Smith College Studies in Social Work

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Attachment Theory’s Universality Hypothesis:

Clinical Implications for Culturally Responsive
Assessment

Zev Ganz

To cite this article: Zev Ganz (2018): Attachment Theory’s Universality Hypothesis: Clinical
Implications for Culturally Responsive Assessment, Smith College Studies in Social Work, DOI:
10.1080/00377317.2018.1507369

To link to this article: https://doi.org/10.1080/00377317.2018.1507369

Published online: 21 Sep 2018.

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SMITH COLLEGE STUDIES IN SOCIAL WORK
https://doi.org/10.1080/00377317.2018.1507369

Attachment Theory’s Universality Hypothesis: Clinical

Implications for Culturally Responsive Assessment
Zev Ganza
a
Family Institute of Neve Yerushalayim

ABSTRACT ARTICLE HISTORY

Attachment theory has achieved a major influence in social Received 12 June 2018
work practice as a basis for research and as a foundation for Revised 2 July 2018
clinical approaches. The contention that attachment as it is Accepted 2 July 2018
contemporarily understood is a ubiquitous phenomenon has KEYWORDS
been labeled the universality hypothesis. This hypothesis is Attachment Theory; Cultural
built on three assertions—that healthy attachment is facilitated Sensitivity; Ultraorthodox
through parental sensitivity, that secure attachment is norma- Jews; Clinical Assessment;
tive, and that healthy attachment leads to longitudinal compe- Cross-Cultural Practice;
tence. Critics argue that contemporary attachment theory Universality Hypothesis
privileges a conception of child-rearing that is fundamentally
based on family structures and societal conditions that ignore
the cultural practices of most of the non-Western world.
Although the universality hypothesis is intended as a tool for
research, this author contends that it can be used as a con-
struct to guide culturally responsive clinical work. The article
will first provide an extensive review of the debate around
cross-cultural attachment and then explore its clinical implica-
tions. A brief case study of clinical work with an ultraorthodox
family will be used to elucidate the author’s contention.

Introduction
In recent years, attachment theory has attained a prominent position among
psychological theories as a guide for developmental research as well as
clinical practice (Keller, 2016; Schore & Schore, 2008; Wallin, 2007). Its
influence ranges from neurobiological research (Siegel, 1999) to popular
literature (Siegel & Hartzell, 2003).
Central to the theory is the contention that children’s early attachment to
caregivers serves as an evolutionarily embedded means of facilitating emo-
tional security during children’s early years of life (Bowlby, 1988). The
ubiquity of attachment theory across cultures is an assertion put forth by
Van IJzendoorn and Sagi (2008) in what they labeled the universality hypoth-
esis, whose primary contention is that, while cultural variables in parenting

CONTACT Zev Ganz zganz@msn.com Yerushalayim, Rechov Hakabian 10, Jerusalem, IsraelFamily Institute
of Neve
© 2018 Taylor & Francis
2 Z. GANZ

practice may indeed exist, the fundamental principles of attachment theory

hold true across cultures.
Critics of this hypothesis contend that while the basic assertion of an
attachment system that is crucial to human development is sound, how this
attachment system is defined has been a question examined through a
constricted lens that ignores the vast array of relationship systems existent
throughout the world (Keller, 2016). They contend that attachment theory’s
theoretical and research base has been developed in a specific cultural milieu
that privileges a conception of emotional connection informed by a strictly
Western perspective of relationships and family. In turn, the nature of
emotional connectedness—and consequently healthy and secure attachment
—has been defined within the confines of this model.
Thus, a polarized debate has emerged as to the universality of attachment,
and while this discourse has taken place primarily among researchers and
attachment theoreticians, the discussion has significant clinical implications.
The importance of cultural sensitivity within the field of mental health has
been extremely well documented, and calls have emerged for careful con-
sideration of how attachment principles are applied in clinical practice
(Brown, Hawkins-Rodgers, & Kapadia, 2008). The relevance of classic attach-
ment norms is of great importance on a clinical level as numerous therapeu-
tic interventions and models are directly based on these principles (e.g.,
Greenspan & Wieder, 2005; Lieberman & Van Horn, 2008). The outcome
of this ongoing discussion is therefore of particular importance to social
workers working with diverse populations, and this issue goes beyond sensi-
tivity to specific cultural norms and practices—it is actually relevant to our
basic models of intervention.
The author begins by providing a basic overview of contemporary attach-
ment theory’s fundamental principles, followed by a detailed review of the
universality hypothesis in which the arguments of supporters and critics will
be systematically examined. Finally, the clinical relevance of the debate will
be explored through a consideration of the ultraorthodox Jewish community
in Israel—a population that retains a strong degree of insularity but has in
recent years begun to engage mental health professionals.
The author contends that looking at contemporary attachment theory’s
applicability to a given community cannot be determined dichotomously, but
instead one must look thoughtfully at the various components of the uni-
versality hypothesis to determine their particular relevance. Indeed, the sub-
categories of the universality hypothesis—initially intended as theoretical
organizers of research—may be of real use to a culturally responsive clinical
assessment.
 SMITH COLLEGE STUDIES IN SOCIAL WORK 3

