“Attachment disorders: Assessment strategies and treatment approaches”, by Thomas G. O’Connor and Charles H. Zeanah, is an article that relates to this case study, in which I have attached. Attachment Theory: “An Attachment is a reciprocal, enduring, emotional and physical affiliation between a child and a caregiver”. The most recognised attachment theorist was a man called John Bowlby, a British Psychologist, Psychoanalyst and Psychiatrist famous for his work and fascination in child development and for his revolutionary and ground-breaking work in attachment theory.
Attachment Theory has grown to be the main influential theory applied today in the study of child behaviour, mental health in toddlers, children’s treatments, and associated domains. It is described as an emotional bond and affectionate tie to another person. Bowlby believed that the bonds formed between the caregivers and a child has a huge impact throughout the child’s life. According to Bowlby, through an optimistic shared reciprocal relationship, infants discover to manage their emotions, calm themselves and are able to connect with other people.
They can form an opinion on themselves, other people and the world around them through the events they experience through attachments. Also, children show an instinctive tendency to get an attached to certain person, which he called Monotropy, although he accepts they may have a variety of hierarchy attachments. He developed the attachment theory through research with institutionalized children who were there due to the effects of world was 2, ethnology and animal research, psychoanalysis psychology, evolutionary psychology, and neurology and brain research. He felt there was a critical time period for this attachment to form.
He believed that if a child was deprived of this attachment between the ages of six months five years that the child would have problems in his life later on. He called this theory Maternal Deprivation. He also believed that a separation from these attachments meant that the child would grow up to have “affectionless psychopathy”, which would result in the person having no sense of conscious, guilt or shame e. g. robbers Bowlby’s attachment theory stresses four main concepts which are, first that infants between the ages of six months to two and a half years were likely to create an emotional attachment bond to known aregivers, and more so if the caregiver was readily available, receptive and reactive to the child. His second important stressor is that the emotional attachments of the infants are seen through their behaviour by their inclinations to go to their recognised caregivers. Third, in later life it is seen that how the child behaves towards the caregivers has continued on to affect their social behaviours and also their attachment formation with the caregiver plays a role to the foundation of their personality and emotional development later on.
And finally, situations that intervene with the child’s attachment development can have both short-term and long-term negative effects on the infants life – cognitively and emotionally, for example, the unresponsive and unavailability of the caregiver to the child or the separation of the child form the caregiver. “Intimate attachments to other human beings are the hub around which a person’s life resolves, not only when he is an infant or a toddler or a schoolchild bit throughout his adolescence and his years of maturity as well, and well on to old age.
From these intimate attachments a person draws his strength and enjoyment of life and through what he contributes he gives strength and enjoyment to others” (Bowlby, 1980) . There are four main characteristics of attachment that care identified: [pic] • Safe Haven – the caregiver is the person that the child can return to when feeling endangered or upset and expect comfort. • Proximity Maintenance – the child ensures he keeps close to the caregiver in a way of security and safety. Separation Distress – the child gets upset when separated from the caregiver • Secure Base – the caregiver is a secure base for the child so he feels happy going out to explore Attachment was encouraged by the ‘The Positive Interaction Cycle’ which is the parent optimistically and actively playing with the child and the child responding in a positive way which gives the child a sense of self-worth, self-esteem and self-efficiency and therefore encouraging the attachment formation. ‘The arousal-relaxation cycle’ is another way to promote the attachment formation.
This is when the caregiver tends to the child’s discomfort and aids their problem such as hunger. Other attachment formation facilitators are Claiming behaviours and Attachment Promotion by the caregiver. The claiming behaviours involve are based around family routine and rituals, identification and relationship link with the child and a feeling of interpersonal connection. The Attachment promotion by the caregivers involves: sharing, communication, interaction, learning and good behaviours. “Barriers to early attachment formation include the Physical or emotional unavailability of the parent or baby and can be partial or complete.
