Developmental psychology, child development and clinical application with trauma have all played important roles in a new understanding of attachment and bonding problems in early childhood.
The patterns and organization of a human personality are established early on. The theme of a person's story and, to a large extent, the fundamental success or failure of his or her entire life is established in early attachment and bonding with his or her environment.
We are beginning to understand very early childhood and the precursors to social and interpersonal success or failure. Patterns of dysfunction in adulthood can be causally linked to the quality of very early attachment.
Securely attached infants are more cooperative, less aggressive and/or avoidant toward their mothers and other less familiar adults. Later on, they emerge as more competent and more sympathetic when they interact with peers. In free-play situations, they have longer bouts of exploration and display more intense exploratory interest; in problem-solving situations, they are more enthusiastic, more persistent and better able to elicit and accept their mothers' help. They are more curious, more self-directed, more ego-resilient, and they usually tend to achieve better scores on developmental tests and measures of language development.1
Some of the most severe attachment disorders are found with abused and neglected children. The trauma of abuse produces formidable hurdles for these children to overcome. Attachment is defined by B. James as "a reciprocal, enduring, emotional and physical affiliation between a child and a caregiver."2 Without attachment, survival is very much in doubt for one of nature's creatures that is most helpless at birth.
The "traditional attachment theory" was first advanced by John Bowlby, an English psychiatrist initially trained as a Freudian psychoanalyst. Bowlby, as well as other clinicians, had noticed in young children's response to loss that there was a somewhat predictable sequence of behaviors: first, the child protested with anger and rage; second, the child became depressed and showed despair; and finally, the child became detached from people and the environment.3
Since Bowlby's early work on attachment starting in the '50s, it has been believed that attachment and bonding may well be essential keys to explaining the most fundamental psychological and social problems. Bowlby called the way a child begins to understand his or her surroundings "inner working models," and the model has been found to influence a child's perceptions from early childhood on into adulthood.4 An abused child may develop a working model of distrusting all relationships.
Ainsworth's research on child abuse shows the effect abuse has on the development of a child far into the future.5 Studies have shown that infants whose relationships with their mothers are more secure are more competent as toddlers, preschoolers and public school students.6 Nurturance the mother experienced in her own childhood predicted the quality of the attachment she developed with her own infant.7 Abusive mothers have been shown to be more emotionally sensitive to their infants than neglectful mothers, but less sensitive than non-abusive mothers.8 There is perhaps a greater risk for children of mothers who, although they are aware of what the child needs and wants, do not respond.
More specific to trauma and abuse, research has also shown that abused and neglected children are more likely to show avoidance and resistance to their mothers after even a brief separation. Abused children have also been found to be more difficult to raise, while neglected children are more passive, and children in supportive environments are more cooperative.
In psychology, as in medicine, we are much quicker to identify a problem than the causes or the solutions to the problem. It is clear that our society has many dysfunctional members. There are well over one million men and women in our jails and prisons. The majority of men and women in our correctional institutions were abused children, and many have lived a life of antisocial behavior. Our drug and alcohol programs are full with waiting lists; domestic violence, divorce and broken homes are at the highest level in our history. Poverty, unemployment and hopelessness exist in abundance in modern America. Although causative cultural phenomena can be identified, failure in our society is experienced one person at a time and one life at a time. The study of early dispositional patterns developed in childhood -- what can be called secure and insecure attachment -- provides insight into the ability of some people to overcome life's obstacles while others seem unable to do so.
Three components of attachment theory are physical, emotional and social dimensions. Physical factors influencing attachment involve aspects of human physiology including hormones and the central nervous system. The importance of physical touch and other senses have already been mentioned. Emotional bonds are developed (or not developed) rapidly in infants, and once established, they are long-lasting. The role of emotions in the attachment process appears to be to assist in appraisal of the infant's internal organismic states and of the external environment.
Social reciprocity is the purpose of attachment. Physical sensations combine with the infant's emotional/intuitive appraisal, producing a behavior that is social or antisocial. Only if the child can accurately assess the affective state of another person can they productively participate in a social interchange.
A major influence upon attachment is instinct. The first instincts of primary importance are the instincts to survive, to be social and to be adaptable to the environment. Instincts are not restricted to infants; they also affect the mother. Deviations in evolutionary adaptedness, as Bowlby describes instinctive behaviors that don't achieve the desired results, can produce maladaptive behavior patterns. When this occurs, a negative cycle develops with the child slipping further and further away from the instinctive goal of connection.
