Attachment Theory and Its Relevance to Adolescent Psychopathology

Clinical Psychology and Psychotherapy
Clin. Psychol. Psychother. 8, 15–32 (2001)
Attachment Theory in Adolescence
and its Relevance to
Developmental Psychopathology
Lucy Scott Brown1* and John Wright2
1
Child and Adolescent Mental Health Service, St. George’s Hospital,
London, UK
2
Adolescent Department, Tavistock Clinic/Northgate Junior Adolescent Unit,
London, UK
The relationship between the quality of early attachment and later
psychological adaptation is frequently emphasized. To date, the
significance of attachment during infancy and adulthood has been
a central focus in the literature, with remarkably little attention being
given to adolescence. The aim of this selective review is to introduce
and critically consider the key concepts of attachment theory, and to
then discuss the relevance of attachment to the period of adolescence.
More specifically, an emphasis will be placed upon the importance
of early attachment experiences in the development of adolescent
psychopathology. Theoretical explanations for this relationship are
considered alongside implications for clinical practice and research.
Copyright  2001 John Wiley & Sons, Ltd.
ATTACHMENT THEORY AND ITS
RELEVANCE TO ADOLESCENT
PSYCHOPATHOLOGY
The quality of the relationship between infant and
primary caregiver is considered to be central to
socio-emotional development, because it represents
the first experience of human intimacy (Sroufe et al.,
1999). Difficulties forming a ‘primary attachment
relationship’ are believed to influence later psy-
chological adaptation (Bowlby, 1980; Lyddon et al.,
1993). Attachment theory focuses on the process by
which strong and enduring relationships develop,
are maintained and can be modified (Bowlby, 1969,
1973, 1980).
The aim of this selective review is to consider
critically the major growth points in the area of
attachment theory, and specifically focus on the
* Correspondence to: Dr Lucy Scott Brown, Clinical Psychol-
ogist, Child and Adolescent Mental Health Service, South
West London and St. George’s Mental Health NHS Trust,
Lanesborough Wing, St. George’s Hospital, London SW17
0QT, UK. E-mail: lscottbrown@hotmail.com
relevance of attachment to adolescent development
and psychopathology. A significant proportion of
the literature has concentrated on the role of attach-
ment in infancy and adulthood. However, remark-
ably little literature considers the importance of
attachment during adolescence. This is surprising
given that the period of adolescence is character-
ized by numerous developmental changes, which
inevitably influence or are influenced by models of
attachment. The first part of this paper will intro-
duce and critically consider the central elements
of attachment theory. The relevance of attach-
ment during adolescence, and its relationship to
the development of psychopathology, will then be
discussed. Theoretical models that explain this rela-
tionship are outlined. Finally, clinical implications
and future areas of development are considered.
THE CONCEPT OF ATTACHMENT
Bowlby’s (1969, 1973, 1980) theory of attach-
ment initially evolved from an interest in child
development, psychiatry and ethology. Ainsworth
Copyright  2001 John Wiley & Sons, Ltd.

16 L. Scott Brown and J. Wright
extended Bowlby’s theory by incorporating be-
havioural measurement and longitudinal develop-
mental research, which emphasized the stability of
attachment over time (Ainsworth et al., 1978). The
issue of stability, together with Bowlby’s under-
standing of the psychoanalytic concept ‘internal
world’ influenced by theories on information pro-
cessing (e.g., Tulving, 1972), led him to develop the
concept of an ‘internal working model’ (IWM). The
IWM has in recent years become a central focus
of attachment research, and developed as a central
theoretical linchpin (Main et al., 1985). This latter
development has resulted in an increase of interest
in adult attachment, creating a gap in understand-
ing the pathway of attachment during middle child-
hood and adolescence. It is important to address
this omission because adolescence is a significant
transitional period in the life span, where from
the standpoint of attachment, important develop-
ments take place. Adolescence is characterized by
biological, mental and social change, and as such
marks a developmental period where the ‘self-in-
relation-to-other’ dialect is particularly strong. The
plan in the first part of this paper is to highlight
relevant attachment related issues from a review of
the current literature in order to then inform how
an understanding of attachment in adolescence can
be appreciated and taken forward.
The Attachment Behavioural System in Infancy
Primary attachments generally develop within the
first nine months of life, and are organized around
a behavioural system that has proximity to the
primary attachment figure (typically the mother)
as a predictable outcome. This has an instinctual
evolutionary function, in that it regulates safety
and promotes survival (Bowlby, 1969). When there
is a discrepancy between desired availability of
the attachment figure and the appraisal of actual
availability, the attachment system is activated.
Once activated, the infant makes attempts to reduce
this discrepancy using attachment behaviours,
such as crying and clinging, which are aimed
at promoting contact with the attachment figure
(the primary strategy). When the infant feels
securely attached to their caregiver, exploration
of the environment can take place, whilst using
the attachment figure as a base. This is termed the
‘secure base phenomenon’.
A governing principle of attachment theory is
that the quality of early attachment is deter-
mined by the interactions between the attachment
figure and the infant (Bartholomew, 1990). Parental
responsiveness to the child’s emotional signals is
thought to be critical in how the infant learns to
organize and regulate emotional experience. If the
child experiences an attachment figure as respon-
sive to distress, the child is more likely to learn
how to regulate distress with strategies that involve
seeking comfort and support, which facilitates the
development of a secure attachment (Ainsworth
et al., 1978; van Ijzendoorn et al., 1995). If distress
signals are met with insensitivity and inconsistency,
this increases the likelihood that the child will learn
to associate distress with aversive consequences,
and will develop coping strategies, contributing to
an insecure attachment. The development of attach-
ment relationships in themselves does not relate to
the quality of care received, because infants become
equally attached to insensitive and abusive figures
and to supportive ones (Main, 1996).
THE ‘STRANGE SITUATION’
The behavioural strategies used to achieve the
goal of security vary according to the quality of
attachment. Ainsworth et al. (1978) first developed
a paradigm to classify attachment security, termed
the ‘Strange Situation’. Classification was based on
the child’s response to a structured procedure, in
which infants were observed responding to two
brief separations and reunions with their mothers.
The behavioural responses were thought to reflect
the child’s expectations of the attachment figure’s
availability, and consequently their attachment
strategy (Weinfield et al., 1997). Ainsworth iden-
tified three strategies used to maintain contact with
the attachment figure. Securely attached infants
(type B) had mothers who responded consistently
and sensitively. Upon reunion, these infants sought
contact or interaction with their mothers, were eas-
ily comforted and were able to use the mother
as a secure base from which to explore the envi-
ronment. In contrast, ‘anxious-ambivalent’ infants
responded with heightened expressions of anger
upon separation, and were hard to settle when
reunited (type C). Their mothers were observed to
be more inconsistent and intrusive in their par-
enting. ‘Anxious-avoidant’ infants behaved in a
detached manner when their mothers returned, as
if unaffected by the separation, and were unable to
use the caregiver as a base from which to explore
(type A). These mothers were observed to behave
in a rejecting manner. Sroufe (1996) hypothesized
that such infants avoid their mothers in an attempt
to be rid of the negative feelings experienced as
Copyright  2001 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 8, 15–32 (2001)

