Attachment Theory and Clinical Practice (CAMS-UA.0206)
Emily Becker-Weidman, Ph.D: emilybw@gmail.com, 215-8400669
Session
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1
Topic
OVERVIEW OF CLASS, INTERFACE OF PSYCHOLOGY PRACTICE AND
ATTACHMENT THEORY
Attachment theory and research have greatly enhanced our understanding of the role of
parent-child relationships in the development of psychopathology. Illuminated are the
ways that early experiences of separation and loss can lead to a range of psychological,
behavioral, and psychosomatic problems, and how these can be addressed in the context
of a healing relationship. Attachment theory is a psycho-bio-social theory, which is
increasingly influential in clinical thinking and practice. It offers a model of emotional,
cognitive and behavioral development, which is founded in the work of John Bowlby and
has been developed in a number of directions in the years since its conception. The model
is embedded in parent-child relationships and emphasizes the impact that this reciprocity
has on the development of the child.
In this session, we will begin our discussion of attachment theory, its early development,
and its basic concepts. In addition, we will review course requirements and expectations.
The objective of this session is to define the terms and concepts utilized when discussing
attachment and to outline the overall objectives of the course.
Readings:
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary
Ainsworth. (1989). Developmental Psychology, 25, 19-53.
Bowlby, J. (1944). Forty-Four Juvenile Thieves: Their Character and Home-Life.
International Journal of Psychoanalysis, 25, 19-52.
2–3
ROOTS OF ATTACHMENT THEORY I-II
In these sessions, we will explore the history and development of attachment theory and
attachment behavior. Part one will focus on the emergence of attachment theory at the
same time as, and in contrast to, the development of object relations theory. Next, we will
discuss attachment as a system in its own right, as a control system, and discuss Harlow’s
research with monkeys. Attachment behavior provides a balance between safety and
exploration. The caregiver provides a secure base from which the child can explore the
world. Attachment is a process that involves a synchrony between the infant and the
mother. We will also discuss the intergenerational transmission of attachment and its
implications in child welfare practice.
Part two will discuss key concepts in the development of emotions. When separation is
threatened, the child feels anxious and angry. Early experiences of the caregiver are
crucial for the child’s developing working model of relationships, the child’s place in the
world, and the world itself. We will discuss the results of care that is attuned to a child’s
needs and the effect on the child when that is not the case. We will discuss Mary
Ainsworth’s work and types of attachment styles (i.e. secure, anxious, avoidant,
disoriented/disorganized). The stability of these patterns will be examined and evaluated
by exploring current research. We will talk about revisions to the theory and Mary
Main’s classifications. The infant strange situation method of classifying attachment type
will be described in detail, and we will review the procedure from printed materials. The
class will discuss how attachment develops and first and second year cycles. We will then
explore how we account for the persistence of attachment patterns and the concept of
working models of self, other, and the world.
Readings:
Holmes, PART I, pp. 13-60.
Becker-Weidman & Shell, CHAPTERS 1-4, pp. 7-108
4
ROOTS OF ATTACHMENT THEORY III
In this session, we will explore the second major round of research and work on
attachment theory (i.e., the work of Mary Main, George Solomon, and Erik Hesse). We
will learn how Foster Cline applied attachment theory to treatment and the early
foundations of attachment therapy. We will cover the neurobiology of attachment and
affect regulation. We will review Bowlby’s “working model” in detail and look at
supporting evidence of the stability of attachment classification.
Readings:
Holmes, PART II & III, pp. 61-216
ACES Study, Felitti 1998
Hesse and Main Article
5
ATTACHMENT THEORY APPLIED TO CHILD DEVELOPMENT
In this session, we will focus on infant and child assessments. To elucidate these points,
clips will be shown of the strange situation protocol, highlighting the behaviors of infants
with varying types of attachment. We will discuss the normal attachment process and
difficulties and disruptions of attachment. We will also address the concept of loss and
explore how loss creates increased vulnerability.
Readings:
Becker-Weidman & Shell, CHAPTER 5, pp. 109-129.
Cassidy & Shaver, chapter 7 (Psychobiological origins of infant attachment and its role in
development), chapter 12 (Normative development: The Ontogency of Attachment)
6
DIFFERENTIAL DIAGNOSES AMONG CHILDREN AND ADULTS
In this session, we will discuss the differential diagnosis of Reactive Attachment. The
symptoms of Attachment Disorder and Complex Trauma will be addressed in detail. In
addition, we will discuss child maltreatment and its effects on attachment. We will study
the diagnoses most often confused with Reactive Attachment Disorder, including Bipolar
Disorder I, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder,
Conduct Disorder, and Post Traumatic Stress Disorder. We will look at symptom overlap
and how to tease apart the differences.
