Attachment From A Clinical Perspective

Some pioneers John Bowlby founder of attachment theory, based on his investigation of mental health implications of children’s reactions to separation Mary Ainsworth investigated individual differences among infants in patterns of attachment Mary Main pioneered research on attachment in adults Peter Fonagy articulated the role of mentalizing in attachment Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Core functions of attachment safe haven provides a feeling of security (regulation of emotional distress and physiological arousal) secure base fosters exploration of the outer world and the inner world, including exploring the mind (mentalizing) Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Ainsworth’s Strange Situation Infant and mother brought into an unfamiliar but comfortable room filled with toys Stranger enters Mother departs, leaving infant with stranger and toys Mother returns, pausing to give the infant a chance to respond to her return Stranger leaves the room Mother leaves the infant alone in the room Mother returns Test: infant’s response to reunions with mother Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Patterns of infant attachment Secure reunites with mother after separation to regulate distress then confidently returns to play Avoidant seemingly indifferent to mother’s absence and return but unabated physiological arousal reflects attachment distress Resistant (Ambivalent) makes contact with mother but distress does not abate; clingy and frustrated Disorganized no stable attachment strategy; fright without solution Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment relationships beyond infancy Parents Siblings Extended family Friendships Romantic relationships Teachers/mentors Clergy Therapists Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment as a model for relationship with self Secure confident in self-concern, understanding, and compassion (mentalizing, with the freedom to think and feel) Avoidant self-neglect; lack of attunement to self; dismissing attitude toward problems and distress Ambivalent abusive relationship; self-hating; frustrated with self Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Patterns of adult attachment Secure confident in the physical and emotional availability of the attachment figure Dismissing (avoidant) lack of reliance on attachment to regulate distress; counterdependent; turn down the dial on attachment Preoccupied (entangled) intense attachments characterized by feeling deprived and frustrated; turn up the dial on attachment; “kick and cling” Fearful (disorganized) no workable attachments; isolated and fearful Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Defining mentalizing Attending to mental states in self and others Holding mind in mind Holding heart and mind in heart and mind Mindfulness of mind Understanding misunderstanding Seeing oneself from the outside and others from the inside Knowing how your mind works Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Intergenerational transmission: Overview parental security of attachment ↔ parental mentalizing capacity mind-minded interactions with infant infant secure attachment (comfort seeking) enhanced mentalizing capacity in childhood Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment trauma Trauma that occurs in an attachment relationship, in childhood or adulthood Trauma that adversely affects the capacity for secure attachment (e.g., evokes fear, distrust, expectation of betrayal)—abuse and neglect, primarily Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Intergenerational transmission of trauma parental attachment insecurity ↔ impaired parental mentalizing capacity non-mentalizing interactions with infant infant attachment insecurity impaired mentalizing capacity in childhood Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Psychotherapy from an attachment perspective John Bowlby: the role of the psychotherapist is “to provide the patient with a secure base from which he can explore the various unhappy and painful aspects of his life, past and present, many of which he finds it difficult or perhaps impossible to think about and reconsider without a trusted companion to provide support, encouragement, sympathy, and, on occasion, guidance.” (a secure base) Jon Allen: “The mind can be a scary place.” Patient: “Yes, and you wouldn’t want to go in there alone!” Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment and mentalizing in hospital treatment Therapeutic alliance: active collaboration based on trust in the staff’s commitment to helping and a feeling of acceptance Safe haven: sense of safety in the milieu Secure base: climate conducive to exploration Mentalizing stance: exploring mental states in self and others with an attitude of: inquisitiveness curiosity open-mindedness compassion Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment and hope Hope is based on belief in some benevolent disposition toward yourself somewhere in the universe, conveyed by a caring person. —Paul Pruyser It has been shown over and over again that if the encouragement is dogged enough—and the support equally committed and passionate—the endangered one can nearly always be saved…It may require on the part of friends, lovers, family, admirers, an almost religious devotion to persuade the sufferers of life’s worth, which is so often in conflict with a sense of their own worthlessness, but such devotion has prevented countless suicides. —William Styron Copyright © 2008 The Menninger Clinic. MenningerClinic.com – 800-351-9058

Attachment From A Clinical Perspective

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