Attachment in Adolescence: An Agenda for Research and Intervention

Ronald Jay Werner-Wilson, Ph.D.

based on Material from

Developmental-Systemic Family Therapy with Adolescents

(Werner-Wilson, 2001)

Reference

A version of this material was published as

Werner-Wilson, R. J. & Davenport, B. R. (2003). Distinguishing between conceptualizations of attachment: Clinical implications in marriage and family therapy. Contemporary Family Therapy, 25, 179-193.

Introduction

“Attachments lie at the heart of family life. They create bonds that can provide care and protection across the life cycle (Ainsworth, 1991), and can evoke the most intense emotions - joy in the making, anguish in the breaking - or create problems if they become insecure” (Byng-Hall, 1995, p. 45).

Conceptual Confusion about Attachment

The word "attachment" is used casually and by professionals in a variety of ways that can create conceptual confusion. It is a term that is used casually to refer to a

general level of affection.Professional Uses:

DSM: Reactive Attachment Disorder (a/k/a attachment disorder)

Influence of John Bowlby:Attachment in childrenAdult nuclear family attachmentAdult romantic attachment

Clinical Conceptualization of Attachment

Common Clinical Usage

“Attachment disorder” has become a popular clinical diagnosis for children.

“Attachment disorder” is described in ways that suggests it is a trait of the child.“These seriously disturbed children have

difficulty forming attachments even when placed in good foster and adoptive homes” (Booth & Wark, 2001, p. 5).

Children are often described as incapable of forming attachment bonds.

Diagnostic and Statistical Manual of Mental Disorders

Clinical use of the term attachment seems to be associated with the DSM diagnosis Reactive Attachment Disorder.

Some clinicians also seem to adopt some aspects of disorganized attachment.

Reactive Attachment Disorder of Infancy or Early Childhood is described in DSM as a “[m]arkedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years”

Reactive attachment disorder is demonstrated by either ...

“persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilent, or highly ambivalent and contradictory responses”

or “diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers …)” (DSM-IV-TR Quick Reference, pp. 78-79).

Characteristics of Reactive Attachment Disorder

According to DSM, reactive attachment disorder is associated with at least one of the following: persistent disregard for basic emotional

needs; persistent disregard for basic physical needs;repeated changes of primary caregiver (DSM-

IV-TR Quick Reference, p. 79).

Reactive Attachment Disorder: Epidemiology

No studies have been conducted to establish prevalence, incidence, or natural course.

DSM simply states that it is very uncommon. Some have inferred prevalence from child

maltreatment statistics, but these are unreliable. Abuse or neglect does not automatically

produce Reactive Attachment Disorder.

Treatment of Attachment Disorder(from Hanson & Spratt, 2000)

Assumption: child has repressed rage which interferes with ability to form an attachment.

Clinical intervention: help child release her/his rage and teach child that parents can and will be in control. “Parents may be told that this is the only way to

keep their child from becoming a serial killer, murderer, or psychopath” (p. 142).

Parents may be told that conventional treatments will not work for their child.

Treatment includes Gestalt-type enacting and fighting with the child’s birth mother.

Holding Therapy

Also referred to as attachment or rage reduction therapy.

Confrontational model that uses coercive techniques to provoke emotional responses in the diagnosed child.

Three Primary Treatment Components

Prolonged restraint for purpose other than protection.

Prolonged noxious stimulation (e.g., tickling, poking ribs).

Interference with bodily functions.

