Attachment--and loss.

Patterns of Attachment

Since the early 1970s, Sroufe, Egeland, Carlson, Collins and others have been following a large cohort of children from the sixth month of the mother’s pregnancy through to the present. Eighty-five percent of the 212 at 24 months are still in the study close to three decades later. Early losses occurred before the decision was made to change the initial shorter study (started by Egeland, a psychologist, and Deinard, a pediatrician) to a longitudinal study. The authors noted that the losses were in the most high stress and unstable of the families.

The families were chosen intentionally to include caregivers who may present parenting difficulties by selecting first born children to mothers who qualified for public assistance for prenatal care and delivery. Poverty was the marker that would ensure this. They were careful to note that these mothers had a wide variety of backgrounds and degrees of support available, thus also ensuring a wide range of outcomes 28 years later (the age now under study).

The authors started with an excellent overview of the challenges faced, the key claims and guide to the book, conceptual and theoretical supports, organizing perspective and assessments. Understanding the frequency, breadth and depth of the assessments with over 10,000 resultant variables is crucial to giving credence to the resulting conclusions. The strength of this work comes not just from the lessons learned about development, change and continuity but from the impressive evidence that places the lessons on a firm foundation and the even more fascinating predictability about development that emerged from the data.

Throughout the book, it is easily possible to pull out sentences that may have made intuitive clinical sense but are now backed up with statistics (kept to an appropriate minimum since background papers are well-referenced). For instance: by heightening and chronically emitting signals of need toward an only intermittently responsive caregiver, a resistant attachment organization is established which is correlated with anxiety disorders at age 17½. By minimizing signals of need that may further alienate rejecting caregivers, an avoidant attachment organization is established which shows a connection to externalizing behavioural disorders through early childhood and adolescence. Anxious attachment in general, with no distinction between avoidance and resistance, was associated with depression. There are remarkable parallels between how mothers responded to tasks with their children at 24 months and the same children more than 20 years later, responding to their own 24-month-old children.

Other conclusions have implications for prevention and intervention. In breaking the cycle of abuse, three relationship factors were most helpful for the mothers: (1) receiving emotional support from an alternative non-abusive adult, therapy experience of at least six months, supportive and satisfying relationship with a mate; (2) ability to predict high school dropping out with 77% accuracy using only quality of care measures up to age 42 months; (3) boundary violators during middle childhood were less competent in dealing with mixed gender relationships during adolescence and were more likely to have mothers who were abused.

As interesting as any individual observation or prediction may have been, it is the general observations and conclusions about development that pull the work together and provide a framework that will be useful to clinicians, program planners and researchers for years to come. They include implications for classification systems such as the Diagnostic and Statistical Manual, for treatment of specific disorders and for prevention and early intervention services. Above all, they have demonstrated that development is a lawful, understandable and predictable process when there have been multiple methods of assessment from multiple independent sources.

This is a book that I wish was written and that I had read as a resident. It’s not that there weren’t books about development, but they were based on the wisdom of clinical observation by gifted clinicians after years of work. What this group has contributed is the research basis for development, and in the process have given it a much more interactive and dynamic life than theory and clinicians have been able to do. They shift us from traits to interactions, from today’s preoccupation with genetics to the psychosocial environment, from blaming parents to acceptance of their unique histories and pasts, and, more importantly, from the unpredictable to the predictable.

Some time ago, when giving an invited talk about personality disorder from the perspective of a child and adolescent psychiatrist, I ended with the thought that we may be training our residents from the wrong end of life. They start out in the world of adult psychiatry and work backwards gradually. My thought was that we needed to start with infancy and the attachment process, then work forward into childhood, adolescence and adulthood. This book has shifted my ‘clinical’ thought into a research base. If we understood the results of this book and the developmental process and predictability, we would practice a more researched based therapy with each growing stage of life.

This book represents the summary of a lifetime dedication by many researchers to the mental health and well-being of children and youth and makes this dedication available to all of us who work with and care about children and youth in society. They deserve not only our thanks, but more importantly, our attention.

Now that the work has been done, the book has been written, it is time for you to read it and then recommend it to every psychiatry resident beginning their career.

