Attachment Across Clinical and

Cultural Perspectives

Attachment Across Clinical and Cultural Perspectives brings together leading thinkers in
attachment theory to explore its importance across cultural, clinical, and social contexts and
the application of attachment relationship principles to intervention with diverse groups of
children and families. These contributions collectively illustrate the robustness of attachment
research in the contexts of culture, early extreme deprivation, trauma, and the developing
brain, providing great inspiration for anyone embracing the idea of evidence-based practice.
Two chapters convey fundamentals of attachment theory, covering links between attach-
ment and normal and pathological development and the interface between attachment and
other features of evolutionary theory. Two others specifically tackle the cultural context of
attachment; fundamental research findings with North American and European samples are
shown to hold as well among indigenous people in a rural Mexican village, whilst the link
between maternal sensitivity and secure attachment is demonstrated in a variety of cultures.
Further chapters explore the role of fear and trauma in the formation of attachment; one
establishes intergenerational links between parental history of trauma, dissociative states
of mind, and infant disorganized attachment; another looks at the consequences of early
extreme deprivation (institutional rearing) for attachment. A third describes the impact
of attachment experiences on brain development. Finally, the book explores intervention
guided by attachment theory, research on fear and trauma, and an understanding of how
attachment experiences leave their mark on parental psyche and behavior.
Attachment Across Clinical and Cultural Perspectives gathers authoritative informa-
tion from leading experts in the field in an easily readable, practical way. It will appeal to
psychoanalysts and psychoanalytic psychotherapists, to professionals who serve the devel-
opmental and mental health needs of adults, children and families, and anyone seeking to
base their intervention work and therapy upon attachment principles.

Sonia Gojman-de-Millan is an Executive Committee member of the International

Federation of Psychoanalytic Societies (IFPS) and a psychoanalyst in private practice in
Mexico City.

Christian Herreman is the Director of ENSO and a psychoanalyst in private practice in

Mexico City.

L. Alan Sroufe is Professor Emeritus of Child Psychology in the Institute of Child

Development at the University of Minnesota.
 PSYCHOANALYTIC INQUIRY BOOK SERIES
JOSEPH D. LICHTENBERG
Series Editor

Like its counterpart, Psychoanalytic Inquiry: A Topical Journal for Mental

Health Professionals, the Psychoanalytic Inquiry Book Series presents a
diversity of subjects within a diversity of approaches to those subjects. Under
the editorship of Joseph Lichtenberg, in collaboration with Melvin Born-
stein and the editorial board of Psychoanalytic Inquiry, the volumes in this
series strike a balance between research, theory, and clinical application. We
are honored to have published the works of various innovators in psychoa-
nalysis, such as Frank Lachmann, James Fosshage, Robert Stolorow, Donna
Orange, Louis Sander, Léon Wurmser, James Grotstein, Joseph Jones, Doris
Brothers, Fredric Busch, and Joseph Lichtenberg, among others.
The series includes books and monographs on mainline psychoanalytic top-
ics, such as sexuality, narcissism, trauma, homosexuality, jealousy, envy, and
varied aspects of analytic process and technique. In our efforts to broaden the
field of analytic interest, the series has incorporated and embraced innovative
discoveries in infant research, self-psychology, intersubjectivity, motivational
systems, affects as process, responses to cancer, borderline states, contextual-
ism, postmodernism, attachment research and theory, medication, and men-
talization. As further investigations in psychoanalysis come to fruition, we
seek to present them in readable, easily comprehensible writing.
After 25 years, the core vision of this series remains the investigation,
analysis, and discussion of developments on the cutting edge of the psy-
choanalytic field, inspired by a boundless spirit of inquiry.

Vol. 52 Vol. 53
The Muse: Attachment Across
Psychoanalytic Clinical and Cultural Perspectives: A
Explorations of Relational Psychoanalytic Approach
Creative Inspiration Sonia Gojman-de-Millan, Christian
Adele Tutter (ed.) Herreman & L. Alan Sroufe (eds.)
Attachment Across Clinical
and Cultural Perspectives

A relational psychoanalytic approach

Edited by Sonia Gojman-de-Millan,

Christian Herreman, and
L. Alan Sroufe
First published 2017
by Routledge
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© 2017 selection and editorial matter, Sonia Gojman-de-Millan, Christian
Herreman, and L. Alan Sroufe; individual chapters, the contributors
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A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Gojman-de-Millan, Sonia, editor. | Herreman, Christian, editor. |
Sroufe, L. Alan, editor.
Title: Attachment across clinical and cultural perspectives : a relational
psychoanalytic approach / edited by Sonia Gojman-de-Millan,
Christian Herreman, and L. Alan Sroufe.
Description: Abingdon, Oxon ; New York, NY : Routledge, 2017. |
Series: Psychoanalytic inquiry book series ; volume 53 | Includes
bibliographical references and index.
Identifiers: LCCN 2016013288| ISBN 9781138999671
(hardback : alk. paper) | ISBN 9781138999688 (pbk. : alk. paper) |
ISBN 9781315658100 (e-book : alk. paper)
Subjects: LCSH: Attachment behavior. | Attachment disorder.
Classification: LCC BF575.A86 A765 2017 | DDC 155.2—dc23
LC record available at https://lccn.loc.gov/2016013288

ISBN: 978-1-138-99967-1 (hbk)

ISBN: 978-1-138-99968-8 (pbk)
ISBN: 978-1-315-65810-0 (ebk)

Typeset in Times New Roman

by Swales & Willis Ltd, Exeter, Devon, UK
Contents

List of illustrations vii

Notes on contributors viii
Preface xiv
Acknowledgements xx

PART I
Attachment, theory, and research 1

1 Attachment theory: A humanistic approach for

research and practice across cultures 3
L. ALAN SROUFE

2 Universality and cultural specificity in child-mother

attachment relationships: In search of answers 30
GERMÁN POSADA AND JILL M. TRUMBELL

3 Unresolved/disorganized responses to the death of

important persons: Relations to frightening parental
behavior and infant disorganization 53
NAOMI I. GRIBNEAU BAHM, MARY MAIN, AND ERIK HESSE

4 Attachment research in urban and rural Mexico:

Clinical and social implications 75
SONIA GOJMAN-DE-MILLAN, SALVADOR MILLÁN, GUADALUPE SÁNCHEZ,
AND PATRICIA GONZÁLEZ DUARTE