Concern about Treatment

“This restraining is not related to child’s immediate behavior, and the procedure may be repeated daily. During the restraining period, the clinician actively attempts to provoke and arouse the child by providing noxious stimulation such as yelling in the child’s face, poking or tapping the child, tickling, or pulling on limbs. The child may try to resist by screaming, fighting, or crying but eventually breaks down. When the child reaches the point of surrender, he is then given to his caregiver(s), to whom he reportedly instantly attaches” (Hanson & Spratt, 2000, p. 142)

Research on Treatment of Reactive Attachment Disorder

Hanson and Spratt (2000) recently completed a review of Reactive Attachment Disorder because of concerns about the “emergence of novel treatments that lack a sound theoretical basis or empirical support, and may potentially be traumatizing and harmful to the child”. “Diagnosis is complicated by the fact that

frequently there are comorbid mental health, medical, and developmental conditions that need to be assessed and treated.”

No treatments put forth for the disorder have been empirically examined for “safety or effectiveness” (p. 137).

“Major Concern” with Holding Therapy (Hanson & Spratt, 2000)

Child clients are particularly vulnerable, especially if they have severe abuse or neglect histories.

Attachment /Holding therapy could be traumatic. Although proponents of attachment contend that it has

been misrepresented (e.g., they suggest that it is also nurturing and sensitive), effectiveness seems to be based on anecdotal testimonials from parents.

“[T]he fact remains that there is simply no empirical evidence at present to support the assertion that attachment therapy is more effective, or even as effective, compared to accepted and conventional approaches” (p. 142).

Attachment Conceptualizations Associated with Bowlby

Areas of Investigation

Attachment in Children (measured via the strange situation and in-home observations)

Adult Nuclear Family Attachment (measured by the adult attachment interview)

Adult Romantic Attachment (measured using several self-report techniques)

An Evolutionary Perspective

Proximity to parents facilitates protection of children.

Infants are predisposed to seek proximity during distress.

Attachment, therefore, contributes to evolutionary survival.

“Within this framework, attachment is considered a normal and healthy characteristic of humans throughout the lifespan, rather than a sign of immaturity that needs to be outgrown” (Cassidy, 1999, p. 5).

Attachment is not …

imprinting a fixed characteristic or attribute

adolescents demonstrate different attachment styles with different caregivers

attachment style may change throughout development

Attachment …

describes an emotional bond. describes a set of behaviors that influence

relationships. is only one feature of the parent-adolescent

relationship. occurs in all children and youth. style is based on an internal working model (set

of expectations about relationships).

Behavioral Systems that Influence Attachment

Attachment Behavioral SystemRepertoire of attachment behaviors.Promotes proximity to caregiver.Attachment occurs even when physical

needs are not met or the child is abused.The attachment behavioral system is a

goal-corrected system that is flexible. Exploratory Behavioral System

Promotes survival because curiosity helps adolescent children learn about and adapt to their environment.

This system reduces attachment behavior.

Behavioral Systems (cont.)

Fear Behavioral SystemPromotes safety.Engages the attachment system.

The Caregiving SystemParent repertoire of behaviors that are

engaged to respond to attachment-seeking in children.

Like other systems, it is activated by internal and external cues.

Behavioral Systems (cont.)

The Sociable System“[T]he organization of the biologically based,

survival-promoting tendency to be sociable with others” (Cassidy, 1999, p. 9).

This system is different from the attachment system.

The Attachment Bond

Attachment bond refers to an affectional tie: “this bond is not between two people; it is instead a bond that one individual has to another individual who is perceived as stronger and wiser … A person can be attached to a person who is not in turn attached to him or her” (Cassidy, 1999, p. 12).

The attachment bond cannot be inferred from the presence or absence of attachment behavior.

Propositions About Attachment Bond (from Cassidy, 1999)

The attachment bond is only one feature of a parent-child relationship. Caregivers also serve as playmates, teachers, and disciplinarians.

Children experience multiple attachments but the quality of the attachment bond is not the same in each relationship. The quality of the bond is influenced by amount of interaction, quality of care provided, and emotional investment of the caregiver.

Early Attachment and Later Development (Thompson, 1999)

There seems to be a “modest” relationship between early attachment and later outcomes.

Influence of attachment seems to be “more contingent and provisional than earlier expected” (Thompson, 1999, p. 280).