Attachment theory
Attachment theory posits that human beings are intrinsically programmed to
seek and form connections with other human beings and that human infants
innately form connections with caregivers (Bowlby, 1969, 1988). This essen-
tial claim is presumed to have elemental evolutionary significance and func-
tions to ensure the survival of vulnerable infants and children by facilitating
physical proximity to caregivers (Allport, 1997). Thus, from birth, infants are
programmed to retain closeness with parents through a range of behaviors
and reactions that are constructed and adapted within a relational milieu.
Correspondingly, human caregivers exhibit a range of behaviors that both
shape and respond to this attachment behavior so as to ensure the vulnerable
child’s safety (Bowlby, 1969).
Because ongoing proximity to caregivers is of such fundamental impor-
tance to survival, attachment theory posits that infants engage in a reactive
process through which their behavior—and ultimately the essential nature of
their personalities—is shaped by cultural norms of parenting as well as the
unique aspects of the specific parent–child dyad (Allport, 1997; Wallin,
2007). In this framework, the particular relational environment within
which the child was raised served as a foundation for personality develop-
ment. On the other hand, deficiencies experienced by the child during
infancy and early childhood could potentially lead to psychopathology and
emotional disturbance (Bretherton, 1992).
Sroufe and Waters (1977, p. 1187) significantly expanded the theory’s
explanatory power by adapting the goal of the attachment system from
proximity to “felt security.” In this model, while proximity remains the
ultimate purpose in an evolutionary sense given the competitive survival
advantage that remaining close to a caregiver affords, on an experiential
level proximity to a caregiver is one mechanism for achieving a state of
emotional regulation that may be attained in other ways as well. Children
create “affective bonds” (p. 1189) with preferred adults and then move
toward those adults in times of stress or fear as a means of regulating
overwhelming emotion.
Attachment is currently understood as emanating from the caregiver’s
capacity to provide the infant an experience of felt security. Children will
develop affective bonds with those caregivers who effectively impart this
feeling by downregulating negative emotion and upregulating positive
emotion. Conversely, infants will adapt their attachment strategies vis-á-
vis caregivers who cannot regulate their emotional volatility and fail to
impart a sense of felt security. With repetition, these patterns ingrain
themselves as internal working models and longitudinally affect relational
functioning.
4 Z. GANZ

Researchers have identified the nuanced and intimate moment-to-moment

experience between a preferred caregiver—in a Western context, usually the
mother—and the nascent infant as the central process in promoting a sense
of felt security and ultimately the development of secure attachment (Biro,
Lenneke, Huffmeijer, Bakermans-Kranenburg, & Van IJzendoorn, 2017;
Sroufe, 2000; Stern, 1985; Wallin, 2007). As Schore and Schore (2008,
p. 11) state, “The regulatory processes of affect synchrony that create states
of positive arousal and interactive repair that modulate states of negative
arousal are the fundamental building blocks of attachment and its associated
emotions.”
This coregulation of affect results in an intersubjective state of connected-
ness between mother and child that instills a state of equilibrium in the child
that is experienced as security. It is this state of security embodied by a select
individual or individuals that the infant attaches to as manifested in the
maintenance of contact and reunification on encountering fear or stress.
Thus, the overwhelming body of literature identifies the intimate
moment-to-moment relationship between an infant and a caregiver as
the fulcrum of healthy attachment. This notion of caregiver sensitivity as
the critical factor in the development of attachment security was initially
proposed by Bowlby in the first volume of his attachment trilogy (1969).
He suggested that when infants are responded to with sensitivity, they gain
confidence in the availability of the caregiver and thus reference that
caregiver as a secure base.
In this conception that emphasizes maternal sensitivity, failures within the
relationship or its overall absence should inexorably result in attachment
insecurity. If facilitation of felt security—and, consequently, healthy attach-
ment—is dependent on the carefully attuned and ongoing presence of the
sensitive caregiver, the absence of that presence would seem decisive in an
inability to achieve healthy attachment and, ultimately, ongoing interpersonal
functioning.

