The Challenge of Attachment for Caregiving

Dorothy Heard, Brian Lake

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429920264
• Subtopic: Developmental Psychology
• Index: Psychology

The Challenge of Attachment for Caregiving describes a theoretical model for the development of caregiving that complements and also extends attachment theory. The model highlights the conditions under which adult caregivers can remain in a state of arrested development, impairing their own ability to give care and resulting in attachment problems for those who seek care from them. It shows how insecure attachment in childhood and adolescence impedes the development of caregiving and how, in times of crisis, even securely attached individuals need appropriate support in order to sustain their capacity to give effective care. Constructing a systemic model of the self, the authors place the instinctive systems for caregiving and careseeking (attachment) within a theory that relates them to other systems of the self, such as the systems for sharing interests, sexuality and for self-defence. The model describes the interplay between these goal-corrected behavioural systems. Because it includes the defensive mechanisms and strategies which an individual values most, it is particularly helpful to the therapist in understanding the interpersonal processes between people who are seeking to influence each other's behaviour. It is presented in a form that enables the therapist to formulate hypotheses about a client's predicament and their way of relating to the therapist and then explore and test these hypotheses in the course of therapy. Drawing on many years' experience as clinicians and researchers, Dorothy Heard and Brian Lake explore in depth an aspect of human development which has profound implications for our future survival. Presenting its own challenge to both theory and practice, this book offers students and practitioners a new perspective on attachment.

Part I
The conceptual base for a theory of companionable caregiving

Chapter 1
A caregiving focus to an extension of attachment theory

This book is written by practising psychoanalytic psychotherapists with a background in medicine and psychiatry. We are writing for members of the caregiving professions who are interested in exploring the nature of caregiving and the circumstances in which it appears to succeed or fail. It is interesting that among the range of theories centred on the development of human beings and ‘the self’, the capacity for caregiving has been taken as implicit and until recently has attracted little attention in its own right.

Most therapists are aware that the predicaments brought by patients or clients are often centred on failures of parental caregiving. They are also aware that parents are often ineffective caregivers because their own upbringing had not encouraged the development of caregiving abilities. In the relative paucity of theoretical explanations of how the capacity to give care develops, we have put forward a theoretical model of caregiving that is based on Bowlby’s model for instinctive behaviour and is complementary to his model of attachment and attachment behaviour. It draws into one theoretical frame a number of recognised clinical and empirical findings that have a crucial bearing on the development of the capacity to give effective care, to which the phenomenon of attachment in the form of careseeking is a major challenge.

After surveying recent literature on interpersonal phenomena, we continue to hold the view already set out (Heard and Lake 1986) that Bowlby’s (1982) theoretical model of instinctive behaviour, of which caregiving is a component, is the most solid theoretical foundation available for understanding how the relationship a child has with his parents can affect his well-being and the unfolding of his developing sense of self. Bowlby’s attachment theory of careseeking matched by caregiving has relevance for many species and has generated a flood of research, although his model for instinctive behaviour (Bowlby 1982) has remained virtually unused by therapists, despite it being a response to Freud’s (1925a) lament that no adequate theory of instincts existed.

Although Bowlby’s model is primarily focused on attachment, it can readily be adapted to explain other aspects of instinctive behaviour. We use it as a foundation on which to construct a theoretical model with a range of psycho-biological systems whose functions enable individuals, within definable environmental limitations, to survive with a range of competencies that enable them to enjoy interests and friendships and to rear children who can in their turn become effective parents.

Bowlby’s Model For Instinctive Behaviour

Bowlby’s model for instinctive behaviour was influenced by psychoanalytic object relations theory, ethological concepts, general systems theory, and control and information theory. He presented a view of psycho-biological systems that defines their functions and their goals. An important part of his theoretical statement is that an individual is motivated by the activation of one or more of his instinctive behavioural systems to reach its goal, when the behaviour is terminated and the motivation is switched off. Many instinctive systems undergo developmental processes that lead them from simple to more complex forms. They are all activated in specifiable circumstances and they revert to a state of quiescence once the goal of the system (which is distinguished from its function) has been reached.

Instinctive Behaviour Within Relationships

Bowlby brought relationships into his model for instinctive behaviour with the idea that behavioural systems can be complementary. By this he meant that an individual whose attachment (careseeking) system has been activated is unable to reach the goal of receiving care without the co-operation of a caregiver, and vice versa. When the caregiver fulfils the current needs of the careseeker, both partners feel satisfied, the goals of their respective systems having been reached. At that point the careseeking system of one and the care-giving system of the other become quiescent.

By introducing the concept of complementary goal-corrected systems, Bowlby implicitly brought into his model the idea ·that some behavioural systems have goals that we make explicit by referring to them as either interindividual, interpersonal or interdependent. Reaching these goals can be seen as a social act. These systems stand in contrast to other systems whose goals can be described as intra-individual, intrapersonal or independent, that is to say, they can be reached without the help of another person and are associated with personal (individual) competencies rather than those that are social. Both kinds of system are present in our model of a systemic dynamic caregiving self. To avoid discussing whether non-human primates can be described as having a self, we use the terms interpersonal and intrapersonal only when talking about human beings and the human self. We use the terms inter and intra-individual when discussing these systems as they are shared by human and non-human primates. We like the term interdependent goal for systems with complementary goals, but think that its opposite, independent, can give a false impression of being able to do without other people.

