A Dynamic‐Maturational Model of Attachment

This article provides an overview of an attachment‐based approach to formulation of behavioural and psychiatric disorder. The dynamic‐maturational model (DMM) of attachment places many such problems within a context of family‐attachment relationships. In the DMM, neurological maturation interacting with experience is central to the self‐protective strategies that individuals develop to regulate familial attachments. When the relationships fail to protect child (or parent), more extreme strategies are organised to wrest some measure of safety and comfort from an otherwise threatening environment. A wide range of such strategies is described. It is argued that recognising attachment strategies in patients is crucial to providing helpful treatment (and to reducing the risk of inappropriate treatment).     

Esketamine for depression faces real‐world barriers

Like its predecessor intravenous ketamine, an anesthetic that has been used off‐label to treat depression, esketamine has shown great promise in treating a disease that can destroy quality of life and lead to suicide. The Food and Drug Administration (FDA) approved esketamine (Spravato) last spring for treating depression that is resistant to traditional treatments.     

African‐American Women and Suicide: A Review and Critique of the Literature

This paper reviews the literature on African‐American women’s suicide rates. This topic is often neglected due to African‐American women’s low rates of suicide occurrence. This review seeks to answer the call for increased scientific inquiry on matters related to African‐American women and suicide. The author begins by identifying complex dynamics surrounding African‐American women’s unique social position in order to establish a better understanding of how socio‐cultural influences are addressed in the literature in relation to the suicide paradox. Both theoretical and empirical studies are thoroughly assessed in order to identify the risk and protective factors exclusive to African‐American women. The literature concludes that a history of mental disorders, particularly depression, a history of physical and emotional abuse, and a history of alcohol and substance abuse have all proven significant in increasing the risk of suicidal behavior among African‐American women. Untreated depression continues to be the leading cause of suicide among African‐American women. Contrarily, the literature identifies religious/spiritual beliefs, strong social ties, low rates of suicide acceptability, and unique coping strategies developed as a result of longstanding oppressive conditions as primary reasons for African‐American women’s exceptionally low suicide rates.     

Culture and Suicide Acceptability: A Cross‐National,Multilevel Analysis

Cultural perspectives on suicidality have been largely marked by work explaining variability in suicide acceptability in the United States using structural variables including marital status and demographics, and limited symbolic or values orientations such as feminism, political liberalism, and civil liberties. The present article applies recent developments in comparative cultural sociology to the problem of suicidality. The central hypothesis is that cultural approval of suicide is related to a general cultural axis of nations (self‐expressionism) encompassing several values orientations such as tolerance and post‐materialism. Data are from Wave 4 of the World Values Surveys and refer to 53,275 individuals nested in 56 nations. Controls are incorporated from previous studies and include structural and demographic constructs. A hierarchical linear regression model determined that the degree of individual‐level adherence to the values of self‐expressionism predicted suicide acceptability (SA), independent of controls including ones interpretable from Durkheimian perspectives. Furthermore, persons high in individual‐level self‐expressionism nested in like‐minded nations were relatively high in SA. The analysis of the subject is expanded to 56 nations representing all major culture zones and varied levels of economic/political development. It determined that SA is shaped by a new, broad cultural construct, self‐expressionism whose impact is independent of Durkheimian familial and religious integration.     

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.     

Parent and Child Therapy (PACT) In Action: An Attachment‐Based Intervention for a Six‐Year‐Old With a Dual Diagnosis

This case study explores Parent and Child Therapy (PACT), an attachment‐based intervention for mothers and children experiencing intractable relationship distress originally developed by Heather Chambers (a Child Psychotherapist and Family Therapist working in New Zealand). We describe the use of PACT with a mother—child dyad presenting a history of severe abuse and neglect. The child had been diagnosed with Conduct Disorder and co‐morbid Attention Deficit Hyperactivity Disorder. We consider the themes arising in the therapy, the emotional process experienced by the mother and child, the initial outcome and 10‐month follow up. The case study indicates that PACT can be learned and used by practitioners outside of the team that conceptualised and developed it. The case highlights the links between externalising difficulties and attachment disorganisation and points to PACT as a promising treatment for the chronic sequelae of early interpersonal childhood trauma. The need for research and possible directions of this research are discussed.     

Chronic and Proximate Depression Among Mothers: Implications for Child Well‐Being

This article uses data from the Fragile Families and Child Well‐Being Survey (N = 2,427) to examine the association between the chronicity and timing of maternal depression and child well‐being. Maternal depression, particularly chronic depression, is linked to internalizing and externalizing problem behaviors in children, and children have worse behaviors when mothers report proximate depression. Children of depressed and nondepressed mothers have similar cognitive outcomes. Results also suggest that boys are more vulnerable to maternal depression than girls and that socioeconomic advantage does not buffer children from the consequences of maternal depression. Given that impairments in early childhood may place children on disadvantaged life‐course trajectories, early intervention and treatment of depressed mothers may help ameliorate social disparities.     