Unavailability can result from a child’s or caregiver’s physical pain, illness, drug addiction or development disability, among other things. Chronic emotional disturbances like depression, extreme shame and distorted perceptions can interfere with attachment formation”. Attachment Types: John Bowlby’s theory an attachment was influenced by the work of Ethnologist Konrad Lorenz and also by psychoanalyst Sigmund Freud. Although the attachment theory originates mainly from John Bowlby, it was an attachment theorist called Mary Ainsworth (1978) that developed the theories through research on his work.
Depending on different interactions and experiences an infant has with their caregiver therefore bases the development of their attachment styles. Mary Ainsworth findings on Bowlby’s theories were that infants have three different types of attachment styles. She came to this conclusion by creating an experimental “Strange Situation” test. This is when she observed children being separated form their caregivers and noted their reactions while also observing their reactions of the child when the caregiver returns. [pic]
The three classifications of attachment that Mary Ainsworth formed were: • Secure/Autonomous Attachment: (Type B) This type of attachment is appropriate to approximately 55 – 65% of children of the population. Children that have this attachment type are able to separate from their caregivers but they show a little distress as they show clear preference to their caregiver over strangers. Even though they are upset on the caregiver leaving, they are happy and confident that their caregivers are going to return to them. They seek comfort when they are distressed as they know their caregiver will be responsive and comforting towards them. Studies have shown that securely attached children are more empathetic during later stages of childhood. These children are also described as less disruptive, less aggressive, and more mature than children with ambivalent or avoidant attachment styles. ” Parents of securely attached children show characteristics such as having good, trusting and lasting relationships; they seek our social support, have good self-esteem, are confident, expression and acknowledgment of their feelings, and are responsive, sensitive and adapted expressions. Insecure: Anxious-Avoidant Attachment: (Type A) From my examination of the case study, I believe that Derlva has developed this type of attachment. When categorizing the attachment type of a child, we must observe the child’s behaviours. According to Howe (1995), “any specific behaviour displayed by an insecure child is a coping mechanism directly related to the attachment type they have developed”. This type of attachment in children is identified in approximately 20-25% of the world. Children with this attachment type may avoid parents. They do not seek much comfort or contact from parents.
They show little preference between parent and stranger. They may not reject attention from parents but they don’t look for comfort or contact either. They show little or no distress on departure and little or no distress is visible to return, ignoring or turning away with no effort to maintain contact if picked up. A child develops an avoidant attachment style when the caregivers are not available when the child needs them. This is an important point when classifying Dervla into this attachment type as Jenny, her mother was not available to her when she needed her, emotionally and physically. The avoidant child is offspring to the dismissive/derogating parent who is unconcerned with attachment behaviours and values”.  This levitates the collapse of proximity seeking and communication behaviours that the child is instinctual to. The child rejects the interactive method and goes towards auto regulation. Auto regulation is a defensive mechanism strategy for self-comforting and self-stimulation. “Attachment and personality organisation involves biological substrates that alter neurological organization both on a structural and functioning level.
The predilection for auto regulation is not merely a preference, although it can be. Primarily it is hardwired into the nervous system”. Dervla was described in her profile as “a solitary child who seemed very self-sufficient” which indicates that Dervla’s defensive mechanism was auto-regulation. “A Child with this attachment also appears to keep their emotions locked away and seen as if they don’t need any care from others”. The child comes to a point were he may lack awareness of time and space identifying to Derlva who was understood to be “aloof”. The caregivers are typically cold in their interactions with the child.
The child then may feel rejected. The parents either do not understand on how to care for a child or they do this on purpose, as some parents try to make their child independent at a young age so when for instances the child runs to them crying, the caregiver may say “Stop crying…why are you crying…you shouldn’t be…you’re a big boy now!! ” Through this response, the child begins to learn that he/she will not get any assurance and concern off the caregiver so he/she becomes self- sufficient. The child may ignore them even after a degree of separation. The child shows little affective sharing in play.
