Still Face Experiment

Graduated Cambridge 1928

School for maladjusted children -> child psychiatrist

Trained at British Psychoanalytic Institute (Klein)

Published 44 Juvenile Thieves in 1944

Tavistock after the war (1946) Children -> Children and Parents First published family therapy paper 1949

A 2 year old goes to the hospital in 1952 (Robertson)

Mary Ainsworth worked with him from 1950 1954

Attachment published in 1969

Nanny leaving family

Boarding school when 7 or 8

Attachment relationship Seek proximity and contact Especially when

Frightened Tired Sick

Concepts from ethology and cybernetics Departure from drive theory

Five tasks Provide a secure base Help client to explore relationships Examine working models between client and therapist Explore links between current expectations beliefs etc. and early relationships Explore current models of self and other

Deeply influenced by 2 analytically oriented social workers

Link between parents childhood and childrens problems Including family members in therapeutic process

Owed social workers a great deal of gratitude

Learned everything from social workers

Security Theory with Blatz in Toronto

Bowlbys research group in 1950

Mothers in Uganda - 1953

Paper on relationship patterns with Bowlby - 1956

Baltimore study - 1963

Strange situation - 1971

Mother as secure base

Mother child interaction patterns

Parental responsiveness to infant signals

Three categories Secure Avoidant Resistant / Ambivalent

Dynamic Maturation Model

Strategies not styles

All strategies are adaptive and protective

Affect and Cognition

New strategies available when older

A/C not disorganization

Fonagy 1997

Reflective function

Mind Mindedness

Ability to interpret actions others and own

Awareness of mental states / willingness to think about them

Difficulty knowing what another is thinking

Link to secure attachment

Observation

Verbal analysis

Projective

(Self report)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Disorganized Resistant Avoidant Secure

Waters 1985 Based on Strange Situation For home observation by observer 12 48 months 90 items (depends on version)

Child readily shares with mother When child returns to mother, sometimes fussy for no reason Child will accept comforting from adults other than mother

Observed semi-structured play (5 mins) Measures fit / attunement of dyad Coded based on

Facial expression Vocal expression Position and body contact Expression of affection Pacing of turns Control Choice of activity

0 15 Months 15 30 Months Adults Cooperativeness Cooperativeness Sensitivity Compulsiveness Compulsiveness Control Difficultness Threateningly

coercive Unresponsiveness

Passivity Disarmingly coercive

Intervention Rationale Parent Education Parent can reflect & integrate

Needs new information

Short-term counseling Parent can integrate and has information Needs dialogue for problem-solving

Parent-child intervention Parent needs help focusing on conflicting information

Adult psychotherapy Parents behavior not consciously generated, triggered, maladaptive

8 or 20 weeks

Psychoeducation

Attachment focus parent as secure base and safe haven

Parental self-care

Initial work with parents trust, shame

Usually parents and one child

Speaking on behalf of the child

PACE Playfulness Acceptance Curiosity Empathy

1.6 million adoptees in US living with adoptive parents

2-4% of families have an adopted child

20,000 children adopted from abroad / yr

50,000 domestically adopted

510,000 children in foster care in 2006

Separation from parents

Possible multiple placements

Possible maltreatment / neglect / poor conditions

0%

20%

40%

60%

80%

Institutionalized Adopted Norm

% Disorganized

First listed in DSM III

Failure to thrive removed in DMS III-TR

Requires hx of pathogenic care

2 subtypes

Withdrawn / Inhibited

Indiscriminate / Disinhibited

Questions about diagnosis / prevalence

Turning away from parents

Role of peers

Attachment to significant other

Capacity for emotion regulation in social interactions

Feel safe when the other is nearby and responsive

Engage in close, intimate, bodily contact

Feel insecure when the other is inaccessible

Share discoveries with one another

Play with one another's facial features and exhibit a mutual fascination and preoccupation with one another

Engage in "baby talk"

Strange Situation AAI Synonyms Secure Autonomous B Avoidant Dismissing A Resistant Preoccupied C

Anxious Angry resistant Ambivalent

Disorganized Unresolved Fearful Avoidant Cannot classify

Avoidant / Dismissing Disorganized

Secure Anxious / Preoccupied

Low anxiety

High anxiety

High avoidance

Low avoidance

Basic attachment theory

Avoidant / Dismissing Secure

Disorganized Anxious / Preoccupied

- Other + Other

+ Self

- Self

Alternative axes

If I encounter an obstacle / become distressed

Approach relationship partner for help

Likely to be available and supportive

Relief and comfort

Can return to other activities

Conflicting research

Strategic (whatever works)

Secure => Secure

Some transposing (A/C/A; C/A/C)

