Attachment?

One of the things that I come across time and again working with adoptive parents, parents with SGO's and indeed the wider system working with adopted, fostered children as well as children on the edge of care is the ‘problem of attachment’. And specifically trying to find a common language to describe real, observable processes, based on the developmental science.

There are so many different meanings of the word ‘attachment’ and few people use it in exactly the same way. This becomes a major issue when different stakeholders come together to think about a child’s specific needs – they may all agree that “attachment is an issue for Jan”, but behind that superficial agreement they may mean quite different things. And that can have big implications for Jan getting the right help.

What do you mean by attachment?

So, it seems like it should be important to ask “What do you mean by attachment?” – but that question often doesn’t go down very well. As if you may be challenging an expert’s fundamental beliefs, or even worse implying they are ignorant; when really you are asking do our ideas about what attachment means align?

When I am teaching practitioners, I usually ask them to sketch out a one sentence ‘pitch’ on what attachment is – as if they had just been asked by a parent or young person or GP or whoever… “What do you mean attachment? What’s all that then?” It is extremely hard to put all that attachment can encompass into one sentence and then to have that stand as a good enough response to a query about attachment.

Typically, if I have a group of practitioners, and we share these one-sentence pitches, while we may find most fit with a broad understanding of what attachment might be, there are notable differences even so. A focus on the earliest experiences in infancy; ideas about attachment patterns or disorders; bonding and connection; through to being a parent; or how it influences personality, perhaps in adult romantic relationships. Sometimes it seems to be within the child entirely; sometimes it is the relationship between them; and at others it appears to be what the parent does… so many possible points of difference.

Here are some of the kinds of things people might say - there are many, many more; probably as many as the people you ask. They may feel very similar as you read through them but drilling down into the detail they can become quite different.

An emotional connection or bond with another person which is not always reciprocal. The way we connect with others is usually influenced by our early experiences of bonding or our relationship with our primary caregiver.

Attachment is an internal model for the way in which a person relates to people throughout life. This is based on our earliest experiences with our caregivers. It can determine how safe and predictable the world is.

When babies are born they activate a caring response from one or more adult caregivers to provide for their physical and emotional needs to survive and thrive and to develop into healthy adults who can form bonds and enable children in the next generation

Attachment is how a person relates or connects with another person based on the connection with their primary caregiver, which creates the pattern for relating with other people.

The emotional and physical relationship between a new born child and a one/ both primary care givers throughout the child's developmental stages.

Attachment is our own way of relating to others, which is formed in our first or primary relationship and gives us our template or pattern of relating to others. Our attachment also shapes our view of ourselves and others.

An emotional connection with a caregiver that enables a person to get their needs met and feel safe. This later influences their ability to relate to others

A connection that you form with early care givers that serves the function of creating emotional safety and regulation which then becomes your pattern of relating to others later on.

A pattern of behaviour / ways of relating to adults based on early childhood experiences with primary caregivers.

Attachment is strategies to keep safe, often to elicit care and protection from care-givers.

Can we get consensus?

I wear two hats. I am an attachment researcher by background, but also a consultant clinical psychologist in the National Adoption & Fostering Clinic at the Maudsley Hospital, London [here]. I was an attachment researcher long before I became a clinician and so attachment terms and their definitions still mean a lot to me in my practice. However, in clinical work or other applied settings [social work, education, policy, teaching & training etc] most people tend to use ‘attachment’ rather differently to how it is used in research settings.

In research we rarely use the term ‘attachment’ on its own but rather pair it other nouns like: attachment system; attachment figure; attachment relationship; attachment behaviour; attachment pattern… Before we even get to ideas of attachment security or insecurity or disorganization/disorientation or attachment pathologies/disorders; or representations and models/scripts or states of mind.

There have been some very interesting developments recently trying to map what different people may mean when they use this important but in practice rather vague term. In particular the Society for Emotion and Attachment Studies (SEAS) has produced a helpful guide [here] which draws in part from some research conducted with colleagues [here]… more about that another day…

And if you are interested in some of the historical reasons why we may have ended up with such a complex mix of understandings about attachment, then Robbie Duschinsky has done a huge amount to clarify this [see here for an intro and pointers to further reading]. Actually, there is a lot one could say about attachment in relation to social-political-historical practices and processes, and Robbie and others have done a lot of thinking about that too, so I may come back to that one day.

Are we there yet?

So can we relax now that there is final consensus and clarity? I think not. If I look at my own take on clarifying attachment terms, I know I write about it somewhat differently at different times and for different audiences – so I end up being part of the problem too. For comparison, below are two examples.

a) One is from an email I wrote to a carer several years ago who wanted clarity about some attachment terms that had been causing problems in their negotiations about getting the right kind of care for their child [see below]. I had a go at clarifying, trying to keep the content accessible, relatively brief and to be true to what I thought the research was saying; and also what seemed important to highlight in that context. I am not sure how helpful my ‘clarifications’ were, to be honest…maybe just more noise in the system?

b) The other is a link to the chapter I wrote on attachment theory for Wiley’s Encyclopaedia of Child and Adolescent Development (2021) – which can be accessed here from my ResearchGate page.

