Using attachment theory to understand the treatment of adult depression

John Bowlby developed attachment theory to explain connections between infant and caregiver behavior and how these impacted children’s behavior. Extended and researched heavily in a variety of contexts, attachment theory has advanced clinical thinking over time. Its core ideas regarding infant and caregiver connections are very useful to mental health practitioners today and have particular ramifications for clinical work with adults. This paper discusses the application of Bowlby’s attachment theory to the clinical treatment of adult depression and explores a relevant case example.     

The Attachment Partnership as Conceptual Base for Exploring the Impact of Child Maltreatment

According to attachment theory children learn the critical importance of trusting others and valuing oneself through communication with an attachment figure about separations and other threats to the child's sense of security (Bowlby, 1982). Lessons learned in the attachment partnership (Marvin, 1977; Ainsworth, 1992) about perceiving a relationship partner's point of view, and communicating emotional experience, are generalized to social relationships outside the home. Maltreatment is likely to harm children's emotional and social development through impairment of these key social skills. Relevant literature from attachment theory and research, including research on child maltreatment from an attachment perspective, is reviewed. Implications and directions for clinical intervention are discussed.     

Adolescents' Perceptions of Family Belonging in Stepfamilies

Prior research has established that adolescents' perceptions of family belonging are associated with a range of well‐being indicators and that adolescents in stepfamilies report lower levels of family belonging than adolescents in two‐biological‐parent families. Yet, we know little regarding what factors are associated with adolescents' perceptions of family belonging in stepfamilies. Guided by family systems theory, the authors addressed this issue by using nationally representative data (Add Health) to examine the associations between family characteristics and adolescents' perceptions of family belonging in stepfather families (N = 2,085). Results from structural equation models revealed that both the perceived quality of the stepfather–adolescent relationship and in particular the perceived quality of the mother–adolescent relationship were the factors most strongly associated with feelings of family belonging.     

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.     

Anxiety in Adolescence: The Integration of Attachment and Neurobiological Research into Clinical Practice

Attachment theory illuminates aspects of adolescent development and points to critical treatment directions for adolescents. Recent neurobiological research illustrates the importance of integrating physiological understanding into clinical work. The application of attachment theory and neurobiology to treatment is illustrated best through the case example of one adolescent with panic disorder treated in an outpatient setting.     

South African social workers' knowledge of attachment theory and their perceptions of attachment relationships in foster care supervision

Despite the prominence of attachment theory in international foster care literature and the importance of attachment relationships in successful foster care, attachment theory and practices do not feature prominently in South African foster care research. Against this backdrop, we interviewed twenty South African social workers' about their knowledge of attachment theory and their perceptions of attachment relationships in their own foster care work. Thematic analysis was used to analyse the interviews. We found that the social workers had limited knowledge of attachment theory and interventions; experienced most biological parents as unmotivated to improve their circumstances and attachment relationships with children; indicated that family reunifications were rare occurrences; reported foster parents were mostly kin; and experienced constraining contextual factors that hindered optimal consideration of attachment relationships in foster care supervision.     

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).     

Patterns of Nonverbal Behavior and Sensivity in the Context of Attachment Relations

Nonverbal behavior and sensitivity to a relationship partner’s nonverbal behavior importantly influence the quality of interpersonal interactions and relationships, including attachment relationships. The abilities to encode, or express, and to decode, or understand, nonverbal cues are crucial to effective communication of emotions and are associated with social adjustment and relationship satisfaction. One important social context for the development and use of nonverbal encodingand decoding abilities is what Bowlby (1969/1982, Attachment and loss: Vol.1.Attachment (2nd ed.). New York: Basic Books) called attachment relationships—interpersonal relationships in which one person’s emotional security depends on another person’s sensitive, responsive caregiving and support. In this paper, we present theoretical ideas, review relevant research, and propose new avenues of research dealing with associations between attachment-related processes and patterns of nonverbal behavior and sensitivity in adulthood, two domains of research that have not previously been adequately connected.     

An Attachment Primer for Couple Therapists: Research and Clinical Implications

According to attachment theory, humans are relational beings and even a child's earliest experiences with caregivers have a profound effect on emotional development and an overall approach to relationships. With increasing regularity, couple therapy has utilized attachment language as a conceptual tool, but more work is needed to understand the full clinical implications of attachment theory. These include understanding the intergenerational nature of attachment and adapting the delivery, timing, and pace of interventions to client attachment strategies. In this article, we summarize the origins of attachment theory, its measurement, the role of attachment in couple relationships, attachment stability and change, and ways that attachment informs therapy process and intervention. We hope that this article will provide an impetus for couple therapists to expand their conceptualization and use of attachment in their clinical work and for couple researchers to conduct more clinically relevant, attachment‐oriented process research.     

“Parenting Is Not a Job … It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children

Parents of gender non-conforming children encounter substantial conflict as they negotiate their children’s “Otherness.” For decades, a pathologizing service model has advocated clinical correction. In opposition, some parents adopt affirming stances toward their children. This study explored the knowledge underneath this stance, asking parents of gender non-conforming children how they know what they know. Analysis revealed a process of recognition and knowledge of the children’s needs acquired through relationship. Drawing on political philosophy and psychoanalytic theory, I argue that the affirming approach to gender non-conforming children is a non-aggressive response to the “Other” and a justice-based parenting practice.     

