Psychology

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Tavistock and Portman NHS Foundation Trust

Assessment Front Sheet

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Student Number: Course Code: M7

Unit Name: Theoretical Perspectives Year 1

Unit Number: Stand 2 Child Development Research

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Word Length (not including appendices and end/footnotes): 1,979

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Attachment Theory

Introduction

Attachment theory encompasses a broad body of research over several decades. In the first part of

this paper I will introduce the topic and the range of relevant research I have studied. In the second

part I will focus on a journal article by Juliet Hopkins, “Overcoming a child’s resistance to late

adoption: how one new attachment can facilitate another” (2000). I have chosen this topic as in my

work with looked after children, particularly adolescents moving towards leaving care, I find myself

confronted often with the power of the predictive reach of attachment theory yet simultaneously

questioning whether these patterns of attachment established in early life can be altered.

Introduction to Attachment theory and range of relevant research studied

Attachment theory offers us a profound understanding of the importance of early relationships and

how they impact on child development. From its initial conception by the psychiatrist and

psychoanalyst John Bowlby (1969), attachment theory has become an important area of research

over the last fifty years, particularly in relation to child development. Whilst not forgetting his roots

in psychiatry and psychoanalysis, Bowlby was also influenced by the science of evolutionary theory

and what drives the human biological instinct to survive (Music, 2017). To begin with Bowlby

focussed his attention on how young children responded to separation from their parents by

observing their behaviours, what emerged was that not only did young children require their basic

physical needs to be met such as food or shelter, but they also have, “a biological need for a

protective attachment figure, the absence of which causes serious psychological difficulties” (Music,

2017, p. 62). Attachment began as a need from an infant for proximity to their primary care giver,

most importantly during moments of distress or alarm.

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The parent or primary care giver serves as what Bowlby termed a ‘secure base’ to which the infant

can return to when in a state of fear or anxiety. Attachment is relational, the child attaches to the

parent and the parent attends to the child’s physical and emotional needs, Bowlby referred to what

happens between them as affectional bonds (Music, 2017). It is important to say that these

affectional bonds can be formed with more than one individual, attachments can be made to several

significant figures in an infant’s life, and indeed throughout their life into childhood and beyond. It is

often however, the caregiver with whom an infant spends the majority of their time in the first

twelve months of life to whom the most significant attachment is made. This raises the question of

those infants who have had multiple care givers. This may be for cultural reasons, or in more

unfortunate circumstances there may have been multiple placements if parents or families are

unable to provide adequate care in the home.

Security of attachment and how it is measured

Following on from Bowlby’s research which focussed more on proximity of a child to their care giver,

there was more of an emphasis placed on the quality of the mother’s availability when she is with

her child, meaning how sensitive and responsive she is to their needs. If an infant comes to know

that their mother will consistently, not only be physically but also emotionally available in times of

distress, then they will develop a sense of safety and security (Hopkins & Phillips, 2009). It was Mary

Ainsworth (1978) a colleague of Bowlby’s who devised a test to measure the security of the

attachment formed between a mother and their twelve month old infant, this is known as the

Strange Situation Test, Hopkins and Phillips summarise this well,

“In this standardised test the infant is left briefly alone in a strange room and then reunited

with his mother: his reactions on reunion are considered indicative of the nature of his

security with his mother, since they reveal the expectations he has developed about her

physical and emotional availability when he is afraid.” (2009, p. 40).

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Four categories emerged from the analysis of the infant’s reactions, secure attachment, insecure-

avoidant attachment, insecure-ambivalent attachment and disorganised attachment. Securely

attached infants become upset when left alone. They seek out and settle with their mother on

reunion and then seek to be put down and continue their play with toys that are available in the

room. These children have a trust that their mother can be relied upon to respond in a predictable

and timely manner to their distress. Those classified as insecure-avoidant become anxious during the

separation (displayed by their increased heart rate) but tend not to show this distress to their care

giver. On reunion they ignore the caregiver, do not seek comfort and can actively avoid it when

offered. These children may also surreptitiously watch the care giver and perhaps approach them,

but not display any negative affect. This behaviour suggests that these care givers can usually

manage their infant’s positive emotions but struggle when they display negative emotions. (van

Rosmalen, van Ijzendoorn & Bakermans-Kranenburg, 2014). Those classified as insecure-ambivalent

become markedly upset during the separation and display ambivalent behaviour when reunited with

their care giver. They cry loudly and seek immediate contact with the caregiver but do not settle and

appear conflicted between wanting to be held but also wanting to express their anger and

frustration at being left. This clinging but simultaneous pushing away can suggest that this infant’s

experience of soothing from their caregiver has been inconsistent. We can think of these three

classifications as organised coping mechanisms for staying in contact, both physically and

psychologically with one’s primary caregiver.