Cross-cultural applicability
The description articulated by attachment researchers of the sensitive and
attuned caregiver who spends substantial amounts of time engaged in inti-
mate contact with their infant is not intended to be limited to a psychological
description specific to time and place; Bowlby proposed that the attachment
system, as an evolutionary structure, is a fundamental driving force in the
behavior of the entire human race (1969/1988). If the assertion is taken at
face value that attachment is indeed a fundamental component of human
psychology and functioning that was naturally selected, then presumably we
should find attachment behavior across all cultures. This is the basic reason-
ing behind the universality hypothesis.
 SMITH COLLEGE STUDIES IN SOCIAL WORK 5

Keller (2016) identified three prerequisites for the type of child centered-
ness that classic attachment theory assumes promotes healthy attachment.
Mothers who assume primary care of their child whilst remaining sensitively
attuned and responsive on an ongoing basis must have sufficient economic
resources to dedicate enough time for this endeavor and responsibility for
only a small number of children so that time and energy are not divided, and
they must possess a sufficient formal education that promotes verbal expres-
sion between mother and child.
These requirements are not characteristic of the types of situations of
mothers worldwide and may be less representative of the majority even in
a Western context (Brown et al., 2008). Studies have shown that across
cultures, infants with low social economic status exhibit high levels of
attachment insecurity—rivaling children who have been victims of maltreat-
ment (Cyr, Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010).
Similarly, Bakermans-Kranenburg, Van Ijzendoorn, and Kroonenberg
(2004) found that African American children score lower on attachment
security than do White children and hypothesize that socioeconomic factors
common to the African American populations they studied impeded the
establishment of attachment security.
While classically attachment researchers typically focus specifically on the
attachment between the mother and the child, Sagi and Van IJzendoorn
(1996), in their examinations of attachment in the communal sleeping
arrangements of Israeli kibbutzim, found that in contexts where multiple
caregivers provide childcare, attachment is best predicted by the overall
quality of the extended networks. Though this research—done by the two
authors who proposed the universality idea—used the basic foundations of
Western attachment (sensitivity, promotion of autonomy, affective tuning,
etc.) as the metrics of attachment security, the idea they proffer does
acknowledge the possibility of multiple attachments as the primary predictor
of attachment security.
There is growing evidence that the universality attributed to the specific
developmental pathways of attachment that, in its current conceptualization,
emphasizes the particularity of the relationship with the mother and the
sensitivity that is necessary for the facilitation of healthy attachment is outdated
and misinformed (Otto & Keller, 2014). This potential overemphasis on
Western models of attachment may actually be part of a larger trend in the
psychological and behavioral sciences that draws universal conclusions from
the study of Western populations that may be overgeneralized and unwarranted
(Arnett, 2008). Henrich, Heine, and Norenzayan (2010) in a highly influential
article argue that while WEIRD (Western, educated, industrialized, rich, demo-
cratic) subjects compose the overwhelming majority of research subjects in the
social sciences, they are outliers across a range of measures.
6 Z. GANZ

As such, the model of parents who spend considerable amounts of time in

child-centered contingently attuned caregiving is likely a Euro-American
construct that is not the dominant form of child-rearing across cultures.
Thus, the question of how attachment is established across cultures is
currently a matter of major importance on theoretical and clinical levels
(Bretherton, 1992; Brown et al., 2008). While attachment theory has perhaps
not sufficiently accounted for alternate forms of caregiving, researchers have
not neglected the issue of cross-cultural attachment. The following section
will review the major findings from cross-cultural attachment research.

The universality hypothesis

The assertion that attachment behavior in its current understanding is a
universal construct stems from decades of research that does seem to confirm
to the ubiquitous nature of attachment behavior (Posada et al., 1995; Posada
& Jacobs, 2001; Van IJzendoorn & Kroonenberg, 1988; Van IJzendoorn &
Sagi, 2008). In a meta-analysis of strange situation studies across cultures,
van IJzenboorn and Kroonberg (1988) found that intra cultural differences in
attachment patterns were 1.5 times as large as intercultural differences,
indicating that, at least within the confines of the strange situation, attach-
ment behavior has a strong universal element. Similarly, Posada and his
colleagues (1995) examined children from seven different countries and
used observational data generated from the attachment q-set (Waters,
1995) as opposed to the strange situation. They found that on average,
children from all the countries that were studied were observed to fit more
closely with the hypothetical securely attached child as scored in the attach-
ment q-set, thus supporting the hypothesis that attachment behavior is a
ubiquitous phenomenon. Moreover, mothers from all seven countries
described ideal attachment behavior in ways that were far more similar
than different—once again supporting a ubiquity argument.
More recently, critics of the universality hypothesis have asserted that
cross-cultural attachment research has studied attachment through an artifi-
cially constricted lens that preserves psychological constructs and with meth-
odology ill-suited to non-Western populations (Morelli & Henry, 2013). This
position rejects the meta-analytic support of the universality hypothesis as
culturally invalid due to its Western informed models that essentially “’best
fit’… subjective evaluations rather than expand the kind of information
needed to better understand variation observed (p. 242).
To examine the universality hypothesis in greater depth, and understand
the position of its proponents and critics, it is useful to parse out what this
position does and does not contend. Van IJzendoorn and Sagi (2008) isolate
three sub-hypotheses within the broader claim of universality.
 SMITH COLLEGE STUDIES IN SOCIAL WORK 7

