Relationships and attachments

Relationships - What is Attachment Theory?

 

Much of the work I do as a psychotherapist and the queries I receive relate to our ways of relating to others, and relating to ourselves. Most people have heard of ‘attachment theory’. This is a very complex area, however I do find it really helps my client to have an understanding of it, and how it informs how we may work together within a psychotherapeutic relationship.  In this article, I share an overview of this theory in the hope that it will help increase your understanding of how you relate to others in your world.

 

In a nutshell

 

John Bowlby (1907-1990), world famous Psychiatrist, Psychoanalyst and pioneer of Attachment Theory* tirelessly researched (initially) the bond between infants and their mothers, and the subsequent psychological and behavioural impact on the formation, maintenance and breaking of ‘affectional bonds’ in adulthood.

 

Taking a walk with his son, Richard (Bowlby, R, 2005), in 1958, he said:

 

“You know how distressed small children get if they’re lost and can’t find their mother and how they keep on searching? Well, I suspect it’s the same feeling that adults have when a loved one dies, they keep on searching too. I think it’s the same instinct that starts in infancy and evolves throughout life as people grow up, and becomes part of adult love”

 

These ideas may be fairly commonplace now, but this conversation arose just as Bowlby’s ‘The nature of the child’s tie to the mother (1958, cited in Bowlby, 2005)’ was published, predicating decades of research into the impact of our first attachments upon adult relating and functioning, and the subsequent impact upon mental health. At the time, Bowlby largely disregarded the role of fathers, believing that the father role played ‘second fiddle’ to the mother. However, thankfully, as his research increased, he became more aware of the father role. Since his death, studies have been published acknowledging the importance of fathers.  Modern day attachment research recognises ‘early caregivers’, as opposed to ‘mother’, ‘father,’ etc, and that is the term that will be used throughout this brief introduction to Attachment Theory.

 

Bowllby recognised that it is inherent in the human spirit to significantly attach to only a select number of particular other human beings, not to every other human being. The term ‘affectional bond’ was coined by Bowlby to describe the significant attraction that ‘one individual has for another individual’.

 

(* this is a very brief introduction to Attachment Theory. Whilst John Bowlby is considered the ‘father’ of Attachment Theory, the research on attachment styles is highly credited to his very active collaborator:  Professor Mary Salter Ainsworth (who conducted pioneering research into ‘the strange situation’, 1967, Ainsworth & Wittig, 1969).

 

Also:  Anthony Ambrose, Mary Boston, Dorothy Heard, Christoph Heinicke, Colin Murray-Parkes, James Robertson, Dina Rosenbluth, Rudolph Schaffer, Ilse Westheimer, and Mary Main (who developed the adult attachment interview).

 

Why is attachment theory important to my relationship difficulties in adulthood?

 

Very few of us grow up in households with a consistent, balanced level of care, with all of our emotional, physical and creative needs being nourished.  Our first experience of intimacy is with our primary caregiver(s). Attachment Theory has demonstrated that the qualities of this attachment, and how we respond to them, can set a template for how we respond to other significant attachments as we become adults.

 

That, in adulthood, our ‘proximity seeking’ behaviours (read on for more about these) can cause us great distress, if the source of our attachment is unavailable to us (for instance by separation, illness, death, rejection or abandonment). The way in which we respond is largely predicated on the way in which we responded to the unavailability of our initial caregiver(s).

 

Facing loss, or threat of loss, in all of it’s guises, is of course what it is to be human.  

 

 

The formation of bonds

 

Adult Attachment Theory is concerned with the formation, maintenance, disruption and renewal of affectional bonds. The formation of a bond is described as falling in love, maintaining a bond as loving someone, and the loss or disruption of a bond as grieving.  Similarly, threat of the (whether real or imagined) loss of a bond causes anxiety, actual loss causes sorrow, with each of these situations being likely to arouse anger.

