Attachment in Adolescence: An

Agenda for Research and Intervention

Ronald Jay Werner-Wilson, Ph.D.

based on Material from
Developmental-Systemic Family
Therapy with Adolescents
(Werner-Wilson, 2001)
Reference
A version of this material was published as

Werner-Wilson, R. J. & Davenport, B. R.
(2003). Distinguishing between
conceptualizations of attachment: Clinical
implications in marriage and family
therapy. Contemporary Family Therapy,
25, 179-193.
Introduction
Attachments lie at the heart of family life. They
create bonds that can provide care and
protection across the life cycle (Ainsworth, 1991),
and can evoke the most intense emotions - joy in
the making, anguish in the breaking - or create
problems if they become insecure (Byng-Hall,
1995, p. 45).
Conceptual Confusion about Attachment
The word "attachment" is used casually and by
professionals in a variety of ways that can
create conceptual confusion.
It is a term that is used casually to refer to a
general level of affection.
Professional Uses:
DSM: Reactive Attachment Disorder (a/k/a
attachment disorder)
Influence of John Bowlby:
Attachment in children
Adult nuclear family attachment
Adult romantic attachment
Clinical Conceptualization of
Attachment
Common Clinical Usage
Attachment disorder has become a popular
clinical diagnosis for children.
Attachment disorder is described in ways that
suggests it is a trait of the child.
These seriously disturbed children have
difficulty forming attachments even when
placed in good foster and adoptive homes
(Booth & Wark, 2001, p. 5).
Children are often described as incapable of
forming attachment bonds.
Diagnostic and Statistical Manual of
Mental Disorders
Clinical use of the term attachment seems to be
associated with the DSM diagnosis Reactive
Attachment Disorder.
Some clinicians also seem to adopt some
aspects of disorganized attachment.
Reactive Attachment Disorder of Infancy or
Early Childhood is described in DSM as a
[m]arkedly disturbed and developmentally
inappropriate social relatedness in most
contexts, beginning before age 5 years
Reactive attachment disorder is
demonstrated by either ...
persistent failure to initiate or respond in a
developmentally appropriate fashion to most
social interactions, as manifest by excessively
inhibited, hypervigilent, or highly ambivalent and
contradictory responses
or diffuse attachments as manifest by
indiscriminate sociability with marked inability to
exhibit appropriate selective attachments (e.g.,
excessive familiarity with relative strangers )
(DSM-IV-TR Quick Reference, pp. 78-79).
Characteristics of Reactive Attachment
Disorder
According to DSM, reactive attachment disorder
is associated with at least one of the following:
persistent disregard for basic emotional
needs;
persistent disregard for basic physical needs;
repeated changes of primary caregiver (DSM-
IV-TR Quick Reference, p. 79).
Reactive Attachment Disorder:
Epidemiology
No studies have been conducted to establish
prevalence, incidence, or natural course.
DSM simply states that it is very uncommon.
Some have inferred prevalence from child
maltreatment statistics, but these are unreliable.
Abuse or neglect does not automatically
produce Reactive Attachment Disorder.
Treatment of Attachment Disorder
(from Hanson & Spratt, 2000)
Assumption: child has repressed rage which
interferes with ability to form an attachment.
Clinical intervention: help child release her/his rage
and teach child that parents can and will be in
control.
Parents may be told that this is the only way to
keep their child from becoming a serial killer,
murderer, or psychopath (p. 142).
Parents may be told that conventional treatments
will not work for their child.
Treatment includes Gestalt-type enacting and
fighting with the childs birth mother.
Holding Therapy
Also referred to as attachment or rage reduction
therapy.
Confrontational model that uses coercive
techniques to provoke emotional responses in
the diagnosed child.
Three Primary Treatment Components
Prolonged restraint for purpose other than
protection.
Prolonged noxious stimulation (e.g., tickling,
poking ribs).
Interference with bodily functions.
Concern about Treatment
This restraining is not related to childs immediate
behavior, and the procedure may be repeated daily.