The sensitivity hypothesis

The sensitivity hypothesis asserts a direct link between attunement and
attachment security. This claim is based on an integration of Sroufe and
Waters’ (1977) contention that attachment is facilitated by felt security—
that is, the child, when frightened, will retreat to relationships that make
her feel secure—and the position that it is the attunement and sensitivity
of the caregiver, developed primarily through the first year of life, that
facilitate this sense of security. Among the Euro-American samples typi-
cally studied in attachment research, maternal sensitivity has been strongly
associated with the development of executive functioning (Bernier,
Carlson, & Whipple, 2010), prosocial behavior (Kochanska, Barry, Aksan,
& Boldt, 2008), and later academic functioning (Kopystynska, Spinrad,
Seay, & Eisenberg, 2016).
Within the universality hypothesis, the sensitivity hypothesis argues that
this relationship between sensitivity and attachment will hold true across
cultures, and research does exist that indicates the uniformity of sensitivity as
a cross-cultural necessity of secure attachment. In a meta-analysis conducted
by De Wolff and Van IJzendoorn (1997), the results indicated a medium
effect size (0.24) across cultures between the factors of sensitivity and attach-
ment security, although the effects size was significantly lower among chil-
dren living in low socioeconomic conditions. In addition, a recent large
cross-cultural study found that there was a strong overlap between mothers’
description of what constitutes ideal parenting and the description of the
sensitively attuned parent that contemporary attachment theory proposes
(Mesman et al, 2016). Specifically, sensitivity has been found to be critical
in traditional societies such as the Gusii in Kenya (Kermoian & Leiderman)
and in the collective caregiving arrangement of the Israeli kibbutz (Sagi et al.,
1985).
Beyond the existing research, there is also a theoretical rationale for the
proposition that sensitivity is a uniform element in child-rearing and the
development of healthy attachment. Mesman et al. (2017, p. 2) argue that
from an evolutionary perspective, sensitively attuned caregiving would seem
to promote survival because “it ensures the infant will be well fed when
signaling hunger, protected when signaling fear, and cared for when signaling
pain.” Moreover, if indeed it is the attunement of caregivers that promotes
felt security as proposed by Sroufe and Waters (1977), and felt security is the
mechanism that draws the infant to the caregiver in times of fear, then it
seems reasonable to assume that sensitivity is a necessary and, therefore,
universal component of the attachment system.
However, researchers arguing for a nonuniform conception of attachment
contend that this proposition misses the point of the evolutionary basis of
attachment (Keller et al., 2017). Natural selection requires an adaptiveness
8 Z. GANZ

that is context dependent. Thus, the manifestation of maternal sensitivity

must necessarily be contingent on cultural, economic, and ecological realities
within the specific environment of the caregiver–child dyad.
Ainsworth et al.’s (1978) original description of sensitive responsiveness in
which the parent follows the child’s lead and remains in dialogical contact
rests on beliefs and assumptions related to the nature of young children,
which are themselves products of ecological circumstances related to the
typical Western lifestyle. Specifically, the typical Western understanding of
infants and children identifies them as autonomous agents with a separate
will that must be cultivated and nurtured. It is thus understandable that an
emphasis would be placed on following the child’s lead and responding
appropriately to her moods.
But in cultures where children are thought of primarily as members of
communal groups, infants are not seen as possessing agentic autonomy, and
consequently sensitive responsiveness will inevitably be deemphasized
(Keller, 2013). Rothbaum, Weisz, Pott, Miyake, and Morelli (2000) argued
that unlike the culture dictating Western parenting styles in Japan, sensitive
responsiveness entails fostering dependency and addressing children’s needs
before those needs are addressed. Thus, maternal care that would be char-
acterized as overbearing in a Western setting would be considered sensitive
within this cultural context. Similarly, Rothbaum, Nagaoka, and Pointe
(2006) found that preschool teachers in Japan prefer to anticipate children’s
needs, while American preschool teachers tend to respond when needs are
verbalized.
A major problem in assessing the validity of the sensitivity hypothesis is
the lack of a consensus definition regarding what actually constitutes sensi-
tivity (Beherens, 2016). For example, Keller et al. (2017) point to the con-
struct of warmth as a measure of sensitivity that was not present in the
original formulation of sensitivity as defined by Ainsworth, Bell, and Stayton
(1974) but has since become a mainstay of contemporary definitions (e.g.,
Mesman & Emmen, 2013). If warmth is truly considered a baseline criterion
for sensitivity, then many traditional cultures whose parenting practices are
devoid of the warmth typical of Western child-rearing would seem to contra-
dict the basic hypothesis of the universality of sensitivity (Keller, 2013).

