Attachment Across Clinical and Cultural Perspectives

A Relational Psychoanalytic Approach

Sonia Gojman-de-Millan, Christian Herreman, L. Alan Sroufe, Sonia Gojman-de-Millan, Christian Herreman, L. Alan Sroufe

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138999671
• eBook ISBN: 9781317330042
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Attachment Across Clinical and Cultural Perspectives brings together leading thinkers in attachment theory to explore its importance across cultural, clinical and social contexts and the application of attachment relationship principles to intervention with diverse groups of children and families. These contributions collectively illustrate the robustness of attachment research in the contexts of culture, early extreme deprivation, trauma and the developing brain, providing great inspiration for anyone embracing the idea of evidence-based practice.

Two chapters convey fundamentals of attachment theory, covering links between attachment and normal and pathological development and the interface between attachment and other features of evolutionary theory. Two others specifically tackle the cultural context of attachment; fundamental research findings with North American and European samples are shown to hold as well among indigenous people in a rural Mexican village, whilst the link between maternal sensitivity and secure attachment is demonstrated in a variety of cultures.

Further chapters explore the role of fear and trauma in the formation of attachment; one establishes intergenerational links between parental history of trauma, dissociative states of mind and infant disorganized attachment, another looks at the consequences of early extreme deprivation (institutional rearing) for attachment. A third describes the impact of attachment experiences on brain development. Finally, the book explores intervention guided by attachment theory, research on fear and trauma, and an understanding of how attachment experiences leave their mark on parental psyche and behaviour.

Attachment Across Clinical and Cultural Perspectives gathers authoritative information from leading experts in the field in an easily readable, practical way. It will appeal to psychoanalysts and psychoanalytic psychotherapists, to professionals who serve the developmental and mental health needs of adults, children and families, and anyone seeking to base their intervention work and therapy upon attachment principles.

Part I

Attachment, theory, and research

Chapter 1

Attachment theory

A humanistic approach for research and practice across cultures

L. Alan Sroufe

From the start, attachment theory has always been a cross-cultural theory, a theory concerned with human welfare, a theory with direct clinical relevance, a theory rooted in biology and a theory capable of empirical test. This set of characteristics makes it virtually unique among psychological theories and likely is responsible for its great and increasing popularity. In modern times, in a shrinking world, we are aware of the need to take into account contextual influences on behavior, including culture, even as we attempt to create theory and practices of clinical utility. At the same time, it is not possible to overlook the extent of human psychological suffering and the ubiquity of trauma and hardship faced by children and adults. Human needs must be attended. Finally, there is an acute need for practices that both deal in a real way with the psychological substance of disturbance and yet are “evidenced based.” Attachment theory promises all of this, and it has done so from the beginning.

These themes will be elaborated throughout this book. In this chapter, I will comment briefly on the cross-cultural nature of attachment theory, its affinity with a compassionate stance toward our fellow beings, and its clinical relevance, and I will discuss more fully its amenability to rigorous empirical testing. I will do this from the perspective of a long-term and comprehensive longitudinal study, the Minnesota Study of Risk and Adaptation, which began in 1974 and continues to the present. Many of the propositions of attachment theory and, indeed, many of the critical questions in developmental psychology can be answered only with such a study. The two central hypotheses formulated by Bowlby (for example, 1973) were: (1) that variations in the quality of infant attachment relationships are based on patterns of interaction between infants and their caregivers early in the first year, and (2) that these variations in the quality of attachment are the foundations for later personality organization—for psychological health and for disturbance. Both of these questions, of course, may be best addressed by prospective longitudinal studies; that is, studies in which early patterns of care are directly observed at the time, and all later outcomes are directly observed throughout childhood and beyond, always by independent observers.

As a background for this discussion and for all of the chapters to follow, a few fundamentals of attachment theory and attachment assessment must be outlined. Attachment concepts are quite distinctive from drive and trait concepts common in other psychological theories. Being clear about these distinctions will make it easier to understand both the nature of attachment research and the clinical applications that derive from it.

Fundamentals of attachment

Attachment theory was part of a revolution in psychology both in moving away from drive-reduction concepts and in moving toward relationship concepts, as opposed to only the study of individual characteristics. Attachment is a relationship concept. In infancy, it refers to the emotional connection and the behavioral coordination between infant and caregiver (attachment figure). It refers to this relationship and not to a characteristic of the infant. When we refer to an infant as “securely attached,” we actually mean that it is secure in (confident about) its attachment with this particular caregiver. Thus, the same infant may be secure in its attachment with one caregiver, and anxious with another. This was difficult for some psychologists to grasp at first, but it is an absolutely critical notion in attachment theory.

