Case study

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SWK313Module4Week7_AttachmentTheory_Powerpoint.pptx

Module 4: Attachment Theory & Trauma Informed Practice

SWK313 Engaging with Individuals and Families in Partnership

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Module 4 Online Learning Activity

Case Study continued: Learning more about Jemima and Isaac

You have now seen Erica on 3 occasions. She tells you her cultural background is Aboriginal. She begins to open up about the problems in her relationship with Jim, and her worries about the impact of this on her children. Erica explains that Jemima is from a previous relationship and that her previous partner was very violent towards her so she left him when Jemima was around 3 years of age and they have not had contact with him at all in the past six years. Erica is worried because she can see signs that Jim is becoming increasingly angry and frustrated with her.

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Module 4 Online Learning Activity

Erica describes Jemima as a sensitive child. Erica tells you that Jim is very harsh on Jemima, yelling at her often, sending her to her room and seems to favour Isaac. Erica has spoken to Jim about this but Jim responds by telling her she is ‘crazy’ and that Jemima needs to ‘grow up’. Erica tells you that Jemima has recently become very withdrawn.

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Module 4 Online Learning Activity

Respond to the following questions: 

How could you use attachment theory and trauma informed practice to understand Jemima’s circumstances in this case?

Would there be any need for risk assessment in this situation? Why or why not?

What specialist skills and knowledge would you need to work directly with Jemima?

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Week 7: Attachment Theory

Self care*

Relevance for practice

Human development

Neurobiology

Assessment

Critique and debates

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*Self care – Equity services, personal support networks, be aware of triggers in content of Module 4.

See also text – Payne: Psychodynamic practice – Chapter 4 pp 120 – 126

People’s behaviour is affected by experiences of attachments to others

Psychological orientations however sociological perspectives also important

AT focuses on child’s early experiences of relationships with others

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Attachment Theory & Assessment

Relevant to diverse fields of practice:

Child protection work

Family Law & post-separation arrangements

Corrections

Adoption

Parenting and family support programs

Education

Mental health

Therapeutic approaches

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What do children need?

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UN Convention on the Rights of the Child

https://depdcblog.wordpress.com/2011/04/28/conventional-wisdom-series-part-3-convention-on-the-rights-of-the-child/

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Nature + Nurture…

“Genes provide a blueprint for the brain, but a child’s environment and experiences carry out the construction.

The excess of synapses produced by a child’s brain in the first three years makes the brain especially responsive to external input. During this period, the brain can “capture” experience more efficiently than it will be able to later, when the pruning of synapses is underway. The brain’s ability to shape itself – called plasticity – lets humans adapt more readily and more quickly than we could if genes alone determined our wiring.”

From http://www.urbanchildinstitute.org/why-0-3/baby-and-brain

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Human Brain Development

Source: Corel, JL. The postnatal development of the human cerebral cortex. Cambridge, MA: Harvard University Press; 1975.

Synapse density over time

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Attachment Theory

“…a way of conceptualising the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality disturbance… to which unwilling separation and loss give rise”

Bowlby (1977 p.127)

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Attachment

“a bond of psychological dependence that a child develops with a caregiving adult”

McIntosh (2000)

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Foundations

Evolution & ethology studies

Konrad Lorenz (1952) – imprinting

Harry Harlow (1960s) – monkey experiments

Erik Erikson (1963) – Stages of psychosocial development

Abraham Maslow (1943) – hierarchy of needs

John Bowlby (1951) – parent-child separation in WWII

Mary Ainsworth – Strange Situation Classification

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Erik Erikson

Erikson’s work in the 1950s grew from, and then challenged dominant psychodynamic perspectives of human development

Normative & descriptive (may not account for diversity or action)

People need different things as they go through different stages of development

First to look at interaction between biological and social factors

Language present in social work practice (e.g. psychosocial assessments)

Caregiver focus – a key factor in development

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Expanded on psychodynamic stages of development

Emphasizes cultural and social pressures

Influenced crisis intervention

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Erikson’s Theory

Social development occurs through a combination of psychological processes within individuals, and through their interaction with others.

Development viewed as a progression through 8 psychosocial stages

The child’s ability to successfully deal with the different psychosocial crises at each stage is primarily dependent upon relationships with parents/caregivers.

