Attachment Issues in Psychopathology and Intervention

Leslie Atkinson, Susan Goldberg, Leslie Atkinson, Susan Goldberg

• Publisher: Routledge
• Year: 2003
• Print ISBN: 9781138003545
• eBook ISBN: 9781135654580
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

To be a human being (or indeed to be a primate) is to be attached to other fellow beings in relationships, from infancy on. This book examines what happens when the mechanisms of early attachment go awry, when caregiver and child do not form a relationship in which the child finds security in times of uncertainty and stress. Although John Bowlby, a psychiatrist and psychoanalyst, originally formulated attachment theory for the express purpose of understanding psychopathology across the life span, the concept of attachment was first adopted by psychologists studying typical development. In recent years, clinicians have rediscovered the potential of attachment theory to help them understand psychological/psychiatric disturbance, a potential that has now been amplified by decades of research on typical development.

Attachment Issues in Psychopathology and Intervention is the first book to offer a comprehensive overview of the implications of current attachment research and theory for conceptualizing psychopathology and planning effective intervention efforts. It usefully integrates attachment considerations into other frameworks within which psychopathology has been described and points new directions for investigation. The contributors, who include some of the major architects of attachment theory, link what we have learned about attachment to difficulties across the life span, such as failure to thrive, social withdrawal, aggression, anxiety, depression, bipolar disorder, dissociation, trauma, schizo-affective disorder, narcissistic personality disorder, eating disorders, and comorbid disorders. While all chapters are illuminated by rich case examples and discuss intervention at length, half focus solely on interventions informed by attachment theory, such as toddler-parent psychotherapy and emotionally focused couples therapy.

Mental health professionals and researchers alike will find much in this book to stimulate and facilitate effective new approaches to their work.

II
INTERVENTION

6
Levels of Processing in Parent-Child Relationships: Implications for Clinical Assessment and Treatment

Roger Kobak
University of Delaware

Alison Esposito
University of Delaware

During the past decade, attachment research has shed new light on the nature of parent-child relationships and their potential contribution to child and adolescent psychopathology. Researchers have linked insecure states of mind in the Adult Attachment Interview to increased risk for a variety of symptoms in adults (Dozier, Stovall, & Albus, 1999) and patterns of insecure parent-infant attachment have been associated with increased risk for child and adolescent psychopathology (Greenberg, 1999). Despite the progress in understanding the relation between attachment and psychopathology, research findings have had several notable limitations for clinicians working with children and their parents. First, available research methods for assessing attachment are labor intensive and often beyond the resources of most practicing clinicians. Second, and perhaps most important, research methodologies such as the “strange situation” and Adult Attachment Interview provide a narrow and rather limited understanding of how attachment processes contribute to the emergence of psychopathology. More specifically, both methodologies focus on the individual child or parent and fail to describe or account for the nature of the current parent-child relationship. Third, these methodologies cannot be used with children and young adolescents. The strange situation is restricted to use with infants up to the age of 18 months while the Adult Attachment Interview can only be used with subjects who are at least 15 years old.

In order to address these limitations, we propose a model of parent-child relationships that is based on the notion that parents and children process attachment information at multiple levels. At the individual level, both the parent and the child have formed internal working models (IWMs) or expectations for the other person and for the self. For children, these models guide appraisals of the parent’s availability and responsiveness and organize strategies for maintaining the relationship. For parents, expectations guide their evaluation of and reaction to the child’s behavior. At the interpersonal level, parents and children engage in a series of interactions and communications and both send and receive signals. Problems in communication can occur both in terms of how clearly and congruently partners send signals and in terms of how sensitively and accurately signals are read. Finally, at the metacognitive level, the parent’s capacity for monitoring self and other may facilitate communication and the degree to which IWMs are open to revision and updating. By adolescence, the child becomes increasingly capable of also monitoring self and other in the parent-child relationship (Kobak & Cole, 1994; Selman, 1980).

We believe that our levels of processing model can integrate constructs and findings from attachment research into a more comprehensive understanding of cognitive and emotional processes in parent-child relationships. In doing so, this model should address several major issues. First, it should provide clinicians with a guide to identifying attachment issues in parent-child relationships. Second, the model should account for the increased developmental complexity in attachment relationships that occurs during the postinfancy period. Third, the model needs to address the parent’s ongoing contribution to the attachment relationship. Without a clear understanding of the parent’s contribution, we believe that efforts to apply attachment theory and research to child psychopathology are seriously limited.