Attachment Theory 17
a result of their mother’s unavailability. More
recent research has identified infant behaviour
that does not fit into Ainsworth’s original clas-
sification system. ‘Disorganized’ infants (type D)
were initially considered to be ‘unclassifiable’ due
to their contradictory and stereotyped behaviours
in the parent’s presence (e.g., seeking the parent,
and then avoiding them). Typically the caregivers
of ‘D’ infants show ‘frightened and frightening’
behaviour, which leaves the child experiencing con-
flict over security issues (Main and Solomon, 1990).
This renders the infant vulnerable to developing
a concept of the self as powerful but dangerous
(Main, 1995), most frequently leading to signifi-
cant mental health problems (Zeanah and Emde,
1993). Finally, ‘A/C’ infants show both avoidant
and ambivalent patterns (Crittenden, 1985). They
typically have attachment figures who are both
insensitive and inconsistent (most often associated
with abuse or neglect—Adam et al., 1995).
Empirical evidence indicates thatattachmentclas-
sifications derived from the ‘Strange Situation’ are
relatively stable over time (Goosens et al., 1986). For
example, stability has been demonstrated by lon-
gitudinal studies, where attachment patterns at 12
months have been found to predict attachment clas-
sification at six years (Main et al., 1985). However,
although this procedure has become a standard
measurement tool, it is worth considering its lim-
itations. Firstly, it relies on brief separations and
reunions holding the same meaning for all children,
although in some cultures children are rarely sepa-
rated from their mothers at this age (Rutter, 1995).
Secondly, stressors within the family have been
shown to affect attachment security (Vaughn et al.,
1979), questioning the reliability of the procedure,
the stability of attachment and using the procedure
diagnostically (Zeanah, 1996; Zeanah and Emde,
1993). Thirdly, the procedure is clearly limited to
use with young children, as behavioural patterns
become increasingly complex beyond infancy. This
complexity denotes the psychological development
to the level of mental representation, something
akin to the Piagetian shift from sensori-motor to
pre-operational thinking (Piaget, 1963). There are
a number of more general criticisms of attach-
ment theory based around infant–caregiver stud-
ies, which also need to be considered.
Overemphasis on Early Relationships
Attachment theory has been criticized for concen-
trating on early relationships without accounting
for the way in which ‘interactional maintaining
factors’ influence continuity. Research suggests
that the child’s behavioural strategies and expecta-
tions of the contingencies being reinforced within
this relationship tend to support and confirm one
another (Bartholomew, 1997; Kobak and Duemm-
ler, 1994; Sroufe, 1983). This self-confirming mech-
anism explains the stability of attachment patterns,
but also suggests that other factors are critical in
maintaining them. Lamb et al. (1985) maintain that
attachment is stable only when the caregiver situ-
ation is constant. When this changes in a dramatic
way (e.g., the death of a parent), the stability of
attachment is more likely to change (Larose and
Boivin, 1998). This challenges the idea that mod-
els are impervious to change, and highlights the
role of context in relation to attachment stability, in
that the person is thought to exist within numer-
ous ecological influences (Belsky and Isabella, 1988;
Bronfenbrenner, 1986).
The Importance of Secondary Attachment
Figures
Although Bowlby (1969, 1973, 1980) emphasized
‘monotropy’ in attachment, ‘secondary’ attach-
ment figures are more influential than originally
thought (Kerns and Barth, 1995; Schneider-Rosen
and Burke, 1999; Youngblade et al., 1993). For
example, Zeanah et al. (1997) review studies that
show infants behave differently across relation-
ships with different attachment figures, and that
some psychopathological behaviours are relation-
ship specific. This points toward differential effects
of relationships on later psychological adaptation,
at least in the early years. If people other than
the primary caregiver influence attachment, one
can question whether the child develops numerous
incompatible attachment expectations depending
on different relationships, whether the various
experiences are integrated somehow or whether
one model predominates. A recent development in
this area is the ‘dual coding hypotheses’ (Main,
1991). In this hypothesis, ‘multiple models’ are
thought to develop when attachment-related infor-
mation is contradictory and incompatible. In these
circumstances, the individual is less able to develop
metacognitive knowledge or mechanisms of cor-
rective metacognitive monitoring, which would
prevent a single IWM from evolving.
Difficulties with Categories of Attachment
There are also difficulties inherent in the categorical
measurement of attachment patterns. Individuals

do not fit neatly into one attachment pattern, and
most people show a complex profile (Bartholomew,
1997; Rutter, 1995). Bartholomew and Horowitz
(1991) found that individuals show elements of up
to four attachment styles and that reducing this
down to one category overlooks the complexity of
attachment styles (Hesse, 1996).
A MOVE TO THE LEVEL OF
REPRESENTATION
Behavioural strategies employed beyond infancy
are thought to be governed by IWMs (Bowlby,
1977). These are representational models of expec-
tations and attitudes about the behaviour of attach-
ment figures, which are generalized to predict
the social world and organize responses to it.
The acquisition of language and internal repre-
sentations through cognitive development offers
new opportunities for the assessment of IWMs.
Recent attachment research has focused on devel-
oping attachment tools for measuring the quality of
attachment as evidenced by mental representations.
The representational measure showing the most
promise so far is the Berkeley Adult Attach-
ment Interview (AAI, George et al., unpublished
manuscript). The AAI infers attachment style from
the process and coherence of reporting on quality
of childhood relationships with caregivers, rather
than the content per se. It aims to distinguish
between different states of mind in relation to
attachment. The AAI involves a semi-structured
interview, where adults are asked about the qual-
ity of their attachment relationships and to draw
on specific memories to substantiate generaliza-
tions made. This distinction has been described as
accessing episodic and semantic aspects of mem-
ory storage and retrieval. It offers a number of
opportunities for the speaker to contradict or fail
to support claims made. The AAI is not a measure
of attachment history, and there is no longitudi-
nal research at present supporting the accuracy
of reports. The measure was originally developed
through interviewing mothers of infants who had
been classified in the Strange Situation. Following
the logic of stability of attachment patterns across
generations, Main et al. (1985) were able to discern
clear discourse markers and patterns in the inter-
views of mothers who had infants categorized as A,
B or C patterns. This has subsequently been empir-
ically validated by Fonagy et al. (1991a), in their
study on pregnant women. The AAI is designed
to assess the coherence of discourse in relation to
attachment. It uses a coding system that catego-
rizes coherence or ‘autobiographical competence’
(Holmes, 1992), and the quality of mental rep-
resentations of attachment figures (Reimer et al.,
1996). For example, securely attached individu-
als are able to give a coherent account of their
childhood, and are able to describe painful events
without detaching themselves. ‘Anxious-avoidant’
attachment (‘devaluing/dismissing’ in the AAI) is
characterized by an inability to recall memories, or
idealizing experiences. Those classified as ‘anxious-
ambivalent’ ‘enmeshed/preoccupied’ in the AAI)
are entangled with the past and incoherent in their
accounts (Holmes, 1993). Differences in coherence
are explained by the idea that secure people can
integrate information from semantic and episodic
memory to create coherent representations (Crit-
tenden, 1997a). Violations in discourse are thought
to result from difficulties in shifting attention across
these domains (Main, 1995).
The AAI has shown satisfactory reliability, as
well as discriminative and predictive validity
(Bakermans-Kranenberg and van Ijzendoorn, 1993;
van Ijzendoorn, 1995). Whilst the measure is
considered to be the most acceptable procedure for
assessing attachment in adulthood, administration
and scoring of the AAI requires in-depth training.
The AAI also assumes that coherence equates
with secure attachment, and there is no direct
empirical evidence that supports this assumption.
Eagle (1997) claims that secure attachment is
operationally defined as the telling of coherent
narratives in the interview. This can be considered
an arbitrary parallel when there have been no
studies examining whether one’s narrative on the
AAI predicts attachment status when attachment is
defined using a more theoretical definition. Whilst
some variations of the AAI use a ‘cannot classify’
category, Crittenden has developed a version
that does not incorporate this (1997a), which, if
validated, is a classifactory strength. Whilst the
AAI is limited in a number of ways, empirical
studies indicate it is a useful way to conceptualize
and measure adult attachment patterns.
Difficulties Inherent in the Concept of the IWM
Although studies of internal representations in
attachment have proved fruitful, the IWM concept
has been challenged in a number of ways. Bowlby
argued that IWMs are an ‘accurate reflection of the
experiences those individuals have actually had’
(1973, p. 235). However, Eagle (1997) maintains that