To return to interindividual systems, should caregivers fail to meet the needs of careseekers, the latter cannot experience the goal of careseeking, and commonly become frustrated and then depressed. What happens when each partner is failing to reach their goals, and what is happening to their respective caregiving and care-seeking systems, is increasingly being researched and understood in both non-human primates and human beings. In human beings, three common behavioural outcomes can be seen:

1. conflict, with each partner attempting in various ways to influence the other to meet his demands for satisfaction;
2. the apparent submission of one to the demands of the other; and
3. negotiations to reach a compromise, so that the loss of what is desired by both partners is minimised if not avoided. It is a common experience that this latter outcome does not come about unless one partner (the parent, when adults and young children are involved) is able to suggest a compromise, or make issues of reality clear, without being drawn into a controlling or compliant pattern of relating.

Bowlby rounded out his model by including in it:

1. the innate ability to construct internal working models of the environment, and of the self interacting with aspects of the environment and with other people. These models are used for making plans and decisions about future action;
2. the mechanisms of psychological defence by means of which the pain of failure to reach the interpersonal goal of careseeking is mitigated or avoided; and
3. a view of the nature and function of affects, feelings and emotion.

In exploring the field of information processing, Bowlby noted that people discard much of the information to which they are exposed, but are alert to any that refers to themselves. He also noted the stability over time of early working models of self and attachment figures. He gave an explanation of the effects on children when parental figures insist that their account of an event is true, when the parental account contradicts what the child has actually witnessed or experienced. He developed this issue in his lectures ‘On knowing what you are not supposed to know and feeling what you are not supposed to feel’ and later gave them to a wider audience (Bowlby 1988). He considered that the outcome of this kind of experience can be the formation of multiple working models of the self and attachment figures which can give rise to the formation of multiple personalities. This view is explored by Barach (1991) and Liotti (1992).

In adding these aspects to his description of instinctive systems, Bowlby created an opening for the expansion of his model, and left a number of issues to be developed. For example, despite his acute awareness of the anxiety, anger and despair which is aroused when attempts to achieve the goal of the care-seeking (attachment) system fail, and of the joy, the sense of security and freedom to explore when the attachment bond is maintained or renewed, he did not commit himself to a description of the blend of feelings, thoughts and urges that make up an individual’s subjective experience of reaching or failing to reach the goals of careseeking and of caregiving. Nor did he make explicit the ways in which the development and functioning of interpersonal and intrapersonal systems are affected by the values and ideals held by parental figures and by peers, and by the ideals a person develops (once old enough) on their own.

This book marks a second stage of extending Bowlby’s ideas by focusing on the concept of supportive companionable caregiving. In the first stage (Heard and Lake 1986 and Chapter 5), we introduced into the concept of an attachment dynamic (Heard 1978), a second pair of goal-corrected interdependent systems - the systems for exploratory interest-sharing between peers. We used findings from the Strange Situation Test (Ainsworth et a/. 1978) to point to the circumstances in which unmet careseeking needs are most likely to override an individual’s exploratory and interest-sharing behaviour. We described the ways in which the experience of reaching, or not reaching, either of the two pairs of interpersonal goals can affect a person’s mood, sense of competence, self-esteem and general well-being. We showed how an internal caregiving system can develop through using internalised working models of self and attachment figures, and can reduce the need for proximity to caregivers when attachment behaviour is aroused in older children and adults.

At that stage we had not conceptualised in any detail a model for a self and were aware that our concept of emotive messages (whereby people make others aware, mainly through non-verbal signals, of the relationship they want with others) had not gone far enough. For example, we did not discuss the phenomenon of social referencing (see Chapter 8); nor did we discuss the physical and psychological effects of being shamed and/or overexcited. We had not considered the relations between Bowlby’s instinctive systems and how individuals come to construct a hierarchy of passionately held values and ideals some of which are discovered personally, but many of which are transmitted by others. And finally we had not considered important differences between systems that maintain physiological and psychological homeostasis and those that carry forward processes of growth and development.

Since finishing our paper in 1985, we allowed our separate capacities a free rein to search for information that is relevant to these concerns. The new literature that we found the most seminal described research findings that filled conceptual gaps or set out ideas that drew us to explore and clarify our intuitive understanding. They included:

1. Stern’s (1985) work on attunement and the studies by Trevarthen (1979) and by Murray and Trevarthen (1985) on intersubjectivity;
2. MacLean’s work (1990) on the non-verbal signals by means of which humans and non-human species convey relational intentions to one another, and a clutch of writings on biological psychology, notably the papers on the psycho-biology of attachment and separation edited by Reite and Field (1985); and
3. Sperry’s (Sperry 1990, Trevarthen 1990) view that the neural infrastructure of any brain process mediating conscious awareness is composed of elements and forces which give rise to simple-complex systems arranged in a hierarchy of levels of organisation; and that consciousness is an emergent self-regulatory property of neural networks which enables them to reach certain built-in goals. Genetic instructions set adaptive goals which give the organism intricately co-ordinated forms of action and categories of experience. Sperry’s mentalistic viewpoint and his concept of hierarchies of simple-complex systems that play a part in expanding subjective consciousness provide individuals with a measure of freedom from reacting to stimulus-bound responses. That is to say, rational thought can influence instinctive behaviour in such a way that innate survival behaviour is influenced by the use of human cognitive capacities.