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Stage 1 & 2

1. TRUST vs. MISTRUST

0-18 months

When a child develops a health sense of trust the infant will view his world as predicable, safe, caring and happy place.

2. AUTONOMY vs. SHAME

18/24 months – 3 years

Successful attempts made by the child to establish their independence contributes to a sense of autonomy.

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Stage 3 & 4

3. INITIATIVE vs. GUILT

3-5 years

Children develop an increasing sense of their own power and independence.

A child may develop a sense of guilt which will impact on the child’s own choices

4. INDUSTRY vs. INFERIORITY

6-13 years

Child comparing self worth to others (e.g. classroom environment).

Child can recognise major disparities in personal abilities relative to other children.

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Stage 5

5. IDENTITY vs ROLE CONFUSION

14 years until mid-20s

If parents allow the young person to explore, they will form their own identity on the basis of their own experiences and healthy sense of self

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Stage 6, 7 & 8

6. INTIMACY vs ISOLATION

mid 20s – early 40s

7. GENERATIVITY vs STAGNATION

40s – mid-60s

8. INTEGRITY vs DESPAIR

from mid 60s

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Harry Harlow

Konrad Lorenz

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Lorenz: imprinting as the primary formation of social bonds – special type of learning.

Harlow: research areas included learning motivation, affection – used monkeys to demonstrate universal need for contact and this is stronger than other needs/drives such as food.

Separated babies from mothers 6-12 hours after birth and raised with surrogate mothers made of cloth or mesh. Food could be obtained from some of both models. Babies chose to spend more time with cloth surrogates rather than wire surrogates, even if wire ones provided food – need for closeness and affection.

As adult monkeys – they had distinct behavioural patterns – excessive aggression, rocking, mating behaviour affected

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Imprinting

Konrad Lorenz (Austrian biologist) devised the term imprinting to describe the behaviour of geese

Imprinting was looked at as the basis for biological survival in animals and humans

Babies will imprint on a human face and this is how a baby will learn from interaction with its mother or carer

Infants are genetically predisposed to form relationships and respond to significant caregivers differently (preference).

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Bowlby’s Theory of Attachment

John Bowlby

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Psychoanalyst – mental health and behavioural problems stem from early childhood

Evolutionary theory of attachment – children pre-programmed to form attachments because this helps them to survive.

Fear of strangers is a survival mechanism

Behaviour of babies – to help ensure proximity and contact can be maintained with the attachment figure (care giver)

Attachment figure provides a safe base for exploring the world

Food is of secondary importance – main determinant of attachment is care and responsiveness

Disruption with initial attachment figure has consequences for later relationships and behaviours

Critical period – 2.5-3 years

Risk continues until age 5

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Bowlby’s Theory of Attachment

Bowlby’s theory grew from his work with children separated from their parents in the UK during WWII.

Humans, like animals have a set of innate behaviours that heighten the likelihood of survival – security is essential and goes beyond biological needs

Adult caregivers interpret and respond to infant’s cues, to remain close and thus protect and respond to a baby/child’s needs

Infants and adult caregivers form an attachment at a critical point (0-2 years)

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Bowlby’s theory continued

Consistent care by a significant carer should be for the first two years of life for a child and if this care was disrupted during this period it could lead to long-term consequences.

Positive experiences through these stages impact on personality development and provides a foundation for healthy future relationships.

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Moved from psychoanalytic interest in mother-child relationships towards research and theory about maternal deprivation – personal development is impacted by contact with caregivers

Loss of parent/caregiver is significant – goes beyond impact of mourning and bereavement for children

Death

Divorce

Abandonment

However there are also a broad range of social factors that can impact on child development

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Bowlby’s theory continued

The child develops a set of expectations of themselves and their primary carer.

Attachment will then involve a view of self and a view of others.