 

The unchallenged maintenance of a bond is experienced as a source of joy.

 

Adult attachment behaviours

 

Attachment Theory, (in opposition to Freud’s ideas), proposes that attachment behaviour is a class of behaviour that is distinct from the  basic human instinctual drives towards feeding and sexual gratification. Attaching (& remaining attached) to significant others holds equal significance in human life, and whilst it develops in infancy, applies to adults, and whoever is perceived by them as their significant attachment (lover, spouse, child, parent, etc):

 

a)    Attachment behaviour is directed towards one or a few specific individuals. Usually in clear order of preference.

b)    An attachment endures, usually for a large part of the life cycle. Although during adolescence early attachments may become supplemented by new ones, and in some cases replaced by them, early attachments are not easily abandoned and they commonly persist.

c)     Engagement of emotion - Many of the most intense emotions arise during the formation, maintenance, disruption and renewal of attachment relationships.  Emotions are usually a reflection of the state of an individual’s affectional bond, and attachment-based psychotherapists are largely concerned with the evolution of an individual’s affectional bonds, as this may be an indicator of the cause of emotional and mental health disturbance.

d)    In the great majority of human infants, attachment behaviour to a preferred attachment figure develops during the first nine months of life.

e)    An attachment can develop even in the most adverse conditions; sadly, an attachment can develop despite repeated punishment from the attachment figure.

f)      The organisation of attachment behaviours occur in certain conditions:  ‘activating’ conditions, and ‘terminating’ conditions. An ‘activating’ condition is usually fear-inducing, and will encourage the seeking out of the attachment figure.  These conditions include: strangeness, hunger, fatigue and anything frightening. A ‘terminating’ condition will include the sight or sound of the significant attachment & if the activating condition is so strong, will require touch.  ‘Terminating’ means that the emotional arousal stimulated by the frightening situation is soothed. (For more information on this process, consult Mary Salter Ainsworth’s research on “The Strange Situation”).

g)    Attachment theory proposes that attachment behaviour is an innate, evolutionary function that has survival value. Bowlby argued that the most likely function of attachment behaviours is to secure protection, mainly from predators.  (Bowlby, 2005).

 

 

The secure base

 

Central to Attachment Theory is the notion of the secure base.  Put simply, the infant/toddler who receives consistency from their initial caregiver, in terms of availability, friendly responses, and willingness to interact is more likely to not constantly seek close proximity to the care-giver. Instead the child willingly begins to explore the wider environment, confident in his /her ability to return to their caregiver  & receive soothing should they encounter a fearful situation.  Importantly, the caregiver willingly allows their child to explore in this way.

 

In these circumstances, it is proposed that the child experiences a ‘secure base’ to return to, and this ‘secure base’ becomes internalised. As this infant becomes an adult he/she will explore the wider ‘world’, whilst maintaining contact with significant attachments.  The securely attached adult can manage threats to their attachments with equanimity, and can tolerate distance and separation.

 

I really want to emphasise here that there is no such thing as a ‘perfect’ parent who can offer 100% of a secure base, 100% of the time - that is truly unrealistic (no matter how much the infant/toddler protests at this!). What is meant here is the general perceived consistency of availability of the primary caregiver.

 

In attachment theory terms, this is classed as a ‘secure’ attachment style.

 

The development of an ‘attachment style’

 

Sadly, for many reasons, there are lots of children who do not grow up in these optimum conditions, due to the lack of emotional and physical availability of care-givers arising from separation, illness, death, abandonment, neglect, poverty, to name but a few.  These children, depending upon the inconsistencies in behaviour and responsiveness of their initial care-giver(s), may go on to develop the following insecure styles of attachment.  For more information on the evidence in which the formation of attachments styles is predicated, consult Mary Salter Ainsworth’s research on “The Strange Situation”,1967, Ainsworth & Wittig, 1969.

