Session Two (Attachment) Flashcards

1
Q

What is Security Theory in terms of child development?

A

A theory, first proposed by Mary Ainsworth but based on work by John Bowlby, that “infants and young children need to develop secure dependence on parents before launching out into unfamiliar situations on their own”

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2
Q

Briefly describe Robertson’s ‘Two year old goes to hospital’ study?

A
  • Looked into how children responded when they were dropped off at hospital for an extended stay, at a time when parents weren’t allowed to stay with them.
  • Robertson observed that while the child was quiet, she wasn’t happy or interested in anything around her or her toys. Showed distress at certain points.
  • The recording of this experiment was central to the development of attachment theory, as well as to the reforming of hospital policy to allow parents to stay with their kids.
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3
Q

Briefly describe Ainsworth’s strange situation test?

A

Test that aimed to investigate how a child reacts to various situations with and without their mother, theorising that different reactions exemplify different types of attachments to their parents. Child was placed in a new but interesting environment with:

  • Their mother and the experimenter
  • Then just their mother
  • Then mother and a stranger
  • Then mother leaves baby and stranger alone
  • Then mother returns and stranger leaves
  • Then mother leaves and baby is left alone
  • Stranger returns and tries to comfort child again
  • Stranger leaves and mother returns.

The child’s response to separation and especially to reunion are crucial at judging attachment type.

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4
Q

Describe Type B attachment pattern (Secure)?

A
  • These children have internalised representation of a caregiver who is available and responsive.
  • You view your parent as there for you if you need and you value yourself as a person worthy of help.
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5
Q

Describe Type A attachment pattern (Insecure-Avoidant)?

A
  • These children anticipate rejection when in need of comfort and have difficulty expressing distress at separation from parent.
  • These people learn as a child that if you’re upset with something you just need to crack on.
  • Self-sufficient, self-reliant.
  • NON-PATHOLOGICAL
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6
Q

Describe Type C attachment pattern (Insecure-Ambivalent)?

A
  • These children expect an unpredictable parent and develop a totally helpless/dependent relationship to them.
  • Aka partial reinforcement.
  • Child learns to essentially try and rank up their separation behaviour in the hopes they’ll eventually get a response
  • Child hasn’t learned to regulate emotional response as they don’t know what response is necessary to get what they want.
  • These children are typically very difficult to settle, e.g. when dropped off at school.
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7
Q

Describe Type D attachment pattern (Disorganised-Disorientated)?

A
  • Response of child can be varied from freeze to intermittent freeze, avoid, cling. No strategy in face of separation, total confusion.
  • Child views parent as unpredictable or frightening (common in parents with psychosis or a mood disorder)
  • These individuals tend to be highly disturbed and are the main source of psych research.
  • Have difficulty in adjusting to a normal social/family/work life.
  • 15% of the general population, 60% of individuals with emotional disturbances.
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8
Q

What is Reflective Functioning and how does it relate to attachment theory?

A
  • Reflective functioning refers to the essential human capacity to understand behaviour in light of underlying mental states and intentions.
  • Parents high in RF have more secure attachment histories with their own parents and more securely attached children.
  • This is likely because high RF in parents helps an infant and young child to understand other minds and other perspectives.
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9
Q

Why is secure attachment important? What influence does a secure attachment have on later life?

A
  • Secure attachment with your own parents makes it more likely your kids will have secure attachments with you.
  • Secure attachment is one of the best predictors of resilience in later life
  • Secure attachment is associated with mentalizing skills and Theory of Mind.
  • Disordered (Type D) attachment is associated with increased risk of emotional disturbances.
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10
Q

Briefly, how would each attachment type respond to separation in the strange situation experiment?

A
  • B: Use mother as safe base to explore, noted anxiety when separated but settles quickly on reunion.
  • A: Child will not explore much regardless of who is in the room, and will not show much emotion when mother leaves or returns. This was initially a puzzle, but further studies have shown that the child is in fact distressed but has learned to suppress this with a mask of not caring.
  • C: Show either resentment towards being left by the caregiver or helpless passivity.
  • D: No clear organised behaviour, child will be confused and not know what to do with themselves.
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11
Q

What are Internal Working Models?