Readings:
Becker-Weidman & Shell, CHAPTER 6 & 7, pp.130-204
Cassidy & Shaver, chapter 18 (Measurement of attachment security), chapter 25 (The
adult attachment interview), chapter 27 (Attachment and psychopathology in childhood).
7
CHILD WELFARE SYSTEM
*Literature Analysis Due
During this class we will discuss the child welfare system. Students will analyze policies
using attachment theory. We will learn about the foster care system, residential treatment
facilities, and child protective services. Material and readings will be applied to narratives
of real placement histories.
Readings:
Gauthier, Y., Fortin, G., & Jeliu, G. (2004). Clinical application of attachment theory in
permanency planning for children in foster care: The importance of continuity of care.
Infant Mental Health Journal, 25(4), pp. 379-396.
Haight, W. Kagle, L., Donner, J., & Black, J (Eds.) (2003). Understanding and supporting
parent-child visits: Attachment theory and research. Social Work, 48 (2), pp. 195-207.
Cassidy & Shaver, chapter 40, (Implications of attachment theory and research for child
care policies). 958-174.
Folman, RD (1998). I was token: How children experience removal from their parents
preliminary to placement into foster care. Adoption Quarterly, 2, 7-35.
8
ATTACHMENT THEORY AND ADOPTION
This session will focus on international adoption. We will first discuss how agencies
prepare families (or rather, do not prepare families). We will then talk about orphanage
care, life in an institution, and its effects on the child. The class will also learn about US
adoption policies, legislation, and international agreements on adoptions.
Readings:
*Students will be guided to find one article on attachment theory and adoption and
prepare a critique.
Deveny-Leggit 2012
Additional articles will be distributed by professor.
9
ATTACHMENT THEORY AND FOSTER-CARE/ADOPTION (Cont.)
This session will focus on foster care and domestic adoption from the child welfare
system. We will first discuss how agencies prepare and train foster parents. We will then
talk about foster care and impermanent settings and the effects of these on the child. The
class will also learn about factors that facilitate or impede child mental health in the foster
care system.
Readings:
Committee on Early Childhood, Adoption and Dependent Care, (2000). Developmental
Issues for Young Children in Foster Care, Pediatrics, 106:1145-1150.
Howe, D., Developmental Attachment Psychotherapy with Fostered and Adopted
Children. Child & Adolescent Mental Health, 11(3): 128-134.
10
TREATMENT OF CHILDREN USING ATTACHMENT THEORY: PARENTING PRINCIPLES For children with an attachment disorder, the birthmother and their foster or adoptive
mother are profound sources of ambivalence and conflict. The birthmother is typically
the one the child most wanted to connect with and also the one who caused the most pain.
She is dangerous, anxiety provoking, an object of love and fear. These children confuse
that mother with their new mother. Increased intimacy commonly leads to increased
acting out to protect against abandonment, or it may lead to hypervigilence and superficial
engagement to avoid another loss. This session will turn the emphasis to attachmentfocused treatment. We will first discuss parenting principles using attachment theory.
The child needs understanding, not arguing; acknowledging feelings is a beginning. We
will discuss the attitude parents should adopt when interacting with their child. Discipline
should be intended to teach, not punish; thus, the child learns his behavior has
consequences but never feels abandoned. Finally, we will talk about facilitating
developmental attachment and the twelve principles of parenting.
Readings:
Becker-Weidman & Shell, Chapters 8, 9, & 10, pp.204-287.
Becker-Weidman, (2011) Chapters 1-5, pp. 1-83.
11
TREATMENT OF CHILDREN USING ATTACHMENT THEORY
*Critical literature review due
In this class, we will begin to discuss treatment using attachment theory, starting with an
overview of attachment-focused therapy. The central issues addressed in treatment are
separation and loss, trust, rejection, shame and guilt, identity, intimacy, loyalty, and power
and control. The primary experience of the child is abandonment, and the core issues tend
to be the loss and fear of further abandonment. We will discuss the symptoms of fear and
loss and how these are expressed in the child’s behavior. Next, we will talk about the
phases and structure of treatment, as well as the process of therapy; core components will
include engagement, therapeutic guidelines, and terminating treatment. We will discuss
how to identify when the family is ready and how to wrap up the work. The class will
cover specific measures of treatment outcome and discuss the pros and cons of various
ways of measuring treatment effectiveness.
Readings:
Becker-Weidman, 2011 chapters 5-end, pp. 65-226.