The final classification, disorganised attachment, was identified some years after Ainsworth’s initial

research (Main & Solomon, 1986). On reunion these infants can display contradictory behaviours

such as approaching but doing so backwards or another example is freezing completely when the

caregiver enters the room. Such a child has not been able to develop an organised strategy which

can suggest that their experience of their caregiver has been confusing, unpredictable and even

frightening. Disorganised attachment is often synonymous with abuse or neglect where the

caregiver has been both the source of the fear whilst also being the source of the care or security.

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What the Strange Situation Test shows us is the human capacity to assess and predict the safety of

situations is firmly established by the time an infant has reached just twelve months of age.

Attachment behaviours change or adapt depending on the environment, the child forms predictions

about the world and how to respond to it in order to achieve a desired sense of safety. The patterns

of behaviour that emerge lead us to Bowlby’s concept of ‘internal working models’. This is a place

where psychoanalysis and attachment theory meet, Music describes these as, “a non-conscious

model in their minds, an internal representation of themselves in relation to others.” (2017, p.66).

Fonagy et al. (1993) found that the security of an infant’s attachment with both their parents at

twelve and eighteen months could be predicted based on assessment of the parents own

attachment styles (as assessed by the Adult Attachment Interview (Main et al., 1985)) before the

baby is even born. This confirmed Fraiberg’s (1980) hypothesis that a person’s own childhood

conflicts can resurface when one has their own children. However, this predictive reach of

attachment through the generations must also be explored with caution. It is important to consider

when thinking about children who may have suffered early abuse or neglect, whether changes in

patterns of attachment can happen with thoughtful, consistent and attuned attention from care

givers, and when required, therapeutic intervention from professionals as discussed below.

There is also debate as to how applicable attachment theory is across cultures having been

formulated in western society. This is also discussed below in the context of the chosen paper.

Critical reflection on ‘Overcoming a child’s resistance to late adoption: how one new attachment

can facilitate another’ Hopkins, J. (2000)

The reason I chose this paper is that often with disorganised attachment in children who have

suffered severe abuse and/or neglect there can be little hope. In the context of my work with

adolescents transitioning from care to independent living, Hopkins offers some insight into the

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potential successes of psychotherapeutic interventions informed by attachment theory. After a brief

summary of the paper, I will firstly address the scope and limitations of case studies. Secondly, I will

highlight the absence of cultural and/or racial context given in the paper, examining the challenges

this bring in interpreting the paper more generally, particularly in the context of my own work with

predominately Black, Asian and Minority Ethnic (BAME) young people.

The paper addresses some of the challenges that can arise for late-adopted children in their ability

to form an attachment to their new parents. Hopkins uses the lens of attachment theory to examine

the psychotherapy of a nine-year-old boy named Max, over the course of two years. She explores

how a disorganised pattern of attachment can have its roots in early neglect and trauma. We get an

insight into the intervention with Max which helps him work through early negative attachment

models and their connected feelings of ‘fright without solution’. The defensive strategies established

which were useful in frightening or unpredictable circumstances have become not only redundant

but also disturbing and obstructive to the formation of new attachments to his adoptive family.

While ultimately a successful intervention I will examine the case study in more detail below.

Case studies and qualitative research more generally play an integral role in highlighting

psychoanalytic concepts, consider for example Freud’s seminal paper detailing a fragment of analysis

of Dora which led to the emergence of the concept of transference (1905). Hopkins describes a

successful intervention showing a causal link between therapy and Max’s newly earned attachment

to his adoptive parents. The rich context provided in the paper is hugely informative. However, case

studies are limited for the very same reason. They highlight a very specific context and set of

circumstances, some of which may be transferable, but others less so. In contrast quantitative

studies (e.g. Fonagy et al., 1993), attempt to highlight the predictive power of attachment theory

more generally. Ultimately a full description of the predictive power of attachment theory requires

both qualitative and quantitative research.