During the restraining period, the clinician actively
attempts to provoke and arouse the child by
providing noxious stimulation such as yelling in the
childs face, poking or tapping the child, tickling, or
pulling on limbs. The child may try to resist by
screaming, fighting, or crying but eventually breaks
down. When the child reaches the point of
surrender, he is then given to his caregiver(s), to
whom he reportedly instantly attaches (Hanson &
Spratt, 2000, p. 142)
Research on Treatment of Reactive
Attachment Disorder
Hanson and Spratt (2000) recently completed a
review of Reactive Attachment Disorder because of
concerns about the emergence of novel treatments
that lack a sound theoretical basis or empirical
support, and may potentially be traumatizing and
harmful to the child.
Diagnosis is complicated by the fact that
frequently there are comorbid mental health,
medical, and developmental conditions that need
to be assessed and treated.
No treatments put forth for the disorder have
been empirically examined for safety or
effectiveness (p. 137).
Major Concern with Holding Therapy
(Hanson & Spratt, 2000)
Child clients are particularly vulnerable, especially if they
have severe abuse or neglect histories.
Attachment /Holding therapy could be traumatic.
Although proponents of attachment contend that it has
been misrepresented (e.g., they suggest that it is also
nurturing and sensitive), effectiveness seems to be
based on anecdotal testimonials from parents.
[T]he fact remains that there is simply no empirical
evidence at present to support the assertion that
attachment therapy is more effective, or even as
effective, compared to accepted and conventional
approaches (p. 142).
Attachment Conceptualizations
Associated with Bowlby
Areas of Investigation
Attachment in Children (measured via the
strange situation and in-home observations)
Adult Nuclear Family Attachment (measured by
the adult attachment interview)
Adult Romantic Attachment (measured using
several self-report techniques)
An Evolutionary Perspective
Proximity to parents facilitates protection of
children.
Infants are predisposed to seek proximity during
distress.
Attachment, therefore, contributes to
evolutionary survival.
Within this framework, attachment is
considered a normal and healthy characteristic
of humans throughout the lifespan, rather than a
sign of immaturity that needs to be outgrown
(Cassidy, 1999, p. 5).
Attachment is not
imprinting
a fixed characteristic or attribute
adolescents demonstrate different attachment
styles with different caregivers
attachment style may change throughout
development
Attachment
describes an emotional bond.
describes a set of behaviors that influence
relationships.
is only one feature of the parent-adolescent
relationship.
occurs in all children and youth.
style is based on an internal working model (set
of expectations about relationships).
Behavioral Systems that Influence
Attachment
Attachment Behavioral System
Repertoire of attachment behaviors.
Promotes proximity to caregiver.
Attachment occurs even when physical
needs are not met or the child is abused.
The attachment behavioral system is a
goal-corrected system that is flexible.
Exploratory Behavioral System
Promotes survival because curiosity helps
adolescent children learn about and adapt
to their environment.
This system reduces attachment behavior.
Behavioral Systems (cont.)
Fear Behavioral System
Promotes safety.
Engages the attachment system.
The Caregiving System
Parent repertoire of behaviors that are
engaged to respond to attachment-seeking in
children.
Like other systems, it is activated by internal
and external cues.
Behavioral Systems (cont.)
The Sociable System
[T]he organization of the biologically based,
survival-promoting tendency to be sociable
with others (Cassidy, 1999, p. 9).
This system is different from the attachment
system.
The Attachment Bond
Attachment bond refers to an affectional tie: this
bond is not between two people; it is instead a
bond that one individual has to another
individual who is perceived as stronger and
wiser A person can be attached to a person
who is not in turn attached to him or her
(Cassidy, 1999, p. 12).
The attachment bond cannot be inferred from
the presence or absence of attachment
behavior.
Propositions About Attachment Bond
(from Cassidy, 1999)
The attachment bond is only one feature of a
parent-child relationship. Caregivers also serve
as playmates, teachers, and disciplinarians.
Children experience multiple attachments but
the quality of the attachment bond is not the
same in each relationship. The quality of the
bond is influenced by amount of interaction,
quality of care provided, and emotional
investment of the caregiver.
Early Attachment and Later Development
(Thompson, 1999)
There seems to be a modest relationship
between early attachment and later outcomes.
