Dustin H. Reed MHS, CRC, PLPC

Doctoral Student

Our Lady of Holy Cross College

Department of Counseling and Behavioral Sciences

New Orleans, Louisiana

Presentation Goals

Definition of Treatment

Overview of Attachment Styles

Professional/People with Disabilities Relationships

PWD and Family Relations

PWDs and Caregivers

PWD and Relationships

PWD and Healthcare Treatment

Disability, Attachment, and Pain

1.) Connect Attachment Theory with its role in

conceptualization of relationships of people with

disabilities with their caretakers, friends, and families.

2.) Connect Attachment Theory with its role in

treatment pertaining to people with disabilities.

3.) Explore how Attachment Theory relates to attitudes

and perceptions of people concerning people with

disabilities.

Kate is a 31 year old Caucasian, bi-sexual female.

She has multiple learning disabilities. Kate also

has trouble remembering to do things at times (lock

the house door when she leaves, close her car door

or house door, put away food, bring her house key

when she leaves the house). Kate talks with her

parents of wanting to have a child with someone.

When asked, Kate says that she is thinking about

having a man get her pregnant and then raise the

child with a woman (believing that the man would

just be the sperm donor and nothing more to the

child)

thinking about interrationships—the

relationships that bind…. What would your

initial impression of Kate be as a counseling

professional if she were your client? How

would you approach her situation to help

Kate help herself and in the process form a

secure bond with Kate instead of making

Kate feel fearful, insecure, or avoidant of

receiving help with her current situation?

Tim is a 16 year old African American male.

He has Type 1 diabetes. He was diagnosed

when he was 10. His parents are very

supportive and he has a very secure

relationship with them. However, Tim acts

out and has trouble in his classes. When he

isspeaking to the school counselor about his

behavior, Tim tells the counselor, “I’m

different from the other kids, they make fun

of me because I have diabetes.”

If you were Tim’s counselor, how

would you approach his situation?

Thinking about interrationships, the

relationships that bind…. What are

some approaches you could use to

help Tim be more secure about

forming relationships with his

peers?

Research suggests that psychiatric

caregivers and the psychiatric

institutions may be viewed as attachment

figures for people with psychiatric

disabilities

(Adshead, 1998)

Through utilization of attachment theory

when listening to patients’ stories, psychiatric

caregivers may provide a basis for helping to

ameliorate patients’ anxieties and allow for a

safe haven that patients with a psychiatric

disability may utilize to help with the

management of their disability.

(Adshead, 1998)

Parents who have intellectual disability

If taught and treated with respect by professionals

- allows for better adapting to parenthood

Negative perception leads to reciprocal negative perception

Secure base of support from professionals lost or strained

(Joreskog & Starke, 2013; McConnell, Llewellyn, & Bye, 1997)

Negative preconceived conceptualization:

affects how professionals treat PWD

relates to attachment style between

professional and PWD

(Joreskog & Starke, 2013)

Some people with Intellectual Disabilities are perceived to lack empathy

Thus relates to and could affect:

child/parent bonding

(Joreskog & Starke, 2013)

There are organizations that provide support for PWD.

(i.e., Disability Issues Office, Families Helping Families).

(American Psychological Association, 2015; Families Helping Families, 2015)

Attachment styles of professional

caregivers are associated with and

affect:

effective response to cues

quality of life

Direct Service Caregivers should

Assess their relationships with PWDs

Try to determine better ways to

interact

(Schuengel, Kef, Damen, & Worm, 2010)

Internal views of self are related to attachment and relationships with others (Johnson & Whiffen, 2006, p. 240).

Some people with disabilities

more than people without disabilities experience negative self-image, depressive symptoms, and suicidal ideations.

(e.g., children and adolescence with spinabifida)

(Appleton et al, 1997)

The children’s perception of the

support parents gave significantly

related to:

depressed mood

global self worth

(Appleton et al, 1997)

Findings suggest interventions aim to:

Promote child/parent communication

Help children with disabilities to feel

competent despite their disability

Help the child address negative self-

schema of body image.

(Appleton et al, 1997)

People with different types of disabilities (i.e., depression, schizophrenia, alcoholism)

Were perceived negatively by individuals according to a study done in the U.K.

(Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000)

Research shows evidence linking

genes (i.e., dopamine, scrutonin,

oxytocin) to social behavior and

disability (i,e., generalized anxiety

disorder).

(Gillath, Shaver, Baek, & Chun, 2008)

Children with learning disabilities reported less secure attachments in close relationships and more anxiety and avoidance

Versus

Children who have normal development who reported more secure attachment in close relationships

(Al-Yagon & Mikulincer, 2004)

There have been cases of parents with disabilities having their rights of being parents taken away from them (i.e., Native American community).