The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood

The paper reviews central concepts and research findings of attachment theory emphasizing its clinical relevance to psychoanalytically informed clinicians We then turn to a historical analysis in order to understand why Bowlby's work was dismissed within psychoanalytic circles and the reasons why Bowlby's contributions and attachment theory have begun to have a significant impact among clinicians within the last ten years

Reclaiming Bowlby's contribution to psychoanalysis

Considerando la diversidad en la conceptualizacion y la comprension de la identidad como proceso de desarrollo, se lleva a cabo en el presente texto, una revision teorica y empirica del mismo. En la primera parte, se revisan las explicaciones tradicionales de la identidad como proceso de desarrollo; en la segunda parte, se realiza un breve recorrido en las versiones explicativas de identidad, desde las explicaciones biologicistas, hasta las teorias psicosociales: teoria de la identidad y teoria de la identidad social. En la tercera parte, se lleva a cabo una revision de las investigaciones sobre identidad profesional, buscando en escenarios laborales, aquellos elementos de puente entre la identidad como proceso de desarrollo humano y la constitucion de la identidad en contextos de trabajo. La revision de textos con alguna cercania a propuestas teoricas, permite recuperar elementos para el analisis. En la cuarta y ultima parte, se hacen algunas consideraciones sobre el vinculo entre la identidad y la identidad profesional; la relevancia en el estudio de la identidad como proceso de desarrollo y particularmente en escenarios laborales configurando la identidad profesional, La importancia de su estudio en psicologos es brevemente discutida

/pdf/identidad-e-identidad-profesional-acercamiento-conceptual-e-2vmg822y8e.pdf

Identidad e identidad profesional: Acercamiento conceptual e investigación contemporánea

Erich Fromm's fortuitous visit to Mexico in 1949, and his meeting with a group of Mexican psychiatrists was the beginning of a working relationship that lasted for over 25 years. It left its mark on a number of community-oriented institutions, professional societies and publications, which are alive even today. This article describes some of the many activities in which researchers, psychoanalysts, medical doctors, psychologists, social workers, sociologists, anthropologists and religious scholars were involved over those 25 years, and the continuing importance of those initial projects and institutions today.

The Legacy of Fromm in México

Unresolved loss and unresolved trauma in adult mothers, and the commonly disorganized attachment pattern developed by their infants, have been repeatedly reported in longitudinal research literature as a crucial correlate or precedent of severe pathology. We describe and illustrate how unresolved loss and unresolved trauma are manifested in verbatim-transcribed language and how they are to be detected, so that psychoanalysts and clinicians in general are able to distinguish them and understand how such “states of mind” evidence the process of fragmentation they involve. We follow each example with a resolved transcript so it can be contrasted with a nonresolved case. We then describe excerpts of a taped “disorganized infant” – an example of infants who are usually babies of unresolved mothers, as shown during the Adult Attachment Interview. The analyst’s ability to identify and understand these “states of mind” and the subsequent sensitive reflection on the transcendental role of primary traumatic...

Mental collapse as “disorganized attachment”: A dynamic understanding for clinicians

Integrating attachment and social character approaches to clinical training – case studies from a Mexican Nahuatl village

https://dialnet.unirioja.es/descarga/articulo/4830384.pdf

Fundamentos Biológicos y Sociales del desarrollo Emocional

We present a study of 40 youngsters who live and work in the streets of Mexico City and who have abandoned their homes for significant periods of time. They seek out their own means of survival from a very young age. In many cases they have children of their own already as teenagers. The Seminario de Sociopsicoan lisis was invited to take part in a project aimed at facilitating the access of these children to graphic arts, artistic creation and therapeutic listening. This article presents our principal findings of the children's everyday life conditions, their work and their dreams, based on data obtained from social character questionnaires – with which therapeutic intervention in this project began. Vignettes of two case studies are also presented. The interviews were complemented by data gathered in weekly sessions attended by the youngsters on a voluntary bases. The sessions attested to both the narcissistic, aggressive impulsiveness of these youngsters and the vital effort they make toward their own recovery and toward establishing affective emotional ties with instructors and therapists. We found that socio-psychoanalytic methods could be used successfully to expand the scope of psychoanalytic theoretic postulates about character to a non-clinical, disadvantaged population. By analyzing the content of the psychoanalytically guided interviews we were able to recognize the central, distinctive motive, which leads these youngsters to run away from home and forge their own sense of identity.

Salvador Millán

Papers

The Legacy of Fromm in México

Mental collapse as “disorganized attachment”: A dynamic understanding for clinicians

Integrating attachment and social character approaches to clinical training – case studies from a Mexican Nahuatl village

Fundamentos Biológicos y Sociales del desarrollo Emocional

Identity in the Asphalt Jungle. A Study of Mexican Youngsters Who Work in the Streets