Influence of attachment seems to be more
contingent and provisional than earlier
expected (Thompson, 1999, p. 280).
Intervening events seem to moderate influence
of attachment.
Thompson reminds us that attachment is only
one dimension of the parent-child relationship.
He noted that Bowlby recognized this as well.
Internal Working Models
Experiences with caregivers influence expectations
about future relationships.
Working models seem to be based on a network of
developing representations that emerge
successively but interactively with age (from
Thompson, 1998).
Early representations provide important information
but they are fairly simplistic and probably do not
provide the conceptual foundation for the
sophisticated and complex representations of self
and relationships in other years (Thompson, 1999,
pp. 267-268).
Representational Systems
Four interrelated conscious and unconscious
representational systems seem to influence internal
working models:
Social expectations about caregivers developed
during the first year are subsequently elaborated.
Event representations: beginning in the third year,
general and specific memories about attachment
experiences are stored.
Beginning at age four, individuals begin to create
their own narratives and self-understandings about
self and relationships.
Beginning in the third and fourth years, the individual
begins to form conclusions about characteristics of
others and relationship expectations.
Significance of Developmental
Processes on Attachment
Working models are continuously revised and
updated throughout development
[T]heir impact on a childs psychosocial
functioning at any particular age may depend
on the security of the representations that are
developed at that particular time (Thompson,
1999, p. 268).
[D]ifferent facets of working models (e.g.,
social expectations, autobiographical
memory) have not only different
developmental timetables but perhaps also
different periods of critical influence.
Significance of Developmental
Processes on Attachment (cont.)
Caregivers not only influence attachment by the
quality of care they provide but also by the
interpretation of that care because their
interpretation may be adopted by the child.
Thompson (1999) concludes that, for these
reasons, it is important to consider working
models in a developmental context in order to
understand them as a source of developmental
continuity.
Multiple Attachments
Children form more than one attachment and
strength of attachment seems to be influenced
by the extent to which the caregiver provides
sensitive care.
The potential number of attachment figures is
not limitless.
Although children have multiple attachment
figures, they do not treat all attachment figures
as equivalent.
Individual Differences
Although there is a biological basis for attachment
and all children become attached (even to abusive
parents), not all children become securely attached.
Secure attachment occurs when a child has a
mental representation of the attachment figure as
available and responsive when needed. Infants are
considered insecurely attached when they lack such
a representation (Cassidy, 1999, p. 7).
Influences on Attachment
Context
Emotion
Cognition
Attachment: The Role of Emotion
Intense emotions are associated with the
formation, the maintenance, the disruption, and
the renewal of attachment relationships
(Cassidy, 1999, p. 6).
Emotions contribute to motivation to seek
attachment.
Attachment: The Role of Cognition
Children learn to use specific attachment
behaviors with specific people in specific
situations.
Children develop internal working models that
help them anticipate the future.
Attachment: The Role of Context
Activation of the attachment behavioral system
is influenced by
conditions in the child
conditions in the environment.
In sum, proximity seeking is activated when the
infant receives information (from both internal
and external sources) that a goal (the desired
distance from the mother) is exceeded. It
remains activated until the goal is achieved, and
then it stops (Cassidy, 1999, p. 6).
Family as a Secure Base
Definition: a family that provides a reliable and
readily available network of attachment
relationships, and appropriate caregivers, from
which all members of the family are able to feel
sufficiently secure to explore their potential
(Byng-Hall, 1999, p. 627).
Factors Associated With a Secure Family
Base
There is a shared awareness that attachment
relationships are important and care for others is
a priority in the family.
Family members should support one another in
providing care for each other.
Factors that Undermine a Secure Base in
Families
Fear of losing an attachment figure or actual loss of
an attachment figure.
A child clings to one caregiver and rejects
relationships with other caregivers. Byng-Hall refers
to this as capturing an attachment figure.
Turning to an inappropriate attachment figure (i.e., if
one parent is not supporting the other parent, a child
may be used as an attachment figure).
Abusive relationships.
Negative self-fulfilling prophecies: there is an
expectation that losses from other generations will
be repeated.