12
CULTURE AND ATTACHMENT
In this class we will examine the relationship between attachment and culture. We will
consider cultural differences and how these relate to the development of attachment. We
will review relevant studies and discuss how to integrate cultural considerations into what
we have learned so far in the course.
Readings:
Chapter 5 in Grossman’s The Major Longitudinal Studies (Bielesfeld and Regensburg
studies)
Takahashi, K. (1990) Are the key assumptions of the “Strange Situation” procedure
universal? A view from Japanese research. Human Development, 33, 23-30.
Rothbaum, F. et al., (2000). Attachment and culture: Security in the United States and
Japan. American Psychologist, 55, 1093-1104.
Rothbaum, F. et al., (2004). Amae and Attachment: Security in Context. Human
Development, 47, 34-39.
13
ADULTS AND ATTACHMENT
In this class, we will focus on how attachment theory applies to adults. We will first
discuss how attachment theory applies to romantic relationships and conceptualize love as
an attachment process. We will review the assessment of attachment in adults and discuss
the Adult Attachment Interview. We will talk about the presentation of insecure
attachment in adults and its manifestations. Finally, we will cover how attachment theory
applies to couples therapy and more general family therapy.
Readings:
Hazan, C. & Shaver, P. (1987). Romantic love conceptualized as an attachment process.
Journal of Personality and Social Psychology, 52, 511-524.
Dozier M, Stovall KC, Albus KA. Attachment and psychopathology in adulthood. In:
Cassidy J, Shaver PR, editors. Handbook of Attachment. New York: Guilford Press; 1999.
pp. 497–519.
Roiseman, G.I. et al. (2007) The Adult Attachment Interview and self-reports of
attachment style: An empirical rapprochement. Journal of Personality and Social
Psychology, 92, 678-697.
Chapter 9 in Grossman’s The Major Longitudinal Studies (Stony Brook Adult
Relationship project)
Fraley, R. C. (2002). Attachment stability from infancy to adulthood: Meta-analysis and
dynamic modeling of developmental mechanisms. Personality and Social Psychology
Review, 6, 123-151.
Fraley, R. C., & Shaver, P. R. (2000). Adult romantic attachment: Theoretical
developments, emerging controversies, and unanswered questions. Review of General
Psychology, 4, 132-154. [read pp. 142-146]
14
ATTACHMENT THEORY AND SOCIAL WELFARE POLICY
This week we will continue to expand upon our discussion of attachment theory and how
it relates to social policy. We will explore social welfare policy, the current standards and
regulations, research, data, and outcomes, and discuss conflicts. The class will start with
an overview of the history and evolution of adoption and the key features of modern
adoption laws. We will further discuss important federal legislation that guides adoption
practices, especially as related to special needs adoption, transracial adoption, and the
adoption of children under the supervision of public child welfare agencies. Since the
passage of the federal Adoption and Safe Families Act (ASFA) in 1997, adoption services
at the state level have noticeably changed; we will explore the impact of this legislation on
safety and permanency for children and termination of parental rights. Finally, we will
discuss international adoption in the context of human rights issues.
Readings:
Golding, K (2003) Helping foster careers, helping children: using attachment theory to
guide practice. Adoption and Fostering, 27, 64-73.
Menne, FE & O’Keefe, M (2005). Informed decisions in child welfare: The use of
attachment theory. Children and Youth Services Review, 27, 577-593.
Cassidy & Shaver, (2008). Handbook of Attachment, NY: Guilford, 958-974.
15
WHERE ARE WE? CURRENT RESEARCH ISSUES, TRENDS, AND FUTURE
DIRECTIONS
In this class we will wrap up class presentations of papers and projects. The second half
of this session will serve as an opportunity for students to synthesize what has been
learned throughout the course and to discuss how perspectives on attachment theory may
be expected to evolve in the future. We will address remaining questions and consider
what we as a society and as individuals can do for children and adolescents with
attachment disorders.
Readings:
Lawler, M. J., Shaver, P. R., & Goodman, G. S. (2011). Toward relationship-based child
welfare services. Children and Youth Services Review, 33, 473-480.
Shaver, P. R., & Mikulincer, M. (2010). New directions in attachment theory and
research. Journal of Social and Personal Relationships, 27, 163-172.
Becker-Weidman, A., (2010). Dyadic Developmental Psychotherapy, Lanham, MD: Jason
Aronson. 1-38.
Cassidy & Shaver, (2009), Chapter 37, 880-905.
Readings:
Ainsworth, M.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.
Becker-Weidman, A., & Shell (eds.) (2005/2008/2011). Creating Capacity for Attachment.