The normativity hypothesis

The second sub-hypothesis within the claim of universality has been called
the normativity hypothesis, which broadly states that beyond the assertion
that attachment is a system common to all humans, secure attachment is the
most widespread form of this behavior (Zreik, Oppenheim, & Sagi, 2017).
This claim is somewhat harder to support because it takes the position that
the manifestation of secure attachment behavior as understood in a Western
 SMITH COLLEGE STUDIES IN SOCIAL WORK 9

context is common across cultures. Evidence drawn from both strange

situation research (Van IJzendoorn & Kroonenberg, 1988) as well as research
using the q-set (Posada, Carbonell, Alzate, & Plata, 2004; Posada et al., 1995)
does indicate that, cross-culturally, secure attachment is the most common
form of attachment. Moreover, specific attachment studies from a vast array
of countries and cultures indicate that, when tested for attachment type, most
children fall into the securely attached category (Van IJzendoorn & Sagi,
2008; Zreik et al., 2017).
Keller (2008) argues that the hypothesis misunderstands evolutionary
theory in its argument for a normative strategy of attachment that promotes
reproduction. The claim that only one attachment tactic has been enough for
sufficient adaptiveness in the vast array of contexts within which humans
developed seems highly questionable. As Simpson and Belsky (2016) point
out, secure attachment as currently understood is contingent on significant
investment on the part of caregivers—something that itself is dependent on
the environment being resource rich, thereby providing the opportunity for
child-centered time. Postulating that this was indeed the dominant environ-
ment of evolutionary adaptiveness during the past 100,000 years runs counter
to the preponderance of the evidence (Wilson, 2012).
In fact, research has found that alloparenting is actually the dominant
form of raising children in many non-Western communities. Traditional
societies often use a communal approach to raising children (Diamond,
2012; Meeha & Hawks, 2013). Specifically, sibling caregiving has been
shown to comprise an important role in the raising of children in non–Euro-
American cultures (Crittendon & Marlowe, 2008; Weisner, 2014). Thus,
normativity of attachment style—the manner in which the child responds
to caregivers—may not be synonymous with a specific normative parenting
style.
However, while nonbiological parents are certainly prevalent, this arrange-
ment does not necessarily disqualify the primary assertion of the normativity
hypothesis of secure attachment as the dominant form of connection across
cultures. As previously noted, attachment research indicates that secure
attachment is dominant across a range of cultures, including African hunter-
gatherers, Israeli kibbutzim, and Japanese communities (Van IJzendoorn &
Sagi, 2008).
Main (1990), while staking the position that attachment behavior exists as
a ubiquitous system in human functioning, nevertheless pointed out that as
an evolutionary theory, attachment must make room for adaptiveness. Thus,
we can expect that cultural context should play a significant role in the
manifestation of specific attachment behavior. Main proposed viewing
attachment patterns as strategies that infants adopt in response to contextual
circumstance. For example, in cultures with lower levels of expressed emo-
tionality and greater frequency of emotional suppression, we would expect to
10 Z. GANZ

find higher levels of avoidant attachment—not as a pathological trend but as

an adaptive ploy. In this model, secure attachment is not normative or
inherently preferable to other patterns of attachment but merely one
response to environmental conditions.

The competence hypothesis

Finally, the competence hypothesis asserts that security of attachment will uni-
formly influence the longitudinal development of functioning so that secure
attachment would predict more competent and successful functioning along a
range of measures regardless of culture (Van IJzendoorn & Sagi, 2008). Meta-
analysis has firmly established the importance of secure attachment as related to
longitudinal adjustment—specifically as related to externalizing behaviors
(Groh, Roisman, Bakermans-Kranenburg, & Fearon, 2012).
While there are robust data emanating from Western sources that support
this contention, cross-cultural research on this topic is scarce (Bretherton,
1992; Rothbaum et al., 2000). Further complicating matters is how compe-
tence is defined. The typical benchmarks of developmental and functional
competence, be they in infancy, childhood, adolescence, or adulthood, are all
established on a set of values that may very well not overlap with the values
held outside of a Euro-American context. How, then, can competence be
defined to test its relationship to security of attachment?
Keller (2008) critiqued attachment theorists’ tendency to minimize how
cultural values affect how successful functioning is defined and, thus, what is
identified as competency within each culture. She hypothesized that Bowlby’s
placement of independence as the outcome of healthy attachment may have
been predicated on his psychoanalytic training, which placed individuation
as the paragon of functionality. Ainsworth and colleagues (1978) in the
parameters of the strange situation defined secure attachment as the integra-
tion of maternal warmth and nurturance together with provision of space
and avoidance of interference. And, yet, what is defined there as interference
is in many contexts seen as ideal child-rearing (Chao, 1995; Keller, 2003).
This critique is echoed in Rothbaum et al. (2000), who differentiated between
samples of mother–child dyads in the United States whose relationship was
marked by a focus on autonomy and dyads in Japan where interdependence
and allegiance to family were primarily valued. In this context, competence
assumes different meanings, thereby calling the competency hypothesis into
question.
Posada and Jacobs (2001) insist that the issue is not the specific nature of
what competence is defined to be but rather the linkage between security and
competence—however, competence is defined in the specific cultural milieu.
The authors state, “The issue is not whether there are cultural differences in
definitions of competence but whether security is associated with the
 SMITH COLLEGE STUDIES IN SOCIAL WORK 11

socialization outcomes that the theory predicts it should be” (p. 822). In this
view, how competence is defined is relevant only insofar as it guides what
researchers must be looking for. Assuming that researchers correctly identify
specific cultural definitions, the linkage between security and competence can
still be established.