Attachment in Adolescence
Research is increasingly showing that
adolescent autonomy is most easily established
not at the expense of attachment relationships
with parents but against a backdrop of secure
relationships that are likely to endure well
beyond adolescence (Allen & Land, 1999, p.
319).
During adolescence, attachment relationships
are gradually transferred to peers.
Problems Associated with Adolescent
Attachment
Caregivers may interpret individuation efforts as a threat
to their relationship with their adolescent children.
Insecurely attached adolescents and their parents may
become overwhelmed by affect associated with
individuation which, in turn, contributes to conflict.
Insecurely attached adolescents may become easily
frustrated because they do not expect to be heard or
understood by their parents.
Caregiver seems to demonstrate more rejecting
behaviors toward adolescent.
Adolescent demonstrates more anger at home than in
the other settings.
Play (exploratory) behavior seems to serve as a
distraction from attachment needs.
Attachment Styles in Children
Avoidant
Resistant or Ambivalent
Disorganized/Disoriented
Secure
Avoidant Attachment
Characteristics of Avoidant Attachment
Avoidant attachment is associated with a high
degree of physiological arousal.
Adolescent engages in behaviors to distract or
soothe her/himself in response to stress or
anxiety.
Internal working model: caregiver is
unresponsive and rejecting.
Adolescent appears to avoid interacting with
parent and acts indifferent.
Characteristics of Avoidant Attachment
(cont.)
Caregiver seems to respond negatively to the
adolescents attempts to make contact: the
caregiver withdraws when the adolescent is sad.
Caregiver seems to demonstrate more rejecting
behaviors toward adolescent.
Adolescent demonstrates more anger at home
than in the other settings.
Play (exploratory) behavior seems to serve as a
distraction from attachment needs.
Presenting Problems Associated with
Avoidant Attachment
Withdrawal as a coping behavior may lead to
social isolation. Adolescent may run away from
home.
Soothing behavior may lead to substance abuse
as a way to self-medicate.
Irritability may be mis-diagnosed as Conduct
Disorder.
Avoidant child is likely to engage in delinquent
activities.
Distraction attempts that rely on stimulation may
be may be mis-diagnosed as ADD/ADHD.
Treatment Implications for Avoidant
Attachment
Adolescent may respond in aggressive or
antagonistic ways toward therapists and other
authority figures.
Assess parenting style. Promote
authoritative/democratic parenting.
Interventions that are experienced by adolescent as
punitive may provide confirmation to the adolescent
of an internal working model based on rejection.
Consequences or structuring interventions should
include attempts to validate and nurture.
Resistant or Ambivalent Attachment
Characteristics of Resistant or
Ambivalent Attachment
Consistent with enmeshed relationships.
Adolescent does not seem to be soothed by the
presence of her/his caregiver and may appear
angry or passive.
Caregiver seems committed to the task of
nurturing but is often emotionally unavailable.
Caregiver seems to be preoccupied with past
relationship experiences and may appear angry.
Characteristics of Resistant or
Ambivalent Attachment (cont.)
Internal working model of adolescent: caregiver
is capable of responding if s/he is persistent at
seeking attention.
Some children may take care of their parent as
a way to foster interaction. This may, according
to Byng-Hall (1995), contribute to parentification
of child.
Presenting Problems Associated with
Ambivalent Attachment
Adolescent may be more susceptible to peer
pressure because of desire for closeness.
Conversely, some adolescents may become
socially isolated if
they are recruited into the role of parentified
child
their relationship with a parent is enmeshed
Separation anxiety disorder, generalized anxiety
disorder, social phobia, and obsessive-
compulsive disorder may be associated with
ambivalent attachment
Treatment Implications for Ambivalent
Attachment
Assess caregiver responsiveness and help
parents who are preoccupied with past
relationships to focus on present needs of
children.
Create a context for independent decision-
making for adolescent.
Promote peer relationships based on mutuality.
Disorganized/Disoriented Attachment
Characteristics of Disorganized/Disoriented
Attachment
Research suggests that a significant number of
children (as many as 80%) who are maltreated
can be classified in this category.