Oklahoma City, OK: Wood & Barnes.
Becker-Weidman, A., (2010). Dyadic Developmental Psychotherapy. Lanham, MD: Jason
Aronson.
Becker-Weidman, A., (2011). The Dyadic Developmental Psychotherapy Casebook. Lanham,
MD: Jason Aronson.
Bowlby, J (1982). Attachment and Loss: Vol. 1 Attachment, 2nd Edition. NY: Basic Books.
Bowlby, J. (1944). Forty-Four Juvenile Thieves: Their Character and Home-Life. International
Journal of Psychoanalysis, 25, 19-52.
Bowlby, J. (1988). Attachment, communication, and the therapeutic process. A secure base. NY:
Basic Books, (pp.137-157).
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth.
Developmental Psychology, 25, 19-53.
Cassidy, Jude, & Shaver, Phillip (Eds). Handbook of Attachment. 2nd. Edition, 2009. Guilford
Press, New York.
Committee on Early Childhood, Adoption and Dependent Care, (2000). Developmental Issues
for Young Children in Foster Care, Pediatrics, 106:1145-1150
Dozier M, Stovall KC, Albus KA. Attachment and psychopathology in adulthood. In: Cassidy J,
Shaver PR, editors. Handbook of Attachment. New York: Guilford Press; 1999. pp. 497–519.
Folman, RD (1998). I was token: How children experience removal from their parents
preliminary to placement into foster care. Adoption Quarterly, 2, 7-35.
Fraley, R. C. (2002). Attachment stability from infancy to adulthood: Meta-analysis and dynamic
modeling of developmental mechanisms. Personality and Social Psychology Review, 6, 123151.
Fraley, R. C., & Shaver, P. R. (2000). Adult romantic attachment: Theoretical developments,
emerging controversies, and unanswered questions. Review of General Psychology, 4, 132-154.
Gauthier, Y., Fortin, G., & Jeliu, G. (2004). Clinical application of attachment theory in
permanency planning for children in foster care: The importance of continuity of care. Infant
Mental Health Journal, 25(4), pp. 379-396.
Golding, K (2003) Helping foster careers, helping children: using attachment theory to guide
practice. Adoption and Fostering, 27, 64-73.
Grossman, K., Grossman., K., Waters., e. (Eds.) (2005). Attachment from infancy to adulthood:
The major longitudinal studies. NY: Guilford.
Haight, W. Kagle, L., Donner, J., & Black, J (Eds.) (2003). Understanding and supporting
parent-child visits: Attachment theory and research. Social Work, 48 (2), pp. 195-207.
Hazan, C. & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal
of Personality and Social Psychology, 52, 511-524.
Holmes, J., (1993)., John Bowlby & Attachment Theory, NY: Routledge.
Howe, D., Developmental Attachment Psychotherapy with Fostered and Adopted Children.
Child & Adolescent Mental Health, 11(3): 128-134.
Lawler, M. J., Shaver, P. R., & Goodman, G. S. (2011). Toward relationship-based child welfare
services. Children and Youth Services Review, 33, 473-480.
Menne, FE & O’Keefe, M (2005). Informed decisions in child welfare: The use of attachment
theory. Children and Youth Services Review, 27, 577-593.
Roiseman, G.I. et al. (2007) The Adult Attachment Interview and self-reports of attachment
style: An empirical rapprochement. Journal of Personality and Social Psychology, 92, 678-697.
Rothbaum, F. et al., (2000). Attachment and culture: Security in the United States and Japan.
American Psychologist, 55, 1093-1104.
Shaver, P. R., & Mikulincer, M. (2010). New directions in attachment theory and research.
Journal of Social and Personal Relationships, 27, 163-172.
Takahashi, K. (1990) Are the key assumptions of the “Strange Situation” procedure universal? A
view from Japanese research. Human Development, 33, 23-30.
REQUIRED TEXTS
Handbook of Attachment: Theory Research and Practice, 2nd Edition, (eds.) Philip Shaver &
Jude Cassidy, Guilford Press, 2009.
Holmes, J., (1993)., John Bowlby & Attachment Theory, NY: Routledge.
Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of
Trauma-Attachment Disorders. Arthur Becker-Weidman, Ph.D., & Debra Shell, (Eds.) Woods N
Barnes publishing, Oklahoma City, OK, 2005.
Additional Optional Texts: Any of these texts will provide you with practice specific
methodologies.
Bowlby, John. Attachment. (2nd. ed.) 1982. New York: Basic Books.
Bowlby, J. A Secure Base. New York, NY: Basic Books, 1988.