5 Attachment within the context of a cooperative and

sharing mind 100
MAURICIO CORTINA
vi Contents

6 Attachment at the extremes: Lesson from the Bucharest

Early Intervention Project 142
CHARLES H. ZEANAH, NATHAN A. FOX, AND CHARLES A. NELSON

PART II
Clinical163

7 The integration of attachment, mindfulness, and

neuroscience165
DANIEL J. SIEGEL

8 Minding The Baby®: The impact of threat on the

mother-baby and mother-clinician relationship 182
ARIETTA SLADE, LOIS SADLER, NANCY CLOSE, SARAH E. FITZPATRICK,
TANIKA SIMPSON, AND DENISE WEBB

9 Attachment, trauma, and reality: Clinical integrations in

the treatment of young children 205
ALICIA F. LIEBERMAN

10 Attachment and complex trauma: An intervention

program for institutionalized infants (0–4 years) 221
FELIPE LECANNELIER

Appendix 235
Index 253
Illustrations

Figures
2.1 Range of security scores by country 37
4.1 Family drawing #1 78
4.2 Family drawing #2 79
4.3 Family drawing #3 79
4.4 Family drawing #4 83
8.1 Threat and the clinical process 193
8.2 Nested mentalization 197
A.1 Distributions of presence or absence of fully formed
attachment behaviors in institutionalized infants of
three samples compared in this study 241

Table
5.1 Comparison of simple and complex forms of
intersubjectivity127

Box
1.1 Ainsworth and Main patterns of attachment 13
Contributors

Nancy Close, Ph.D., IMH-IV® is Assistant Professor at the Yale Child

Study Center, an endorsed infant mental health clinical mentor, and
one of the Co-Directors of Minding the Baby®, where she has been
supervising and training for the last ten years. A clinical psycholo-
gist and educator specializing in assessment and treatment of chil-
dren under age 5, she also teaches at Yale University, and is the
author of Listening to Children: Talking to Children About Difficult
Issues.
Mauricio Cortina, M.D. is Director of the Attachment and Human
Development Center at the Washington School of Psychiatry,
Washington, DC. He is Co-President of the Ibero-American Attachment
Network, a Fellow, American Academy of Dynamic Psychiatry and
Psychoanalysis. He is a faculty member of the Washington School of
Psychiatry, the Institute of Contemporary Psychotherapy and Psycho­
analysis, Washington, DC, and the Seminario de socio-psiciananisis,
A.C. Mexico D.F. Dr. Cortina has published numerous works on the
interface between attachment theory, inter-subjectivity theory, and
other theories of human motivation.
Patricia González Duarte is a psychologist and psychoanalyst. She is
a teacher and supervisor in the Seminario de Sociopsicoanálisis in
Mexico City, a member of the International Federation of Psycho­
analytic Societies, and participates in the investigation of attachment
and social character.
 Notes on contributors ix

Sarah E. Fitzpatrick, LCSW, is Assistant Clinical Professor at the

Yale Child Study Center, and has worked as a social work home visi-
tor, supervisor and trainer for Minding the Baby® for ten years. She
has a private psychotherapy and consultation practice in New Haven,
Connecticut, and has been on the clinical and teaching faculty at the
Department of Psychiatry, Yale School of Medicine.
Nathan A. Fox, Ph.D. is Distinguished University Professor and Chair of
Human Development and Quantitative Methodology in the University
of Maryland College of Education. A winner of the G. Stanley Hall
Award from Division 7 of the American Psychological Association for
outstanding scientific contributions, he has an extraordinary record of
publications in the areas of temperament, emotion regulation, neuro-
psychological development, and the consequences of institutionalization.
Sonia Gojman-de-Millan, Ph.D. combines her experience as a clini-
cian and a researcher at Semsoac, an Excellence Mexican National-
registered research institution RENIECYT, is a Training/Didactic and
Supervising Analyst, conducted a 17-year longitudinal attachment
research project in both Indian-rural and mestizo-urban mother-infant
dyads that has been published in AHD. She is a Spanish and English
Adult Attachment Interview (AAI) trainer; was Secretary General of
the IFPS and has published several books and articles.
Naomi I. Gribneau Bahm, Ph.D. University of California, Berkeley is
Adjunct Professor of Psychology, at Los Rios Community College
District, Sacramento, California. Professor Bahm received her Ph.D.
with Professors Marian Diamond (Integrative Biology) and Mary Main
(Psychology). She is a certified Adult Attachment Interview (AAI)
trainer who trains regularly with Professors Main and Hesse. Professor
Bahm conducted research using the AAI and psychophysiology, and is
currently archiving Mary Main’s papers for the Wellcome Trust.
Erik Hesse, Ph.D. Leiden University is Adjunct Associate Professor of
Psychology, University of California, Berkeley; honorary member
of the American Psychoanalytic Association, and Adjunct Scientist,
Leiden University. Professor Hesse is co-author with Mary Main and
Ruth Goldwyn of the Adult Attachment Scoring and Classification
x Notes on contributors

System (2003) as well as co-author with Mary Main on the classifi-

cation system for Frightened/Frightening/Dissociative (FR) parental
behavior. He is currently director of the Social Development Project
at UC Berkeley and is co-director of the Adult Attachment Trainers’
Consortium.
Felipe Lecannelier, Ph.D. (c), is President of the National Foundation
of Attachment and former Director of the Center for Attachment and
Emotion Regulation, in Universidad del Desarrollo. He is a found-
ing member of the Ibero-American Attachment Network. Lecannelier
has spearheaded a countrywide program for identification and early
intervention for families and caregivers in high risk contexts. He has
published widely on early attachment, infant mental health, intersubjec-
tivity and mentalization, and early intervention strategies.
Alicia Lieberman, Ph.D. is Professor of Psychiatry in the University
of California, San Francisco School of Medicine. She is a past presi-
dent of Zero to Three. A leading expert on the interplay of trauma and
attachment, Dr. Lieberman has been a pioneer in the development of
attachment-based intervention strategies for young children and fami-
lies. She has published highly influential papers and books on family
violence, emotional development, attachment representation, and infant-
parent psychotherapy.
Mary Main, Ph.D. is Professor of Psychology, University of California,
Berkeley. Professor Main received her Ph.D. with Mary Ainsworth. In
conjunction with the longitudinal Social Development Project, she dis-
covered infant disorganized behavior with Judith Solomon, and with
Erik Hesse pointing to infant disorganized behavior’s frequent origin
in fear of the parent. She also developed the highly influential Adult
Attachment Interview (AAI). Professor Main holds honorary degrees
from the Universities of Goteborg, Haifa and Uppsala, and is an Adjunct
Scientist at Leiden University. Her great volume of work is currently
being archived at London’s Wellcome Trust.
Salvador Millán, M.D. is a psychiatrist and psychoanalyst, and co-
founder, training and supervising analyst and faculty member of the
Seminario de Sociopsicoanálisis A.C. (SEMSOAC) México City. He
was a faculty member at the Psychiatry Department of the Medicine
 Notes on contributors xi