A

Cognitive representations the child has of themselves and of their caregiver that they use to predict, interpret and plan attachment behaviour.

Develop in childhood and are clearly on display in the SST, however they remain relevant to use later in life as they effect how we form relationships throughout our life.

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12
Q

What did Bowlby suggest about excessive and absent separation anxiety?

A

Too much separation anxiety was caused by a fear of abandonment the child has developed, possibly following an adverse family event e.g. divorce or sibling death.

Too little separation anxiety was interpreted as self defence, that the child was actually upset but hiding it (this was later confirmed experimentally). He theorised that any well loved child should react adversely to separation.

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13
Q

Describe the Still Face experiment?

A
  • Mother initially plays with the child, smiles at it, responds to it and generally mirrors the baby’s actions.
  • Then she turns away and stares back at the baby with a blank face.
  • Baby instantly realises something is wrong, tries to re-engage with the mother by using the same behaviour as possible.
  • When this fails baby shows distress, body starts to tense up, lets out cries and squeals to try and get mother’s attention back.
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14
Q

What does the Still Face Experiment show us about human attachment development?

A
  • Works on the process of Contingent Marked Mirroring; people like having their emotions reciprocated back to them, and feel shame and rejection when they aren’t. This is true in babies as well as in adults.
  • CMM is hugely important to emotional development.
  • CMM allows the child to feel understood and find its own feelings in its mother’s face.
  • Mother gives the baby’s feeling life and manages to regulate the baby’s feeling.
  • This ‘manageability’ is internalised by the baby and has an impact on how they regulate emotions throughout the rest of their life.
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15
Q

What happens when a child grows up without CMM? When they feel their emotions aren’t reciprocated (as in the still face experiment)?

A
  • Dissociation between the child’s emotion and the mother’s response is a source of shame to the child.
  • We can deal with this to an extent but if repeated throughout childhood can have a permanent effect.
  • In adulthood show disordered emotional development, which may present as a Personality Disorder.
  • These people tend to frequently misinterpret people’s emotions, often as more negative than they actually are, and struggle to interpret the minds of others.
  • Typically form emotionally unstable relationships with high degrees of conflict and abandonment, caused by this lack of self developed in childhood.
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16
Q

How does Contingent Marked Mirroring help a child develop emotionally?

A
  • Reflecting on a child’s mental state helps the child regulate their feelings.
  • Mirroring the child’s feelings helps them understand the feeling, child sees his feelings reflected back at him.
  • Through mirroring they ‘find’ themselves in the minds of others, and after understanding and regulating the feeling, the child learns to organise them.
  • When a child experiences a negative emotion (e.g. sadness or anxiety) they lose a sense of celebration of their feelings, seek help understanding them from a parent.
  • This allows the child to develop emotionally.
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17
Q

How does Contingent Marked Monitoring allow for affect regulation to develop in a baby?

A
  • The baby couples the experience of distress with the experience of an other being able to understand and manage this distress.
  • They retain this memory, as well as the relief that comes from this coupling.
  • This lays the seed for affect regulation and forms the basis of secure future attachment relationships.
  • Affect regulation is a crucial part of managing emotions and behaviour.
  • Children with insecure attachments often lack in affect regulation, which presents itself as behavioural problems, commonly misdiagnosed as ADHD.
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18
Q

What evidence is there linking attachment and later cognitive development?

A

Fonagy et al (1997):

  • Established link between attachment and cognitive development, specifically the Theory of Mind.
  • Led to work that linked attachment to mentalization, a cognitive process linked to the ToM.

Sroufe et al:
- More generally secure attachment is related to improved cognitive functioning and fewer behavioural problems

19
Q

What is the ‘Theory of Mind’

A
  • Theory of mind is the ability to attribute mental states — beliefs, intents, desires, emotions, knowledge, etc. — to oneself, and to others, and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own.
  • E.g. The moved ball story, requires an understanding that the character does not know what we (the viewer knows).
  • Develops around the age of 3 years old.
  • “My mother thinks, therefore I think, therefore I am”
20
Q

What effect does attachment have on a child developing the theory of mind?

