Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment

The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.     

Attachment and Divorce

In this paper, recent efforts to integrate attachment theory and family systems theory are reviewed and extended to the context of therapy with families coping with the divorce process. Family members' global working models of attachment, rather than the spousal attachment alone, are proposed as the point of intervention, with the goal of helping families reestablish an "attachment equilibrium" during and after divorce, thus addressing potentially problematic expressions of attachment behavior that could interfere with resolution of the divorce, causing difficulties in future co-parenting and other family functioning.     

Attachment to Volunteering

We propose that volunteers' attachment to their work is determined by the level of resources they bring to it, the rewards they derive from it, and the context in which the work is carried out. We test this theory using two waves of the Americans' Changing Lives panel study (1986–1989). The resources part of the theory is supported: the likelihood of remaining in the volunteer labor force across the two waves is greater for the more highly educated, those who report higher rates of formal and informal social interaction, and those who have children in the household—the last effect is stronger for women. Respondents reporting an increase in regular working hours across the two waves are more likely to cease volunteering. However, declining functional ability has no effect on attachment. The reward part of the theory is not consistently supported. Commitment to volunteer work in the first wave (measured by hours volunteered) predicts being a volunteer in the second, but enjoying the work has no effect, and being satisfied with the results of the work decreases attachment. Compared to a number of other work contexts, church-related volunteering in the first wave is the strongest predictor of being a volunteer in the second.     

Examining Attachment Avoidance and Attachment Anxiety Across Eight Sessions of Couple Therapy

This study examined initial levels of attachment anxiety and avoidance, as well as their patterns of change, across eight sessions of couple therapy. Participants were 461 couples in a treatment‐as‐usual setting. Dyadic latent growth modeling was used to determine whether couples started therapy at similar levels of attachment anxiety and avoidance and whether attachment anxiety and avoidance changed. An actor partner interdependence model was used to see whether partner attachment anxiety was related to avoidance. Results showed relative stability of attachment anxiety and avoidance over the course of therapy, with the only change being a slight decline in attachment anxiety among women. Results showed that a person's attachment anxiety was not related to their partner's avoidance and vice versa.     

The Emotional Dance of Attachment

Conceptualized as an emotional dance between the child and the primary caregiver, this article summarizes the primary principles of attachment theory as they pertain to clinical practice. The development of the attachment relationship goes smoothly in a secure attachment because the caregiver and child are effectively attuned to one another’s needs. Insecure attachment, on the other hand, occurs when the emotional dance goes awry leaving both the caregiver and the child with an emotional void. The article summarizes current treatment models geared specifically toward helping parent–child dyads resolve attachment problems.     

Attachment Between Former Spouses

This study examines the relationship between attachment of former spouses and parental communication and involvement. Data were collected from one hundred and seventeen divorced persons (46 men and 71 women) with school aged children. Research instruments included a shortened version of Kitson's (1982) attachment scale and Goldsmith's (1980) Co-Parental Communication and Parental Participation scales. Results suggest attachment may not be an adequate predictor in how involved divorced men are with their children. Rather, family boundary ambiguity in divorced families (particularly for males) may contribute to both low parental involvement and co-parental communication.     

A Preliminary Investigation of the Effectiveness of Attachment Therapy for Adopted Children with Reactive Attachment Disorder

The purpose of this preliminary investigation was to examine the effectiveness of attachment therapy for adopted children diagnosed with Reactive Attachment Disorder (RAD). Although attachment therapy is widely utilized in the practice community, outcomes of such therapy have not been well documented. In this study a pretest–posttest one-group design was used with a sample of 24 adopted children who received attachment therapy from trained, licensed therapists. Therapy was funded by the Georgia Office of Adoptions under a contract with a non-profit adoptive parent advocacy group which provided training of therapists and direct services to families. RAD was measured with the Randolph Attachment Disorder Questionnaire (RADQ), Third Edition; functional impairment was measured with the Child and Adolescent Functional Assessment Scale (CAFAS). Statistically significant decreases in scores on the RADQ and CAFAS from pretests to posttests indicate improvement for the children who received therapy. In spite of methodological limitations, the current study adds to the limited knowledge about effective treatment for RAD.     