Greenberg, M., Cicchetti, D., & Cummings, E., (Eds.) (1990). Attachment in the Preschool
Years. Chicago: University of Chicago Press.
James, Beverly, Handbook for Treatment of Attachment-Trauma Problems in Children. 1994.
Free Press, New York
Jewett, Claudia L. Adopting the Older Child. 1978. Harvard Common Press, Boston, MA.
Jewett, Claudia L. Helping Children Cope with Separation and Loss. 1982. Harvard, MA., The
Harvard Common Press.
Karen, Robert. Becoming Attached. 1998. Oxford University Press.
Karr-Mores, Robin, & Wiley, Meredith S. 1997. Ghosts from the Nursery. The Atlantic
Monthly Press, 841 Broadway, New York, NY 10003.
Lamb, Michael E., Thompson, R. A., Gardner W., & Charnov, Eric L., Intnat-Mother
Attachment, 1985, Lawrence Erlbaum Associates Publishers, Hillsdale, NJ.
Parkes, C., Stevenson-Hinde, J., & Marris, P., (Eds.) (1991). Attachment Across the Life Cycle,
NY: Routledge.
Shemmings, D., & Shemmings, Y., (2011). Understanding Disorganized Attachment,
Philadelphia: Jessica Kingsley.
Steele, H., & Steele, M., (Eds.) (2008). Clinical Applications of the Adult Attachment Interview,
NY: Guilford.
Takinso, Leslie, & Zucker, Kenneth J., Attachment and Psychopathology, 1997, The Guilford
Press, NY.
van der Kolk, Bessel A., McFarlane, Alexander C., & Weisaeth, Lars, Editors. 1996.
Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and
Society. The Guilford Press, A Division of Guilford Publications, Inc., 72 Spring St., NY, NY
10012.
Grading:
a. Class participation (10%)
b. Beginning the second week and continuing through the remainder of the term,
students will submit a two-paged, double spaced, summary of the readings due at the
beginning of class, with a cogent, well-thought-out question (20%). The paper may
be a summary of the major points of the readings, or a more in depth discussion of a
particular point of interest. The question must be for class discussion. You will be
evaluated on the depth of your understanding of the material and the pertinence of
your question. Keep one copy for use during class and turn in the second copy at the
beginning of class.
c. Literature Review (20%): These papers may be completed at any point during the
course but are to be turned in no later than session 10. Paper should be six to eight
pages, double-spaced. Students are to select a confined area of study and thoroughly
read and critique a minimum of 6 journal articles beyond those required in the course
syllabus. These articles must be on recent (2000-2013) attachment research as it
pertains to one of the following areas of study: (1) Infant and/or early child
development, (2) adolescent development, (3) adult development, (4) adult romantic
relationships, (5) adult or child psychopathology, (6) cross-cultural issues, (7) clinical
practice, or (8) child maltreatment and/or child welfare. The paper should be a
summary and critique of the articles, including implications for practice. The paper
will be graded as follows: Explanation of the research (30%), critique of the research
(25%), implications for practice and/or policy and recommendations for future
research (30%), writing style and use of correct APA formatting (15%). Students
must make copies of all articles addressed and submit them with the literature review.
d. Literature Analysis Paper (20%): Due at week 7. Students are required to read one
of the following stories:
i. “The Shawl” from Louise Erdrich’s (2005) The Painted Drum.
ii. “ATemporary Matter” from Jhumpa Lahiri’s (1999) Interpreter of
Maladies.
iii. “Thailand” from Haruki Murakami’s (2002) After the Quake.
iv. “After Rain” from Trevor William’s (1996) After Rain.
v. Pinocchio
Students must then analyze the story from an attachment perspective. The analysis
should focus on the relationships or character development and its association with
attachment theory and research. The papers must be four to six pages in length and
utilize at least three references.
e. FINAL PAPER (30%): Due at the final class session. Students are to critically
review the evidence for one subtopic in attachment theory, using recent empirical
literature. All topics must be reviewed and approved by the instructor. The paper
should critique the methods of research presented (i.e. point out strengths and
weaknesses of design, sampling, measurement, analysis, interpretation, etc). Sample
topics include: Maltreated children show disorganized attachments; children’s
attachment security changes when they are exposed to negative events and negative
parenting styles; mothers with insecure attachments have children with insecure
attachments; and aspects of maternal versus paternal attachment.
All papers must be typewritten with a font size of 12pt. and 1"margins. Two unstapled
copies of each paper must be provided. Students must reference using APA style. Students
are strongly encouraged to carefully proofread their papers. Poorly written papers will be
penalized. Late papers will not be accepted and will receive a score of zero.