A discussion of current attachment research and its clinical applications

This article highlights Stern's recent conceptualization of the infant's development of internal working models of attachment and the relationship between internal working models and the narrative self. Research studies, including Ainsworth's and Main's seminal work on types of infant attachment models, are reviewed. These include secure, avoidant insecure, ambivalent insecure, and disorganized-disoriented types of infant attachment. Later research supports the continuation of these same attachment patterns in the children at age six. A clinical case, a sixteen year old and her infant, is presented to illustrate how the client's working model of attachment plays out in the treatment process.     

Meaning and attachment in mothers and toddlers

This research explored if a mother's view of her attachment experience with her own mother was associated with sensitivity to her toddler's attachment related signals. Thirty mother-child dyads were videotaped and maternal sensitivity to toddler signals was coded. Mothers were interviwed and completed questionnaires regarding their experiences with their own mothers. Based on the subjects' responses to the questionnaires and the content and organization of their interview narrations, subjects were divided into two groups based on the security of their internal working model of attachment with their own mothers. Mothers with a secure working model of attachment were significantly more sensitive to toddler signals than those mothers with an insecure working model of attachment (p=.028) and differed in their style of narrating their lifespan attachment experiences.This study was completed as partial requirement for the degree of Doctor of Philosophy, Institute for Clinical Social Work, Chicago, Illinois.     

Family attachment narrative therapy: healing the experience of early childhood maltreatment

Based on attachment theory and research, Family Attachment Narrative Therapy is introduced as a new family therapy modality developed to heal the experience of early childhood maltreatment. Unresolved childhood trauma has been correlated with impaired and delayed cognitive, behavioral and emotional functioning. Gentle, soothing, nonprovocative and nonintrusive narratives told by parents provide an alternative restorative experience designed to shift and change the child's destructive internal working model. The result is improved functioning and the ability to accept nurturing and care in relationships that offer love and safety. A representative case example is used to illustrate theory, practice and outcome. Pre- and posttherapy assessment supports the claim of improved functioning.     

FIELD NOTES: A CONCEPTUAL APPLICATION OF ATTACHMENT THEORY AND RESEARCH TO THE SOCIAL WORK STUDENT-FIELD INSTRUCTOR SUPERVISORY RELATIONSHIP

This article conceptualizes an attachment-based model of the student–field instructor relationship, based on empirical research concerning internal working models of attachment, which continue into adulthood and serve as templates for life-long relating. Supportive relationships within a noncritical context are salient for effective supervision; attachment theory provides a framework for developing supportive supervisory relationships and augments existing theories of supervision. Ideal and problematic supervisory relationships are presented followed by recommendations for interventions and future research. The supervisory relationship will be most successful when the field instructor is guided by attachment theory and its conceptualization of a "secure base" (Bowlby, 1988).     

A Case Study of a Maltreated Thirteen-Year-Old Boy: Using Attachment Theory to Inform Treatment in a Residential Program

This paper presents therapeutic interventions from an attachment perspective with a thirteen-year-old boy with a history of maltreatment, living in a residential treatment facility. Attachment theory holds that accumulated memories of experiences with caregivers become organized into representational structures called internal working models. The guiding principles of the therapy begin with the critical role played by the individual therapist as an attachment figure. The central purposes of the therapy are conceived as promoting the restructuring of the internal working models of others to reflect expectations of trustworthiness and reliability, and models of the self as worthy to receive care. The approach described is contrasted with common approaches to residential treatment that rely on environmental behavioral contingencies, modeled on social learning theory.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

Bindung und Impression-Management: Beeinflusst der individuelle Bindungsstil das Selbstdarstellungsverhalten in sozialen Situationen?

A central tenet of John Bowlby’s attachment theory is that people’s attachment experiences are integrated into so-called ‘internal working models’. These working models are supposed to contain representations about ‘the world’ as well as certain attitudes towards one’s self or one’s self-concept. In the present study, it is assumed that this self-concept, which reflects the individual’s attachment experience, exerts substantial influence on one’s self-portrayal in social situations, which is viewed as the process during which the self-concept is communicated to an audience. In the present study the attachment type was determined by the ‘Skala zur Erfassung von Bindungsrepräsentationen’ (Scale for the determination of attachment representations) which was developed by Grau (1999). Additionally, the tendency to exhibit ‘positive’ impression management strategies was measured by the ‘Fragebogen zur Erfassung positiver Selbstdarstellung’ (Questionnaire for recoding positive self-portrayals) by Mummendey and Eifler (1994). Subsequently, people’s positive self-portrayal score was compared to their attachment type. Analysis indicated that the attachment type merely had an influence on the tendency to exhibit positive self-portrayal strategies when participants had a negative representation of their-self, as well as a negative representation of others, a pattern which characterises the ‘fearfulavoidant’ type. Results also demonstrated that elder participants scored lower on the positive self-portrayal scale, irrespective of their attachment type.     