A
  • Studies show children with a secure attachment develop the theory of mind sooner.
  • Children with insecure attachment and with reduced CMM develop the ToM much later, which may have an impact on their future relationships, as they struggle to relate to others and deduce how they are thinking.
21
Q

What are Adult Attachment Interviews?

A
  • A way of classifying an adult’s mental representations concerning relationships.
  • Series of questions that try and elicit both the participant’s childhood attachment experiences and how they’ve affected current functioning.
  • Produced 3 types of adult attachment.
22
Q

What are the 3 AAI classifications?

A
  • D: Dismissing-detached
  • E: Entangled-preoccupied
  • F: Autonomous-secure (“Free”)
23
Q

Describe AAI attachment Type D?

A

D = Dismissing-detached:

  • These mothers appear cut off from the emotional nature of their childhood experiences.
  • Current state of mind regarding their attachment is characterised by idealisation, derogation, insistence on not being able to remember, and cognitive formulations divorced from affect.
24
Q

Describe AAI attachment Type F?

A

F = Autonomous-secure:

  • These mothers show objectivity and balance when discussing their childhood experiences.
  • Were able to discuss both positive and negative experiences rationally.
25
Q

Describe AAI attachment Type E?

A

E = Entangled-preoccupied:

  • Over involved with their (sometimes traumatic) childhood experiences at time of interview.
  • Have often assumed the role of parenting the parent.
  • Interview style is incoherent and preoccupied with anger or passivity.
26
Q

How do mother’s AAI classification relate to infant’s Strange Situation response?

A

Autonomous Mother (F) = Secure Infant (B)

Dismissing Mother (D) = Avoidant Infant (A)

Preoccupied Mother (E) = Resistant/Ambivalent Infant (C)
(this is the most common one in therapy, most clinically relevant).
27
Q

What studies support the link between the mother’s attachment type and the child’s future attachment?

A

Fonagy et al (1991):

  • Prospective study.
  • Aimed to look at concordance between mother and child attachment classifications.
  • Predicted an association between a prenatal AAI classification and subsequent mother-infant attachment.
  • Found a 75% concordance between the two.
28
Q

What is Attachment Disorder? How is it different from disordered attachment?

A
  • In Attachment Disordered children, we are looking at wether that have an attachment at all, secure or otherwise.
  • Attachment Disordered children have difficulty forming any sort of attachment representation (again be it secure or insecure).
  • They have a theory of mind deficit.
29
Q

What studies have been conducted into Attachment Disorder?

A

O’Connor’s Romanian Adoptee Study:
- Found children placed later showed more disturbance, but length of time in placement did not make a significant difference to level of disturbance.

30
Q

How common are childhood mental and behavioural problems in the UK?

A
  • 1/8 have mental health problems.

- 1/16 have behavioural problems.

31
Q

What are the long and short term issues relating to attachment issues?

A

Short Term: immediate harm to child’s development, wellbeing, learning, achievement, family function, peer relationships

Long Term: risk to adult mental health, employment, economic independence, family welfare, crime

32
Q

How effective are Parenting Programmes as an intervention?

A

According to a 2013 NICE investigation, very effective when used HOWEVER..

Multiple issues in getting them to work, including:

  • Families often do not get the help they need
  • Families often don’t get the help early enough to make any real difference
  • Scale of need far outweighs resources
  • Complicated to set-up and maintain
  • Complex referral pathways
  • Stigma, patients don’t like the idea that they might be responsible for their child’s issues.
33
Q

What is Mentalizing?

A
  • Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes.
  • Mentalizing is a form of imaginative mental activity about others or oneself, where we perceive, interpret and make sense of behaviour in terms of intentional mental states (needs, desires, feelings…)
  • It focuses on the distinction and separateness of different minds, and the understanding that someone’s behaviour relates to activity going on in their own mind.
  • It lies somewhere between mindfulness (awareness of the self) and empathy (awareness of others).
  • A child’s secure attachment is partially to do with their parent being able to mentalize well.
34
Q

What are the key components to Mentalizing well?