a direct causal relationship between the IWM and
caregiving behaviour is too simplistic. He high-
lights the way in which dependence on internal
representation and fantasy is underestimated. For
example, seemingly identical parenting may be
experienced and represented quite differently by
different infants. Variations in the infant’s tem-
perament must inevitably also play a role in the
development of attachment (Sroufe, 1983), and the
infant may be significantly more active within inter-
actions than the theory assumes (Schaffer, 1984).
IWMs are assumed to be constant representa-
tions of attachment. Some theorists have alterna-
tively conceptualized IWMs as having situation
specificity, operating as ‘strategies’ that guide the
individual (Jellema, 1999; Main, 1990). However, as
the individual is thought to be largely ignorant of
the ‘rules’ governing their IWM (Cooper et al., 1998;
Crittenden, 1992; Roberts et al., 1996), these alterna-
tive positions appear to be somewhat contradictory.
It may be that our understanding of the differen-
tial contingencies inherent in secure and insecure
patterns of attachment go someway to explaining
this. That is, situation specificity may be dependent
upon the flexibility of IWMs constructed through
early attachment experiences.
The concept of an IWM has also been criticized
for being overinclusive, which limits its testability
and explanatory power (Rutter, 1995). Main (1991)
has refined the thinking about IWMs through the
idea of ‘metacognition’. This is defined as ‘relatively
stable . . . often fallible, late developing information
that human thinkers have about their own cognitive
processes and those of others’ (Brown et al., 1983).
Fonagy et al. (1991b) also extended the IWM
concept, through developing the idea of ‘reflective
self’. A reflective-self scale has been developed,
designed to measure the clarity of individual’s
representations of their own and others’ mental
states, as well as their ability to reflect on these
(Fonagy et al., 1995, unpublished manual). The
idea of a reflective self is a major contribution in
the area, because reflective self-functioning links
the concept of an IWM with the development
of a theory of mind (Fonagy, 1991). That is,
developing a theory of mind relies on the capacity
to think hypothetically about the mental life of
oneself and others (e.g., intentionality, causality).
These developments promise to contribute to the
concept of an IWM and facilitate the process
of scientific analysis, particularly in terms of
measuring attachment patterns beyond infancy.
The developmentof attachmentmeasures beyond
infancy has also enabled the stability of attachment
to be investigated more comprehensively. Empir-
ical studies have found support for the stability
of attachment patterns intergenerationally (e.g.,
Benoit and Parker, 1994; Fonagy et al., 1991a; Main
and Hesse, 1990). High concordance rates have
been found between attachment security in chil-
dren (using the Strange Situation) and their parents
(using the AAI), suggesting intergenerational trans-
mission of attachment patterns (Fonagy, 1994).
These findings substantiate the way in which an
adult’s state of mind in relation to their emotional
experience during childhood links to their own par-
enting practices, thus maintaining attachment pat-
terns (Rosenstein and Horowitz, 1996). However,
instances have also been found when transmission
of patterns does not occur intergenerationally (e.g.,
Sagi et al., 1995), which arguably points towards the
probabilistic nature of the transmission of attach-
ment, and indicates that attachment patterns can
change in some circumstances. Research has also
shown that some adults have been able to develop
autonomous states of mind in relation to attachment
figures (termed ‘earned security’), despite clear
indications of early adverse attachment experiences
in later years (Pearson et al., 1994; Phelps et al., 1998;
Schuengel et al., 1999). Although the exact nature of
the factors and mechanisms underlying the change
are unclear, later alternative relationships, social
factors and environmental influences are all indi-
cated as significant.
A common misconception of attachment theory
is that secure attachment is considered to be ‘nor-
mal’, and insecure attachment directly equates with
‘pathology’. Although attachment processes have
shown both predictive and concurrent associations
with maladaptation in infancy and early childhood
it is unlikely that insecure attachment is either a
necessary or a sufficient cause of later pathology,
and in some cases it may be an effect of the disorder
itself. Rather attachment is more generally con-
ceptualized within a risk/vulnerability model for
psychopathology. For example, Greenberg (1999)
proposes a model based on four significant risk
domains; child characteristics (temperament, neu-
rology etc), attachment history, parental manage-
ment style and family ecology. In this model
different disorders are thought to evolve as a
consequence of differential convergences and com-
binations of these risk factors. However, it still
remains to be seen to what extent such domains
can truly be held as independent variables. For
example, could a child with a low stimulus arousal
threshold brought up by harsh strict parents in