Intervening events seem to moderate influence of attachment.

Thompson reminds us that attachment is only one dimension of the parent-child relationship. He noted that Bowlby recognized this as well.

Internal Working Models

Experiences with caregivers influence expectations about future relationships.

Working models seem to be “based on a network of developing representations that emerge successively but interactively with age (from Thompson, 1998).

Early representations provide important information but they are fairly simplistic and “ probably do not provide the conceptual foundation for the sophisticated and complex representations of self and relationships in other years” (Thompson, 1999, pp. 267-268).

Representational SystemsFour interrelated conscious and unconscious representational systems seem to influence internal working models:

Social expectations about caregivers developed during the first year are subsequently elaborated.

Event representations: beginning in the third year, general and specific memories about attachment experiences are stored.

Beginning at age four, individuals begin to create their own narratives and self-understandings about self and relationships.

Beginning in the third and fourth years, the individual begins to form conclusions about characteristics of others and relationship expectations.

Significance of Developmental Processes on Attachment

Working models are continuously revised and updated throughout development“[T]heir impact on a child’s psychosocial

functioning at any particular age may depend on the security of the representations that are developed at that particular time” (Thompson, 1999, p. 268).

“[D]ifferent facets of working models (e.g., social expectations, autobiographical memory) have not only different developmental timetables but perhaps also different periods of critical influence.

Significance of Developmental Processes on Attachment (cont.)

Caregivers not only influence attachment by the quality of care they provide but also by the interpretation of that care because their interpretation may be adopted by the child.

Thompson (1999) concludes that, for these reasons, it is important to consider working models in a developmental context in order to understand them as a source of developmental continuity.

Multiple Attachments

Children form more than one attachment and strength of attachment seems to be influenced by the extent to which the caregiver provides sensitive care.

The potential number of attachment figures is not limitless.

Although children have multiple attachment figures, they do not treat all attachment figures as equivalent.

Individual Differences Although there is a biological basis for attachment

and all children become attached (even to abusive parents), not all children become securely attached.

“Secure attachment occurs when a child has a mental representation of the attachment figure as available and responsive when needed. Infants are considered insecurely attached when they lack such a representation” (Cassidy, 1999, p. 7).

Influences on AttachmentContextEmotionCognition

Attachment: The Role of Emotion

Intense emotions are associated with the “formation, the maintenance, the disruption, and the renewal of attachment relationships” (Cassidy, 1999, p. 6).

Emotions contribute to motivation to seek attachment.

Attachment: The Role of Cognition

Children learn to use specific attachment behaviors with specific people in specific situations.

Children develop “internal working models” that help them anticipate the future.

Attachment: The Role of Context

Activation of the attachment behavioral system is influenced byconditions in the childconditions in the environment.

“In sum, proximity seeking is activated when the infant receives information (from both internal and external sources) that a goal (the desired distance from the mother) is exceeded. It remains activated until the goal is achieved, and then it stops” (Cassidy, 1999, p. 6).

Family as a Secure Base

Definition: “a family that provides a reliable and readily available network of attachment relationships, and appropriate caregivers, from which all members of the family are able to feel sufficiently secure to explore their potential” (Byng-Hall, 1999, p. 627).

Factors Associated With a Secure Family Base

There is a shared awareness that attachment relationships are important and care for others is a priority in the family.

Family members should support one another in providing care for each other.

Factors that Undermine a Secure Base in Families

Fear of losing an attachment figure or actual loss of an attachment figure.

A child clings to one caregiver and rejects relationships with other caregivers. Byng-Hall refers to this as “capturing” an attachment figure.

Turning to an inappropriate attachment figure (i.e., if one parent is not supporting the other parent, a child may be used as an attachment figure).

Abusive relationships. Negative self-fulfilling prophecies: there is an

expectation that losses from other generations will be repeated.