Caregiver seems frightened by the memory of
past trauma which may promote momentary
disassociation.
Caregiver seems to be scripting child into past
trauma (Byng-Hall, 1995).
Presenting Problems Associated with
Disorganized/Disoriented Attachment
Adolescent may engage in bizarre or socially-
inappropriate behavior.
Adolescents who are maltreated may mistreat
other youth.
In cases of maltreatment, adolescents may run
away from home. (Note: avoidant adolescents
also run away but for different reasons.)
Treatment Implications for
Disorganized/Disoriented Attachment
Adolescents who seem to demonstrate Post
Traumatic Stress Disorder should be assessed
for disorganized/disoriented attachment.
Adolescents who abuse other youth should be
assessed for disorganized/disoriented
attachment.
Cultivation of trust is a necessary first step in
treatment.
Secure Attachment
Characteristics of Secure Attachment
Communication between caregiver and
adolescent seems to be warm and sensitive.
Adolescent does not seem afraid to express
anger.
Caregiver permits age-appropriate autonomy
and exploration.
Caregiver seems to have a coherent view of
attachment and recognizes that it is important to
the adolescent.
Caregiver and adolescent seem to have fun
interacting.
Promoting Secure Attachment
Promote communication that includes empathy
and validation.
Help families that are conflict-avoidant or
conflict-habituated to express anger in non-
destructive ways.
Help parents recognize importance of
attachment.
Encourage parents to engage in activities that
are fun.
Help parents recognize typical aspects of
adolescent development.
Adult Nuclear Family Attachment
Measurement of Adult Attachment
Research on attachment styles in children
inspired investigation of attachment styles in
adults.
An Adult Attachment Interview (AAI; George,
Kaplan, & Main, 1984) was developed to
assess attachment styles in adults and has
been revised three times.
Adult Attachment Interview Process
During the AAI, the participant is asked to provide five
adjectives that describe each parent and an example
of an episode that illustrates each adjective.
Interviewers inquire about the following:
how caregivers responded to them when s/he
was upset;
whether caregiver threatened her/him;
whether s/he felt rejected;
explanation for caregivers behavior;
affect of these childhood experiences on her/his
adult personality
Coding Adult Attachment Interview
The responses are evaluated on two
dimensions.
The first dimension is coherence. Coherence
refers to answers that
provide a clear and convincing description;
are truthful, succinct, and complete;
are presented in a clear and orderly manner.
The second dimension is the ability to reflect
on the motives of others.
The attachment of participants children can be
predicted from these interviews.
Adult Nuclear Family Attachment Styles
Dismissing
Preoccupied
Unresolved/Disorganized
Secure/Autonomous
Dismissing Adult Attachment.
Responses on the AAI are not coherent: adjectives used
to describe caregivers are usually positive but
descriptions either do not support the positive adjective
or actively contradict it.
The person seems to be dismissive about the
importance of attachment.
This type of adult attachment promotes avoidant
attachment in children. The shared parent/child
attachment strategy is to maintain distance in order to
reduce the likelihood of emotional outbursts that might
lead to rejections. The price is a loss of sensitive care
for the child when it is needed (Byng-Hall, 1995,p. 50).
Preoccupied Adult Attachment
Response on the AAI are not coherent:
descriptions of adjectives include vague
references.
The person seems to be preoccupied with past
relationship experiences and may appear angry.
As a result, boundaries in the family become
blurred.
This type of adult attachment promotes resistant
or ambivalent attachment in children. There is
a great deal of mutual monitoring and mind
reading, all in an attempt to forestall any
potential drifting away on the part of either the
parent or the child (Byng-Hall, 1995, p. 50).
Unresolved/Disorganized Adult
Attachment
This person seems frightened by the memory of
past trauma which may promote momentary
disassociation.
Responses on the AAI about topics that deal
with loss or abuse are incoherent.
Other responses are consistent with the other
categories.
This type of adult attachment promotes
disorganized/disoriented attachment in children.
Unresolved/Disorganized Adult
Attachment (cont.)
