Attachment Theory in Clinical Work with Children: Bridging the Gap Between Research and Practice.
Article Type: Book review
Subject: Books (Book reviews)
Author: Angelini, Sara
Pub Date: 01/01/2012
Publication: Name: Existential Analysis Publisher: Society for Existential Analysis Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2012 Society for Existential Analysis ISSN: 1752-5616
Issue: Date: Jan, 2012 Source Volume: 23 Source Issue: 1
Topic: NamedWork: Attachment Theory in Clinical Work with Children: Bridging the Gap Between Research and Practice (Collection)
Persons: Reviewee: Oppenheim, David; Goldsmith, Douglas F.
Accession Number: 288874185
Full Text: Attachment Theory in Clinical Work with Children: Bridging the Gap Between Research and Practice David Oppenheim and Douglas F. Goldsmith (eds). (2007). London: Guilford Press

The editors of this book have put together a series of chapters on attachment research, and attachment-focused clinical practice, for clinicians working with children and their families. It was following a meeting of the Society for Research in Child Development in Seattle, Washington, when the need arose to bridge the gap between a thriving research community on attachment, and clinical work with children and families. The editors therefore hoped to contribute to a deepening of clinicians' understanding of the application of attachment concepts into practice, and wished to enable practitioners to adopt an attachment focus in both their assessment and intervention.

The editors say that the book will not review attachment theory and they do not provide much information on the associated observational procedure and interview, as they assume the readership has enough knowledge of that. I will however, briefly outline its history.

Attachment theory has its roots in clinical practice, and it was developed from the Second World War onwards by John Bowlby (1907-1990) who was, at first, interested in the effects of deprivation and separation on children, in particular as a result of the war. He was commissioned by the World Health Organization to write a report on the mental health of homeless children in post-war Europe. Over the years his theory of attachment became widely disseminated following the publication of three of his volumes on attachment, coined the Attachment Trilogy. His ideas were later supported by research conducted by Mary Ainsworth in the 1950s and 1960s, and his theories were further disseminated after the publication of Ainsworth's studies of the 'The Strange Situation' in the 1970s.

'The Strange Situation' is an observational model that has survived to this day and it aims to establish how securely a child is attached to its primary carer. After a period where parent and child are left alone in the room with toys, which the child is allowed to explore, a stranger enters the room, briefly chats with the parent and then approaches the child whilst the parent leaves inconspicuously. There are two separation and reunion episodes, and the play behaviour and departure/reunion reactions of the child are noted in order to categorise the child into three attachment styles; secure attachment, anxious-resistant insecure attachment, and anxious-avoidant insecure attachment. A fourth category was added later called disorganized-disoriented attachment. Later on Mary Main and colleagues expanded the attachment research into the domain of internal representations of attachment that evolve into adulthood, by devising the Adult Attachment Interview, which results in a categorisation of four attachment styles. These have been found to predict the interviewee's children's classifications in the 'The Strange Situation'.

To return to Oppenheim and Goldsmith's book, it is divided into two parts; Part One consists of five chapters describing research and clinical application. In this part, attachment instruments in the form of in-depth clinical interviews have been devised and applied to working with children and families. For example in chapter one The Working Model of the Child Interview was used to help a clinician assess and then make a formulation with regards to a very anxious mother with a three-month-old baby. In chapter two The Insightfulness Assessment was devised to help parents to think in insightful, accepting and open ways about the motives underlying their children's behaviours. Chapter three describes an attachment-based assessment with comprehensive coding system of parent-child interaction, helping clinicians intervene with maltreated children and their adoptive families. Chapter four describes the This is My Baby Interview, which measures commitment of foster carers towards the children in their care. Finally, in chapter five, through the use of the Reaction to Diagnosis Interview, awareness is raised about the emotional effects of diagnosis and how they can impact negatively on the attachment relationship between parent and child.

Part Two consists of four chapters on attachment theory in psychotherapy. In chapter six the link between attachment and trauma is described with a clinical vignette of a family with two children affected by domestic violence. Chapter seven talks about the Circle of Security Project, which used video material of parent-child interactions in a group intervention of parents struggling with children's behaviour. Chapter eight presents the case of a therapeutic pre-school, where therapists work with children and help them to challenge their negative internal working models of adults. Finally in chapter nine a psychodynamically oriented therapist presents a case study of a mother who has been insecurely attached in her childhood and who, in turn, had great difficulties providing a secure attachment for her adoptive daughter.

