Tenets of attachment theory

Attachment theory uses a set of assumptions to connect observable human social behaviors. As
is the case for any theory, these assumptions are in themselves difficult or impossible to test, but
form a coherent whole that fits with available data. The following is a list of the assumptions that
form the theory:[1]

1.Adaptiveness. Common human attachment behaviors and emotions are adaptive. Evolution of
human beings has involved selection for social behaviors that make individual or group survival
more likely. For example, the commonly observed attachment behavior of toddlers includes
staying near familiar people; this behavior would have had safety advantages in the environment
of early adaptation, and still has such advantages today.

2. Brain functions. Specific structures and functions of the central nervous system underlie at
least some of human attachment behavior. For example, the preference of infants for looking at
faces and eyes is based on brain and sensory functioning as it exists in the early months. Such
brain characteristics are genetically controlled and therefore can be shared by all, or almost all,
human beings, thus establishing basic behavioral tendencies that need not be learned.

3. Developmental changes. Specific attachment behaviors begin with predictable, apparently

innate, behavior in infancy, but change with age in ways that are partly determined by
experiences and by situational factors. For example, a toddler is likely to cry when separated from
his mother, but an 8-year-old is more likely to call out, "When are you coming back?" or to turn
away and begin the familiar school day.

4. Experience as essential factor in attachment. Infants in the first months have no preference for
their biological parents over strangers and are equally friendly to anyone who treats them kindly.
Preference for particular people, and behaviors which solicit their attention and care, develop
over a period of time.

5. Monotropy. Early steps in attachment take place most easily if the infant has one caregiver, or
the occasional care of a small number of other people.

6. Social interactions as cause of attachment. Feeding and relief of an infant's pain do not cause
an infant to become attached to a caregiver. Infants become attached to adults who are sensitive
and responsive in social interactions with the infant, and who remain as consistent caregivers for
some time.

7. Transactional processes. As attachment behaviors change with age, they do so in ways

shaped by relationships, not by individual experiences. A child's behavior when reunited with a
caregiver after a separation is determined not only by how the caregiver has treated the child
before, but on the history of effects the child has had on the caregiver in the past.

8. Critical period. Certain changes in attachment, such as the infant's coming to prefer a familiar
caregiver and avoid strangers, are most likely to occur within a fairly narrow age range. the period

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between about 6 months of age and 2 or 3 years is the time during which attachment to specific
caregivers is most likely to occur.

9.Robustness of development. Attachment to and preferences for some familiar people are easily
developed by most young humans, even under far less than ideal circumstances.

10. Internal working model. Early experiences with caregivers gradually give rise to a system of
thoughts, memories, beliefs, expectations, emotions, and behaviors about the self and others.
This system, called the internal working model of social relationships, continues to develop with
time and experience, enables the child to handle new types of social interactions. For example, a
child's internal working model helps him or her to know that an infant should be treated differently
from an older child, or to understand that interactions with a teacher can share some of the
characteristics of an interaction with the mother. An adult's internal working model continues to
develop and to help cope with friendships, marriage, and parenthood, all of which involve different
behaviors and feelings. The internal working model is likely to owe much to the individual's early
experiences with caregivers, but it can and does change with both real and vicarious
experiences.

Attachment is an affectional tie that one person or animal forms between him/herself and another
specific one (usually the parent) — a tie that binds them together in space and endures over
time.. Attachment theory states that attachment is a developmental process based on the evolved
adaptive tendency for young children to maintain proximity to a familiar person, called the
attachment figure Attachment Theory has become the dominant theory used today in the study of
infant and toddler behavior and in the fields of infant mental health, treatment of children, and
related fields. Many evidence-based treatment approaches are based on applications of
attachment theory.

History

The concept of infants' emotional attachment to caregivers has been known anecdotally for
hundreds of years. Most early observers focused on the anxiety displayed by infants and toddlers
when threatened with separation from a familiar caregiver. Freudian theory attempted a
systematic consideration of infant attachment and attributed the infant's attempts to stay near the
familiar person to motivation learned through feeding experiences.

The formal origin of attachment theory can be traced to the publication of two 1958 papers, one
being John Bowlby's "the Nature of the Child's Tie to his Mother", in which the precursory
concepts of "attachment" were introduced, and Harry Harlow's "the Nature of Love", based on the
results of experiments which showed, approximately, that infant rhesus monkeys spent more time
with soft mother-like dummies that offered no food than they did with dummies that provided a
food source but were less pleasant to the touch.[4][5]

As John Bowlby began to formulate his concept of attachment, he was influenced by case studies
such as one by David Levy [6] that associated an adopted child's lack of social emotion to her

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early emotional deprivation. Bowlby himself was interested in the role played in delinquency by
poor early relationships, and explored this in a study of young thieves [7]

Other sources that influenced Bowlby's thought included ethological studies such as those
discussed by Tinbergen [8]. Tinbergen and his colleague Konrad Lorenz had examined the
phenomenon of "imprinting" and felt that it might have some parallels to human attachment.
Imprinting, a behavior characteristic of some birds and a very few mammals, involves rapid
learning of recognition by a young bird or animal exposed to a conspecific or an object or
organism that behaves suitably. The learning is possible only within a limited age period, known
as a critical period. This rapid learning and development of familiarity with an animate or
inanimate object is accompanied by a tendency to stay close to the object and to follow when it
moves; the young creature is said to have been imprinted on the object when this occurs. As the
imprinted bird or animal reaches reproductive maturity, its courtship behavior is directed toward
objects that resemble the imprinting object. Bowlby's attachment concepts later included the
ideas that attachment involves learning from experience during a limited age period, and that the
learning that occurs during that time influences adult behavior. However, he did not apply the
imprinting concept in its entirety to human attachment, nor assume that human development was
a simple as that of birds. He did, however, consider that attachment behavior was best explained
as instinctive in nature.

Bowlby's view of attachment was also influenced by observations of young children separated
from familiar caregivers, as provided during World War II by Anna Freud and her colleague
Dorothy Burlingham. Observations of separated children's grief by Rene Spitz were another
important factor in the development of attachment theory.

The important concept of the internal working model of social relationships was adopted by
Bowlby from the work of Kenneth Craik, the philosopher .

The theory of control systems (cybernetics), developing during the '30s and '40s, influenced
Bowlby's thinking about attachment. The young child's need for proximity to the attachment figure
was seen as balancing homeostatically with the need for exploration. The actual distance
maintained would be greater or less as the balance of needs changed; for example, the approach
of a stranger, or an injury, would cause the child to seek proximity when a moment before he had
been exploring at a distance.

Mary Ainsworth conducted research based on Bowlby's theory and devised the Strange Situation
protocol, still used today to assess attachment style in children, as the laboratory portion of a
larger study that included extensive home visitations over the first year of the child's life. This
study identified three attachment patterns that a child may have with his primary attachment
figure: secure, anxious-avoidant, and anxious-ambivalent.

Further research by Dr. Mary Main and colleagues (University of California at Berkeley) identified
a fourth attachment pattern, called disorganized attachment, which reflects these children's lack
of a coherent coping strategy.

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Other recent research has followed children into the school environment, where securely
attached children generally relate well to peers, avoidantly attached children tend to victimize
peers and ambivalently attached children may be victimized by peers and be coy. These early
studies focused on attachment between children and caregivers.

Although research on attachment behaviors continued after Bowlby's death, there was a period of
time when attachment theory was considered to have run its course. Some authors argued that
attachment should not be seen as a trait (lasting characteristic of the individual), but instead
should be regarded as an organizing principle with varying behaviors resulting from contextual
factors[16]. Related later research looked at cross-cultural differences in attachment, and
concluded that there should be re-evaluation of the assumption that attachment is expressed
identically in all humans [17]

Interest in attachment theory continued, and the theory was later extended to adult romantic
relationships by Cindy Hazen and Phillip Shaver.

Peter Fonagy and Mary Target have attempted to bring attachment theory and psychoanalysis
into a closer relationship by way of such aspects of cognitive science as mentalization, the ability
to estimate what the beliefs or intentions of another person may be.

A "natural experiment" has permitted extensive study of attachment issues, as researchers have
followed the thousands of Romanian orphans who were adopted into Western families after the
end of the Ceasescu regime. The English and Romanian Adoptees Study Team, led by Sir
Michael Rutter, has followed some of the children into their teens, attemtping to unravel the
effects of poor attachment, adoption and new relationships, and the physical and medical
problems associated with their early lives. Studies on the Romanian adoptees, whose initial
conditions were shocking, have in fact yielded reason for optimism. many of the children have
developed quite well, and the researchers have noted that separation from familiar people is only
one of many factors that help to determine the quality of development.

Basic attachment theory

Children develop different styles of attachment based on experiences and interactions with their
primary caregivers. Researchers have developed various ways of assessing attachment in
children, including the Strange Situation Protocol developed by Mary Ainsworth and story-based
approaches such as Attachment Story Completion Test. Four different attachment styles have
been identified in children: secure, anxious-ambivalent, anxious-avoidant, and disorganized. (For
research purposes, Avoidant, Secure and Resistant are called A,B and C respectively. Group D,
Disorganized/disoriented insecure attachment was added later when it became apparent some
infants did not fit A,B or C.

• Secure Attachment - The child protests the mother's departure and quiets promptly on
the mother's return, accepting comfort from her and returning to exploration.

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 • Avoidant Attachment - The child shows little to no signs of distress at the mother's
departure, a willingness to explore the toys, and little to no visible response to the
mother's return.

• Ambivalent Attachment - The child shows sadness on the mother's departure, ability to
be picked up by the stranger and even 'warm' to the stranger, and on the mother's return,
some ambivalence, signs of anger, reluctance to 'warm' to her and return to play.

• Disorganized Attachment - The child presents stereotypes upon the mother's return
after separation, such as freezing for several seconds or rocking. This appears to indicate
the child's lack of coherent coping strategy. Children who are classified as disorganized
are also given a classification as secure, ambivalent or avoidant based on their overall
reunion behavior.

Additionally, the attachment patterns observed in children are correlated with certain behavior
patterns and communication styles in the attachment figure:

• Secure Attachment - The attachment figure responds appropriately, promptly and

consistently to the emotional as well as the physical needs of the child. She helps her
child to transition and regulate stress, and as a result, the child uses her as a secure
base in the home environment.

• Avoidant Attachment - The attachment figure shows little response to the child when
distressed. She discourages her child from crying and encourages independence and
exploration. The avoidantly attached child may have lower quality play than the securely
attached child.

• Ambivalent Attachment - The attachment figure is inconsistent with her child, at times
be appropriate and at other times neglectful to the child. The child raised in an ambivalent
relationship becomes preoccupied with the mother's availability and cannot explore his
environment freely or use his mother as a secure base. The ambivalently attached child
is vulnerable to difficulty coping with life stresses and may display role reversal with the
mother.

• Disorganized Attachment - This can be associated with frightened/disoriented

behaviour, intrusiveness/negativity and withdrawal, role/boundary confusion, affective
communication errors and child maltreatment.

Changes in attachment after the infant-toddler period

According to Bowlby's theory, the child's early experience of social interactions with familiar
people leads to the development of an internal working model of social relationships, a set of
ideas and feelings that establish the individual's expectations about relationships, the behavior of
others toward him or her, and the behaviors appropriate for him or her to show to others. The
internal working model continues to develop and become more complex with age, cognitive

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growth, and continued social experience. As the internal working model of relationships
advances, attachment-related behaviors lose some of the characteristics so typical of the infant-
toddler period, and take on a series of age-related tendencies.

Attachment in adults

Attachment in adults is commonly measured using the Adult Attachment Interview and self-report
questionnaires. Self-report questionnaires have identified two dimensions of attachment, one
dealing with anxiety about the relationship, and the other dealing with avoidance in the
relationship. These dimensions define four styles of adult attachment: secure, preoccupied,
dismissive-avoidant, and fearful-avoidant.

There are a wide variety of attachment measures used in adult attachment research. The most
popular measure in the social psychological research is the Experiences in Close Relationships-
Revised scale. This scale treats attachment as two dimensions: anxiety and avoidance. The Adult
Attachment interview is also commonly used to assess an individual's ability to discuss previous
relationships with attachment figures. The interview consists of 36 questions, varying in detail
from basic background information to instances of loss and trauma (if any). An independently
trained coder determines the consistency of the individual's descriptions based on emotion
regulation and content of information in the interview. Developmental psychologists use the Adult
Attachment Interview (AAI; George,Kaplan, & Main) or the Adult Attachment Projective (AAP;
George, West, & Pettem). The AAI is an interview about attachment experiences that gets
recorded and analysed for attachment status. The AAP is a guided interview which uses vague
drawings about which the individual can tell a story. The story responses are recorded and
decoded for attachment status. Generally attachment style is used by social psychologists
interested in romantic attachment, and attachment status by developmental psychologists
interested in the individual's state of mind with respect to attachment. The latter is more stable,
while the former fluctuates more.

Attachment in adult romantic relationships

Hazan and Shaver extended attachment theory to adult romantic relationships in 1987. It was
originally characterized by three dimensions: secure, anxious/ambivalent and avoidant. Later
research showed that attachment is best thought of as two different dimensions: anxiety and
avoidance. These dimensions are often drawn as an X and Y axis. In this model secure
individuals are low in both anxiety and avoidance. Thus, attachment can also be broken down
into four categories: secure, anxious-ambivalent (preoccupied), avoidant (dismissive), and fearful-
avoidant. However, people's attachment varies continuously so most researchers do not currently
think in terms of categories.

Attachment research into romantic relationships has led to a wide variety of findings. Mario
Mikulincer has shown through a wide variety of studies that attachment influences how well
people are able to cope with stress in their life. Nancy Collins and colleagues have shown that
attachment influences many kinds of care-giving behavior. Jeff Simpson and Steve Rholes have

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conducted a number of studies showing that attachment influences how people parent their
newborn children and how well they are able to cope with the stress of having a newborn child.

Attachment disorder

Attachment disorder refers to an inability to form normal attachments with caregivers during
childhood. This may have adverse effects throughout the lifespan. Results of a study showed a
positive and strong correlation between the security of the child-mother attachment
representation and positiveness of self. It also showed significant and positive correlations
between positiveness of self to competence and social acceptance, to behavioral adjustment at
school, and to behavioral manifestations of self-esteem.[23]

Attachment disorder is a term based on the psychological theories that

1. normal mother-child attachment forms in the first two years of life; and
2. if a normal attachment is not formed during the first two to three years, attachment can be
induced later.
3. Attachment disorder is a term that is often seen in the research literature (O'Connor &
Zeanah) but which is much broader than the clinical diagnosis of Reactive attachment
disorder, which is described in the Diagnostic & Statistical Manual, 4th Edition.This theory
( Attachment Theory ) is used, for example, to explain the behavioral difficulties of
children who have experienced chronic early maltreatment, such as foster and adopted
children.Attachment theory was developed by John Bowlby in the 1940s and 1950s and
is the leading theory used in the fields of Infant Mental Health, Child Development, and
related fields (Zeanah, C., 1999). It is a well researched theory that describes how the
attachment relationship develops, why it is crucial to later healthy development, and what
are the effects of early maltreatment or other disruptions in this process.

• Reputable approaches to treatment based on theory and research evidence include

Theraplay and Dyadic Developmental Psychotherapy. However, the use of coercive
interventions has no basis in theory and is not supported by any reputable professional
organization, including The Association for The Treatment and Training in the Attachment
of Children, APSAC, APA, NASW, or AMA. Neither Theraplay nor Dyadic Developmental
Psychotherapy use coercive interventions and are in full compliance with the above
referenced standards.
Signs of attachment problems

Attachment is fundamental to healthy development, normal personality, and the capacity to form
healthy and authentic emotional relationships[1]. How can one determine whether a child has
attachment issues that require attention? What is normal behavior, and what are the signs of
attachment issues? When adopting an infant, will attachment problems develop? These and other
related questions are often at the forefront of adoptive parents’ minds.

