Dialogue on adult attachment: diversity and integration

Six attachment discourses: convergence, divergence and relay

Attachment concepts are used in diverging ways, which has caused confusion in communication among researchers, among practitioners, and between researchers and practitioners, and hinders their potential for collaboration. In this essay we explore how attachment concepts may vary in meaning across six different domains: popular discourses, developmental science, social psychological science, psychiatric diagnosis, psychotherapy, and child welfare practice. We attempt to typify these forms of attachment discourse by highlighting points of convergence, divergence, and relay between the different domains. Our general conclusions are that diversity in the use of attachment concepts across different domains of application has been largely unrecognised, and that recognition of these differences would reduce confusion, help identify sites where infrastructure needs to be developed to support coordination, and strengthen opportunities for collaboration to mutual benefit. We suggest that academic attachment discourse would benefit from clarification of core terminology, including: "attachment", "internal working model", "trauma", and "dysregulation".

The Lived Experiences of Non-Offending Fathers with Children Who Survived Sexual Abuse

A non-offending father figure plays an integral role in the healing process of a child who survived sexual abuse. However, becoming aware of the sexual abuse can significantly affect non-offending father figures and therefore impact their ability to properly support and care for the survivor. We sought to better understand the non-offending father figures' reactions to the aftermath of sexual abuse of their children. Using an existential-phenomenological approach, we offered a platform for non-offending father figures to share their stories. Through the interviews, we found five major themes, which include: "Guilt, anguish, and stigma", "Hypervigilance and competing demands of fathering", "Who can we trust?", "Refocusing on the family", and "Picking up the pieces". Based on this and previous studies, non-offending father figures experience psychological pain in the aftermath of the disclosure of sexual abuse, they deal with competing demands of various fatherly roles, and they prioritize supporting the family through the healing process. The findings suggest that the psychological well-being of the non-offending father figures can benefit the family. Therefore, mental health treatment protocols addressing father figures' needs can contribute to a sexual abuse treatment model that encourages paternal involvement in the care of children with a sexual abuse history.

The role of maternal attachment in mental health and dyadic relationships in war trauma

BACKGROUND

Infant care is a demanding task in dangerous war conditions, but research on the wellbeing of mother-infant dyads is mainly available in peaceful conditions. Knowledge on protective versus risking processes is especially vital for tailoring effective help, and the present study proposes the maternal attachment style to play an important role in dangerous war conditions.

OBJECTIVE

The study analyses, first, how various traumatic war events, such as losses, horrors and life-threat, are associated with maternal mental health and dyadic mother-infant interaction quality, indicated by maternal emotional availability (EA). Second, it tests a hypothesis that maternal insecure attachment risks and secure attachment protects good mental health and optimal EA from negative impacts of traumatic war events.

METHOD

The prospective three-wave study involved 502 Palestinian mothers, who were pregnant during the 2014 War on Gaza, and participated at delivery (T1), and when the infant was seven (T2; N = 392) and eighteen (T3; N = 386) months. Mothers reported about war events at T1 and T2 (death and losses, witnessing horrors and life-threat), and posttraumatic stress disorder (PTSD) and depression symptoms at T2 and T3. Dyadic interaction quality was assessed by mother-perceived emotional availability (EA) scale at T2 and T3, and attachment styles by mothers' self-reports at T3.

RESULTS

Death and losses, witnessing horrors, and life-threat were all associated with a high level of maternal PTSD, but only at T2, whereas death and losses were associated with her depressive symptoms both at T2 and T3. Witnessing horrors was associated with a low close and positive and a high distant and negative emotional availability at T2 and T3. As hypothesized, maternal avoidant attachment was associated with a low level of close and positive EA in general, and especially when the dyads were exposed to a high level of traumatic war events, thus indicating a risking function. Against the hypothesis, secure attachment did not show any protective function on emotional availability, while, unexpectedly, maternal preoccupied attachment was associated with close and positive emotional availability, when dyads were exposed to a high level of traumatic war events.

CONCLUSION

Mothering in conditions of war and military violence is an overwhelmingly demanding task, and mother-infant dyads need legal, social, and psychological assistance. Knowledge and reflection of unique responses and meanings of different attachment styles would be fruitful in tailoring effective help.

Fearful-Avoidant Attachment: A Specific Impact on Sexuality?

