1/5); iii) insecure ambivalent (1/6); and iv) disorganized (1/20)

Attachment Relationship can be defined by: i) proximity seeking to preferred figure; ii) the secure-base effect; and iii) separation protest (Weiss, 1982)

Attachment categories/styles:- i) secure (2/3); ii) insecure avoidant (1/5); iii) insecure ambivalent (1/6); and iv) disorganized (1/20)

How do different Attachment Categories/Styles emerge?

How do different Attachment Categories/Styles emerge?

Bowlby- recognized importance of environment, contexts, circumstances, relationships and interactions in a way not previously considered

Emotional development was recognized as as important as physical development

Events/interactions that disrupted the interaction with attachment figures were seen as crucial to emotional development

Further work focusing on emotional development was conducted by Ainsworth, Main, Lyons-Ruth

Bowlby- recognized importance of environment, contexts, circumstances, relationships and interactions in a way not previously considered

Emotional development was recognized as as important as physical development

Events/interactions that disrupted the interaction with attachment figures were seen as crucial to emotional development

Further work focusing on emotional development was conducted by Ainsworth, Main, Lyons-Ruth

Overview: Attachment strategiesOverview: Attachment strategies

We use the most effective strategy to ensure responsiveness of caregiver…..

‘Security’ is about flexible integration of both minimizing and maximizing expressions of attachment needs

So called ‘Disorganized’ classifications are thought to occur where no single strategy works effectively, and where caregiver is simultaneously a source of comfort and fear ie childhood abuse


‘Security’ is about flexible integration of both minimizing and maximizing expressions of attachment needs

So called ‘Disorganized’ classifications are thought to occur where no single strategy works effectively, and where caregiver is simultaneously a source of comfort and fear ie childhood abuse

Overview: Attachment strategiesOverview: Attachment strategies


For some, this means emphasising exploration & minimizing expression of attachment needs [minimizing/ ‘deactivating’ strategies] Overemphasis = ‘Avoidant’/ ‘Dismissing’

For some, this means emphasising attachment & maximizing expression of attachment needs [maximizing/ ‘hyperactiviting’ strategies] Overemphasis =‘Ambivalent’/ ‘Preoccupied’


For some, this means emphasising exploration & minimizing expression of attachment needs [minimizing/ ‘deactivating’ strategies] Overemphasis = ‘Avoidant’/ ‘Dismissing’

For some, this means emphasising attachment & maximizing expression of attachment needs [maximizing/ ‘hyperactiviting’ strategies] Overemphasis =‘Ambivalent’/ ‘Preoccupied’

Are Attachment Strategies constant from infant to adult?

Are Attachment Strategies constant from infant to adult?

Different perspectives…1) Two Models of Attachment stability/instability:-

i)existing representations are revised/updated with new experiences- early styles ‘overwritten’ii) representations from 1yr are preserved & continue to influence behaviour thru life [Fraley]

2) Client’s ‘constant attitude’ (Reich) -> one attachment style? Category? (AAI)

3) Repertoire of attachment styles? -> Dimensions rather than discrete categories? (Holmes, 2001)

Different perspectives…1) Two Models of Attachment stability/instability:-

i)existing representations are revised/updated with new experiences- early styles ‘overwritten’ii) representations from 1yr are preserved & continue to influence behaviour thru life [Fraley]

2) Client’s ‘constant attitude’ (Reich) -> one attachment style? Category? (AAI)

3) Repertoire of attachment styles? -> Dimensions rather than discrete categories? (Holmes, 2001)



Early attachment factors leading to patterns:- i) Secure - parents-children play, ‘good enough’

parenting, child can express negative emotions ii) Insecure avoidant - parent rejects child’s

contact/ emotions -> child withdraws iii) Insecure ambivalent - emotionally

inconsistent parent,‘parentified child’ iv) Disorganized - parent doesn’t have child in

mind, attachment figure may be maltreating child

Early attachment factors leading to patterns:- i) Secure - parents-children play, ‘good enough’

parenting, child can express negative emotions ii) Insecure avoidant - parent rejects child’s

contact/ emotions -> child withdraws iii) Insecure ambivalent - emotionally

inconsistent parent,‘parentified child’ iv) Disorganized - parent doesn’t have child in

mind, attachment figure may be maltreating child



Implications in Adult life/relationships:- i) Secure - working model of self as worthy of

care, autonomous, regulates negative emotion ii) Insecure avoidant - dismisses rels, compulsive

self-reliance, shuts down to avoid distress iii) Insecure ambivalent - clinging/ neediness, self

worth low, hyper-vigilance to distress iv) Disorganized - chaotic, fear of intimacy,

expects rejection (approach/avoidance conflict)

