Implications of attachment theory for working in psychoanalytic psychotherapy

John Bowlby's Attachment Theory is being increasingly operationalised in the world of developmental research, but as yet its implications for clinical work are relatively less discussed. This paper addresses the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts’ work with their patients. It looks at the implications of Attachment Theory at all stages of the therapeutic process, but concentrates particularly on how it can help with the crucial phase of building the working alliance.     

Intrusiveness from an attachment theory perspective: A dyadic diary study

This 14-day dyadic diary study of 60 heterosexual couples examines links between attachment insecurities, intrusiveness, and relationship dissatisfaction by exploring the effects of attachment insecurities on intrusiveness and examining the daily interplay between intrusiveness and relationship dissatisfaction. We assessed attachment orientations, daily self-reported intrusive behavior, and daily relationship satisfaction of members of each couple. Results indicated that self-reported intrusiveness was associated with actor’s attachment anxiety and with their partner’s attachment avoidance. Unexpectedly, partner’s previous-day intrusiveness was positively associated with actor’s next-day relationship satisfaction. This association was driven mainly by women scoring high on avoidance. The theoretical and practical implications of the findings are discussed.     

Individual differences in attachment and dispositional mindfulness: The mediating role of emotion regulation

Recent interest in the relationship between individual differences in attachment and dispositional mindfulness has led to empirical investigations into this association. Although several studies have demonstrated an association between attachment and mindfulness, little is known as to why these two seemingly distinct constructs are related. In a sample of 572 individuals we explored whether the relationship between attachment and mindfulness was mediated by emotion regulation difficulties. Difficulties in emotion regulation fully mediated the association between attachment anxiety and mindfulness, and between attachment avoidance and mindfulness. Thus, the mechanism by which attachment and mindfulness are related is through emotion regulation difficulties. Theoretical and clinical implications are discussed.     

Maternal sensitivity assessed during the strange situation procedure predicts child's attachment quality and reunion behaviors

The 72-item version maternal behavior Q-set (MBQS; Pederson & Moran, 1995) was used to assess maternal behaviors (N = 74) during the Strange Situation Procedure. Results indicated that the MBQS scores significantly differentiated infant attachment categories and were significantly associated with a series of infants’ reunion behaviors.     

Narcissism and recollections of early life experiences

Recent studies have found associations between narcissistic personality features and retrospective accounts of early experiences. The current study sought to extend these previous findings by examining whether adaptive and maladaptive features of narcissism were associated with recollections of early life experiences in a non-clinical sample of undergraduate students (N = 334). Results revealed that the Entitlement/Exploitativeness feature of narcissism was associated with low security, high parental discipline, and high threats of separation. Narcissistic Grandiosity was positively associated with peer affectional support and parental discipline, whereas Narcissistic Vulnerability was not uniquely associated with memories of early life experiences. The results provide partial support for models of narcissism in which parents are recalled as failing to provide a secure base while inducing threats of separation and discipline.     

Comorbid social anxiety disorder in clients with depressive disorders: predicting changes in depressive symptoms, therapeutic relationships, and focus of attention in group treatment

The current study examined whether depressed outpatients with comorbid SAD respond differently to a cognitive-behavioral group intervention and if so, how and why. Using growth curve modeling, we found evidence that depressed clients with comorbid SAD had rapid improvement in depressive symptoms over the course of treatment and generally did not differ from those without comorbidity in developing close therapeutic relationships and modifying the direction of attentional focus away from the self. Non-linear effects demonstrated that rates of change in depressive symptoms, relationship variables, and focus of attention, were most rapid early in treatment. In contrast to hypotheses, trajectories of change in therapeutic relationships and attentional focus did not mediate the effect of SAD on treatment improvement in depressive symptoms. These findings suggest that comorbid SAD does not have a detrimental effect on the course of depression treatment and group-based treatments can be as beneficial for depressed individuals with comorbid SAD. It may be that group-based treatments for depression provide explicit opportunity for emotional processing in social situations (i.e., exposure) and hence mimic efficacious therapies for SAD.     

The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder

This is the first study that explores whether early maladaptive schemas are related to treatment outcome for patients with obsessive-compulsive disorder (OCD). The sample consisted of 88 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory and Young Schema Questionnaire – Short Form were administered before and after treatment. Regression analyses using post-treatment Y-BOCS as the dependent variable indicated that higher scores on the abandonment schema at pre-treatment were related to poor outcome and explained 7% of the variance in symptoms at post-treatment. Higher scores on the self-sacrifice schema at pre-treatment were related to good outcome and explained 6% of the variance in obsessive-compulsive symptoms at post-treatment. During treatment, only changes in the failure schema were significantly related to good outcome and explained 18% of the variance in symptoms at post-treatment.     

Changes in attachment orientations across the transition to parenthood

According to attachment theory, individuals should experience changes in attachment orientations (styles) if they encounter experiences or events that strongly reinforce or directly contradict the major concerns of their existing orientations. Systematic changes should be most evident across stressful life transitions. Wives and husbands expecting their first child completed scales measuring their attachment orientations along with perceptions of themselves, their spouses, and their marriage both 6 weeks before and 6 months after childbirth. As predicted, women became more ambivalent across the transition if they entered parenthood perceiving less spousal support and more spousal anger, with perceptions of anger having stronger impact. Women who entered parenthood seeking less spousal support and those whose husbands were higher in avoidance became more avoidant across the transition. Men who perceived themselves as providing more prenatal support to their wives became less avoidant. These results extend attachment theory and research in novel directions.     

A Multifactorial Model for the Etiology of Anxiety in Non-Clinical Adolescents: Main and Interactive Effects of Behavioral Inhibition, Attachment and Parental Rearing

There has been limited research examining the additive and interactive effects of multiple factors on the development of anxiety symptoms and anxiety disorders in youths. This study was an attempt to examine the reciprocal connections among temperament, attachment, and rearing style, and their unique and interactive relations to anxiety symptoms. Six hundred forty-four non-clinical children aged 11–15 years (mean age = 12.7 years) completed questionnaires measuring behavioral inhibition, attachment, parental rearing behavior, and anxiety symptoms. Results indicated that there were small to moderate positive correlations among various risk factors. Furthermore, modest but significant positive correlations were found between behavioral inhibition, attachment quality, and anxious and controlling rearing behaviors on the one hand, and anxiety scores on the other hand. That is, higher levels of behavioral inhibition, insecure attachment, and parental control and anxious rearing were associated with higher levels of anxiety symptoms. Finally, behavioral inhibition, attachment quality, parental control and anxious rearing each accounted for a small but unique proportion of the variance of anxiety disorders symptomatology. Little support was found for interactive effects of these vulnerability factors on childhood anxiety.