The general impression is that the parent does
not have the child in mind at all but, rather, is
scripting the child into some past drama As the
children grow older, overall strategies do seem to
evolve. They either become more controlling of
the parent, often in a punitive way, or they become
caretaking of their parents (Byng-Hall, 1995).
Secure/Autonomous Adult Attachment
Research using the AAI suggests that
caregivers seem to be able to respond
appropriately to children if they can make sense
of their own childhood experience and are able
to understand the motives of others.
This seems to facilitate secure attachment in
their children.
As a caregiver, the person seems to recognize
that attachment is important.
This type of attachment promotes secure
attachment in children.
Adult Romantic Attachment
Attachment to Contemporary Peers
and/or Romantic Partners
Assumption: romantic love is fundamentally an
attachment process through which affectional
bonds are formed (Simpson & Rholes, 1998, p.
6).
Measurement relies primarily on self-report
instruments to assess perception of current
relationship experiences with peers or romantic
partners.
Conceptual Distinction Between Types of
Adult Attachment
Research suggests that there is limited
correspondence between AAI and measures of
adult romantic attachment.
Simpson & Rholes suggest that lack of
correspondence should not be surprising
because they measure different dimensions of
attachment: the two traditions should provide
unique information about an individuals
attachment history in different kinds of
relationships experienced at different points in
time (1998, p. 6; emphasis added).
Conceptual Distinctions (cont.)
Important distinction to amplify: the AAI
measures perception of relationship with parents
to predict caregiving while measures or
peer/romantic attachment assess contemporary
relationships with other adults.
Methodological issue: different forms of
measurement (e.g., self-report versus
observational) do not often correspond because
they seem to measure different perceptions
(e.g., insider versus outsider views).
The Peer/Romantic Partner Tradition
Conceptualization of attachment as a continuous rather
than a categorical variable.
Identification of two forms of avoidant attachment in
adult romantic relationships was a divergence from
nuclear family tradition.
Two dimensions: distinctions are based on view of self
and others (see Table 1):
Secure: positive view of self and others.
Preoccupied: negative self views and positive (yet
apprehensive) views of others.
Fearful-avoidant: negative views of self and others.
Dismissing-avoidant: positive self views but negative
views of others.
Table 1
MODEL OF SELF
(Dependence)
Positive
(Low)
Negative
(High)
Positive
(Low)
SECURE
Comfortable with
intimacy and
autonomy
PREOCCUPIED
Preoccupied (Main)
Ambivalent (Hazan)
Overly dependent
MODEL OF
OTHER
(Avoidance)
Negative
(High)
DISMISSING
Denial of attachment
Dismissing (Main)
Counterdependent
FEARFUL
Fear of attachment
Avoidant (Hazan)
Socially avoidant
Correspondence between Types of
Attachment
Correspondence Between Attachment
Styles
Child Attachment
Style
Adult Parenting
Attachment Style
(AAI)
Adult Romantic
Attachment Style
Couple and
Family
Relationship
Characteristics
Secure: limited
distress;
continued
exploration after
initial reunion
Secure: dev.-
approp. interac.;
recognizes sig. of
attachment; parent
is sensitively
responsive to child
Autonomous/
Free
Flexible distance
regulation;
adaptable
interaction styles;
shared initiation for
contact.
Avoidant: child
appears indifferent
Dismissing:
dismissive about
attachment;
withdrawn and
rejecting parent
style
Avoidant Distant and
withdrawn;
disengaged
interactions;
avoidance of
emotional or
physical closeness
Correspondence Between Attachment
Styles
Child
Attachment Style
Adult Parenting
Attachment Style
(AAI)
Adult Romantic
Attachment Style
Couple and
Family
Relationship
Characteristics
Resistant or
Ambivalent: child
appears
distressed,
preoccupied with
caregiver &
clingy
Preoccupied:
recognizes sig. of
attachment, but
preoccupied with
past; parent
appears angry;
parent is
intermittently
available
Ambivalent/
Preoccupied
Overly close and
intrusive
relationships;
enmeshed; mutual
monitoring;
blurred
boundaries and
role reversal
Correspondence Between Attachment
Styles
Child
Attachment Style
Adult Parenting
Attachment Style
(AAI)
Adult Romantic
Attachment Style
Couple and
Family
Relationship
Characteristics
Disorganized/
Disoriented:
difficult to
categorize
reunion
experience (80%
of maltreated
youth)
Unresolved/
Disorganized:
frightened by
memory of past
trauma promotes
momentary
dissassociation;
scripts child into
past drama
No common
interaction
strategies, but
could include
approach-
avoidance conflict
style; disoriented
interactions;
dissociation.