Attachment in Adolescence

“Research is increasingly showing that adolescent autonomy is most easily established not at the expense of attachment relationships with parents but against a backdrop of secure relationships that are likely to endure well beyond adolescence” (Allen & Land, 1999, p. 319).

During adolescence, attachment relationships are gradually transferred to peers.

Problems Associated with Adolescent Attachment

Caregivers may interpret individuation efforts as a threat to their relationship with their adolescent children.

Insecurely attached adolescents and their parents may become overwhelmed by affect associated with individuation which, in turn, contributes to conflict.

Insecurely attached adolescents may become easily frustrated because they do not expect to be heard or understood by their parents.

Caregiver seems to demonstrate more rejecting behaviors toward adolescent.

Adolescent demonstrates more anger at home than in the other settings.

Play (exploratory) behavior seems to serve as a distraction from attachment needs.

Attachment Styles in Children

Avoidant Resistant or Ambivalent Disorganized/Disoriented Secure

Avoidant Attachment

Characteristics of Avoidant Attachment

Avoidant attachment is associated with a high degree of physiological arousal.

Adolescent engages in behaviors to distract or soothe her/himself in response to stress or anxiety.

Internal working model: caregiver is unresponsive and rejecting.

Adolescent appears to avoid interacting with parent and acts indifferent.

Characteristics of Avoidant Attachment (cont.)

Caregiver seems to respond negatively to the adolescent’s attempts to make contact: the caregiver withdraws when the adolescent is sad.

Caregiver seems to demonstrate more rejecting behaviors toward adolescent.

Adolescent demonstrates more anger at home than in the other settings.

Play (exploratory) behavior seems to serve as a distraction from attachment needs.

Presenting Problems Associated with Avoidant Attachment

Withdrawal as a coping behavior may lead to social isolation. Adolescent may run away from home.

Soothing behavior may lead to substance abuse as a way to self-medicate.

Irritability may be mis-diagnosed as Conduct Disorder.

Avoidant child is likely to engage in delinquent activities.

Distraction attempts that rely on stimulation may be may be mis-diagnosed as ADD/ADHD.

Treatment Implications for Avoidant Attachment

Adolescent may respond in aggressive or antagonistic ways toward therapists and other authority figures.

Assess parenting style. Promote authoritative/democratic parenting.

Interventions that are experienced by adolescent as punitive may provide confirmation to the adolescent of an internal working model based on rejection.

Consequences or structuring interventions should include attempts to validate and nurture.

Resistant or Ambivalent Attachment

Characteristics of Resistant or Ambivalent Attachment

Consistent with enmeshed relationships. Adolescent does not seem to be soothed by the

presence of her/his caregiver and may appear angry or passive.

Caregiver seems committed to the task of nurturing but is often emotionally unavailable.

Caregiver seems to be preoccupied with past relationship experiences and may appear angry.

Characteristics of Resistant or Ambivalent Attachment (cont.)

Internal working model of adolescent: caregiver is capable of responding if s/he is persistent at seeking attention.

Some children may take care of their parent as a way to foster interaction. This may, according to Byng-Hall (1995), contribute to parentification of child.

Presenting Problems Associated with Ambivalent Attachment

Adolescent may be more susceptible to peer pressure because of desire for closeness.

Conversely, some adolescents may become socially isolated ifthey are recruited into the role of parentified

childtheir relationship with a parent is enmeshed

Separation anxiety disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder may be associated with ambivalent attachment

Treatment Implications for Ambivalent Attachment

Assess caregiver responsiveness and help parents who are preoccupied with past relationships to focus on present needs of children.

Create a context for independent decision-making for adolescent.

Promote peer relationships based on mutuality.

Disorganized/Disoriented Attachment

Characteristics of Disorganized/Disoriented Attachment

Research suggests that a significant number of children (as many as 80%) who are maltreated can be classified in this category.

Caregiver seems frightened by the memory of past trauma which may promote momentary disassociation.