Faculty in the Mexican National University (UNAM). Dr. Millán is

a co-founder and co-editor of the IFPS Online Journal in Romance
languages—Italian, Spanish and Portuguese. He co-directs with Sonia
Gojman de Millan the Attachment and Social Character Research
Project of Mexican Urban and Indian Dyads. An active Social
Character Researcher in various communities and intercultural partici-
pative action projects since 1974.
Charles A. Nelson, Ph.D. is Professor of Pediatrics in the Program in
Neuroscience at Harvard University and Director of Research of the
Developmental Medicine Center of Boston Children’s Hospital. His
research is broadly concerned with developmental cognitive neurosci-
ence, with specific interests in the effects of early biological insults and
psychosocial adversity on brain and development. He has been a leader
in the Bucharest Foster Placement Study and has published numerous
articles in each of these areas.
Germán Posada, Ph.D. is Associate Professor in the Department of Child
Development and Family Studies, Purdue University. He is a trainer on
the child attachment Q-sort set and a consultant on the NICHD childcare
study. A leading international expert on cross-cultural studies of attach-
ment, he has published numerous publications on this and related top-
ics, demonstrating the commonalities of attachment in diverse contexts.
His path-breaking work was recognized with the Bowlby-Ainsworth
Award in 2004.
Lois Sadler is a professor at the Yale University School of Nursing and
Yale Child Study Center, and one of the founders and Co-Directors of
Minding the Baby®. A pediatric nurse practitioner, her scholarship and
publications focus on adolescent pregnancy prevention, supportive pro-
grams for adolescent parents, home visiting for at-risk young families,
community-engaged research, and research ethics.
Guadalupe Sánchez has been a psychoanalyst since 1992. She is a found-
ing member of Seminario de Sociopsicoanálisis A.C. (Semsoac) and has
carried out research in attachment and social character. She has mem-
berships in the International Federation of Psychoanalytic Societies, the
International Erich Fromm Society and the Ibero-American Attachment
Network, where she is an officer.
xii Notes on contributors

Daniel J. Siegel, M.D. is Clinical Professor of Psychiatry at the University

of California-Los Angeles School of Medicine and Co-Director of the
Mindful Awareness Research Center at UCLA. Dr. Siegel is Executive
Director of the Mindsight Institute. He has published numerous books,
including The Developing Mind, Mindsight, Parenting From the Insight
Out, The Mindful Therapist, and Brainstorm. An internationally recog-
nized expert in attachment, neurobiology, and the developing mind, he
has lectured broadly to educators, parents, health care providers, policy
makers, and neuroscientists.
Tanika Simpson, MSW, LCSW, IMH-E® is a licensed clinical social
worker and an endorsed infant mental health clinical mentor. She is the
senior social worker in the Minding the Baby® program, where she has
served as home visitor, supervisor, and trainer for six years. She is a
member of the program’s training and consultation faculty, participat-
ing in training institutes and program replication.
Arietta Slade, Ph.D. is Clinical Professor at the Yale Child Study Center, and
one of the founders and Co-Directors of Minding the Baby®. She has pub-
lished widely on parental reflective functioning, the clinical implications
of attachment theory, and the origins of symbolization, and is editor, with
Jeremy Holmes of the six-volume set, Major Work on Attachment, with
Elliot Jurist and Sharone Bergner, of Mind to Mind: Infant Research, Neuro­
science, and Psychoanalysis, and with Dennie Wolf, of Children at Play.
L. Alan Sroufe, Ph.D. is Professor Emeritus at the Institute of Child
Development at the University of Minnesota. An internationally recog-
nized expert on early attachment relationships, emotional development,
and developmental psychopathology, he has published seven books
and 150 articles on these and related topics. Awards received inclued
the Distinguished Scientific Contribution Award from the Society for
Research in Child Development, the Bowlby-Ainsworth Award for
Contributions to Attachment Research, the G. Stanley Hall Award, and
the Eleanor Maccoby Book Award.
Jill M. Trumbell, Ph.D. is Assistant Professor of Human Development
and Family Studies at the University of New Hampshire. She completed
her doctoral training in Human Development and Family Studies at
Purdue University, graduating in 2014. Her research focuses on explor-
ing the various contextual factors impacting the quality of child-mother
relationships across early childhood.
 Notes on contributors xiii

Denise Webb, MSN, APRN, IMH-E® is a pediatric nurse practitioner and

endorsed infant mental health clinical mentor. She is the senior nurse
clinician in the Minding the Baby® program, where she has been a home
visitor, supervisor, and trainer for the Minding the Baby® program since
its inception. She is a member of the program’s training and consulta-
tion faculty, participating in training institutes and program replication.
Charles Zeanah, M.D. Tulane University, is a Distinguished Fellow of
the American Psychiatric Association, and a Fellow of the American
Academy of Child and Adolescent Psychiatry. His many awards include
the Blanche F. Ittelson Award for Research in Child and Adolescent
Psychiatry (2009), the Sarah Haley Award for Clinical Excellence from
the International Society for Traumatic Stress Studies. Director of the
Bucharest early intervention project, he is a world leader in the study
of attachment disorders and the lasting impact of institutional rearing.
Preface

