Dissociation and the parent-infant dialogue: a longitudinal perspective from attachment research

Two longitudinal attachment studies of families at social risk have now followed their cohorts of infants to late adolescence. Several key findings have emerged related to outcomes of interest to psychoanalysts. First, data from both studies indicate that disorganized attachment behaviors in infancy are important precursors of later dissociative symptomatology. Second, this early vulnerability is related to patterns of parent-infant affective communication, particularly quieter behaviors like emotional unavailability or role reversal, and does not appear to reside in the infant alone. Finally, the results suggest that the quality of the attachment relationship may in part account for why some people exposed to later trauma develop dissociative symptoms and others do not. To paraphrase Dori Laub (1993), the mother's seeing and not knowing in infancy may be a precondition of her child's knowing and not knowing in late adolescence. It remains unclear, however, whether the early relationship is predictive due primarily to the onset of an internal defensive process in infancy or whether its predictive power resides primarily in enduring patterns of parent-child dialogue that continually reinforce the child's segregated and contradictory mental contents.     

Indiscriminate behavior observed in the strange situation among institutionalized toddlers: Relations to caregiver report and to early family risk

Socially disinhibited or indiscriminate behavior (IB) has traditionally been investigated using caregiver reports. More recently, an observational measure based on the Strange Situation Procedure (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978), the Rating of Infant and Stranger Engagement (RISE; C. Riley, A. Atlas‐Corbett, & K. Lyons‐Ruth, 2005), was validated in home‐reared at‐risk children. The present study aimed to validate the RISE in an institutionally reared sample using the caregiver report, to assess whether IB assessed with the RISE was elevated among the institutionalized children, and to explore potential risk factors associated with IB. The study was conducted among 74 institutionalized toddlers aged 11 to 30 months. Sociodemographic questionnaires were used to assess pre‐admission experiences, and aspects of institutional placement were coded from the children's files in the institution and staff's report. Institutionalized children displayed high frequencies of IB as assessed on the RISE, and this instrument was validated against caregiver report. Pre‐admission experiences of the institutionalized children in their biological families—namely, prenatal risk and maternal emotional neglect risk—predicted IB. Results suggest that the RISE is adequate to use among institutionally reared toddlers and point to aspects of the early familial environment that may be implicated in IB.     

Case illustration: Moving along…and,is change gradual or sudden?

A sequence of analytic sessions of a professional woman in her forties is used to illustrate the moving along process. The material shows a gradual change, where the patient's experience of her sense of agency is altered through a particular kind of interactive sequence. The example is intended to make it clear that the group's view of how change occurs is not strictly or primarily in terms of sudden changes, and that the problem of assessing moments of meeting as well as quantitative and qualitative shifts is one with which the group continues to struggle. © 1998 Michigan Association for Infant Mental Health     

THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth –3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, 2015 ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.     

Differential attachment responses of male and female infants to frightening maternal behavior: Tend or befriend versus fight or flight?

Taylor and colleagues (2000) proposed that males tend to display fight or flight responses to threat while females are more likely to display affiliative "tend or befriend" responses. In light of this hypothesis, gender differences in infant attachment behaviors were examined in a sample of 65 low-income mother-infant dyads, half of whom were referred to a home-based intervention service because of concerns about the quality of caregiving. Attachment behaviors were assessed in the Ainsworth Strange Situation when infants were 18 months old, and maternal behaviors were coded both for frightened or frightening behaviors, using the Main and Hesse (1992) coding inventory, and for disrupted affective communication using the Atypical Maternal Behavior Instrument for Assessment and Classification assessment tool (AMBIANCE; Lyons-Ruth, Bronfman, & Parsons, 1999). Results indicated that as maternal behavior became more frightening, female infants tended to approach their mothers more than male infants. These gender differences in response to maternal frightening behavior also were evident in the clinically referred subsample. The results suggest that gender-based differences in tendencies to show affiliative behaviors to threat may complicate interpretation of attachment behavior in clinical contexts.     

Reflections on the process of psychotherapeutic change as applied to medical situations

This article takes the basic ideas on the process of changing implicit knowledge put forward in this special issue, and extends them beyond psychotherapy to include other therapeutic relationships that occur in medicine. One vignette, from an encounter between a medical student and a dying patient, illustrates how a “moment of meeting” changes the student as well as the patient. The second shows how therapeutic interventions for new mothers with their newborn infants involve “moments of meeting” that alter the mother's implicit knowledge of her baby and of herself as a mother. © 1998 Michigan Association for Infant Mental Health     

The disturbed caregiving system: Relations among childhood trauma,maternal caregiving,and infant affect and attachment