A
  • Having curiosity about ourselves and others, absence of paranoia.
  • Having awareness of the impact of of affect on self and others
  • Understanding that other people’s minds are hard to read (and not just assuming we know what others are thinking). Parents should be curious about the thinking behind their child’s actions.
  • Contemplation and reflection on each other’s mental states.
  • Openness to discovery.
  • Predictability.
35
Q

What does good mentalizing allow between the parent and child?

A
  • Taking of different perspectives
  • Building of trust
  • Development of a coherent narrative about what is going on.
  • For good development, a child needs to experience a mind that has their mind in mind, a mind that is able to reflect his intentions accurately.
36
Q

Explain what happens when we mentalize well?

A
  • Parent notices child is grumpy.
  • Parent understands that they are grumpy and shows the child that they understand that they are grumpy.
  • This teaches the child about their emotions, what they are, why they exist and how to regulate them.
  • This teaching can help protect the child from later emotional disturbance.

HOWEVER if the parent has a deranged attachment style, they may struggle to do this, and this lack of understanding the child feels can create behavioural issues.

37
Q

What are the benefits to good mentalizing between a parent and their child?

A
  • Leads to greater emotion regulation for both the parent and the child.
  • In turn, greater emotion regulation is linked to better managed behaviour.
  • Secure attachment and good mentalizing are correlated.
  • It helps children to learn and practice skills in their own emotion regulation and hence have fewer behavioural problems.
  • Children have stronger pro-social orientations, more numerous and better friendships, and higher levels of peer acceptance when their parent mentalize well with them.
  • Good mentalizing also improves behavioural interventions in children with issues.
38
Q

What early evidence pointed researchers towards the importance of Mentalizing?

A
  • Initial research linked security of attachment to ability to understand the thoughts, feelings and intentions of others (Fonagy et al 1997)
  • Then a link between cognition and affect was established.
39
Q

At what age does the Theory of Mind begin to develop in a normal child?

A

2 y/o: Children make verbal references to mental states (desires and perceptions).

3 y/o: Kids begin to understand mental states related to thinking and knowing.

4 y/o: Children come to understand other minds (that someone can hold a false belief).

40
Q

What is the evidence supporting the importance of Reflective Parenting (aka making use of Mentalizing practices in parenting)?

A

Caspi et al (2004) found that more RP lead to:

  • Increased warmth, affection and positive affect.
  • Better adjustment.
  • Greater compliance.
  • Less anti-social behaviour.

Various other studies have linked Reflective parenting to anything from:

  • Secure attachment
  • Cognitive development
  • Social development
  • Fewer behavioural problems
  • Better emotional regulation
41
Q

What happens from the child’s perspective when they are mentalized well?

A
  • Parent reflecting on a child’s mental state helps the child regulate their feelings
  • Mirroring the child’s feelings helps them understand the feeling
  • Through mirroring, the child finds themselves in the mind of others.
  • After understanding and regulating the feeling, the child can learn to organise them.
  • Mentalizing helps a child understand both HOW he is feeling, WHY he feels this way, and HOW he’s going to manage them.
42
Q

How does stress affect mentalizing ability?

A
  • The more stressed we are, the more difficult we find it to mentalize.
  • BUT similarly, it’s also very difficult to mentalize when we have little emotional involvement in the situation.
  • There is a perfect mid ground of emotional involvement for peak mentalizing.
43
Q

Why is mentalizing especially relevant to Looked After Children?

A
  • Children who’ve been victims of abuse or neglect show really poor CMM ability.
  • They often have a perceptual bias towards feeling negative emotions, will interpret a neutral emotion in a threatening way.
  • This interpretation bias typically leads them to taking a “fight or flight” attitude, either becoming totally withdrawn or over active.
  • Therefore the more reflective a substitute parent is (e.g. in care), the better the outcome for the child in terms of behavioural development.
44
Q

What is poor mentalizing most strongly linked to in adolescence?

A
  • Self harm
  • Borderline Personality Disorder
  • Difficulties with identity, relationships and affect regulation.