Attachment is the base of emotional health, social relationships, and one's worldview (Zeanah,
C., 1993). The ability to trust and form reciprocal relationships affects the emotional health,

7
security, and safety of the child, as well as the child's development and future inter-personal
relationships. The ability to regulate emotions, have a conscience, and experience empathy all
require secure attachment. Healthy brain development is built on a secure attachment
relationship.

Children who are adopted after the age of six months are at risk for attachment problems. Normal
attachment develops during the child's first two to three years of life. Problems with the mother-
child relationship during that time, orphanage experience, or breaks in the consistent caregiver-
child relationship interfere with the normal development of a healthy and secure attachment.
There are wide ranges of attachment difficulties that result in varying degrees of emotional
disturbance in the child. One thing is certain; if an infant's needs are not met consistently, in a
loving, nurturing way, attachment will not occur normally and this underlying problem will manifest
itself in a variety of symptoms.

When the attachment-cycle is undermined and the child’s needs are not met, and normal
socializing shame is not resolved, mistrust begins to define the perspective of the child and
attachment problems result[2]. The cycle can become undermined or broken for many reasons:

• Multiple disruptions in care giving

• Post-partum depression causing an emotionally unavailable mother
• Hospitalization of the child causing separation from the parent and/or unrelieved pain. For
example, stays in a NICU or repeated hospitalizations during infancy.
• Parents who have experienced their own relational trauma, leading to neglect, abuse
(physical/sexual/verbal), or inappropriate parental responses not leading to a
secure/predictable relationship
• Genetic factors
• Pervasive developmental disorders
• Caregivers whose own needs are not met, leading to overload and lack of awareness of
the infants needs

The child may develop basic mistrust (Erikson), impeding effective attachment behavior. The
developmental stages following these first three years continue to be distorted and/or retarded,
and common symptoms emerge. It is very important to realize that when one is trying to parent a
child with attachment difficulties one must focus on the cause of the behaviors and not on the
symptoms or surface behaviors. Furthermore, the following behaviors can be indicators of a
variety of problems. A child exhibiting several of these behaviors should receive a comprehensive
evaluation by a licensed mental health professional to determine the cause of these symptoms.
Many of these symptoms can be seen in children who have experienced complex trauma [3],
attachment difficulties and other issues.

• Superficially engaging and charming behavior, phoniness

• Avoidance of eye contact
• Indiscriminate affection with strangers
• Lack of affection in a reciprocal manner
• Destructiveness to self, others, and material things

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 • Cruelty to animals
• Crazy lying (lying in the face of the obvious)
• Poor impulse control
• Learning lags
• Lack of cause/effect thinking
• Lack of conscience
• Abnormal eating patterns
• Poor peer relationships
• Preoccupation with fire and/or gore
• Persistent nonsense questions and chatter indicating a need to control
• Inappropriate clinginess and demandingness
• Inappropriate sexuality

It is important to get a thorough evaluation as one symptom can have many causes. There are a
variety of evidence-based methods to assess a child's pattern and style of attachment such as
the Strange situation developed by Mary Ainsworth and a variety of narrative methods. Among
adults, the Adult Attachment Interview is a frequently used research method.

Causes
What are the underlying causes of these various symptoms? The cause is some break in the
early attachment relationship that results in difficulties trusting others [4]. The child experiences a
fear of close authentic emotional relationships because early maltreatment or other difficulties has
"taught" the child that adults are not trust worthy and that the child is unloved and unlovable.
Fundamentally, the cause is a developmental delay. The child may be chronologically six, ten, or
fifteen, but developmentally these children are much younger. It is often useful to consider, "at
what age would this behavior be normal?" Frequently one may find that the child’s behavior
would be normal if the child were of a younger age.

Chronic Maltreatment (abuse or neglect) or other disruptions to the normal attachment

relationship cause ]:

• Fear of intimacy
• Overwhelming feelings of shame (not guilt... shame causes a person to want to hide and
not be seen. So, for example, some children’s chronic lying can be seen as a
manifestation of this pervasive sense of shame. A lie is then another way to hide.)
• Chronic feelings of being unloved
• Chronic feelings of being unlovable
• A distorted view of self, other, and relationships based on past maltreatment
• Lack of trust
• Feeling that nothing the child does can make a difference; hence, low motivation and
poor academic performance
• A core sense of being Bad
• Difficulty asking for help
• Difficulty relying on others in a cooperative and collaborative manner

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How can the difference between a child who "looks" attached and a child who really is making a
healthy, secure attachment be distinguished? This question becomes important for adoptive
families because some adopted children will form an almost immediate dependency bond to their
adoptive parents. To mistake this as secure and healthy attachment can lead to many problems
down the road. Just because a child calls someone "Mom" or "Dad," snuggles, cuddles, and
says, "I love you," does not mean that the child is attached or even attaching. Saying, "I love
you," and knowing what that really feels like, can be two different things. Attachment is a process.
It takes time. The key to its formation is trust, and trust becomes secure only after repeated
testing. Generally attachment develops during the first two to three years of life (Bowlby 1988).

Older adopted children (see Adoption article for additional details.) need time to make
adjustments to their new surroundings. They need to become familiar with their caregivers,
friends, relatives, neighbors, teachers, and others with whom they will have repeated contact.
They need to learn the ins and outs of new household routines and adapt to living in a new
physical environment. Some children have cultural or language hurdles to overcome. Until most
of these tasks have been accomplished, they may not be able to relax enough to allow the work
of attachment to begin. In the meantime, behavioral problems related to insecurity and lack of
attachment, as well as to other events in the child's past, may start to surface. Some start to get
labels, like "manipulative," "superficial," or "sneaky." On the inside, this child is filled with anxiety,
fear, grief, loss, and often a profound sense of being bad, defective, and unlovable. The child has
not developed the self-esteem that comes with feeling like a valued, contributing member of a
family. The child cares little about pleasing others since his relationships with them are quite
superficial.

When are problems first apparent? Children who have experienced physical or sexual abuse,
physical or psychological neglect, or orphanage life will begin to show difficulties as young as six-
months of age [6]. For example, the signs of difficulties for an infant include the following:

• Weak crying response or rageful and/or constant whining; inability to be comforted

• Tactile defensiveness
• Poor clinging and extreme resistance to cuddling: seems stiff as a board
• Poor sucking response
• Poor eye contact, lack of tracking
• No reciprocal smile response
• Indifference to others
• Failure to respond with recognition to parents
• Delayed physical motor skill development milestones (creeping, crawling, sitting, etc.)
• Flaccidity

Subtle signs of attachment problems

What are the subtle signs of attachment issues?

1. Sensitivity to rejection and to disruptions in the normally attuned connection between

mother and child

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 2. Avoiding comfort when the child’s feelings are hurt, although the child will turn to the
parent for comfort when physically hurt
3. Difficulty discussing angry feelings or hurt feelings
4. Over-valuing looks, appearances, and clothes
5. Sleep disturbances, not wanting to sleep alone
6. Precocious independence - a level of independence that is more frequently seen in
slightly older children
7. Reticence and anxiety about changes
8. Picking at scabs and sores
9. Secretiveness
10. Difficulty tolerating correction or criticism

Internationally adopted children experience at least two significant changes during the first few
months of life that can have a profound impact on later development and security. Birth mother to
orphanage or foster care and then orphanage to adoptive home are two transitions. It is known
from extensive research that prenatal, post-natal, and subsequent experiences create lasting
impressions on a child. During the first few minutes, days, and weeks of life, the infant clearly
recognizes the birth mother’s voice, smell, and taste. Changes in caregivers are disruptive.
The new caregivers look different, smell different, sound different, taste different. In the
orphanage there are often many care givers but no one special caregiver. Adoption brings with it
a whole new, strange, and initially frightening world. These moves and disruptions have profound
effects on a child's emotional, interpersonal, cognitive, and behavioral development. The longer a
child is in alternate care, the more these subtle signs become pervasive.

There are effective ways for a parent to help his or her child[7]. Parents and the right parenting are
vital to preventing subtle signs from becoming anything more than sensitivities. Parenting
consistently with clear and firm limits is essential. Discipline should be enforced with an attitude of
sensitive and responsive empathy, acceptance, curiosity, love, and playfulness. This provides the
most healing and protective way to correct a child.

These sensitivities do not constitute a mental illness or Reactive attachment disorder. They are
subtle signs of attachment sensitivities. So, what can be done?

First, the most important thing one can do is maintain an attuned, emotionally close, and positive
relationship with the child even when the child is being nasty or pushing buttons. It is at those
times that the child most needs to feel loved and loveable, even if the behavior is unacceptable.
First, a connection with the child must be created, and then the child must be disciplined.

Second, bringing the child in close is better than allowing the child to be alone or isolate him or
her self.

Third, talking for the child is required - putting words to what the child is feeling. This allows the
child to feel understood by the parent, maintains a connection, and helps assuage the fear of
rejection and abandonment. It also helps the child become self-aware, models verbal behavior,
and facilitates a sense of emotional attunement between parent and child.

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Fourth, food shouldn't be made a battle. A child who steals food or hoards food usually has sound
emotional reasons for this. Providing the child with food so that the child experiences the parent
as provider is often the solution. Putting a bowl of fruit (which is kept filled) in the child’s
room, or providing the child with a fanny pack and keeping it stocked with snacks might be useful,
ending hoarding and stealing of food.

Fifth, for the child who is overly independent, doing for the child and not encouraging precocious
independence is helpful. So, making a game of brushing the six-year-old’s teeth, dressing the
seven-year-old, or playing at feeding a nine-year-old, are all ways to demonstrate that the parent
will care for the child. Keeping it playful and light allows the child to experience what the child
needs and helps eliminate hurtful battles.

Sixth, use Time-In rather than Time-Out. When the child is becoming dysregulated, they need the
parents to regulate their emotions. They do that by reflecting the child’s emotions back to the
child: putting into words what they think the child may be feeling. In this manner the parents
demonstrate that they can accept what the child is feeling, that feelings can be tolerated and
discussed, even if the behavior will be disciplined at a later time. Remember: first connect with
the child, then discipline.

Seventh, reducing shame. Shaming parenting methods and interactions that might be harsh or
punitive should be avoided. If the child is already experiencing too much shame, increasing that
will only be destructive to the child and the relationship with the parents. The parents set the
emotional tone for the relationship, so keeping things positive is important. So, as an example, a
seven year old has just screamed at the parent, "I hate you," because he or she said that it's time
to go to bed. One could start by reflecting the child’s feelings back to the child as one walks
the child to bed with one's arm around the child, "Boy, you are really mad that you have to go to
bed now." "You sure don’t want to go to bed now. I wonder what you think is making me send
you to bed now? … Maybe you just think I’m being mean?" Through this sort of dialogue,
the caregiver is demonstrating acceptance of the child's feelings and interest in the child's
thinking and feeling. The parent is showing the child how to reflect on inner life. The model
suggested for parents is to create a healing PLACE (being Playful, Loving, Accepting, Curious,
and Empathic) (Hughes, 2003).

In conclusion, these subtle signs are important reminders that the children have ongoing
sensitivities that must be addressed by the parents. Responsive and sensitive communication is
essential. Attachment is a function of reciprocal communication; attachment does not reside in
the child alone. It is very important for the parent to manage and facilitate this attuned connection
within a framework of clear limits and boundaries, natural consequences, and firm loving
discipline..

Treatment

There are a variety of evidence-based and effective prevention programs and treatment
approaches for attachment disorder. Attachment theory is the basis for these and other treatment
approaches. Several evidence-based and effective treatments are based on attachment theory

12
including Theraplay and Dyadic Developmental Psychotherapy. Nearly all mainstream programs
for the prevention and treatment of disorders of attachment use attachment theory. For example,
the Circle of Security Program, (Dr. Robert Marvin, University of VA) is one such early
intervention program with demonstrated effectiveness. Dr. Marvin and Dr. Siegel (University of
California) both also endorse Dyadic Developmental Psychotherapy. Other promising treatment
methods include the Circle of Security Program of Dr. Robert Marvin at the University of Virginia,
Developmental, Individual-difference, Relationship-based therapy (DIR or Floor Time) by Stanley
Greenspan. This treatment is consistent with the general principles for the treatment of trama [11]
(Briere & Scott, 2006).

Dyadic developmental psychotherapy (Hughes, 2004) is an evidence-based [10] ("Treatment for

Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy" Child and
Adolescent Social Work Journal. 12(6), December 2005) treatment approach for the treatment of
attachment disorder and reactive attachment disorder. Children who have experienced pervasive
and extensive trauma, neglect, loss, and/or other dysregulating experiences can benefit from this
treatment. Dyadic Developmental Psychotherapy is based on principles derived from Attachment
theory and Research; see the work of Bowlby. The treatment meets the standards of the
American Professional Society on Child Abuse, The American Academy of Child Psychiatry,
American Psychological Association, American Psychiatric Association, National Association of
Social Workers, and various other groups' standards for the evaluation and treatment of children
and adolescents. This is a non-coercive treatment.

Attachment therapy is a term with little or no agreed upon meaning. It is not a term that is used in
generally accepted texts on psychotherapy. Components of "attachment therapy" have been
disapproved by a task force of the American Professional Society on Abuse of children. However,
the Circle of Security Program, Dyadic developmental psychotherapy, Developmental, Individual-
difference, Relationship-based therapy (DIR or Floor Time) by Stanley Greenspan, and Theraplay
are not considered controversal and meet the standards of the American Professional Society on
Abuse of Children, as well as various other professional association standards for practice.

Extending Attachment Theory

John Bowlby and Mary Ainsworth founded modern attachment theory on studies of children and
their caregivers. Children and caregivers remained the primary focus of attachment theory for
many years. Then, in the late 1980's, Cindy Hazan and Phillip Shaver applied attachment theory
to adult romantic relationships. Hazan and Shaver noticed that interactions between adult
romantic partners shared similarities to interactions between children and caregivers. For
example, romantic partners desire to be close to one another. Romantic partners feel comforted
when their partners are present and anxious or lonely when their partners are absent. Romantic
relationships serve as a secure base that help partners face the surprises, opportunities, and
challenges life presents. Similarities such as these led Hazan and Shaver to extend attachment
theory to adult romantic relationships.

Of course, relationships between adult romantic partners differ in many ways from relationships
between children and caregivers. The claim is not that these two kinds of relationships are

13
identical. The claim is that the core principles of attachment theory apply to both kinds of
relationships.

Investigators tend to describe the core principles of attachment theory in light of their own
theoretical interests. Their descriptions seem quite different on a superficial level. For example,
Fraley and Shaver ] describe the "central propositions" of attachment in adults as follows:

• The emotional and behavioral dynamics of infant-caregiver relationships and adult

romantic relationships are governed by the same biological system.
• The kinds of individual differences observed in infant-caregiver relationships are similar to
the ones observed in romantic relationships.
• Individual differences in adult attachment behavior are reflections of the expectations and
beliefs people have formed about themselves and their close relationships on the basis of
their attachment histories; these "working models" are relatively stable and, as such, may
be reflections of early caregiving experiences.
• Romantic love, as commonly conceived, involves the interplay of attachment, caregiving,
and sex.

