Intimacy

Clinical, Cultural, Digital and Developmental Perspectives

Gurmeet Kanwal, Salman Akhtar, Gurmeet Kanwal, Salman Akhtar

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367085940
• eBook ISBN: 9780429662898
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Intimacy: Clinical, Cultural, Digital and Developmental Perspectives applies a contemporary, psychoanalytic lens to the many facets of intimacy between people, from romantic and sexual relationships, to friendliness, as well as the ways intimacy is mediated by new digital technologies.

Identifying commonalities and differences between a range of approaches, including Classical Freudian, attachment theory, and interpersonal theory, the book includes case studies that highlight how intimacy is framed in a variety of relationships. It examines the line between privacy and intimacy, as well as how intimacy changes at different stages of one's lifespan.

From the friends we have to the pets we own, or the faith we follow, a cross-cultural perspective ensures that intimacy is conceived of as a broad, essential element underlying all human relationships. The intimacy between analyst and analysand is also examined.

This far-reaching book will interest both practicing and training psychoanalysts and psychotherapists, as well as those in related disciplines.

The spectrum of intimacy

Chapter 2

Attachment and intimacy

April Fallon and Rama Rao Gogineni

Intimacy, love and compassion are overlapping and intertwined aspects of the human experience that develop through the lifespan. The ability and ease in giving and receiving these experiences enhances one’s quality of physical and social life or potentially destines one to loneliness, alienation and despair (Durkheim, Buss, Sennett, & Riley, 1897). The underpinnings of these capacities can be understood within the framework of the attachment and caregiving systems which have evolutionary foundations and are formed and reworked throughout a lifetime (Bowlby, 1969, 1973, 1980, 1988). In this chapter we focus on how attachment and caregiving affect the capacity and desire for intimacy in adults, weaving theory, research and clinical observation. We briefly review the origins of the attachment bonds and caregiving systems. We then highlight research and provide brief clinical examples that illustrate how differences in attachment affect the development of intimacy and relationships.

Constructs of intimacy, attachment and caregiving

Intimacy

While ‘intimacy’ came into use as a euphemism for sexual intercourse in the 1600s, its meaning has broadened in contemporary use (Online Etymology Dictionary, 2018; Random House, 2018). ‘Intimate’ refers to private and personal (Dictionary.com, 2018). The Latin, intimus, translates into the “inmost, profound most or very secret” (Wiktionary, 2018). We are most interested in it as it applies to the relational domain ‒ the close, familiar and usually affectionate or loving personal connection with another person. Intimacy may involve a mental, physical (including affectionate and sexual), social and/or emotional closeness. Intimate relationships encompass physical, emotional, social, intellectual, spiritual and recreational dimensions (Bochner, 2017). Adult intimacy involves the knowledge and acceptance of one’s private feelings and behaviors, the sharing of it truthfully with another and accepting of the other’s inner good and bad characteristics, conscious and unconscious. We explore how the capacity for intimacy is significantly influenced by the development of early attachment bonds. Cassidy (2001) has articulated four essential abilities required for intimacy that can be viewed as emerging from the primary caregiver’s sensitive care and the ensuing quality of attachment that the child develops – the ability to seek out care, the ability to give care, the ability to feel comfortable with an autonomous self and the ability to negotiate. These will be further elaborated upon after the constructs of attachment and caregiving are described.

Attachment theory

Proposed by Bowlby (1958) and empirically supported by Ainsworth (1967), attachment theory is ensconced in an ethological and Darwinian evolutionary framework. The essence of it proposes that infants have an inborn propensity to seek and develop a unique and enduring affectional bond in order to increase their chances of survival. To that end, the infant is equipped with an innate and developing repertoire of behaviors (e.g. crying, smiling) that are likely to provoke caregiving in a maternally sensitive adult (Bowlby, 1958).¹ These behaviors become increasingly sophisticated and interactive as the infant matures and the caregiver becomes more engaged and attuned to the child idiosyncrasies.² The child’s desire for proximity varies depending upon the child’s age, internal state (e.g. if sick or hungry) and the perceived environmental threats. Bowlby describes the attachment system as one of several biologically based regulatory behavioral systems that are in dynamic equilibrium to each other. These other systems mature over the course of development as well. The exploratory system allows the child to explore the world and increases survival. When the child experiences the maternal connection as providing both a safe haven and a ‘secure base’, the need for attachment behaviors is downregulated; play and exploration increase. The fear system, aroused by frightening environmental stimuli, increases survival and also activates attachment seeking and deactivates exploratory behaviors. The sociable or affiliative behavioral system promotes proximity to peers and fosters the development of social skills and other non-attachment affectional bonds. The sociability behavioral system is activated when the attachment and fear systems are not (Cassidy, 2016).