 

 

A word of caution:  attachment styles are not ‘diagnosed’, or a form of ‘mental illness’, although admittedly adverse childhood experiences can lead to many mental health problems in adulthood. Attachment theory is offered as a map to understanding what your preferred and automatic attachment style may be, and how this can change (more on this later). Neither is learning about attachment theory, or entering into attachment-based psychotherapy about ‘blaming’ initial care-givers, it is simply about seeking to understand what may be driving and influencing our responses in relation to others. Due to more recent advances in studies of attachment and the brain (see below), we now refer to ‘attachment relationships’ as opposed to ‘attachment style’ as this suggests that our ‘style’ is fixed for life, and we now are far more hopeful that our attachment behaviours can change.

 

Anxious/Preoccupied

 

Adults with this style of attachment  may have had care-givers who were conditional, or punishing/blaming.  Anxious/Preoccupied attachment styles may seek high levels of intimacy, approval, and responsiveness from their attachment figure, and can become overly dependent. Compared to securely attached adults, those who are anxious or preoccupied with attachment tend to have less positive views about themselves. They may feel a sense of anxiousness that only recedes when in contact with the attachment figure, and may spend time dwelling on (imagined or real) rejection or abandonment. They often doubt their worth as a person and blame themselves for the attachment figure's lack of responsiveness. People who are anxious or preoccupied about their attachment figures may demonstrate high levels of emotional outbursts, with an inability to soothe or regulate their emotions, worry, and impulsiveness in their relationships.

 

Avoidant Attachment Styles:

           

Insecure/Avoidant

 

People with this attachment style may have had care-givers who were unresponsive, or rejecting, and so will strive for a high level of independence, which often appears as an attempt to avoid attachment altogether. They may view themselves as self-sufficient and invulnerable to feelings associated with being closely attached to others, and often deny needing close relationships. People with an insecure–avoidant attachment style tend to suppress and hide their feelings, and tend to deal with rejection by distancing themselves from the sources of rejection (e.g. their attachments).

 

Ambivalent/Avoidant

 

People with this attachment style may also have had early care-givers who were unresponsive or rejecting, or intermittently overly involved or intrusive towards them. They may have mixed feelings about close relationships. On one hand, they desire to have emotionally close relationships, and on the other, they tend to feel uncomfortable with emotional closeness. These mixed feelings are combined with sometimes unconscious, negative views about themselves and their attachments. Someone with an ambivalent/avoidant attachment style commonly view themselves as unworthy of responsiveness from their attachment figures, and distrusting of their attention.

 

Similar to the insecure–avoidant attachment style, people with ambivalent–avoidant attachment style seek less intimacy from attachments and frequently suppress and deny their feelings. Because of this, they are much less comfortable expressing affection.

 

 

Disorganised Attachment

 

Some caregivers raise their children by being frightened or frightening, and may act in ways that do not make sense, demonstrating unpredictable, confusing or erratic behaviour to their child. This can lead to the child experiencing a ‘disorganised’ attachment with their caregiver.

 

An individual who grew up with a disorganised attachment often won’t learn healthy ways to self-soothe. They may have trouble socially or struggle in depending upon others to co-regulate their emotions. It may be difficult for them to open up to others or to seek out help. They often have difficulty trusting people, as they were unable to trust those they relied on for safety, whilst growing up. They may struggle in their relationships or friendships or when parenting their own children.  Those with a disorganised attachment style may have difficulty managing stress and even demonstrate hostile or aggressive behaviours. Because of their negative early life experiences, they may see the world as an unsafe place.

 

 

What is ‘attachment-based’ psychotherapy & how can it help me in my relationships?

 

A psychotherapist that is informed by attachment theory will seek to help you to understand patterns in your early attachments, either visually, through drawings and creative work, or verbally.. This can be confusing at times, because you may be seeking therapy to address a current problem, and your therapist is asking about your early care-givers!  This is to try to establish some sense of your attachment style, and to identify patterns of behaviour that may be out of your awareness.  As humans, we often unconsciously create the conditions that we seek to avoid, but we don’t know we are doing it. Working on your patterns in this way can help you bring your emotions and behaviours under conscious control.