Clinical implications
Despite the substantial efforts put into the topic of cross-cultural attachment,
research testing the validity of universality hypothesis is still in its infancy
(Behrens, 2016), thus calling into question van IJzendoorn and Sagi’s (2008)
claim that universality of attachment has been settled. While data exist
attesting to greater intracultural differences compared with intercultural
differences in attachment, a large number of refutations have emerged that
call these data into question.
What is at stake goes beyond culturally sensitive practice, which has
general acceptance as a clinical imperative. Instead, the general relevance of
our basic models is the matter in question. As an example, we may take
Stanley Greenspan’s Floortime model (Greenspan & Wieder, 2005) that
espouses 15 to 30 minutes a day of individualized child-centered time as a
means of promoting intellectual and emotional development in children. For
communities who do not fit the criteria elucidated by Keller (2016) that
include a small number of children, educated parents, and sufficient eco-
nomic resources, this model may be ineffective or perhaps even counter-
productive for many reasons. First, it seems completely infeasible to expect
parents of large families to dedicate daily individualized time to all of their
children. Efforts on the part of the caregiver to deliver this may actually be
counterproductive in that we might expect high levels of parental
burnout. Second, this model assumes a nuclear family model that is not the
norm outside of a Euro-American context. Moreover, this model is based on
the sensitivity hypothesis. If sensitivity is not a significant factor in attach-
ment across all cultures, then the intervention misses the point completely
for those to whom sensitivity is not a formative element of healthy
attachment.
In identifying the relevance of attachment principles to clinical practice it
is instructive to utilize the three sub-hypotheses as a means of assessing its
applicability to given population. Using these categories, the culturally
responsive clinician will consider the relevance of sensitivity and warmth
within a specific community’s child-rearing practice, whether autonomy is
identified as an ideal, and the means by which community members identify
success and competence.
In the following section, a case study of an ultraorthodox family will be
used to explore how the sub-hypothesis of the universality hypothesis might
12 Z. GANZ

be used to assess the relevance of therapeutic models and interventions

within a community whose values and circumstances do not correspond to
those of the traditional Western household.
Haredi families are organized along patriarchal lines, with men assuming
most of the responsibility for family religious rituals and major family
decisions (Goshen-Gottenstein, 1984; Heilman & Friedman, 1991). While
husbands may take on some domestic responsibilities (accompanying chil-
dren to school, food shopping, etc.), wives assume a clearly dominant role in
the concrete tasks of child-rearing, yet are expected to maintain a moderate
level of subservience and respect to their husbands. Children in the ultra-
orthodox community are expected to demonstrate maturity and responsibil-
ity from a young age (Yafeh, 2007). As mentioned earlier, elder female
siblings assume partial responsibility for raising younger children by the
time they reach adolescence, and by the same age boys are expected to
manage serious study in Talmud—often until late in the evening (Heliman
& Friedman, 1991).
For a number of reasons, the ultraorthodox community in Israel provides
a useful population for exploring the issue of the clinical relevance of
diversity in attachment. First, the Haredim (ultraorthodox) have very high
birthrates (Paltiel, 2013). It is not unusual for an ultraorthodox family to
have eight or more children. Furthermore, though the Haredim in Israel are
predominately of European background, the values and ethics of the com-
munity are far more traditional than those of typical Western society and
contain a collectivist element that is foreign to the secular culture surround-
ing them (Finkleman, 2011). Thus, while they maintain locational embedd-
edness in a larger secular society largely informed by Western values,
ultraorthodox society preserves unique family constellations and values that
may significantly inform standard familial relational patterns. It is important
to note that the family used in this case study hails from the ultraorthodox
community in Israel. Haredi communities exist outside of Israel as well, and
while many commonalities exist, the ultraorthodox community in Israel is
typically considered to be more extreme in its insularity and rejection of
secular culture (Heilman & Friedman, 1991). Thus, insights drawn from this
case study may have limited relevance to ultraorthodox communities outside
of Israel whose child-rearing beliefs and consequent attachment ethos may be
more akin to standard Euro-American principles.