There is a preference for a principal attachment figure, most frequently the biological mother initially, which is referred to as ‘monotrophy’ (Bowlby, 1969).³ When separated involuntarily from the attachment figure, the child experiences distress and seeks proximity, security and comfort in that primary attachment (Bowlby, 1973, 1980). If the separation persists, the initial distress and protest become despair and finally detachment. The ontogeny of attachment bonds over the first four years of life have significant influence over the development of trust, emotion regulation, social skills, positive identity and quality of relationships throughout the lifespan (Marvin, Brittner, & Russell, 2016; Mikulincer & Shaver, 2016).⁴

Attachment bonds are co-constructed in the mother-child relationship. A child, with unique biological proclivities, and the attachment figure engage in a multitude of daily sensory, physical and verbal interactions which transform over the course of the preschool years. In normal development, the relationship proceeds from the necessity of physical proximity to the primary attachment to a more symbolic enduring “representation in the internal organization of the individual” (Ainsworth, 1989, p. 711). Bowlby referred to this internalized relationship as an ‘internal working model’ and outlines four stages of development. The first, which lasts from birth to approximately 3 months, entails the infant gazing, crying, grasping and smiling, with the mother returning loving gazes, touching, holding and sensitively meeting biological needs and required level of comfort. In the second phase, which ends at approximately 6–9 months, the child focuses increasingly more elaborate behaviors toward familiar caregivers with differentiated vocalizations, gestures and exploratory behavior (Ainsworth, 1967). The quality of attachment is affected by the “extent to which the mother has permitted clinging, and following, and all the behaviors associated with them” (Bowlby, 1958, p. 370). The next stage, from 6 to 9 months up to 18 months–2 years, involves the child’s increased locomotion and burgeoning cognitive development which allows for interactions to become symbolic. The key component ‒ a felt security ‒ is the child’s notion of where the attachment figures can be found if needed and how the child expects them to respond. Bowlby (1969) notes, “The mothers whose infants are more securely attached to them are mothers who respond to their babies’ signals promptly and appropriately, and who engage in much social interchange with them ‒ to the delight of each party” (p. 316). At the same time, there is increased fear and wariness toward unfamiliar people. Bowlby observed that a significant disruption of this bond between mother and child after one-year mark increases the possibility of long-term negative outcomes. Research on adoption confirms that those children adopted after their first year of life are more likely to suffer from reactive attachment disorders and increased insecure attachment styles, whereas those adopted before 1 year of age appear similar to the cohort of biological children.⁵ The child’s physical, cognitive and emotional growth allows for greater flexibility in how felt security is maintained. At this stage, the child develops more stable sociable, attachment, fear and exploratory behavioral systems and preferred strategies to manage attachment needs become more salient. In the final stage, from 18 months to 2 years and on, a goal-corrected partnership is achieved where both mother and child negotiate a mutual plan for proximity (Bowlby, 1969). The children recognize that others have thoughts that are distinct from theirs. The perceived availability of the primary attachment figure rather than physical connection is the central component in security experienced. Although the child’s temperament, biology and environmental circumstances are important, the quality and variations in attachment capacities are significantly influenced by the sensitivity and caregiving of the attachment figure(s) (Bowlby, 1973; Kobak, Zajac, & Madsen, 2016).

