Attachment
30th November 2012
Dr Helen Brotherton
Session Outline
• Historical perspectives on Attachment Theorythe work of Bowlby & others
• DVD- Early research studies of Attachment
• 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 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? ….”
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
‘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.
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
Evidence against ‘Cupboard
Love Theories’
• Harlow observed infant rhesus monkeys
• The studies found that, in times of stress,
monkeys preferred a more comforting clothcovered ‘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 Bowlby
• Bowlby - British child psychiatrist, part of the
psychoanalytic community, training when objectrelations (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
• 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 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’s Theory of 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’
DVD- Exploring Early
Attachment Research
‘Attachment’ DVD
– Look at Harlow’s early research studies
– Thinking about the ethics of the research, both with
historical & contemporary perspectives
– Think about what information we can gain today from
this research, in terms of the:• Importance of attachment to the primary caregiver
• The impact of neglect
• How this research may relate to well-known cases
of childhood maltreatment, neglect, and disrupted
attachments in humans
Bowlby’s Theory of Attachment
• 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 important
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’s Theory of 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)
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
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
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
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: Separation
Anxiety/Protest
• 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
• 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
Contemporary Attachment
Theory
• Attachment Relationship can be defined by:i) proximity seeking to preferred figure; ii) the securebase effect; and iii) separation protest (Weiss, 1982)
• Attachment categories/styles:– i) Secure (2/3; 60%);
– ii) Insecure avoidant (1/5; 20%);
– iii) Insecure ambivalent (1/6; 15%); and
– iv) Disorganized (1/20; 5%)
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
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
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
Infant Mental Health
0-12 months
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
Infant Mental Health
0-12 months
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
Infant Mental Health
0-12 months
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
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 ….
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)
Contemporary Attachment
Theory
Four main findings from Attachment Theory:1) Universality hypothesis- in all cultures, human
infants become attached to 1+ specific
caregivers
2) Normality hypothesis- secure attachment is
numerically & physiologically normal (70%)
3) Sensitivity hypothesis- attachment security is
dependent on sensitive & responsive caregiving
4) Competence hypothesis- differences in
attachment security lead to differences in social
competence [Van Ijzendoorm & Sagi, 1999]
Contemporary Attachment
Theory
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
Contemporary Attachment
Theory
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
Contemporary Attachment
Theory
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)
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?
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 -
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
Disrupted Attachments: Risk
Factors to Babies/Infants
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
Disrupted Attachments: Risk
Factors to Children
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
Impact 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
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 critical
b) 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
Disruptions in Childhood/Early
Attachment- the Research
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
Disruptions in Childhood/Early
Attachment- the Research
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
Disruptions in Childhood/Early
Attachment- the Research
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
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!
Links between Early Attachment
& Adult 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
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?
Research on links between
early attachment and later AMH
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 on links between
early attachment and later AMH
• 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
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 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
Summary of links between
Attachment and Mental Health
• Mood Disorders- linked to all 3 attachment
types
• Bipolar Disorder- under-researched
• Anxiety Disorders- ‘preoccupied’ (ie insecure
ambivalent) but also ‘unresolved to trauma’
• Eating Disorders- predominantly insecure,
mixed categories depending on classification
• Schizophrenia- high proportion of ‘dismissing’
(ie insecure avoidant) but difficult to assess
• BPD- v strong links with ‘disorganized’
categories
• Antisocial PD- ‘unresolved’ & ‘dismissing’
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?