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The attachment system as a bio-social mechanism of homeostatic regulation
Attachment theory, developed by John Bowlby (Bowlby, 1969; Bowlby, 1973; Bowlby, 1980), postulates a universal human need to form close affectional bonds. At its core is the reciprocity of early relationships, which is a precondition of normal development probably in all mammals, including humans (Hofer, 1995). The attachment behaviours of the human infant (e.g. proximity seeking, smiling, clinging) are reciprocated by adult attachment behaviours (touching, holding, soothing) and these responses strengthen the attachment behaviour of the infant toward that particular adult. The activation of attachment behaviours depends on the infant’s evaluation of a range of environmental signals which results in the subjective experience of security or insecurity. The experience of security is the goal of the attachment system, which is thus first and foremost a regulator of emotional experience (Sroufe, 1996). In this sense it lies at the heart of many forms of mental disorder and the entire psychotherapeutic enterprise.
None of us is born with the capacity to regulate our own emotional reactions. A dyadic regulatory system evolves where the infants’ signals of moment to moment changes in their state that are understood and responded to by the caregiver thereby achieving their regulation. The infant learns that arousal in the presence of the caregiver will not lead to disorganisation beyond his coping capabilities. The caregiver will be there to re-establish equilibrium. In states of uncontrollable arousal, the infant will come to seek physical proximity to the caregiver in the hope of soothing and the recovery of homeostasis. The infant’s behaviour by the end of the first year is purposeful, and apparently based on specific expectations. His past experiences with the caregiver are aggregated into representational systems which Bowlby (1973) termed ‘internal working models’. Thus, the attachment system is an open bio-social homeostatic regulatory system.
Patterns of attachment in infancy
The second great pioneer of attachment theory, Mary Ainsworth (1969; 1985; Ainsworth, Blehar, Waters, & Wall, 1978), developed the well-known laboratory based procedure for observing infant’s internal working models in action. Infants, briefly separated from their caregiver in a situation unfamiliar to them, show one of four patterns of behaviour. Infants classified as Secure explore readily in the presence of the primary caregiver, are anxious in the presence of the stranger and avoid her, are distressed by their caregivers’ brief absence, rapidly seek contact with the caregiver afterwards, and are reassured by this. The infant returns to exploration. Some infants, who appear to be made less anxious by separation, may not seek proximity with the caregiver following separation, and may not prefer the caregiver over the stranger; these infants are designated ‘Anxious/Avoidant’. A third category, ‘Anxious/Resistant’ infants show limited exploration and play, tend to be highly distressed by the separation, but have great difficulty in settling afterwards, showing struggling, stiffness, continued crying, or fuss in a passive way. The caregiver’s presence or attempts at comforting fail to reassure, and the infant’s anxiety and anger appear to prevent them from deriving comfort from proximity.
Secure infants’ behaviour is based on the experience of well co-ordinated, sensitive interactions where the caregiver is rarely over-arousing and is able to restabilise the child’s disorganising emotional responses. Therefore, they remain relatively organised in stressful situations. Negative emotions feel less threatening, and can be experienced as meaningful and communicative (Grossman, Grossmann, & Schwan, 1986; Sroufe, 1979; Sroufe, 1996).
Anxious/Avoidantly attached children are presumed to have had experiences where their emotional arousal was not restabilised by the caregiver, or where they were over aroused through intrusive parenting; therefore they over-regulatetheir affect and avoid situations that are likely to be distressing. Anxious/Resistantly attached children under-regulate, heightening their expression of distress possibly in an effort to elicit the expectable response of the caregiver. There is a low threshold for threat, and the child becomes preoccupied with having contact with the caregiver, but frustrated even when it is available (Sroufe, 1996).
A fourth group of infants exhibits seemingly undirected behaviour, giving the impression of disorganisation and disorientation (Main & Solomon, 1990). Infants who manifest freezing, hand clapping, head-banging, the wish to escape the situation even in the presence of the caregiver, are referred to as ‘Disorganised/Disoriented’. It is generally held that for such infants the caregiver has served as a source of both fear and reassurance, thus arousal of the attachment behavioural system produces strong conflicting motivations. Not surprisingly, a history of severe neglect or physical or sexual abuse is often associated with this pattern (Cicchetti & Beeghly, 1987; Main & Hesse, 1990). I would like to consider this group in much greater detail, this afternoon.