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This paper offers great insight into successful therapeutic intervention but lacks description of Max’s

cultural or ethnic background and what consideration was given to this, if any, at the time of

adoption. Significantly culture has been shown to play an important role in the quality of

attachments formed (Erdman, 2010). In a similar vein, the paper could have offered a broader

understanding if consideration had been given to the similarity or difference of ethnicity within the

therapeutic relationship. In my own experience as a white woman working with majority BAME

young people it has been valuable to name any racial or cultural differences and to explore any

impediments to the work that may accompany them. Equally if there are many similarities it can be

helpful to acknowledge them and what they might bring.

What Hopkins offers is a rich example of how, with therapeutic support, children who have

experienced trauma can overcome extensive difficulties in forming attachments. Hopkins mentions

that Max’s adoptive parents are receiving support in parallel to Max, however a deeper

understanding of Max’s intervention may have been gained by expanding on this work.

Conclusion

The extensive body of work around attachment theory continues to give us a way to understand the

behaviour of young children not merely as a reaction but an intelligent and highly adaptive response

to their environment from infancy. Whilst it’s predictive reach is strong it is by no means unalterable

as we have seen in the case of Max above. Attachments can continue to be formed throughout the

life cycle which offers some hope for those children that have had negative early experiences.

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References

Ainsworth, M.D. (1978) Patterns of Attachment: A Psychological Study of the Strange Situation. New

Jersey: Lawrence Erlbaum.

Bowlby, J. (1969). Attachment and Loss. Vol. 1: Attachment. London: Hogarth.

Erdman, Phyllis jt. editor, & Ng, Kok-Mun jt. editor. (2010). Attachment. Expanding the cultural

connections. New York: Routledge.

Fonagy, P. Steele, M. Moran, G. Steele, H. and Higgitt, A., 1993. ‘Measuring the ghost in the nursery:

An empirical study of the relation between parents' mental representations of childhood

experiences and their infants' security of attachment.’ Journal of the American Psychoanalytic

Association, Volume 41(4), pp.957-989.

Fraiberg, S. H, Adelson, E, & Shapiro, V. (1980). Ghosts in the nursery: A psychoanalytic approach to

the problem of impaired infant-mother relationships. Clinical studies in infant mental health. The

first year of life. (pp. 164–196). London: Tavistock Publications.

Freud, S. (1953) ‘Fragment of an analysis of a case of hysteria (’Dora')’, in The standard edition of the

complete psychological works of Sigmund Freud, Vol. 7. 1901-1905. A case of hysteria. Three essays

on sexuality. Other works. London: Hogarth Press. (pp. 1–123).

Hopkins, J. (2000) ‘Overcoming a child's resistance to late adoption: How one new attachment can

facilitate another’, Journal of Child Psychotherapy, Volume 26(3), pp. 335-347.

Hopkins, Juliet, & Phillips, Gail. (2009). Some contributions of attachment theory and research. The

handbook of child and adolescent psychotherapy. Psychoanalytic approaches. London:

Routledge. (pp. 38–50).

Main, M. Kaplan, N. and Cassidy, J., 1985. Security in infancy, childhood, and adulthood: A move to

the level of representation. Monographs of the society for research in child development, pp.66-104.

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Main, M. and Solomon, J. (1986) `Discovery of an insecure disorganized/disoriented attachment

pattern', in T. Brazelton and M. Yogman (eds) Affective Development in Infancy.New Jersey:

Norwood, pp. 95-124.

Music, G. (2017). Nurturing natures: Attachment and children's emotional, sociocultural and brain

development. 2nd edn. Routledge.

van Rosmalen, Lenny, van Ijzendoorn, Marinus H., & Bakermans-Kranenburg, Marion J. (2014). ABC+

D of attachment theory. the Strange Situation procedure as the gold standard of attachment

assessment. The Routledge handbook of attachment. Theory (pp. 11–30). New York: Routledge.