Other factors that lead to the child developing an avoidant attachment style would be if the child moved around a lot – from one caregiver to another caregiver, and also factors such as abuse and a loss of an attachment figure. Dervla has experienced all of these three incidences. “Gradually they become more hostile and distant with peers and teachers alike, socially isolated less compliant with rules and more expressive of negative emotions. As they grow older, these children are frequently very independent: sullen, oppositional: disproportionately represented in samples of abuse or neglected children. 9] This quote is very appropriate to Dervla’s circumstances as she is displays be quite, withdrawn, solitary, self-sufficient, socializing difficulties, trouble-making, little interest on appearance or making friends, isolated as she likes to listen to music on her own, unmotivated, aloof, bad language, crying at night, defensive and she has a general lack of interest. As the child gets older, characters shown are to be vigorously aggressive, needy, bullying, objective but compulsively autonomous and isolated. “I don’t need you” kind of attitude.
Also, they find it hard in creating and maintaining healthy relationships, they may show features of being a sociopath, they may accuse others for their errors, not dependable, not able to express affection, easy to get infuriated, takes other peoples actions personally, may be out to get retribution, and frequently relies on external modulation devices in a strategy to control affect. • Insecure: Anxious- Resistant/Ambivalent Attachment: (Type C) This type of attachment is usually uncommon with only about between 10-15 % of children displaying this type.
The child show huge amounts of distress when the parent leaves yet on the parents return the distress persist. The child may show signs of rejecting the caregiver by refusing consolation and even display aggression towards them. Children with this attachment type are very wary and suspicious of strangers. They also shown signs of clinginess and over-dependence to people when they are older, such as teachers, as studies show that children with this type of attachment have low parental availability. Parents of the child mainly show characteristics such as selfishness, inconsistency and impatience.
The child cannot depend on the caregiver for security and comfort. They may have unclear emotional boundaries and have an uncertainty about the relationship. A fourth category was conceptualized by Main and Solomon in 1986 when a number of children didn’t not entirely fit into the categories fashioned by Mary Ainsworth. The category is named “Disorganized Attachment” following the theory that the children in a lack of rational or coherent structured behavioural strategy when it came to dealing with discomfort and stresses such as Ainsworth’s “Strange Situation” test. 15-20% of children fall into this category.
The caregiver may show systems such as intrusiveness, withdrawn, aggression, role confusion, maltreatment, negativity and emotional communication errors but the most prominent sign is frightening or frightened behaviour. They show insensitivity, unavailability and ‘refrigeration’ like parenting. It is believed that children see their caregivers as scary or scared. The parent who is appears scared to the child has a very distressing for the infant and it is thought that the child even may analysis their parents expression as the parent enters the room to decided if situation is safe.
For the child that sees their caregiver as scary and frightening, he/she has a ‘catch 22’ situation which is called “fear of solution”. Here, they view the caregiver as both their safe haven yet is frightened of them causing confusion to the child. The scared caregiver tends to be aggressive towards the child, physically or sexual, mild or indirect. Other related concepts: Attachment relationships: Jones (1994) Categories of Attachment Relationships: a. Good enough attachment b. Maladaptive attachment relationships with the potential to change c.
Maladaptive attachment relationships with no potential to change d. New primary caregiver e. Nonprimary supplemental attachment I think Derlva’s and her family fall into Category (B): Maladaptive attachment relationships with the potential to change. Even if the relationship doesn’t offer proper protection, care and attention, the caregiver displays the abilities and willingness to learn and change. This type of relationship is characterized by in the child with no interest to explore, clinginess, withdrawal and a concerned interest for the caregiver’s welfare which relates to the facts in Derlva’s case.
Traumatic Relationships: A traumatic relationship is regarded as control, compliance, fright and panic, little room for personal growth and space and also being near that specific person results in insecurity, dispute and unpleasantness provoking a numbing response. In the Journal that I have attached the there was a study investigation carried out on 39 adolescents resident on five regional adolescent units in the south-east of England and “when interviews were rated additionally in terms of resolution, 59% of the sample were unresolved with respect to experiences of trauma or loss”.
Out of the nine symptoms of someone who is suffering from an attachment trauma, Derlva has five of them, which the first one is Dysregulation of affect inc. numbing…Derlva was described as “aloof”. “Her key-worker Karen has being trying to get her to open up more” which suggests to me that she has the symptom alexithyma, which is poor self-reflection on emotions. A third symptom is regressive behaviour, where Dervla tends to “go out of her way to spoil an occasion that seems to be going good for her”.
