Attachment theory and the early years

Authored by Henry Strick van Linschoten

The early strands of attachment theory are based on a combination of Bowlby’s (1969) early views about attachment as a behavioural system and Ainsworth’s (Ainsworth, 1964; Ainsworth & Bell, 1970; Ainsworth et al., 1971; Ainsworth et al., 1978; Ainsworth & Wittig, 1969) inspired experiments with observing infants in an artificially constructed Strange Situation, in which they would twice be confronted with being separated from their primary caregiver, and their behavioural response was observed and scored.

Holmes defines attachment theory as “spatial” (2014:53). He proposes that the child feels good when close to the attachment figure, but sad, lonely, and anxious when far from that person. Attachment behaviours refer to any behaviour that achieves and maintain a state of proximity to a preferred person. Attachment styles are a more complex concept. There are three main attachment styles that were formulated by Mary Ainsworth in her early empirical research on the Strange Situation (Ainsworth, 1964; Ainsworth & Bell, 1970; Ainsworth et al., 1971; Ainsworth et al., 1978; Ainsworth & Wittig, 1969).

This experimental paradigm involves two brief separations between mother and her infant of about 8 to 12 months, and careful observation and analysis of the behaviour of the infant during the whole process. “Securely attached” infants display distress after separation, but approach the mother when she returns and allow themselves to be soothed. “Anxious/ambivalent” infants likewise become distressed after mother leaves and approach her when she returns, but appear clingy and unable to be comforted. “Avoidant” infants show no distress upon separation and consequently no interest in the mother when she returns. Anxious/ambivalent infants are understood to be “hyper activating” (Cassidy & Berlin, 1994) their attachment system because they perceive their caregivers as unpredictable and they have learnt that the only way to secure support is to amplify their distress. Avoidant infants, on the other hand, have no expectation that the caregiver will respond and they manage by “deactivating” or “hypo activating” the attachment system.

A fourth important category, “disorganised/disoriented” (often abbreviated to “disorganised”) infants, was added in later research: Main & Solomon (1986; 1990) wrote the first complete research reports; an overview of the history of this category since then can be found in Lyons-Ruth & Jacobvitz (2008). These children reacted in a different and more complicated way to the Strange Situation. In fact, they were often classified as “unclassifiable” in careful earlier protocols. The interpretation generally made is that their response was the result of having experienced severely abusive or neglectful caregivers and having likely been traumatised. Because they depend on the primary caregiver, the same person that is responsible for their distress, they exhibit considerable arousal when separated, but display a mixture of avoidance and approach when reunited, freezing, as well as other unusual behaviours. It is now standard, whenever possible, to extend the Strange Situation protocol with coding for all four categories.

The current state of developmental research has led to some refinement of Bowlby’s original formulations about the effects of maternal deprivation (Holmes, 2014). Holmes (2014) summarises evidence based on the report of Rutter (1981) that suggests a less direct relationship between maternal deprivation and later mental disorder or problems. Research tends to confirm that the period of six months to four years is critical in establishing the capacity to form secure attachments. It is the overall quality of the available support network for the child that determines the development of a secure base, regardless of who the primary caregiver is, the constitution of the parental couple, the presence of a single parent, the availability of grandparents, the provision of child minders and nurseries, and so forth (Rutter, 1981). Psychotherapists and psychologists sometimes assume an isomorphic relationship between the attachment to the therapist and the relationship with early figures, a view that, although widely endorsed, appears to be misleading. Holmes (2014) suggests that some of the central issues that manifest in therapy are around the child’s self-esteem and capacity to form supportive relationships. One of Bowlby’s points of emphasis is on vicious cycles that arise as a consequence of the individual’s experiences: if a person has not been given something, they are unlikely to know how to give it to their own children and are less likely to recognise relationships that can offer them what they need. Instead they are more likely to parent in a way that leads to the same deprivation they have experienced as a result of their own earlier attachment experiences. This is the foundation of interpersonal intergenerational trauma.

Implicit relational knowing is present from the first year of life, as evidenced by a number of developmental theories (Stern, 1985). Infants begin to demonstrate expectations related to their caregivers’ behaviour and are able to generalise these to other relational contexts. For example they show surprise when their expectations are violated. These expectations are the outcome of a series of tasks between infant and parent that lead to the development of an initial set of adaptive strategies. The dynamic systems perspective proposes the view that the infant’s mind operates on a self-organising principle, and unless there are external opposing forces, the infant will use all the information available to develop increasing complexity and coherence of representation. In clinical practice this is achieved when there is a moment when the interaction between client and therapist allows a new context and can be used by the client’s mind to reorganise existing patterns of implicit relational knowing. The occurrence in a moment of meeting can be detected by a sudden shift in implicit relational knowing for both participants. Stern et al. (1998:910)also use the notion of “moving along” in a manner similar to Lachmann & Beebe’s (1996) “ongoing regulation”.