an adverse economic and social milieu nonetheless
develop a secure attachment?
In line with the idea that attachment patterns
are not completely ‘change resistant’ (Wilson and
Costanzo, 1996, p. 236), there is evidence that IWMs
can be modified in relation to the social, bio-
logical and cognitive developments (Kenny et al.,
1998; Larose and Boivin, 1998). Crittenden (1997a)
maintains that development enables attachment-
related information to become integrated, yielding
more complex representations of relationships, per-
haps most clearly exemplified during the period
of adolescence. Investigating this idea in relation
to the period of adolescence has been hindered
by the scarcity of measurement tools. It is within
this developmental context that researchers have
turned to more indirect measures of representation
in middle childhood and adolescence. For example,
play narratives and story stem techniques (Brether-
ton et al., 1990; Mueller and Tingley, 1990). Most
promising for adolescents might be semi-projective
tools (Hansburg, 1980; Resnick, 1993; Scott Brown
and Wright, 2000), although there is limited infor-
mation on psychometric properties and use in
clinical samples at present. Such an approach is
not directly reliant on behavioural observations or
the direct interviewing style of the AAI.
ATTACHMENT DURING
ADOLESCENCE: SAFETY, SEXUALITY
AND EXPLORATION IN THE SOCIAL
WORLD
The review now puts us in the position to consider
what should be included as key elements for
attachment in adolescence, as well as what is
currently missing from the literature. We have
demonstrated that a consideration of development
has been a key factor in understanding attachment,
that the importance of ‘secondary attachment’
relationships should not be overlooked, and that
ecological influences and social contexts need
inclusion. It was also emphasized that there is
a measurement gap at adolescence in the study
of attachment patterns. These issues will now be
considered in more detail.
Biological Change and Puberty at Adolescence
Maturational development in adolescence is
marked by the onset of puberty and the fact that
adolescents become (at least biologically) able to
become parents themselves. Puberty is the final
period of rapid neurological change in human
development, and rises in and fluctuating hormone
levels have an influence on mental functions in
both marked and subtle ways. The development of
secondary sexual characteristics and explicit moves
towards active sexual interests brings the issue of
reproduction as well as protection into the attach-
ment equation. Predominant attachment patterns
in the adolescent become sexualized. The resulting
‘goodness of fit’ for this new emerging adult world
can result in adolescents taking a cautious but curi-
ous interest in themselves and others, something
akin to the secure base phenomenon. The hope
is that sexual contact will take place within an
intimate relationship. However, it is equally likely
that if the adolescent brings with them an inse-
cure attachment history, then alternative outcomes
result. When sexual interest is activated as a sec-
ond central motivator of behaviour, the protective
strategies associated with attachment are probably
reorganized (Crittenden, 1997a).
As with infancy, at adolescence the process of
clarifying ‘whom am I in relation to you’ is a central
focus of relationships. The secure base dialectic is
once again in ascendancy as a central issue because
of the task of how to combine sexual needs with
safety needs. For most young people adolescence
marks a period of sensual physical closeness with
another which has not been experienced since the
mother–infant dyad over a decade previously. The
goal-correctedpartnership forthe secure adolescent
aims to find a relationship where the young person
can feel sexually safe in their own acceptability to a
significant other while also feeling confident in their
own competence to make and express personal
sexual choices (Kobak and Duemmler, 1994). This
is a complex task involving both parents, peers and
wider social contexts.
Sexual feelings for the adolescent with an ambiva-
lent attachment organization may become confused
with attachment feelings based on fear of abandon-
ment and hostility. This is because the IWM is
based on the assumption of unpredictability in inti-
mate relations. Charm, seductiveness and threat
may evolve as central characteristics. Alternatively
for the avoidantly organized adolescent, who has
learnt to distance him/herself from affect, sexu-
ally intimate feelings may be defensively excluded
producing an experience of ‘sex without love’ to
please the other, expressed through promiscuous
behaviour or channelled into other activities alto-
gether (Crittenden, 1997b).

From an attachment perspective, the develop-
ment in sexuality during adolescence also raises
the issue around choice of partner. This will be
significantly influenced by the compatibility with
existing IWMs between the two young people
coming together (Bartholomew, 1997). Whether a
perceived incongruence leads to rejection or accep-
tance will depend on the extent it is felt to fill an
experiential gap. That is, successful partnerships
require flexibility of mind and accommodating to
the other to create a goal-corrected partnership. An
inflexible, rigid organization in contrast can lead
to dangerous physical and psychological liaisons.
The more profound the insecurity the greater the
degree of unpredictability and volatility (West and
George, 1999).
Cognitive Development
We now turn to a second characteristic of adoles-
cent maturational development, that of cognitive
development and a move to formal operational
thinking. This shift allows an increased ability to
think hypothetically, with possibilities rather than
actualities being considered. The move to formal
operational thinking stands in marked contrast to
the earlier pre- and concrete operational phases
of childhood, where parents are often felt to hold
unquestionable truths (Piaget, 1972). The transition
from dichotomous classification to greater flexibil-
ity allows the adolescent to access inner thoughts,
feelings and memories. The young person becomes
more able to reflect on aspects of the self and other
with parents in a way that is more ‘finely tuned’
to suit the circumstances. With all these changes,
a more truly working model of relationships can
now be said to be operating. This enables the adoles-
cent to take a more autonomous perspective, which
Main (1991) referred to as ‘meta-monitoring’. It is
this developmental process that facilitates the rein-
tegration of information, revision of models and
the development of more effective strategies to
manage the models (Crittenden, 1995; Kobak and
Cole, 1994). The outcome is potentially even greater
complexity in the organization of behaviour. Matu-
ration results in many young people changing their
understanding of themselves, their parents and the
world generally, and experimenting with alterna-
tive ideas and behaviours, some of which may
result in conflict. However, there is also the possi-
bility of the adolescent being increasingly able to
appreciate the caregiver’s perspective, and to move
to a goal-directed partnership (Kobak and Duemm-
ler, 1994). With this increased reflective capacity the
adolescent more frequently asks ‘who am I in the
social world?’
Caregivers, Autonomy and Adolescence
Attachment to parents during adolescence differs
from other ages because it emphasizes emotional
autonomy whilst maximizing levels of support
(Schneider and Younger, 1996). This helps the
adolescent to retain a sense of stability when
so many changes are taking place, as well as
acting as a secure base from which to explore
new social situations (Cooper et al., 1998; Rice,
1990). Particularly salient during adolescence is the
process of separation–individuation from parents,
and the development of relationships outside the
family (Daniels, 1990; McCurdy and Scherman,
1996; Mayseless et al., 1996).
The quality of earlier childhood attachments
appears to lay the foundation for later social
relationships with peers and other adults, which
can be modified or more firmly established during
adolescence. In this sense, adolescence is a period
of consolidation in attachment (Lyddon et al., 1993).
For example, Sroufe et al. (1999) outline studies that
found infant attachment assessments to be highly
predictive of adolescent social group functioning.
The quality of attachment relationships is important
as protective or risk factors for later psychological
adjustment and for the quality of peer relationships
(Batgos and Leadbeater, 1994; Kobak et al., 1993).
Let us now turn to some of the factors at play
in shaping the adolescent’s relationship to their
peers and the adult world of work: what Erikson
(1968) called a ‘psychosocial moratorium’. While
some identity strengths will come from within
the adolescent linked to earliest attachments with
caregivers, ideologies and beliefs will accompany
particular social groups as ready available identity
strengths at this age. Between the world of play
and the world of work, adolescence stands at a
unique psychosocial point. The newly acquired
reflective capacities often means a marked ‘trying
on’ of identities, both to see how they fit and to
hide behind to observe the adult world’s reactions.
From an attachment standpoint this is potentially a
time of exploratory playfulness and an opportunity
to work on opposing internal forces—and requires
a reciprocal ‘selective permissiveness’ and reliable
authority from parents and society. It is worth
noting that Bowlby (1973) argued for the continued
importance of the parent–child attachment from
preadolescence to adulthood in the growth of a
sense of self-reliance, and recent research using an

