Associations Among Attachment Style,Burnout, and Compassion Fatigue in Health and Human Service Workers: A Systematic Review

Health and human service workers are at risk for developing burnout or compassion fatigue due to the demanding nature of their work. Attachment theory makes specific predictions that may help explain why some workers experience burnout or compassion fatigue and others do not. The purpose of this systematic review is to identify and attempt to explain patterns and inconsistencies in results across studies that have examined the association between adult attachment style and burnout or compassion fatigue. Ten studies representing a diverse range of disciplines within the health and human service sectors were included in the research synthesis. The findings demonstrated consistent results for secure and anxious attachment, suggesting that attachment security is associated with lower levels of burnout, whereas attachment anxiety is associated with higher levels of burnout. Some studies found an association between avoidant attachment and burnout, whereas others did not. The results are discussed in terms of their implications for the selection, training, and supervision of health and human service workers.     

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.     

Adult Exploration of Attachment Interview in Family Therapy

The Adult Exploration of Attachment Interview (AEAI) is a therapeutic interview developed by the author to assist adults to understand themselves and their relationships with others, especially with a partner, co‐parent and/or children. It is suitable for individuals and couples struggling to overcome repeated patterns of relating, helping to improve their intimate or parenting relationships through greater self and other understanding. The AEAI explores an adult's early relational learning, especially in regard to attachment needs, in order to allow change. The interview uses specific externalising language to help persons tolerate difficult memories, reduce guilt and shame and integrate their thoughts and feelings. It applies key implications of attachment theory and the approach is illustrated by examples from therapy.     

The Pet Connection: An Attachment Perspective

Using the ethological-evolutionary framework of attachment, and including how the theory has been updated and expanded by findings from attachment-based research, neuroscience and animal studies, this paper proposes that a relationship with a family pet, especially a dog or cat, reflects certain dynamics of attachment which may account for the sense of comfort and connection they provide to individuals at all stages of the life cycle. There is now convincing scientific evidence that companion animals have positive effects on psychological and physical well-being, helping shape how people regulate their emotions, deal with stress or trauma, and relate to others. Discussion considers the implications of these benefits for social work, in particular for policy, prevention, and psychotherapy. An illustration of treatment for pet loss, as well as a framework for promoting attachment in pets adopted from rescue shelters, is also presented. It is recommended that both social work professionals and social work students be educated about the human-animal bond and the significance of pets to so many of our clients.     

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.     

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.     

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.     

Clinical implications of attachment narratives

This paper discusses attachment theory and research with emphasis on the empirical studies of Many Main. Main's work emphasizes the relationship between an individual's narrative regarding attachment relationships and their underlying internal working model of attachment. The internal working model of attachment is a representation of attachment experience and a set of rules for processing attachment experience. This paper describes various categories of attachment narrative construction and presents a case history that is discussed from an attachment theory perspective.     

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.     

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.     

Assessing interpersonal fusion: reliability and validity of a new DSI fusion with others subscale

The Differentiation of Self Inventory (DSI) is a multidimensional measure of differentiation consisting of four subscales focusing on adults (ages 25+), and their significant relationships, including current relationships with family of origin. Although the DSI full scale and three of its subscales are theoretically and psychometrically sound, the Fusion with Others (FO) subscale is lacking. Therefore, responses of 225 adults were used to revise the FO subscale. Results yielded a 12-item, revised FO subscale with improved internal consistency reliability and construct validity. Greater fusion with others was associated with greater spousal fusion and dimensions of adult attachment insecurity. Implications for Bowen theory and suggestions for future research with the DSI-R are discussed.     

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.     

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 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.     

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.     

Preface to the Special Issue on Child and Adolescent Attachment

The implications of John Bowlby’s attachment theory resound through the mental health community. While we know now that much of what Bowlby posited was true, we are still discovering the value of such findings for our clinical work with children and adolescents. Our special issue in Clinical Social Work Journal explores how attachment theory is being used in clinical settings throughout the country. It presents articles relevant to work with infants and toddlers, children and adolescents and families. How can we translate what we know about attachment theory and research into practice? Our special issue authors have attempted to answer this question.     

Child sexual abuse and attachment theory:are we rushing headlong into another controversy?

The child sexual abuse knowledge base has developed within a highly charged political and social context. As such, early theories of sexual abuse were susceptible to biases that reflected the larger sociocultural context. The purpose of this paper is to consider whether attachment theory as it is applied to child sexual abuse might also be susceptible to such biases. Although this paper concludes that attachment theory can potentially add an important dimension to the conceptualization of child sexual abuse and its dynamics, it is also suggested that attachment theory may remain at risk for becoming a vehicle for transmitting political and ideological agendas.     

Single Mothers “Do” Family

This paper explores how single mothers both incorporate others into family life (e.g., when they ask others to care for their children) and simultaneously “do families” in a manner that holds out a vision of a “traditional” family structure. Drawing on research with White, rural single mothers, the author explores the manner in which these women both endorse their children’s attachment to other caregivers and maintain boundaries around issues of discipline and attachment vis‐à‐vis these others. The author demonstrates that single mothers are willing to share this protected realm of family life with a new man (a fiancé or cohabiting boyfriend) as they pursue the goal of what has been called the “Standard North American Family.”