The Friedman family

At the behest of their local social services department the Friedman family
entered therapy in an outpatient mental health center specializing in the
treatment of an ultraorthodox clientele. The referral came in the aftermath
of a report filed by their 4-year-old son’s nursery school teacher who
 SMITH COLLEGE STUDIES IN SOCIAL WORK 13

suspected physical violence due to repeated visible bruising on the child’s

face. The social worker assigned to the case, a person who was not
ultraorthodox, found no evidence of physical violence but recommended
family therapy due to what she perceived to be a lack of communication
between the parents and their children and a limited capacity on the part
of the mother to express any positive emotion toward her children. The
social worker reported that all seven children (the oldest of whom was 10)
seemed to be extremely well cared for in terms of physical needs and the
home was neat and organized, but in her assessment the children’s “emo-
tional needs” were not being met.
During the first session, the parents, Yehoshua and Batsheva, presented as
serious, yet friendly. Yehoshua asked respectfully how many sessions the
process would entail because the meetings forced him to be absent from
his kollel (a religious seminary). Upon hearing that the therapist could not
give a firm number, Yehoshua seemed disappointed but did not protest.
Both parents were able to articulate the reasons for being sent to therapy,
but seemed lost as to why it was necessary. Batsheva explained that their
4-year-old son was an extremely active boy and often followed his older
brothers into physical activities that were bound to get him hurt. They both
felt betrayed by the nursery school teacher—Yehoshua hypothesized that she
had just undergone training by the education ministry and had been duped
into thinking that reporting was an appropriate thing to do. When asked
about the proximate reason for the referral—that the social worker felt that
there was an emotional disconnect between them and their children—both
parents shrugged and seem perplexed by what the social worker was looking
for. They both claimed that they had a good relationship with all their
children. They pointed to the fact that their oldest daughter eagerly helped
her mother with housework and cared for the younger children and that their
boys were excelling in their studies at school.
The parents were invited to bring their children to the following session.
The children, whose ages ranged from 10 years to 8 months, were dressed
neatly, with children of the same sex wearing identical clothes. Batsheva had
brought along chicken cutlets and cut up vegetables, and the session was
delayed as the children finished their dinner in the waiting room. Batsheva,
apologetically explained that since the session was scheduled for dinner time
she had decided to bring along food so that the children would not be hungry
on the way back home, and so that she would be able to proceed with
bedtimes immediately on their return.
During the session, the children were cooperative, albeit somewhat wild.
Yehoshua and Batsheva seemed comfortable with their children’s activities,
and consequently the therapist followed their lead in terms of creating order
in the room. Batsheva was highly focused on the care of her 8-month-old and
was more or less absent from participation in any of the family activities.
14 Z. GANZ

All family members were asked to draw a family. The children seemed
confused by the vagueness of the directive and turned to their parents for
direction. When told that there was no correct way of drawing the picture,
the children either drew stick figure drawings or abstained from the activity
altogether.
The therapist conducted one more session with the parents to assess their
thoughts about the family session and to gauge their interest in therapy. Both
parents reported that the session was interesting in that it provided an
opportunity for them to play together as a family, which was something
they did not get a chance to do. With regard to interest in therapy, Yehoshua
expressed a willingness to get “parenting tips” from the therapist but pre-
ferred not to get involved in a long process of therapy. The therapist, having
concluded that the children were well cared for, called the social worker to
clarify whether therapy was legally mandated. When informed that it was
not, the therapist contracted for two sessions with the parents to talk about
parenting. At the conclusion of these sessions, Yehoshua and Batsheva agreed
that further clinical work would not be necessary.

Discussion
The Friedman family provides an illustration of a well-functioning ultra-
orthodox family whose model of effective parenting contrasted with that of
the assessing social worker. In examining this family through the lens of the
universality hypothesis’ three sub-categories, we can determine divergence in
the manner with which attachment is established.
Sensitivity from a Euro-American standpoint often is defined by warmth
and emotional attunement. Sensitive parents are ones who maintain
empathic connection with their children and respond contingently to them.
This in turn establishes in the child felt security (Sroufe & Water, 1977) and
serves as the foundation of the secure base. The Friedman family showed
minimal sensitivity under the terms of this definition. Batsheva and
Yehoshua were often distracted and disconnected from even their younger
children whose vacillations in emotional output were often not responded to.
Presumably, this was partially due to the inevitable spreading of attention
that accompanies the care of seven children; however, we may posit that this
lack of sensitivity also stems from an intrinsic lack of focus placed on their
children’s individual emotional expression.
This lack of emphasis may be a function of a broader pattern in ultra-
orthodox culture specifically, and insular religious communities in general.
Frosh (2004) describes the fundamentalist family as one that refrains from
placing children at the center of attention and instead stresses the collective.
Indeed, ultraorthodox children are socialized to emphasize communal
responsibility at the expense of individual actualization. In an analysis of
 SMITH COLLEGE STUDIES IN SOCIAL WORK 15