Attachment Styles and Self‐Image in Turkish Adolescents

The purpose of this article is to examine the attachment styles and the relation of these styles to the self‐image in Turkish adolescents. The study included 378 adolescents (196 females and 182 males) from high schools with different socioeconomic status (SES) who were administered Relationship Scale Questionnaires and Offer Self‐Image Questionnaires. The findings indicate that adolescents from a low SES had significantly low scores on self‐image scales compared with those from high and middle SES. It was found that secure attachment patterns affect social relationships and superior adjustment aspects of self‐image positively. The results of this study show that attachment patterns play an important role in the development of the self‐image, which is a crucial psychological structure gained in adolescence.     

Parent and Child Therapy: An Attachment‐Based Intervention for Children With Challenging Problems

Parent and Child Therapy (PACT) is an attachment‐based intervention for children aged between 4 and 12 years old experiencing emotional and behavioural problems. It is appropriate for distressed parent—child relationships which have not responded to systemic family therapy. PACT seeks to reframe parent—child relationship distress using narrative techniques and experiential tasks based on the concept of supported looking. Therapy occurs in parallel for parent and child using a one‐way screen. PACT improves parents' reflective capacity and sensitivity, and for the child's sense of security in her primary attachment relationship. An outline of the four stages of PACT is presented along with a case study to illustrate the course of PACT. Finally, we discuss the dissemination of PACT within a busy child and adolescent mental health service and outline our plans for future outcome evaluation.     

Changes in parenting behaviors, attachment, depressive symptoms, and suicidal ideation in attachment-based family therapy for depressive and suicidal adolescents

This study examined whether Attachment-Based Family Therapy (ABFT) was associated with decreases in maternal psychological control and increases in maternal psychological autonomy granting, and whether such changes were associated with changes in adolescents' attachment schema and psychological symptoms. Eighteen suicidal adolescents and their mothers received 12 weeks of ABFT. Maternal psychological control and autonomy granting behaviors were observationally coded at sessions 1 and 4. Adolescents' reports of perceived maternal care and control, attachment-related anxiety and avoidance, and depressive symptoms and suicidal ideation were collected at baseline, 6, 12 weeks (posttreatment), and 36 weeks. Results indicated that from session 1 to session 4, maternal psychological control decreased and maternal psychological autonomy granting increased. Increases in maternal autonomy granting were associated with increases in adolescents' perceived parental care from pre to mid-treatment and decreases in attachment-related anxiety and avoidance from pre to 3 months posttreatment. Finally, decreases in adolescents' perceived parental control during the treatment were associated with reductions in adolescents' depressive symptoms from pretreatment to 12 weeks posttreatment. This is the first study examining the putative change mechanisms in ABFT.     

Attachment-based family therapy: adherence and differentiation

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy (MDFT) and cognitive-behavioral therapy (CBT). Results indicate that ABFT therapists employed essential ABFT interventions, such as focusing on vulnerable affect, highlighting attachment-related themes, and promoting adolescent-parent reattachment through in-session enactments. In accordance with the sequential nature of the treatment, these interventions were used more extensively during the early stage of treatment, when there is a greater focus on reattachment. ABFT was perfectly discriminable from CBT, with ABFT therapists using more restructuring and reattachment interventions and CBT therapists using more signature CBT interventions, such as cognitive monitoring and homework. ABFT was also discriminable from MDFT, with ABFT therapists placing a greater emphasis on reattachment. These results suggest that ABFT is a viable and differentiated treatment. Together with prior findings supporting its efficacy, ABFT should be considered a promising new approach for working with depressed adolescents and their families.     

The Effects of Parent‐Adolescent Relationships and Parental Separation on Adolescent Well‐Being

This article uses data from the National Longitudinal Study of Adolescent Health (Add Health) to investigate the short‐term effects of parental separation on adolescent delinquency and depression. Findings indicate that parent‐adolescent relationships prior to marital dissolution moderate the effects of parental separation on adolescent delinquency. The higher adolescents' satisfaction with their relationship with the same‐sex parent prior to residential separation the greater their increases in delinquent behavior when they are separated from this parent at Wave 2. These results highlight the importance of interpersonal relationships within the family prior to parental separation. Opposite‐sex parents constitute a significant influence on adolescents' depression regardless of family structure. These findings suggest that research on parental influences on children's well‐being needs to pay more attention to gender‐specific effects.     

Changes in Relationship‐Specific Attachment in Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT; Johnson, The practice of emotionally focused couple therapy (1st/2nd edition). Brunner‐Routledge, New York, 2004) is an effective treatment of relationship distress (Johnson et al., Clinical Psychology: Science and Practice, 1999; 6, 67). However, less is known about EFT's impact on couples' relationship‐specific attachment bond. Using hierarchical linear modeling with a sample of 32 couples, we examined session‐by‐session changes in couples' relationship‐specific attachment anxiety and avoidance and pre‐ to posttherapy changes in their relationship‐specific attachment behaviors. Couples significantly decreased in relationship‐specific attachment avoidance, and those who completed a blamer softening significantly decreased in relationship‐specific attachment anxiety. Couples' attachment behavior significantly increased toward security. Finally, session‐by‐session decreases in relationship‐specific attachment anxiety and avoidance were significant associated with increases in relationship satisfaction across sessions. These results provide empirical support for the attachment‐based assumptions of EFT. Video abstract accessible by clicking here     