Implications in Adult life/relationships:- i) Secure - working model of self as worthy of

care, autonomous, regulates negative emotion ii) Insecure avoidant - dismisses rels, compulsive

self-reliance, shuts down to avoid distress iii) Insecure ambivalent - clinging/ neediness, self

worth low, hyper-vigilance to distress iv) Disorganized - chaotic, fear of intimacy,

expects rejection (approach/avoidance conflict)

Adult Attachment Types - AAI Classifications

Adult Attachment Types - AAI Classifications

Adult Attachment Interview (AAI) (Main):- i) Secure-autonomous - logical, concise, coherent ii) Insecure Avoidant - unelaborated, childhood

amnesia (life seen as good, but don’t know why) iii) Insecure Ambivalent - rambling, inconclusive iv) Disorganized - disjointed, broken narratives• Clinical use/research base - see Steele & Steele

(2008)

Adult Attachment Interview (AAI) (Main):- i) Secure-autonomous - logical, concise, coherent ii) Insecure Avoidant - unelaborated, childhood

amnesia (life seen as good, but don’t know why) iii) Insecure Ambivalent - rambling, inconclusive iv) Disorganized - disjointed, broken narratives• Clinical use/research base - see Steele & Steele

(2008)

Disruptions in Childhood/Early Attachment

Disruptions in Childhood/Early Attachment

Group Exercise:- What may we actually mean by childhood/

early attachment disruptions? What events, circumstances, relationship

patterns etc do you think we would be looking for, in the histories our child or adult patients with insecure or disorganized attachments?

How may disrupted attachments present?

Group Exercise:- What may we actually mean by childhood/

early attachment disruptions? What events, circumstances, relationship

patterns etc do you think we would be looking for, in the histories our child or adult patients with insecure or disorganized attachments?

How may disrupted attachments present?

Disrupted Attachment Presentations

Disrupted Attachment Presentations

Spitz- breaking attachment in first few years leads to depression with physical and mental deterioration (studied privation in institutions)

Short term separation Bowlby considered a universal

pattern of reactions to short-term separation ->

Protest -> despair ->detachment

Spitz- breaking attachment in first few years leads to depression with physical and mental deterioration (studied privation in institutions)

Short term separation Bowlby considered a universal

pattern of reactions to short-term separation ->

Protest -> despair ->detachment

Disrupted Attachments: Risk Factors to Babies/Infants


Negative risk factors to attachment & bonding in infants [the bad news…]

Difficulties with pregnancy, labour & birth Child’s developmental difficulties Parents’ mental health problems -> post-natal

depression, past abuse histories Domestic violence & other forms of abuse Single parenthood, teenage parenthood and poor

social support Child’s temperament

Negative risk factors to attachment & bonding in infants [the bad news…]

Difficulties with pregnancy, labour & birth Child’s developmental difficulties Parents’ mental health problems -> post-natal

depression, past abuse histories Domestic violence & other forms of abuse Single parenthood, teenage parenthood and poor

social support Child’s temperament



Negative risk factors for babies [more bad news..] • Gerhardt (2004) ‘Why love matters’ book

”quality of the relationship between parent and child influences both the biochemistry and the structure of the brain” (p.211)

• The baby’s nervous system is more vulnerable early on -> very early experiences are crucial

• Early experiences of affection, nurturing and attachment impact on both emotional & cognitive development -> early brain developments continue to have an impact in later life

Negative risk factors for babies [more bad news..] • Gerhardt (2004) ‘Why love matters’ book