Caregiver seems to be “scripting” child into past trauma (Byng-Hall, 1995).

Presenting Problems Associated with Disorganized/Disoriented Attachment

Adolescent may engage in bizarre or socially-inappropriate behavior.

Adolescents who are maltreated may mistreat other youth.

In cases of maltreatment, adolescents may run away from home. (Note: avoidant adolescents also run away but for different reasons.)

Treatment Implications for Disorganized/Disoriented Attachment

Adolescents who seem to demonstrate Post Traumatic Stress Disorder should be assessed for disorganized/disoriented attachment.

Adolescents who abuse other youth should be assessed for disorganized/disoriented attachment.

Cultivation of trust is a necessary first step in treatment.

Secure Attachment

Characteristics of Secure Attachment

Communication between caregiver and adolescent seems to be warm and sensitive.

Adolescent does not seem afraid to express anger.

Caregiver permits age-appropriate autonomy and exploration.

Caregiver seems to have a coherent view of attachment and recognizes that it is important to the adolescent.

Caregiver and adolescent seem to have fun interacting.

Promoting Secure Attachment

Promote communication that includes empathy and validation.

Help families that are conflict-avoidant or conflict-habituated to express anger in non-destructive ways.

Help parents recognize importance of attachment.

Encourage parents to engage in activities that are fun.

Help parents recognize typical aspects of adolescent development.

Adult Nuclear Family Attachment

Measurement of Adult Attachment Research on attachment styles in children

inspired investigation of attachment styles in adults.

An Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984) was developed to assess attachment styles in adults and has been revised three times.

Adult Attachment Interview Process

During the AAI, the participant is asked to provide five adjectives that describe each parent and an example of an episode that illustrates each adjective. Interviewers inquire about the following: how caregivers responded to them when s/he

was upset; whether caregiver threatened her/him; whether s/he felt rejected; explanation for caregivers behavior; affect of these childhood experiences on her/his

adult personality

Coding Adult Attachment Interview

The responses are evaluated on two dimensions.The first dimension is coherence. Coherence

refers to answers that provide a clear and convincing description; are truthful, succinct, and complete; are presented in a clear and orderly manner.

The second dimension is the ability to reflect on the motives of others.

The attachment of participant’s children can be predicted from these interviews.

Adult Nuclear Family Attachment Styles

Dismissing Preoccupied Unresolved/Disorganized Secure/Autonomous

Dismissing Adult Attachment.

Responses on the AAI are not coherent: adjectives used to describe caregivers are usually positive but descriptions either do not support the positive adjective or actively contradict it.

The person seems to be dismissive about the importance of attachment.

This type of adult attachment promotes avoidant attachment in children. “The shared parent/child attachment strategy is to maintain distance … in order to reduce the likelihood of emotional outbursts that might lead to rejections. The price is a loss of sensitive care for the child when it is needed” (Byng-Hall, 1995,p. 50).

Preoccupied Adult Attachment

Response on the AAI are not coherent: descriptions of adjectives include vague references.

The person seems to be preoccupied with past relationship experiences and may appear angry.

As a result, boundaries in the family become blurred.

This type of adult attachment promotes resistant or ambivalent attachment in children. “There is a great deal of mutual monitoring and mind reading, all in an attempt to forestall any potential drifting away on the part of either the parent or the child” (Byng-Hall, 1995, p. 50).

Unresolved/Disorganized Adult Attachment

This person seems frightened by the memory of past trauma which may promote momentary disassociation. Responses on the AAI about topics that deal

with loss or abuse are incoherent. Other responses are consistent with the other

categories. This type of adult attachment promotes

disorganized/disoriented attachment in children.

Unresolved/Disorganized Adult Attachment (cont.)

“The general impression is that the parent does not have the child in mind at all but, rather, is scripting the child into some past drama … As the children grow older, overall strategies do seem to evolve. They either become more controlling of the parent, often in a punitive way, or they become caretaking of their parents” (Byng-Hall, 1995).

