Attachment theory in clinical work with adolescent mothers

Introduction

The roots of attachment theory were first established in the 1930s and 1940s when a number of clinicians observed the negative effects of maternal separations early in life. The theory of attachment was first proposed by John Bowlby who described it as a ‘lasting psychological connectedness between human beings in 1988. Attachment theory is the joint work of John Bowlby and Mary Ainsworth. Attachment refers to the special bond and the lasting relationships that young children form with one or more adults. He considered that children need to develop a secure attachment with their main care giver in their early years. Secure attachments support mental processes that enable the child to regulate emotions, reduce fear, attune to others, have self-understanding and insight, empathy for others and appropriate moral reasoning. Bowlby called these mental representations the internal working model. Insecure attachments, on the other hand, can have unfortunate consequences. If a child cannot rely on an adult to respond to their needs in times of stress, they are unable to learn how to relax themselves, manage their emotions and engage in reciprocal relationships. It refers specifically to the child’s sense of security and safety when in the company of a particular adult. During adolescence, the hierarchy of attachment figures is gradually reshuffled as young people increasingly direct their attachment behaviors and concerns toward peers rather than parents. This theory has been revised to acknowledge that multiple attachments can occur with other adults throughout the lifespan, although early experiences may continue to have an impact. A child’s initial dependence on others for protection provides the experiences and skills to help a child cope with frustrations, develop self-confidence and pro-social relationships - all qualities necessary to promote positive engagement with learning. Although parents are generally not completely displaced as attachment figures during this period, or perhaps ever, they slowly become what Weiss called 'attachment figures in reserve.' By the end of this period, sometime in early adulthood, most people settle on a single romantic partner who will serve for years, if not for the remainder of life, as a primary attachment figure. While making this transition, many adolescents alter their conceptions of and feelings about themselves and experiment with a range of exploratory behaviors (e.g., sex and substance use) that may be developmentally functional but nonetheless carry substantial risk of harm. Despite the co-occurrence of these phenomena during adolescence, little is known about how attachment patterns are related to the emotional experiences, attempts at self-definition, and exploratory behaviors characteristic of this developmental period. Mary Ainsworth, 6 years younger than Bowlby, finished graduate study at the University of Toronto just before World War II courses with William Blatz had introduced her to security theory, which both reformulated and challenged Freudian ideas, though Blatz chose not to recognize his debt to Freud because of the anti-Freudian climate that pervaded the University of Toronto at that time. One of the major tenets of security theory is that infants and young children need to develop a secure dependence on parents before launching out into unfamiliar situations. In her dissertation, entitled “An Evaluation of Adjustment Based Upon the Concept of Security,” Mary Salter states it this way: Familial security in the early stages is of a dependent type and forms a basis from which the individual can work out gradually, forming new skills and interests in other fields. Where familial security is lacking, the individual is handicapped by the lack what might be called a secure base italics added to work.

Review Of Literature

This paper provides a review of attachment theory and relates the attachment perspective to the unique challenges of clinical work with adolescent mothers and their children. Infants of adolescent mothers are at risk for poor attachment outcomes that are associated with long-term adverse consequences in cognitive, adaptive, and behavioral domains. A secure attachment relationship evolves from a mother’s ability to be reflective, responsive, and sensitive to her infant’s needs and results in the infant’s development of trust, confidence, and resilience in later life. Adolescent mothers may not intuitively be able to assume these characteristics that foster secure attachment because of their own developmental stage. It is critical for clinicians to be able to recognize signs of poor attachment that can most easily be picked up by observations of the mother’s interactions with her infant and to learn to model favorable parenting behaviors that enhance attachment. Secure attachment is a critical part of the foundation for a healthy life. Therefore, maternal-infant interactions, particularly in this high-risk adolescent population, need to assessed in the context of pediatric clinical care.

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Attachment theory has evolved from work by numerous researchers, primarily John Bowlby and Mary Ainsworth, and later Mary Main Attachment, according to Ainsworth (1963) is a “secure base from which to explore,” and this idea has since remained a fundamental principle of attachment theory. Bowlby subsequently described attachment as a unique relationship between an infant and his caregiver that is the foundation for further healthy development. Bowlby described attachment theory as an inherent biological response and behavioral system in place to provide satisfaction of basic human needs. Mary Main, a student of Ainsworth’s, found that adult attachment representations, the construct of how adults remember their own childhood experiences, might influence the attachment categorization of their children.

Attachment security and the theory of the internal working model are two hallmark ideas that comprise attachment theory and influence how the child views himself and other relationships. Whether mother-child interactions are positive or negative, some level of attachment security and subsequent IWM develops. According to Bowlby, individuals develop “internal working models” of attachment that describe the relationship between the infant’s self and his attachment figure. In response to experiences and behavior of the attachment figure toward the infant, the infant is able to formulate mental responses to his attachment figure’s behavior that are catalogued as mental representations of the infant’s view of himself and understanding of his attachment figure. The infant’s ability to explore the world and relationships within it hinges on the type of attachment security that develops during the first year of life. In the context of attachment theory, it is important to distinguish attachment behavior and attachment bond. Attachment behavior is behavior on the part of the infant that promotes proximity to the attachment figure, such as smiling and vocalization. Attachment bond, however, is described by Ainsworth and Bowlby not as a dyadic and reciprocal relationship existing between the infant and his caregiver, but rather as the infant’s interpretation of his relationship to his mother. Evidence supports the positive influence of secure mother-child attachment on later development and aptitude. A secure attachment system serves as a foundation for expression of emotions and communication in future relationships, provides opportunities for self-regulation of affect and creates potential for resilience.

