ATTACHMENT THEORY

John Bowlby (and Mary Ainsworth)

Presentation By: Breana Draudt OBJECTIVES PURPOSE v Purpose of the theory development v Bowlby: To study attachment and and selection effects of deviations from v Historical context of authors and attachment theory v Draudt: To determine applicability of v Structural elements Attachment Theory to v Analysis using Barnum’s criteria v Utility to research and practice psychological well-being and v Applicability to psychology well being relationship quality in homeless and relationship quality in homeless adolescents adolescents JOHN BOWLBY

v February 26, 1907 to September 2, 1990 v 4th of 6 children; upper middle class family v Spent an average of 1 hour with his mother per day v Grieved the loss of one of his nannies v Father was a surgeon, encouraged Bowlby to attend medical school • Attended medical school and later became interested in psychiatry http://www.psicoterapiaintegrativa.com/ therapists/htms/John_Bowlby.htm v Said to be one of the top 4 most influential people in psychology this century MARY AINSWORTH

http://www.famouspsychologists.org/mary-ainsworth/ v December 1, 1913 to March 21, 1999 v Notable contributions to Attachment Theory v Studied bonding and attachment in Uganda before the formal presentation of Attachment Theory v Proposed some of the major concepts of Attachment Theory: Patterns of Attachment and Secure Base INFLUENCES: THEORIES v Control Systems Theory (“A control system is a means by which a variable quantity or set of variable quantities is made to conform to a prescribed norm;” the ability of one to control her environment (Waters)) v Dependency Theory (Learned drive, acquired through its association with the reduction of primary drive (Ainsworth)) Singer and Prebisch’s theory v Object-Relations Theory (“object” of an instinct is the agent through which the instinctual aim is achieved, and the agent is usually conceived as being another person” (Ainsworth)) Greenberg and Mitchell 1983 INFLUENCES: DISCIPLINES v Medicine: Bowlby’s father was a surgeon; Bowlby attended medical school v Ethology: Study of animal behavior. Heavily influenced by Harlow’s rhesus monkeys and Lorenz’s study of avian species v Psychology: Bowlby was educated in psychoanalysis after medical school. He believed that current psychoanalytic theory did not describe the bond between an infant and his/her parent

Patterns • Insecure • Secure Figures Functions • Maternal • Sensitivity Deprivation • Comfort

Behaviors Attached • Early Interaction Person Attachment • Internal Working Models

CONCEPTS ATTACHMENT

“ The dimension of the infant-caregiver relationship involving protection and security regulation. Within this theoretic framework, attachment is conceptualized as http://familymatters.vision.org/FamilyMatters/ an intense and enduring affectional bond that bid/36390/Beyond-Attachment-Theory the infant develops with the mother figure, a bond that is biologically rooted in the function of protection from danger”’ (Mooney, 2010) THE ATTACHMENT BEHAVIOURAL SYSTEM (HOLMES, 1993) ATTACHMENT BEHAVIORS

“Attachment behaviour […] refers to any of the various forms of behaviour that the person engages in from time to time to obtain and/or maintain a desired proximity” (Bowlby, 1988). “The condition in which an individual is linked emotionally with another person, usually, but not always, someone perceived to be older, stronger and wiser than themselves” (Holmes, 1993)

Examples: Crying, clinging, smiling, vocalizing http://www.lilomaternity.com/ blog/is-your-baby-crying/

THE EVOLUTION OF ATTACHMENT BEHAVIOR

Holmes, 1993)

INFANCY Babyhood Latency Adolescence Adulthood

• Maternal • Attachment • Relationship • Internal World • ‘thinking’ about Handling Pattern Style ‘thinking’ • Self-other representation ATTACHMENT PATTERNS v Secure Attachment: v Anxious Ambivalent: • Emotionally open and straight • Insecure forward • Show mixed emotions to caregiver when • Accept comfort and protection distressed from caregiver when distressed • Periods of helplessness and passivity, aggression, or fear • From available, predictable and • Explores surrounding but concerned with sensitive caregiving proximity v Anxious Avoidant: • From unpredictable/impulsive caregivers; neglect • Insecure • Suppress or hide negative emotions v Disorganized: • Avoid eye contact • Insecure • Use toys as distraction • Confusing mixture of conflicting-need to seek proximity vs. need to escape • From consistent distant, rejecting, punitive caregiving; emotional/ • May have abnormal body movements e.g. tics physical abuse • From prolonged isolation, neurological illness