Avoidance of intimacy due to poor trust is another indication of an experienced traumatic relationship wherein Dervla’s case she has little interest in making friends. Lastly, conduct behaviour are signals of this also. Dervla, “will cause trouble for no reason, like smoking in-doors, leaving a mess in the bathroom” and using bad language to someone. Dervla uses the Alarm/Numbing Response as a defence mechanism. • When a child looks out for a harmful and bad situation and reacts to good, happy or normal situations with challenging and confrontational behaviour and actions. He/She has a desire to spoil everything which provokes numbing and release from distress and anxiety. • The outcomes of this challenging behaviour are punishments, reactions and effects therefore redirecting the focus on something else rather than the child’s original anxiety. Sexual Abuse: Dervla was sexually abused by her mother boyfriend at the age nine. Rather than relying on the stability of social relationships, detached and abused children either distain human contact or worse come to loathe and fear these connections.
Children of abuse like Dervla, experiences feelings of guilt and shame. They may experience long-term emotional and psychological problems and difficulties in forming relationships later in life. Adult attachment: • Secure attachment: Approximately 50% of people have this attachment style. They have a positive view of themselves and others. The adult has a valuing of relationships. They are trusting of others and have a good relationship with their parents. They tend to have long-lasting relationships where they are comfortable seeking closeness.
They are more balanced than people of the other adult attachment styles and look for constructive solutions to problems rather than revenge. They tend to have secure children. • Preoccupied attachment: Approximately 14% of people have this attachment style. They tend to be inconsistent and incoherent. They may have unresolved conflicts but are still anxious to please. They have a negative view of themselves. They look for excessive closeness in relationship but they have a fear of being rejected. They are prone to feel shamed and having high levels of emotionally distress. They tend to have resistant children.
I would classify Jenny as having this attachment type. She portrays characteristics that relate to a having preoccupied attachment style such as having inconsistent parenting, as Derlva has been in and out of foster care all of her life. She would constantly argue with her mother which may be because is emotionally distresses. Jenny was known to have had … “a series of relationships that has never worked out for long” relating to people who have preoccupied attachment that are preoccupied with relationships and have high emotional reactivity. Jenny also feels shame, as she put Derlva into are when she was sexually abused when she felt that it was her fault for it happening and also she brings her lovely presents when she visits showing that she is feeling guilty and ashamed. Jenny obviously has unresolved conflicts in all of her relationship during her life. Relationships such as her father who left her as a teenager, her mother and her younger sister who she rarely contacted after she moved out because of all the arguments and also with Derlva’s father because he never supported her when Dervla was born and she showed resistance towards him later on when he wanted to form a relationship with Derlva. Dismissing attachment: Approximately 21% of people have this attachment style. They view themselves in an overly unrealistic positive way. The adult has a lack of value of relationships as they expect the worst from others. They tend to idealize childhood with little proof as they have lack of memory of childhood. They tend to have avoidant children. • Unresolved/Fearful attachment: Approximately 15% of people have this attachment style. They also show one of the other attachment styles as well as this one. They have a negative view of themselves and others.
They refuse to get close in a relationship for fear of rejection. They can be hostile. They may have suffered neglect, abuse, and trauma. They tend to have unresolved conflicts and grief. They tend to have disorganized children. Separations: Dervla had many different type of separations from relationships in her life: Rutter (1985) categorized these separations experienced into three groups: Deprivation: This is when the child had the relationship but lost it. Dervla experienced Deprivation Separation with her mother first at the age of one, when she put into care for four years, as Jenny moved country.
Later on, she experienced this again… “she had to move school again and lost touch with the best friend she ever had”. Rutter believed that any disruption in the relationship between the child and the mother would impact on the child’s ability to regulate his/her emotions. Jenny, Dervla’s mother also experienced this type of separation as her father separated from her mother when she was thirteen. She also had this lost through all her failed romantic relationship Distortion: This is when the relationship has distorted or transformed.
Dervla experienced this type of separation with her mother and her father. With her mother their relationship kept on altering as she would spend a period of time in care and then a period of time under the care of her mother. In relation to her father, he also had slowly built a relationship with Dervla when he entered her life at the age of six. But this relationship faltered at the age of nine when she was taken into care. Privation: This is where the relationship never existed. This has a harmful effect on the child.
