Early attachment relationships play a crucial role in the development of healthy attachments in the later stages of our life. The ways we have been brought up, create the first templates of communication, which have unconscious effects in the way we behave and relate in our social interactions later on. In the following passages, there is going to be a brief discussion on the polarities of our experience with the world and how we form secure and insecure attachment styles. Traumatic experiences from parents could have a negative impact on the formation of a secure attachment, leading to the disorganized type. Even if the external reality is internalized, mentalization and mindfulness may work as buffers to keep the child from developing a healthy sense of self as an adult.
It is noteworthy to begin with Blatt’s (2008) book on the Polarities of Experience, which shows the need to integrate two essential poles of experience, self-definition, and relatedness. As he maintains, psychological development is a synergy between these two polarities, with most people leaning towards the anaclitic (relatedness) dimension or the introjective (self-definition) dimension. Emphasis on one at the expense of the other leads towards imbalance, which could lead to a mental disorder.
Blatt’s thesis deserves some more elaboration here. As he describes, on the anaclitic pole, the focus is to “establish and maintain reciprocal, meaningful, and personally satisfying interpersonal relationships” and on the introjective polarity, the focus is “to establish and maintain a coherent, realistic, differentiated, integrated, essentially positive sense of self” (p.3). Considering culture and gender differences, traits associated with self-definition are independence, achievement, separateness, power, self-reliance, agency, competition, and autonomy. Overemphasis on this pole, brings maladaptive traits such as envy, narcissism, entitlement, self-critical perfectionism, isolation, alienation, and aggression. The results on interpersonal relationships, could be being aloof, critical, judgmental, hostile, and domineering (Allen, 2018, p. 3). Traits associated with relatedness consist of cooperation, collaboration, mutuality, reciprocity, dependency, communion, empathy, affection, and intimacy. Overemphasis on that pole, brings excessive dependency, neediness, being sensitive to abandonment, passivity, submissiveness, and self-sacrifice.
A synergistic collaboration between these two poles brings a balance in the development of our relational self. We know and define ourselves in the context of being known by others, and by creating a healthy sense of identity and self-worth, we can safely enter into social relationships while maintaining our own boundaries and autonomy (Allen, 2018, p. 4).
Overreliance on one of the two poles, is evident in the developmental patterns of secure and insecure attachment. Specifically, avoidant attachment is associated with a focus on self-definition and autonomy to the marginalization of social relationships, whereas attachment characterized as ambivalent, is associated with an excessive effort to create close relationships to the marginalization of self-definition and identity (Allen, 2018, p. 4).
No exploration on attachment theory would be sufficient without mentioning Bowlby’s and Ainsworth’s classification of attachment. Described as the “dynamic duo” (R. Bowlby, personal communication, 2004, as cited in Wallin, 2007, p. 11) they are both regarded as the parents of attachment theory who have contributed to the understanding and necessity of the attachment of a child to its caregiver. As they maintained, it is the quality of communication that aids towards a secure or insecure attachment style. Of particular importance was Ainsworth’s Strange Situation observation, from which four distinct attachment patterns were distilled, namely, Secure Attachment, Avoidant Attachment, Ambivalent Attachment, and Disorganized/Disoriented Attachment which will be briefly described next.
Secure Attachment
For babies classified in this category, the reunion with the caregiver is such that they feel reassured and safe enough to resume back in exploration and play. Specifically, they show relatively low distress; cry comparatively little; are less anxious; enjoy close contact with their mother; and are more cooperative with the requests of their mothers (Allen, 2018, p. 29). With the words of Ainsworth (1963, p.103, as cited in Allen, 2018, p.29) secure babies “showed the strength of their attachment to the mother through their readiness to use her as a secure base from which they could both explore the world and expand their horizons to include other attachments”. This type of behavior was the result of the mothers’ sensitive approach who were responsive to their baby’s needs: quick to picking them up when in distress, showing tenderness and care, appreciating when the baby wants to be held, and being in attunement and acceptance, cooperating and emotionally available (Ainsworth et al., 1978, as cited in Wallin, 2007, p. 19).
Children in this pattern type turn out to be adults with high self-esteem; resilient; having positive affect; develop initiatives; socially competent; and able to maintain their concentration longer than their counterparts in the insecure attachment pattern (Wallin, 2007, p. 23).
Avoidant Attachment
Babies in this category appear to be unconcerned about the mother’s departure or return. They do not show any distress and show a calm demeanor despite their physiological arousal. There is a marked difference in their choice to explore instead of being attached to the caregiver. The child is absorbed in a solitary activity of play (Allen, 2018). Ainsworth concluded that this superficial indifference of the baby’s behavior seemed to describe a detachment from the primary caregiver as a result of an avoidant mother, as if the baby’s efforts of comfort and care would be in vain. A withdrawn mother exhibiting inhibition of emotional expression and aversion to physical contact would eventually result in an avoidant attachment with the toddler (Main & Weston, 1982).