Secure/Autonomous Adult Attachment

Research using the AAI suggests that caregivers seem to be able to respond appropriately to children if they can make sense of their own childhood experience and are able to understand the motives of others.

This seems to facilitate secure attachment in their children.

As a caregiver, the person seems to recognize that attachment is important.

This type of attachment promotes secure attachment in children.

Adult Romantic Attachment

Attachment to Contemporary Peers and/or Romantic Partners

Assumption: “romantic love is fundamentally an attachment process through which affectional bonds are formed” (Simpson & Rholes, 1998, p. 6).

Measurement relies primarily on self-report instruments to assess perception of current relationship experiences with peers or romantic partners.

Conceptual Distinction Between Types of Adult Attachment

Research suggests that there is limited correspondence between AAI and measures of adult romantic attachment.

Simpson & Rholes suggest that lack of correspondence should not be surprising because they measure different dimensions of attachment: “the two traditions should provide unique information about an individual’s attachment history in different kinds of relationships experienced at different points in time” (1998, p. 6; emphasis added).

Conceptual Distinctions (cont.)

Important distinction to amplify: the AAI measures perception of relationship with parents to predict caregiving while measures or peer/romantic attachment assess contemporary relationships with other adults.

Methodological issue: different forms of measurement (e.g., self-report versus observational) do not often correspond because they seem to measure different perceptions (e.g., insider versus outsider views).

The Peer/Romantic Partner Tradition Conceptualization of attachment as a continuous rather

than a categorical variable. Identification of two forms of avoidant attachment in

adult romantic relationships was a divergence from nuclear family tradition.

Two dimensions: distinctions are based on view of self and others (see Table 1): Secure: positive view of self and others. Preoccupied: negative self views and positive (yet

apprehensive) views of others. Fearful-avoidant: negative views of self and others. Dismissing-avoidant: positive self views but negative

views of others.

Table 1

MODEL OF SELF(Dependence)

Positive(Low)

Negative(High)

Positive(Low)

SECUREComfortable with

intimacy andautonomy

PREOCCUPIEDPreoccupied (Main)Ambivalent (Hazan)

Overly dependentMODEL OFOTHER(Avoidance)

Negative(High)

DISMISSINGDenial of attachmentDismissing (Main)Counterdependent

FEARFULFear of attachmentAvoidant (Hazan)Socially avoidant

Correspondence between Types of Attachment

Correspondence Between Attachment Styles

Child AttachmentStyle

Adult ParentingAttachment Style(AAI)

Adult RomanticAttachment Style

Couple andFamilyRelationshipCharacteristics

Secure: limiteddistress;continuedexploration afterinitial reunion

Secure: dev.-approp. interac.;recognizes sig. ofattachment; parentis sensitivelyresponsive to child

Autonomous/Free

Flexible distanceregulation;adaptableinteraction styles;shared initiation forcontact.

Avoidant: childappears indifferent

Dismissing:dismissive aboutattachment;withdrawn andrejecting parentstyle

Avoidant Distant andwithdrawn;disengagedinteractions;avoidance ofemotional orphysical closeness

Correspondence Between Attachment Styles

ChildAttachment Style

Adult ParentingAttachment Style(AAI)

Adult RomanticAttachment Style

Couple andFamilyRelationshipCharacteristics

Resistant orAmbivalent: childappearsdistressed,preoccupied withcaregiver &“clingy”

Preoccupied:recognizes sig. ofattachment, butpreoccupied withpast; parentappears angry;parent isintermittentlyavailable

Ambivalent/Preoccupied

Overly close andintrusiverelationships;enmeshed; mutualmonitoring;blurredboundaries androle reversal

Correspondence Between Attachment Styles

ChildAttachment Style

Adult ParentingAttachment Style(AAI)

Adult RomanticAttachment Style

Couple andFamilyRelationshipCharacteristics

Disorganized/Disoriented:difficult tocategorizereunionexperience (80%of maltreatedyouth)

Unresolved/Disorganized:frightened bymemory of pasttrauma promotesmomentarydissassociation;scripts child into“past drama”

No commoninteractionstrategies, butcould includeapproach-avoidance conflictstyle; disorientedinteractions;dissociation.