Compare this to the five "core propositions" of attachment theory listed by Rholes and Simpson: ]

• Although the basic impetus for the formation of attachment relationships is provided by
biological factors, the bonds that children form with their caregivers are shaped by
interpersonal experience.
• Experiences in earlier relationships create internal working models and attachment styles
that systematically affect attachment relationships.
• The attachment orientations of adult caregivers influence the attachment bond their
children have with them.
• Working models and attachment orientations are relatively stable over time, but they are
not impervious to change.
• Some forms of psychological maladjustment and clinical disorders are attributable in part
to the effects of insecure working models and attachment styles.

While these two lists clearly reflect the theoretical interests of the investigators who created them,
a closer look reveals a number of shared themes. The shared themes claim that:

• People are biologically driven to form attachments with others, but the process of forming
attachments is influenced by learning experiences.
• Individuals form different kinds of attachments depending on the expectations and beliefs
they have about their relationships. These expecations and beliefs constitute internal
"working models" used to guide relationship behaviors.
• Internal "working models" are relatively stable even though they can be influenced by
experience.
• Individual differences in attachment can contribute positively or negatively to mental
health and to quality of relationships with others.

14
No doubt these themes could be described in a variety of ways (and other themes added to the
list). Regardless of how one describes the core principles of attachment theory, the key insight is
that the same principles of attachment apply to close relationships throughout the lifespan. The
principles of attachment between children and caregivers are fundamentally the same as the
principles of attachment between adult romantic partners.

Attachment Styles

Adults have four attachment styles: secure, anxious-preoccupied, dismissive avoidant, and fearful
avoidant. The secure attachment style in adults corresponds to the secure attachment style in
children. The anxious-preoccupied attachment style in adults corresponds to the
anxious/ambivalent attachment style in children. However, the dismissive avoidant attachment
style and the fearful avoidant attachment style, which are distinct in adults, correspond to a single
avoidant attachment style in children. The descriptions of adult attachment styles offered below
are based on the relationship questionnaire devised by Bartholomew and Horowitz and on a
review of studies by Pietromonaco and Barrett.

Secure Attachment

Securely attached people tend to agree with the following statements: "It is relatively easy for me
to become emotionally close to others. I am comfortable depending on others and having others
depend on me. I don't worry about being alone or having others not accept me." This style of
attachment usually results from a history of warm and responsive interactions with relationship
partners. Securely attached people tend to have positive views of themselves and their partners.
They also tend to have positive views of their relationships. Often they report greater satisfaction
and adjustment in their relationships than people with other attachment styles. Securely attached
people feel comfortable both with intimacy and with independence. Many seek to balance
intimacy and independence in their relationships.

Anxious-Preoccupied Attachment

People who are anxious or preoccupied with attachment tend to agree with the following
statements: "I want to be completely emotionally intimate with others, but I often find that others
are reluctant to get as close as I would like. I am uncomfortable being without close relationships,
but I sometimes worry that others don't value me as much as I value them." People with this style
of attachment seek high levels of intimacy, approval, and responsiveness from their partners.
They sometimes value intimacy to such an extent that they become overly dependent on their
partnership condition colloquially termed clinginess. Compared to securely attached people,
people who are anxious or preoccupied with attachment tend to have less positive views about
themselves. They often doubt their worth as a partner and blame themselves for their partners'
lack of responsiveness. They also have less positive views about their partners because they do
not trust in people's good intentions. People who are anxious or preoccupied with attachment
may experience high levels of emotional expressiveness, worry, and impulsiveness in their
relationships.

15
Dismissive-Avoidant Attachment

People with a dismissive style of avoidant attachment tend to agree with these statements: "I am
comfortable without close emotional relationships. It is very important to me to feel independent
and self-sufficient, and I prefer not to depend on others or have others depend on me." People
with this attachment style desire a high level of independence. The desire for independence often
appears as an attempt to avoid attachment altogether. They view themselves as self-sufficient
and invulnerable to feelings associated with being closely attached to others. They often deny
needing close relationships. Some may even view close relationships as relatively unimportant.
Not surprisingly, they seek less intimacy with relationship partners, whom they often view less
positively than they view themselves. Investigators commonly note the defensive character of this
attachment style. People with a dismissive-avoidant attachment tend to suppress and hide their
feelings, and they tend to deal with rejection by distancing themselves from the sources of
rejection (i.e., their relationship partners).

Fearful-Avoidant Attachment

People with a fearful style of avoidant attachment tend to agree with the following statements: "I
am somewhat uncomfortable getting close to others. I want emotionally close relationships, but I
find it difficult to trust others completely, or to depend on them. I sometimes worry that I will be
hurt if I allow myself to become too close to others." People with this attachment style have mixed
feelings about close relationships. On the one hand, they desire to have emotionally close
relationships. On the other hand, they tend to feel uncomfortable with emotional closeness.
These mixed feelings are combined with negative views about themselves and their partners.
They commonly view themselves as unworthy of responsiveness from their partners, and they
don't trust the intentions of their partners. Similarly to the dismissive-avoidant attachment style,
people with a fearful-avoidant attachment style seek less intimacy from partners and frequently
suppress and hide their feelings.

Working models

Bowlby theorized that children learn from their interactions with caregivers. Over the course of
many interactions, children form expectations about the accessibility and helpfulness of their
caregivers. These expectations reflect children's thoughts about themselves and about their
caregivers:

"Confidence that an attachment figure is, apart from being accessible, likely to be responsive can
be seen to turn on at least two variables: (a) whether or not the attachment figure is judged to be
the sort of person who in general responds to calls for support and protection; (b) whether or not
the self is judged to be the sort of person towards whom anyone, and the attachment figure in
particular, is likely to respond in a helpful way. Logically, these variables are independent. In
practice they are apt to be confounded. As a result, the model of the attachment figure and the
model of the self are likely to develop so as to be complementary and mutually confirming."
(Bowlby, 1973, page 238 ).

16
Children's thoughts about their caregivers, together with thoughts about themselves as deserving
good caregivers, form working models of attachment. Working models help guide behavior by
allowing children to anticipate and plan for caregiver responses. Once formed, Bowlby theorized
that working models remain relatively stable. Children usually interpret experiences in light of their
working models rather than change their working models to fit new experiences. Only when
experiences cannot be interpreted in light of working models do children modify their working
models. When Hazen and Shaver extended attachment theory to adults, they included the idea of
working models. Research into adult working models has focused on two issues. First, how are
the thoughts that form working models organized in the mind? Second, how stable are working
models across time? These questions are briefly discussed below.

Organization of working models

Bartholomew and Horowitz have proposed that working models consist of two parts. [9] One part
deals with thoughts about the self. The other part deals with thoughts about others. They further
propose that a person's thoughts about self are generally positive or generally negative. The
same applies to a person's thoughts about others. Thoughts about others are generally positive
or generally negative. In order to test these proposals, Bartholomew and Horowitz have looked at
the relationship between attachment styles, self-esteem, and sociability. The diagram below
shows the relationships they observed:

The secure and dismissive attachment styles are associated with higher self-esteem compared to
the anxious and fearful attachment styles. This corresponds to the distinction between positive
and negative thoughts about the self in working models. The secure and anxious attachment
styles are associated with higher sociability than the dismissive or fearful attachment styles. This
corresponds to the distinction between positive and negative thoughts about others in working
models. These results suggested working models indeed contain two distinct domains--thoughts

17
about self and thoughts about others--and that each domain can be characterized as generally
positive or generally negative.

Baldwin and colleagues have applied the theory of relational schemas to working models of
attachment. Relational schemas contain information about the way partners regularly interact with
each other. [10] [11] For each pattern of interaction that regularly occurs between partners, a
relational schema is formed that contains:

• information about the self

• information about the partner
• information about the way the interaction usually unfolds.

For example, if a person regularly asks his or her partner for a hug or kiss, and the partner
regularly responds with a hug or kiss, the person forms a relational schema representing the
predictable interaction. The schema contains information about the self (e.g., "I need lots of
physical affection"). It also contains information about the partner (e.g., "My partner is an
affectionate person"). And it contains information about the way the interaction usually unfolds,
which can be summarized by an IF-THEN statement (e.g., "IF I ask my partner for a hug or kiss,
THEN my partner will respond with a hug or kiss and comfort me"). Relational schemas help
guide behavior in relationships by allowing people to anticipate and plan for partner responses.

Baldwin and colleagues have proposed that working models of attachment are composed of
relational schemas. The fact that relational schemas contain information about the self and
information about others is consistent with previous conceptions of working models. The unique
contribution of relational schemas to working models is the information about the way interactions
with partners usually unfold. Relational schemas add the IF-THEN statements about interactions
to working models. To demonstrate that working models are organized as relational schemas,
Baldwin and colleagues created a set of written scenarios that described interactions dealing with
trust, dependency and closeness. [12] For example, the scenarios for closeness included:

• You want to spend more time with your partner.

• You reach out to hug or kiss your partner.
• You tell your partner how deeply you feel for him or her.

Following each scenario, people were presented with two options about how their partners might
respond. One option was "he/she accepts you." The other option was "he/she rejects you."
People were asked to rate the likelihood of each response on a seven point scale. Ratings of
likely partner responses corresponded to people's attachment styles. People with secure
attachment styles were more likely to expect accepting responses from their partners. Their
relational schema for the third closeness scenario would be, "IF I tell my partner how deeply I feel
for him or her, THEN my partner will accept me." People with other attachment styles were less
likely to expect accepting responses from their partners. Their relational schema for the third
closeness scenario would be, "IF I tell my partner how deeply I feel for him or her, THEN my
partner will reject me." Differences in attachment styles reflected differences in relational

18
schemas. Relational schemas may therefore be used to understand the organization of working
models of attachment, as has been demonstrated in subsquent studies. [13] [14] [15]

The relational schemas involved in working models are likely organized into a hierarchy.
According to Baldwin:

"A person may have a general working model of relationships, for instance, to the effect that
others tend to be only partially and unpredictably responsive to one's needs. At a more specific
level, this expectation will take different forms when considering different role relationships, such
as customer or romantic partner. Within romantic relationships, expectations might then vary
significantly depending on the specific partner, or the specific situation, or the specific needs
being expressed." (Baldwin, 1992, page 429).

The highest level of the hierarchy contains very general relational schemas that apply to all
relationships. The next level of the hierarchy contains relational schemas that apply to particular
kinds of relationships. The lowest level of the hierarchy contains relationship schemas that apply
to specific relationships.

In fact, several theorists have proposed a hierarchical organization of working models. [16] [17] [18] [19]
[20]
Pietromonaco and Barrett note:

"From this perspective, people do not hold a single set of working models of the self and others;
rather, they hold a family of models that include, at higher levels, abstract rules or assumptions
about attachment relationships and, at lower levels, information about specific relationships and
events within relationships. These ideas also imply that working models are not a single entity but
are multifaceted representations in which information at one level need not be consistent with
information at another level." (Pietromonaco & Barrett, 2000, page 159) [21]

Every hierarchy for working models includes both general working models (higher in the
hierarchy) and relationship-specific working models (lower in the hierarchy). Studies have
supported the existence of both general working models and and relationship-specific working
models. People can report a general attachment style when asked to do so, and the majority of
their relationships are consistent with their general attachment style. [14] A general attachment
style indicates a general working model that applies to many relationships. Yet, people also report
different styles of attachments to their friends, parents, and lovers. [22] [23] Relationship-specific
attachment styles indicate relationship-specific working models. Evidence that general working
models and relationship-specific working models are organized into a hierarchy comes from a
study by Overall, Fletcher, and Friesen. [24] Findings from this study support a three-tier hierarchy
of working models. The highest level of the hierarchy consists of a global working model. The
next level of the hierarchy contains working models for different types of relationships (e.g.,
friends, parents, lovers). The lowest level in the hierarchy consists of working models for each
specific relationship.

In summary, the mental working models that underlie attachment styles appear to contain
information about self and information about others organized into relational schemas. The

19
relational schemas are themselves organized into a three-tier hierarchy. The highest level of the
hierarchy contains relational schemas for a general working model that applies to all
relationships. The middle level of the hierarchy contains relational schemas for working models
that apply to different types of relationships (e.g., friends, parents, lovers). The lowest level of the
hierarchy contains relational schemas for working models of specific relationships.

Stability of working models

Investigators study the stability of working models by looking at the stability of attachment styles.
Attachment styles reflect the thoughts and expectations that constitute working models. Changes
in attachment styles therefore indicate changes in working models.

Around 70-80 percent of people experience no significant changes in attachment styles over time.
[25] [13] [26] [27] [28]
The fact that attachment styles do not change for a majority of people indicates
working models are relatively stable. Yet, around 20-30 percent of people do experience changes
in attachment styles. These changes can occur over periods of weeks or months. The number of
people who experience changes in attachment styles, and the short periods over which the
changes occur, suggest working models are not rigid personality traits.

Why attachment styles change is not well understood. Waters, Weinfield and Hamilton propose
that negative life experiences often cause changes in attachment styles. Their proposal is
supported by evidence that people who experience negative life events also tend to experience
changes in attachment styles. Davila, Karney and Bradbury have identified four sets of factors
that might cause changes in attachment styles: (a) situational events and circumstances, (b)
changes in relational schema, (c) personality variables, and (d) combinations of personality
variables and situational events. They conducted a study to see which set of factors best
explained changes in attachment styles. Interestingly, the study found that all four sets of factors
cause changes in attachment styles. Changes in attachment styles are complex and depend on
multiple factors.

Relationship outcomes

Adult romantic relationships vary in their outcomes. The partners of some relationships express
more satisfaction than the partners of other relationships. The partners of some relationships stay
together longer than the partners of other relationships. Does attachment influence the
satisfaction and duration of relationships?

Satisfaction

Several studies have linked attachment styles to relationship satisfaction. People who have
secure attachment styles usually express greater satisfaction with their relationships than people
who have other attachment styles. Although the link between attachment styles and marital
satisfaction has been firmly established, the mechanisms by which attachment styles influence
marital satisfaction remain poorly understood. One mechanism may be communication. Secure
attachment styles may lead to more constructive communication and more intimate self-

20
discolsures, which in turn increase relationship satisfaction. Other mechanisms by which
attachment styles may influence relationship satisfaction include emotional expressiveness,
strategies for coping with conflict, and perceived support from partners. Further studies are
needed to better understand how attachment styles influence relationship satisfaction.

Duration

Some studies suggest people with secure attachment styles have longer-lasting relationships.
This may be partly due to commitment. People with secure attachment styles tend to express
more commitment to their relationships. People with secure attachment styles also tend to be
more satisfied with their relationships, which may encourage them to stay in their relationships
longer. However, secure attachment styles are by no means a guarantee of long-lasting
relationships.

Nor are secure attachment styles the only attachment styles associated with stable relationships.
People with anxious-preoccupied attachment styles often find themselves in long-lasting, but
unhappy, relationships. Anxious-preoccupied attachment styles often involve anxiety about being
abandoned and doubts about one's worth as a relationship partner. These kinds of feelings and
thoughts may lead people to stay in unhappy relationships.

Relationship dynamics

Attachment plays a role in the way partners interact with one another. A few examples include the
role of attachment in affect regulation, support, intimacy, and jealousy. These examples are
briefly discussed below. Attachment also plays a role in many interactions not discussed in this
article, such as conflict, communication, and sexuality.

Affect regulation

Bowlby has observed that certain kinds of events trigger anxiety in children, and that children try
to relieve their anxiety by seeking closeness and comfort from caregivers. Three main sets of
conditions trigger anxiety in children:

• Conditions of the child (fatigue, hunger, illness, pain, cold, etc.)