The continuity of patterns of attachment
Bowlby proposed that internal working models of the self and others provide prototypes for all later relationships. Such models are relatively stable across the lifespan (Collins & Read, 1994). Early experiences of flexible access to feelings are regarded as formative by attachment theorists. The autonomous sense of self emerges fully from secure parent-infant relationships (Emde & Buchsbaum, 1990; Fonagy et al., 1995a; Lieberman & Pawl, 1990). Most importantly the increased control of the secure child permits him to move toward the ownership of inner experience, and toward understanding self and others as intentional beings whose behaviour is organised by mental states, thoughts, feelings, beliefs and desires (Fonagy et al., 1995a; Sroufe, 1990). Consistent with this, prospective longitudinal research has demonstrated that children with a history of secure attachment are independently rated as more resilient, self-reliant, socially oriented (Sroufe, 1983; Waters, Wippman, & Sroufe, 1979), empathic to distress (Kestenbaum, Farber, & Sroufe, 1989), with deeper relationships (Sroufe, 1983; Sroufe, Egeland, & Kreutzer, 1990).
Prediction from adult attachment measures
The stability of attachment is demonstrated by longitudinal studies of infants assessed with the Strange Situation and followed up in adolescence or young adulthood with the Adult Attachment Interview (AAI) (George, Kaplan, & Main, 1996). I assume most of you are familiar with this wonderful structured clinical instrument which elicits narrative histories of childhood attachment relationships – the characteristics of early relationships, experiences of separation, illness, punishment, loss, maltreatment or abuse. The AAI scoring system (Main & Goldwyn, 1994) classifies individuals intoSecure/Autonomous, Insecure/Dismissing, Insecure/Preoccupied or Unresolved with respect to loss or trauma, categories based on the structural qualities of narratives of early experiences. While autonomous individuals value attachment relationships, coherently integrate memories into a meaningful narrative and regard these as formative, insecure individuals are poor at integrating memories of experience with the meaning of that experience. Those dismissing of attachment show avoidance in denying memories, idealizing or devaluing (or both idealizing and devaluing) early relationships. Preoccupied individuals tend to be confused, angry or passive in relation to attachment figures, often still complaining of childhood slights, echoing the protests of the resistant infant. Unresolved individuals give indications of significant disorganisation in their attachment relationship representation in semantic or syntactic confusions in their narratives concerning childhood trauma or a recent loss. Again, we shall revisit this clinically most important group this afternoon.
Three major longitudinal studies (Hamilton, 1994; Main, 1997; Waters, Merrick, Albersheim, Treboux, & Crowell, 1995) have shown a 68-75% correspondence between attachment classifications in infancy and classifications in adulthood. This is an unparalleled level of consistency between behaviour observed in infancy and outcomes in adulthood. Obviously, such individual differences may well be maintained by consistent environments as well as by patterns laid down in the first year of life.
Attachment relationships play a key role in the transgenerational transmission of deprivation. Secure adults are 3 or 4 times more likely to have children who are securely attached to them (van IJzendoorn, 1995). This is true even where parental attachment is assessed before the birth of the child (Benoit & Parker, 1994; Fonagy, Steele, & Steele, 1991b; Radojevic, 1992; Steele, Steele, & Fonagy, 1996; Ward & Carlson, 1995). Parental attachment patterns predict variance in addition to temperament measures or contextual factors, such as life events, social support and psychopathology (Steele, Steele, & Fonagy, in preparation). How is such transgenerational transmission mediated? Genetics may appear to provide an obvious explanation. The early findings of an ongoing twin study in our laboratory have yielded no evidence of differential levels of concordance of attachment classification between identical and non-identical twins (Fearon, 1998). Attachment theorists have assumed that securely attached adults are more sensitive to their children’s needs thus fostering an expectation in the infant that dysregulation will be rapidly and effectively met (Belsky, Rosenberger, & Crnic, 1995; De Wolff & van IJzendoorn, 1997). Disappointingly, standard measures of caregiver sensitivity do not appear to explain at all well transgenerational consistencies in attachment classification (van IJzendoorn, 1995).