 

This is where the hope lies. People often assume that their attachment style is ‘fixed’, and this is not the case. It requires hard work, but you can work on developing your own ‘secure base’, if you have not experienced this from your early caregivers. Having an internalised secure base can help you to feel more secure in your self, and ultimately your relationships.

 

Bowlby proposed that the therapeutic relationship can be offered as the ‘secure base’ that the individual may not have received in early care. Experiencing a therapist who will be consistently attentive, even if your behaviour and feelings towards the therapist can be distant/dismissive/angry/rejecting etc, can help you to develop a sense of ‘inner safety’, that you then take out into the wider world.

 

Attachment and the brain

 

(Again, in a nutshell!)

 

Functional MRI scans are a relatively recent phenomena, and can detect activity in the regions of the brain. Worryingly, brain studies have shown that in early cases of emotional and physical neglect, certain connections in the right hemisphere of the brain get ‘pruned’ (meaning that if the connection is not used, it ceases to exist).

 

This is important in the case of understanding attachments;  for example, if our early care-givers are inattentive and unresponsive to our physical and emotional needs, then our brains adapt so that we no longer expect to receive a response to our distress.  Think about the ongoing impact of this upon our behaviours and feelings when we are relationship forming as we become adults?

 

Alternatively, if we have a caregiver who is frightening or intimidating, who activates, but does not  calm our fearful responses, our brains learn to be ‘on red alert’ for fear, and sadly we do not learn the appropriate ways to be able to soothe our fears, and calm our regulatory system.  This can lead to ongoing disruptive patterns in relationships, and also to the development of unhelpful coping strategies, such as self harming, and dependency upon substances, or risky & impulsive behaviours.

 

 A recently published fMRI study (Hariri et al., 2000, cited in Schore, 2001) demonstrated that: “higher regions of specifically the right prefrontal cortex attenuate emotional responses at the most basic levels in the brain, that such modulating processes are fundamental to most modern psychotherapeutic methods that aim to modulate emotional experience, by labelling emotional responses”. Put in every day language, there is evidence from neuroscience that therapy (or having positive and safe relationships, where risks can be taken in terms of emotional expression), can lead to those ‘pruned’ connections being re-established. In other words, our clever brains have plasticity - if you have experienced damaging or neglectful care in childhood, there is evidence that your brain, (and therefore your emotions and behaviours) can be restored to healthier functioning, to help you to recover.

 

This is amazing, and these advances in neuroscience are progressing rapidly. I am sure that if Bowlby & his early associates had lived to see these advances, they would be very proud indeed to have scientific validation of their intensive empirical studies.

 

 

I am interested in seeking attachment-based psychotherapy, what can I expect?

 

As stated before, the focus of attachment-based psychotherapy is upon establishing a safe, therapeutic relationship, based on the following (Bowlby, 1976):

 

•   To provide you with a secure base from which you can take the risk of exploring relationships, past and present.

•   To join in with your exploration, encouraging you to consider how you behave, feel and think when forming close relationships.

•   To draw attention to the therapeutic relationship, and the possible predictions you are making about the therapist’s thoughts and feelings towards you, particularly when your therapist is absent or unavailable due to holidays, illness, etc

•   To help consider your typical reactions during real life experiences with attachment figures in childhood, adolescence and currently, and what your responses were and are today.