The authors included in this volume comprise a most distinguished collec-

tion of attachment scholars and researchers. Never before has the thinking
of this particular group, including Mary Main, Daniel Siegel, Arietta Slade,
Charles Zeanah, and others, been brought together in a single, accessible
volume. The collected work integrates the many features of attachment
theory and research, along with implications for practice. The final prod-
uct here grew out of efforts of the Ibero-American attachment network,
first formed in 2009.
One of the most attractive characteristics of attachment theory is the
way it is capable of bringing together different perspectives into a com-
plex and ever-growing base of knowledge. Combining state-of-the-art
research and precise clinical interventions, attachment theory has helped
to close the gap between researchers and clinicians in many ways. This
book is but one example of this. It not only manages to bring together the
work of some of today’s leading figures in the field of attachment, but
also is in itself the work of collaboration of many researcher-clinicians
of many parts of the world who organized the San Diego Inter-American
Attachment Conference of 2014. Attachment Theory: A Humanistic
Approach for Cross-Cultural Practice and Research was a joint effort of
the University of San Diego, Department of Psychiatry, and Department
of School, Family and Mental Health, family and mental health profes-
sionals and the Relationship Training Institute, with the Ibero-American
Attachment Network (RIA for its initials in Spanish).
In February 2009, Alan Sroufe invited a group of young and senior
researchers from Latin America and Spain to a first meeting in Minnesota.
He had realized there was an ongoing effort in many countries to develop
 Preface xv

the attachment field through academic programs, research projects, and

clinical interventions, but a regional organization which would allow an
international collaboration had still to be established. This was Alan’s main
proposal at that first meeting, and we all agreed to collaborate as a group
to promote attachment research and interventions in our Spanish-speaking
countries. This marked the birth of RIA, the Ibero-American Attachment
Network. RIA’s goal was established

to develop and promote research and scientific collaboration from an

interdisciplinary perspective with regard of attachment theory as well
as the divulgation of the knowledge that Attachment theory has to offer
among a new Ibero-American generation and to promote research and
clinical application.

The network is organized for educational and scientific purposes includ-

ing, but not limited to, organizing and sponsoring biannual conferences
with the purpose of promoting human development and well-being,
always informed by attachment theory, centering in research and clini-
cal applications, and with implications for public policies, education, and
intervention.
The first conference took place in Panama City in 2010. With more
than two hundred attendants from various countries, this congress proved
to be a success in presenting to a wide audience current attachment the-
ory, research and interventions in several countries of Latin America and
Spain. It also allowed the network to consolidate and set the next goals: a
second congress to take place in Santiago de Chile and a book presenting,
for the first time, a thorough and comprehensive review of the fundamen-
tals of attachment theory, as well as ongoing regional research in Spanish.
Attachment Theory: Research and Clinical Applications (La Teoria del
Apego: Investigación y Aplicaciones Clínicas, eds. Torres, Causadias and
Posada, 2014) allowed a vast majority of Spanish-speaking mental health
professionals, teachers and social workers to have access to a representa-
tive text that combines examples of attachment research and intervention
efforts in multiple contexts.
The Santiago conference was held in 2012, with more than three hun-
dred attendants. This event not only consolidated the group as an organi-
zation capable of generating and promoting Spanish-speaking attachment
theory, but also assembled some of the most distinguished figures within
xvi Preface

the field. This group was expanded in the third congress of the Ibero-
American Attachment Network RIA, held in San Diego, CA in 2014. An
extraordinary set of papers was presented at that conference by an illustri-
ous group of scholars Fortunately, the editors of this volume were able to
persuade every participant to create a chapter for this book. This is how
Attachment Across Cultural and Clinical Perspectives came into being.
The result is a compendium of the very best thinking and scholarship on
research-based clinical applications of attachment theory.
In the introductory chapter, “Attachment theory: A humanistic approach
for research and practice,” Alan Sroufe describes how attachment theory
was from the beginning oriented toward clinical applications and anchored
in cross-cultural work. From the time when Bowlby discovered the early
deprivation that lay in the background of young boys with conduct prob-
lems to our present interest in the consequences of trauma, research on
attachment has retained a focus on alleviating human suffering. At the
same time, attachment work has always been concerned with emotional
ties in a variety of context. The theory has at times been unjustly critiqued
as a theory about white, Northern Europeans, yet early insights stimulat-
ing attachment theory came from the study of non-human primates, and
the first empirical study of Bowlby’s theory took place in East Africa. A
final distinguishing feature of the theory described by Sroufe is its emi-
nent testability. Sroufe draws on the extensive data from the Minnesota
longitudinal study from birth to adulthood to illustrate the power of early
attachment experiences in shaping personality and adaptation.
In the second chapter, “Universality and cultural specificity in child-
mother attachment relationships: In search of answers,” Germán Posada
and Jill Trumbell review key theoretical and empirical foundations of
attachment and examine pertinent research on what is universal and what
is culturally specific in attachment relationships. Of course, cultural con-
text influences the manifestations of particular attachment behaviors. But
across a diverse array of cultures, core principles of attachment theory
apply. In every culture, studies and variations in attachment security are
dependent upon prior sensitive care.
One of the most fruitful areas of research within attachment theory has
been a direct result of the Adult Attachment Interview. Throughout their
chapter, “Unresolved parental trauma as seen in the AAI,” Bahm, Main and
Hesse further support the well-established insights of the clinical useful-
ness of the Adult Attachment Interview, and present new insights into the
 Preface xvii

clinical worth of the AAI by paying close attention to fear and unresolved
states of mind. This chapter and the one presented by Gojman, Millán, and
collaborators, “Attachment research in a Mexican village: Clinical and
social implications,” are excellent examples of the linking of research
and clinical interventions. Attachment researchers usually provide critical
data that becomes meaningful outside the research programs in the clients
and communities that clinicians work regularly. The chapter by Gojman
and Millán combines nomothetic and idiographic data, closing the gap
between research and application and offering a clear example of the rich-
ness of attachment theory in addressing both general and individual issues.
One of the most revolutionary aspects of attachment theory is the way
it provided psychoanalysis with a new way of relating to biological dis-
ciplines, such as ethology and more recently to evolutionary psychology.
The groundbreaking idea that attachment is but one of several motive
systems, independent from sexuality and aggression, helped to establish
the modern view of the psyche as complexly motivated. Mauricio Cortina
shows how prosocial motivations for intimate social engagement, and for
sharing and cooperating with others, co-evolved with the more ancient
attachment and caregiving systems to create new emergent phenomena.
In “Attachment within the context of a cooperative and sharing mind,”
Cortina explores the complex relations between attachment, cooperation
and prosocial motivations. He shows how a history of secure attachment
promotes intersubjective communications while paving the way for emer-
gent mentalizing capacities.
Since its origins, attachment theory has been actively involved in public
policy, especially the well-being of infants and young children. The work
of Bowlby’s collaborators, James and Joyce Robertson, helped change
hospital policies regarding the way children were treated before the 1970s.
Unfortunately, social and economic conditions in several parts of the
world are making proper conditions for institutionalized children difficult.
Chapter 6, “Institutional deprivation in early childhood: Attachment and
recovery,” by Charles Zeanah, Fox, and Nelson addresses this critical sub-
ject. The classic work of Zeanah and his collaborators in Rumania is a
groundbreaking example of the way attachment research informs psycho-
social policies across contexts.
In Chapter 7, “Attachment and the developing brain: Implications for
mindful therapy,” Daniel Siegel brings together the latest research on neu-
roscience and integrates it with research on human relationships in a clear
xviii Preface

