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

John Bowlby presenta una casuistica clinica singular en su articulo “Saber lo que se supone que no debemos saber y Sentir lo que se supone que no debemos sentir” (Bowlby 1979). Los pacientes presentados eran adultos con sintomatologia diversa respecto a sus formas de relacion, que sufrieron perdidas tempranas. Solo la investigacion terapeutica cuidadosa les hizo descubrirse y reconocerse como testigos presentes en el suicidio de alguno de sus padres. Los sujetos recuperaron los recuerdos fragmentarios, por mucho tiempo reprimidos, de las escenas en las que estuvieron indudablemente presentes. Sorprendidos ellos mismos, encontraron en la investigacion terapeutica, los indicios de haber sido testigos de los tan dramaticos como secretos hechos (elementos que se pudieron confirmar con los testimonios de quienes participaron en su vida infantil temprana). Como ninos, hubo un momento en el que aceptaron, creyeron y endosaron las versiones amables pero distorsionadas de los acontecimientos sobre la muerte de sus respectivos progenitores, que les fueron impuestas por quienes los criaron, con el afan de protegerlos mitigando los hechos.

Salvador Millán

Papers

Fundamentos Biológicos y Sociales del desarrollo Emocional. Una Contribución Empírica derivada de la Teoría del Apego y de la del Carácter Social