• Conditions involving the caregiver (caregiver absent, caregiver departing, caregiver
discouraging of proximity, caregiver giving attention to another child, etc.)
• Conditions of the environment (alarming events, criticism or rejection by others)

The anxiety triggered by these conditions motivates children to engage in behaviors that bring
them physically closer to caregivers. A similar dynamic occurs in adults. Conditions involving
personal well-being, conditions involving a relationship partner, and conditions involving the
environment can trigger anxiety in adults. Adults try to alleviate their anxiety by seeking physical
and psychological closeness to their partners.

21
Mikulincer, Shaver and Pereg have developed a model for this dynamic. According to the model,
when people experience anxiety, they try to reduce their anxiety by seeking closeness with
relationship partners. However, the partners may accept or reject requests for greater closeness.
This leads people to adopt different strategies for reducing anxiety. People engage in three main
strategies to reduce anxiety.

The first strategy is called the security based strategy. The diagram below shows the sequence of
events in the security based strategy.

A person perceives something that provokes anxiety. The person tries to reduce the anxiety by
seeking physical or psychological closeness to her or his partner. The partner responds positively
to the request for closeness, which reaffirms a sense of security and reduces anxiety. The person
returns to her or his everyday activities.

The second strategy is called the attachment avoidance strategy. The following diagram shows
the sequence of events in the attachment avoidance strategy.

22
The events begin the same way as the security based strategy. A person perceives something
that triggers anxiety, and the person tries to reduce anxiety by seeking physical or psychological
closeness to her or his partner. But the partner is either unavailable or rebuffs the request for
closeness. The lack of responsiveness fuels insecurity and heightens anxiety. The person gives
up on getting a positive response from the partner, suppresses her or his anxiety, and distances
herself or himself from the partner.

The third strategy is called the hyperactivation strategy. The diagram below shows the sequence
of events in the hyperactivation strategy.

23
The events begin the same way. Something provokes anxiety in a person, who then tries to
reduce anxiety by seeking physical or psychological closeness to a partner. The partner rebuffs
the request for greater closeness. The lack of responsiveness increases feelings of insecurity and
anxiety. The person then gets locked into a cycle with the partner: the person tries to get closer,
the partner rejects the request for greater closesness, which leads the person to try even harder
to get closer, followed by another rejection from the partner, and so on. The cycle ends only when
the person shifts to a security based strategy (because the partner finally responds positively) or
to an attachment avoidant strategy (because the person gives up on getting a positive response
from the partner).

Mikulincer, Shaver, and Pereg contend these strategies of regulating attachment anxiety have
very different consequences. The security based strategy leads to more positive thoughts, such
as more positive explanations of why others behave in a particular way and more positive
memories about people and events. More positive thoughts can encourage more creative
responses to difficult problems or distressing situations. The attachment avoidance and
hyperactivation strategies lead to more negative thoughts and less creativity in handling problems
and stressful situations. From this perspective, it would benfit people to adopt security based
strategies for dealing with anxiety.

Support

24
People feel less anxious when close to their partners because their partners can provide support
during difficult situations. Support includes the comfort, assistance, and information people
receive from their partners.

Attachment influences both the perception of support from others and the tendency to seek
support from others. People with secure attachment styles seek more support and get more
support from their relationship partners, while people with other attachment styles seek less
support and get less support from their relationships partners. People with secure attachment
styles may trust their partners to provide support because their partners have reliably offered
support in the past. They may be more likely to ask for support when it's needed. People with
insecure attachment styles often do not have a history of supportive responses from their
partners. They may rely less on their partners and be less likely to ask for support when it's
needed. Keep in mind, however, that attachment is only one of many factors that influence how
people perceive support and whether or not they choose to seek support.

Changes in the way people perceive attachment tend to occur with changes in the way people
perceive support. One studylooked at college students' perceptions of attachment to their
mothers, fathers, same-sex friends, and opposite-sex friends. When students reported changes in
attachment for a particular relationship, they usually reported changes in support for that
relationship as well. Changes in attachment for one relationship did not affect the perception of
support in other relationships. The link between changes in attachment and changes in support
was relationship-specific.

Intimacy

Attachment theory has always recognized the importance of intimacy. Bowlby writes:

"Attachment theory regards the propensity to make intimate emotional bonds to particular
individuals as a basic component of human nature, already present in germinal form in the
neonate and continuing through adult life into old age." (Bowlby, 1988, pages 120–121)

The desire for intimacy has biological roots and, in the great majority of people, persists from birth
until death. The desire for intimacy also has important implications for attachment. Relationships
that frequently satisfy the desire for intimacy lead to more secure attachments between partners.
Relationships that rarely satisfy the desire for intimacy lead to less secure attachments between
partners.

Collins and Freeney have examined the relationship between attachment and intimacy in detail.
They define intimacy as a special set of interactions in which a person discloses something
important about himself or herself, and a partner responds to the disclosure in a way that makes
the person feel validated, understood, and cared for. These interactions usually involve verbal
self-disclosure. But intimate interactions can also involve non-verbal forms of self-expression
such as touching, hugging, kissing, and sexual behavior. From this perspective, intimacy requires
the following:

25
 • willingness to disclose one's true thoughts, feelings, wishes, and fears
• willingness to rely on a partner for care and emotional support
• willingness to engage in physical intimacy

Collins and Freeney review a number of studies showing how each attachment style relates to
the willingness to self-disclose, the willingness to rely on partners, and the willingness to engage
in physical intimacy. The secure attachment style is generally related to more self-disclosure,
more reliance on partners, and more physical intimacy than other attachment styles. However,
the amount of intimacy in a relationship can vary due to personality variables and situational
circumstances, so each attachment style may function to adapt an individual to the particular
context of intimacy in which they live.

Mashek and Sherman report some interesting findings on the desire for less closeness with
partners. [62] Sometimes too much intimacy can be suffocating. People in this situation desire less
closeness with their partners. On the one hand, the relationship between attachment styles and
desire for less closeness is predictable. People who have fearful-avoidant and anxious-
preoccupied attachment styles typically want greater closeness with their partners. People who
have dismissive-avoidant attachment styles typically want less closeness with their partners. On
the other hand, the relatively large numbers of people who admit to wanting less closeness with
their partners (up to 57% in some studies) far outnumbers the people who have dismissive-
avoidant attachment styles. This suggests people who have secure, anxious-preoccupied, or
fearful-avoidant attachment styles sometimes seek less closeness with their partners. The desire
for less closeness is not determined by attachment styles alone.

Jealousy

Jealousy refers to the thoughts, feelings, and behaviors that occur when a person believes a
valued relationship is threatened by a rival. A jealous person experiences anxiety about
maintaining support, intimacy, and other valued qualities of her or his relationship. Given that
attachment relates to anxiety regulation, support, and intimacy, as discussed above, it is not
surprising that attachment also relates to jealousy.

Bowlby observed that attachment behaviors in children can be triggered by the presence of a
rival:

"In most young children the mere sight of mother holding another baby in her arms is enough to
elicit strong attachment behaviour. The older child insists on remaining close to his mother, or on
climbing on to her lap. Often he behaves as though he were a baby. It is possible that this well-
known behaviour is only a special case of a child reacting to mother's lack of attention and lack of
responsiveness to him. The fact, however, that an older child often reacts in this way even when
his mother makes a point of being attentive and responsive suggests that more is involved; and
the pioneer experiments of Levy (1937) also indicate that the mere presence of a baby on
mother's lap is sufficient to make an older child much more clinging." (Bowlby, 1969/1982, page
260) When children see a rival contending for a caregiver's attention, the children try to get close
to the caregiver and capture the caregiver's attention. Attempts to get close to the caregiver and

26
capture the caregiver's attention indicate the attachment system has been activated. But the
presence of a rival also provokes jealousy in children. The jealousy provoked by a sibling rival
has been described in detail. ] Recent studies have shown that a rival can provoke jealousy at
very young ages. The presence of a rival can provoke jealousy in infants as young as six months
old. Attachment and jealousy can both be triggered in children by the presence of a rival.

Attachment and jealousy can be triggered by the same perceptual cues in adults, too. The
absence of a partner can trigger both attachment and jealousy when people believe the partner is
spending time with a rival. The presence of a rival can also trigger attachment and jealousy.

Differences in attachment styles influence both the frequency and the pattern of jealous
expressions. People who have anxious-preoccupied or fearful-avoidant attachment styles
experience jealousy more often and view rivals as more threatening than people who have
secure attachment styles People with different attachment styles also express jealousy in
different ways. One study found that:

"Securely attached participants felt anger more intensely than other emotions and were relatively
more likely than other participants to express it, especially toward their partner. And although
anxious participants felt anger relatively intensely, and were as likely as others to express it
through irritability, they were relatively unlikely to actually confront their partner. This might be
attributable to feelings of inferiority and fear, which were especially characteristic of the anxiously
attached and which might be expected to inhibit direct expressions of anger. Avoidants felt
sadness relatively more intensely than did secures in both studies. Further, avoidants were
relatively more likely than others to work to maintain their self-esteem and, perhaps as a
consequence, relatively unlikely to be brought closer to their partner." (Sharpsteen & Kirkpatrick,
1997, page 637)

A subsequent study has confirmed that people with different attachment styles experience and
express jealousy in qualitatively different ways. Attachment thus plays an important role in jealous
interactions by influencing the frequency and the manner in which partners express jealousy.

Adult Treatment Based on Attachment Theory

There are several attachment-based treatment approaches that can be used with adults.[ In
addition, there is an approach to treating couples based on attachment theory.

Attachment in children

Attachment in children deals with the theory of attachment between children and their
caregivers.

Attachment theory has led to a new understanding of child development. Children

develop different styles of attachment based on experiences and interactions with their
caregivers. Four different attachment styles have been identified in children: secure,
anxious-ambivalent, anxious-avoidant, and disorganized. Attachment theory has become

27
the dominant theory used today in the study of infant and toddler behavior and in the
fields of infant mental health, treatment of children, and related fields.

•
Attachment Theory and Children

Attachment theory led not only to increased attention to attachments as a psychosocial process, it
also led to a new understanding of child development. Freudian theory suggested that as libidinal
drives fixed on different objects, former attachments would be broken; failure to break an
attachment effectively would constitute a sort of trauma that could lead to later mental illness.
Attachment theory, however, suggested that growing children did not break former attachments,
but rather (1) learned to become more active (or sovereign) within previously established
attachments, and (2) added new attachments, which did not necessarily require a break with (and
are not necessarily substitutes for) previous attachments.

Attachment theory assumes that humans are social beings; they do not just use other people to
satisfy their drives. In this way, attachment theory is similar to object relations theory.

Attachment styles in children

On the basis of their behaviours, children can be categorized into four groups. Each of these
groups reflects a different kind of attachment relationship with the mother. It should be noted that
Bowlby believed that mothers were the primary attachment figure in children's lives, but
subsequent research has confirmed that children form attachments to both their mothers and
their fathers.

Bowlby, like many of his colleagues at the time, infused the gender norms of the day into
otherwise "unbiased" scientific research.) Modern studies use a variety of standardized
interviews, questionnaires, and tests to identify attachment styles. See also: Allomother theory.
The most commonly used procedures for children are the Strange Situation Protocol and various
narrative approaches and structured observational methods. [6] A frequently used method of
assessing attachment styles in adults is the Adult Attachment Interview developed by Mary Main
and Erik Hesse. [7] Attachment styles in adults can also be assessed using a questionnaire
developed by Shaver and colleagues. All of these methods can be used to classify people into
the classic attachment styles described below.

Secure attachment

A child who is securely attached to its parent will explore freely while the parent is present, will
engage with strangers, will be visibly upset when the parent departs, and happy to see the parent
return.

Securely attached children are best able to explore when they have the knowledge of a secure
base to return to in times of need (also known as "rapprochement", meaning in French "bring
together"). When assistance is given, this bolsters the sense of security and also, assuming the

28
parent's assistance is helpful, educates the child in how to cope with the same problem in the
future. Therefore, secure attachment can be seen as the most adaptive attachment style.
According to some psychological researchers, a child becomes securely attached when the
parent is available and able to meet the needs of the child in a responsive and appropriate
manner. Others have pointed out that there are also other determinants of the child's attachment,
and that behavior of the parent may in turn be influenced by the child's behavior.

Anxious-resistant insecure attachment

A child with an anxious-resistant attachment style is anxious of exploration and of strangers, even
when the parent is present. When the mother departs, the child is extremely distressed. The child
will be ambivalent when she returns - seeking to remain close to the parent but resentful, and
also resistant when the parent initiates attention.

According to some psychological researchers, this style develops from a parenting style which is
engaged but on the parent's own terms. That is, sometimes the child's needs are ignored until
some other activity is completed and that attention is sometimes given to the child more through
the needs of the parent than from the child's initiation.

Anxious-avoidant insecure attachment

A child with an anxious-avoidant attachment style will avoid or ignore the parent - showing little
emotion when the parent departs or returns. The child will not explore very much regardless of
who is there. Strangers will not be treated much differently from the parent. There is not much
emotional range displayed regardless of who is in the room or if it is empty.

This style of attachment develops from a parenting style which is more disengaged. The child's
needs are frequently not met and the child comes to believe that communication of needs has no
influence on the parent.

Disorganized attachment

A fourth category termed disorganized attachment is actually the lack of a coherent style or
pattern for coping. While ambivalent and avoidant styles are not totally effective, they are
strategies for dealing with the world. Children with disorganized attachment experienced their
caregivers as either frightened or frightening. Human interactions are experienced as erratic, thus
children cannot form a coherent interactive template. If the child uses the caregiver as a mirror to
understand the self, the disorganized child is looking into a mirror broken into a thousand pieces.
It is more severe than learned helplessness as it is the model of the self rather than of a situation.

This was not one of Ainsworth's initial three categories, but identified by Mary Main in subsequent
research.

Attachment and Treatment

29
Attachment theory has become the dominant theory used today in the study of infant and toddler
behavior and in the fields of infant mental health, treatment of children, and related fields. Several
evidence-based and effective treatments are based on attachment theory including Theraplay
and Dyadic Developmental Psychotherapy. In fact nearly all treatments for children with trauma
and attachment difficulties are based on attachment theory today. [8] [9] Nearly all mainstream
programs for the prevention and treatment of disorders of attachment attachment disorder use
attachment theory. For example, the Circle of Security Program, (Dr. Robert Marvin, University of
VA) is one such early intervention program with demonstrated effectiveness. Dr. Marvin and Dr.
Siegel (University of California) both also endorse Dyadic Developmental Psychotherapy Other
promising treatment methods include the Circle of Security Program of Dr. Robert Marvin at the
University of Virginia, Developmental, Individual-difference, Relationship-based therapy (DIR or
Floor Time) by Stanley Greenspan.

Dyadic developmental psychotherapy is an evidence-based treatment(1) approach for the

treatment of attachment disorder and reactive attachment disorder. The treatment is based on
sound clinical principles and uses methods, techniques, and approaches that have strong
empirical evidence, such as relationship and unconditional positive regard. Children who have
experienced pervasive and extensive trauma, neglect, loss, and/or other dysregulating
experiences can benefit from this treatment. Dyadic Developmental Psychotherapy is based on
principles derived from Attachment theory and Research; see the work of Bowlby. The treatment
meets the standards of the American Professional Society on Child Abuse, The American
Academy of Child Psychiatry, American Psychological Association, American Psychiatric
Association, National Association of Social Workers, and various other groups' standards for the
evaluation and treatment of children and adolescents. This is a non-coercive treatment.