Research Agenda
Research on Adolescent Attachment
Maintain conceptual clarity about research topic.
Identify measures for data collection that are
consistent with conceptualization of attachment.
Investigate interrelationship between types of
attachment.
Investigate individual differences associated
with various aspects of adolescent development
(e.g., emotional development, cognitive
development, identity development).
Self-Report Assessment of Attachment
The Inventory of Parent and Peer Attachment
(IPPA) is a self-report measure of attachment for
adolescents that is both exceptionally reliable and
valid.
It includes three 25-item scales that measure
attachment to mother, father, and close friends.
It uses subscales rather than classification
categories that measure trust, communication,
and alienation.
The IPPA and coding instructions are available
for free from Mark T. Greenberg
(mxg47@psu.edu).
Intervention Agenda
Attachment Disorder Intervention
(Hanson & Spratt, 2000)
Identify insecurely attached children at an early
age.
Promote a nurturing and secure environment.
Promote developmentally appropriate parenting
skills.
Focus on childs and families coping rather than
inferred or vague pathologies (p. 143).
Maintain child in the least restrictive and least
intrusive level of care (p. 143).
Age Appropriate Autonomy and
Exploration
Assess attachment styles from Bowlby tradition.
Develop interventions that are sensitive to the
internal working model associated with attachment
style.
Help Parents and Adolescents Recognize Typical
Aspects of Development Throughout Adolescence
Relevant developmental themes:
Cognitive development
Emotional development
Identity development
Self-esteem
Task: Provide a Secure Therapeutic Base
for the Family
This is similar to the idea in object relations
family therapy of developing a safe container
for therapy.
Byng-Hall suggests that the therapist will serve
as an attachment figure to family members.
As a result, we should be regularly available to
our clients throughout their clinical experience
and communicate to them that we will continue
to be available to them in the future.
Task: Work With Current Significant
Relationships
Byng-Hall suggests that it may be helpful to
normalize attachment difficulties.
Attachment theory can offer explanations that
are clear to both therapist and family, and that
make sense out of what may be otherwise
perplexing. a child who is angry, demanding,
and controlling is often seen as intentionally
bad, but the child can be seen in a different light
if described as insecure and trying to make sure
he or she is in the parents minds when he or
she feels unloved and unlovable (1999, p. 636).
Task: Work With Current Significant
Relationships (cont.)
In addition to providing reframes, Byng-Hall
contends that we should attend to significant
relationships by promoting more coherent
narratives for the family. Narrative therapy
techniques would be particularly helpful.
Two other types of problems that relate to
current significant relationships may require
attention: distance conflicts and power battles.
Structural techniques may helpful for these
problems.
Task: Explore Relationship Between
Family Members and Therapist
Therapists become part of the family system during
therapy so we should pay attention to our influence.
Feeling understood is crucial to family members
establishing secure attachments to the therapist
(Byng-Hall, 1999, p. 636).
Since therapists may be seen as attachment
figures, an experiential approach to therapy may
help us address these issues.
Augustus Napier and Carl Whitakers The Family
Crucible should be mandatory reading for anyone
interested in incorporating attachment theory into
their clinical work.
Task: Review and Evaluate Influence of
Past Relationships on Current Ones
Exploring the connections between stories of
what happened in past generations and what is
happening now in the session can help the
therapist and the family members to elucidate
what comes from the past, and the to assess
whether or not behaving in old ways is helpful
now (Byng-Hall, 1999, p. 639).
This is similar to Murray Bowens
recommendation to embrace family history in
order to promote differentiation.
Narrative and symbolic experiential therapies
could also be used to help evaluate these
relationship patterns.