adolescent version of the Separation Anxiety Test
(Resnick, 1991) has found support for this view.
ATTACHMENT DURING
ADOLESCENCE AND
PSYCHOPATHOLOGY
While evidence supports the link between secu-
rity of attachment and psychosocial functioning,
there has been increased interest in recent years to
understand the clinical implications of attachment
theory, particularly within the field of develop-
mental psychopathology. Unfortunately studies of
attachment in clinical populations have been lim-
ited and there is a clear need to open up this
area. It seems that the biopsychosocial changes
at adolescence also produce notable increases in
specific pathologies. For example, eating disor-
ders, delinquency, suicide and attempted suicide
all dramatically increase at this developmental time
(Graham and Rutter, 1985). There is a clinical need
to develop measures of attachment which can be
used for day-to-day assessments in clinical settings
involving adolescents (and adults) (Gerlsma and
Luteijn, 2000). Moreover, with emphasis placed on
normative samples the application of attachment
to more profound states of insecurity are likely
to require refinement of the classificatory system,
and how this in turn can inform interventions (and
vice versa). With this in mind the next section
will consider what is known about attachment and
psychopathology in adolescence, and also some of
the questions and challenges it raises for future
research.
Given the availability of attachment measures in
infancy and adulthood, it has been possible for
empirical studies to gain an appreciation of the
nature of this relationship, which can then inform
our understanding of specific parallel processes
operating during other developmental periods,
such as adolescence. Longitudinal studies have
been particularly valuable, not only in understand-
ing the development of psychopathology in relation
to attachment patterns, but also in providing sup-
port for the predictive validity of attachment, for
example, the Minnesota High Risk Study which fol-
lowed a large sample of mothers and their infants
from the child’s birth to adolescence. The results
highlighted the relationship between adverse moth-
ering experiences and maladaptive and aggressive
behaviour during the school years (Sroufe, 1983).
A number of recent studies on adolescent
populations indicate that attachment patterns link
to psychopathology in ways that parallel findings
from these earlier developmental periods. For
example, depression during adolescence has been
linked to maternal attachment insecurity (Homann,
1997). Furthermore, Adam et al. (1995) found that
adolescents who reported high levels of suicidality
were significantly more likely to be preoccupied
and unresolved in their attachment status. Taken
together these findings suggest a potentially impor-
tant link between hopelessness in adolescence and
specific attachment organizations. However, Allen
et al. (1996) also recognize that their findings are
limited by a racially homogeneous and upper mid-
dle class sample, alongside a reliance on self-reports
of symptoms. With this in mind we now turn to con-
sider two common disorders in adolescence (eating
disorders, delinquency) in more depth in order
to demonstrate what is known about attachment
during adolescence and psychopathology but also
what is not.
Eating Disorders and Adolescent Attachment
Bowlby (1973) suggested that a child feels inad-
equate and out of control if given the message
that they are incompetent or unlovable. A signifi-
cant number of studies of adolescents and adults
with eating disorders have reported retrospec-
tive accounts of parenting experiences (O’Kearney,
1996). These findings generally produce a picture
of parents described as over-controlling and per-
fectionist, emotionally unavailable and generally
unsupportive of independence. In such a climate
the young person may develop an avoidant attach-
ment strategy, diverting attention away from inter-
nal distress, as a solution to their situation. The
control of eating behaviour is externally oriented
and diverts distress onto a focus on the body and
away from internal concerns. Two notable studies
have examined the association between IWMs of
attachment and eating disorders, with somewhat
contradictory results. Cole-Dekte and Kobak (1996)
in a study of college women compared four groups:
those reporting eating disorders, depression, a com-
bination of the two or neither. College students who
reported only eating disorders were significantly
associated with a dismissing (avoidant) attachment
organization. In contrast, women who reported a
combination of depression and eating disorders
were associated with a preoccupied (ambivalent)
strategy—which was similar to the depression only
group (and the two depression studies reported
above). However, in a study by Fonagy et al. (1996)
the majority of participants in their sample with

eating disorders were classified as being preoc-
cupied with regards to attachment. Furthermore,
they noted that all but one of this sample were also
unresolved with regards to loss or trauma. Their
findings did not find a unique attachment-based
difference for eating disorders from other psychi-
atric disorders. A complicating factor in comparing
the two studies is that the work of Fonagy et al.
(1996) did not differentiate an ‘eating disorders
group only’. It therefore remains to be seen whether
the Cole-Dekte-Kobak findings are replicable (refer
to Ward et al., 2000, for a fuller review). However,
the clinical implications of such work would lie in
the need to help such young people develop the
ability to symbolize and reflect on their psycho-
logical states as opposed to defensively excluding
them and expressing distress through their body in
a concrete way.
Delinquency and Adolescent Attachment
In thinking about delinquency and conduct disor-
ders Bowlby (1973) described how separations from
or repeated threats of abandonment by parents can
leave a child or adolescent feeling intense anxiety,
anger and rage. It also leaves them deeply suspi-
cious about the predicability of significant others.
Studies of the backgrounds of conduct disordered
adolescents has found a number of key variables
from an attachment perspective, including passive
or neglectful parental attitudes, harsh or erratic
discipline, and the use of coercion in the home
(Sheldrick, 1985). Two recent attachment-based
empirical studies suggest that antisocial conduct
disorders are associated with unresolved and dis-
missing (avoidant) states of mind (Allen et al., 1996;
Rosenstein and Horowitz, 1996). Of particular note
from the Allen et al. (1996) study is that a signifi-
cant number of adolescents with antisocial conduct
problems were categorized as actively derogat-
ing of their attachment needs. The sample also
included a significant number of young people
who described multiple incompatible attachment
narratives. However, the study by Fonagy et al.
(1996) found different results in a group of anti-
social and paranoid personality disordered adults,
where the majority were classified as preoccupied
or autonomous rather than dismissing. The authors
note the significance of unresolved attachment-
related issues for most participants. Overall these
findings lead to the conclusion that both avoidant
and unresolved adolescents may be at greatest risk
of developing these problems.
Winnicott (1991) stated ‘delinquency indicates
that some hope remains’. By this he meant that
the adolescent is turning to wider society rather
than his/her family to provide the stability he/she
needs. A recent development of this view in attach-
ment terms has been formulated by Fonagy et al.
(1997b). They suggest that a generalization of IWMs
at adolescence leads to a development in the young
person’s relation to social institutions and the adults
who represent them (e.g. teachers, police, employ-
ers). Adolescents with avoidant or unresolved
attachment patterns would develop similarly cor-
responding bonds to social institutions and as such
be probabilistically more likely to follow a delin-
quent/criminal career path. The implication is that
societal and institutional responses to such young
people needs in turn to be mindful of such under-
lying dynamics and needs—as was highlighted
earlier on adolescent autonomy. The stumbling
block is the difficulty institutions have in recog-
nizing the significance of unconscious feelings in
this context.
Summary
Attachment during adolescence plays a central
motivating force, particularly because there are
so many developmental changes that are being
negotiated during this period. This includes a
move to a formal operational way of thinking,
which offers an opportunity for IWMs to be
revised and consolidated. The empirical research
that has been carried out with adolescents is
suggestive of a significant relationship between
insecure attachment patterns, psychopathology
and interpersonal problems, although a number
of methodological limitations make it impossible to
draw firm conclusions.
TOWARDS AN ATTACHMENT-BASED
MODEL OF ADOLESCENT
PSYCHOPATHOLOGY
In this final section we aim to integrate a number
of recent developments in theory, referred to
in different contexts above, to demonstrate how
attachment theory can inform an understanding of
adolescent psychopathology. We also aim to draw
out some of the many questions which still remain
to be answered in this area.
The work of Kobak et al. (1993) is a useful
starting point. Their formulation of a ‘control
theory’ aspect to attachment emphasizes how at