and cogent manner, making difficult concepts accessible. He also supports

the view of the mind as a self-organizing emergent process by focusing on
energy-information exchanges within and between individuals, that allows
neuronal connections and human relations to be connected in new and
meaningful manners. Mindfulness is one of the concepts in the forefront
of attachment research.
In Chapter 8, “Minding The Baby®: The impact of threat on the mother-
baby and mother-clinician relationship,” Slade and her colleagues explore
an exciting new program called “Minding the Baby®.” The model exam-
ines the role of threat and fearful arousal in the organization of psychic
experience, and the application of these ideas to dyadic work with mothers
and young children.
Alicia Lieberman has extensive experience working with at-risk popu-
lations, and has done one of the most important intervention studies ever
conducted with Latino-Americans. Her chapter allows us to see, through
clinical vignettes, the principles of attachment embedded in child-parent
psychotherapy in Chapter 9, titled “Attachment, trauma, and reality:
Clinical integrations in the treatment of young children.”
In Chapter 10, “Attachment and complex trauma: An intervention pro-
gram for institutionalized infants (0–4 years),” Felipe Lecannelier presents
the relationship of attachment and complex trauma as well as an ongoing
program for institutionalized infants in Chile. The scope of the early inter-
vention work in Chile, being carried out on a country-wide basis, is an
inspiration for developed and undeveloped countries alike.
All of this work in combination allows the reader to have an idea of the
richness of the San Diego conference and of the work currently being done
by both clinicians and researchers within the Ibero American Attachment
Network and their fellow collaborators.
The experience of conducting poster presentations at the conference in
San Diego, created a special dynamic of vivid interactions between the
young clinician and researchers from Spain and Latin American presenters
and the mostly American attending audience. The originality of the poster
presentations’ titles were witness to the particular conditions in which they
develop innovative attachment research projects reflecting the diverse eth-
nic, linguistic, and cultural ways of living and their particular child-raising
practices.
We include them with their abstracts in the Appendix, with the hope
that the reader will learn from their efforts to develop and create innovative
 Preface xix

interventions, which are each followed by a careful assessment of their

effects. These practices, we claim, can indeed benefit the development of
children and the unusual non-traditional understanding of the patients in
such different conditions. A distinct humanistic approach for clinical prac-
tice and research may be the outcome.
This body of research and interventions are not only benefiting Latin
American populations, but they are also enriching attachment theory with
new cultural and social perspectives from which to observe the effect of
these conditions on the development of attachment relations.

Christian Herreman, Sonia Gojman-de-Millan, and L. Alan Sroufe

Acknowledgements

“Funeral Blues,” copyright © 1940 and renewed 1968 by W.H. Auden;

from W.H. Auden Collected Poems. Used by permission of Random
House, an imprint and division of Penguin Random House LLC. All rights
reserved. Any third-party use of this material, outside of this publication,
is prohibited. Interested parties must apply directly to Penguin Random
House LLC for permission.
Part I

Attachment, theory, and

research
Chapter 1

Attachment theory
A humanistic approach for research
and practice across cultures
L. Alan Sroufe

From the start, attachment theory has always been a cross-cultural theory,
a theory concerned with human welfare, a theory with direct clinical rel-
evance, a theory rooted in biology and a theory capable of empirical test.
This set of characteristics makes it virtually unique among psychological
theories and likely is responsible for its great and increasing popularity. In
modern times, in a shrinking world, we are aware of the need to take into
account contextual influences on behavior, including culture, even as we
attempt to create theory and practices of clinical utility. At the same time,
it is not possible to overlook the extent of human psychological suffer-
ing and the ubiquity of trauma and hardship faced by children and adults.
Human needs must be attended. Finally, there is an acute need for prac-
tices that both deal in a real way with the psychological substance of dis-
turbance and yet are “evidenced based.” Attachment theory promises all of
this, and it has done so from the beginning.
These themes will be elaborated throughout this book. In this chapter,
I will comment briefly on the cross-cultural nature of attachment theory,
its affinity with a compassionate stance toward our fellow beings, and its
clinical relevance, and I will discuss more fully its amenability to rigor-
ous empirical testing. I will do this from the perspective of a long-term
and comprehensive longitudinal study, the Minnesota Study of Risk and
Adaptation, which began in 1974 and continues to the present. Many of
the propositions of attachment theory and, indeed, many of the critical
questions in developmental psychology can be answered only with such
a study. The two central hypotheses formulated by Bowlby (for example,
1973) were: (1) that variations in the quality of infant attachment rela-
tionships are based on patterns of interaction between infants and their
4 L. Alan Sroufe

caregivers early in the first year, and (2) that these variations in the qual-
ity of attachment are the foundations for later personality organization—
for psychological health and for disturbance. Both of these questions, of
course, may be best addressed by prospective longitudinal studies; that is,
studies in which early patterns of care are directly observed at the time,
and all later outcomes are directly observed throughout childhood and
beyond, always by independent observers.
As a background for this discussion and for all of the chapters to follow,
a few fundamentals of attachment theory and attachment assessment must
be outlined. Attachment concepts are quite distinctive from drive and trait
concepts common in other psychological theories. Being clear about these
distinctions will make it easier to understand both the nature of attachment
research and the clinical applications that derive from it.

