Mental health, Resilience and Attachment Theory

What is Attachment Theory?

Thompson clearly expresses the place of Attachment Theory in current psychological theory building.

“Attachment Theory has become the dominant approach to understanding early socioemotional and personality development during the past quarter-century of research. It is easy to understand why [1].

The writers Diamond, et al. [2] have highlighted some of the insights this theoretical model of attachment has contributed: insights into both normal and pathological psychological and neural development, into memory structures, memory storage and recall, relationship formation, instinctual motivation systems and it is also a theory of affectivity. As Bowlby states, some of our most powerful emotions are linked to attachment figures in our lives.

As human infants are born relatively helpless and dependent on the caretaker for nourishment and safety, the bond between mother and child is a vital instinctual, inborn function in both mother and infant.

“First and foremost, attachment relationships are clearly presented as a biological predisposition evolved to ensure survival [3].

Hence attachment behaviours and the building of emotional bonds have an instinctual basis and function initially preverbally and according to Schore primarily from the right hemisphere of the caretaker to the right hemisphere of the infant.

From a historical perspective, one of the early leading researchers who is credited with being the father of attachment theory, is John Bowlby. Bowlby a psychiatrist and psychoanalyst, however in developing his theory of attachment he moved away from traditional psychoanalytic theories of child development of the time and drew on findings from ethology, and evolutionary psychology (1979). This he detailed in a series of lectures he gave in the late 1950s [4].

One of his first major findings was with respect to the impact lengthy separation from the parents had on young children. Bowlby observed that young children when separated from their caretaker went through the following phases: protest, despair and finally detachment and the experience of prolonged separation impacted on their later relationship behaviour. The concept of attachment and bonding introduced in his various publications was based initially on his observations made of a particular group of teenage delinquents who had a history of early separation from their caregivers. He showed that when the bonds between mothers and children were disturbed by the mother’s prolonged absence, it was related to increased rates of many forms of psychopathology (1979).

He postulated that infants instinctively bond with their caretaker and the caretaker with the infant. This is a survival mechanism as infants come into the world dependent on their primary caretakers. The nature of this bond is influenced by the way the caretaker responds to the infant’s needs. The infant expresses distress vocalizations for a variety of reasons (discomfort, hunger, cold etc.) and the mother responds by providing comfort and meeting the infant’s needs.

With time on the basis of these experiences, the child unconsciously constructs what is referred to as an internal working model (IWM) or representational model; a generalized model based on the repeated experiences with the mother. These IWMs go on to guide their perception of themselves and the nature of their relationship with others. Although IWMs are modifiable and, in a sense, a ‘work in progress’ Bowlby was of the view that they are relatively stable over the lifespan. Bowlby did however hold the view that more than one IWM can coexist and can function at differing levels of consciousness.

“Clinical experience suggests that the stronger the emotions aroused in a relationship the more likely are the earlier and less conscious models to become dominant” [4].

This is in line with Jungian thinking about the nature of complexes (emotionally charged memories which have not been integrated into the person’s conscious autobiographical narrative).

Right across the psychological theoretical spectrum conceptualisations similar to IWMs have been proposed. The concept of IWM is, for example, closely related to Daniel Stern’s [5] concept of RIGS; Representations of Interactions that have been generalised. Stern an American psychoanalyst and developmental psychologist based his theories on the close and detailed observation of young children. He described RIGs as being a generalisation of situations the infant has experienced repeatedly, which go on to form part of the child’s sense of self. Even although they are generalizations, they have an emotional tone as do IWMs.

In addition, as stated earlier the relationship experiences between mother and child become generalized relationship models in the child, influencing the way they interact in key relationships. In the case of a securely attached child they go from a position that their needs are likely to be met in relationships.

Perhaps the next important development in attachment theory came when Ainsworth a Canadian psychologist joined Tavistock to work with Bowlby in 1950. She then left to conduct research into mother-child relationships in Uganda. She continued collaborating with Bowlby, even after later moving to Baltimore in the 1960s. She developed what is referred to as the “Strange Situation”, an observational method for assessing the nature of the infants’ bonding behaviors and styles.

