Prior - Understanding Attachment and Attachment Disorders

This book was initially conceived as an evidence-based document on attachment, along similar lines to other publications by FOCUS which have considered the evidence base for interventions in a number of different disorders. However, it became apparent early in the endeavour that a somewhat different format would be required. In discussing the clinical application of the concept of attachment, three aspects needed to be considered in detail: (1) attachment theory; (2) the assessment of attachment patterns; and (3) disturbances related to attachment. An evidence-based approach has been applied to considering these three aspects.

Attachment theory was introduced and described in detail by John Bowlby in his many papers and books. Bowlby regarded attachment as a biological instinct, evolved to ensure the survival of the vulnerable young. Bowlbys trilogy (1969/1982, 1973, 1980) considered the formation of attachment, separation and loss. Subsequent attention has become focused on the process of attachment of children to their caregivers, with much less emphasis on separation and loss. It is clear that separation and loss are painful and distressing and, if unresolved, may leave lasting emotional sequelae. Prior security of attachment is, however, protective of the effects of later stresses. Insecure attachment is best regarded as a vulnerability factor or a marker of risk to the childs functioning and wider social adaptation. How attachment behaviour becomes organised is largely determined by the caregiving environment. This places the onus of responsibility for the formation of secure attachments on the young childs caregivers.

What is remarkable is the extent to which Bowlbys writing and predictions, which were based on extensive observations, have been proved correct. The theory has stood the test of empirical scrutiny and is referred to throughout the book, extending into the more uncertain territory of attachment disorders.

Attachment theory has generated a great deal of interest within the fields of psychology and child development and there is a wealth of scientific work and evidence relating to it. Much of it has been referred to in the Handbook of Attachment (Cassidy and Shaver 1999) and by Goldberg (2000; Goldberg, Muir and Kerr 1995). Our book is a further distillation of this vast knowledge base. The conclusions in the various Parts of this book are based on the available evidence base and its appraisal. In addition, Part Four presents a clarification of the meaning of attachment disorders, which is based both on attachment theory and the evidence base.

It has not been possible to mention, let alone appraise, every study in this field, some aspects of which are very richly researched. As well as using meta-analyses where these are available, the studies selected have included classic ones as well as those illustrating different approaches or practice. The aim has been to bring a representative selection of the evidence which is based on attachment theory to guide practice.

Alongside the requirement to base the contents of this book on the appraisal of the available evidence, the needs of practitioners have also been considered. A number of questions that might be asked by practitioners were, therefore, posed by the authors at the outset. The questions were:

What is attachment?

Is attachment organisation continuous over time?

What determines attachment security?

What is the relationship between a parents own attachment organisation, their parenting of the child and the childs own attachment organisation?

Does good overall parentchild interaction predict secure attachment?

When and how does an individuals attachment organisation move from being specific to particular caregivers to becoming consolidated into one organisation?