Fundamentals of attachment
Attachment theory was part of a revolution in psychology both in mov-
ing away from drive-reduction concepts and in moving toward relation-
ship concepts, as opposed to only the study of individual characteristics.
Attachment is a relationship concept. In infancy, it refers to the emotional
connection and the behavioral coordination between infant and caregiver
(attachment figure). It refers to this relationship and not to a characteristic
of the infant. When we refer to an infant as “securely attached,” we actu-
ally mean that it is secure in (confident about) its attachment with this
particular caregiver. Thus, the same infant may be secure in its attach-
ment with one caregiver, and anxious with another. This was difficult for
some psychologists to grasp at first, but it is an absolutely critical notion
in attachment theory.
One implication of thinking of attachment as a quality of a rela-
tionship, as opposed to a trait of the baby, is that one can quickly get
beyond certain confusions regarding strength of attachment—that is,
“how attached” an infant is. All infants become attached if some consist-
ent person cares for them, whether poorly or well. They don’t become
weakly or strongly attached. They are just attached. Some may be anx-
ious in their attachments and some may be confident, but all are attached,
even to abusive caregivers. Saying that a baby is “too attached” likewise
is a misnomer—a throwback to dependency-trait terminology. It is not
a problem to be very confident in the responsiveness of your caregiver;
 Attachment theory: A humanistic approach 5

rather, such confidence is a sign of a good-quality, effective relation-

ship. Infants described as “too attached” are no more attached than those
who are secure; their unremitting clinging is simply a sign that they are
anxiously attached.
It can readily be seen how attachment is distinctive from temperament.
Temperament refers to individual variations in behavioral style—for exam-
ple, dimensions such as activity level, thresholds of responsiveness, or
reactivity to stimulation. These would be expected to show some consist-
ency across contexts and to some extent across situations. Infants who are
secure (or anxious) in their attachments may be high or low on any of these
dimensions. For example, in the Ainsworth Strange Situation Procedure,
some infants assessed to be in secure relationships become quite upset by
the brief separations and cry a great deal, while others cry hardly at all. Yet
those who are very distressed by the separations are judged to be secure in
their relationship because they go immediately to the caregiver upon reun-
ion and are readily settled by contact, as opposed to ineffectively seeking
contact or failing to be settled by it, perhaps even fighting against it. Their
confident expectations are revealed by the directness of their approach and
the ease of settling. They know the contact will work and they use it to
return to play and exploration. Those secure cases that are not distressed
are judged to be secure because they actively greet and initiate interac-
tion with their caregivers upon reunion, and this psychological contact is
sufficient to promote their return to active play and exploration. They do
not ignore or avoid the caregiver. As temperamentally different as these
infants may be viewed, they have in common that they have confident
expectations regarding their caregivers and they are able to effectively use
their relationship to promote exploration.
In summary, all human infants are expected to form attachments with
the person or persons that interact with them on a consistent basis. These
relationships, however, vary in quality: in some cases, they will be charac-
terized by confident expectations regarding caregiver responsiveness and
by effectiveness in using the caregiver as a secure base for exploration,
and in some cases, they will not manifest such expectations. It is hypoth-
esized that such variations derive from the history of interaction with
the particular caregiver. Finally, these variations may be observed in the
dyadic organization of behavior, that is, the way the infant adjusts behav-
ior with respect to the caregiver in various circumstances across time.
Secure infants will explore when external stress is minimal, seek contact
6 L. Alan Sroufe

when stress increases, and use that contact (physical or psychological) for
reassurance, which promotes a return to exploration.
Attachment theory is distinctive from classic psychoanalytic positions
that conceive of self as preceding relationships, as when a primitive self
cathects a part object and subsequently a whole object, thus forming a
relationship. In attachment theory, the infant is seen as born into and
embedded in an organized relationship matrix, from which self emerges.
Such a revised viewpoint solves a complicated problem in the study of per-
sonality. If we cannot simply assume the fully formed personality exists
from the beginning, and we cannot assume something coming from noth-
ing, how can we explain the complex organization that is the person. The
answer is that there is an organization in the beginning; that organization is
in the infant-caregiving relationship (Sander, 1975). In a later section, we
will see the implications for research of this revised position.

Attachment theory as a cross-cultural theory

As was true with classic psychoanalytic theory, attachment theory has

been criticized as culturally biased, that is, as based in white, Northern
European culture (for example, Rothbaum et al., 2000). In the case of
attachment theory, this critique is surprising for several reasons. First,
attachment theory derived originally from studies of animals, especially
non-human primates. Thus, beyond being a panhuman theory, it is even a
cross-species theory. Moreover, the first empirical application of Bowlby’s
theory was Ainsworth’s (1967) study in rural Uganda, about as far from
Northern European culture as one could imagine. Most of the ideas about
the link between parental sensitive responsiveness and quality of attach-
ment derived from that study. The next study by Ainsworth was with a
largely black sample in inner-city Baltimore (Ainsworth et al., 1978).
Only following this were studies done with middle-class North Americans
and northern European samples.
Some studies did find results dissimilar from those of Ainsworth using
the Strange Situation Procedure, for example, in one north German sam-
ple (Grossman et al., 1985) and in a traditional Japanese sample (Miyake
et al., 1985). But the north German sample proved to ref lect a cohort effect.
The mothers in this sample were born just after World War II in con-
ditions of extreme hardship. They believed their children needed to be
pushed toward independence and, as Bowlby (1973) predicted, this led
to a dramatic increase in avoidant attachment. But the theory worked as
 Attachment theory: A humanistic approach 7

before. Avoidant attachment predicted heightened aggression just as it

does in American samples. Moreover, in a southern German sample and a
subsequent sample in northern Germany, such an increase was not found.
Cultural bias is not indicated by this set of findings but rather the impact
of hardship upon parenting.
The Japanese case is a bit different. These infants were unable to be con-
soled in the reunions following brief separation and therefore appeared to
fit the anxious-resistant (ambivalent) category. However, such differences
in the laboratory were not reflective of differences observed in the home.
In Western samples, anxious-resistant patterns of attachment are associ-
ated with inconsistent, chaotic care and much crying in the home, but not
so in the traditional Japanese families. Even their exploration in the labo-
ratory was adequate prior to the first separation, making it unlikely that
they were genuinely anxiously attached cases. But these infants, who in
this cultural setting never experienced brief separations, were thoroughly
distressed by the separations, which were unfortunately allowed to go on
too long, rather than being cut short as is standard practice with distressed
babies. As a consequence, these infants were inconsolable upon reunion.
Such difficulty settling fallaciously implied anxious attachment. The most
plausible interpretation of these results is that the Ainsworth procedure
(which assumes modest though increasing stress) was not appropriate for
these infant-caregiver pairs. It does not call into question the cultural gen-
erality of attachment theory, just this particular assessment procedure in
this case. It should be noted that modern Japanese families (where mothers
often work) and Japanese-American families show the same proportion of
secure attachment as other US samples in the Strange Situation. (See also
a paper by Behrens, Hesse, & Main, 2007, that illustrates the distinction
between the Japanese concept of amae and attachment, and nonetheless
provides validity for the attachment construct in Japan.)
The cross-cultural validity of attachment theory is not dependent on the
general applicability of a particular assessment method, such as the Strange
Situation Procedure; rather, it hinges on whether the process of attachment
itself is culturally general. There is now substantial empirical evidence
that core propositions of attachment theory hold across cultures (Posada,
this volume; Gojman & Millán, this volume). This is despite the fact that,
of course, cultures also differ widely in both parenting practices and infant
behavior. There are cultures in which infants are in near-constant physical
contact with mothers in the early months of life, for example, being carried
in slings and co-sleeping, while in some modern cultures neither of these is
8 L. Alan Sroufe