VISUAL MODEL OF ATTACHMENT PATTERNS

http://internal.psychology.illinois.edu/~rcfraley/attachment.htm ATTACHMENT FUNCTIONS v Proximity Maintenance allows the person to stay close to and resist separation from the attachment figure v Safe Haven Behavior provides reliability on the attachment figure for support and comfort http://blog.lib.umn.edu/vanm0049/myblog/ 2011/12/attach-vs.-detach.html v A Secure Base is an environment provided by the attachment figure from which a child/adolescent can return knowing that he will be welcomed, nourished physically and emotionally, comforted and reassured. This allows for non-attachment behaviors such as exploration, which can allow an individual to learn things that may increase survival

OTHER CONCEPTS v Attachment Figure: one with whom another person (in the original context an infant/child) is attached v Maternal Depravation: Term from Bowbly’s earlier work describing the process of an infant losing or being deprived of its mother. v Early Interaction between infant and mother considered important for secure attachment. Ainsworth emphasizes interaction within the first 9 months of life v Sensitivity of the mother to her child’s needs; described as a parenting style that facilitates secure attachment; part of “secure base” v Comfort is the mother’s ability to soothe a distressed child; also part of “secure base” v Internal Working Models • From Cognitive Psychology • Higher animals need a map of the world in the brain to predict, control and manipulate their environment through thoughts • Environmental and organismal models that tell us about ourselves in relation to the world

DEVELOPMENTAL PATHWAYS FROM MATERNAL DEPRIVATION (HOLMES, 1993) ASSUMPTIONS/STATEMENTS v Assumptions not explicitly stated • Psychological bonds exist • Attachment Behaviors exist • Patterns of Attachment exist • Attachment Figures exist (usually mother) v Statement importance not prioritized explicitly • I interpreted some of the assumptions as existential statements (above) • Relationship statements among attachment, attachment behaviors, patterns of attachment, attachment figure, infant/child EVALUATION: INTERNAL CRITICISM v Clarity • concepts are difficult to discern, but overall clearly described • concepts are further separated into sub-concepts which are described several ways; no single definitions • the relationship between attachment and mental health are clearly explicated • Bowlby wrote the theory in a trilogy of lectures, a synthesis of information may that explains the theory parsimoniously is needed v Consistency • terms are used consistently • delineates terms that may be misunderstood or have been misunderstood • Attachment Theory has recently been applied to relationships other than parent/ child, which compromises consistency of original terms, meanings EVALUATION: INTERNAL CRITICISM v Adequacy • the theory fulfills it’s purpose • further refinement and clarification may be necessary (e.g. synthesis of information) • the subject matter is well accounted for v Logical Development • Developed from several theories and disciplines • Refined with input from Ainsworth and clarified in response to critique • In early development, the idea was radical and unproven; today extensive literature supports its premises • Conclusions seem logical, argument was considered overstated given the available evidence during the original development. v Level of Theory Development • Well developed through several revisions (in response to critique, misunderstandings) • Work continues to be done, specifically with measurement and expanding the applicability