Various organizations have adopted standards against the use of coercive interventions: APSAC,
the American Academy of Child and Adolescent Psychiatry, the American Psychological
Association, the American Psychiatric Association, the [[National Association of Social Workers]].
All of the aforementioned organizations have adopted formal statements (in some cases practice
parameters) opposing the coercive treatments. Recognized professional organizations have been
unanimous in recommending against the use of coercive treatments. Circle of Security,
Theraplay, Dyadic Developmental Psychotherapy, and others being non-coercive approaches,
meet these standards as evidenced by the support of Dyadic Developmental Psychotherapy by
Dr. Daniel Siegel of the University of California at LA medical school and author of The
Developing Mind, among many other articles and books and Dr. Robert Marvin of the University
of Virginia Attachment Clinic.

Atachment measures
Attachment measures refer to the various procedures used to assess attachment in children
and adults.

30
Researchers have developed various ways of assessing attachment in children, including
the Strange Situation and story-based approaches such as Attachment Story Completion
Test. These methods allow children to be classified into four attachment styles: secure,
anxious-ambivalent, anxious-avoidant, and disordered. Attachment in adults is commonly
measured using the Adult Attachment Interview and self-report questionnaires. Self-
report questionnaires have identified two dimensions of attachment, one dimension
dealing with anxiety about the relationship, and the other dimension dealing with
avoidance in the relationship. These dimensions define four styles of adult attachment:
secure, preoccupied, dismissive-avoidant, and fearful-avoidant.

•
Measuring Attachment in Children

Researchers have developed several ways to assess attachment in children.

The Strange Situation

Mary Ainsworth is a developmental psychologist who devised a procedure called The Strange
Situation, to observe attachment relationships between a human caregiver and child. [1] In this
procedure the child is observed playing for 20 minutes while caregivers and strangers enter and
leave the room, recreating the flow of the familiar and unfamiliar presence in most children's lives.
The situation varies in stressfulness and the child's responses are observed. The child
experiences the following situations:

1. Mother and baby enter room.

2. Mother sits quietly on a chair, responding if the infant seeks attention.
3. A stranger enters, talks to the mother then gradually approaches infant with a toy. The
mother leaves the room.
4. The stranger leaves the infant playing unless he/she is inactive and then tries to interest
the infant in toys. If the infant becomes distressed this episode is ended.
5. Mother enters and waits to see how the infant greets her. The stranger leaves quietly and
the mother waits until the baby settles, and then she leaves again.
6. The infant is alone. This episode is curtailed if the infant appears to be distressed.
7. The stranger comes back and repeats episode 3.
8. The mother returns and the stranger goes. Reunion behaviour is noted and then the
situation is ended.

Two aspects of the child's behaviour are observed:

• The amount of exploration (e.g. playing with new toys) the child engages in throughout,
and
• The child's reactions to the departure and return of its caregiver.

Other Approaches

31
Narrative and story-stem approaches are often used with older toddlers, children, and teens to
determine their state of mind with respect to attachment. The Attachment Story Completion Test
is one such methodology.

Measuring Attachment in Adults

The two main ways of measuring attachment in adults include the Adult Attachment Interview
(AAI) and self-report questionnaires. The AAI and the self-report questionnaires were created
with somewhat different aims in mind. Shaver and Fraley note:

"If you are a novice in this research area, what is most important for you to know is that self-report
measures of romantic attachment and the AAI were initially developed completely independently
and for quite different purposes. One asks about a person's feelings and behaviors in the context
of romantic or other close relationships; the other is used to make inferences about the defenses
associated with an adult's current state of mind regarding childhood relationships with parents. In
principle, these might have been substantially associated, but in fact they seem to be only
moderately related--at least as currently assessed. One kind of measure receives its construct
validity mostly from studies of romantic relationships, the other from prediction of a person's
child's behavior in Ainsworth's Strange Situation. Correlations of the two kinds of measures with
other variables are likely to differ, although a few studies have found the AAI to be related to
marital relationship quality and a few have found self-report romantic attachment measures to be
related to parenting." (Shaver & Fraley, 2004) [2]

The AAI and the self-report questionnaires offer distinct, but equally valid, perspectives on adult
attachment. It's therefore worthwhile to become familiar with both approaches.

Adult Attachment Interview (AAI)

Developed by Mary Main and her colleagues, this is a semi-structured interview that takes about
one hour to administer. It involves about twenty questions and has extensive research validation
to support it. A good description can be found in Chapter 19 of Attachment Theory, Research and
Clinical Applications, edited by Shaver & Cassidy, Guilford Press, NY, 1999.

Self-report questionnaires

Hazen and Shaver created the first questionnaire to measure attachment in adults. [3] Their
questionnaire was designed to classify adults into the three attachment styles identified by
Ainsworth. The questionnaire consisted of three sets of statements, each set of statements
describing an attachment style:

• Secure - I find it relatively easy to get close to others and am comfortable depending on
them and having them depend on me. I don't often worry about being abandoned or
about someone getting too close to me.

32
 • Avoidant - I am somewhat uncomfortable being close to others; I find it difficult to trust
them completely, difficult to allow myself to depend on them. I am nervous when anyone
gets too close, and often, love partners want me to be more intimate that I feel
comfortable being.
• Anxious/Ambivaent - I find that others are reluctant to get as close as I would like. I often
worry that my partner doesn't really love me or won't want to stay with me. I want to
merge completely with another person, and this desire sometimes scares people away.

People participating in their study were asked to choose which set of statements best described
their feelings. The chosen set of statements indicated their attachment style. Later versions of this
questionnaire presented scales so people could rate how well each set of statements described
their feelings.

One important advance in the development of attachment questionnaires was the addition of a
fourth style of attachment. Bartholomew and Horowitz presented a model that identified four
categories or styles of adult attachment. [4] Their model was based on the idea attachment styles
reflected people's thoughts about their partners and thought about themselves. Specifically,
attachment styles depended on whether or not people judge their partners to be generally
accessible and responsive to requests for support, and whether or not people judge themselves
to be the kind of individuals towards which others want to respond and lend help. They proposed
four categories based on positive or negative thoughts about partners and on positive or negative
thoughts about self.

Bartholomew and Horowitz used this model to create the Relationship Questionnaire (RC). The
RC consisted of four sets of statements, each describing a category or style of attachment:

33
 • Secure - It is relatively easy for me to become emotionally close to others. I am
comfortable depending on others and having others depend on me. I don't worry about
being alone or having others not accept me.
• Dismissive - I am comfortable without close emotional relationships. It is very important to
me to feel independent and self-sufficient, and I prefer not to depend on others or have
others depend on me.
• Preoccupied - I want to be completely emotionally intimate with others, but I often find
that others are reluctant to get as close as I would like. I am uncomfortable being without
close relationships, but I sometimes worry that others don't value me as much as I value
them.
• Fearful - I am somewhat uncomfortable getting close to others. I want emotionally close
relationships, but I find it difficult to trust others completely, or to depend on them. I
sometimes worry that I will be hurt if I allow myself to become too close to others.

Tests demonstrated the four attachment styles were distinct in how they related to other kinds of
psychological variables. Adults indeed appeared to have four styles of attachment instead of
three attachment styles.

David Schmitt, together with a large number of colleagues, validated the attachment
questionnaire created by Bartholomew and Horowitz in 62 cultures. [5] The distinction of thoughts
about self and thoughts about partners proved valid in nearly all cultures. However, the way these
two kinds of thoughts interacted to form attachment styles varied somewhat across cultures. The
four attachment styles had somewhat different meanings across cultures.

A second important advance in attachment questionnaires was the use of independent items to
assess attachment. Instead of asking people to choose between three or four sets of statements,
people rated how strongly they agreed with dozens of individual statements. The ratings for the
individual statements were combined to provide an attachment score. Investigators have created
several questionnaires using this strategy to measure adult attachment.

Two popular questionnaires of this type are the Experiences in Close Relationships (ECR)
questionnaire and the Experiences in Close Relationships - Revised (ECR-R) questionnaire. The
ECR was created by Brennan, Clark, and Shaver in 1998. [6] The ECR-R was created by Fraley,
Waller, and Brennan in 2000. [7] Readers who wish to take the ECR-R and learn their attachment
style can find an online version of the questionnaire at http://www.web-research-design.net/cgi-
bin/crq/crq.pl.

Analysis of the ECR and ECR-R reveal that the questionnaire items can be grouped into two
dimensions of attachment. One group of questionnaire items deal with how anxious a person is
about their relationship. These items serve as a scale for anxiety. The remaining items deal with
how avoidant a person is in their relationship. These items serve as a scale for avoidance. Many
researchers now use scores from the anxiety and avoidance scales to perform statistical
analyses and test hypotheses.

34
Scores on the anxiety and avoidance scales can still be used to classify people into the four adult
attachment styles. [8] [6] [9] The four styles of attachment defined in Bartholomew and Horowitz's
model were based on thoughts about self and thoughts about partners. The anxiety scale in the
ECR and ECR-R reflect thoughts about self. Attachment anxiety relates to beliefs about self-
worth and whether or not one will be accepted or rejected by others. The avoidance scale in the
ECR and ECR-R relates to thoughts about partners. Attachment avoidance relates to beliefs
about taking risks in approaching or avoding other people. Combinations of anxiety and
avoidance can thus be used to define the four attachment styles. The secure style of attachment
is characterized by low anxiety and low avoidance; the preoccupied style of attachment is
characterized by high anxiety and low avoidance; the dismissive avoidant style of attachment is
characterized by low anxiety and high avoidance; and the fearful avoidant style of attachment is
characterized by high anxiety and high avoidance.

References

1. ^ Ainsworth. Mary D. (1978) Patterns of Attachment: A Psychological Study of the

Strange Situation. Lawrence Erlbaum Associates. ISBN 0-89859-461-8.
2. ^ Shaver, P.A. & Fraley, R.C. (2004). Self-report measures of adult attachment. Online
article. Retrieved June 20, 2006, from
http://www.psych.uiuc.edu/~rcfraley/measures/measures.html .
3. ^ Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachmenpt
process. Journal of Personality and Social Psychology, 52, 511-524.
4. ^ Bartholomew, K. & Horowitz, L.M. (1991). Attachment styles among young adults: A
test of a four-category model. Journal of Personality and Social Psychology, 61, 226-244.

35
 5. ^ Schmitt, D.P., et al. (2004). Patterns and universals of adult romantic attachment
across 62 cultural regions. Journal of Cross-Cultural Psychology, 35, 367-402.
6. ^ a b Brennan, K.A., Clark, C.L., & Shaver, P.R. (1998). Self-report measurement of adult
romantic attachment: An integrative overview. In J.A. Simpson & W.S. Rholes (Eds.),
Attachment theory and close relationships (pp. 46-76). New York: Guilford Press.
7. ^ Fraley, R.C., Waller, N.G., & Brennan, K.A. (2000). An item-response theory analysis of
self-report measures of adult attachment. Journal of Personality and Social Psychology,
78, 350-365.
8. ^ Bartholomew, K. & Shaver, P.R. (1998). Methods of assessing adult attachment. In J.
A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships, pp. 25-45.
New York, NY: Guilford Press.
9. ^ Collins, N.L. & Freeney, B.C. (2004). An Attachment Theory Perspective on Closeness
and Intimacy. In D.J. Mashek & A. Aron (Eds.), Handbook of Closeness and Intimacy, pp.
163-188. Mahwah, NJ: Lawrence Erlbaum Associates.

Recommended Reading

• Becker-Weidman, A., & Shell, D., (Eds). (2005) Creating Capacity for Attachment Wood
N Barnes, Oklahoma City, OK. ISBN 1-885473-72-9
• Cassidy, J., & Shaver, P., (Eds). (1999) Handbook of Attachment: Theory, Research, and
Clinical Applications. Guilford Press, NY.
• Greenberg, MT, Cicchetti, D., & Cummings, EM., (Eds) (1990) Attachment in the
Preschool Years: Theory, Research and Intervention University of Chicago, Chicago.
• Greenspan, S. (1993) Infancy and Early Childhood. Madison, CT: International
Universities Press. ISBN 0-8236-2633-4.
• Holmes, J. (1993) John Bowlby and Attachment Theory. Routledge. ISBN 0-415-07730-
3.
• Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and
Psychotherapy. London: Brunner-Routledge. ISBN 1-58391-152-9.
• Karen R (1998) Becoming Attached: First Relationships and How They Shape Our
Capacity to Love. Oxford University Press. ISBN 0-19-511501-5.
• Parkes, CM, Stevenson-Hinde, J., Marris, P., (Eds.) (1991) Attachment Across The Life
Cycle Routledge. NY. ISBN 0-415-05651-9
• Siegler R., DeLoache, J. & Eisenberg, N. (2003) How Children develop. New York:
Worth. ISBN 1-57259-249-4.
• Sturt, SM (Ed) (2006). New Developments in Child Abuse Research Nove, NY. ISBN 1-
59454-980-X

Attachment parenting
Attachment parenting, a phrase coined by pediatrician William Sears, is a parenting philosophy
based on the principles of the attachment theory in developmental psychology. According to
attachment theory, a strong emotional bond with parents during childhood, also known as a
secure attachment, is a precursor of secure, empathic relationships in adulthood.

36
Contents

• 1 History
• 2 Dr. Sears' Eight Ideals of Attachment Parenting
• 3 Attachment Parenting and Childcare
• 4 Attachment Parenting and Discipline
• 5 Criticisms of attachment parenting
• 6 Response to criticisms
• 7 See also
• 8 External links
o 8.1 Critical articles

• 9 Relevant publications
History

Attachment parenting describes a parenting approach inspired in part by attachment theory.

Attachment theory, originally proposed by John Bowlby, states that the infant has a tendency to
seek closeness to another person and feel secure when that person is present. In comparison,
Sigmund Freud proposed that attachment was a consequence of the need to satisfy various
drives. In attachment theory, children attach to their parents because they are social beings, not
just because they need other people to satisfy drives and attachment is part of normal child
development.

Developmental psychologist Mary Ainsworth devised a procedure, called The Strange Situation,
to observe attachment relationships between a human mother and child. She observed
disruptions to the parent/child attachment over a 20 minute period, and noted that this affected
the child's exploration and behavior toward the mother. This operationalization of attachment has
recently come under question, as it may not be a valid measure for infants that do not experience
distress upon initial encounter with a stranger (e.g., Clarke-Stewart, Goossens, & Allhusen,
2001).

According to Dr. Sears there are 8 ideals that foster healthy attachment between the caretaker
and infant. However, none of these ideals stem directly from original attachment theory.

Dr. Sears' Eight Ideals of Attachment Parenting

Per Dr. Sears' theory of attachment parenting (AP), proponents attempt to foster a secure bond
with their child by promoting eight "ideals," which are identified as goals for parents to strive for.
These eight ideals are:

1. Preparation for childbirth

2. Emotional responsiveness
3. Breastfeeding
4. Babywearing

37
 5. Co-sleeping safely
6. Avoiding frequent and prolonged separations between parents and a baby
7. Positive discipline
8. Maintaining balance in family life

These values are interpreted in a variety of ways across the movement. Many attachment parents
also choose to live a natural family living (NFL) lifestyle, such as natural childbirth, home birth,
stay-at-home parenting, homeschooling, unschooling, the anti-circumcision movement, the anti-
vaccination movement, natural health, cooperative movements, and support of organic food.

However, Dr. Sears does not require a parent to strictly follow any set of rules, instead
encouraging parents to be creative in responding to their child's needs. Attachment parenting,
outside the guise of Dr. Sears, focuses on responses that support secure attachments.

Attachment Parenting and Childcare

Attachment parenting proponents value continuous attachment to a primary caregiver. However,

many still engage childcare, regardless of whether a parent stays at home. AP-friendly childcare
focuses on meeting the child's needs first, but without denying the working parent of their duties
outside of the home.