Attachment and mentalising: The move from a teleological to a mentalistic construal of attachment relationships in development
To do so, we have to explore a further aspect of the determinants of attachment. Mary Main and Inge Bretherton independently drew attention to what the philosopher Dennett called the "intentional stance". Dennett (1987) stressed that human beings try to understand each other in terms of mental states: thoughts and feelings, beliefs and desires, in order to make sense of and, even more important, to anticipate each others’ actions. If the child is able to attribute an unresponsive mother’s apparently rejecting behaviour to her sadness about a loss, rather than simply feeling helpless in the face of it, the child is protected from confusion and a negative view of himself. The hallmark of the intentional stance is the child’s recognition at around 3-4 years that behaviour may be based on a mistaken belief. Developmentalists have designed numerous tests of the quality of understanding false beliefs and tend to refer to this capacity as ‘a theory of mind’. We prefer the term mentalisation or reflective function which denotes the understanding of one’s own as well as others’ behaviour in mental state terms.
Say a three-year-old sees his friend, Maxi, hiding a piece of chocolate in a box, saying that he has to leave now but will come back to eat it later (Perner, 1991). After Maxi leaves, the child sees the experimenter move the chocolate to a basket. The child is asked: "Where will Maxi look for the chocolate, when he comes back?" The three year olds tend to predict that Maxi will look in the basket where the chocolate actually is, rather than in the box where he left it. Four and five year olds are already able to predict Maxi’s behaviour on the basis of what one might expect to be his belief, that the chocolate will still be where he left it. The four year old is said to have "a theory of mind", which is indicated by his ability to attribute false beliefs (Wimmer & Perner, 1983). He adopts an intentional stance and reasons in terms of the beliefs that may be attributed to Maxi. The three year old, however, is basing his prediction on his own representation of reality, and not on the other’s mind state.
Peter Fonagy, PhD, FBA
Paper to the Developmental and Psychoanalytic Discussion Group, American Psychoanalytic Association Meeting, Washington DC 13 May 1999
The attachment system as a bio-social mechanism of homeostatic regulation
Attachment theory, developed by John Bowlby (Bowlby, 1969; Bowlby, 1973; Bowlby, 1980), postulates a universal human need to form close affectional bonds. At its core is the reciprocity of early relationships, which is a precondition of normal development probably in all mammals, including humans (Hofer, 1995). The attachment behaviours of the human infant (e.g. proximity seeking, smiling, clinging) are reciprocated by adult attachment behaviours (touching, holding, soothing) and these responses strengthen the attachment behaviour of the infant toward that particular adult. The activation of attachment behaviours depends on the infant’s evaluation of a range of environmental signals which results in the subjective experience of security or insecurity. The experience of security is the goal of the attachment system, which is thus first and foremost a regulator of emotional experience (Sroufe, 1996). In this sense it lies at the heart of many forms of mental disorder and the entire psychotherapeutic enterprise.
None of us is born with the capacity to regulate our own emotional reactions. A dyadic regulatory system evolves where the infants’ signals of moment to moment changes in their state that are understood and responded to by the caregiver thereby achieving their regulation. The infant learns that arousal in the presence of the caregiver will not lead to disorganisation beyond his coping capabilities. The caregiver will be there to re-establish equilibrium. In states of uncontrollable arousal, the infant will come to seek physical proximity to the caregiver in the hope of soothing and the recovery of homeostasis. The infant’s behaviour by the end of the first year is purposeful, and apparently based on specific expectations. His past experiences with the caregiver are aggregated into representational systems which Bowlby (1973) termed ‘internal working models’. Thus, the attachment system is an open bio-social homeostatic regulatory system.