The many challenges and consequences associated with teen pregnancy and parenthood are well documented, but less is known about attachment relationships among adolescent mother-infant dyads. Many of the background and developmental characteristics of adolescent mothers also may be linked to poor attachment outcomes in their infants. Poverty, poor parental modeling, growing up in single-parent homes, and lack of educational opportunities and career goals are often associated with teen pregnancy and early parenthood. Adolescent mothers are less likely to receive adequate prenatal care and are more likely to experience pregnancy and birth complications often because they are likely to be living in poverty. An analysis of the National Longitudinal Study of Adolescent Health from 1994 through 2008 revealed that adolescent parents are more likely to be from families that report incomes below 200% of the federal poverty level (FPL) (59% of survey respondents reported living in families with incomes below 200% of the FPL, and 41% reported living in families with incomes greater than or equal to 200% of the FPL). These factors, independently and collectively, heighten the risk of compromised parenting behaviors with these young families. Parenting behaviors among adolescent mothers vary, but many experience higher degrees of stress related to parenting, tend to be less responsive, less sensitive, more detached, and more likely to exhibit intrusive behaviors with their infants. These parenting characteristics specific to adolescent parents are precisely what place them at risk for compromised attachment relationships. We are only beginning to learn about the quality of attachment relationships among infants of adolescent mothers, but it appears they are often compromised, leading to less optimal infant outcomes in developmental and socio-emotional domains, all of which are more likely to be the case when there are limited supportive programs or family members available to help the young mother in her new and complex parenting roles.

In addition to the socioeconomic profile of many adolescent mothers that may contribute to poor attachment outcomes, adolescent mothers differ developmentally from most adult mothers since they are working to combine their adolescent developmental tasks with the new tasks and roles of parenthood. When a pregnancy occurs during adolescence, the period of development during which adolescents develop the cognitive skills to assume parenting responsibilities is interrupted. As a result, many adolescent mothers may not have the developmental capacity to adopt parenting behaviors that enhance the maternal-infant attachment relationship. Adolescents tend to be idealistic, have a diminished capacity for reflection, and tend to embody egocentricity, individuality, and independence. Adolescent development allows for the transition to higher levels of cognitive function and ability to appreciate more abstract processes. Maternal characteristics that enhance the attachment relationship, such as sensitive parenting, reflectivity, and responsiveness are challenging for adolescent mothers to intuitively adopt because they often do not have that cognitive awareness afforded by full adult development.

Abstract

Attachment theory focuses on the cognitive models that underline our interactions with attachment figures. Global or generalized mental models are thought to develop on the basis of attachment models with parents and might form the initial basis of internal working models in novel relationships. However, as discrepant information presents itself in a new relationship, it is thought that specific relational models develop. When conflict arises it can threaten the attachment bonds of the relationship. Analyses also indicated differential gender results for positive problem solving in terms of secure parental and partner attachment. Secure parental attachment was also found to impact on the report of compliant behavior during conflict resolution. Based on the early discovery of different attachment patterns in infants researchers have identified distinct attachment styles that characterize individual differences in social interactions and emotional responses to others extending even during adulthood and for novel encounters with strangers. Four different attachment styles are typically distinguished: secure, anxious-preoccupied (AX), dismissive-avoidant (AV), and fearful-avoidant/disorganized. Lastly, the belief that arguing is threatening was found to be impacted by an interaction effect between parental and partner attachment. In general secure partner attachment was more predictive of conflict resolution behavior and conflict beliefs, than a global attachment model. However, it would appear that the global attachment model can be activated in the context of the current relationship under certain conditions. This research lends support to the notion that generalized and specific attachment representations impacts differently on close relationship functioning, and encourages a further mapping of relationship functions in this regard.

Conclusion

Findings from this study support the distinction between global and specific relational models specifically with regards to secure parental and secure partner attachment. In addition, the current study’s findings that specific relational models are more closely tied to partner-specific relational outcomes, also gives support to previous findings. In general it was found that secure partner attachment was more predictive of conflict resolution behaviour and conflict beliefs, than a global attachment model. However, it would appear that the global attachment model can be activated in the context of the current relationship under certain conditions. Thus, a gendered response to positive problem solving became evident. For example, for men a secure parental attachment is more likely to elicit positive problem solving behaviour during conflict, than for women. Women, however, who are not securely attached to their current romantic partners, will more infrequently use positive conflict strategies, than men. Neither does one model or another get activated or impact on the current relationship. For individuals who not only have a secure partner attachment, but also have a secure primary caregiver attachment, it becomes much more likely that they will believe that arguing is not threatening. In this manner there is one mental model compounding the effects of another mental model, pointing to the conceptual overlap between the global and specific mental models, but only with regards to some relationship variables. Similarly, it shows the closely intertwined nature of general and specific attachment as it impacts on an individual’s current romantic relationship.

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