 

What you need to understand about the conditions your therapist is offering & what will be expected from you:

 

•   Your therapist will offer you a genuine relationship, giving honest reflections and feedback about the therapist’s responses

•   Your therapist can tolerate intense and painful displays of emotion, without retribution or retaliation towards you

•   Your therapist will respond to you with empathy & is not seeking to judge the actions of you or your earlier care-givers

•   Your therapist will offer interpretations and reflections about your behavioural and emotional patterns in relationships

•   Your therapist will offer you secure boundaries, so that you know, explicitly, from the start of therapy, what to expect from them

•   Your therapist will require you to describe difficult feelings towards the therapist him/herself, and will be able to receive these feelings without judgment, to enable you to work through them (in therapy language, this is called a process of ‘projection’).

 

 

A note on trauma, emotional regulation & dissociation

 

Where there have been experiences of chronic early neglect and/or sexual abuse, it can be difficult for an individual to regulate the intense and powerful emotions that they are feeling. This can lead to unhelpful behaviours such as self harming, substance dependency, impulsive behaviours and dissociation (not feeling/experiencing anything in the here and now).  These are understandable responses, and so your therapist may need to introduce other techniques such as a ‘grounding’ experience, to help you to manage any damaging impulses, before being able to explore the difficulties you have had in early relationships. 

 

When someone has these responses every day, this can be known as ‘chronic or complex trauma/PTSD’.

 

This is where a more trauma-focused intervention may be required. Such as EMDR and trauma-focused CBT.  Any trauma-focused work will require some level of grounding work, before emotional processing of difficult experiences and relationships can take place, and this can take some time.

 

Why choose Nicola at Nine Wellbeing for attachment-based psychotherapy?

 

Alongside working in private practice, as a psychotherapist, I have worked in specialist NHS settings for 11 years, including primary care, Eating Disorder and Personality Disorder services. Within these settings, I frequently supported individuals who have experienced difficult attachments, and subsequently developed difficulties in their functioning, either by developing an eating disorder, or by self harming and developing suicidal impulses.

 

During my initial core training as a counsellor, I took an immediate interest in attachment theory, and have practiced this approach from the outset. As my psychotherapy career developed within specialist services, I undertook specialist qualifications in Dialectical Behaviour Therapy (DBT), which helps people to develop skills in emotional regulation, and relationship building. Furthermore, I have worked with many individuals who present with symptoms of trauma (both through neglectful or abusive relationships, and through traumatic events), and so is an experienced trauma focused CBT therapist, and qualified EMDR psychotherapist.

 

Educated to Masters level (with distinction), and accredited by the British Association of Counselling & Psychotherapy (BACP), you can be sure that I am well qualified and experienced in helping you to resolve attachment difficulties that you are facing.

 

I am interested in starting attachment or trauma-focused psychotherapy, what is the first step?

 

You can contact me via the contacts page to arrange an initial consultation. The initial consultation lasts one hour, and you are under no obligation to continue with therapy if you don’t feel it is the right time, right approach, or that I am not the right therapist for you.  During the consultation, I will help to create a formulation of your difficulties, and will discuss a proposed plan of therapy with you. You will understand how many sessions will be undertaken initially, and how frequently they will take place, and the type of therapy that you are having.

 

 

List of References

 

 

Ainsworth, M.D.S. (1964). Patterns of attachment behaviour shown by the infant in interaction with his mother. Merrill-Palmer Quarterly of Behaviour & Development, 51-58

 

Ainsworth, M.D.S & Wittig, B.A. (1969). Attachment and exploratory behaviour of one year olds in a  strange situation. In B.M. Ross (ed), Determinants of Infant behaviour (Vol 4, 113-136).  London: Methuen.

 

Bowlby, J. (1976). The Making & Breaking of Affectional Bonds - lecture at the Royal College of Psychiatrists, London.

 

Bowlby, J. (2005). The Making and Breaking of Affectional Bonds. Oxon. Routledge.

 

Bowlby, R. (2005).  Foreword:  The Making and Breaking of Affectional Bonds. Oxon. Routledge.

 

Schore.A.N. (2001). The effects of early relational trauma on right brain development, affect regulation and infant mental health. Infant Mental Health Journal Vol 22 (1-2), 201-269.

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