EVALUATION: EXTERNAL CRITICISM v Reality Convergence • Attachment is needed for human development • Kettle suggests that attachment belongs in Maslow’s Hierarchy of Needs • Theory builds on existing work, very reality-based • Considered a middle-range theory (possibly high middle range given increasingly broader applicability) v Utility • Applied extensively to research and practice in psychology and outside of the discipline including social work, nursing v Significance • Mental illness is a significant problem • Although intent was not necessarily to be useful to nursing, Attachment Theory addresses a phenomenon experienced by nurses EVALUATION: EXTERNAL CRITICISM v Discrimination • borrowed from psychology, not unique to nursing; boundaries gray • nursing interventions can influence attachment behaviors, which clouds the boundaries v Scope: High middle range with “gushy” empirical testability and applicability • Ethics of true empirical testability; retrospective studies possible • Highly applied v Complexity • Relatively few concepts, well described although lacking concision • Factors influencing attachment are multidimensional and complex • Macro, Meso, Micro level factors • Mediators and Moderators discussed in later revisions

OTHER CRITICISM v Strongly focused on the maternal-infant bond • Inadequately describes paternal-infant bond • Implicitly blames mothers for children’s mental illness + takes responsibility away from fathers • Feminists objected to Bowlby’s use of biology “to justify what is essentially a cultural product of our own ‘patriarchal but father-absent’ society” Leupnitz (1988) v Nature vs. nurture • Too strongly accepts nurture are causative factor for mental illness • Does not account for genetic predisposition to mental illness v Mentions “attachment figures” but does not describe the differences in attachment between parents (particularly mothers) and other individuals to which one can be attached UTILITY IN RESEARCH AND PRACTICE Research Practice v Psychosomatic Illness v Guides clinical psychology • Chronic Pain v Applied to psychiatric mental health • Cardiovascular Disease and women and infants nursing v Relationships v Head start v Nurse-Patient relationship + Patient v Custody cases Outcomes (e.g. adherence) v v Child sexual abuse, child maltreatment Foster care v Extensive research in psychology • Developmental psychopathology • Cognitive Psychology • Psychoanalysis

NEWER AND FUTURE APPLICABILITY v May be more broadly applied with additional research studying attachment in situations other than parent/child • nurse/patient • adolescent peer • romantic couples • attachment and loss at end of life v Newly applied to psychosomatic illness

APPLICATION TO PRESENTER’S RESEARCH

-Bowlby studied homeless children and adolescents • Wrote a report on mental health in homeless children in post-war Europe for the World Health Organization (WHO) -Several researchers apply Attachment Theory to their research with homeless youth including Tavechhio, Taylor-Seehafer, and Whitbeck http://johma.org/who_we_serve

-Effective at providing a framework to understand psychological well being and relationship quality in relation to childhood attachment in homeless adolescents -New research leading to further applicability to peer relationships, which can also be applied to psychological well being and relationship quality in homeless adolescents References Ainsworth, M. (1969) Object Relations, Dependency, and Attachment: A Theoretical Review of the Infant-Mother Relationship. Child Development 40 969-1025 Alhusen, J. L. (2008). A literature update on maternal-fetal attachment. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(3), 315-328. doi: 10.1111/j.1552-6909.2008.00241.x Bowlby, J. (1977). The making and breaking of affectional bonds. I. aetiology and psychopathology in the light of attachment theory. an expanded version of the fiftieth maudsley lecture, delivered before the royal college of psychiatrists, 19 november 1976. The British Journal of Psychiatry, 130(3), 201-210. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books INC. Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment. Attachment Theory and Close Relationships, , 46-76. Bretherton, I. (1992). The origins of attachment theory: John bowlby and mary ainsworth. Developmental Psychology, 28(5), 759-75. Ciechanowski, P. S., Katon, W. J., Russo, J. E., & Walker, E. A. (2001). The patient-provider relationship: Attachment theory and adherence to treatment in diabetes. American Journal of Psychiatry, 158(1), 29-35. Crowell, J. A., Fraley, R. C., & Shaver, P. R. (2008). Measurement of individual differences in adolescent and adult attachment. Holmes, J. (1993). John bowlby and attachment theory. New York: Routledge. Klette, T. (2013). Attachment. In Peterson, S., Bredow, T. (Ed.), Middle range theories application to nursing research (3rd ed., pp. 160-170). PA: Lippincott Williams & Wilkins.

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