Children in this pattern type turn out to be adults with arrogance, usually oppositional and aggressive and easy to victimize others. Additionally, avoidant attachment has been tied to narcissistic, obsessional, and schizoid problems (Wallin, 2007, p. 24).
Ambivalent Attachment
Babies classified in this category, show patterns of being either angry or passive. There was a preoccupation of the mother’s presence, which as a result they would not freely explore their environment and they would be overly distressed of their mother’s departure. On reunion, the angry infants would be throwing a temper tantrum or rejecting any physical connection, whereas the passive infants would be only slightly solaced and then thrown in a state of helplessness and despair (Wallin, 2007, p. 20).
Ainsworth suggested that the ambivalent infants had mothers who were only occasionally and capriciously available, and their responsiveness to the infants’ needs were not sensitive and attuned. Additionally, the mothers would discourage the child’s autonomy by picking them up whenever they wanted without the child’s assent (Wallin, 2007, p. 20).
Children in this pattern type turn out to show signs of immaturity and clinginess, and often seem to show a behavior of being victimized and might later show hysteric or histrionic symptoms of behavior (Wallin, 2007, p. 23)
Internal Working Models and Psychoanalysis
The mentalizing model has been described to be a recent psychoanalytic extension associated with attachment theory, positing that there is a synergy between attachment processes and the child’s internal capacity state. This capacity is described as mentalizing or reflective functioning, as a contributing factor of self-organization and affect regulation (Fonagy, Luyten, Allison, & Campbell, 2018, pp. 20-21).
According to Bowlby, children develop internal working models of attachment relationships as soon as they develop their language ability. As he describes it, the children construct working models on how the physical world may be expected to behave, how their significant caregivers are expected to behave, how he himself is expected to behave and how each system interacts with the other. Then, the child evaluates this situation and makes his plans. In other words, the child creates mental representations of the outer reality (Allen, 2018, p. 16).
However, how Bowlby differentiated from psychoanalysis was that despite the inner workings and gravitation towards fantasy, he maintained that “the varied expectations of the accessibility and responsiveness of attachment figures that different individuals develop during the years of immaturity are tolerably accurate reflections of the experiences those individual have actually had” (Bowlby, 1973, p.202, as cited in Allen, 2018, p.17). If in these internal mental representations, the child conceives the world as a threatening place, it will eventually lead him to feel afraid and alone, which can be abusive and traumatic to the child’s development (Allen, 2018, p. 164).
Attachment Trauma and Disorganized/Disoriented attachment
Before proceeding to a brief discussion on the Disorganized attachment type, it is warranted that a definition of trauma should be laid out. According to the 13th John Bowlby Memorial Conference in 2006, trauma is defined as
…the exposure to life threatening experiences (actual or perceived) where a person is faced with overwhelming feelings of helplessness and terror at the possibility of annihilation: life and death moments, accompanied by abandonment, isolation, hopelessness, shame, and invincibility. These include experiences that engender a fear of disintegration and threaten a person’s psychic survival far beyond the moment of actual threat (Benamer & White, 2018, p. 2).
Furthermore, unpredictability and uncontrollability are the hallmarks of traumatic experience (Foa, Zinbarg, & Rothbaum, 1992). In addition to that, there is a failure from the parent to have the child’s mind to mind (mentalization), which results in the feeling of helplessness and distrust (Allen, 2018, p. 198). Attachment trauma, therefore, results to what Fonagy and Target (1997, as cited in Allen, 2018, p.163) describe: a dual liability in the sense that trauma induces intense emotional distress, and it challenges emotional regulation.
Trauma can be particularly evident in the fourth attachment type, the disorganized type. Babies in this category appear to show bizarre and contradictory behaviors. Upon reunion with the mother, they would turn their backs toward them; freeze; collapse to the floor; be avoidant; or appear be mentally absent and confused (Wallin, 2007, p. 22; Padrón, Carlson, & Sroufe, 2014).
Moreover, the toddler will show a sequence of behaviors such as contradictory behavior to the separations and reunions; stereotypical or anomalous movements such as twisting, tics, or other movements; apprehension regarding the parent; disorganized wandering; dissociative detachment in being disconnected from the present reality and dissociative compartmentalization of emotions or memories out of awareness until a sudden eruption of anger (Allen, 2018, p. 168).
Children in this category often develop controlling strategies to interact with their mother (Allen, 2018, p. 169) and adopt role reversals in an attempt to reestablish the protective caregiving attachment (Solomon & George, 2011). Controlling-punitive children use cruel commands, verbal threats, humiliation, and physical aggression to manage the relationship whereas controlling-caregiving children are animated, helpful, polite, and attentive to their mother (Allen, 2018, pp. 169-170).