adolescence the capacity for effective regulation
has a sophisticated behavioural repertoire. We
highlight this aspect because of its ongoing link
to the earlier behavioural studies of infancy as well
as the maturational recognition that for adolescents
attachment-related behavioural cues and responses
from their caregiver are still centrally significant.
In Kobak’s scheme a secure attachment leads
to the development of a ‘primary behavioural
strategy’ (Main, 1990) based upon available and
responsive caregiving experiences. ‘Secondary’ or
‘conditional behavioural’ strategies override the
primary system and operate when the caregiver
is considered to be unavailable (Main, 1995, p. 57).
If the attachment figure is experienced as rejecting,
the adolescent ‘deactivates’ the system by diverting
attention from attachment cues, thus minimizing
distress (Cole-Dekte and Kobak, 1996), which
allows the likelihood of experiencing rejection
to be reduced. It is hypothesized that those
with deactivating strategies are more likely to
overlook distress cues, minimizing vulnerability
and the need for others (the avoidant pattern).
If the patient is experienced as inconsistent, the
adolescent ‘hyperactivates’ the attachment system,
and becomes hypervigilant to maximize positive
outcomes and predictability with the caregiver (the
anxious pattern). Hyperactivating strategies focus
excessively on attachment-related information and
on exaggerating distress signals (Cole-Dekte and
Kobak, 1996).
Thus the tripartite behavioural model is trans-
posed to adolescence and is helpful in a number
of ways. It keeps a focus on attachment as a
behavioural system, adheres to the continuity of
attachment strategies and emphasizes regulatory
aspects of behaviour. As we have described above,
there is some empirical evidence to support this
model from clinical and non-clinical populations
(Kobak and Cole, 1994; Allen et al., 1996; Cole-
Dekte and Kobak, 1996). In view of the secondary
strategies proposed, it can be argued that ado-
lescents with ‘avoidant’ attachment styles are more
likely to under-report difficulties, while adolescents
with anxiously attached styles may over-report and
exaggerate distress (Cole-Dekte and Kobak, 1996;
Pianta et al., 1996). This conclusion holds important
implications for the use of self-report measures of
distress (Field et al., 1991; Scott Brown and Wright,
2000).
This functional analysis of behavioural strategies
is highly compatible with recent developments in
theory at the IWMs and states of mind domain with
regard to attachment. Two major strands in theory
have been emphasized, Crittenden’s dynamic-
maturational model and the work of Fonagy and
colleagues on ‘mentalizing’ and the reflective func-
tion. Firstly Crittenden’s model emphasizes the
importance of different memory biasing in types
of insecure attachment organizations (Crittenden,
1997a, 1997b). This builds on Bowlby’s (1988) ideas
about why and under what conditions memories
and the experiences are shut off from conscious
awareness while continuing to be extremely influ-
ential in affecting thoughts, feelings and behaviour.
Bowlby describes three categories: (i) those that
parents wish their children not to know about;
(ii) those in which parents have treated children in
ways children find too unbearable to think about;
(iii) those in which children have done, or perhaps
thought, things about which they feel unbearably
guilty or ashamed. For Crittenden, these categories
influence memory organization and development
in particular ways. In the first category episodes of
experience are denied or shut off such that the
young person learns to rely to a large degree
on semantic information (what the parents tell
them) and disregard autobiographical information.
Splitting of information occurs of a characteris-
tic type which Crittenden links to the avoidant
attachment organization and dismissing state of
mind. She has further refined this to describe sub-
categories of avoidant strategies. This increases the
predictability of specific pathologies in relation to
attachment style. For example, while delinquency
has been empirically linked to a derogating style
of avoidant attachment (Allen et al., 1996) compul-
sive caregiving is an alternative based on a more
idealized avoidant style. Kobak’s control theory of
behavioural strategies (Kobak et al., 1993) links here
in that for one adolescent early parenting would
have been based on absent or punitive caregiving
which led to inhibition of affect and reliance on cog-
nition in a dogmatic way (e.g., ‘love is pathetic’, ‘I’m
not interested in what you feel’, ‘crying is for mis-
erable babies’). The ‘delinquent act’ is then formu-
lated as the procedure used for affective regulation
resulting from an unsafe situation where the ado-
lescent has been subjected to and relies upon rigid
semantic information based on contempt of vul-
nerable feelings which is generalized. Conversely,
compulsive caregiving while similar in inhibition
of displays of affect and reliance upon semanti-
cally biased information has different underlying
assumptions about the world. In this case the dog-
matism is likely to be biased towards being good
and helpful at all times. An alternative false self is
constructed with concordant behavioural strategies