Place Attachment and Community Development

ABSTRACT

Place attachment is a multidimensional concept about bonds people have for the places with which they interact. We are intrigued by its implications and potential influences on community development, particularly when explored from a community-oriented view. We use the case of Sunnyslope (a place within the Phoenix, Arizona municipal boundary) and a community development assessment conducted with stakeholders there. This community has survived through the decades, despite being subsumed into one of the largest cities in the United States. From 27 stakeholder interviews, we uncovered deep attachments to Sunnyslope that appear to have an interaction effect with social community capacity.     

Using Attachment to Better Understand the Therapy Alliance: The Attachment Based Alliance Questionnaire

Questionnaires on the therapeutic alliance are available, but most show inflated scores, limited variability, and few significant findings on the bonds domain. Results of a study of 251 clinical couples, on the development of an Attachment Based Alliance Questionnaire (ABAQ), are presented. Factor analysis (EFA and CFA), show that a one‐factor or two‐factor structure fit the data, with more support for a one‐factor model. Both models map closely with attachment constructs. Results also show that the ABAQ is predictive of changes couples make early in therapy and demonstrated adequate reliability and validity. The ABAQ provides a tool for clinicians as they learn how to attune to relationships in couple therapy and is helpful to researchers in understanding the alliance.     

Insecure Attachment Behavior and Partner Violence: Incorporating Couple Perceptions of Insecure Attachment and Relational Aggression

Intimate partner violence and insecure attachment are therapeutically relevant concepts when working with couples. The link between attachment and intimate partner violence has been examined in the literature, but an area of aggression that often goes unexamined is relational aggression, or using third parties as a means of being aggressive toward a partner. We asked how participants' attachment behaviors were related to their own and partners' relational and physical aggression. We used structural equation modeling to estimate actor–partner interdependence among these relationships in 644 heterosexual couples. Results indicated significant partner paths from attachment to relational aggression, as well as significant actor paths between relational aggression and physical aggression. Implications were discussed. Data for this study were collected from the RELATE assessment.     

Sexuality Examined Through the Lens of Attachment Theory: Attachment,Caregiving, and Sexual Satisfaction

Attachment researchers have proposed that the attachment, caregiving, and sexual behavioral systems are interrelated in adult love relationships (Mikulincer &; Shaver, 2007 Mikulincer , M. , &; Shaver , P. R. ( 2007 ). Attachment in adulthood: Structure, dynamics, and change . New York , NY : Guilford . [Google Scholar]). This study examined whether aspects of partners’ caregiving (proximity, sensitivity, control, compulsive caregiving) mediated the association between their attachment insecurities (anxiety and avoidance) and each other's sexual satisfaction in two samples of committed couples (Study 1: 126 cohabiting or married couples from the general community; Study 2: 55 clinically distressed couples). Partners completed the Experiences in Close Relationships measure (Brennan, Clark, &; Shaver, 1998 Brennan , K. A. , Clark , C. L. , &; Shaver , P. R. ( 1998 ). Self-report measurement of adult attachment: An integrative overview . In J. A. Simpson &; W. W. Rholes (Eds.), Attachment theory and close relationships (pp. 46 – 76 ). New York : Guilford .[Crossref] , [Google Scholar]), the Caregiving Questionnaire (Kunce &; Shaver, 1994 Kunce , L. J. , &; Shaver , P. R. ( 1994 ). An attachment-theoretical approach to caregiving in romantic relationships . In K. Bartholomew &; D. Perlman (Eds.), Advances in personal relationships (pp. 205 – 237 ). London : Kingsley . [Google Scholar]), and the Global Measure of Sexual Satisfaction (Lawrance &; Byers, 1998 Lawrance , K. , &; Byers , E. S. ( 1998 ). Interpersonal Exchange Model of Sexual Satisfaction Questionnaire . In C. M. Davis , W. L. Yarber , R. Bauserman , G. Schreer &; S. L. Davis (Eds.), Sexuality-related measures: A compendium (pp. 514 – 519 ). Thousand Oaks , CA : Sage . [Google Scholar]). Path analyses based on the actor-partner interdependence model (APIM) revealed that caregiving proximity mediated the association between low attachment avoidance and partners’ sexual satisfaction in distressed and nondistressed couples. Sensitivity mediated this association in nondistressed couples only. Control mediated the association between men's insecurities (attachment-related avoidance and anxiety) and their partners’ low sexual satisfaction in nondistressed couples. Attachment anxiety predicted compulsive caregiving, but this caregiving dimension was not a significant mediator. These results are discussed in light of attachment theory and their implications for treating distressed couples.     