(National Council on Disability, 2015)

Attachment style is related to reported symptoms of some PWD in healthcare

Women with fearful and preoccupied attachment

Reported higher somatic symptoms

versus secure and dismissive patients

Fearful and dismissive women

had less utilization of healthcare

(Ciechanowski, Walker, Katon, & Russo, 2002)

Why did females with fearful and preoccupied attachment report higher somatic symptoms versus secure and dismissive patients?

The authors suggest it is related to self esteem due to earlier caregiving relationships.

(Ciechanowski, Walker, Katon, & Russo, 2002)

Human rights of people with mental disabilities are a global concern advocated for by The World Health Organization (WHO)

The stigma associated with mental disability breeds prejudice among healthcare professionals and the public.

(WHO, 2007)

How well people deal with perceived pain

levels, in combination with levels of comfort

about being close to another person….

moderates the level of perceived

disability.

(Meredith, Strong, & Feeny, 2006)

People who have an insecure attachment style have vulnerability to developing disability after experiencing acute pain.

(Meredith, Ownsworth, & Strong, 2008)

1.) Connect Attachment Theory with its role in

conceptualization of relationships of people with

disabilities with their caretakers, friends, and families.

2.) Connect Attachment Theory with its role in

treatment pertaining to people with disabilities.

3.) Explore how Attachment Theory relates to attitudes

and perceptions of people concerning people with

disabilities.

Questions?

Adshead, G. (1998). Psychiatric staff as attachment figures – Understanding management problems in psychiatric services in the light of attachment theory. The British Journal of Psychiatry, 172, 64-69. doi: 10.1192/bjp.172.1.64

Al-Yagon, M. & Mikulincer (2004). Patterns of close relationships and socioemotional and academic adjustment among school-age children with learning disabilities. Learning Disabilities Research & Practice, 19(1), 12-19. The Division for Learning Disabilities of the Council for Exceptional Children.

American Psychological Association (2015). Disability issues office. Retrieved from

http://www.apa.org/pi/disability/

Appleton, P. L., Ellis, N. C., Minchom, P. E., Lawson, V., Boll, V., & Jones, P. (1997). Depressive Symptoms and self-concept in people with spina bifida. Journal of Pediatric Psychology, 22(5), 707-722.

Crawford, N. (2003). Parenting with a disability: The last frontier. Monitor on Psychology, 68. American Psychological Association. Retrieved from https://www.ncd.gov/publications/2012/Sep272012/Ch6

Ciechanowski, P.S., Sullivan, M., Jensen, M., Romano, J., & Summers, H. (2003). The relationship of attachment style to depression, catastrophizing and healthcare utilization in patients with chronic pain. Pain, 104(3), 627-637. doi: 10.1016/S0304- 3959(03)00120-9.

Ciechanowski, P. S., Walker, E. A., Katon W. J. , & Russo J. E. (2002). Attachment theory: A model for health care utilization and somatization. Psychosomatic Medicine, 64, 660-667. doi: 10.1097/01.PSY.0000021948.90613.76

Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000).

Stigmatisation of people with mental illnesses. BJP, 177, 4-7.

Families Helping Families of Jefferson Parish, (2015). Retrieved from

http://fhfjefferson.org/

Gillath, O., Shaver, P. R., Baek, J. M., & Chun, D. S. (2008). Genetic correlates of adult

attachment. PSPB. doi: 10.1177/0146167208321484

Joreskog, K. & Starke, M. (2013). Professionals’ perceptions of and approach to parents

with intellectual disability: A question of knowledge? International Journal of Social

Sciences, 1(2), 20-30. doi: 10.11114/ijsss.vli2.134

McConnell, D., Llewellyn, G., & Bye, R. (1997). Providing services for parents with

intellectual disability: Parent needs and service constraints. Journal of Intellectual

and Developmental Disability, 22, 5-17. Retrieved from

http://informahealthcare.com/doi/abs/10.1080/13668259700033251

Meredith, P., Ownsworth, T., & Strong, J. (March, 2008). A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clinical Psychological Review, 28(3), 407-429. Retrieved from http://www.sciencedirect.com/science/article/pii/S027273580 00 1304

Meredith, P., Strong, J. & Feeny, J. A. (2006). Adult attachment, anxiety, and pain self efficacy as predictors of pain intensity and disability. Pain, 123, 146-154.

National Council on Disability (2015). Parental disability and child welfare in the native american community.

Whiffen, V. E. & Johnson, S. M. (2006). Attachment processes: In couple and family therapy, 240. New York: The Guilford Press.

WHO (2007). Mental health legislation & human rights denied citizens: Including the excluded - Promoting the rights of people with mental

disabilities. World Health Organization.