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Chapter 4 Insecure Attachment and Related Difficulties
Amanda Venta and Anna Abate
Chapter Overview
We will begin by introducing attachment theory in order to provide a lens through which to think about the other topics covered in this book. Attachment refers to a biologically based instinct to seek a caregiver when in need of safety, security, and/or comfort (Bowlby, 1960). Attachment theory is heavily influential in research related to child development, psychopathology, and treatment and is not exclusively related to one psychological disorder. Thus, in this chapter we will use the term attachment styles to describe categories of attachment behavior and avoid confusing them with specific disorders. After defining attachment styles, we will focus on how psychopathology relates to attachment styles and on the development of insecure attachments. Often, attachment issues and emerging psychopathology go hand‐in‐hand, making attachment theory a critical piece of developmental psychopathology.
Case study in attachment issues and behavioral difficulties
Ivan is a six‐year‐old Hispanic boy who lives with his grandparents. He first lived with his young mother who regularly used narcotics, left Ivan alone for long periods of time, and struggled to provide adequate food, water, and shelter for the family. Ivan was removed from the home by child welfare when he was three years old. His mother’s parental rights were terminated and his grandparents adopted him. Ivan currently has no contact with his mother. His grandparents have struggled with how to manage Ivan’s behavioral difficulties since they adopted him; he cries, yells loudly, breaks things when he is frustrated and behaves aggressively when they try to comfort him. Ivan’s grandparents also worry about his social development, noting that he has behavioral issues at school (e.g., tantrums) and tends to be rude and physically aggressive towards peers.
As the clinician seeing this family, what diagnoses would you consider? Discuss how Ivan’s early experiences with his mother might underlie his current difficulties and use this information to guide how you might intervene to treat Ivan’s behaviors.
Definition and Theoretical Underpinnings
John Bowlby originally put forth the idea that early in development, the emotional and physical needs of a baby, and whether those needs are consistently met by caregivers, inform the development of an internal working model (Bowlby, 1969, 1973)—a template we carry with us to make sense of ourselves and others. Attachment security emerges when the child’s needs are consistently met; his or her internal working model is one of him‐ or herself as worthy of care and others as reliable caregivers (Bretherton & Munholland, 2008). Attachment insecurity, on the other hand, is characterized by an internal working model of the self as unworthy of care and others as unreliable caregivers. Attachment behavior differs depending upon the caregiver’s behavior (see Figure 4.1) and development (see Figure 4.2).
FIGURE 4.1 Control Systems Model of the Attachment Behavioral System.
Source: Fraley and Speiker (2003a). Reproduced with permissions of American Psychological Association.
FIGURE 4.2 Ways in Which Attachment Manifests Behaviorally Across Development.
Source: Fraley and Speiker (2003a). Reproduced with permissions of American Psychological Association.
Mary Ainsworth, a student of John Bowlby, made a major contribution to attachment theory by developing the Strange Situation Paradigm (Ainsworth, Blehar, Waters, & Wall, 1978). In this paradigm, an infant (ages 12–20 months) and caregiver are together in an unfamiliar playroom and guided through separations and reunions. You can watch the Strange Situation in videos created by researchers (https://www.youtube.com/watch?feature=player_embedded&v=QTsewNrHUHU). By using this procedure, Ainsworth discovered four patterns of behavior, known as attachment styles (Ainsworth et al., 1978). A child with a secure attachment will use the caregiver as a safe base to explore but return to when distressed. This pattern of behaviors is thought to arise from consistent, sensitive caregiving. A child with an anxious‐resistant (or ambivalent) insecure attachment may demonstrate clingy behavior but will reject the attachment figure when they try to engage. This behavior is likely a response to unpredictable caregiving; the behavior of the child may be a strategy for maintaining the attention of the caregiver (e.g., Crittenden, 1999). A child with an anxious‐avoidant insecure attachment tends to be independent and ignore the caregiver during both separations and reunifications. This behavior is thought to emerge as a self‐protective strategy when attachment behavior has been rejected by the caregiver in the past. The fourth category, called disorganized attachment, refers to children that cannot be classified into one of the aforementioned