In this study, we investigated sexual outcomes in individuals presenting fearful-avoidant attachment, that is, those who have both high avoidant and anxious attachment tendencies (reluctant to engage in a close relationship and a dire need to be loved by others). A community sample of men and women (N = 600; 25-45 years) completed self-reported questionnaires related to attachment, sexuality, and control variables. Results showed that fearful avoidance is predictive of (a) more sexual partners in individuals during their lifetime and (b) greater sexual compliance. These effects were true for women as well as for men.

Measuring attachment and parental bonding in psychosis and its clinical implications

BACKGROUND

Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Early relationships with parents or caregivers lay the foundations for attachment styles. These styles are proposed to influence how we relate to others during our life can be modified by the relationships and events we experience in our lifespan. A secure attachment style is associated with a capacity to manage distress, comfort with autonomy and the ability to form relationships with others, whereas insecure attachment can lead to dysfunctional relationships, emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people with psychosis. This paper aims to complement recent systematic reviews by providing an overview of attachment theory, its application to psychosis, including an understanding of measurement issues and the clinical implications offered.

METHOD

A narrative review was completed of the measures of attachment and parental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illness course, social functioning and symptomatology. The following questions are addressed: What are the key attachment measures that have been used within the attachment and psychosis literature? What are the results of studies that have measured attachment or parental bonding in psychosis and what clinical implications can we derive from it? What are some of the key questions for future research from these findings in relation to the onset of psychosis research field?

RESULTS

The most commonly used measures of attachment in psychosis research are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recent years comprise a measure specifically developed for a psychosis group. The review suggests that insecure attachment styles are common in psychosis samples. Key relationships were observed between insecure, avoidant and anxious attachment styles and psychosis development, expression and long-term outcome.

CONCLUSIONS

Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greater attention should be given to the assessment of attachment needs and to the development of interventions that seek to compensate for these difficulties. However, further investigations are required on specifying the exact mechanisms by which specific attachment styles impact on the development of psychosis and its course.

Attachment to work, job satisfaction and work centrality

Purpose

– The purpose of this paper is to investigate the associations between attachment styles, work centrality and job satisfaction with turnover intentions.

Design/methodology/approach

– A self-report questionnaire that included psychometrically sound measures of the key constructs was completed by a sample of 125 employees. A structural equation model was conducted to test the proposed relations and mediating hypotheses.

Findings

– Attachment styles were found to be linked directly to turnover intentions, and not mediated by job satisfaction and work centrality, as predicted. Avoidant and anxious employees showed higher levels of turnover intentions. A positive relationship was found between work centrality and job satisfaction; job satisfaction was negatively related with turnover intentions.

Research limitations/implications

– Although the study involved cross-sectional self-report data, it shed light on the associations between attachment theory and the costly organizational phenomena of voluntary turnover.

Practical implications

– Managers should pay particular attention to employees characterized by an insecure attachment style. Efforts should be made to improve work centrality and job satisfaction among employees.

Originality/value

– The study adds attachment styles as an additional tool available to managers in their efforts to manage turnover.

Partners' empathy increases pain ratings: effects of perceived empathy and attachment style on pain report and display

Pain can be influenced by its social context. We aimed to examine under controlled experimental conditions how empathy from a partner and personal attachment style affect pain report, tolerance, and facial expressions of pain. Fifty-four participants, divided into secure, anxious, and avoidant attachment style groups, underwent a cold pressor task with their partners present. We manipulated how much empathy the participants perceived that their partners had for them. We observed a significant main effect of perceived empathy on pain report, with greater pain reported in the high perceived empathy condition. No such effects were found for pain tolerance or facial display. We also found a significant interaction of empathy with attachment style group, with the avoidant group reporting and displaying less pain than the secure and the anxious groups in the high perceived empathy condition. No such findings were observed in the low empathy condition. These results suggest that empathy from one's partner may influence pain report beyond behavioral reactions. In addition, the amount of pain report and expression that people show in high empathy conditions depends on their attachment style.

Perspective

Believing that one's partner feels high empathy for one's pain may lead individuals to rate the intensity of pain as higher. Individual differences in attachment style moderate this empathy effect.

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The role of empathy and attachment style on pain was studied experimentally.

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Empathy from one's partner may influence pain report and behavioral reactions.

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Perceived high empathy from a partner may lead to higher pain ratings.

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Individual differences in attachment style moderate this empathy effect.

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Individual differences in attachment style also moderate facial display of pain.

