Attachment Theory
Introduction
Attachment is "[a] strong affectional tie that binds a person to an intimate companion and is characterized by affection and a desire to maintain proximity" (Sigelman & Rider, 2015, p. 587). Attachment theory was developed by John Bowlby and Mary Ainsworth, and it holds that "close emotional bonds such as parent-child attachments are biologically based and contribute to species survival" (Sigelman & Rider, 2015, p. 587).
Having an attachment figure is essential for healthy development. Several studies from the early twentieth century showed that children who did not have motherly affection -- generally because they were orphans -- suffered greatly in terms of their emotional, intellectual, and physical development (Karen, 1994, pp. 13-25). Some studies even found that these child had significantly higher mortality rates than other children (Karen, 1994, p. 19). Modern research has corroborated that children who lack an attachment figure "are especially at risk of suffering from delayed growth and delayed mortor, cognitive and social-emotional development" (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 12).
Although attachment is "most crucial during the early years of life, and although age and development increase a person's ability to gain comfort from internal, symbolic representations of attachment figures and feelings of self-efficacy," having attachment figures remains important throughout one's life, as is indicated by "adults' tendency to seek proximity and support when threatened or distressed" (Mikulincer & Shaver, 2012, p. 260). Unlike infants, adults have many methods for establishing contact with attachment figures, including by having mental representations of these figures. Studies have shown that having such mental representations "can increase a person's sense of security and allow him or her to continue pursuing other goals without having to interrupt them to engage in actual bids for proximity and protection" (Mikulincer & Shaver, 2012, p. 260).
Attachment Styles
Mary Ainsworth noticed that children have different attachment studies. A child's attachment style can be ascertained through a procedure Ainsworth devised known as the Strange Situation, which consists of the following episodes: (1) a mother and her baby enter an unfamiliar playroom, (2) the baby is allowed to explore the room, (3) a stranger enters the room, (4) the mother leaves the room, (5) the mother returns and the stranger leaves, (6) the mother again leaves, and after some time the stranger returns and tries to comfort the baby, and (7) the mother returns (Karen, 1994, p. 148). "During those reunion episodes the child shows how much it trusts the caregiver and how long it takes before the balance between exploration of the environment and focus on the praent or caregiver has been restored...Being separated twice from the caregiver in an unknown environment is stressful for children and prompts attachment behavior" (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 18).
Most of the babies initially explored the room and expressed some wariness when the stranger appeared. About half of the babies cried when the mother left the first time, and few of those were able to find comfort in the stranger. When the mother returned, most of the babies "greeted her by smiling, vocalizing, or crying," and half of them expressed desire for physical contact. When the mother left the second time, "the distress was usually very intense, with most of the babies crying, many of them so pitifully the episode had to be curtailed. When the stranger returned, she did not have much success in comforting the babies who [were] distressed." When the mother returned this time, most of the babies "greeted her in some way, often with intensified crying," and more than twice as many babies "achieved contact with mother within fifteen seconds of her return this time than in the previous reunion." Surprisingly, "almost half the babies also avoided the mother in some way during this episode, most prominently by turning away from her" (Karen, 1994, p. 149).
This procedure showed that children have one of three attachment styles.
- Securely attached children grow upset when their caregiver leaves them and stop playing and exploring. When the caregiver returns, "these children will openly show their feelings of distress" and immediately begin seeking "reassurance and comfort." But they soon resume playing and exploring, their "curiosity about the nice toys in the playroom" prevailing over "their longing for immediate proximity to the caregiver" (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 19).
- Avoidant children experience stress during the procedure, "as becomes apparent from their accelerated heartbeat, but they will not show this stress to the caregiver. When the caregiver returns, they seem to be engrossed in play and they seem to want to avoid being close to the caregiver. In the meantime, however, the child is actually watching their caregiver in an unobtrusive way, and after a while she/he may look for some contact and closeness, still not showing any negative emotions (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014 p. 19).