Separation anxiety,attachment and agoraphobia

Within a framework of attachment, developed by John Bowlby, the anxiety disorder of agoraphobia (fear of leaving familiar surroundings, especially when alone) is conceived as a condition of anxious attachment, related to fear of separation from those with whom one has formed affectional bonds. Bowlby attributes this anxiety to earlier separation or loss experiences or threat of separation. Uncertain about his/her attachment figures, the person is prone to separation anxiety and clinging behavior and lacks confidence for exploring the world and dealing with stressful situations. Psychotherapy offers a temporary attachment relationship, a secure base from which to explore and understand the effects of these experiences in order to develop more self reliance in relationships with others.     

A Piagetian approach to social work practice with children and adolescents

While the field of social work is heavily committed to the treatment of children and adolescents with behavior problems, it has given little attention to the application of Piaget's egocentrism theory to these problems. This paper outlines the theory proposed by Piaget and reviews subsequent empirical validation and clinical applications of his theory. The role of social work in developing more sophisticated applications of Piaget's theory is discussed.     

Bonding and attachment of Australian Aboriginal children

In New South Wales, Australia, there is an increasing emphasis in the children's court on bonding and attachment assessments to determine whether or not a child remains with their carers. Aboriginal children and young people are over nine times more likely than other children and young people to be in out‐of‐home care. There is a paucity of information on culturally appropriate assessments of Aboriginal children in relation to bonding and attachment. Most assessments on the Australian indigenous families are based on the dominant Australian community's perception of what constitutes competent parenting. The question arises as to whether we are making psychologically and ethically sound decisions about whether or not a child remains with their Aboriginal carers based on evidence that is culturally appropriate for Western families but culturally inappropriate for the indigenous families. It is argued that the core hypotheses of attachment theory such as caregiver sensitivity, competence and secure base have to be based on the Australian Aboriginal people's cultural values. The aims of this paper are to explore the current practice on the bonding and attachment assessment of Aboriginal children using a dynamic eco‐systemic approach in the assessment of bonding and attachment of the indigenous people, with an emphasis on the historical, cultural and spiritual contexts. Copyright © 2003 John Wiley & Sons, Ltd.     

Review of Attachment Theory: Familial Predictors,Continuity and Change,and Intrapersonal and Relational Outcomes

Initially, the major focus of attachment theory was the parent–child relationship, but Bowlby (1988 Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routeledge. [Google Scholar]) also described the attachment system as active over the entire life course. Accordingly, a proliferation of research on attachment theory in the past two decades has addressed an array of familial predictors as well as intrapersonal and relational outcomes of attachment. The purpose of this review is to present: 1) measurement of attachment, 2) family violence, parental depression, and parental divorce as predictors of attachment, 3) (in)stability of attachment over time, 4) impact of attachment on emotion regulation and psychopathology, and 5) influence of attachment on romantic relationship. Special attention is paid to the role of attachment as a mediator between family of origin experiences and outcomes among youth and adults.     

Implications of the Literature on Equine-Assisted Activities for Use as a Complementary Intervention in Social Work Practice with Children and Adolescents

This article reviews the literature investigating psychosocial benefits of equine-assisted activities (EAA) for children and adolescents with physical, mental, and family challenges. It further analyzes implications for clinical social work practice in the use of EAA as complementary or adjunct interventions with these populations, thus addressing a gap in the literature on population-specific outcomes of EAA. As a contribution to methodology in future research, the conceptual analysis suggests that concurrent examination of complementary interventions across categories of special needs could add to the knowledge base concerning these children’s psychosocial status. Cross-domain investigations could also assess the contribution of each challenge to the status of children with multiple conditions.     

Introduction to the special issue: Sociology and feminist scholarship

Feminist writers in the seventies angrily criticized the work of male academicians, arguing that what scholarship presented as the norm was in fact white male experience. That critique generated a body of interdisciplinary theory and scholarship. This introduction examines what feminist sociologists mean when they talk about feminist theory—how they use the interdisciplinary theories, and how they apply a feminist methodological stance to generate feminist theory within sociology. It provides a context for understanding the articles that follow in this special issue as examples of feminist research in sociology and as statements of some of the current issues and as problems of concern to feminists in sociology. She is interested in gender, culture, religion and feminist theory. She wroteCharisma and Community: A Study of Religious Commitment within the Catholic Charismatic Renewal and is currently studying witchcraft traditions and the communities that support them.     

Harnessing the Power of Play in Emotionally Focused Family Therapy With Preschool Children

Emotionally focused family therapy (EFFT) is an attachment‐based therapy model that has been used with older children and adolescents. More recently, it has been suggested for use with young children. EFFT holds promise as a clinical treatment for young children coping with attachment problems, but more detailed guidelines are needed for implementing the model with this age‐group. Whereas preschool and kindergarten age children are less able to participate in talk therapy than older children, accommodations need to be made to this approach when the identified patient is a young child. This article offers a variety of play therapy activities that may be incorporated within an EFFT framework to strengthen the emotional bonds in families with children ages four to six.     

The Meaning of Crying Based on Attachment Theory

Crying is inborn attachment behavior which, according to attachment theorists John Bowlby and Margaret Ainsworth, is primarily an appeal for the protective presence of a parent. Infant crying triggers corresponding caretaking behavior in the parents. These reciprocal behaviors help establish and maintain the parent-child attachment bond. Crying continues throughout life to be a reaction to separation and loss, to carry an attachment message, and to trigger caretaking responses. Crying can be classified according to the stage of the grieving process to which it corresponds: protest or despair. The absence of crying when it would be expected or appropriate corresponds to an unresolved grief reaction representing detachment. Each type of crying and noncrying elicits different caretaking responses with interpersonal, clinical, and cultural implications.