The practical importance of therapist sensitivity to brief moments of heightened affective change (“moments of meeting” or “now moments”) has especially been studied by Stern and his colleagues on the Boston Change Process Study Group. This is reported in Stern et al. (1998) and Stern (2004). These processes very much partake of and are based on implicit relational knowing. This work, while using a different terminology, is clearly influenced and builds on attachment theory.

Bowlby (1969/1982; 1973; 1980) argued that the child’s attachment relationship to its primary caregivers sets down a series of interpersonal expectations that, although amenable to modification in later life, affect adolescent and adult relationship patterns to a considerable extent. Cognitive psychology from the 1970s onwards demonstrated that there are broadly speaking two types of memory, explicit or declarative (further divided into episodic and semantic) and implicit or procedural. Procedural memory is not accessible to consciousness because it is not encoded in verbal terms and is the primary type of memory until the child is at least three to four years of age. Internal Working Models (IWMs) can be understood to be procedural and non-verbal in nature, which suggests they are not amenable, at least not entirely, to insight. Instead, IWMs change through relational affective experiences with a suitably attuned other, such as a therapist.

Beebe & Lachmann (1988; 1994; 2005; 2014; Lachmann & Beebe, 1996) have elaborated a model of change that rests at the interface of relational/intersubjective psychoanalysis and attachment theory and has been articulated through research in developmental psychology. Psychotherapy allows the co-creation of healing relational contexts through the meeting of two subjectivities (an account of the relational psychoanalytic view of how this occurs can be found in Confer’s Relational Psychoanalysis study aid, included in the module of the same name). In Beebe & Lachmann’s account (1998) client and therapist regulate each other, although their contributions to the process are not equal. Self-regulation refers to an individual’s capacity to modulate their states of arousal, that is to self-comfort/self-sooth and organise one’s behaviour in predictable ways. Interactive regulation is seen as an ongoing process that is constructed moment-by-moment by the participants. Both client and therapist affect the process of interactive regulation based on their own capacities for self-regulation at the time that are specific both in style and range. Beebe & Lachmann note that concepts akin to interactive regulation have been articulated previously by both Stern (1971) and Tronick (1989). They do not see adult psychotherapy as consisting only of the process of interactive regulation, because it involves the adult’s capacity for symbolisation, and the elaboration of experience in terms of wishes, fantasies, and defences.

Lachmann & Beebe (1996) propose three principles of interactive regulation: “(O)ngoing regulations, disruption and repair of ongoing regulations, and heightened affective moments”. These forms of interactive regulation determine the management of attention, how client and therapist participate in dialogue, and how the client, and sometimes the therapist, share their feelings. The first two principles are based on second-by-second “microanalyses” of mother and infant in face-to-face interaction. In contrast, there is much less research on heightened affective moments; Lachmann & Beebe (1996) draw information from psychoanalytic insights of the second half of the 20th century to describe what these moments may look like.

Ongoing regulation involves the participants’ perceived capacity to influence and affect each other and their expectations about this capacity with this particular partner. These involve the rituals that take place in the beginning and ending of sessions, the participants’ subtle and more overt use of body language, including the rhythm, intonation, and prosody of voice. The client speaks about situations and their emotions while the therapist listens, describes, clarifies, and asks questions. Although this part of the process does not involve the use of more explicit techniques such as interpretation, it allows for the disconfirmation of interpersonal expectations of not being listened to, being rejected or misunderstood that form part of the client’s IWMs. As such they provide the basis for the internalisation of new representations of self and other. Ongoing self-regulation is therefore not secondary to interpretative or technique based work, but constitutes therapeutic action in itself.

Disruption / rupture and repair, also important concepts in relational psychotherapy, refer to violations of the participants’ expectations and the attempts involved in repairing these. The milder forms of disruption that can be repaired readily are an ordinary part of child development and ordinary therapy, although a therapist should not assume that even small disruptions can be experienced as such by this particular client. The origins of disruptions vary according to therapeutic models, but in attachment informed therapy they are considered to be the outcome of both participants’ actions. The aim of repair is to promote both verbal and non-verbal understanding for the client and to inform the therapist of the need to reconsider interventions, for example in terms of timing, pace, and tone. The outcome is also the establishment of more flexibility in the relationship, internalised by the client as a vehicle for expanding interpersonal expectations.

Heightened affective moments (Pine, 1981) refer to moments that involve a state of arousal associated with intense positive or negative affect and expressed through a range of body language resources. The outcome of the process following these can be an invaluable source for new learning as well as of (re-) traumatisation. Lachmann & Beebe (1996) offer numerous examples, such as the occurrence of silence and the use of humour.

The Strange Situation and its categorisation of attachment patterns is completely central to attachment theory. The work of Stern and colleagues, and of Beebe & Lachmann, are prime examples of later developments in ideas directly relevant to psychotherapeutic practice that were substantively influenced by attachment theory.