One implication of thinking of attachment as a quality of a relationship, as opposed to a trait of the baby, is that one can quickly get beyond certain confusions regarding strength of attachment—that is, “how attached” an infant is. All infants become attached if some consistent person cares for them, whether poorly or well. They don’t become weakly or strongly attached. They are just attached. Some may be anxious in their attachments and some may be confident, but all are attached, even to abusive caregivers. Saying that a baby is “too attached” likewise is a misnomer—a throwback to dependency-trait terminology. It is not a problem to be very confident in the responsiveness of your caregiver; rather, such confidence is a sign of a good-quality, effective relationship. Infants described as “too attached” are no more attached than those who are secure; their unremitting clinging is simply a sign that they are anxiously attached.

It can readily be seen how attachment is distinctive from temperament. Temperament refers to individual variations in behavioral style—for example, dimensions such as activity level, thresholds of responsiveness, or reactivity to stimulation. These would be expected to show some consistency across contexts and to some extent across situations. Infants who are secure (or anxious) in their attachments may be high or low on any of these dimensions. For example, in the Ainsworth Strange Situation Procedure, some infants assessed to be in secure relationships become quite upset by the brief separations and cry a great deal, while others cry hardly at all. Yet those who are very distressed by the separations are judged to be secure in their relationship because they go immediately to the caregiver upon reunion and are readily settled by contact, as opposed to ineffectively seeking contact or failing to be settled by it, perhaps even fighting against it. Their confident expectations are revealed by the directness of their approach and the ease of settling. They know the contact will work and they use it to return to play and exploration. Those secure cases that are not distressed are judged to be secure because they actively greet and initiate interaction with their caregivers upon reunion, and this psychological contact is sufficient to promote their return to active play and exploration. They do not ignore or avoid the caregiver. As temperamentally different as these infants may be viewed, they have in common that they have confident expectations regarding their caregivers and they are able to effectively use their relationship to promote exploration.

In summary, all human infants are expected to form attachments with the person or persons that interact with them on a consistent basis. These relationships, however, vary in quality: in some cases, they will be characterized by confident expectations regarding caregiver responsiveness and by effectiveness in using the caregiver as a secure base for exploration, and in some cases, they will not manifest such expectations. It is hypothesized that such variations derive from the history of interaction with the particular caregiver. Finally, these variations may be observed in the dyadic organization of behavior, that is, the way the infant adjusts behavior with respect to the caregiver in various circumstances across time. Secure infants will explore when external stress is minimal, seek contact when stress increases, and use that contact (physical or psychological) for reassurance, which promotes a return to exploration.

Attachment theory is distinctive from classic psychoanalytic positions that conceive of self as preceding relationships, as when a primitive self cathects a part object and subsequently a whole object, thus forming a relationship. In attachment theory, the infant is seen as born into and embedded in an organized relationship matrix, from which self emerges. Such a revised viewpoint solves a complicated problem in the study of personality. If we cannot simply assume the fully formed personality exists from the beginning, and we cannot assume something coming from nothing, how can we explain the complex organization that is the person. The answer is that there is an organization in the beginning; that organization is in the infant-caregiving relationship (Sander, 1975). In a later section, we will see the implications for research of this revised position.

Attachment theory as a cross-cultural theory

As was true with classic psychoanalytic theory, attachment theory has been criticized as culturally biased, that is, as based in white, Northern European culture (for example, Rothbaum et al., 2000). In the case of attachment theory, this critique is surprising for several reasons. First, attachment theory derived originally from studies of animals, especially non-human primates. Thus, beyond being a panhuman theory, it is even a cross-species theory. Moreover, the first empirical application of Bowlby’s theory was Ainsworth’s (1967) study in rural Uganda, about as far from Northern European culture as one could imagine. Most of the ideas about the link between parental sensitive responsiveness and quality of attachment derived from that study. The next study by Ainsworth was with a largely black sample in inner-city Baltimore (Ainsworth et al., 1978). Only following this were studies done with middle-class North Americans and northern European samples.

Some studies did find results dissimilar from those of Ainsworth using the Strange Situation Procedure, for example, in one north German sample (Grossman et al., 1985) and in a traditional Japanese sample (Miyake et al., 1985). But the north German sample proved to ref lect a cohort effect. The mothers in this sample were born just after World War II in conditions of extreme hardship. They believed their children needed to be pushed toward independence and, as Bowlby (1973) predicted, this led to a dramatic increase in avoidant attachment. But the theory worked as before. Avoidant attachment predicted heightened aggression just as it does in American samples. Moreover, in a southern German sample and a subsequent sample in northern Germany, such an increase was not found. Cultural bias is not indicated by this set of findings but rather the impact of hardship upon parenting.