”quality of the relationship between parent and child influences both the biochemistry and the structure of the brain” (p.211)

• The baby’s nervous system is more vulnerable early on -> very early experiences are crucial

• Early experiences of affection, nurturing and attachment impact on both emotional & cognitive development -> early brain developments continue to have an impact in later life

Disrupted Attachments: Risk Factors to Children


Most disruptive if: 7-36/12 old boy poor language have pre-existing behavioural problems initial bond was poor no previous history of separations only one attachment

Most disruptive if: 7-36/12 old boy poor language have pre-existing behavioural problems initial bond was poor no previous history of separations only one attachment



Negative risk factors [more bad news ….] All forms of abuse can cause disruptions to the

security and attachment of a child:- physical, sexual and emotional abuse.

Neglect has interestingly been found to have some of the most profound effects - are inconsistent attachments better than no attachments at all?

This research influences current policy to try and keep families together, despite their difficulties

Negative risk factors [more bad news ….] All forms of abuse can cause disruptions to the

security and attachment of a child:- physical, sexual and emotional abuse.

Neglect has interestingly been found to have some of the most profound effects - are inconsistent attachments better than no attachments at all?

This research influences current policy to try and keep families together, despite their difficulties

Positive Factors for Infant and Child Attachment

Positive Factors for Infant and Child Attachment

The Good news for infants ….• Mothers mis-attune with their babies more times

than they attune (about 70%) - human beings are therefore very forgiving & resilient (60-70% ‘securely’ attached)

• ‘Angels in the nursery’ - One secure figure may be enough, even if parental bonding is poor

• Child’s temperament • Resilience and normal pathology!

The Good news for infants ….• Mothers mis-attune with their babies more times

than they attune (about 70%) - human beings are therefore very forgiving & resilient (60-70% ‘securely’ attached)

• ‘Angels in the nursery’ - One secure figure may be enough, even if parental bonding is poor

• Child’s temperament • Resilience and normal pathology!

Impact of long term disruptionsImpact of long term disruptions Most common is death and divorce Contexts around death and divorce can lead to

more or less traumatic responses

Long term disruption Can lead in children to:-

separation anxiety psychosomatic reactions aggressive and demanding behaviour clinging or detachment from other attachments

Most common is death and divorce Contexts around death and divorce can lead to

more or less traumatic responses

Long term disruption Can lead in children to:-

separation anxiety psychosomatic reactions aggressive and demanding behaviour clinging or detachment from other attachments

Disruptions in Childhood/Early Attachment- the Research


a) Loss- incl actual loss & prolonged absences,eg parental illness, death, family disruptions leading to

foster/care placements circumstances/ caregiving before & after the loss are also criticalb) Stressful Events- incl marital conflict, divorce,

parental illness/dysfunction, parent-child conflict affect attachment when child perceives threat to the

attachment bond or caregiver availability an insecure child defensively distorts signals/

strategies, perceiving a threat

a) Loss- incl actual loss & prolonged absences,eg parental illness, death, family disruptions leading to

foster/care placements circumstances/ caregiving before & after the loss are also criticalb) Stressful Events- incl marital conflict, divorce,

parental illness/dysfunction, parent-child conflict affect attachment when child perceives threat to the

attachment bond or caregiver availability an insecure child defensively distorts signals/

strategies, perceiving a threat



c) Abuse & Trauma- incl sexual, physical or emotional abuse, and neglect

abuse impacts on child’s attachment style, both as trauma and context in which abuse occurs

nature of the abuse/abuser is important ‘perverse paradox’ of abuse [Holmes]- vicious circle

where adult carer is both attachment figure child turns to for protection and is the main source of threat child needs protection from-

More frightened/in pain child becomes, the more they cling to the perpetrator

c) Abuse & Trauma- incl sexual, physical or emotional abuse, and neglect

abuse impacts on child’s attachment style, both as trauma and context in which abuse occurs

nature of the abuse/abuser is important ‘perverse paradox’ of abuse [Holmes]- vicious circle

where adult carer is both attachment figure child turns to for protection and is the main source of threat child needs protection from-