In this chapter, we describe our levels of processing (LOP) model and then use it to distinguish between secure, anxious, and distressed parent-teen relationships. These three types of relationships represent a continuum of risk for child and adolescent psychopathology and can serve as a heuristic guide to clinical assessment and treatment. Whereas in secure relationships cognitive and emotional processes operate to protect the child from the various stresses encountered over the course of development, in anxious relationships the child is vulnerable at times of stress and is at a higher risk of developing symptoms that require professional attention. By the time many children reach treatment, their parent-child relationships are no longer simply anxious, but may be actively distressed and these distressed relationships often become a major impediment to symptom reduction. Our LOP model provides a way to describe the dynamics of secure, anxious, and distressed parent-child relationships. These descriptions can provide the clinician with a guide for assessing children and their parents and for establishing treatment goals that increase security in the relationship.

LEVELS OF PROCESSING IN THE PARENT-CHILD RELATIONSHIP

An LOP model of parent-child relationships can be used to describe and integrate the major findings and constructs from the past two decades of attachment research, including IWMs (Bretherton, 1985), attachment strategies (Main, 1990), open communication (Bowlby, 1988), states of mind (Hesse, 1999), and reflective function (Fonagy & Target, 1997). We believe that an adequate understanding of parent-child relationships must consider the individual level at which IWMs of self and other organize feelings and cognitions in the relationship, the interpersonal level at which communication is exchanged, and the metacognitive level at which parents, and eventually children, become capable of establishing a perspective on IWMs and communication between self and other. In addition to integrating existing findings, a comprehensive LOP model of the parent-child relationship also points toward major gaps in researchers’ understanding of parents and children.

The Individual Level: IWMs of Self and Other

At the core of attachment theory is Bowlby’s (1969/1982) account of the child’s attachment system and how it develops within the context of the parent-child relationship. According to the theory, children develop motivational or behavioral control systems that foster the formation and maintenance of a parent-child attachment bond (Cassidy, 1999). The emotional significance of this bond is evident in the child’s enjoyment in maintaining contact with the parent and, conversely, in the extreme fear, anger, and sadness that accompany perceived threats to the relationship or disruptions of the bond (Bowlby, 1973). Bowlby also introduced the notion that individual differences in personality could be traced to the child’s IWMs of their caregivers’ availability. Children whose IWMs confidently forecast caregiver availability and responsiveness would feel secure, whereas those that lacked such confidence would feel anxious and, at times, angry.

Beginning in the 1960s, Ainsworth’s (1978) studies of mothers and infants at home and in a laboratory situation illustrated the complex interplay between infants’ IWMs and their strategies for maintaining the attachment relationship. Ainsworth found that infants’ IWMs of their mothers’ availability could be inferred from how infants organized their behavior in the strange situation (Ainsworth, Blehar, Waters, & Wall, 1978). Infants judged to be secure showed a pattern that reflected an IWM that confidently forecasted maternal availability in the novel situation created by a laboratory environment. These infants actively used the mother as a safe haven at times of distress and as a secure base for exploration. Infants judged to be anxious or insecure were restricted in the use of their mother as secure base and safe haven, reflecting underlying cognitive schemas or IWMs that forecast uncertainty or negative expectation about maternal response.

IWMs or expectations for the mother’s availability organize the child’s strategy for regulating the attachment system (Main, 1990) and for maintaining the attachment relationship (Main & Weston, 1982). IWMs serve as filters of both parent and child behavior in ongoing interactions, which guide appraisals of core issues such as whether the parent is perceived to be available and responsive to the child and whether the parent views him- or herself as a competent caregiver. These core appraisals of self and other in the parent-child relationship in turn organize emotion, cognition, and strategies for maintaining the attachment bond. For the most part, these appraisals and interpretations operate automatically and outside of awareness (Bowlby, 1980). In this respect, IWMs are similar to core cognitive schemas that form the basis for contemporary cognitive behavioral therapies (Safran & Segal, 1990).

Infant attachment patterns in the strange situation illustrate how IWMs organize feeling and behavior. Whereas infants who were confident in the mother’s availability actively communicated distress and sought comfort, infants whose IWMs forecasted rejection or inconsistent response developed secondary strategies that either minimized or maximized attachment feelings and behavior (Main, 1990). It is clear then that IWMs carry enormous emotional significance for the child. If the child’s IWM forecasts an available and responsive parent, he or she will feel secure and will enter situations with confidence, knowing that the parent would respond if called upon for help or support. Alternatively, if the child anticipates that the caregiver will be rejecting, neglecting, or physically inaccessible, he or she will feel anxious, angry, or sad.

During the toddler and early childhood periods of development, children are also forming an IWM of self. This IWM of self guides children’s appraisals of their abilities to succeed in day-to-day challenges and to gain support from others. Both theory and research suggest that the appraisal of the parent as available supports an appraisal of the self as worthy of support (Bowlby, 1973) and as confident and competent in situations involving challenge (Sroufe, 1988). Thus, an IWM of the parent that forecasts parental availability supports the development of an IWM of the self that forecasts successful outcomes in challenging situations.