- Ambivalent/Anxious children "emphasize their negative emotions, for instance by crying loudly, and they continue to do so when the caregiver returns. They desperately try to get close to the caregiver and want to be picked up and to sit on their lap. But at the same time they seem to want to show the caregiver their disappoint in having been left alone in a strange situation full of unknown threats, even for a short time. They grab hold of the caregiver but at the same time push him or her away" (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 19).
Later research showed that some children displayed a fourth style, known as Disorganized Attachment. This type of child is "at times scared of the attachment figure, even though the attachment figure is, at the same time, their only source of protection and safety. This is an insoluble paradox that causes the child to behave in a disorganised way." Such children might display contradictory behavior -- e.g., approaching the caregiver and then backing away (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 21).
Attachment in Adulthood
John Bowlby believed that as one grows older their ties to their parents "gradually weaken" but their need for attachment figures remains essential (Karen, 1994, p. 382). The "secure base function" that originally resided with one's parents is "slowly shifted to other figures, eventually resting fully on one's mate" (Karen, 1994, p. 382). Without such attachment figures, Bowlby argued, an adult cannot thrive, as human thriving consists of being both self-reliant and when needed, being able to rely on someone else for help (Karen, 1994, p. 382).
Research has shown that attachment styles tend to persist into adulthood. Three longitudinal studies "found continuity in quality of attachment in 70-77 per cent of cases of children in diverse populations. A secure attachment relationship with a parent at age one predicted secure attachment representation in adolescence, 16 to 18 years later" (Van Rosmalen, Van IJzendoorn, & Bakermans-Kranenburg, 2014, p. 15). Hazan and Shaver (1987) argued that the major attachment styles translated into adult romantic relationships, with individuals from each of the three main attachment styles feeling the following:
- Secure individuals: "I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don't worry about being abandoned or about someone getting too close to me."
- Avoidant individuals: "I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, others want me to be more intimate than I feel comfortable being."
- Ambivalent/Anxious individuals: "I find that others are reluctant to get as close as I would like. I often worry that my partner doesn't really love me or won't want to stay with me. I want to get very close to my partner, and this sometimes scares people away." (p. 515)
These researchers found that 56 percent of respondents were secure, 24 percent avoidant, and 20 percent ambivalent/anxious, percentages which roughly corresponded with the attachment styles of infants (62 percent, 23 percent, 15 percent) (p. 521).
Adult attachment styles are now generally classified in dimensional, not categorical, terms, as it's believed that attachment styles "vary in degree rather than kind" (Farley, n.d.). Thus, one's attachment style can thus be said to be (1) Secure (Low Avoidance and Low Anxiety), (2) Fearful-Avoidant (High Avoidance and High Anxiety), (3) Preoccupied (Low Avoidance but High Anxiety), or (4) Dismissing-Avoidant (High Avoidance but Low Anxiety) (Farley, n.d.). One's attachment style can be measured by the Experiences in Close Relationships Inventory (Brennan, Clark, & Shaver, 1998).
The Importance of Secure Attachment
Wei, Paul, and Brent (2003) write that secure attachments serve as "important coping resources" for children. "Infants and young children who discover that their caregivers are relatively responsive to their cries of distress and bids to elicit comfort develop a growing sense of their own capacity to have important needs met through direct communication." These experiences "lead to internalized perceptions of oneself as capable of performing effective goal-directed behavior, perceptions of others as responsive and caring, and the belief that relationships are flexible and capable of being influenced." On the other hand, "infants who experience repeated failure to achieve desired outcomes in the attachment relationship are more likely to have representations of themselves as ineffective, others as unreliable, and relationships as unrewarding" (pp. 438-439).
Much research has shown that having a secure attachment early in life generally confers significant advantages in the years and decades that follow. The Minnesota Longitudinal Study of Risk and Adaptation tracked a group of mothers and their children for 28 years, beginning when the mothers were still pregnant. Sroufe and Siegel (2011) summarizes the study's more relevant findings:
Those with secure histories had a greater sense of self-agency, were better emotionally regulated, and had higher self-esteem than those with histories of anxious (insecure) attachment. In general, attachment predicted engagement in the preschool peer group, the capacity for close friendships in middle childhood, the ability to coordinate friendships and group functioning in adolescence, and the capacity to form trusting, nonhostile romantic relationships in adulthood. Those with secure histories were more socially competent and likelier to be peer leaders.