Trauma can impact on the brain and central nervous system

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Ainsworth & the Strange Situation Classification

Mary Ainsworth

Strange Situation Classification

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Categories of attachment – build a picture of how the relationship between child and care giver works (Payne p.120-121

Children aged 1-3 years

Preparation – child plays, parent is present but uninvolved

First appearance of stranger – chats to parent, offers toys to child. Child looks for reassurance

First separation – parent leaves, If child stops playing stranger interests child in toys. Most children do not go to stranger

First reunion – parent returns and waits for child to respond. 3 different reactions (categories) to seek proximity

Second separation – child settles and parent leaves – child cries and goes to door

Second appearance of stranger – tries to interest child with toy – most children don’t go to stranger

Second reunion – parent reenters & picks up child – three reactions possible

Possible reactions:

Secure – go to carer and carer responds

Insecure avoidant – learnt not to display feelings – supress anxiety – upset when carer leaves but unmoved when parent returns (carer expects child to manage emotions)

Insecure ambivalent – learnt carer does not respond consistently – children also react randomly and unpredictably

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Categories of Attachment

Mary Ainsworth (1978) identified different patterns of attachment through empirical studies of childrearing patterns in Uganda and USA

Proposed 3 categories of infant attachment behaviours (Type D later added by Main and Solomon in 1986)

Linked the child behaviours to the carer’s behaviours.

Primary caregivers may have differing levels of responsiveness, nurturing and care toward an infant.

This will impact upon the type of attachment relationship formed between infant and carer

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Cultural factors taken into account?

Ainsworth’s research indicated

60% of children fall into secure category

25% avoidant

11% ambivalent

4 % disorganised - fearful – do not know if they can safely achieve proximity

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Secure Attachment (Type B)

Child feels secure and safe in a carer’s presence and is allowed to safely explore and examine their environment.

Upon separation from the carer the child may be upset but can be easily pacified until the carer’s return.

Children with a secure attachment tend to have positive self esteem, autonomy, independence.

Carer responds readily responds to cries, communicates and reciprocates with smiles and affection

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Anxious-Avoidant Attachment (Type A)

Child who is unaffected or not distressed by a caregiver’s departure from an area.

The child is often unresponsive to the carer when available and may show little preference for this individual in comparison to a stranger

When carer returns the child may ignore them and keep their distance (indiscriminate attachment)

Carers insensitive to child’s expressions of discomfort, little physical contact or emotional responsiveness

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Anxious-Resistant Attachment (Type C)

Also referred to as Ambivalent

Little interest in exploring the environment

Child becomes extremely distressed when left alone or in the presence of an unfamiliar adult.

When the carer returns, will respond in an angry manner and will not be easily comforted or accept reassurance

Carers demonstrated clear inconsistency in in responding to child’s needs, uninvolved, withdraws.

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Disorganised-Disoriented (Type D)

Child with this style of attachment shows confused, conflicting or contradictory behaviour in the presence of their significant caregiver.

This style of attachment may have resulted from a child who should find comfort from their mother/carer but instead are stressed by them.

Present in 80% of maltreated children (e.g. alcohol abuse and/or intimate partner violence may be a factor)

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Attachment Style Parental Styles Adult characteristics
Secure (B) Aligned with child. In tune with child’s emotions Able to create meaningful relationships; empathetic; appropriate boundaries
Avoidant (A) Unavailable or rejecting Avoids closeness or emotional connection; critical; rigid; intolerant
Ambivalent (C) Inconsistent, intrusive parental communication Anxious; insecure; controlling; blaming; erratic; unpredictable
Disorganised (D) Ignored or didn’t see child’s needs; frightening or traumatizing Chaotic; explosive; abusive; insensitive; untrusting but craves security
Reactive Extremely unattached; malfunctioning Cannot establish positive relationships

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Critique

Normative theory of secure attachment - assumptions of universality not always supported)

Understood in terms of survival? Strengths?

Research has not expanded much into ‘natural settings’ (e.g. home environment)

Cultural considerations - see Keller (2013)

Relies on dyadic relationship between carer and child and ignores other parenting arrangements

What about resilience, repair and recovery…

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Assessing Attachment

Range of tools, procedures and policies depending on the context of practice (e.g. family court, caregiver assessments)

Use in decision making? Accountability? Purpose?

Transparency with client, acknowledgement of intrusiveness?

Training for staff?

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Assessing Attachment

Normative standards combined with recognition of context

Evidence – observations, other sources of information? (time required)

Practitioner-oriented or allow for participation and other perspectives? (extended family, teachers etc.)

Strengths approach? Intervention/support available?

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Discussion

Brainstorm the types of services that focus on the health and wellbeing of children in your local area. How might these services use attachment theory in practice?

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Refer to materials on Learnline (e.g. You tube clips, links to child protection information on AIFS, Life Matters pod cast) for examples as needed.

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