We also reflected on Gilbert’s views (1984, 1989, 1992) on depression and suffering. We kept abreast of the burgeoning attachment literature, especially the work of Mary Main on the disorganised child and her adult attachment interview. We noted Kagen’s (1994) views on the self and on temperament, and the views of the authors assembled by Chance (1988). We have also noted recent advances in psychoanalytic thought and current views on moral behaviour. The picture of a self and of instinctive partnerships described in this book reflects the integration of this kind of information. It forms the second stage of an extension of attachment theory which we hope will provide a fuller understanding of the effects of the phenomenon of attachment upon the development and functioning of the caregiving system.

To construct the theory we have focused on interpersonal phenomena that psychotherapists are most frequently called upon to understand and handle in the course of their clinical work. We describe them in concrete terms from a subjective point of view that takes into account ‘Who does what, to whom, and when?’ and ‘What does it make the individual feel?’ In developing the theory, we have used a mixture of anecdotal evidence from clinical experience and research findings. However, we rely on research studies to correct and develop this theory’s explanatory power through the exploration of theory-based hypotheses. Such findings will either support aspects of the theory or will point to the direction in which it needs to be reconstructed or discarded.

The Plan and Content of the Book

In order to tell a coherent story, we have divided the book into three parts. In Part I we set out the conceptual base on which we have constructed a theory of companionable caregiving, before showing in Part II how we use this information to construct the theory. Part III describes how the theory can be used as a guide when working with clients.

Following this introductory chapter, we describe the studies of MacLean on the evolution of non-verbal signals, which also point to the evolution of caregiving, and a primate pattern of relating in which dominant/submissive patterns are a prominent feature. We then describe studies (primarily those of Trevarthen, Fernald and Stern on the non-verbal communication of mothers and infants) to suggest the evolution of a uniquely human pattern of relating which is phylogenetically in advance of the patterns of non-human primates. Here caregiving is more supportive and companionable and, when caregiving is on this level, dominant/submissive patterns are not used to a significant degree. From this perspective, we move on to describe Bowlby’s model for instinctive behaviour and the extensions which we added in 1986. We end the first part with a chapter on Sperry’s views about how brain is related to mind and his concept of high-order systems which enlarge human consciousness and free individuals from impulsive instinctive behaviour.

The second part discusses the construction of the theory of care-giving. It begins with a categorisation of instinctive goal-corrected systems according to their functions. In the course of so doing we distinguish four behavioural systems with interpersonal goals: care-giving, careseeking, interest-sharing and sexual. This chapter is followed by one which reaches a personal level by showing how behavioural systems are represented in relationships between specific people. The part ends with three chapters showing the way in which individuals evaluate the experience of reaching, and not reaching, the goals of the behavioural systems and the part played by aspirations and ideals to develop and maintain their personal and social skills and well-being.

We open Part III with a chapter giving an outline of the various psycho-biological theories of human nature commonly used by therapists, which we consider to be supportive of the integrative attachment-based object-relational theory of caregiving on which our therapy is based. We move then to discuss assessment by presenting a frame of reference which enables the assessor to arrive at a view about: one, the way prospective clients relate to the assessor and talk about their life; two, the number and quality of their affectional relationships; and three, how far they are seeking to reach maturational ideals that help them move on to new stages of development and how far their maturation is impeded by aspirations that can be described as non-maturative defensive idealisations. In the final two chapters we discuss how a therapist can put into effect the principles of professional caregiving we have found to be therapeutic.

The Language in Which the Book is Written

Although we inevitably introduce specialised terms, our aim has been to use words as defined in standard dictionaries and avoid language associated with theories that we have not used. Such language (e.g. libido) inevitably carries meanings that are specific to the theories to which it belongs, and which tend to override any other meaning placed on it. We have sought to find terms which will keep the focus on what is happening between each individual person when two or more people interact with one another. This has led to some longwinded terms such as supportive companionable relating and caregiver/careseeker partnerships. In the interests of making the text less cumbersome we have used abbreviations to some extent (e.g. SC relating for the former and CG/CS for the latter) although we find them unattractive and mechanical. For the same reasons, we have, after careful consideration, reverted to the convention of using he, him and himself to refer to unnamed individuals who may be of either gender.

In the interests of brevity we do not argue the merits of one position against another in relation to a phenomenon or a topic ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Part I The conceptual base for a theory of companionable caregiving
• Part II The construction of a theory of companionable caregiving
• Part III Principles of therapy guided by an attachment-based theory of caregiving
• Appendices
• Bibliography
• Author index
• Subject index