Sroufe and Siegel (2011) explain that secure children tend to have more successful interpersonal relationships because "early attachments create social expectations in children, and may incline them to see the present in terms of negative past experiences." The attachment history of insecurely attached children "can become a self-fulfilling prophesy as they behave toward new people in their lives—like peers or teachers—in ways that reproduce old, negative relationships.
Mikulincer and Shaver (2012) summarize additional research showing that adults with avoidant or anxious attachment styles experience more problems in their interpersonal relationships. Predictably, avoidant individuals are "relatively unlikely to encourage warm and affectionate exchanges" with intimates, and their "tendency to minimize interdependence makes them unlikely to attend carefully to others' verbal and nonverbal messages," which in turn hinders their ability to decode such messages (p. 262). Anxious individuals, on the other hand, "readily self-disclose their needs and wishes," but they are overly focused on "their own emotions, vulnerabilities, and unsatisfied attachment needs" and thus often fail to maintain "mutual satisfaction and happiness." Additionally, their "uncertain or negative self-views" cause them to often "dismiss or doubt others' expressions of positive feelings for them" (p. 262).
Wei, Paul, and Brent (2003) point out that securely attached individuals experience significantly less distress than those with insecure attachments. Studies have shown that "insecure adult attachment is related to negative affect; lower levels of emotional adjustment; depression, anxiety, and hostility; shame, anger, fear of negative evaluation, and pathological narcissism; and interpersonal problems and core relationship conflicts. In general, previous studies have shown that securely attached persons are significantly less anxious, depressed, and angry and have less interpersonal distress than those with either anxious or avoidant attachment" (p. 439).
Karen (1994) nicely states the importance that secure attachment plays throughout one's life, writing that young adults "continue to be aided by the secure base they have had at home. It gives them the strength to do the adult equivalent of exploration -- take risks, face challenges, be open to the new. In all likelihood, it also puts them in a better position to find a new attachment figure -- and thus a new secure base -- and to serve that role themselves" (p. 383). Karen goes on to write that those who lack this secure base struggle with "a profound and painful loneliness." Anxious individuals know this base exists and are "driven nuts" because they cannot attain it. Avoidant individuals disavow this belief. But both individuals are "haunted by a fear of loneliness, some form of separation anxiety, occasioned by panic attacks or depressions." It is for this reason, Karen concludes, that these types of individuals "seem prone to certain types of addiction," the anxious "becoming addicted to people, the avoidant to work, power, acquisition, achievement, or obsessive rituals" (p. 383).
Reactive Attachment Disorder (RAD)
The DSM-5 lists the following criteria for Reactive Attachment Disorder (RAD):
(A) A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by of the following: (1) The child rarely or minimally seeks comfort when distressed. (2) The child rarely or minimally responds to comfort when distressed.
(B) A persistent social and emotional disturbance characterized by at least two of the following: (1) Minimal social and emotional responsiveness to others. (2) Limited positive affect. (3) Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
(C) The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: (1) Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. (2) Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
(D) The care in Criterion C is presumed to be responsible for the disturbed behavior in Crition A.
(E) The crtieria are not met for autism spectrum disorder.
(F) The distrubance is evident before age 5 years.