More frightened/in pain child becomes, the more they cling to the perpetrator



d) Quality of caregiving- inadequate caregiving’s been linked to all forms of later psychopathology

Perceived threats to carer availability incl:- prolonged absence * emotional disengagement rejection * harsh discipline *neglect [most sig?] inadequate control * over-protection unresponsiveness *physical inaccessibility disrupted communication witnessing violence/suicide

d) Quality of caregiving- inadequate caregiving’s been linked to all forms of later psychopathology

Perceived threats to carer availability incl:- prolonged absence * emotional disengagement rejection * harsh discipline *neglect [most sig?] inadequate control * over-protection unresponsiveness *physical inaccessibility disrupted communication witnessing violence/suicide



Most importantly, it is not just disruptions per se that influence attachment responses…..

But cognitive appraisals/perception of threat following separation/loss-> these develop into ‘Internal Working Models’ of adult attachment

A child’s attachment responses will therefore be based on:-

i) Intrapersonal processes- IWM; strategies ii) Interpersonal processes- sensitivity; positive

parenting; open communication

Most importantly, it is not just disruptions per se that influence attachment responses…..

But cognitive appraisals/perception of threat following separation/loss-> these develop into ‘Internal Working Models’ of adult attachment

A child’s attachment responses will therefore be based on:-

i) Intrapersonal processes- IWM; strategies ii) Interpersonal processes- sensitivity; positive

parenting; open communication

Links between early attachment & later mental health difficultiesLinks between early attachment & later mental health difficulties

Holmes:- We can speculate about different forms of abuse/loss underlying attachment styles, ie

Avoidance may arise with parental aggression Ambivalent patterns may follow from CSA by

parents/step-parents Disorganized style may result from parental

neglect, where child despairs of finding a workable attachment strategy

But, this is over-schematic, with mixed patterns more common in clinical presentations

Holmes:- We can speculate about different forms of abuse/loss underlying attachment styles, ie

Avoidance may arise with parental aggression Ambivalent patterns may follow from CSA by

parents/step-parents Disorganized style may result from parental

neglect, where child despairs of finding a workable attachment strategy

But, this is over-schematic, with mixed patterns more common in clinical presentations

Links between early attachment & later mental health difficultiesLinks between early attachment & later mental health difficulties

Holmes- thought about obvious links between adult psychological reactions and attachment styles:-

Sadness- if an attachment bond is severed Depression- if there are threats to status in a group Anger or Anxiety- if an attachment bond is under

threat; Phobias- excessive fears of attack Mania- has a triumphant/delusional sense that

attachment bonds can be dispensed with BPD- where minor threats to attachment bond are

experienced as devastating

Holmes- thought about obvious links between adult psychological reactions and attachment styles:-

Sadness- if an attachment bond is severed Depression- if there are threats to status in a group Anger or Anxiety- if an attachment bond is under

threat; Phobias- excessive fears of attack Mania- has a triumphant/delusional sense that

attachment bonds can be dispensed with BPD- where minor threats to attachment bond are

experienced as devastating

Research on links between early attachment and later AMH


Conclusions from research:- “Attachment-related events, such as loss and abuse,

lead to modifications in these internal representations and affect a child’s strategies for processing thoughts and feelings.”

Therefore, they become “more vulnerable to psychopathology” [Handbook of Attachment]

But, are Holmes’ predictions of associations between particular attachment styles and development of specific disorders borne out in research findings?

Conclusions from research:- “Attachment-related events, such as loss and abuse,

lead to modifications in these internal representations and affect a child’s strategies for processing thoughts and feelings.”

Therefore, they become “more vulnerable to psychopathology” [Handbook of Attachment]

But, are Holmes’ predictions of associations between particular attachment styles and development of specific disorders borne out in research findings?