practiced. In some cultures, parents talk a great deal to even young infants,
but there are other cultures where the belief is held that there is no point
talking to children before they begin speaking. In some cultures, children
as young as 3 tend to toddlers; in some, any relative may discipline a child
(Whiting & Whiting, 1975). The list goes on and on.
On the other hand, there are constancies across cultures. In all but mod-
ern industrial cultures, babies in the first months of life are cared for pri-
marily by one person, usually a nursing mother. Moreover, the variations
in care described above are not central to attachment theory. At the core
of attachment theory is the belief that a single figure or a small hierarchy
of figures will serve as a safe haven—a portable source of protection—
for the infant. Infants will seek out these persons specifically when fright-
ened or distressed. This “safe haven” or “secure base” phenomenon also
is apparently constant across all cultures. Likewise, it has been shown
that individual differences in quality of attachment (effective secure base
behavior) are related to caregiver responsiveness to signals in every cul-
ture studied (see again Posada, this volume).

Attachment theory and the concern for

human well-being
As has been true with other psychoanalytic theories, Bowlby’s theoriz-
ing began with a clinical problem (Bowlby, 1944). At the time, Bowlby
was working with a large number of “juvenile thieves,” who today would
likely be referred to as “conduct disordered.” He thought he discerned a
common problem—namely, a lack of care in early life that he referred to
as “maternal deprivation.” In a sense, all of his work for the next four dec-
ades can be seen as an effort to rigorously examine this hypothesis. Along
the way, however, he never lost sight of the goal of improving the lives
of such children, both in terms of prevention and improved clinical under-
standing and treatment. Early on, he spearheaded a report for the World
Health Organization (1951) to call attention to early privation and depriva-
tion of care in creating problems for children. Later, in his collaboration
with James and Joyce Robertson, he worked to change hospital policies
with regard to the damaging practice of forbidding parent-child visitations
in medical settings.
His investigations led him to a novel approach within psychoanalytic
theory; namely, begin not with disorder but with understanding normal
 Attachment theory: A humanistic approach 9

development. The questions arose: how do attachments typically arise and

what functions do they serve? Followed by: how can this process go awry
and what are the consequences of such deviations? This approach turned
out to be incredibly fruitful. It led to new paradigms in psychiatry and
psychology, playing an important role in the emergence of the f ield today
known as “developmental psychopathology.” It also inspired a revolution
in the study of social development wherein the role of relationships came
to the fore. At the same time, this approach led Bowlby to a new emphasis
on the lived experience of the person and the expectations for self and other
that derive from that experience. Not only did this create a psychodynamic
theory readily capable of being empirically tested; at the same time, it pro-
moted enhanced compassion for clients in therapy. When one understands
that clients are suspicious because their trust has been violated, anxious
about minor separations because early separations frequently occurred or
were frequently threatened, or expect hostility from others because hostil-
ity has been frequently visited upon them, the task of remaining empathic
becomes easier for the clinician. In general, from the start, attachment theory
has promoted compassion regarding the struggles that so many face.
Mary Ainsworth, Bowlby’s longtime collaborator, showed equal con-
cern for human well-being, as well as being a non-combative scholar and a
gentle mentor for so many. Ainsworth, the primary attachment researcher,
showed her compassion through her sensitivity regarding the parents she
studied, even those whose parenting was inadequate. She understood
the difference between loving one’s children and being able to care for
them properly. She discovered that being able to be sensitively responsive
depended on much more than simply wanting to do well. She was one of
the first to call our attention to the context of care. Once one understands
context, one is no longer condemning of parents even though the harm
that they sometimes do cannot be disregarded. The following quotation, in
Ainsworth’s own words, illustrates this attitude:

Kasozi’s mother, who had been deserted by her husband, had to work
most of the day in a desperate effort to establish a new garden in order
to provide food for her family and she left Kasozi with a neighbor.
The father’s desertion thus affected Kasozi both through the mother’s
anxiety and by making it necessary for her to give him less care and
attention than most . . . Ganda mothers gave their babies.
(Ainsworth, 1967, pp. 392–3)
10 L. Alan Sroufe

Thus, while parents provide the context for their infants’ development,
and therefore are crucial in shaping individual outcomes, parenting itself
occurs in the context of surrounding supports and stresses. Such an under-
standing yields compassion for parents who participate in research in the
Bowlby-Ainsworth tradition.

The clinical relevance of attachment theory and research

Attachment theory and research have proven to have great clinical utility.
They are, first, highly relevant for understanding the etiology of problems,
their emergence step-by-step beginning in early relationships. Bowlby’s
view about how lived malevolent experience becomes the progenitor of
disturbance is captured in the following quotation from his 1973 book:

In the working model of the world that anyone builds, a key feature is
the notion of who his attachment figures are . . . and how they may be
expected to respond. Similarly, in the working model of the self that
anyone builds a key feature is how acceptable or unacceptable he is in
the eyes of his attachment figures [p. 236] . . . The model of the attach-
ment figure and the model of the self are likely to develop so as to be
complementary and mutually confirming. Thus an unwanted child is
likely not only to feel unwanted by his parents but to believe that he is
essentially unwantable, namely unwanted by anyone. [p. 238]