Early research by Ainsworth (1954, 1985) first observing families with infants and then later developing the strange situation procedure distinguished three specific strategies that toddlers used in dealing with separation and have come to represent types of attachment that children were observed to have: secure, avoidant and ambivalent attachment. How children interacted with parents during play and exploration, how they reacted to brief separations from and then reunion with the attachment figure, and how they respond to a stranger’s affiliative efforts differed among the three types. Securely attached children were distressed when their mothers left but were calmed by the mother’s return. These children were interested in their environment when the attachment figure was present. The avoidant group of children appeared relatively undisturbed when the mother left and did not reunite with her when she returned. The anxious ambivalent group was distressed when their mothers left. When their mothers returned they seemed to want comfort, but rejected bids by the mother to do so, continuing to express distress. These children are reluctant to explore their environment even when mother is present. Main and Solomon (1990) added a disorganized style where the child’s exhibited conflicting behaviors, alternating between approaching the mother and freezing upon reunion. The Adult Attachment Interview was developed as an alternative method with adults to mirror the strange situation for children (George, Kaplan, & Main, 1985). Adult memories of their primary attachment figures are evaluated for coherence and integration. To understand attachment in the child more fully, we introduce the complementary maternal caregiving system and discuss the relationship between caregiving and the child’s attachments.

The caregiving system

Attachment initially was conceptualized as the child’s connection to the primary caregiver (Bowlby, 1969). The caregiving behavioral system is the complementary response of the caregiver’s sensitivity and effectiveness in providing a safe haven (safety from danger, access to comfort for the distress) and a secure base (support for exploring the world and promoting the psychological and social growth) for the child. Ainsworth (1985) in her research with Baltimore and Ugandan mothers found that attachment figures who responded promptly and sensitively encouraged attachment security with their children. Meta-analyses have confirmed the link between maternal sensitivity, maternal attachment and child attachment security (DeWolff & Van Ijzendoorn, 1997; Van Ijzendoorn, 1995). Similarly, a meta-analysis of father sensitivity is modestly but significantly linked to child attachment (Lucassen et al., 2011).⁶ The intergenerational transmission of these relationships cannot be explained by genetics (Feeney & Woodhouse, 2016).⁷

In addition to consistency and responsivity, what aspects of caregiving are more specifically responsible for this link to child attachment? Reviewing the research, Solomon and George (2008) posit that coherence, balance and flexibility of the maternal caregiver impact attachment bonds. Children securely connected to their mothers are more likely to have representations of mothers who are flexible and coherent. In contrast, insecurely attached children have disparate, unintegrated and hostile representations of their mothers. Bowlby (1980) characterizes the underlying processes for these differences as a result of mothers’ unconscious methods of processing relational connections and related memories. These defenses are “an exclusion from further processing of information of certain specific types for relatively long periods or even permanently” (p. 45). There are three forms of exclusion: deactivation, cognitive disconnection and segregation (Bowlby, 1980; Solomon & George, 2008).

Mothers who use deactivation manage anxieties about safety and loss in the relationship by diminishing the importance of the relational connection, even when children are under 1 year of age. Although these mothers may be consistent, responsible and view themselves as caring, they often oversee their children from a psychological distance. For example, when a mother of a 2-month-old decided to return to work which involved much time away from home, she reasoned the father and grandmother could provide for the child in her absence. She planned elaborate schedules and made lists of tasks that needed to be done, yet seemed to have little thought about the child missing her or her missing the child. These mothers encourage early exploration and value the child’s accomplishments such as talking. Mothers who use this relational strategy extensively often have children with avoidant attachment style. When mothers use cognitive disconnection their affect and the events they experience are disconnected; neither is completely remembered or excluded. In contrast to mothers who use deactivation, these mothers provide close physical and psychological oversight and cannot separate themselves from their child’s psychological or physical discomforts.

They often express intense anxiety over the child’s safety and their lack of control over it and externalize their anger toward outsiders. Mothers who use this strategy extensively have children who are fearful of exploration and often have anxious ambivalent attachment styles. For example, a pediatrician referred a mother whose infant was dehydrated and emaciated. This seemed to be the result of mother producing very little milk, but refusing to give supplements, blaming the lactation consultants for not providing more assistance. Breast feeding was extremely important to her sense of competence as a mother. She did not recognize the danger that her child was in. She would also not allow the father or relatives to hold the infant or help care for the infant, afraid that they would drop the baby.