Romantic attachment in Chilean adults: development of a short-form version of the experiences in close relationships

Though the study of romantic attachment has expanded into all areas of psychology, it remains the case that there is no valid, reliable test available to measure it in Latin America. The present research objective was to adapt a Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark, & Shaver 1998) questionnaire, developing a short-form version, and to determine its factor structure in two samples of Chilean adults of different ages. A pool of 25 items was chosen to capture the two dimensions (Anxiety and Avoidance), which were obtained through principal components analysis in a sample of 477 adults. Subsequently, the short-form ECR's two-dimensional structure was confirmed using confirmatory factor analysis in a new sample (N = 296). All sub-dimensions' internal consistencies were found to be satisfactory. Evidence for the test's concurrent validity with the variables age, gender, and socioeconomic status was also obtained. The dimensions of romantic attachment showed no differences according to age or gender. However, participants of high socioeconomic status exhibited lower levels of anxious attachment than those with low socioeconomic status. It was concluded that the Chilean short-form version of the ECR has good psychometric properties and is a suitable assessment of adult attachment.

Attachment-related individual differences in the consistency of relationship behavior interpretation

The consistency with which people interpret relationship-based information has important implications for attachment theory and research. Our objective is to determine whether there are attachment-related individual differences in the manner and the consistency with which individuals interpret hypothetical relationship behaviors. In two studies (N = 629, 79% female, 63% American, M(age)  = 29; N = 820, 78% female, 65% American, M(age)  = 29), we assessed participants' ability and consistency in relationship behavior interpretation across two blocks and estimated how they would have performed had they interpreted information perfectly consistently. Secure participants were generally more consistent in their interpretations relative to insecure participants. Estimates of perfectly consistent interpretation revealed that improvements to both systematic factors related to behavior interpretation (e.g., working models) and consistency would have led to a more secure interpretation style for participants of all attachment styles. Results imply that both secure and insecure individuals process relationship-based information according to secure scripts, but insecure individuals do so inconsistently. Our results imply that, due to the inconsistent behavioral responses that may occur as a result of inconsistent information processing, the consistency with which people process relationship-related information will be related to relationship satisfaction. Further directions for future research are discussed.

The implementation of mentalization-based treatment for adolescents: a case study from an organizational, team and therapist perspective

BACKGROUND

Reports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature. This is remarkable given the inherent difficulties of such enterprises and the associated safety risks for patients involved.

CASE DESCRIPTION

A case study of the problematic implementation process of Mentalization- Based Treatment for Adolescents (MBT-A), a new therapy for 14 to 18 year old youngsters with severe personality disorders, is presented. The implementation process is described and analyzed at an organizational, team and therapist level.

DISCUSSION AND EVALUATION

Our analysis shows that problems at all three levels contributed and interacted to make the implementation cumbersome and hazardous.

CONCLUSION

The implementation of complex psychotherapeutic programs for difficult patients could benefit from a structured attention to processes at multiple levels. We therefore propose a new comprehensive heuristic model of treatment integrity. This new model includes organisational, team and therapist adherence to the treatment model as necessary components of treatment integrity in the implementation of complex interventions. The application of this new model of treatment integrity potentially increases the chance of successful implementations and reduces safety risks for first patients enrolling in a new program.

Attachment insecurity and psychological resources associated with adjustment disorders

This study examined the adult attachment styles, interpersonal distance from potential attachment figures and strangers, coping strategies, perceived social support, and stress-related self-variables among patients diagnosed with adjustment disorders (AJD). Seventy patients at an outpatient clinic and 61 matched controls completed a battery of standardized questionnaires. Univariate and multivariate statistical analyses were used to evaluate the parameters of interest. Using attachment theory (J. Bowlby, 1988) and the dynamic stress-vulnerability model of depressive disorder (G. W. Brown & T. O. Harris, 1989) as the analytical frameworks, the authors hypothesized that participants with AJD would: (a) display more insecure attachment styles, (b) be less tolerant of close interpersonal proximity, (c) use more emotion-oriented coping strategies, (d) display lower self-efficacy and self-esteem, and (e) perceive less social support from family, friends, and significant others. We further hypothesized that these variables would be predictive of depressive symptoms. All of the hypotheses were confirmed. The results suggest that the insecure fearful-avoidant attachment style is associated with severe depressive symptoms in patients with AJD. However, other psychosocial factors, such as low self-esteem and poor social support from friends, were more predictive of AJD symptoms. The findings warrant further studies on the risk and protective effects of these factors in the development of AJD and other stress-induced disorders.