Our LOP model suggests that the construct of IWMs should be extended to parents as well as their children. From this perspective, not only are children’s interpretations influenced by IWMs, but parents’ interpretations of their children are guided by IWMs as well. Attachment researchers have only begun to consider parent’s IWMs of the child (George & Solomon, 1999). Theoretically, parents’ IWMs should guide parental behavior and regulate parents’ caregiving behavioral system. The biological functions of the caregiving system include protecting the child and fostering the child’s preparation for adult roles that ultimately increase the likelihood of reproductive success. In this respect, the parent’s motivation to protect the child and facilitate the child’s learning complements the child’s need for the parent to serve as a safe haven from danger and a secure base to support exploration.

In contrast to the child, the parent’s IWM of self precedes the development of the parent’s IWM of the child. As a result, the parent’s IWM of self may bias perceptions of the child and the development of an IWM of the child in complex ways. In situations where parents have an IWM of self as worthy and competent, they may be free to more fully attend and adapt to the needs of their child. Such a model of self may also increase the parent’s abilities to manage the child’s anger or oppositional bouts, both of which are an integral part of the child’s growing capacities for self-regulation.

The Interpersonal Level: Reading and Sending Signals

The notion that individual differences in IWMs could be assessed in the first 18 months in the strange situation has captured the imagination of researchers interested in later periods of development (Crowell, Fraley, & Shaver, 1999; Hazan & Shaver, 1987; Main, Kaplan, & Cassidy, 1985). As a result, Ainsworth’s patterns of attachment have been turned into a theory of personality across the life span. Unfortunately, this focus on IWMs as a core feature of personality has come at the expense of another aspect of Ainsworth’s work that focused on the interpersonal communication between mothers and their infants (Kobak, 1999). For Ainsworth, the infant’s IWM or expectations for a parent’s availability went hand in hand with her observations of mother-infant interaction at the interpersonal level. Infants with IWMs that forecasted mothers’ availability in the strange situation had mothers who had sensitively responded to their signals during normal day-to-day interaction during the first year of life. Thus, IWMs at the individual level were inextricably linked to a pattern of communication at the interpersonal level.

Although researchers have devoted considerable effort to assessing maternal sensitivity in parent-infant relationships, Bretherton (1999) noted that observation of interpersonal communication between parents and older children has been relatively sparse. The lack of research on interpersonal communication stems from both pragmatic and theoretical problems. Pragmatically, assessment at the interpersonal level requires observation of parent-child interaction and this type of research is time consuming and difficult. Theoretically, parent-child communication undergoes a dramatic transformation during early childhood, with the emergence of verbal communication and what Bowlby (1969/1982) described as the goal-corrected partnership phase of the attachment relationship (Marvin, 1999). With the emergence of the child as a partner in the relationship, communication consists of not only the parent reading and responding to the child’s signals, but also the child reading and responding to the parent’s signals. For the most part, attachment research has failed to take into account the dramatic transformation of the parent-child relationship into a goal-corrected partnership. As children become capable of understanding parents’ goals, delaying their own goals, and negotiating compromise, the criteria for a secure parent-child relationship shift from sensitive caregiving by parents in infancy to cooperation between parents and children by the end of early childhood (Thompson, 2000). The shift to a goal-corrected partnership places new importance on both the parent’s and the child’s abilities to use conversation to resolve goal conflicts and addressing the child’s needs for safety and learning becomes an essential feature of a secure relationship. As a result, conversations that conform to Grice’s criteria for cooperative or coherent discourse become essential to the child’s security or appraisal of the parent’s availability (Kobak & Duemmler, 1994). For a conversation to meet these criteria, both the parent and the child must effectively express their own concerns, acknowledge the other person’s concerns, and establish a give-and-take relationship in situations involving goal conflicts.

The importance of parent-child communication has been demonstrated in studies of adolescents and their parents. The importance of both communicating goals and validating one’s partner is assessed in Allen et al.’s (1994) Autonomy and Relatedness Coding System for parents and their teenage children. Allen found that relationships in which parents and adolescents demonstrate autonomous assertion of their position while also acknowledging their partner’s perspective lead to higher levels of adolescent ego development and self-esteem (Allen, Hauser, Bell, & O’Connor, 1994). Similarly, mother-teen problemsolving interactions characterized by mothers dominating the conversation and by a mutual lack of perspective taking were associated with depressive symptoms in adolescents over a 9-month period (Kobak, Sudler, & Gambler, 1991).

The Metacognitive Level: Updating and Revising IWMs

During the past decade, a great deal of re...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface
• I Psychopathology
• II Intervention