(e.g. always smiling and eager to please). Early par-
enting experiences of such adolescents may have
been based on actual or threatened abandonments
by the parent if they were not looked after (e.g.,
a parent with a chronic illness who overwhelmed
by their own fears of dying relies on the child to
take care of them and manage the now reversed
attachment system). In such a situation a positive
false-self develops in order to deactivate the child’s
own attachment needs, because turning to the par-
ent with distress and needing comfort predictably
activates the parent’s own attachment needs as
opposed to eliciting care (George and Solomon,
1996).
Crittenden’s (1997b) model considers the pro-
cess of developing attachment strategies more
comprehensively using the concept of memory sys-
tems (Tulving, 1987) to explain the encoding and
accessing of attachment-related information and
the relevance of this process during adolescence
(Crittenden, 1997a). By organizing information in
memory systems, the possibility of error, dis-
tortion and falsification increases. Four systems
are discussed, procedural, imaged, semantic and
episodic memory.Each systemevolves ata different
period developmentally, and regulates behaviour
in specific situations. Adult perspectives, particu-
larly those of attachment figures, heavily bias how
information is organized. Procedural memory is
biased towards behaviour and relies upon enact-
ment of affect. In contrast, semantic memory is
biased towards generalized statements and logical
principles and is influenced by what significant
others may say (e.g., ‘good children do what they
are told’). In the case of the episodic system, the
bias is towards affectively loaded autobiographical
experiences which adults may correct or highlight
as important. This process renders children and
adolescents vulnerable to developing biases and
distortions in their memory systems until they are
able to test out the accuracy of information inde-
pendently. Crittenden maintains that children and
young people may learn to misconstrue and distort
information, particularly in conditions of threat
or unpredictability. Distortion is adaptive in that
it serves to promote protection in dangerous sit-
uations while increasing maladaptive behaviour
in other contexts which are comparatively safe,
but misconstrued as threatening. Crittenden argues
that when interpretative errors occur at a very early
age, the extinction of mis-learned contingencies
may be difficult to identify and correct develop-
mentally during adolescence. She emphasizes the
way in which adolescence is a critical period, when
considerable change occurs. In particular, adoles-
cence is a time when information from the memory
systems can potentially become more integrated
through cognitive development.
The emphasis on cognitive development for social
understanding has been further developed by Fon-
agy and associates who have explored the clinical
utility of the ‘theory of mind’ concept for under-
standing the development of IWMs and borderline
pathology (Fonagy et al., 1995; unpublished man-
ual). This capacity they term ‘mentalizing’ and have
demonstrated, through clinical and empirical stud-
ies, how some individuals with disturbed attach-
ment histories have developed a defensive process
which inhibits their capacity to empathise (or think
about intentionality in themselves and others). It
may be that such relationship-based metacognitive
functions are central to and a prerequisite for the
integration of the different perspectives on reality
afforded by the different memory systems in the
individual. Failures in the capacity to mentalize
may offer a particularly useful way for understand-
ing the development of borderline pathologies
which typically emerge during mid/late adoles-
cence. The clinical implications of this theory is
that adolescence may offer a major opportunity for
increasing reflective functioning via a therapeutic
‘secure base’ and thus afford an opportunity to avert
borderline symptoms becoming entrenched. It also
potentially confirms the centrality of transference
and countertransference in the psychotherapeutic
treatment of severe attachment-based disorders.
Whilst adolescence may be an opportunity for
insecure models to be revised, the reverse is also
true. Reimer et al. (1996) state that models that
are defensively biased are less likely to be revised
because they rely on perceptual and cognitive dis-
tortions. The defensive exclusion of information
may make it difficult for adolescents with insecure
attachment to attend flexibly and nondefensively
during interactions, thus reinforcing models, which
are then harder to modify (Dozier, 1990). Models
may become more resilient and harder to adapt to
reality. Similarly, Crittenden (1992) argues that ado-
lescents with insecure attachment patterns are less
able to integrate and reorganize models because
information is considered unreliable, so discrepan-
cies in the model being used are not identified, pre-
venting integration from taking place. Because the
IWM is constantly being consulted for a desirable
course of action, if the model is distorted, inaccu-
rate forecasting and interpretation is probable. An
adolescent who predicts negative responses from
others will devote more attention to preparing for

this outcome and selectively attend to information
that confirms this, rather than considering other
possibilities (Kobak and Duemmler, 1994). It is
thought that IWMs are reinforced through inter-
actions, and have a tendency to favour assimilation
over accommodation. This tendency might explain
how biases are maintained (Batgos and Leadbeater,
1994), and why the revision of information may be
inhibited.
In summary, an attachment-based model of ado-
lescent psychopathology is appealing because it
explains processes by which different experiences
lead to variations in mental processes. Such varia-
tions in turn lead to behavioural variations in the
kinds of interpersonal difficulty and psychopathol-
ogy displayed. The theory incorporates a matu-
rational component, which is far less restrictive
than that of models reliant on linear predictions,
and a way of conceptualizing individual difference.
Attachment Theory emphasizes how multiple fac-
tors influence development, alongside individual
variation in the ability to integrate information,
and the way in which chance impinges on each per-
son in terms of life events. This idea links well with
the stress-vulnerability model that appears to be
operating in the relationship between attachment
patterns and psychopathology during adolescence.
Each of these factors needs consideration in order
to conceptualize the development of psychologi-
cal difficulties accurately. However, the evidence
that individuals with specific attachment patterns
selectively attend to different kinds of information,
or that individuals anticipate, encode or transform
experiences in accordance with IWMs, has not been
supported consistently (e.g., Belsky et al., 1996). It is
also worth considering that recent developments in
theory, such as the multiple memory system of the
mind, is also one of a number of models of memory
functioning (Horowitz, 1988). Further studies are
needed to substantiate these claims.
IMPLICATIONS FOR FUTURE WORK
A number of clinical implications stem from the
material that has been discussed in this paper.
These will be considered with a particular reference
to adolescence.
Implications for Assessment
The importance of developing an understanding of
the presenting adolescent’s attachment pattern has
been highlighted in this paper. Ultimately devel-
oping an understanding involves investigating
the adolescent’s perceptions of their parental and
peer relationships. The role of secondary attach-
ment figures also requires consideration within
the adolescent’s attachment network. Whilst it is
important to develop an appreciation of the ado-
lescent’s attachment experiences during infancy,
the importance of current relationship functioning
also needs attention. Interactional processes estab-
lished during infancy might be critical in setting
the foundation for difficulties, but alternative influ-
ences may be responsible for the maintenance (and
potential revision) of attachment patterns.
Assessment needs to investigate the main sec-
ondary attachment strategy used by the adolescent,
and what function this strategy might have in
terms of clinical presentation, interpersonal diffi-
culties and the quality of the information commu-
nicated. Identifying the central secondary strategy
employed allows the clinic to develop an under-
standing of how information is construed and
distorted, in that it inevitably represents an ear-
lier environment that was perceived as threatening
and unsafe. Strategies may be outdated and in need
of revision, thus pinpointing areas of intervention.
Assessment of secondary strategies is clearly
hindered by the paucity of attachment measures
developed for adolescents. The interpretation of
self-report measures requires particular thought, as
very low responses may be an attemptto ‘fake good’
(Field et al., 1991). Underreporting of difficulties
from adolescents with deactivating strategies is
easily taken at face value, resulting in services
not being offered because difficulties and needs
are minimized. Such adolescents may be much
harder to engage in treatment (Dozier, 1990; Dozier
et al., 1994), and may be more likely to experience
difficulties because their dismissing tendencies may
result in low levels of social support, rendering
them more vulnerable to difficulties (Dozier and
Lee, 1995).
Whilst the quality of attachment is a critical factor
in understanding the development and function
of adolescent psychopathology, assessment also
needs to consider a number of additional risk fac-
tors that have been shown to be critical in this
relationship. Areas of assessment should include
biological and neurological vulnerabilities, family
adversity (e.g., exposure to high levels of con-
flict and aggression), single parenthood, maternal
depression and low SES. These areas of risk indicate
a need to consider both parents and family in the
assessmentof the adolescent.Such a comprehensive