Attachment issues and the cocaine exposed dyad

Through the theoretical lens of attachment theory, the relationship between substance abusing parents and their children exposed prenatally to drugs is explored. Attachment theory, the quality of attachment, attachment classifications, internal working models of attachment, and correlates of attachment classifications are discussed. Case studies of two schoolaged children exposed prenatally to cocaine are presented and interpreted in light of attachment theory set within a social-ecological perspective. Implications for practice and the use of federal policy for this population are explored.     

The importance of volitional narrative in treatment: An ethnographic case study in a work progran

The revised theory of the model of human occupation expands the concept of volition to include volitional narrative. This paper focuses on the application of this theory of volition to a client's experience in a work program. This ethnographic case study describes the volitional narrative and life world of one client who attended the occupational therapy work based program. For fifteen months the client was the subject of narrative interviews, participant observation, videotapes and telephone contacts. The findings will illustrate how knowledge of a client's volitional narrative and life world can shed critical light on understanding treatment conflicts. Finally, the discussion will underscore how important it is for work based programs to be designed to encourage therapists to adapt their treatment approaches to maximize the opportunities to seek out the client's volitional narratives and to create meaningful experiences that are consistent with the client's life world.     

“I Deserve a Family”: The Evolution of an Adolescent’s Behavior and Beliefs About Himself and Others When Treated with Theraplay in Residential Care

This article chronicles a seriously disturbed adopted adolescent’s experience in an attachment focused residential program at which the primary treatment was Theraplay^®. Adopted at age four following significant abuse and neglect, Tom lived in institutions for 5 years before participating in Chaddock’s Developmental Trauma and Attachment Program (DTAP). He now resides successfully in the home of therapeutic foster parents. Theraplay treatment directly meets attachment needs through adult-guided, highly positive, engaging and nurturing interactions to change the child’s working models of attachment and to develop affect regulation. Theraplay was especially useful with this adolescent who was born addicted and who had little ability to participate in insight oriented therapy. Topics include adolescence and attachment, Theraplay theory, process and applications, and the DTAP milieu and treatment program. This case study demonstrates that it is possible to improve the outcome for adolescent development by directly meeting the adolescent’s attachment needs through the Theraplay model.     

Using Attachment Theory When Placing Siblings in Foster Care

Attachment theory offers a useful model for determining if siblings removed from their birth parent's home and awaiting placement should remain together or be separated when placed in foster care. The paper draws from the attachment theory literature, social work literature, and the author's experience as an outpatient psychotherapist. Using the concept of a secure attachment environment, this paper argues that siblings can potentially contribute to, or detract from, a secure attachment environment. When siblings are supportive of each other they can contribute to it. When the sibling relationships are chronically abusive, the individual siblings within a sibling-set are precluded from achieving a secure attachment environment. In these cases the need for separation of the siblings is indicated, and must be considered.     

Adolescent Violence—Strategies,Outcomes and Dilemmas in Working with Young People and their Families

MATTERS is a program of Berry Street, and has been in existence since 1990. The service is funded to address parent/adolescent conflict and the service delivery model has developed over time in a direction which incorporates family therapy and conflict resolution techniques. Many families come to the service seeking assistance for problems regarding violence, and increasingly around a young person's violence to parents and other family members. In some instances, violence has been present over a long period and has become normalised within the family's experience. When working with families who present with problems of adolescent violence, the service aims to find a pathway for the young person/family to confront violent behaviour and move to a different position about the meaning of violence in their lives. This paper describes the team's approach to working with adolescent violence, utilising ideas from narrative family therapy and psychodynamic theory, and incorporating issues of power in society, culture and gender. Outcomes, dilemmas and future directions are also discussed.     

Tell Me a Story: A Review of Narrative Assessments for Preschoolers

The use of narrative assessments in mental health research with young children has increased significantly over the last 15 years. This article reviews 13 empirically validated narrative assessments for preschool populations. The reviewed instruments assess children’s attachment relationships, moral values, separation anxiety, pro-social behavior, object relations and depression, among other constructs. The authors present an analysis of each instrument including a discussion of its methodological rigor, and point to needed directions in the field. These narrative assessment instruments provide researchers and clinicians with insight into the internal worlds of young children, offering windows into a difficult-to-assess population.     