(G) The child has a developmental age of at least 9 months. (American Psychiatric Association, 2013 pp. 265-266)
Responses of Caregivers and Therapists
Ainsworth rated four qualities of the mothers in the experiment: sensitivity, acceptance, cooperation, and emotional accessibility. Mothers of securely attached infants were found to score high in all of these qualities. In other words, these mothers "were significantly more responsible to their infants' signals, quicker to pick them up when they cried, inclined to hold them longer and with more apparent pleasure" (Karen, 1994, p. 155). The mothers of insecurely attached children "rated equally low on all four measurements, the main difference being that, while the mothers of the ambivalent children were often maddeningly unpredictable, the mothers of avoidant children were substantially more rejecting" (p. 155). Ainsworth also found that the children whose mothers "responded quickly and warmly to their babies' cries during the early months of life" tended to cry less when they were one year old; instead of crying, "these one-year-olds tended to use gestures, facial expressions, and vocalizations to get their mothers' attention" (p. 156).
Subsequent research has corroborated the finding that sensitive caregiving -- that is, a caregiver's "ability to perceive the infant's signals accurately, and the ability to repond to these signals promptly and appropriately" -- leads to secure attachment in children (Wolff & Ijzendoorn, 1997, p. 573).
Bakermans-Kranenburg, Van Ijzendoorn, and Juffer (2003) found that interventions exist which successfully increase parental sensitivity and thus infant attachment security.
These authors explain the therapy the families received as follows:
Therapy consisted of family-focused counseling addressing current behavioral and discipline issues, the child’s understanding of his history of neglect and abuse, and active intensive bonding of the child and parent through emotional catharsis and the use of holding. Holding therapy is described as "primarily done by the parent. This is used in an effort to allow a child to have nurturing from their caregiver...This technique is used in an across the lap nurturing cradling, as one would feed or hold an infant...All holding is done at the request and consent of the parent and child. We do not use any type of therapy that elicits painful responses from a child or causes them any physical discomfort."
"Pretest and posttest data on the Randolph Attachment Disorder Questionnaire (RADQ) and on the total score of the Child and Adolescent Functional Assessment Scale (CAFAS) show statistically significant improvement for the children who received therapy in this program as measured from the perspective of their adoptive mothers. Although the data in the study are limited in scope, based on the statistically significant outcomes, this program was successful in improving the permanency and wellbeing of the adopted children with attachment disorders who received services."
Sroufe and Siegel (2011) write that change can be difficult and emotional intimacy very difficult for some people, as they get "lost in familiar places" and "continually recreate their earliest patterns of interactions across the lifespan." Nonetheless, they write, "[e]arly experience influences later development, but it isn't fate," and therapists can "bring awareness to such patterns and then intentionally create new pathways for clients to take as they unlearn their long-established habits." Moreover, therapists can help such individuals
References
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Bakermans-Kranenburg, M. J., Van Ijzendoorn, M. H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological bulletin, 129(2), 195.
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Sroufe, A., & Siegel, D. (2011). The verdict is in: Fifty years of research has confirmed that the emotional quality of our earliest attachment relationships is central to our well-being as adults. Psychotherapy Networker, 35(2), 34.
Van Rosmalen, L., Van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2014). ABC + D of attachment theory. In P. Holmes & S. Farnfield (Eds.), The Routledge handbook of attachment: implications and interventions. New York: Routledge.
Sroufe, A., & Siegel, D. (2011). The verdict is in: Fifty years of research has confirmed that the emotional quality of our earliest attachment relationships is central to our well-being as adults. Psychotherapy Networker, 35(2), 34.
Van Rosmalen, L., Van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2014). ABC + D of attachment theory. In P. Holmes & S. Farnfield (Eds.), The Routledge handbook of attachment: implications and interventions. New York: Routledge.
Wei, M., Heppner, P. P., & Mallinckrodt, B. (2003). Perceived coping as a mediator between attachment and psychological distress: A structural equation modeling approach. Journal of Counseling Psychology, 50(4), 438.
Wimmer, J. S., Vonk, M. E., & Bordnick, P. (2009). A preliminary investigation of the effectiveness of attachment therapy for adopted children with reactive attachment disorder. Child and Adolescent Social Work Journal, 26(4), 351-360.
Wolff, M. S., & Ijzendoorn, M. H. (1997). Sensitivity and attachment: A meta‐analysis on parental antecedents of infant attachment. Child development, 68(4), 571-591.
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