Attachment Parenting and Discipline

Attachment parents seek to understand the biological and psychological needs of the children,
and to avoid unrealistic expectations of child behavior. In setting boundaries and limits that are
appropriate to the age of the child, attachment parenting takes into account the physical and
psychological stage of development that the child is currently experiencing. In this way, parents
may seek to avoid the frustration that occurs when they expect things their child is not capable of.

Attachment parenting holds that it is of vital importance to the survival of the child that he be
capable of communicating his needs to the adults and having those needs promptly met. Dr.
Sears advises that while still an infant, the child is mentally incapable of outright manipulation.
Sears says that in the first year of life, a child's needs and wants are one and the same. Unmet
needs are believed, by Dr. Sears and other AP proponents, to surface beginning immediately in
attempts to fulfill that which was left unmet. AP looks at child development as well as infant and
child biology to determine the psychologically and biologically appropriate response at different
stages. Attachment parenting does not mean meeting a need that a child can fulfill himself. It
means understanding what the needs are, when they arise, how they change over time and
circumstances, and being flexible in devising ways to respond appropriately.

Similar practices are called natural parenting, instinctive parenting, intuitive parenting, immersion
parenting or "continuum concept" parenting.

Criticisms of attachment parenting

38
One criticism of attachment parenting is that it can be very strenuous and demanding on parents.
Without a support network of helpful friends or family, the work of parenting can be difficult. Writer
Judith Warner contends that a “culture of total motherhoodâ€ﾝ, which she blames in part on
attachment parenting, has lead to an “age of anxietyâ€ﾝ for mothers in modern American
society[citation needed].

Another criticism is that there is no conclusive or convincing body of research, aside from
testimonials from participating parents, that shows this labor-intensive approach to be in any way
superior to what attachment parents term "mainstream parenting" in the long run[citation needed].
Psychologist Jerome Kagan has criticised attachment parenting studies for neglecting the
influence of innate temperament. He argues that personality factors such as shyness are partially
inherited[citation needed]. A child in the “strange situationâ€ﾝ may be securely attached to his
mother but cry because he has a highly reactive temperament.

The American Academy of Pediatrics has recently amended its policy statement regarding SIDS
prevention, and has come out against sharing a bed with small babies (though it does encourage
room-sharing)[citation needed].

Response to criticisms

Attachment parenting adherents argue that the extra parenting effort is an investment in future
ease, since the resulting strong relationship often makes future parenting simpler. Rather than
being "strenuous", attachment parenting theory regards being available to one's children as
natural and instinctive.

In response to the above-mentioned American Academy of Pediatrics policy statement

recommending against co-sleeping, Attachment Parenting International (API) issued a response
which alleged the data referenced in the statement was unreliable, and that co-sponsors of the
campaign had created a conflict of interest. API's response also outlines calls for an "objective,
comprehensive, and independent report which analyzes the relative risk of all types of sleeping
environments. Only when that is available can the CPSC truly assist parents in making the best

Attachment theory
Attachment theory is a psychological theory about the evolved adaptive tendency to maintain
proximity to an attachment figure. The origin of attachment theory can be traced to the publication
of two 1958 papers, one being John Bowlby's "the Nature of the Child's Tie to his Mother", in
which the precursory concepts of "attachment" were introduced, and Harry Harlow's "the Nature
of Love", as based on the results of experiments which showed, approximately, that infant rhesus
monkeys preferred emotional attachment over food.

Contents

39
 • 1 Overview
• 2 Basic attachment theory
o 2.1 Attachment of children to Caregivers
o 2.2 Attachment in adult romantic relationships
o 2.3 Attachment measures in children
o 2.4 Attachment measures in Adults
o 2.5 Attachment measures
• 3 Attachment theory in clinical practice
o 3.1 Attachment disorder
o 3.2 Reactive attachment disorder
o 3.3 Dyadic developmental psychotherapy
o 3.4 Theraplay
• 4 References
• 5 See also
• 6 Further reading

• 7 External links
Overview

Attachment is defined as an affectional tie that one person or animal forms between him/herself
and another specific one [usually the parent] — a tie that binds them together in space and
endures over time. [1] Attachment theory, from one perspective, has its origins in the observation
of and experiments with young animals. In the 1950s, a famous series of experiments on infant
monkeys by Harlow and Harlow demonstrated that attachment is not a simple reaction to internal
drives such as hunger. [2]

In these experiments, young monkeys were separated from their mother shortly after birth. They
were offered two wire monkeys to serve as surrogate mothers. The first monkey had a body of
wire mesh. The second monkey had a body of wire mesh covered in terry cloth and foam rubber.
The wire mesh doll was secured with a bottle of milk, the softer doll had no sustenance. (In the
control group, the soft doll provided milk as well). The young monkeys nursed at the wire monkey
and then promptly sought contact with the cloth monkey. The experiment proved that what a baby
ultimately seeks is a mother's warmth and the familiar feeling of being with the mother. The
experiment also hushed psychoanalyst's claims that mother was based on sustenance alone, as
the monkeys preferred a mother's proximity and comfort.

The young monkeys clung to the soft cloth doll and also explored more when in the presence of
the soft cloth doll, and the doll seemed to provide them with a sense of security. However, the
passive doll was not an adequate alternative for a real mother. Infant monkeys raised without
contact with other monkeys showed abnormal behavior in social situations. They were either very
fearful of other monkeys or responded with unprovoked aggression when they encountered other
monkeys. They also showed abnormal sexual responses. Female monkeys who were raised in
isolation often neglected or abused their infants. This abnormal behaviour is thought to

40
demonstrate that the instruction, affection and imitation afforded in a bond with the mother is
necessary for mental and social development. The effects of early exposure to the wire and cloth
mothers could be seen roughly 2 years later, well into the adulthood. The experiment implied
young babies without mothers or primary caregivers are likely to have compromised mental and
social development.

Much of early attachment theory was written by John Bowlby, a clinician, and his works include
Attachment, Separation and Loss, a trilogy, which brought together many disciplines such as
ethology, psychology and psychoanalysis. Mary Ainsworth conducted research based on his
theory and she devised the strange situation as the laboratory portion of a larger study that
included extensive home visitations over the first year of the child's life. In the strange situation a
mother (or other caregiver) and child are separated and reunited twice across eight episodes. 1)
Ainsworth placed the mother and child in a room with toys to explore. 2) A stranger entered. 3)
The mother left. 4) The stranger left. 5) The mother returned and comforted the child. 6) The
mother left. 7) The stranger entered and attempted to comfort the child. 8) The mother returned
and comforted the child. Infants were classified in one of three categories, based on their
behavior on reunion with their mothers.

• Secure Attachment - If the child protested the mother's departure and quieted promptly
on the mother's return, accepting comfort from her and returning to exploration, then the
child's relationship to the mother would be classified as a secure attachment.

• Avoidant Attachment - If the child showed little to no signs of distress at the mother's
departure, a willingness to explore the toys, and little to no visible response to the
mother's return, then the child-mother relationship would be classified as avoidant.

• Ambivalent Attachment - If the child showed sadness on the mother's departure, ability to
be picked up by the stranger and even 'warm' to the stranger, and on the mother's return,
some ambivalence, signs of anger, reluctance to 'warm' to her and return to play, then
this child would be classified as ambivalent.

A mother whose child is securely attached would respond appropriately, promptly and
consistently to the emotional as well as the physical needs of the child. She would help her child
to transition and regulate stress, and as a result, the child would use her as a secure base in the
home environment.

A mother whose child has an avoidant attachment would show little response to the child when
distressed. She would discourage her child from crying and encourage independence and
exploration. The avoidantly attached child may have lower quality play than the securely attached
child.

A mother whose child is ambivalently attached would be inconsistent with her child, at times be
appropriate and at other times be neglectful to the child. The child raised in an ambivalent
relationship becomes preoccupied with the mother's availability and cannot explore his

41
environment freely or use his mother as a secure base. The ambivalently attached child is
vulnerable to difficulty coping with life stresses and may display role reversal with the mother.

Further research by Dr. Mary Main and colleagues (University of California, Berkeley) have
identified a small number of children who present stereotypes on the mother's return, such as
freezing for several seconds or rocking. This appears to indicate the child's lack of coherent
coping strategy, and the child would be classified as disorganized. Children who are classified
as disorganized are also given a classification as secure, ambivalent or avoidant based on their
overall reunion behavior.

Other recent research has followed children into the school environment, where securely
attached children generally relate well to peers, avoidantly attached children tend to victimize
peers and ambivalently attached children may be victimized by peers and be coy.

[3] [4] [5] [6]

These early studies focused on attachment between children and caregivers. Attachment
theory was later extended to adult romantic relationships by Cindy Hazen and Phillip Shaver. [7] [8]
[9]

Basic attachment theory

Attachment of children to Caregivers

Main article: Attachment in children

Attachment theory has led to a new understanding of child development. Children develop
different styles of attachment based on experiences and interactions with their primary
caregivers. Four different attachment styles have been identified in children: secure, anxious-
ambivalent, anxious-avoidant, and disorganized. Attachment Theory has become the dominant
theory used today in the study of infant and toddler behavior and in the fields of infant mental
health, treatment of children, and related fields. Many evidence-based treatment approaches are
based on attachment theory (see section below). Mary Ainsworth was a leader in applying
Bowlby's theory to research.

Attachment in adult romantic relationships

Main article: Attachment in adults

Hazan and Shaver extended attachment theory to adult romantic relationships in 1987. It was
originally characterized by three dimensions: secure, anxious/ambivalent and avoidant. Later
research showed that attachment is best thought of as two different dimensions: anxiety and
avoidance. These dimensions are often drawn as an X and Y axis. In this model secure
individuals are low in both anxiety and avoidance. Thus, attachment can also be broken down
into four categories: secure, anxious-ambivalent (preoccupied), avoidant (dismissive), and fearful-
avoidant. However, people's attachment varies continuously so most researchers do not currently
think in terms of categories.

42
Attachment research into romantic relationships has led to a wide variety of findings. Mario
Mikulincer has shown through a wide variety of studies that attachment influences how well
people are able to cope with stress in their life. Nancy Collins and colleagues have shown that
attachment influences many kinds of care-giving behavior. Jeff Simpson and Steve Rholes have
conducted a number of studies showing that attachment influences how people parent their
newborn children and how well they are able to cope with the stress of having a newborn child.

Attachment measures in children

Researchers have developed various ways of assessing attachment in children, including the
Strange Situation Protocol developed by Mary Ainsworth and story-based approaches such as
Attachment Story Completion Test. These methods allow children to be classified into four
attachment styles: secure, anxious-ambivalent, anxious-avoidant, and disorganized. Attachment
in adults is commonly measured using the Adult Attachment Interview and self-report
questionnaires. Self-report questionnaires have identified two dimensions of attachment, one
dealing with anxiety about the relationship, and the other dealing with avoidance in the
relationship. These dimensions define four styles of adult attachment: secure, preoccupied,
dismissive-avoidant, and fearful-avoidant.

Attachment measures in Adults

There is a wide variety of attachment measures used in adult attachment research. The most
popular measure in the social psychological research is the Experiences in Close Relationships-
Revised scale. This scale treats attachment as two dimensions, anxiety and avoidance. The Adult
Attachment interview is also commonly used to assess an individual's ability to discuss previous
relationships with attachment figures. The interview consists of 36 questions, varying in detail
from basic background information to instances of loss and trauma (if any). An independently
trained coder determines the consistency of the individual's descriptions based on emotion
regulation and content of information in the interview. Developmental psychologists use the Adult
Attachment Interview (AAI; George,Kaplan, & Main)or the Adult Attachment Projective (AAP;
George, West, & Pettem). The AAI is an interview about attachment experiences that gets
recorded and analysed for attachment status. The AAP is a guided interview which uses vague
drawings about which the individual can tell a story. The story responses are recorded and
decoded for attachment status. Generally attachment style is used by social psychologists
interested in romantic attachment, and attachment status by developmental psychologists
interested in the individual's state of mind with respect to attachment. The latter is more stable,
while the former fluctuates more.

Attachment measures

Main article: Attachment measures

Researchers have developed various ways of assessing attachment in children, including the
Strange Situation and story-based approaches such as Attachment Story Completion Test. These

43
methods allow children to be classified into four attachment styles: secure, anxious-ambivalent,
anxious-avoidant, and disorganized. Attachment in adults is commonly measured using the Adult
Attachment Interview and self-report questionnaires. Self-report questionnaires have identified
two dimensions of attachment, one dealing with anxiety about the relationship, and the other
dealing with avoidance in the relationship. These dimensions define four styles of adult
attachment: secure, preoccupied, dismissive-avoidant, and fearful-avoidant.

Attachment theory in clinical practice

Attachment disorder

Main article: Attachment disorder

Attachment disorder refers to the failure to form normal attachments with caregivers during
childhood. This can have adverse effects throughout the lifespan. Clinicians have identified
several signs of attachment problems. Attachment problems can be resolved at older ages
through appropriate therapeutic interventions. Reputable interventions include Theraplay and
Dyadic Developmental Psychotherapy.

Reactive attachment disorder

Main article: Reactive attachment disorder

Reactive attachment disorder, sometimes called "RAD", is a psychiatric diagnosis (DSM-IV

313.89, ICD-10 F94.1/2). The essential feature of Reactive attachment disorder is markedly
disturbed and developmentally inappropriate social relatedness in most contexts that begins
before age 5 years and is associated with gross pathological care.

Dyadic developmental psychotherapy

Main article: Dyadic developmental psychotherapy

Dyadic developmental psychotherapy is an evidence-based treatment approach [10] for the

treatment of attachment disorder and reactive attachment disorder. Children who have
experienced pervasive and extensive trauma, neglect, loss, and/or other dysregulating
experiences can benefit from this treatment. Dyadic Developmental Psychotherapy is based on
principles derived from attachment theory.

Theraplay

Main article: Theraplay

Theraplay is a play therapy which has the intention of helping parents and children build better
attachment relationships through attachment-based play. It was developed in 1967 by the

44
Psychological Services staff of a Head Start program in Chicago. Theraplay is based on model of
healthy parent-infant attachment and interactions.

References

1. ^ Ainsworth, Bell, & Stayton (1974) "Infant-mother attachment". In M.P.M. Richards (Ed.)
Integratin of a child into a social world.. Cambridge, England: Cambridge University
Press.
2. ^ Harlow, H. F. & Harlow, M. K. (1969) "Effects of various mother-infant relationships on
rhesus monkey behaviors". In B. M. Foss (Ed.) Determinants of infant behavior (Vol. 4).
London: Methuen.
3. ^ Bowlby, J. (1969) Attachment , Vol. 1 of Attachment and loss. London: Hogarth Press.
New York: Basic Books; Harmondsworth: Penguin (1971).
4. ^ Bowlby, J. (1973) , Separation: Anxiety & Anger. Vol. 2 of Attachment and loss London:
Hogarth Press; New York: Basic Books; Harmondsworth: Penguin (1975).
5. ^ Bowlby, J. (1980) Loss: Sadness & Depression, in Vol. 3 of Attachment and loss,
London: Hogarth Press. New York: Basic Books; Harmondsworth: Penguin (1981).
6. ^ Bretherton, I. (1992). The Origins of Attachment Theory: John Bowlby and Mary
Ainsworth. Developmental Psychology, 28, 759-775.
7. ^ Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachmenpt
rocess. Journal of Personality and Social Psychology, 52, 511-524.
8. ^ Hazan, C., & Shaver, P. R. (1990). Love and work: An attachment theoretical
perspective. Journal of Personality and Social Psychology, 59, 270-280.
9. ^ Hazan, C., & Shaver, P. R. (1994). Attachment as an organizational framework for
research on close relationships. Psychological Inquiry, 5, 1-22.
10. ^ Becker-Weidman, A., & Shell, D. (2005) Creating Capacity for Attachment. Wood 'N'
Barnes, Oklahoma City, OK.