All of the chapters are well written and interestingly presented with clinical vignettes. It shows how research can indeed inform clinical practice in a useful way when clinicians have to work with families and their children. There's a focus on educating parents about child development and psychology, with a particular focus on attachment. Parents are taught how an insecure attachment can be turned around into a more secure and fulfilling attachment. All the various projects and interventions sounded quite hopeful and there was a sense that the clients were given as much time as they needed to get to a better place in their relating. It's a shame that the contributors of the book, both in the research and clinical sections, were predominantly reporting from an American perspective, and to a lesser extent from an Israeli perspective, so with regret I can't tell whether similar ways of working would be found in the UK within the Child and Adolescent Mental Health Services (CAMHS).

Both attachment theory and the validity of The Strange Situation procedure are not without criticism. Because of space constraints I can't go into all of them here, but an important one is the assumptions around what constitutes a good mother and what constitutes warm, intimate and continuous relating as a basis for good mental health. In particular Bowlby's concept of maternal deprivation at the time made a lot of mothers feel guilty about their mothering, and the concept was perhaps unduly used in the post-war period as part of a political agenda to get women and mothers back behind the stove and away from the workplace.

Furthermore, Ainsworth's procedure and the resulting categorisations, which seem to form the backdrop to subsequent research, represent a reduction of complex human interactions into rigid categories, where you are either securely attached (one category) or insecurely attached (three categories). The various meanings individuals and their children or different cultures place on separation and reunion is also not taken into account. It is important to note that the editors or authors don't go into the potential limitations of either the theory or the research procedures. A position of implicit acceptance of the theory and these formative years of research are thus taken and presumably therefore still inform the newer research presented in the book.

This is where my mixed reaction to the book comes into play. Attachment is an emotive issue. The book made at times for uncomfortable reading, to do mainly with a sensation of a shrinking of the world that constitutes mothering. I found myself wondering several times how my child and I would be classified under observation, and more often than not I felt the pressure of judgement and of ' having to get it right'. The notion of the perfect mother, encapsulated perhaps in the category of securely attached child, came to mind, and I have often experienced guilt-ridden and worried conversations between us mothers, talking about child-rearing mishaps, falling thus short of the 'perfect mother' notion and proclaiming 'jokingly' to be a 'bad mother'. Isn't mothering in reality a complex phenomenon that happens in a variety of contexts that bring about different aspects of the experience of feeling secure or insecure?

I also wondered how it must feel to be observed by strangers and to be at the mercy of their assessment behind a smoked screen, when you are already feeling vulnerable? I imagine that it can potentially feel quite shaming to be labelled, particularly because mothering one's child is such an intimate experience that reflects oneself. One particular vignette in the final chapter of the psychotherapy section entitled 'Disorganized Mother Disorganized Child' made for chilling reading as the author described how a mother and her four-month-old baby were observed in a face-to-face scenario, with no toys or props. The mother, AnaRosa, 'intruded upon Sophia's physical and visual space in an extremely aggressive way for 20 minutes (my italics). She poked, she loomed, she slapped in a playful but very rough way, and she mocked Sophia's distress' (Slade, A. p230). The author says that the mother found the instructions of face-to-face interaction without any toys or objects very difficult (Would she encounter that in real life?), that she felt pressure to perform, and that the baby had just woken from a nap and in fact was hungry, something the researchers only learned about later (Why?). My question here is: isn't there a kinder, more human and more reality based way to assess a troubled mother and child relationship? And of course, context in the existential understanding of the person and the world is very important. How does a particular context give rise to a particular phenomenon?

Having said that, there were some very impressive projects described. I was touched in particular by the Circle of Security Project (chapter seven), where the intervention happened in a group of parents who were there for similar child-parent relationship problems, looking at clips of their own interactions together. They described a supportive ethos in the group of parents, which was lead by the therapist to achieve therapeutic insights. The account of Rachel's experience of this intervention was moving, and the educational message to the parents was powerful: they were asked to see themselves in the role of cupped hands, providing a secure base for exploration, and a safe haven to welcome the child back, with a central message of the parent needing to be bigger, stronger, wiser and kind to the child.

I suspect many of us don't work with families or children. It's perhaps because of that, that this book may be of interest. And the ideas, concepts and projects described can be useful for psychotherapy with adults, since there is a child in every client we encounter and of course there is a child in ourselves as therapists. Attachment history and patterns of relating are therefore of importance to all of us, inside or outside of the consulting room, and reading this book could be a useful way to connect or re-connect with attachment ideas and their application. In particular, in my existential training there was very little presentation or discussion of child development and attachment needs, and how the quality of such experiences translate into adult relationships. Even less so, how one might work with someone who presents with an attachment trauma, which is something the book discusses. I would therefore recommend this book to trainees and professionals alike.
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.