Attachment Theory and Practice

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Attachment Theory and Practice

• Dr. Zeev Levita
• Consultant Clinical Psychologist
• Options Institute

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What is Attachment?

• Instinctive tie between the infant and carer
• A biological function
• Based on the need for safety, security and
  protection
• Promotes survival
• Promotes genetic replication

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What is not Attachment?

• Not the same as love and affection
• Not attachment of parents to infant (this is
  referred to as Care giving Bond )
• Not appropriate to refer to attachment between
  parents and children
• Not an overall descriptor of the relationship
  between the parents and child that includes other
  parent-child interactions such as feeding,
  stimulation, play, problem solving, teaching etc.

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What does the attachment behaviour do?

• Infants are born predisposed to respond to other
  people with innate preference for human faces.
• The infant naturally presents behaviours
  (attachment behaviours) that elicit interest and
  nurture, increasing the likelihood that contact
  will be created and will continue.
• The infants attachment behaviour brings the
  infant closer to the caregiver or maintains the
  caregivers proximity to secure removal of the
  stressors thus deactivating the need for
  attachment behaviour.
• However the attachment system is never fully
  de-activated.

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Activation of Attachment Behaviour

• Condition of the Child
• Fatigue
• Hunger
• Ill health
• Pain
• Cold

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Activation of Attachment Behaviour

• 2. Whereabouts and the Behaviour of the Mother
• Mother absent
• Mother departing
• Mother discouraging proximity

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Activation of Attachment Behaviour

• 3. Other Environmental Conditions
• Occurrence of alarming events
• Rebuff by other adults or children

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The Development of Attachment

• Initial Pre-attachment - Orientation and signals
  without discrimination birth to 8 weeks
• Attachment in the Making - Orientation and
  signals towards one (or more) discriminated
  figure/s 8 weeks to 6 months
• Clear Cut Attachment - Maintenance of proximity
  to a discriminated figure by means of locomotion
  as well as signals 6m/1 year to 2/3year
• Formation of goal-directed partnership starts at
  2/3 years

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Internal Working Models of Attachment
Representations

• The child develops expectations about
  him/herself, others and the response of others to
  his/her attachment needs
• Can internal working models change? They can be
  affected by new experience but new experience is
  also shaped by the existing model.
• Unconscious aspects of internal models are likely
  to be particularly resistant to change

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Attachment and Exploration

• Infants use their attachment figure as a secure
  base from which to explore
• Secure base provides the child with the
  confidence that if he explores/distances
  him/herself the attachment figure will be always
  there to provide comfort ,re-assurance and help
• Exploration and Autonomy are promoted by
  responding to childs proximity-seeking
  attachment behaviours rather than resisting it,
  proximity promotes autonomy rather than inhibits
  it.

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Attachment and Self-Regulation

• The childs ability to elicit care and engage in
  exploration is facilitated by the process of
  attunement that the relationship with the
  attachment figure offers.
• The child becomes less dependent on external
  regulation and more autonomous in his ability to
  lead the relationship and achieve comfort,
  reduction in arousal etc.
• With continuing experience that his/her
  behaviours result in appropriate and sensitive
  care giving and arousal reducing response this
  co-regulatory ability develops into a capacity
  for self-regulation
• The child learns that his/her emotional states
  can be understood, handled, controlled and
  contained and becomes able to manage this for
  him/herself

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Attachment and Capacity for Mentalising

• Development of self regulatory capacity is
  accompanied by development of psychological self,
  sense of agency and its own mind
• The carer by understanding and responding to the
  childs emotional state promotes the childs
  ability for mentalising which in turn helps the
  child to understands his/her emotional states and
  regulate them

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Attachment and Socialising

• Care giving role includes socialisation
• When the carer disapproves of a childs behaviour
  he/she creates a state of mis-attunement as they
  demonstrate disapproval or prohibition
• The child experiences shame as a result of
  negative arousal
• The carer then needs to create conditions for
  re-attunement
• The child feels again being loved and cared for
  and the relationship is repaired
• This ongoing experiences of attunement, rapture
  and re-attunement provide the child with
  experience that leads to the development of
  impulse control and socially appropriate
  behaviour.

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Patterns of Attachment
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• Organised patterns Disorganised patterns
  Non-attachment
• Secure Insecure
• Avoidant Ambivalent/
  Disorganised/ Disinhibited Inhibited
• Resistant
  disoriented
• Compliance Coercive
• Self-reliance
• Controlling

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Types of Attachment and the Internal Working Model
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Secure, insecure and difficulties in attachment

• Attachment Disorder Lack of opportunity for
• selective attachments.
• Inability to form meaningful
• intimate relationships
• Attachment Difficulty Traumatic attachments
• Impacts on how children
• organise their behaviour
• in relation to others.
• Insecure Attachment Impacts on how children
• approach current and
• future relationships
• Secure Attachment Children signal attachment
• and exploratory needs in a
• straightforward way.

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Attachment Disorder

• Develops on the basis of absence of available or
  responsive care
• Possible Conditions
• (some) Institutions
• Repeated changes of primary care-giver
• Extremely neglectful identifiable primary care
  giver that disregards the child basic attachment
  needs and ignores the childs attachment
  behaviours.

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Intervention with parents/carers of Infants

• Creating a safe and secure environment
• Enable parents to provide the child with
  experience of comfort and co-regulation
  (attunement and repair following episodes of
  mis-attunement)
• Help parents to promote resilience and
  psychological resources within the child

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Intervention for Older Children

• Have more strongly established patterns of
  relating to others based on their early
  experience
• They need to experience an environment that will
  provide them with the opportunity to explore and
  learn different patterns of behaviour
• Whether the above leads to recovery or
  improvement is still an open question.

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Guide for Practitioners working with
Parents/Carers and Children

• Provide security
• Be empathic (see and feel the world through the
  childs eyes)
• Help to construct and re-construct working models
  of self and attachment figures
• Help them to distance themselves from their past
  experiences and see present relationship for what
  they are
• Providing them with experiences missed in their
  infancy

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Guide for Practitioners Working with the Child

• Provide safe and secure environment
• Provide positive experiences of care giving and
  attunement
• Traditional individual therapy will only be
  useful after the child had an experience of and
  benefited from a protective environment and
  sensitive care
• We cannot expect to mould the children to an
  environment they are not equipped for. Too narrow
  emphasis on individual therapy may be misguided
• Bottom-up approaches are recommended instead of
  Top-down approaches (e.g. CBT)

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Hope

• We may not be able to reverse the
  neuro-developmental damage that has been done but
  we can help them to adapt.