Attachment in adolescence: A move to the level of emotion regulation

The early adolescent's state of mind in the Adult Attachment Interview (AAI) is more closely linked to social interactions with peers, who are unlikely to serve as attachment figures, than it is to (i) qualities of the adolescent's interactions with parents, (ii) the AAI of the adolescent's mother, or (iii) the adolescent's prior Strange Situation behavior. This unexpected finding suggests the value of reconceptualizing AAI autonomy/security as a marker of the adolescent's capacity for emotion regulation in social interactions. Supporting this, we note that the AAI was originally validated not as a marker of attachment experiences or expectations with one's caregivers, but as a predictor of caregiving capacity sufficient to produce secure offspring. As such, the AAI may be fruitfully viewed as primarily assessing social emotion regulation capacities that support both strong caregiving skills and strong skills relating with peers.

Adult Attachment

Attachment security in adulthood is not profitably conceptualized as a single, monolithic construct. It is reflected both in adults' confidence in themselves and others in close relationships (as noted by social-personality psychologists) and in their ability to successfully construct a coherent life narrative about childhood experiences with primary attachment figures (as emphasized by developmental psychologists). Evidence suggests that measures tapping these forms of attachment-related variation represent the underlying structure of adult attachment similarly, in that both may be best captured by two continuously distributed, albeit correlated dimensions tapping anxiety and avoidance. Nonetheless, differing approaches to measuring adult security demonstrate weak empirical overlap, and emerging evidence suggests that each is associated with personal and interpersonal outcomes central to attachment theory in empirically distinct ways. Discussion focuses on how recent insights—in combination with needed experimental and longitudinal data—can help reconcile the developmental- and social-psychological literatures on adult attachment.

Reliability and Validity of the Greek Version of the Revised Experiences in Close Relationships Measure of Adult Attachment

The present article examined the psychometric properties (factor structure, internal and test-retest reliability, convergent and criterion validity) of the Greek version of the Revised Experiences in Close Relationships (G-ECR-R) self-report inventory. Exploratory and confirmatory factor analyses demonstrated that the G-ECR-R is characterized by a clear two-factor structure consistent with adult attachment research and theory developed mainly in English-speaking countries. The results showed that the scale has adequate classical psychometric properties in terms of internal consistency and test-retest reliability. The G-ECR-R anxiety and avoidance dimensions showed convergent validity with the widely used Relationship Questionnaire ( Bartholomew & Horowitz, 1991 ) as well as with theoretically relevant variables such as self-esteem and trait anxiety. The results also demonstrated criterion validity on measures of relationship satisfaction. The importance of using culturally validated dimensional measures of romantic attachment is discussed.

Organization and predictive power of general and relationship-specific attachment models: one for all, and all for one?

Given recent evidence for multiple attachment models, we examined the organization and predictive power of general and relationship-specific attachment representations in two samples using two distinct measures of attachment models. With regard to associations among relationship-specific models, peer models (romantic partner and friend) and parental models (mother and father) were more similar to each other than to any other models, and anxiety/self-model representations were more consistent across relationships than avoidance/other-model representations. With regard to links between general and specific models, romantic and friend models made the strongest and independent contributions to general models, and romantic relationship involvement moderated the importance of romantic models to general models. With regard to differential predictive power of multiple models, general, romantic partner, and mother attachment made unique contributions to well-being indicators; relationship outcomes, however, were only predicted by individuals' corresponding relationship-specific models. Implications for the measurement and conceptualization of adult attachment are discussed.

Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style

BACKGROUND

This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth.

METHOD

One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined.

RESULTS

At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms.

LIMITATIONS

Self-report measures were used to measure insecure attachment styles and depression at 12 months.

CONCLUSIONS

Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.

Attachment Predicts Treatment Completion in an Eating Disorders Partial Hospital Program Among Women With Anorexia Nervosa

The goal of this study was to examine if attachment theory can provide a framework for understanding treatment completion in an eating disorders partial hospital program among women with anorexia nervosa (AN). Attachment was measured using the Attachment Styles Questionnaire (Feeney, Noller, & Hanrahan, 1994). As hypothesized, self-reports of high avoidant attachment predicted noncompletion of treatment for those with AN binge-purge subtype (ANB). However, this relationship did not emerge for those with AN restricting subtype (ANR). Also as hypothesized, self-reports of high anxious attachment predicted completing treatment for those with ANB but not for those with ANR. For completers with ANB and ANR, the program was helpful in increasing body weight and lowering drive for thinness, body dissatisfaction, interpersonal problems, and depression. Attachment avoidance, characterized by devaluing one's need for relationships, may be a contraindication for group-based partial hospital treatment of ANB. Attachment anxiety, characterized by high preoccupation with relationships, may facilitate remaining in treatment for those with ANB.