Attachment Theory and Parental Alienation

Following an acrimonious divorce or separation, arguments are frequently presented as to why a child should not be with a nonresident parent. The custodial parent, whether a father or a mother, uses the concept of a child being attached to himself or herself and therefore this should prevent the child from having actual or reasonable contact with the absent parent. This view is based on antagonism between the former partners rather than the importance of the attachment theory being relevant. The attachment theory is also used to discredit the intentions of the noncustodial parent. This is especially the case for the younger child. With older children this is not likely to be as relevant. The history of the development of the attachment theory commencing with Bowlby and Ainsworth is presented, and the counterarguments are also presented. Attachment to the mother is obviously important initially but attachment to the father is equally important to the child and such bonding is likely to lead to positive emotional and behavioral development. It is therefore argued that both fathers and mothers have an important role to play and are, or should be, responsible for the rearing of children. The acrimony between the couple should not be considered as relevant as it is, in fact, the real reason why attachment theory is used against a nonresident parent.     

Bonding and Attachment in Adoption

SUMMARY

The meaning of the words “bonding” and “attachment” as terms related to human connections are examined from an historical perspective and as important tools in the field of adoption. For over three decades there has been confusion between the two words and about the processes which they represented. Because adoption, by definition, changes the usual patterns of family connections, it is especially important that there be common agreement about terminology. Clinical observations have led to the discrete definitions proposed here. The words are defined, for utilitarian purposes, in a way that underscores the qualitative differences. The result is a tool that can improve placement decisions, help resolve controversial custody cases, reduce tensions among the families to which an adopted child has connections, and provide concrete assistance to children in their efforts to learn how to make significant attachments.     

Parental Alienation in Light of Attachment Theory

Abstract

Few ideas have captured the attention and charged the emotions of the public, of mental health and legal professionals as thoroughly as the concept of parental alienation and Gardner's (1987) Parental Alienation Syndrome. For all of this controversy, the alienation concept stands outside developmental theory and without firm empirical support. The present paper explores alienation and its conceptual counterpart, alignment, as the necessary and natural tools of child-caregiver attachment (Ainsworth & Wittig, 1969; Bowlby, 1969) and of family system cohesion. This conceptual foundation offers developmentalists, clinicians, and family law professionals alike a common language and valuable instruments with which to understand those relatively infrequent but highly charged circumstances in which these tools are used as weapons, particularly in the context of contested custody litigation. The need to establish baseline measures, child-centered interventions, and legal remedies anchored in the attachment model is discussed.     

Attachment and Racial Identity Issues:

Court battles are being wages and state laws are being challenged to enable white foster families to be considered as viable adoptive placements for black infants and young children. This article examines the issues associated with transracial adoption decision making and provides recommendations for agency practice and policy.     

Attachment theory and clinical social work

Recent additions have rendered attachment theory potentially viable for clinical social work practice. The author examines its formulations and possible use, seeing it as an important alternative to other psychosocial approaches that attempt to explain how early childhood experiences may affect later mental health. The emphasis of this theory on the cognitive makes it congenial to those who favor cognitive approaches to individual therapy, and its emphasis on patterns of attachment makes it of appeal to family therapists.