Derlva initially experienced this type of separation with her father as he was non-existent in her life till she was aged six. She also never got to form a relationship with her younger bother that was put up for adoption in the United Kingdom. Internal working model The Internal Working Model is a “Mental schema or internal representation – the inner organisation of attitudes, feelings, expectations and scripts which are a product of our social relationships. Early parental insensitivity may lead to a model of social inadequate and unworthy which guides future relationships”.
According to Bowlby, the first relationship that the child develops gives the child an idea or map of what a relationship is supposed to be like. In turn, it gives the child his bases on how to form relationship and gives him the bases for his own parenting regime for when he has children. A child that has a secure attachment type would have a positive working model. Their parent would be emotionally available, sensitive and supportive. A child that has a resistant attachment type would have negative self-image and exaggerated their emotional response to gain attention.
The parent of this child would be very inconsistent. A child that has an avoidant attachment style would view themselves as unacceptable and unworthy. Dervla is showing an avoidant attachment style and “children of this attachment type tend to develop internal working models of people as being emotional unavailable, untrustworthy and rejecting”. As Dervla was put in and out of foster care most of her life and is currently in foster care, she may feel rejected and may feel that people are unreliable and unpredictable, which is supported by the attachment type that she portrays.
Also, Dervla began building a relationship with her father even though she didn’t have much trust in relationships anyway before he returned due to Jenny’s inconsistent parenting. She was shy at first but slowly became to trust him. Then the relationship falters, re-enforcing her initial perceptions of relationships, re-enforcing her initial feeling of people being unreliable and unpredictable and reinforcing the negativity in her internal working model of being unlovable, in which she comprehended from her first crucial relationship with her mother.
As her father is living with his two other children and not her, there is a good possibility that she feels that the other children must be more worthy, more lovable and more significant than she is. The sexual abuse she encountered when she was nine has a huge effect on children her age, mentally physically, emotionally and behaviourally. “When a child or youth is molested, she/he learns that adults cannot be trusted for care and protection: well-being is disregarded, and there is a lack of support and protection. These lead to grief, depression, extreme dependency, inability to judge trustworthiness in others, mistrust, anger and hostility.
And as if all that isn’t enough, children’s bodies often respond to the sexual abuse, bringing on shame and guilt”. To help Dervla through this traumatic experience, she needed her mother to have been available and supportive in a comforting, loyal and compassionate role as it lessens the sufferer’s traumatic ordeal. In contrast to this, her mother put her back into care, showing a little support and this is proven to deepen the effects of the abuse and leaves the child feeling more extreme to loneliness, helpless, and unworthiness.
Her resistance to make friends and form relationships stem down to her feelings of her internal working model as she feels if she gets close to them that they are going to let her down like her previous relationship have. In the Journal attached it states that “The overall findings confirm the global hypothesis, becoming increasingly firmly established, i. e. that psychopathology is associated with profound insecurities in terms one ones state of mind regarding attachment experiences (Dozier et al. , 1999)”.
Fatherhood “Children who have a secure, supportive, reciprocal and sensitive relationship with their parents are much more likely to be well-adjusted psychologically than individuals whose relationships with their parents are less satisfying”. In Dervla’s case, she was deprived of a father figure in the first six years of her life, as her father Dave chose not to be involved. They then formed a relationship, despite Jenny’s resistances, but it faltered when Dervla was taken into care again, aged nine.
Conflict between Jenny and Dave can be damaging for Dervla. Studies have steadily revealed that young people can profit from the on-going paternal participation in the rearing and nurturing in their lives. Larger participation levels of fathers in their children’s lives can generate many constructive outcomes in their lives in regards to their learning, social and emotional skills. When daughters are deprived of their fathers it is most influential and effective on them through their adolescent years, like Dervla, who is now at the age of sixteen.