200 children’s stories written for Haredi children, Yafeh (2001) found that
the themes of the stories accentuated the normative cultural model that
should be adhered to and that the characters presented little in the way of
personal emotions or characteristics.
The normativity hypothesis, which states that secure attachment patterns
will be standard across cultures, seems to have been crucial in the assessment
of the social worker who suspected attachment problems partially because of
the 4-year-old’s risky behavior. His lack of a fear mechanism and an auto-
matic response to return to his parents upon encountering danger indicated
to the social worker that the Friedmans were guilty of some level of neglect.
This makes sense in the context of a cultural imperative that emphasizes a
balance between autonomy and dependence while also tasking parents with
keeping their children safe from physical harm.
However, in understanding the Friedman parents’ approach to child-
rearing, it is important to recognize that children in the ultraorthodox
community are expected to demonstrate maturity and responsibility from a
young age and are often given independence that would seem irresponsible
in more Western communities (Yafeh, 2007). The fact that the parents did
not intervene more directly and allowed their 4-year-old son to accumulate
consistent bruising may simply have been a function of a different threshold
of danger sensitivity. Both Batsheva and Yehoshua expressed confidence that
their son was not getting into major trouble and saw the injuries he sustained
as unfortunate but minor.
Finally, sensitivity to cultural variations in the definition of competence
proved to be crucial in contextualizing the Friedman family. During the
family meeting, much of the children’s behavior would have been worrisome
in the context of a family more exposed to Western values. The children had
difficulty expressing or identifying emotions, had trouble with independent
projective assignments, and exhibited a limited capacity to regulate them-
selves enough to sit still. Self-awareness and mentallizing capacities that
considered emotional states did seem to be restricted.
However, this presentation, when understood in the framework of cultural
imperatives, is more easily understood and decreases the need to pathologize.
The uniform dress of the children—with boys wearing identical shirts and
pants and girls wearing matching dresses—is quite typical for Haredi
families, and possibly works both as an expression of the cultural imperative
toward conformity to the group, as well as a signal that these are children
who have their physical needs met. The children’s difficulty with drawing a
family may plausibly be traced to cultural imperatives towards conformity
and the fundamental principle—enshrined prominently in Jewish law—to
honor and respect one’s parents. Drawing a picture of their family may have
been perceived as an intrusion by an outsider into personal family matters as
well as an unwelcome invitation to express unsanctioned individuality.
16 Z. GANZ

Batsheva and Yehoshua gave insight into how they defined competence
when they described with pride how their older daughter complacently
helped her mother with chores and child care and how their boys were
excelling in their studies. The Friedman children were demonstrating a strict
adherence to cultural norms and expectations. This level of obedience and
lack of autonomy, while arguably pathological in a Western context, were, in
the metrics of the ultraorthodox community, evidence of significant compe-
tence. Recognition of this relativity was crucial in preventing the therapist
from pathologizing ordinary and successful child-rearing. Interventions
designed to enhance attachment between the parents and their children
would have merely met with resistance and perhaps even have been
counterproductive.
This analysis does not completely negate sensitivity and warmth as factors
in ultraorthodox child-rearing, nor does it present an argument that attune-
ment is irrelevant developmentally outside of a Western context. In examin-
ing this case, we might easily posit that increased sensitivity on the part of the
parents may have had positive implications for their children’s development.
Perhaps their oldest daughter would benefit from a more intimate and
emotionally expressive relationship with her parents, and it is possible that
she would experience increased self-esteem if her competence was not judged
primarily by her domestic performance.
However, in this case the key assessment factor related to basic emotional
well-being. As a nonmandated case without self-motivated parents the clini-
cian’s primary assessment centered on the question of how much pressure
would be put on the parents to continue treatment given their reluctance.
The conclusion that was reached—in contrast to the assessment of the family
social worker—was that the observed attachment concerns could be attributed
to normative cultural factors and were not indications of emotional neglect.
In learning and perhaps generalizing from this case study, one important
element needs to be added. As an insular community situated proximate to
Westernized secular society, the ultraorthodox are subject to the inevitable
intrusion of Western culture. The extent to which the ultraorthodox have
actually created firm cultural barriers is difficult to gauge. Writers such as
Finkelman (2011) and Hakak (2011) have described in detail how Haredi
society has been influenced by secular ideas on parenting. Significant diver-
sity exists within the ultraorthodox community and there is growing recog-
nition that Westernized child-rearing practices and values have begun to
assume significant influence within certain segments of the community. The
Friedman’s belonged to a particularly insular sub-sect of Haredim, and their
presentation is thus not representative of community members with greater
exposure to Western parenting practices and ideals. Research is necessary to
determine the manner in which attachment is developed in the ultraorthodox
 SMITH COLLEGE STUDIES IN SOCIAL WORK 17

community, and the different ways that Western style parenting values have
gained influence.
Nevertheless, the Friedman case exhibits how the universality hypothesis and
it sub-categories—initially conceived of as purely theoretical constructs designed
to organize research initiatives—may be useful in recognizing cultural variations
in attachment and assessing whether treatment interventions designed around
the principles of contemporary attachment theory are called for.

Disclosure statement
No potential conflict of interest was reported by the author.

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