Attachment Therapy
"Attachment Therapy", also called "holding therapy" or rebirthing, is an ambiguous term
which is sometimes used to describe a form of "treatment" for behavioral difficulties in children
suffering from attachment disorder that involves coercive and intrusive methods. However,
because the term has no common meaning, or generally accepted meaning, in the professional
community, its actual definition is unclear. A number of advocacy groups, such as Advocates for
Children in Therapy and Quackwatch have undertaken to label nearly all treatments for children
with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies.

The advocacy group, Advocates for Children in Therapy define, "Attachment Therapy (AT) is a
growing, underground movement for the treatment of children who pose disciplinary problems to

45
their parents or caregivers. AT practitioners allege that the root cause of the children’s
misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is —
literally — to force the children into loving (attaching to) their parents ...there is a hands-on
treatment involving physical restraint and discomfort. Attachment Therapy is the imposition of
boundary violations - most often coercive restraint - and verbal abuse on a child, usually for hours
at a time...Typically, the child is put in a lap hold with the arms pinned down, or alternatively an
adult lies on top of a child lying prone on the floor." [[1]

The term has little commonly agreed upon meaning in the professional literature. For example, it
is not a term found in the American Medical Association's Physician's Current Procedural Manual.
The American Professional Society on Abuse of children (APSAC) (Chaffin et al.,2006, PMID
16382093) does not use the term "Attachment Therapy," but has disapproved of coercive and
intrusive methods of treatment as inappropriate for treatment while approving a broad range of
effective treatments for children with disorders of attachment that do not use coercive methods.

Contents

• 1 Treatment characteristics
o 1.1 Definition of Attachment Therapy
• 2 Parenting methods association with Attachment Therapy
• 3 Prevalence
• 4 See also
• 5 References

• 6 External links
Treatment characteristics

The "Attachment Therapy," "rebirthing," or "holding therapy" group of treatments vary in their
specifics, and which do not have any commonly agreed upon definition. These terms are subject
to much debate and are ill-defined since there is no common definition for these terms. For
example, these terms are not terms found in the American Psychiatric Associations's DSM IV-R
or in the American Medical Association's book of CPT codes for treatment methods. Enforced
coercive physical restraint is a shared characteristic of some versions of these ill-defined
approaches.

"Attachment Therapy" or "holding therapy" or rebirthing is not a mainstream approach to treating

children experiencing attachment disorder. The term is not applicable to generally accepted
approaches to the treatment of children and adolescents with disorders of attachment. "The
holding approach would be viewed as intrusive and thereforer non-sensitive and counter
therapeutic" (O'Connor & Zeanah, (2003), p. 235).

Treatment and prevention programs that use methods congruent with attachment theory and with
well established principles of child development (American Academy of Child and Adolescent
Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant

46
Mental Health, 1993 )(Lieberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic
Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier
(autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis
Jernberg (Theraplay), Daniel Schechter (Clinician Assisted Videofeedback Exposure Sessions)
(Schechter, 2003), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993). None of
these approaches use coercive methods nor do they fit the definition of "Attachment Therapy"
described by Advocates for Children in Therapy cited in the next section.

Definition of Attachment Therapy

There is no generally accepted definition of "Attachment Therapy," and it is not a term that is
found in generally recognized texts on treatment modalities, such as Bergin & Garfield's
Handbook of Psychotherapy and Behavior Change, nor is there any specific text that describes
this "treatment" approach. However, the advocacy group, Advocates for Children in Therapy does
offer guidance on this subject. While this group is not a professional mental health group in the
same manner that the American Psychiatric Association or American Psychological Association
or National Association of Social Workers are, and none of the leaders are licensed mental
professionals or clinicians, they do offer some ideas for a description of what this term can mean.

ACT states, "Attachment Therapy is a growing, underground movement for the 'treatment' of
children who pose disciplinary problems to their parents or caregivers." In discussing Attachment
Therapy they state, "there is a hands-on treatment involving physical restraint and discomfort.
Attachment Therapy is the imposition of boundary violations - most often coercive restraint - and
verbal abuse on a child, usually for hours at a time...Typically, the child is put in a lap hold with
the arms pinned down, or alternatively an adult lies on top of a child lying prone on the floor." [2]

ACT further defines "Attachment Therapy" as, "Attachment Therapy almost always involves
extremely confrontational, often hostile confrontation of a child by a therapist or parent
(sometimes both). Restraint of the child by more powerful adult(s) is considered an essential part
of the confrontation."[3]

The group also uses the terms "rebirthing" and "holding therapy" as terms for "Attachment
Therapy."

Treatment and prevention programs that use methods congruent with attachment theory and with
well established principles of child development (American Academy of Child and Adolescent
Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant
Mental Health, 1993 )(Lieberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic
Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier
(autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis
Jernberg (Theraplay), Daniel Schechter (Clinician Assisted Videofeedback Exposure Sessions)
(Schechter, 2003), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993 do not fit
the definition of "Attachment Therapy" described by Advocates for Children in Therapy because
they do not use coercive or prohibited methods.

47
Parenting methods association with Attachment Therapy

"Attachment Therapy" treatments, using the definition above, may be accompanied by parenting
interventions that are coercive, painful or shaming, according to the ACT. These approaches
have been criticized as inappropriate in accordance with some professional association
standards, such as the American Academy of Child and Adolescent Psychiatry and APSAC. For
example, obedience-training techniques such as "strong sitting" (frequent periods of required
silence and immobility) and withholding or limiting food (Thomas, 2001). However, since this is
not a clearly defined treatment, it is generally unclear what methods fall under this approach.

Advocates of "Attachment Therapy" claim that the treatment derives from John Bowlby's theory of
the development of emotional attachment (Bowlby, 1982). Bowlby's work stresses the infant's
experiences of social interactions in the second half of the first year as the foundation of
attachment; his theory considers attachment to be shown by an infant's ability to use an adult as
a secure base for exploration and learning, as well as by concerns about separation.

Some practitioners of "Attachment Therapy" connect their practice to belief systems such as
those of Verny (Verny & Kelly, 1981) and Emerson (1996), who claimed that memories dating
from the time of conception (or earlier) shape personality and that these memories are contained
in all cells. The ideas that attachment resulted from stimulation of cathartic expression of rage
and on the experience of the complete authority of the adult were codified by Cline (1994), Levy
(2001), and Zaslow (Zaslow & Menta,1975), whose practices involved physically-intrusive actions
intended to bring about those events. However, there is ample evidence that at birth neonates
can distinguish the voice (see infant), smell, and taste of their birth mother from that of others.
Furthermore, new-borns show clear evidence of an ability to relate socially and interact with
others in a responsive and contingent manner. (see works by pediatrician, Marshall Klaus.)

Some components of "Attachment Therapy" have been disapproved by a task force of the
American Professional Society on Abuse of Children. (Chaffin et al.,2006, PMID 16382093)
Specifically, the task force addressed coercive methods and practices as inappropriate for
treatment. In this regard the task force's recommendations mirror that of generally accepted
practices for treatment generally, and specifically for children. Some have criticized the treatment
as using coercion and physically painful methods to achieve the desired results.

The APSAC report does not describe "Attachment Therapy", it uses the term "attachment
therapy" (no caps or quotation marks). They state, “The terms attachment disorder,
attachment problems, and attachment therapy, although increasingly used, have no clear,
specific, or consensus definitions. Pg 77 Furthermore, what seems to be focus of this proposed
page only addresses a very narrow area, “Controversies have arisen about potentially
harmful attachment therapy techniques used by a subset of attachment therapists.â€ﾝ Pg 76
Attachment therapy is better discussed in context, especially if the focus is on “a particular
subset of attachment therapy techniques developed by a subset of attachment therapy
practitionersâ€ﾝ pg 77. The controversy is a narrow one and should be placed in context so that
readers understand the full range of issues. “ The attachment therapy controversy has
centered most broadly on the use of what is known as “holding therapyâ€ﾝ (Welch, 1988) and

48
coercive, restraining, or aversive procedures such as deep tissue massage, aversive tickling,
punishments related to food and water intake, enforced eye contact, requiring children to submit
totally to adult control over all their needs, barring children’s access to normal social
relationships outside the primary parent or caretaker, encouraging children to regress to infant
status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional
dischargeâ€ﾝ pg 83.

Prevalence

There are no reliable statistics on how many professionals actually practice "Attachment Therapy"
or "rebirthing as it is also known. However, as defined in this article, "Attachment Therapy"
involves the use of practices prohibited by a large number of professional organizations such as
the following: American Psychological Association[[4]], National Association of Social
Workers[[5]], American Professional society on the Abuse of Children (APSAC) [[6]], Association
for the Treatment and Training in the Attachment of Children, American Academy of Child and
Adolescent Psychiatrry ("Practice Parameter for the Assessment of Children and Adolescent with
Reactive Attachment Disorder of Infancy and Early Childhood" in the Journal of the American
Academy of Child and Adolescent Psychiatry, vol 44, Nov 2005 and at [[7]]) , and the American
Psychiatric Association. [[8]]. Members of those organizations are prohibited from using methods
and techniques proscribed by those organizations codes of ethics and practice parameters.
Violations of those standards would result in expulsion of the organization. Therefore there are
very few practitioners of "AT" as defined in this article. Furthermore, several states have outlawed
"rebirthing," and anyone using such methods would be guilty of malpractice, which is a small
problem in all professions.

See also
• Attachment disorder • reactive attachment disorder
• Attachment theory • Stanley Greenspan
• Bowlby • Theraplay
• Child Development • rebirthing
• Candace Newmaker • Advocates for Children in Therapy
• Stephen Barrett
• Dyadic Developmental Psychotherapy
• Quackwatch
References

Becker-Weidman, A., & Shell, D., (2005) Creating Capacity for Attachment. Oklahoma City, OK:
Wood 'N' Barnes.

Berliner, L. (2002).Why caregivers turn to "attachment therapy" and what we can do that is better.
APSAC Advisor, 14(4), 8-10.

Bowlby, J. (1982). Attachment. New York: Basic.

49
Chaffin M, Hanson R, Saunders BE, Nichols T, Barnett D, Zeanah C, Berliner L, Egeland B,
Newman E, Lyon T, LeTourneau E, Miller-Perrin C. Report of the APSAC task force on
attachment therapy, reactive attachment disorder, and attachment problems. Child Maltreat. 2006
Feb;11(1):76-89. PMID 16382093

Cline, F. (1994). Hope for high risk and rage-filled children. Evergreen, CO: EC Publications.

Hughes, D., (2003). Psychotherapeutic interventions for the spectrum of attachment disorders
and intrafamilial trauma. Attachment and Human Development 5-3, 271-279.

Hughes, D. (2004). An attachment-based treatment of maltreated children and young people.

Attachment & Human Development, 3, 263–278.

Krenner, M. (1999). Ein Erklaerungsmodell zur "Festhaltetherapie" nach Jirina Prekop. Retrieved
Oct. 25, 2000, from http://wwwalt.uni-wuerzburg.de/gbpaed/mixed/work/mkrenner1.html.

Levy, T.M., Ed. (2000). Handbook of attachment interventions. San diego: Academic.

Lieberman, A., (2003). The treatment of attachment disorder in infancy and early childhood.
Attachment and Human Development 5-3, 279-283.

Marvin, R., & Whelan, W., (2003) Disordered attachment: toward evidence-based clinical
practice. Attachment and Human Development 5-3, 284-299.

O'Connor, C., & Zeanah, C., Attachment disorder: assessment strategies and treatment
approaches, Attachment and Human Development 5, 223-244.

Schechter, D.S. (2003). Intergenerational communication of maternal violent trauma:

Understanding the interplay of reflective functioning and posttraumatic psychopathology. In S.W.
Coates, J.L. Rosenthal, & D.S. Schechter (Eds.), September 11: Trauma and Human Bonds.
New York, NY: The Analytic Press, pp. 115-143.

Thomas, N. (2001). Parenting children with attachment disorders. In T.M. Levy (Ed.), Handbook
of attachment interventions. San Diego, CA: Academic.

Verny, T., & Kelly, J. (1981). The secret life of the unborn child. New York: Dell.

Welch, M.G. (1989) Holding time. New York:Fireside.

Welch, M.G., Northrup, R.S., Welch-Horan, T.B., Ludwig, R.J., Austin, C.L., & Jacobson, J.S.
(2006). Outcomes of prolonged parent-child embrace therapy among 102 children with
behavioral disorders. Complementary Therapies in Clinical Practice, 12, 3-12.

Zaslow, R., & Menta, M. (1975) The psychology of the Z-process: Attachment and activity. San
Jose, CA: San Jose University Press.

50
Zeanah, C., (1993) Infant Mental Health. NY: Guilford.

PLAY THERAPY

Play therapy is a technique whereby the child's natural means of expression, namely play, is
used as a therapeutic method to assist him/her in coping with emotional stress or trauma. It has
been used effectively with children who have an understanding level of a normal three to eight
year old, who are; distraught due to family problems (e.g., parental divorce, sibling rivalry), nail
biters, bed wetters, aggressive or cruel, social underdeveloped, or victims of child abuse. It has
also been used with special education students whose disability is a source of anxiety or
emotional turmoil.

Practitioners of play therapy believe that this method allows the child to manipulate the world
on a smaller scale, something that cannot be done in the child's everyday environment. By
playing with specially selected materials, and with the guidance of a person who reacts in a
designated manner, the child plays out his/her feelings, bringing these hidden emotions to the
surface where s/he can face them and cope with them. In it's most psychotherapeutic form, the
teacher is unconditionally accepting of anything the child might say or do. The teacher never
expresses shock, argues, teases, moralizes, or tells the child that his/her perceptions are
incorrect. An atmosphere should be developed in which the child knows that s/he can express
herself/himself in a non punitive environment. Yet, even though the atmosphere is permissive,
certain limits may have to be imposed such as restrictions on destroying materials, attacking the
teacher, or going beyond a set time limit.

Many psychologists, counselors and other professionals may view this technique as being
within their jurisdiction only. They may be correct when referring to long term, in-depth
counseling. However, although this technique is usually practiced by school counselors, social
workers and psychologists, it can easily be modified for use by the teacher in the classroom for
less intensive problems. If you plan to conduct pre-planned sessions, it is best to obtain the
permission of administrators and parents.

How To Use Play Therapy

1. Select a student who might benefit from play therapy.
2. Decide if you will have a separate session with this child or whether you will sit near the
student during your class play period or recess.
3. Obtain materials for the session. Recommended items include:
-manipulatives (e.g., clay, crayons, painting supplies)
-water and sand play containers
- toy kitchen appliances, utensils, and pans

51
 - baby items (e.g., bottles, bibs, rattles, etc.)
- dolls and figures of various sizes and ages
- toy guns, rubber knives
- toy cars, boats, soldiers, and animals
- blocks, erector sets
- stuffed animals

4. Place the materials in specific places where they can be located for each session.

5. Meet the student and introduce him/her to the play area.

6. Inform the student of limitations and how long the session will last (usually 30-60 minutes).

7. Allow the student to choose materials. Do not suggest materials or activities. If the student
wishes to leave before the session ends, that is allowed. However, the student is not allowed to
return that day. He is informed of the time of the next scheduled session.

8. Use the "reflection" technique (see the filed named "Non-Directive Counseling) to respond to
the student's comments. If the student is non-verbal, your role will change. You will be
describing what the student is doing.