According to Kohut (1977) “the quality of the father-child relationship is an inevitable part of the development of a psychological “self” structure”. Lamb (1987) classified fatherly participation to include: Accessibility, Responsibility and Engagement. It is in agreement to researches to the conclusion that there are disparities among infants brought up in a home with the father there and the infants in the family without a father. Paternal absences affect children in many ways. Jenny grew up in a house where her parents were separated when she was thirteen, and she was then raised by her mother.
Separation results in the lost of a co-parent, a person to assist with child-care, to help make certain choices and to relieve the other parent when they need a rest from the continual weight and strain of parenthood. Economic difficulties often come hand-in-hand with a one-lone parent, where in turn provokes emotional stress along with a stigma of social isolation due to the social disapproval of separation or divorce. This all affected the life of Jenny which in turn has a detrimental effect on this case, as it is proven that Intergenerational transmission of attachment occurs where the patterns occurs in following generations.
Parents that separate are often seen by children that they are abandoning them, which makes them feel unwanted and unloved. There are the colossal effects that follow when a child has to bare witness to the pre-divorce and post-divorce marital arguments, battles and conflicts. When this happens it is without failure that there is a negative effect on the children and parental conflict has a huge part in identifying the problems of fatherless infants. The facts imply that without the father figure role for the child, it is very possible that it would be damaging and wounding to the child, not necessarily due to the ex role model that is missing but due to many factors of the father figure position that are absent such as the emotional, social and economic areas. A reason that Derlva may be resisting attachment to others could be because, “A child living apart from a birth parent may resist forming a new attachment because she believes that any positive relationship with another adult will ensure the estranged parent will not return”. Also, it is extremely difficult for Dervla to experience her father first of all not wanting any involvement with her and then having two other kids with a different woman.
Feelings of being unlovable and unwanted are present in children in this situation. Discussion on how to work on this case: First of all, I would ensure that there was a shared awareness between Dervla, Jenny and Dave that attachment relationships are important and care for others is a priority in the family. Also, relationships with key others must be supported and maintained. In this case, I would recommend a treatment used for families that are classified as having a ‘Maladaptive Attachment Relationship with Potential for Change’.
This therapy firstly is to establish the past history and situation that the family is in and the framework to their behaviours, in more depth than what we have already done. The main aspect and goal is a potential for constructive change in the long-term by Dervla, Jenny and Dave through expression of their capabilities and enthusiasm to change. The therapy concentrate on their past attachment formations, their affective roles on each other and their traumatic encounters. Family therapy and child-parent dyad therapy will identify their dysfunctional designs of interaction and communication.
During this process, they will need active support, guidance, discussion and surveillance. Dervlas work in this therapy will be learning how to cope and manage with her traumatic life events thus gradually helping her reduce the characteristics of her Avoidant Attachment type. Dervla’s therapy sessions can be both individual and group sessions with her parents. Dave and Jenny will be working on two elements. One area is psychodynamic work, which is facilitating the caregivers in learning about their past childhood may be affecting their current parenting and recognising the origins to their behaviours.
The second area they will be working on is Psychoeducational work. This is the teaching, promoting and exercising of positive parenting skills in group therapy. Other ways in which I would deal with this case would be to help Dervla to understand her Dave’s new circumstances in regards to his relationship with Sue and his son’s Colm and Brendan. I would set up a meeting with all of these individuals to help Dervla form a bond with her bothers and step-mother in order to promote a sense of a family unit for her.
During the times that Dervla did not see her parents, I would try to promote as much positive contact as possible by encouraging her to engage in letters writing, emails, phone calls, or send photos to them. Reunion should always be considered as I think there is a stronger potential there for Dervla to live with her father, however the situation must have to dramatically improve over a substantial period of time. I would tap into her interest, such as music.. ‘preferring listening to music on her own’ and would organise a hobby or activity around that to try to get her motivated.
Due to all the various issues, traumatic events and problems that Dervla is experiencing, I would also send her for a Psychological Assessment. Another therapy that I would try if the original one was to fail would be Dyad Developmental Psychotherapy (DDP). It was developed in the 1990s for the therapy of children who had developed psychological issues linked to the traumas in their lives and their insecure attachment formations. Dyadic developmental therapy is making a creating a happy environment where the therapist commits to the child personal experiences.