Research Evidence looking at linking infants’

behavioural strategies to psychopathology in adulthood is limited

More research is available looking at links between attachment-related events in childhood and later psychopathology/ mental health conditions

Research Evidence looking at linking infants’

behavioural strategies to psychopathology in adulthood is limited

More research is available looking at links between attachment-related events in childhood and later psychopathology/ mental health conditions



Extensive, but complicated body of research Some longitudinal studies look specifically at

attachment-> childhood/adolescent/adult psychopathology, ie Minnesota Parent-child project Lyons-Ruth et al

Key attachment researchers to consider are:- Ainsworth; Main; Sroufe; Egeland; Cassidy; Lyons-Ruth; Crittenden; Fonagy etc

Extensive, but complicated body of research Some longitudinal studies look specifically at

attachment-> childhood/adolescent/adult psychopathology, ie Minnesota Parent-child project Lyons-Ruth et al

Key attachment researchers to consider are:- Ainsworth; Main; Sroufe; Egeland; Cassidy; Lyons-Ruth; Crittenden; Fonagy etc

Research on links between attachment strategies and AMH

Research on links between attachment strategies and AMH

Insecure defensive strategies [Main, Holmes etc]:- a) ‘Minimizing strategies’[‘deactivating’]-

defensively turning attention away from distress= develop limited access to own feeling-> predispose child to externalizing disorders

b) ‘Maximizing strategies’[‘hyperactivating’]- defensively turning attention towards own distress= unable to accurately appraise threats-> predispose child to internalizing disorders

Insecure defensive strategies [Main, Holmes etc]:- a) ‘Minimizing strategies’[‘deactivating’]-

defensively turning attention away from distress= develop limited access to own feeling-> predispose child to externalizing disorders

b) ‘Maximizing strategies’[‘hyperactivating’]- defensively turning attention towards own distress= unable to accurately appraise threats-> predispose child to internalizing disorders

Research ConclusionsResearch Conclusions

Findings re: Attachment states of mind show some consistencies & inconsistencies

Classification system has changed over time & comorbidity is difficult to assess

Overall though, psychiatric disturbance is nearly always linked to insecure states, unresolved states and disorganized patterns are over-represented

Findings re: Attachment states of mind show some consistencies & inconsistencies

Classification system has changed over time & comorbidity is difficult to assess

Overall though, psychiatric disturbance is nearly always linked to insecure states, unresolved states and disorganized patterns are over-represented

Summary of links between Attachment and Mental Health

Summary of links between Attachment and Mental Health

Mood Disorders- linked to all 3 attachment types Bipolar Disorder- under-researched Anxiety Disorders- ‘preoccupied’ but also

‘unresolved to trauma’ Eating Disorders- predominantly insecure, mixed

categories depending on classification Schizophrenia- high proportion of ‘dismissing’ but

difficult to assess BPD- strong links with ‘disorganized’ categories Antisocial PD- ‘unresolved’ & ‘dismissing’

Mood Disorders- linked to all 3 attachment types Bipolar Disorder- under-researched Anxiety Disorders- ‘preoccupied’ but also

‘unresolved to trauma’ Eating Disorders- predominantly insecure, mixed

categories depending on classification Schizophrenia- high proportion of ‘dismissing’ but

difficult to assess BPD- strong links with ‘disorganized’ categories Antisocial PD- ‘unresolved’ & ‘dismissing’

DVD- Exploring attachment links to AMH difficulties

DVD- Exploring attachment links to AMH difficulties

Cases of mothers with PND…. Mothers’ attachment patterns have been shown to be

correlated to their baby’s patterns‘Help me love my baby’ DVD Look at the mirroring between mother & child Think about how the mother’s early attachment disruptions

may have impacted on her attachment style and her later development of post-natal depression

Think about the mothers’ narratives attachment strategies, both in her early life and now in adulthood

Think about the infant’s attachment strategies, both at 6 months and at 16 months- why these styles?

Cases of mothers with PND…. Mothers’ attachment patterns have been shown to be

correlated to their baby’s patterns‘Help me love my baby’ DVD Look at the mirroring between mother & child Think about how the mother’s early attachment disruptions

may have impacted on her attachment style and her later development of post-natal depression

Think about the mothers’ narratives attachment strategies, both in her early life and now in adulthood

Think about the infant’s attachment strategies, both at 6 months and at 16 months- why these styles?

Documents

Attachment 19th Nov 2010 Dr Helen Brotherton 19th Nov 2010 Dr Helen Brotherton