approach not only facilitates assessment of interper-
sonal functioning with attachment figures but also
enables intergenerational patterns to be recognized.
Implications for Treatment
The early development and robustness of IWMs
has implications for preventative work as well as
for treatment during adolescence. It highlights the
need to enhance the quality of the infant–mother
attachment as early as possible, because it appears
that there is a tendency for IWMs and any
distortions within the model to become self-
confirming once established (Cicchetti and Toth,
1995). Identification of infants ‘at risk’ of developing
attachment difficulties may be facilitated through
considering the risk factors mentioned, as well
as behavioural observations of the primary carer
interacting with the infant. Van Ijzendoorn et al.
(1995) suggest preventative work might take the
form of reinforcing a concrete element of behaviour
(e.g., enhancing physical contact) or addressing
parental IWMs (e.g., encouraging the primary carer
to discuss childhood experiences, and reflecting on
the impact this has on parenting skills). Helping
parents to become more responsive and sensitive
to their infants during the first few months could
help the development of secure attachment (Beebe
et al., 1992; Lieberman and Zeanah, 1995), which
could potentially act as a protective factor in the
face of later adversity.
Adolescence is a particularly turbulent time for
parents in a number of ways. Whilst parent train-
ing programmes have been developed for parents
of young children (e.g., Webster-Stratton, 1994),
few address the difficulties for parents coping with
adolescents. Addressing parental IWMs based on
their own autobiographical experiences of adoles-
cence, and reflecting on what was helpful for them,
may help parents thinking about negotiating this
developmental period. Treatment should focus on
helping parents understand the period of adoles-
cence, their critical role during this developmental
phase and possible strategies that might help to
manage difficulties. In this way, it is more likely
that parents will be able to act as secure bases from
which their adolescent can explore new ways of
relating, thus consolidating a healthier model of
attachment.
The period of adolescence is another good oppor-
tunity for intervention, in that the developmental
changes offer a chance for intervention to impact
on the process of reintegration and consolidation
of attachment-related information. In particular,
cognitive development leads to an enhanced ‘meta-
monitoring’ ability, which offers the potential for
revision and reintegration (Feeney and Noller,
1996). Clearly, therapy has a critical role in facil-
itating the revision of insecure models (Sperling
and Lyons, 1994). Eagle (1997) maintains that
the therapeutic relationship mirrors attachment
relationships, offering a secure base from which
the patient can explore their IWM and try out
new ways of relating (Warren et al., 1997). Insight
may be achieved through working in the trans-
ference, which allows discrepancies between the
adolescent’s expectations and the therapist’s actual
responses to be open to analysis (Harris, 1997). Sen-
sitive and consistent interactions offer a positive
attachment experience, which not only counteracts
expectations (Lynch and Cicchetti, 1992; Mace and
Margison, 1997), but also offers opportunities for
‘reality testing’.
Identifying the information processing bias inher-
ent in insecure attachment is important for appro-
priate treatment. It may be that reintegration is facil-
itated through raising the adolescent’s awareness of
the strategy being used, the reasons why the strat-
egy is employed and how the strategy is contribut-
ing to clinical symptomatology and interpersonal
functioning. The therapeutic process of reintegrat-
ing attachment-related information from all of the
memory systems is determined by the secondary
strategy (Jellema, 1999). For example, an adolescent
using a hyperactivating strategy might benefit from
accessing information from their semantic mem-
ory, and treatment might focus on weakening their
dependency on attachment figures and their ten-
dency to seek out idealized others inappropriately
(Lessard and Moretti, 1998). Intervention might also
use a problem-focusedapproach to develop alterna-
tive ways to meet attachment needs (e.g., emotion
regulation; developing internal coping resources;
considering their expectations of others). In con-
trast, an adolescent with a deactivating pattern
might need to integrate information from their
episodic memory, which necessitates increasing the
adolescent’s awareness of their tendency to cut
themselves off from distressing feelings. Using an
exploratory approach could facilitate this process.
There is considerable scope for a number of
psychological approaches in terms of interven-
tion. For example, cognitive-behavioural therapy
(Beck et al., 1978) and cognitive analytic therapy
(Ryle, 1995a, 1995b) are two approaches in which
distortions about the self and others can be identi-
fied and challenged (Jellema, 1999). The increased
ability of the adolescent to reflect renders these

interventions particularly appropriate for the revi-
sions of IWMs. In this way defensive strategies
can eventually be replaced by behaviours that are
more adapted to reality (Sable, 1997; Warren et al.,
1997). Enhanced adaptation might also be achieved
through using a group of family-based approach,
each of which offers opportunities for interactive
patterns contributing to the maintenance of the
IWM to be identified (thus optimizing the possibil-
ity of revision). For example, Byng-Hall (1991) has
discussed the idea of a ‘family attachment script’,
which encompasses the interplay between attach-
ment relationships. Members develop scripts which
may be mutually protective in that they decrease
emotions or memories that are defended against
(Byng-Hall, 1991, p. 203). He illustrates the way in
which a family therapist can provide a safe base
from which current interactions can be thought
about and understood. Alternative ways of relating
can then be explored, which in turn increases the
possibility that new working models of attachment
can develop.
Attachment theory facilitates the construction of a
rich formulation of psychopathology,both develop-
mentally, systematically and across psychological
domains. It also offers a coherent therapeutic focus
as well as affording a broad and flexible treat-
ment base.
FUTURE RESEARCH
Although there has been a recent surge of studies
investigating the utility of attachment as a concept,
our understanding of attachment in adolescence
would be enhanced if future research targeted
three main areas. Firstly, there is a clear gap in
the attachment literature around the period of ado-
lescence, which is considered to be a time when
attachment relationships and IWMs undergo a sig-
nificant transformation. Understanding this critical
period would be facilitated by the development
of psychometrically robust attachment measures
for adolescents, rather than relying solely on self-
report measures and on tools designed for other
age ranges.
Secondly, whilst sensitivity of parenting is con-
sidered to be importantin the security of attachment
(van Ijzendoorn et al., 1995), it is not particularly
clear what other factors might be influential in the
development of IWMs. We are even less clear on the
process maintaining IWMs. There is a clear need
to identify processes that maintain or disrupt these
developmental continuities, and the extent to which
adolescence offers a unique opportunity for reinte-
gration. It is unclear whether revision can take place
only within a sensitive and responsive relationship
(and whether this needs to be therapeutic or not).
The extent to which information-processing biases
might operate in the maintenance and revision of
models is, as yet, also unclear. There is a distinct lack
of evidence regarding whether individuals selec-
tively attend to different kinds of information, or
whether individuals anticipate, encode and trans-
form information in accordance with their IWM, all
of which require investigation.
Finally, identifying risk and protective factors in
the development of adolescent psychopathology is
critical. More specifically, the processes by which
risk factors link to outcome require consideration,
and multiple risk factors need to be considered
concurrently in relation to the development of
psychological disturbance (Cicchetti and Cohen,
1995; Zeanah et al., 1997).
CONCLUSION
The aim of this selective review has been to crit-
ically consider the major growth points in the
area of attachment theory, and specifically focus
on its relevance to adolescent development and
psychopathology. The review demonstrated that
a significant proportion of studies have concen-
trated on the role of attachment in infancy and
adulthood. However, remarkably little literature
considers the importance of attachment during
adolescence. The significance of the neglect of
adolescent development in attachment terms was
described. Adolescence is a particularly important
period for the revision of attachment patterns due
to the many developmental changes taking place.
Some of the clinical implications and future areas
of research have been explored. Finally, the review
has outlined theoretical explanations for the link
between attachment patterns and psychopathol-
ogy in adolescence. There is evidence to suggest
that secondary strategies and information process-
ing patterns may be critical in understanding the
developmentof symptomatology and interpersonal
difficulties during this period.
ACKNOWLEDGEMENTS
Acknowledgement goes to Professor Glenn Waller
and members of the Adolescent Department for

their helpful comments and guidance in the prepa-
ration of this article.
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