Research Agenda

Research on Adolescent Attachment

Maintain conceptual clarity about research topic. Identify measures for data collection that are

consistent with conceptualization of attachment. Investigate interrelationship between types of

attachment. Investigate individual differences associated

with various aspects of adolescent development (e.g., emotional development, cognitive development, identity development).

Self-Report Assessment of Attachment

The Inventory of Parent and Peer Attachment (IPPA) is a self-report measure of attachment for adolescents that is both exceptionally reliable and valid. It includes three 25-item scales that measure

attachment to mother, father, and close friends. It uses subscales rather than classification

categories that measure trust, communication, and alienation.

The IPPA and coding instructions are available for free from Mark T. Greenberg (mxg47@psu.edu).

Intervention Agenda

Attachment Disorder Intervention (Hanson & Spratt, 2000)

Identify insecurely attached children at an early age.

Promote a nurturing and secure environment. Promote developmentally appropriate parenting

skills. Focus on “child’s and families coping rather than

inferred or vague pathologies” (p. 143). Maintain child in “the least restrictive and least

intrusive level of care” (p. 143).

Age Appropriate Autonomy and Exploration

Assess attachment styles from Bowlby tradition.

Develop interventions that are sensitive to the internal working model associated with attachment style.

Help Parents and Adolescents Recognize Typical Aspects of Development Throughout Adolescence

Relevant developmental themes:Cognitive developmentEmotional development Identity developmentSelf-esteem

Task: Provide a Secure Therapeutic Base for the Family

This is similar to the idea in object relations family therapy of developing a “safe container” for therapy.

Byng-Hall suggests that the therapist will serve as an attachment figure to family members.

As a result, we should be regularly available to our clients throughout their clinical experience and communicate to them that we will continue to be available to them in the future.

Task: Work With Current Significant Relationships

Byng-Hall suggests that it may be helpful to normalize attachment difficulties.

“Attachment theory can offer explanations that are clear to both therapist and family, and that make sense out of what may be otherwise perplexing. … a child who is angry, demanding, and controlling is often seen as intentionally bad, but the child can be seen in a different light if described as insecure and trying to make sure he or she is in the parents’ minds when he or she feels unloved and unlovable” (1999, p. 636).

Task: Work With Current Significant Relationships (cont.)

In addition to providing reframes, Byng-Hall contends that we should attend to significant relationships by promoting more coherent narratives for the family. Narrative therapy techniques would be particularly helpful.

Two other types of problems that relate to current significant relationships may require attention: distance conflicts and power battles. Structural techniques may helpful for these problems.

Task: Explore Relationship Between Family Members and Therapist

Therapists become part of the family system during therapy so we should pay attention to our influence.

“Feeling understood is crucial to family members’ establishing secure attachments to the therapist” (Byng-Hall, 1999, p. 636).

Since therapists may be seen as attachment figures, an experiential approach to therapy may help us address these issues. Augustus Napier and Carl Whitaker’s The Family

Crucible should be mandatory reading for anyone interested in incorporating attachment theory into their clinical work.

Task: Review and Evaluate Influence of Past Relationships on Current Ones

“Exploring the connections between stories of what happened in past generations and what is happening now in the session can help the therapist and the family members to elucidate what comes from the past, and the to assess whether or not behaving in old ways is helpful now” (Byng-Hall, 1999, p. 639).

This is similar to Murray Bowen’s recommendation to “embrace” family history in order to promote differentiation.

Narrative and symbolic experiential therapies could also be used to help evaluate these relationship patterns.