This environmental assessment technique has the following stages: • Infants between the ages of one and two enter an unfamiliar environment together with their mothers. The room has toys scattered around.

• After approximately three minutes a stranger then joins them in the room.

• The mother leaves the child alone with the stranger, and after a few minutes returns.

• The stranger then leaves the room, and the mother leaves so leaving the infant alone.

• Then stranger re-enters the room and after a while the mother returns and the stranger leaves.

During the whole process the infant and mother’s behaviour is recorded behind a one-way mirror.

On the basis of Ainsworth’s initial system of behavioural rating, the child’s attachment style was assessed as being either secure, or insecure. Insecure attachment was in turn, divided into avoidant or ambivalent attachment styles.

Generally, children rated as being securely attached showed clear behavioral signs of distress when the mother was not present, but on the mothers’ return they sought comfort, were comforted and went back to playing and exploring. According to Ainsworth, they had internalized the figure of their mother as a ‘secure base’.

Details of the behaviors characterizing the four attachment styles are readily available. This focus of this paper is primarily on secure attachment and in a later paper I will address the other forms of attachment and their implications for psychopathology. Focusing here on secure attachment it has been linked to psychological health later in life.

What Aspects of Parental Interaction Encourages Secure Attachment in the Infant?

Bowlby initially focused on the impact of prolonged separation from the parent had on the young child. With time the focus of attachment theory has changed to examine how the parent’s behaviour had on the child and what about the parents’ behaviour is important in creating secure attachment in the young child?

Adult attachment styles has been researched and one of the most widely used measuring instruments in this field was constructed by Carol George, et al. [6] who produced the Adult Attachment Interview (AAI). It consists of a series of open-ended questions on the basis of which the adult was rated as falling into one of the following attachment categories: secure/ autonomous, dismissing, preoccupied and unresolved/disorganized. The AAI establishes the caretaker’s IWM, in other words their attachment style. Repeated studies subsequently, have shown a clear relationship between the parenting style and the infant’s attachment style.

Parents of children who were categorized as being securely attached in the Strange Situation, were generally in the ‘autonomous-secure’ category in the AAI. The autonomous/secure adults’ responses to the questions about their relationship past in the AAI were coherent and showed clearly that attachment was important for them. They were also able to demonstrate a degree of objectivity when describing past experiences regardless as to whether it placed them in a favorable or unfavorable light. When questioned about their childhood, they told of vivid memories framed in a coherent narrative. Coherence analysis was assessed by examining both the logic and understandability of the adult’s autobiographical narrative.

The importance of autobiographical memory and the integration of life events into a story of one’s life has been regularly established as an important aspect of mental well- being and is reflected in greater neural integration. It forms an important part of one’s sense of self [7].

What is interesting and of particular relevance to psychotherapists is that the caretaker could be rated as falling into the autonomous category in the AAI in spite of having had traumatic experiences in childhood, as long as the trauma had been consciously processed. This is sometimes referred to as ‘earned secure’.

However, in cases where the parents had not resolved early trauma, it impacted on their response to the infants emotional needs. When caregivers have experienced trauma which hasn’t been worked through (say in psychotherapy), their traumatic memories could be triggered in response to their infant’s needs and so influencing the nature of attachment and the IWM the child forms.

Work in the area of personality assessment has through factor analyses of multiple personality measuring instruments come up with what have been referred to as the ‘big five’ personality characteristics. The big five are: extraversion, agreeableness, conscientiousness and emotional stability and openness to experience [8]. These dimensions can be linked to attachment styles.

As stated earlier the relationship experiences between mother and child become generalized relationship models in the child, influencing the way they interact in key relationships. In the case of a securely attached child they go from a position that their needs are likely to be met in relationships. As Erikson [9] put forward in his theory, the child would have established a sense of basic trust in themselves and their world Through the parental empathy the child develops what is referred to as a ‘theory of mind’, the ability to understand the other person’s emotional state and perspective.