In this situation, it is hypothesized that the caregiver is concurrently experienced as a safe haven and danger, which causes the child to become contradicted in alarm situations in turning towards the caregiver or avoiding her. Hesse and Main (2000) proposed that certain types of frightening parent behavior will provoke “contradictory biologically channeled propsensities to approach and to take flight from the parents” which often stems from mistreated infants. Three forms of maltreatment are evident here: physical abuse (i.e. spanking and angry parental eruptions); psychological unavailability (i.e. parental unresponsiveness, rejection, detachment and emotional withdrawal); and neglect (i.e. no provision of physical care or protection from dangers in the house) (Allen, 2018, p. 171).
Children in this category will turn out to be in high risk for a psychopathology such as borderline traits (Wallin, 2007, p. 24) and become developmentally traumatized by developing mistrust and fear of emotional openness and connection (Allen, 2018, p. 165).
Treatment
The emphasis here is on developing a secure therapeutic relationship with our client and foster a reflective mentalizing approach, incorporating values of flexibility, openness, and curiosity in considering multiple perspectives of the experience. Using the representations of the internal world, we can learn to develop what Wallin (2007, p. 307) states “the double helix of psychological liberation”, that is, mentalizing and mindfulness.
Speeth (1982) in her article on Psychotherapeutic Attention, makes a case on the necessity of maintaining attention in both the inner and the outer worlds, in order for therapy to be real therapy and not just a conversation; from the panoramic (wide focus evenly invested attention) to the narrow focused (specifically invested attention) while witnessing our own consciousness shifting from inside to the outside and back again while being aware of it. Much like Freud’s “evenly hovering attention”, we become mindful of the present moment and vigilant of what the client brings to therapy. Using mentalization by thinking about the meaning of our experience, and mindfulness of the here-and-now, we set the tone for effective and secure therapy.
As Wallin (2007, p. 310) states, mentalizing is the “…staple of psychotherapeutic practice”. Trying to understand the client’s experience in terms of feelings, beliefs, and desires that give meaning to the experience is a therapeutic practice. Used interchangeably with mindfullness, we can learn to be better “mentalizers” by being “fully and calmly present”.
Consequently, much like the sensitively responsive parent, the empathically attuned therapist can use the experience of the relationship, in which the attachment figure has the client’s mind in mind (Wallin, 2007, p. 311). As Wallin states,
“we mentalize explicitly, and invite the patient to do the same…to understand the experience of the patient or… the therapeutic interaction…. It is the therapist’s mentalizing…in the context of an increasingly secure relationship of attachment that gradually strengthens the patient’s ability to adopt a mentalizing stance. Similarly, the therapist who is capable of mindfulness can use the relationship to help foster the patient’s own capacity to be mindful” (p. 312).
In the presence of a calm, caring, cognitively flexible and accepting therapist, the traumatized client can relive the past in the here-and-now, and adopt this “double helix” to liberate our clients from their struggles; help them feel a sense of agency; regulate their emotions effectively; and within the security of the relationship, to integrate the dissociated experience of the past and recognize the new experience of the present moment (Wallin, 2007, p. 312) in a humanistic and kind way (Allen, 2018, p. 273).
References
Allen, J. G. (2018). Mentalizing in the Development and Treatment of Attachment Trauma. New York: Routledge.
Benamer, S., & White, K. (2018). Trauma and Attachment. Introduction to the Monograph of the 13th John Bowlby Memorial Conference 2006 (pp. 1-3). New York: Routledge.
Foa, E. B., Zinbarg, R., & Rothbaum, B. O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. Psychological bulletin, 112(2), 218-238.
Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2018). Reconciling psychoanalytic ideas with attachment theory. Guilford Press, 1-66.
Hesse, E., & Main, M. (2000). Disorganized infant, child, and adult attachment: Collapse in behavioral and attentional strategies. Journal of the American Psychoanalytic Association, 48(4), 1097-1127.
Main, M., & Weston, D. (1982). Avoidance of the attachment figure in infancy: Descriptions and interpretations. In C. Parker, & J. Stevenson-Hinde, The Place of Attachment in Human Behavior. New York: Basic Books.
Padrón, E., Carlson, E. A., & Sroufe, L. A. (2014). Frightened versus not frightened disorganized infant attachment: Newborn characteristics and maternal caregiving. American Journal of Orthopsychiatry, 84(2), 201-208.
Solomon, J., & George, C. (2011). Disorganization of maternal caregiving across two generations. Disorganized attachment & caregiving, 25-51.
Speeth, K. R. (1982). On psychotherapeutic attention. Journal of Transpersonal Psychology, 14(2), 141-160.
Wallin, D. J. (2007). Attachment in psychotherapy. New York : Guilford Press.