Attachment Theory Behaviorally DefinedAttachment theory has been primarily defined in behavioral terms and can be summarized in eight important steps:
Whether or not the above processes remain functional for attachment may depend on the final phase of four attachment processes in infants: a) preferences to look at certain patterns and movements; b) discrimination of one stimuli over another; c) preference for the familiar; and d) resulting positive feedback continues approach behavior, while negative feedback results in diminished approach response and then becomes withdrawal behavior.
There are also disruptive behavior patterns that can develop which are contrary to the attachment process. The very early affective or intuitive appraisal of the environment develops standards or "set points" by which situations are measured. When set points are maladapted due to early disruptions, parental bonding behaviors may be met with anxiety, alarm and anger.
A variety of other behavior patterns can develop as well. Early negative experiences with hunger, illness, unhappiness and pain can produce disrupted bonding. Children have egocentrism, which means that after 12 months of age, they often construct their own internal world and can ignore exterior information that contradicts this internal world. When the focus turns to abused children, several important outcomes arise:
What can we do about attachments that have become disturbed or that have never developed in any form? In most cases, the presence of a reactive attachment disorder in a child indicates dysfunction in the parent, not the child. The clinical focus of all attachment work must be on the total environment, not solely on the child.
James has identified the roots of attachment in fundamental interactions such as: crying or responding, proximity seeking, attention getting and distress or comfort. The progressive mission of attachment is:
A number of factors can disrupt each of these social transmissions, but few as massively as the trauma resulting from child abuse. One of the most damaging dimensions of abuse is how frequently the abuser is a primary care provider.
Some behaviors that appear to be signs of attachment in children are actually seriously confused interactions which reverse the purpose of healthy attachment. These behaviors have been called trauma bonds and have as their purpose the protection of the abuser by the child. These displays of loyalty are bred upon fear and perhaps even concern for survival on the part of the child. It is clinically essential to distinguish between healthy attachment and a trauma bond.
Most attachment disorders are adaptations to initially unresponsive, painful or otherwise unsuccessful attempts to attach. A serious clinical challenge arises when the child's adaptations become psychologically ingrained. When this occurs, the child is not aware of having made the adaptations and doesn't remember the reasons for acting the way he or she does. Nearly all attachment adaptations are pre-cognitive because they cannot be recalled due to the age of onset, and they are pre-verbal as well. The deepest levels of attachment issues are not available to insight or cognitive interventions.
The goal in clinical attachment work is to facilitate the reciprocal, enduring affiliation between parent and child, if this is possible. This does not mean that attachment therapy should not be initiated, but it does mean that we must recognize the stress factors and inhibitors in the child's life that potentially work against the clinical goal.
In general, attachment problems are adaptations on the part of the child for survival and self-protection. To children who remember, it is like it happened yesterday. To children too young to remember, their bodies, through neurological processes that store trauma memories independently, do the remembering for them.10 The clinician or parent cannot hope to understand the child's present without understanding his or her past. Because of past experiences, expectancies develop that fit the child's working models of himself and others. Until clinicians know this, they cannot know the child.
B. James has outlined a treatment process for attachment disorder therapy:
James' above points are excellent, and her clinical handbook on attachment problems is highly recommended. She identifies five steps in the treatment of attachment disorders:
While each of the above are clearly important to treating attachment disorders, it is equally important in what order the process occurs. The building blocks can be viewed as a therapeutic staircase that begins with the bottom step and progressively moves upward. The important aspect of the staircase analogy is that to be stable, stairs must be firmly established on the foundation of the step below. Thus, without safety, there is no attachment, no relationship and no successful therapy can occur. The stairs progress from security through to acceptance, belonging, trust, relationships and self-awareness.
The building blocks can be used to determine how far the treatment has progressed and what the next step should be. It can also be an important diagnostic tool to consider on what step a child enters treatment and how far up the stairs they have been able to go. It is important to mention that a child may be on a different step with a variety of people. It is also important to point out the most common misconception of inexperienced attachment therapists -- believing they have a relationship with a child long before they have climbed the essential steps.
References
Dave Ziegler holds a doctorate in counseling psychology and is a licensed marriage and family therapist. He founded and directs a program in the mountains of Oregon, where he has lived with troubled children over the last sixteen years. He gives credit to the children for teaching him about attachment.