9. As the end of the session nears, inform the student of that fact, stating the number of minutes
left.

10. Upon reaching the time limit, inform the student in a manner similar to the following: "Our
time is up for today. We'll have to stop now and put the toys back where we found them." The
student is not allowed to continue playing.

11. Inform the student as to when the next session will be held.

Activities and Discussion Questions

1. Read the file on the home page of "BehaviorAdvisor.com" titled "Non-Directive Counseling
Techniques" for pertinent additional information.

52
2. Write some utterances that kids might say about problem areas in their lives. Verbalize a
"reflection" for each of the comments. You can restate the comment exactly, restate part of the
comment, or reflect the content of the comment.

Other Resources

Axline, V. (1969). Play therapy.

Axline, V. (1969). Dibs: In search of self.

Heidi Kaduson & Charles Schaefer (2000). Short-term play therapy for children.
Order at www.guilford.com

Nemiroff & Annunziata (199-). A child's first book about play therapy. Washington, DC:
Magination Press Order at: www.maginationpress.com

P.R. White (2000). Clay therapy: A manual of therapeutic application of clay with children. To
investigate or order: Order at: www.playtherapyclay.com/Books.html

To purchase items, toys, etc. for conducting play therapy sessions, go to

www.annastoydepot.com or www.childtherapytoys.com

Fetch Dr. Mac's Home Page

Author: Tom McIntyre at www.BehaviorAdvisor.com
6/15/05

Reactive attachment disorder

Reactive Attachment Disorder

Classification & external resources
ICD-10 F94.1/2

53
 ICD-9 313.89

Reactive Attachment Disorder (sometimes called "RAD") (DSM-IV 313.89) is a

psychophysiologic condition (1) with markedly disturbed and developmentally inappropriate social
relatedness in most contexts that begins before five years of age and is associated with grossly
pathological care. This pathological caregiving behaviour may consist of any form of neglect,
abuse, mistreatment or abandonment.

In mental retardation, attachments to caregivers are consistent with the level of development. In
pervasive developmental disorders, attachments to caregivers either fail to develop or are highly
deviant, but this usually occurs in a context of reasonably supportive care. Due to maltreatment
by caregivers, RAD sufferers have difficulty forming healthy relationships with their caregivers,
peers and families. RAD can reportedly be diagnosed as early as the first month of life.

A study by the National Adoption Center found that 52% of adoptable children (meaning those
children in U.S. foster care freed for adoption) had symptoms of RAD. Other estimates range
from 10 to 80%. [1][2]

A crucial defining characteristic of Reactive Attachment Disorder--explicit in DSM and ICD--is that
there be pathogenic caregiving. This can be very difficult to prove, but it makes lasting effects on
the children concerned.

Contents

• 1 Classification
• 2 Framework
• 3 Diagnosis
• 4 Intervention
o 4.1 Dyadic Developmental Psychotherapy
• 5 References
• 6 See also

• 7 External links
Classification

The DSM-IV specifically includes two forms of clinical presentation:

• "Inhibited" (Criterion A1), and

• "disinhibited" (Criterion A2)

These are roughly equivalent to the ICD-10, in which 94.1 represents the "inhibited" form of the
disorder, and 94.2 represents the "disinhibited" form.

54
When either classification system is used, the inhibited form tends to have more withdrawal
behaviours towards a caregiver, (4) and the disinhibited more externalising behaviours. (5)

Many popular, informal classification systems, outside the DSM and ICD, have been created out
of clinical and parental experience. Some critics have charged these informal classification
systems are inaccurate, too broadly defined or applied by unqualified persons.

One popular classification system is the Randolph Attachment Disorder Questionnaire. (6) The
checklist includes 93 discrete behaviours, many of which overlap with other disorders, like
Conduct Disorder and Oppositional Defiant Disorder.

Children who are adopted after the age of six months are at risk for attachment problems.[3]
Normal attachment develops during the child's first two to three years of life. Problems with the
mother-child relationship during that time, orphanage experience, or breaks in the consistent
caregiver-child relationship interfere with the normal development of a healthy and secure
attachment. There are wide ranges of attachment difficulties that result in varying degrees of
emotional disturbance in the child. One thing is certain; if an infant's needs are not met
consistently, in a loving, nurturing way, attachment will not occur normally and this underlying
problem will manifest itself in a variety of symptoms Bowlby.

When the first-year-of-life attachment-cycle is undermined (Basic Trust vs. Mistrust, in Erik
Erikson's framework) and the child’s needs are not met, and normal socializing shame is not
resolved, mistrust begins to define the perspective of the child and attachment problems result. [4]
[5]
In direct consequence, the child may develop mistrust, impeding effective attachment behavior.
The developmental stages following these first three years continue to be distorted and/or
retarded, and common symptoms emerge. [6]

Framework

The theoretical framework for Reactive Attachment Disorder is Attachment theory based on work
by Bowlby, Ainsworth and Spitz, from the 1940s to the 1980s.

The development of diagnostic criteria was further operationalised by Zeanah and O’Connor
throughout the 1980s and 1990s9, and through greater awareness garnered from the adoption of
institutionalised children from Romania, Russia and China, and also foster care in America and
other nations.

Psychiatrist Michael Rutter has done an outcome study, the largest of its kind, called the
Romanian Adoption Project. Victor Groza has done another outcome study, and as of 2004 there
are many in process. (10)

A defining characteristic of Reactive Attachment Disorder is early chronic maltreatment.

Maltreatment means child abuse, physical abuse, neglect, sexual abuse, and is closely
associated with Complex post-traumatic stress disorder. Another defining trait of Reactive
Attachment Disorder is Emotional dysregulation.

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Diagnosis

In mainstream medical practice, Reactive Attachment Disorder is most often diagnosed by social
workers or psychologists. Psychiatrists may be called in when there is medication involved.

There are various "attachment styles" that are not pathological, and attachment issues that may
be found anywhere within the continuum. "Reactive Attachment Disorder" has been traditionally
used to describe a "severe disturbance in the attachment between caregiver and child that is of
long standing and applicable/observable in all contexts in which the child interacts."

Some of the attachment styles are named: "avoidant", "aggressive", "ambivalent" and
"disorganised/mixed". There is often a blending of several attachment styles in an individual.

Reactive Attachment Disorder affects the "basic working model" of the self. This working model is
shaped by the child's attachment to mother and father. [7] Many parents of RAD children report
that they do not understand what their child is thinking or feeling. This may be due to inconsistent
signals from the child, or to the inability of parents to interpret signals (due, for example, to the
parents own experience with childhood abuse), or both. As with all disorders, the focus of the
diagnosis of RAD is on the cause of the observed attachment style, not on specific symptoms or
surface behaviors.

Intervention

Evidence based approaches do exist for the effective treatment of Reactive Attachment Disorder.
Two important studies found that "usual treatments" for RAD are ineffective, while the intervention
under investigation, Dyadic Developmental Psychotherapy (10) (11), was effective [8]. (see
"Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental
Psychotherapy", Child and Adolescent Social Work Journal. 23(2), April 2006). There is a
significant body of literature on the assessment and treatment of Post Traumatic Stress Disorder
and Complex Post Traumatic Stress Disorder which apply to the treatment of this condition.

Dyadic Developmental Psychotherapy

Dyadic Developmental Psychotherapy[9] [10] is an effective and evidence-based treatment

developed by Daniel Hughes, Ph.D., (Hughes, 2005, Hughes, 2004, Hughes, 2003; Hughes,
1997)(13-15). Its basic principals are described by Hughes (2003) and summarized as follows:

1. A focus on both the caregivers and therapists own attachment strategies. Previous research
(Dozier, 2001,(16) Tyrell 1999 (17)) has shown the importance of the caregivers and therapists
state of mind for the success of interventions.

2. Therapist and caregiver are attuned to the child’s subjective experience and reflect this
back to the child. In the process of maintaining an intersubjective attuned connection with the

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child, the therapist and caregiver help the child regulate affect and construct a coherent
autobiographical narrative.

3. Sharing of subjective experiences.

4. Use of PACE and PLACE are essential to healing.

5. Directly address the inevitable misattunements and conflicts that arise in interpersonal
relationships.

6. Caregivers use attachment-facilitating interventions.

7. Use of a variety of interventions, including cognitive-behavioral strategies.

PACE refers to the therapist setting a healing pace by being playful, accepting, curious, and
empathic. PLACE refers to the parent creating a healing environment by being playful, loving
accepting, curious, and empathic. These ideas are described more fully below.

Dyadic Developmental Psychotherapy interventions flow from several theoretical and empirical
lines (Becker-Weidman & Shell, 2005). Attachment theory (Bowlby, 1980, Bowlby, 1988) provides
the theoretical foundation for Dyadic Developmental Psychotherapy.

This treatment has been found to produce meaurable and sustained improvement in children
diagnosed with Reactive Attachment Disorder (Becker-Weidman, 2005)(12). In that study it was
found that other forms of treatment, such as individual therapy or play therapy did not produce
any improvement; thus indicating that Dyadic Developmental Psychotherapy is effective while
other forms of treatment are not effective for this disorder.

Measuring Attachment in Adults

The two main ways of measuring attachment in adults include the Adult Attachment Interview
(AAI) and self-report questionnaires. The AAI and the self-report questionnaires were created
with somewhat different aims in mind. Shaver and Fraley note:

"If you are a novice in this research area, what is most important for you to know is that self-report
measures of romantic attachment and the AAI were initially developed completely independently
and for quite different purposes. One asks about a person's feelings and behaviors in the context
of romantic or other close relationships; the other is used to make inferences about the defenses
associated with an adult's current state of mind regarding childhood relationships with parents. In
principle, these might have been substantially associated, but in fact they seem to be only
moderately related--at least as currently assessed. One kind of measure receives its construct
validity mostly from studies of romantic relationships, the other from prediction of a person's
child's behavior in Ainsworth's Strange Situation. Correlations of the two kinds of measures with
other variables are likely to differ, although a few studies have found the AAI to be related to

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marital relationship quality and a few have found self-report romantic attachment measures to be
related to parenting." (Shaver & Fraley, 2004) [2]

The AAI and the self-report questionnaires offer distinct, but equally valid, perspectives on adult
attachment. It's therefore worthwhile to become familiar with both approaches.

Adult Attachment Interview (AAI)

Developed by Mary Main and her colleagues, this is a semi-structured interview that takes about
one hour to administer. It involves about twenty questions and has extensive research validation
to support it. A good description can be found in Chapter 19 of Attachment Theory, Research and
Clinical Applications, edited by Shaver & Cassidy, Guilford Press, NY, 1999.

Self-report questionnaires

Hazen and Shaver created the first questionnaire to measure attachment in adults. [3] Their
questionnaire was designed to classify adults into the three attachment styles identified by
Ainsworth. The questionnaire consisted of three sets of statements, each set of statements
describing an attachment style:

• Secure - I find it relatively easy to get close to others and am comfortable depending on
them and having them depend on me. I don't often worry about being abandoned or
about someone getting too close to me.
• Avoidant - I am somewhat uncomfortable being close to others; I find it difficult to trust
them completely, difficult to allow myself to depend on them. I am nervous when anyone
gets too close, and often, love partners want me to be more intimate that I feel
comfortable being.
• Anxious/Ambivaent - I find that others are reluctant to get as close as I would like. I often
worry that my partner doesn't really love me or won't want to stay with me. I want to
merge completely with another person, and this desire sometimes scares people away.

People participating in their study were asked to choose which set of statements best described
their feelings. The chosen set of statements indicated their attachment style. Later versions of this
questionnaire presented scales so people could rate how well each set of statements described
their feelings.

One important advance in the development of attachment questionnaires was the addition of a
fourth style of attachment. Bartholomew and Horowitz presented a model that identified four
categories or styles of adult attachment. [4] Their model was based on the idea attachment styles
reflected people's thoughts about their partners and thought about themselves. Specifically,
attachment styles depended on whether or not people judge their partners to be generally
accessible and responsive to requests for support, and whether or not people judge themselves
to be the kind of individuals towards which others want to respond and lend help. They proposed
four categories based on positive or negative thoughts about partners and on positive or negative
thoughts about self.

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Bartholomew and Horowitz used this model to create the Relationship Questionnaire (RC). The
RC consisted of four sets of statements, each describing a category or style of attachment:

• Secure - It is relatively easy for me to become emotionally close to others. I am

comfortable depending on others and having others depend on me. I don't worry about
being alone or having others not accept me.
• Dismissive - I am comfortable without close emotional relationships. It is very important to
me to feel independent and self-sufficient, and I prefer not to depend on others or have
others depend on me.
• Preoccupied - I want to be completely emotionally intimate with others, but I often find
that others are reluctant to get as close as I would like. I am uncomfortable being without
close relationships, but I sometimes worry that others don't value me as much as I value
them.
• Fearful - I am somewhat uncomfortable getting close to others. I want emotionally close
relationships, but I find it difficult to trust others completely, or to depend on them. I
sometimes worry that I will be hurt if I allow myself to become too close to others.

Tests demonstrated the four attachment styles were distinct in how they related to other kinds of
psychological variables. Adults indeed appeared to have four styles of attachment instead of
three attachment styles.

David Schmitt, together with a large number of colleagues, validated the attachment
questionnaire created by Bartholomew and Horowitz in 62 cultures. [5] The distinction of thoughts
about self and thoughts about partners proved valid in nearly all cultures. However, the way these
two kinds of thoughts interacted to form attachment styles varied somewhat across cultures. The
four attachment styles had somewhat different meanings across cultures.

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A second important advance in attachment questionnaires was the use of independent items to
assess attachment. Instead of asking people to choose between three or four sets of statements,
people rated how strongly they agreed with dozens of individual statements. The ratings for the
individual statements were combined to provide an attachment score. Investigators have created
several questionnaires using this strategy to measure adult attachment.

Two popular questionnaires of this type are the Experiences in Close Relationships (ECR)
questionnaire and the Experiences in Close Relationships - Revised (ECR-R) questionnaire. The
ECR was created by Brennan, Clark, and Shaver in 1998. [6] The ECR-R was created by Fraley,
Waller, and Brennan in 2000. [7] Readers who wish to take the ECR-R and learn their attachment
style can find an online version of the questionnaire at http://www.web-research-design.net/cgi-
bin/crq/crq.pl.

Analysis of the ECR and ECR-R reveal that the questionnaire items can be grouped into two
dimensions of attachment. One group of questionnaire items deal with how anxious a person is
about their relationship. These items serve as a scale for anxiety. The remaining items deal with
how avoidant a person is in their relationship. These items serve as a scale for avoidance. Many
researchers now use scores from the anxiety and avoidance scales to perform statistical
analyses and test hypotheses.

Scores on the anxiety and avoidance scales can still be used to classify people into the four adult
attachment styles. [8] [6] [9] The four styles of attachment defined in Bartholomew and Horowitz's
model were based on thoughts about self and thoughts about partners. The anxiety scale in the
ECR and ECR-R reflect thoughts about self. Attachment anxiety relates to beliefs about self-
worth and whether or not one will be accepted or rejected by others. The avoidance scale in the
ECR and ECR-R relates to thoughts about partners. Attachment avoidance relates to beliefs
about taking risks in approaching or avoding other people. Combinations of anxiety and
avoidance can thus be used to define the four attachment styles. The secure style of attachment
is characterized by low anxiety and low avoidance; the preoccupied style of attachment is
characterized by high anxiety and low avoidance; the dismissive avoidant style of attachment is
characterized by low anxiety and high avoidance; and the fearful avoidant style of attachment is
characterized by high anxiety and high avoidance.

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