Making sense of leaving care: The contribution of Bridges model of transition to understanding the psycho-social process

This paper is based on research into the transition of young people leaving public care in Romania. Using this specific country example, the paper aims to contribute to present understandings of the psycho-social transition of young people from care to independent living by introducing the use of Bridges (2002) to build on existing theories and literature. The research discussed involved mixed methods design and was implemented in three phases: semi-structured interviews with 34 care leavers, focus groups with 32 professionals, and a professional-service user working group. The overall findings confirmed that young people experience two different, but interconnected transitions - social and psychological - which take place at different paces. A number of theoretical perspectives are explored to make sense of this transition including attachment theory, focal theory and identity. In addition, a new model for understanding the complex process of transitions was adapted from Bridges (2002) to capture the clear complexity of transition which the findings demonstrated in terms of their psycho-social transition. The paper concludes with messages for leaving and after care services with an emphasis on managing the psycho-social transition from care to independent living.     

Attachment Perspective on Marital Dissolution and Relational Family Therapy

Divorce or dissolution of a long-term intimate relationship is an event on the continuum of an individual’s experience of attachment injury that is reawakened and played out again in this process. An attachment injury means the experience of rejection and betrayal of trust at a critical time of distress when one is in need of support. By means of the case study method, the article presents a case of a female client dealing with divorce. The history of traumatic relations through a lens of attachment theory is presented, along with divorce as the reawakening of an attachment injury and its processing in a relational family therapy model.     

Attachment and Self‐Efficacy in Career Search Activities: A Structural Model

The author integrated attachment theory with social cognitive career theory (SCCT) to examine how attachment styles influence the career search self‐efficacy activities of interviewing, networking, job searching, and personal exploration. Using an undergraduate sample (N = 275, 81% women), the author tested a structural model. Results indicated that anxious attachment style was negatively related to interviewing self‐efficacy, whereas avoidant attachment style was negatively related to networking, job searching, and personal exploration self‐efficacy. Theoretical implications based on these findings provide support for an integrative model of attachment theory with SCCT. Career counselors are encouraged to consider clients’ attachment styles when working with individuals who are searching for employment. To help address the limitations of the study, future researchers could test the applicability of the current model with a more diverse sample.     

Limits and Possibilities of the Postmodern Narrative Self

The task of theorising the self has been of little interest historically in systemic therapy, yet becomes more interesting in the postmodern turn to the narrative metaphor and social constructionist ideas. Within this frame, the self is theorised as relational, fluid, and existing in narrative. The ‘postmodern narrative self’ counters modernist assumptions of self as an autonomous and fixed ‘internal’ entity, and brings with it theory and practice possibilities. However, any theory also brings limits, and this paper explores the limits of the central ideas of the postmodern narrative self. Through questioning and discussion, an argument is made for holding a dialectic in our thinking about the relational and autonomous self, for acknow-ledging very real boundaries on the fluidity of self, and for thinking of narrative as one way of knowing self, rather than exclusively constituting the ‘being’ of self.     

Some Clinical Applications of Attachment Theory in Adult Psychotherapy

This paper discusses the usefulness of attachment theory in working with adults in psychotherapy. There are four classifications of attachment status in adults: secure attachment, and three types of insecure attachment: dismissing, preoccupied, and disorganized. These categories do not conform to standard diagnostic entities. I discuss examples of the three insecure attachment categories and the likely transference and countertransference configurations that may occur in each category. These categories provide an additional way for therapists to understand and to respond to the needs of their clients.     

Specific Cases,Techniques and Approaches; Narrative Behaviour Therapy? Integration in Practice1

This is a clinically‐oriented paper which seeks to describe the integration of narrative and cognitive‐behavioural approaches in working with children and adolescents. It is suggested that a CBT model can be augmented by typical narrative manoeuvres. For example, it is often helpful to relieve children as quickly as possible of the ‘problem‐saturated story’ with which they and their parents enter therapy. The narrative approach of ‘externalising the problem’ can achieve this within the first session, and helps the family to a) find a good working relationship with the therapist, b) clarify goals, and c) embrace the possibility of change. The use of CBT and narrative therapy in conjunction is illustrated by a case study of obsessive compulsive disorder in a young adolescent girl.