The Japanese case is a bit different. These infants were unable to be consoled in the reunions following brief separation and therefore appeared to fit the anxious-resistant (ambivalent) category. However, such differences in the laboratory were not reflective of differences observed in the home. In Western samples, anxious-resistant patterns of attachment are associated with inconsistent, chaotic care and much crying in the home, but not so in the traditional Japanese families. Even their exploration in the laboratory was adequate prior to the first separation, making it unlikely that they were genuinely anxiously attached cases. But these infants, who in this cultural setting never experienced brief separations, were thoroughly distressed by the separations, which were unfortunately allowed to go on too long, rather than being cut short as is standard practice with distressed babies. As a consequence, these infants were inconsolable upon reunion. Such difficulty settling fallaciously implied anxious attachment. The most plausible interpretation of these results is that the Ainsworth procedure (which assumes modest though increasing stress) was not appropriate for these infant-caregiver pairs. It does not call into question the cultural generality of attachment theory, just this particular assessment procedure in this case. It should be noted that modern Japanese families (where mothers often work) and Japanese-American families show the same proportion of secure attachment as other US samples in the Strange Situation. (See also a paper by Behrens, Hesse, & Main, 2007, that illustrates the distinction between the Japanese concept of amae and attachment, and nonetheless provides validity for the attachment construct in Japan.)

The cross-cultural validity of attachment theory is not dependent on the general applicability of a particular assessment method, such as the Strange Situation Procedure; rather, it hinges on whether the process of attachment itself is culturally general. There is now substantial empirical evidence that core propositions of attachment theory hold across cultures (Posada, this volume; Gojman & Millán, this volume). This is despite the fact that, of course, cultures also differ widely in both parenting practices and infant behavior. There are cultures in which infants are in near-constant physical contact with mothers in the early months of life, for example, being carried in slings and co-sleeping, while in some modern cultures neither of these is practiced. In some cultures, parents talk a great deal to even young infants, but there are other cultures where the belief is held that there is no point talking to children before they begin speaking. In some cultures, children as young as 3 tend to toddlers; in some, any relative may discipline a child (Whiting & Whiting, 1975). The list goes on and on.

On the other hand, there are constancies across cultures. In all but modern industrial cultures, babies in the first months of life are cared for primarily by one person, usually a nursing mother. Moreover, the variations in care described above are not central to attachment theory. At the core of attachment theory is the belief that a single figure or a small hierarchy of figures will serve as a safe haven—a portable source of protection—for the infant. Infants will seek out these persons specifically when frightened or distressed. This “safe haven” or “secure base” phenomenon also is apparently constant across all cultures. Likewise, it has been shown that individual differences in quality of attachment (effective secure base behavior) are related to caregiver responsiveness to signals in every culture studied (see again Posada, this volume).

Attachment theory and the concern for human well-being

As has been true with other psychoanalytic theories, Bowlby’s theorizing began with a clinical problem (Bowlby, 1944). At the time, Bowlby was working with a large number of “juvenile thieves,” who today would likely be referred to as “conduct disordered.” He thought he discerned a common problem—namely, a lack of care in early life that he referred to as “maternal deprivation.” In a sense, all of his work for the next four decades can be seen as an effort to rigorously examine this hypothesis. Along the way, however, he never lost sight of the goal of improving the lives of such children, both in terms of prevention and improved clinical understanding and treatment. Early on, he spearheaded a report for the World Health Organization (1951) to call attention to early privation and deprivation of care in creating problems for children. Later, in his collaboration with James and Joyce Robertson, he worked to change hospital policies with regard to the damaging practice of forbidding parent-child visitations in medical settings.

His investigations led him to a novel approach within psychoanalytic theory; namely, begin not with disorder but with understanding normal development. The questions arose: how do attachments typically arise and what functions do they serve? Followed by: how can this process go awry and what are the consequences of such deviations? This approach turned out to be incredibly fruitful. It led to new paradigms in psychiatry and psychology, playing an important role in the emergence of the f ield today known as “developmental psychopathology.” It also inspired a revolution in the study of social development wherein the role of relationships came to the fore. At the same time, this approach led Bowlby to a new emphasis on the lived experience of the person and the expectations for self and other that derive from that experience. Not only did this create a psychodynamic theory readily capable of being empir...

Table of contents

• Cover Page
• Attachment Across Clinical and Cultural Perspectives
• Psychoanalytic Inquiry Book Series
• Title
• Copyright
• Contents
• List of Illustrations
• Notes on Contributors
• Preface
• Acknowledgements
• PART I Attachment, Theory, and Research
• PART II Clinical
• Appendix
• Index