Patterns of attachment in infancy
The second great pioneer of attachment theory, Mary Ainsworth (1969; 1985; Ainsworth, Blehar, Waters, & Wall, 1978), developed the well-known laboratory based procedure for observing infant’s internal working models in action. Infants, briefly separated from their caregiver in a situation unfamiliar to them, show one of four patterns of behaviour. Infants classified as Secure explore readily in the presence of the primary caregiver, are anxious in the presence of the stranger and avoid her, are distressed by their caregivers’ brief absence, rapidly seek contact with the caregiver afterwards, and are reassured by this. The infant returns to exploration. Some infants, who appear to be made less anxious by separation, may not seek proximity with the caregiver following separation, and may not prefer the caregiver over the stranger; these infants are designated ‘Anxious/Avoidant’. A third category, ‘Anxious/Resistant’ infants show limited exploration and play, tend to be highly distressed by the separation, but have great difficulty in settling afterwards, showing struggling, stiffness, continued crying, or fuss in a passive way. The caregiver’s presence or attempts at comforting fail to reassure, and the infant’s anxiety and anger appear to prevent them from deriving comfort from proximity.
Secure infants’ behaviour is based on the experience of well co-ordinated, sensitive interactions where the caregiver is rarely over-arousing and is able to restabilise the child’s disorganising emotional responses. Therefore, they remain relatively organised in stressful situations. Negative emotions feel less threatening, and can be experienced as meaningful and communicative (Grossman, Grossmann, & Schwan, 1986; Sroufe, 1979; Sroufe, 1996).
Anxious/Avoidantly attached children are presumed to have had experiences where their emotional arousal was not restabilised by the caregiver, or where they were over aroused through intrusive parenting; therefore they over-regulatetheir affect and avoid situations that are likely to be distressing. Anxious/Resistantly attached children under-regulate, heightening their expression of distress possibly in an effort to elicit the expectable response of the caregiver. There is a low threshold for threat, and the child becomes preoccupied with having contact with the caregiver, but frustrated even when it is available (Sroufe, 1996).
A fourth group of infants exhibits seemingly undirected behaviour, giving the impression of disorganisation and disorientation (Main & Solomon, 1990). Infants who manifest freezing, hand clapping, head-banging, the wish to escape the situation even in the presence of the caregiver, are referred to as ‘Disorganised/Disoriented’. It is generally held that for such infants the caregiver has served as a source of both fear and reassurance, thus arousal of the attachment behavioural system produces strong conflicting motivations. Not surprisingly, a history of severe neglect or physical or sexual abuse is often associated with this pattern (Cicchetti & Beeghly, 1987; Main & Hesse, 1990). I would like to consider this group in much greater detail, this afternoon.
The continuity of patterns of attachment
Bowlby proposed that internal working models of the self and others provide prototypes for all later relationships. Such models are relatively stable across the lifespan (Collins & Read, 1994). Early experiences of flexible access to feelings are regarded as formative by attachment theorists. The autonomous sense of self emerges fully from secure parent-infant relationships (Emde & Buchsbaum, 1990; Fonagy et al., 1995a; Lieberman & Pawl, 1990). Most importantly the increased control of the secure child permits him to move toward the ownership of inner experience, and toward understanding self and others as intentional beings whose behaviour is organised by mental states, thoughts, feelings, beliefs and desires (Fonagy et al., 1995a; Sroufe, 1990). Consistent with this, prospective longitudinal research has demonstrated that children with a history of secure attachment are independently rated as more resilient, self-reliant, socially oriented (Sroufe, 1983; Waters, Wippman, & Sroufe, 1979), empathic to distress (Kestenbaum, Farber, & Sroufe, 1989), with deeper relationships (Sroufe, 1983; Sroufe, Egeland, & Kreutzer, 1990).
Prediction from adult attachment measures
The stability of attachment is demonstrated by longitudinal studies of infants assessed with the Strange Situation and followed up in adolescence or young adulthood with the Adult Attachment Interview (AAI) (George, Kaplan, & Main, 1996). I assume most of you are familiar with this wonderful structured clinical instrument which elicits narrative histories of childhood attachment relationships – the characteristics of early relationships, experiences of separation, illness, punishment, loss, maltreatment or abuse. The AAI scoring system (Main & Goldwyn, 1994) classifies individuals intoSecure/Autonomous, Insecure/Dismissing, Insecure/Preoccupied or Unresolved with respect to loss or trauma, categories based on the structural qualities of narratives of early experiences. While autonomous individuals value attachment relationships, coherently integrate memories into a meaningful narrative and regard these as formative, insecure individuals are poor at integrating memories of experience with the meaning of that experience. Those dismissing of attachment show avoidance in denying memories, idealizing or devaluing (or both idealizing and devaluing) early relationships. Preoccupied individuals tend to be confused, angry or passive in relation to attachment figures, often still complaining of childhood slights, echoing the protests of the resistant infant. Unresolved individuals give indications of significant disorganisation in their attachment relationship representation in semantic or syntactic confusions in their narratives concerning childhood trauma or a recent loss. Again, we shall revisit this clinically most important group this afternoon.