If I was asked to write the same things now, without looking at what I had written before, I am sure it would be pretty similar, but also at least a bit different. So too if you asked another expert colleague to do the same. Probably the only area that I am rigidly consistent about in the clinic is around attachment pathology [e.g., reactive attachment disorder or disinhibited social engagement disorder] because these are my particular clinical/research interest, and because as diagnoses they have their definitions written out in formal, diagnostic systems - even if lots of practitioners don’t seem to bother to follow these definitions…but that’s another story, for another day.

Just ask

So, if someone talks to you about attachment, it is probably safest to be curious, and ask them what they mean, because you know people can mean many different things by it. It feels almost inevitable that there will continue to be these differences, so we need to find a way to manage them and accommodate them; and that means talking about them, sharing our understanding. And to be open to others also being curious about what we mean by it.

a) Attachment terms email [from circa 2018]

Attachment System

Bowlby described a biologically rooted system that had been hardwired into us by evolution to keep the vulnerable human infant safe by ensuring that when the child became distressed, or tired or ill or frightened, this system would kick into action and directing the child to seek comfort from a small set of specific caregivers, seeking proximity to them and comfort from them. This system is important because human infants are born very immature compared to other mammals and their brains and bodies need to keep growing outside the womb. So that means they need to be carefully looked after during this critical but vulnerable phase and this system keeps children close to parents when they come under some kind of threat. And when the child isn’t under threat then the attachment system isn't activated, so you don’t see attachment behaviours. Instead, other behavioural systems such as those to explore their environment or meet their biological needs for hunger and warmth etc come to the forefront. It means that attachment is not the only show in town, even for infants.

Attachment Figure

Infants need to identify a small set of people towards whom their attachment system is oriented and to whom attachment behaviour is directed, and these are their attachment figures. In the original theory Bowlby talked about a child's relationship to the mother and the idea of "monotropy" which means one figure above all else. But the research, and Bowlby himself, loosened this up over time to incorporate others beyond mothers. Parents will recognise that there can be other people in the system around the child who have important caretaking duties and over time, the child may well develop an attachment relationship to them. But the number of attachment figures a child has any one time isn't going to be open-ended and there are good reasons for thinking there ought to be fewer rather than many.

Attachment Relationship

An infant has a relationship with an attachment figure to whom their attachment system is oriented and towards whom their attachment behaviour is directed [once the attachment system is activated by stress etc]. Now, an infant may well have other elements in their relationship with their attachment figure that are not at all about attachment. They may well enjoy playing with that person, that person may well feed and bathe them and keep them warm as well, all of which are not directly related to the activation of the attachment system or attachment behaviours, but take place within this special relationship they have the attachment figure. So they are related to it, in so far as they occur between the same people, but are not the same as the attachment behaviours that a child expresses. It can be important to distinguish what bits of a parent-child relationship are specifically attachment-related and what bits are not. You cannot just look at the parent-child relationship and assume you are seeing the ‘attachment’ in some way…nor can you attribute all behaviour in an attachment relationship to be about, or because of, ‘attachment’.

Attachment Behaviours

When an infant is stressed and their attachment system is activated and they have need of their attachment figure, then they are likely to express a number of attachment behaviours which could include things like crying, as a signal to the caregiver (their attachment figure) that they need some help, love or support. They may also call or make their way towards their attachment figure; they may reach up to them, or they may try and climb up on their legs to get their attention and to achieve the proximity and to maintain that closeness until they feel sufficiently calmed again that they can return to play - because their attachment system has started to deactivate and the other non-attachment systems have come back into play. There is a lot more that could be said about what behaviours are specifically attachment behaviours, but not here. But briefly, attachment behaviours can vary over time and context, but their common thread is that they occur when the attachment system is activated and are directed towards the attachment figure, with the purpose of seeking or maintaining proximity to their attachment figure, until they feel calmer and the attachment system begins to deactivate. 

Attachment Pattern

There has been a huge amount of research in developmental psychology looking at the quality of an infant's attachment relationship with their attachment figure by paying attention to the kinds of attachment behaviours they express once the attachment system has been activated. The gold standard approach to this is the Ainsworth strange situation procedure, which is a structured way of gradually increasing the stress on an infant in order to activate their attachment system in a carefully controlled way. This procedure is especially interested to see how their attachment behaviours work when their attachment figure is separated from them and then is returned to them in a series of two reunions. The way in which they express their attachment behaviours, but especially the ways in which they move from an activated [or aroused] attachment state to a calmer, deactivated state with their attachment figure tells us something about the quality of the strategies they use in that attachment relationship, when their attachment system is activated. Specifically, we look for evidence in the first instance of three types of organised attachment strategies that enable a child to achieve their attachment aims of closeness and proximity to the parent, in a way that is most adaptive to the quality of caregiving that attachment figure has given them in the past and is thus likely to offer them right now when they need it. We watch videos of the procedure over and over, and using a Handbook to guide us, can assign an infant to one of three organised attachment patterns that best fit their behaviours. Then we can also look at their degree of disorganization/disorientation across the episode. Again, much, much more could be said here.