A use of ‘segregated defenses’ is the most pathological and often the result of a mother’s traumas that are either unconscious or conscious. These intrude into her thoughts and overwhelm her so that she cannot adequately attend to her baby’s needs, leaving the child vulnerable to a disorganized attachment and at risk for later more severe psychopathology (Solomon & George, 2008). Fraiberg et al. (1975) provide some excellent examples of these mothers.

Research on this topic has revealed two other prominent factors in the development of healthy attachments. The first is the caregiver’s ‘mind-mindedness’, which is the recognition that the child has a mind separate from the caregiver (Meins et al., 2012). Sensitively knowing the child deeply and respecting the child’s separateness provide a model for later empathic accuracy of another. Second, the primary caregiver’s avoidance of closeness (eye gaze, smiling, holding, cuddling, etc.) and a decreased display of emotions are linked to less sensitive and responsive caregiving. This early avoidance and lack of physical and emotional connection sets up a working model of adult relationships that lacks in intimate behaviors. Over the course of development, mothers and other caregivers are not perfect. Most children tolerate some parental insensitivity as long as major caregivers are not hostile or frightening and could reasonably manage the attachment-exploration balance. That is, major caregivers can be intrusive and insensitive as long as their intrusiveness does not activate the child’s attachment system (Feeney & Woodhouse, 2016). It has been shown that therapy and even brief interventions that improve parental sensitivity augment children’s attachment security (Bakermans-Kranenburg, Van Ijzendoorn, & Juffer, 2003).

Caregiving abilities are a function of having been cared for. Physical, emotional and instrumental support enhances psychological wellbeing by providing a safe environment when children are distressed (safe haven) and supporting their personal growth with a safety net to fall back upon (secure base). Effective caregiving determines the quality of the attachment bond between child and mother and impacts the child’s ability to become a future caregiver to progeny, as well as the capacity for romantic and other affectional bonds.

As Freud has suggested, psychic structures and behaviors likely have biological foundations. Nascent research in neurobiology has suggested that two neuro endocrine systems, oxytocinergic and dopaminergic, have been implicated in attachment and maternal caregiving. The former is important in the formation of social memories, affiliative behavior and emotional regulation (Diminich & Bonanno, 2014; Strathearn, 2011). The latter is involved in the reward system. There is new work (mostly in animal models) that suggests that the release of oxytocin, a neuropeptide by the posterior pituitary hormone, is implicated in the maternal bond.⁸ Toward the end of pregnancy, oxytocin has been found to increase and then surge after birth in new mothers. It aids the childbirth process and helps with nursing. In response to social cues, it also has been found to activate the dopaminergic reward system which may help explain the intense pleasure that mothers experience with their newborns. These two systems likely interconnect with the infant’s vocalization and tactile stimulation, releasing oxytocin which may result in the activation of the dopaminergic reward pathway. In addition, oxytocin appears to have long-term anxiolytic effects. Women who report emotional neglect in childhood have lower levels of oxytocin, and mothers who neglect their infants also appear to have lower indicators of oxytocin. Individuals with insecure and dismissing attachment have both a reduced activation of the dopamine reward system when viewing infant faces and decreased oxytocin in response to mother-infant contact (Strathearn, 2011). There is also a correlation between mother-infant oxytocin levels. Oxytocin also increases in fathers, but not until after birth. Thus it appears that oxytocin increases mothers’ and fathers’ caregiving behaviors which are rewarding and thus reinforcing. These in turn match the infant’s affiliative and pleasure neurobiological systems (Bretherton & Munholland, 2016). Caregiving impacts attachment and attachment then influences the next generation of caregiving. These systems are likely biologically primed and unfold differentially with critical environmental events.

Attachment from the cradle to the grave

Bowlby (1969) distinguishes attachment bonds from other social relationships with defining features of safe haven, proximity maintenance, separation distress and secure base. Affectional bonds are emotional connections to a specific person who does not necessarily provide protection, but satisfies humans’ needs for social connection. Initially all later relationships were viewed as affectional. However, in Bowlby’s (1988) later work, he suggested: “All of us, from the cradle t...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• About the editors and contributors
• Introduction
• Prologue
• The spectrum of intimacy
• Epilogue
• References
• Index