The interrelations among maternal childhood experiences of physical or sexual abuse, adult trauma-related symptoms, adult caregiving behavior, and infant affect and attachment were investigated among 45 low-income mothers and their 18-month-old infants. A history of physical abuse was associated with increased hostile-intrusive behavior toward the infant, increased infant negative affect, and a decreased tendency to report trauma-related symptoms. A history of sexual abuse was associated with decreased involvement with the infant, more restricted maternal affect, and more active reporting of trauma-related symptoms. Infants of mothers who had experienced childhood violence or abuse were not more likely to display insecure attachment strategies than infants of mothers who had not experienced trauma. However, the form of insecure behavior was significantly different. Insecure infants of violence-exposed mothers displayed predominantly disorganized strategies, whereas insecure infants of mothers with benign childhoods or neglect only displayed predominantly avoidant strategies. Results are discussed in relation to Main and Hesse's (1990) concept of frightened or frightening behavior and to current literature on psychological sequelae of trauma.     

ASSESSING MEDIATED MODELS OF FAMILY CHANGE IN RESPONSE TO INFANT HOME VISITING: A TWO-PHASE LONGITUDINAL ANALYSIS

The objective of this study was to assess whether a mediated model of change could account for the long-term effects of infant home-visiting services observed at ages 5 and 7 years in a high-risk cohort. Participants were 41 mothers and infants from low-income families who were referred to parent-infant home-visiting services during the first 9 months of life due to concerns about the caretaking environment. Services ended when infants reached 18 months of age. Families received between 0 and 18 months of weekly home visits based on infant age of entry into the study. During childhood (ages 5 and 7 years), teachers rated children's behavior problems using standardized instruments. Early home-visiting services accounted for positive child outcomes at 18 months, 5 years, and 7 years of age; however, earlier positive outcomes related to intervention did not account for intervention-related effects at later ages. Further inspection of the data revealed that two additional principles, one of escalating morbidity among less intensively served groups and one of generalized family problem-solving skills, were needed to account for the pattern of effects over time. We conclude that the "domino models" assessed by mediational analyses may be too simple to capture the intervention-related change processes occurring in high-risk cohorts over time.     

Childhood Maltreatment and Prospectively Observed Quality of Early Care as Predictors of Antisocial Personality Disorder Features

Few studies have evaluated the separate contributions of maltreatment and ongoing quality of parent-child interaction to the etiology of antisocial personality features using a prospective longitudinal design. 120 low-income young adults (aged 18-23) were assessed for extent of ASPD features on the Structured Clinical Interview for Diagnosis-Axis II, for presence of maltreatment on the Conflict Tactics Scale, Traumatic Experiences Scale, and Adult Attachment Interview, and for referral in infancy to parent-infant clinical services. Fifty-six of these families had been studied longitudinally since the first year of life. In infancy, attachment disorganization and disrupted mother-infant interaction were assessed; in middle childhood, disorganized-controlling attachment behaviors were reliably rated. In kindergarten and second grade, behavior problems were assessed by teacher report. In cross-sectional analyses, maltreatment was significantly associated with ASPD features but did not account for the independent effect of early referral to parent-infant services on ASPD features. In longitudinal analyses, maternal withdrawal in infancy predicted the extent of ASPD features twenty years later, independently of childhood abuse. In middle childhood, disorganized attachment behavior and maladaptive behavior at school added to prediction of later ASPD features. Antisocial features in young adulthood have precursors in the minute-to-minute process of parent-child interaction beginning in infancy.     

The Interface Between Attachment and Intersubjectivity: Perspective from the Longitudinal Study of Disorganized Attachment

This article considers the interface between the concepts of attachment and intersubjectivity in light of accumulated research on infant development. Both Tomasello (1999) and Hobson (2002) have argued persuasively that the flexible human capability for sharing mental states with others reframes and revolutionizes our older, more highly channeled primate biological heritage. In contrast to this emphasis on discontinuity from primate to human evolution, attachment theorists have stressed the continuities between human attachment and attachment in other primates. The implication of new work on infant intersubjectivity for reframing aspects of attachment theory is first explored. By the same token, however, the extent to which the infant–caregiver attachment relationship functions to maintain positive engagement and regulate the infant's fearful arousal will have escalating consequences over development for the organization of intersubjectivity. Therefore, attachment research has much to offer in understanding the development of joint attention and the sharing of mental states under conditions of increased emotional arousal. The potential contributions of attachment research for understanding the development of intersubjectivity are discussed in light of recent work from the author's lab on forms of young adult symptomatology associated with deviance in the early intersubjective dialogue between mother and infant. The clinical implication emerging from all these diverse areas of research is that fostering more collaborative forms of communication may lie at the heart of evolutionary change, developmental change, and changes resulting from psychodynamic psychotherapy.