Grandmother may be better predictor

Main 1985 AAI

Hazan and Shaver 1987 3 paragraphs

Bartholomew and Horowitz 1991 Relationship Questionnaire, 4 styles

Brennan, Clarke, Shaver 1998 ECR

Crittenden 1999 DMM

Fraley, Waller, Brennan 2001 ECR-R

5 Words for each attachment figure

Give Examples

20 questions, increasing pressure

Narrative coherence more than content

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NonClin M

NonClin F Ado Euro At Risk Clinical

Disorg / CC Preoccupied Avoidant Secure

Experience in Close Relationships Revised

Derived from 323 items in 60 self-report measures

Revised using item response analysis

2 scales (anxious, avoidant)

Expect they can rely on the availability and sensitivity of the people they love Able to become emotionally close and express affection Feel comfortable depending on and being depended on Feel calmed and comforted by contact and support when distressed Generally sensitive to others signals Coherent narratives about life events

Tend to minimize or dismiss importance of close relationships Uncomfortable with emotional intimacy, physical contact Derive sense of self-worth from independence Disparage sentimentality, tenderness, discussion or expression of feelings Tend to withdraw or attempt to cope alone Sparse narratives, unable or unwilling to describe specific examples

Seek intense emotional intimacy but feel ambivalent toward others Experience others as not accessible enough Leading to distress, frustration, anger, anxiety, passive helplessness May feel smothered while not quite getting enough Turn to others for support but disappointed Tend to have trouble staying on topic, excessively long descriptions, crying continuously, vague words (dadadadada)

Have had trouble getting beyond / making meaning of traumatic events Appear inconsistent, contradictory, dissociative in intimate relationships Have difficulty trusting significant others Contradictory responses when distressed Controlling through hostile, critical, punitive responses or over-involved smothering care-giving Talking about traumatic events show disorientation, disorganization, dissociation

Individuals Accelerated Experiential Dynamic Psychotherapy (AEDP)

Couples Emotionally Focused Therapy for Couples (EFT) Psychobiological Approach to Couples Therapy (PACT)

Families / Children Dyadic Developmental Psychotherapy

Accelerated Experiential Dynamic Psychotherapy

Non-pathologizing

Dyadic regulation of affect

Creating safety for core / primary affect

Meta-processing

Attachment behaviors in intimate relationships make sense

Couples recognize their cycles / dance

Couples build new patterns through experiential practice

Therapists and attachment strategies / styles

Attachment and therapeutic alliances

Attachment in and out of the office

Supervisory relationships

Factors impacting grief Attachment to person who died Attachment history

Concept of compulsive self-reliance

Emotional dysregulation

Possible similar roots (temperament)

Possible issues of fit

Prenatal stress?

Insecure attachment

DMM compulsive caregiving, compulsive compliance

Mothers possibly dealing with unresolved losses

Need more data on fathers

Attachment neglected in organizational behavior literature

Secure attachment and leadership

Secure leaders more likely to delegate

Secure attachment and trust

Nature, nurture, or both?

Parent / child fit

Epigenetics

LGBT

Culture?

Across caregivers?

Age / Lifespan?

Secure attachment and coming out

LGBT relationships similar

Perceived discrimination and attachment

Conflicting research Questions about Western bias Asian Americans, Hispanic

Americans more anxious attachment than Caucasian

African Americans, Asian Americans more avoidant attachment than Caucasian

More research needed Primary or secondary attachment

figure? Different roles and potential

impact? Multiple caregivers?

Earned secure attachment Some evidence of change over

lifespan Adolescence More avoidance in later years

What is being measured?

What is most useful to clinicians

Categorical / Dimensional?

Styles / Strategies?

Insecure styles adaptive?

js@jonathansibley.net www.jonathansibley.net

ApplyingAttachment Theoryin your Clinical WorkAgendaOne of many lensesA quick exampleInsecure attachmentSecure AttachmentSecure AttachmentBowlby 1Bowlby 2Bowlby additional backgroundBowlby key conceptsBowlby on psychotherapyBowlby and social workInfluences LorenzInfluences - HarlowHistory AinsworthAinsworth conceptsDMMDMM - CrittendenMentalizationInfants and ChildrenAssessmentsStrange situationStrange Situation DistributionAttachment Behavior Q-SetChild Adult Relationship Experimental Index - CARECARE IndexClinical ApplicationsParenting Interventions(Crittenden)Circle of securityParenting - Circle of SecurityParenting Dyadic Developmental PsychotherapyAdoption / Foster CareAdoption / Foster Care IssuesReactive Attachment D/OTeensAdultsSimilarities between adults and childrenAttachment vocabularyAttachment typesAttachment typesSecure base scriptIntergenerational TransmissionAdult assessmentsHistory of adult attachment measuresAAIAAI DistributionECR-RAttachment prototype questionnaire - Pattern AAttachment prototype questionnaire Pattern BAttachment prototype questionnaire Pattern CAttachment prototype questionnaire Pattern DClinical ApplicationsAttachment-based therapiesAEDPEmotionally Focused Therapy (EFT)Attachment and the therapistApplications of attachment theoryAttachment and griefAttachment and ADHDAttachment and eating D/OAttachment and the workplaceAttachment Temperament debateHow universal?LGBTCultureCaregivers / FathersLifespanAdditional issuesThank you!