Three major longitudinal studies (Hamilton, 1994; Main, 1997; Waters, Merrick, Albersheim, Treboux, & Crowell, 1995) have shown a 68-75% correspondence between attachment classifications in infancy and classifications in adulthood. This is an unparalleled level of consistency between behaviour observed in infancy and outcomes in adulthood. Obviously, such individual differences may well be maintained by consistent environments as well as by patterns laid down in the first year of life.
Attachment relationships play a key role in the transgenerational transmission of deprivation. Secure adults are 3 or 4 times more likely to have children who are securely attached to them (van IJzendoorn, 1995). This is true even where parental attachment is assessed before the birth of the child (Benoit & Parker, 1994; Fonagy, Steele, & Steele, 1991b; Radojevic, 1992; Steele, Steele, & Fonagy, 1996; Ward & Carlson, 1995). Parental attachment patterns predict variance in addition to temperament measures or contextual factors, such as life events, social support and psychopathology (Steele, Steele, & Fonagy, in preparation). How is such transgenerational transmission mediated? Genetics may appear to provide an obvious explanation. The early findings of an ongoing twin study in our laboratory have yielded no evidence of differential levels of concordance of attachment classification between identical and non-identical twins (Fearon, 1998). Attachment theorists have assumed that securely attached adults are more sensitive to their children’s needs thus fostering an expectation in the infant that dysregulation will be rapidly and effectively met (Belsky, Rosenberger, & Crnic, 1995; De Wolff & van IJzendoorn, 1997). Disappointingly, standard measures of caregiver sensitivity do not appear to explain at all well transgenerational consistencies in attachment classification (van IJzendoorn, 1995).
Attachment and mentalising: The move from a teleological to a mentalistic construal of attachment relationships in development
To do so, we have to explore a further aspect of the determinants of attachment. Mary Main and Inge Bretherton independently drew attention to what the philosopher Dennett called the "intentional stance". Dennett (1987) stressed that human beings try to understand each other in terms of mental states: thoughts and feelings, beliefs and desires, in order to make sense of and, even more important, to anticipate each others’ actions. If the child is able to attribute an unresponsive mother’s apparently rejecting behaviour to her sadness about a loss, rather than simply feeling helpless in the face of it, the child is protected from confusion and a negative view of himself. The hallmark of the intentional stance is the child’s recognition at around 3-4 years that behaviour may be based on a mistaken belief. Developmentalists have designed numerous tests of the quality of understanding false beliefs and tend to refer to this capacity as ‘a theory of mind’. We prefer the term mentalisation or reflective function which denotes the understanding of one’s own as well as others’ behaviour in mental state terms.
Say a three-year-old sees his friend, Maxi, hiding a piece of chocolate in a box, saying that he has to leave now but will come back to eat it later (Perner, 1991). After Maxi leaves, the child sees the experimenter move the chocolate to a basket. The child is asked: "Where will Maxi look for the chocolate, when he comes back?" The three year olds tend to predict that Maxi will look in the basket where the chocolate actually is, rather than in the box where he left it. Four and five year olds are already able to predict Maxi’s behaviour on the basis of what one might expect to be his belief, that the chocolate will still be where he left it. The four year old is said to have "a theory of mind", which is indicated by his ability to attribute false beliefs (Wimmer & Perner, 1983). He adopts an intentional stance and reasons in terms of the beliefs that may be attributed to Maxi. The three year old, however, is basing his prediction on his own representation of reality, and not on the other’s mind state.