From Scared to Repaired: Using an Attachment‐Based Perspective to Understand Situational Couple Violence

Situational couple violence (SCV) is a common problem in couples presenting for therapy. SCV, as seen through the lens of attachment, can be viewed as a result of an insecure attachment system within the couple. Although several authors have discussed individual attachment styles as predictors of both the receipt and perpetration of violence, in this article we seek to portray the attachment system as a relational and changing construct. As such, we argue for conjoint treatment for SCV as a way to restructure a more secure attachment system within the couple. Cautions for the appropriateness of couples counseling with ongoing violence are included. Finally, we discuss the use of an attachment‐based safety plan and time‐out strategy to use with couples experiencing SCV.     

Maternal Depression and the Ability to Facilitate Joint Attention With 18‐Month‐Olds

Maternal depression has been associated with the mother‐child dyad's ability to engage in joint attention. This study of 69 depressed and 63 control mothers and their 18‐month‐olds addresses how aspects of maternal psychopathology are related to joint attention during a snack interaction. Although nondepressed‐mother dyads appeared better at joint attention than depressed‐mother dyads, this difference was not statistically significant. Among the depressed‐mother dyads, joint attention was related to presence of a comorbid Axis I diagnosis (usually an anxiety disorder) versus a diagnosis of major depressive disorder (MDD) only. Surprisingly, dyads with mothers who met criteria for a comorbid diagnosis were better at joint attention than those with MDD only, despite the fact that those mothers were likely to have longer and more severe depressive histories. The relationship between comorbid status and joint attention was mediated by the mother's affect. Rationale for the paradoxical finding that the “more pathological” mothers had greater success in engaging in joint attention is discussed.     

Individual Differences in Infants’ Joint Attention Behaviors With Mother and a New Social Partner

Relations between infant–mother attachment security at 15 months and infants’ (N = 206) joint attention behaviors (a) with an experimenter at 8 and 15 months, and (b) with their mothers at 15 months were investigated. No concurrent or longitudinal relations were observed between attachment security and infants’ tendency to respond to an experimenter’s bids for joint attention. Higher levels of initiating joint attention with an experimenter at 15 months were associated with insecure‐avoidant attachment. Insecure‐avoidant attachment was also associated with lower scores for initiating high‐level joint attention behaviors (pointing, showing, and giving) with the mother at age 15 months. The fact that security‐related differences in initiating joint attention with an experimenter were observed only once the attachment relationship was consolidated suggests that (a) attachment security may influence infants’ active engagement with new social partners, and (b) insecure‐avoidant infants may compensate for reduced social contact with the caregiver by initiating more interaction with other social partners.     

Attachment and Risk of Future Harm: A Case of Non‐Accidental Brain Injury

Decision making in cases of non‐accidental brain injury is complex. Courts often view ‘alternate care’ as a means of ensuring that children are protected from further physical abuse. It is important for treating and assessing clinicians to present the court with a broad systems perspective highlighting the multiple factors which combine to impact on the child's future safety, welfare and wellbeing. These include risk and protective factors in the family of origin, the family's openness to monitoring and treatment; the child's needs for long‐term attachment relationships, and the risks associated with alternate care. This article highlights the need to consider long‐term attachment needs as part of any risk‐of‐harm assessment for young children who have been maltreated. Attachment issues are considered in the case of Nellie, a 17‐month‐old toddler with a serious and unexplained non‐accidental brain injury.     

Self‐Destructive Symptomatic Frames in Clinical Adolescents: Is the Same Different?

This study examines individual and family predictors of different self‐destructive patterns—only suicidal ideation, only nonsuicidal self‐injury (NSSI), or suicide attempts (that may also include both suicide ideation (SI) and NSSI)—in a sample of outpatient adolescents (N = 42; 86% females) with mean age of 16 years (SD = 1.86). Results indicated that there are differences in youngsters with self‐destructive behaviors in their perception of paternal rejection and maternal control, when compared with youngsters reporting only SI. Adolescents from the groups with self‐destructive behaviors differ only in age. Together, these data highlight the relevance of adopting an ecosystemic perspective, which includes both the patients and their families, regarding treatment and prevention of self‐destructive symptomatic frames.     

Suicide among elderly white men: development of a profile.

1. Older white men have the highest suicide rate in the nation; a linear increase of suicide occurs with each passing year of chronological age. 2. Elderly who attempt suicide are more likely to communicate their intentions less frequently and to use violent and lethal means. 3. Chronic sleep problems, pain, degenerative illness, or clinical depression may be experienced by older white men at suicidal risk; somatic complaints including imaginary symptoms can mask depression. 4. Educational programs, outreach mental health programs, and enhanced consultation/coordination improve case findings and early intervention. Holistic nursing care, including pain alleviation, depression assessment, and simple comfort measures, are imperative in suicide prevention in the elderly.