There are certain specific aspects of the parent’s behaviour that are important: predictability in their response to the child, empathic comforting responses, recognising and meeting the child’s needs.

Predictability in the caretaker’s response to the infant conveys to the infant that the world is predictable and safe and one in which one’s needs are taken seriously and met. The child is likely to build stable IWMs.

Empathic comforting on the part of the caretaker is likely to contribute to emotional regulation. In terms of IWM of the child who has their needs met and is comforted is likely to be able to regulate their emotions. In other words, the parental responses become internalized. This in essence requires the caretaker to be attuned to the needs and emotions of the infant. The interaction between caretaker and child initially takes place at a preverbal level and the caretaker through soothing sounds and physical closeness on the one hand brings the infant’s intense emotions into a manageable range and also stimulates positive emotions and these interactions, over time, becomes internalised in the child in the form of IWM. Schore [10] an affective neuroscientist and psychologist, describes the interaction between mother and child as follows:

“During the dynamic synchronized, reciprocal attachment transactions, the primary caregiver, at levels beneath conscious awareness, perceives (recognizes) appraises and regulates nonverbal expressions of the infant’s more and more intense states of positive and negative affective arousal. Via these communications, the mother regulates the infants postnatally developing central (CNS) and autonomic (ANS) nervous systems”.

Secure bonding between mother and infant results in positive self-esteem in toddlers aged three. The child’s level of self-esteem and integrated sense of self is reflected in an integrated autobiographical narrative [1].

The Neurobiology of Secure Attachment

Recently there has been a great deal of research into attachment styles and their impact on brain development. Not only does the dynamic between caretaker and infant impact on the child’s IWM but also affects the brain at a structural level Writers like Schore [10, 11] a leading neuropsychologist has researched and published work on how secure attachment and other forms of attachment influence the development of the brain. This new field of research has been referred to as interpersonal neurobiology. We now have a much clearer understanding of the interpersonal bonding has on brain development of the young child. Secure attachment results in optimal brain development.

In the case of secure attachment, the main finding is that there is neural integration of the three main brain areas as defined by McClean [12]: the reptilian brain, the paleomammalian and the neo-mammalian/neocortex. This integration is reflected in the individual’s ability to recount a coherent narrative of their lives.

As mentioned earlier, there are three characteristics of secure attachment: the capacity for emotional regulation, high levels of self-esteem and the ability to form satisfying relationships. Resilience is in part related to emotional regulation. Some studies showing the connections of secure attachment to brain development are highlighted.

Starting with emotional regulation, Schore [10] a neuropsychologist, describes the process on a neurological level as follows:

“During the dynamic synchronized, reciprocal attachment transactions, the primary caregiver, at levels beneath conscious awareness, perceives (recognizes) appraises and regulates nonverbal expressions of the infant’s more and more intense states of positive and negative affective arousal. Via these communications, the mother regulates the infants postnatally developing central (CNS) and autonomic (ANS) nervous systems” [10]. This mutual gazing between caretaker and infant activates facial processing in the right hemisphere [10, 11].

Secure attachment thus results in the development of a healthy limbic system as early bonding impacts on the myelination of this system.

Tops, Buisman-Pijman, et al. [13] outline the neural implications when parents meet the infants needs on a regular and predictable basis. They focus on the impact of secure attachment and the involvement of oxytocin vs the involvement of the dopamine system.

“These internal working models are formed and kept stable by slow learning, a specialization that is adaptive in predictable environment or context.”

What Hampers the Formation of Secure Attachment?

This complex topic will be addressed in detail in another paper; however, a brief mention is important. Not all children form secure attachment to their key caretaker. There are circumstances when secure attachment is not achieved. This can occur when the adult caretaker has unresolved traumatic memories which can be activated by the infant’s needs, or in extreme cases where the young child is exposed to sexual or physical abuse or neglect. Understanding the impact of abuse and neglect requires addressing the whole area of trauma and its impact both on the caretaker and the infant and its effects on brain structures.