Second, such a developmental viewpoint has inevitably led to an empha-

sis on prevention and early intervention. A plethora of attachment-based
early interventions now exist worldwide. Often they are comprehensive,
involving both direct guidance toward sensitive interaction with infants and
toddlers, adjusting internal representations of negative experience that are
interfering with adequate parenting, and helping parents establish more ser-
viceable support networks. Some outstanding examples of such programs
with infants and toddlers are to be found in later chapters of this volume (for
example, Lieberman; Slade). Another attachment-based program addresses
behavior problems of school-aged children, not by working directly with the
children, but by training teachers in attachment concepts and helping them
serve as secure bases for children, with promising results (Pianta, 1990).
Third, it is not surprising that attachment theory pointed the way to
a thoroughgoing relationship-based therapy (Bowlby, 1988; Cassidy &
 Attachment theory: A humanistic approach 11

Shaver, in press; Wallin, 2007). In fact, when Bowlby outlined his five
tasks of therapy, the very first one was that the therapist is to become
established as a “secure base” for the client. This firm sense of safety
would then allow addressing the second task—namely, an examination
with the client of expectations regarding the self and other in relation-
ships. Such expectations, while deriving logically from the history of
lived experience, nonetheless undercut current relationships and are the
root of many disturbances of personality. Task three is to examine the
current therapeutic relationship as a potential counter-case to previously
established relationship models. The fourth task is to then examine the
family origins of the previous expectations and patterns of relating. This
step is, of course, often challenging, because such examination may be
painful, and there has been a longstanding taboo against making these
connections. Bowlby posited that the root of many personality distur-
bances is conflict between what is insisted to children that they believe
and what their actual experience would suggest. Accepting the reality
of mistreatment, hostility, or lack of care from one’s attachment fig-
ures is indeed difficult. Having done this, however, the client will be
prepared for task 5: evaluating these longstanding expectations anew.
Further discussion of attachment-based therapies will be found later in
this volume.

Empirical support for attachment theory

Attachment theory has proven to be not only a theory capable of empirical

test, but a theory whose core propositions have been amply and repeat-
edly supported (for example, Cassidy & Shaver, in press; Grossmann,
Grossmann, & Waters, 2005; Sroufe et al., 2005). The outpouring of
research has led both to three editions of the Handbook of Attachment
Theory and Research and the launching of the journal Attachment and
Human Development in 1999. While much of this research has been
devoted to validating major assessment instruments (the Strange Situation,
the Attachment Q-sort, and the Adult Attachment Interview) and the util-
ity of attachment-based interventions, ample research has also supported
Bowlby’s two central hypotheses: that variations in quality of attachment
derive from patterns of caregiver responsiveness in the first year of life and
that variations in attachment are the foundation for individual differences
in later functioning of the person.
12 L. Alan Sroufe

Variations in attachment as an outcome of variations in care

Her observations in Uganda led Ainsworth to propose that the critical

aspect of care in the first year was the caregiver’s sensitive responsive-
ness to the infant. The sensitive caregiver is attuned to the infant, con-
tinually monitoring the infant and being alert to the infant’s signaled
needs or desires. Such signals are interpreted accurately and responded to
sufficiently promptly and thoroughly so that infant arousal is in general
modulated. Such a caregiver also fits his or her behavior to the infant’s
state, mood, and ongoing behavioral direction rather than disrupting the
flow of infant behavior or distressing the infant with sudden stimulation
for which it was not prepared. Ainsworth summarized these concepts in
a set of well-crafted scales that have been widely used to test Bowlby’s
first hypothesis.
In her Baltimore study (Ainsworth et al., 1978), Ainsworth obtained a
very strong relationship between home observations of sensitive respon-
siveness and later attachment security in the laboratory. Her study was
hard to match, in that she had 72 hours of home observation on each case.
Still, later studies with somewhat extensive observations (6–8 hours in
the home) replicated Ainsworth’s original findings (Pederson et al., 1998;
Posada et al., 1999). Summaries of a large number of studies using what
is called “meta-analysis” also confirm that this link is robust, although
most studies are based on much briefer home observations and obtain
smaller correlations. Finally, one very large-scale study, based on 1,200
cases across 5 sites, confirmed the link between caregiver sensitivity in
the home and later attachment security in the Strange Situation (NICHD,
1997). The important thing to note is that in all of these studies the home
observations were completely independent of the outcome assessment,
almost always not even being made by the same individuals. And only
the caregiver sensitivity measures, not measures of temperament that were
obtained in many of the studies, predicted attachment outcomes.
The cumulative body of information also suggests some specificity
regarding early experience and particular manifestations of anxious attach-
ment. Avoidant attachment, in which infants show little preference for car-
egivers under stress and even actively avoid them following brief separations
in the Strange Situation (see Box 1.1), is associated with emotional unavail-
ability, hostility or rejection, especially when the infant expresses a ten-
der need (Ainsworth et al., 1978; Egeland & Sroufe, 1981; Isabella, 1993).
 Attachment theory: A humanistic approach 13

Disorganized attachment (see Box 1.1) has been linked to physical abuse
and specifically to frightening parental behavior (Cicchetti & Toth, 2000;
Schuengel, Bakermans-Kronenburg, & van IJzendoorn 1999; Jacobvitz,
Hazen, & Riggs, 1997). While the data are less clear, it appears that resist­
ant attachment (Box 1.1) results from care that is inconsistent, haphazard,
neglectful, or chaotic (Egeland, Sroufe, & Erickson, 1983).

Box 1.1 Ainsworth and Main patterns of attachment

1 Secure attachment
•• Effective use of caregiver as a secure base
•• Clear preference for caregiver when distressed
•• Active initiation of contact/interaction following brief separations
•• Ease of being comforted by caregiver if distressed
2 Avoidant attachment
•• Little obvious preference for caregiver when stressed
•• Little emotional sharing
•• Active avoidance following brief separations
•• Minimizing the expression of attachment behavior
3 Resistant attachment
•• Poverty of exploration
•• Wariness of the unfamiliar and difficulty with separation
•• Difficulty being settled by caregiver; visible anger
•• Maximizing the expression of attachment behavior
4 Disorganized attachment
•• Caregiver as a source of threat
•• Irresolvable paradox (f lee to or away?)
•• Disorientation and incoherence
•• Apprehension or confusion

Attachment variations as the foundation for the personality

Bowlby’s major idea was that the working models or representations of

self and other that derive from early attachment relationships form the
foundation for later personality, be it healthy or disturbed. This is because
these representations or expectations (Sroufe & Fleeson, 1986) guide one’s
behavior, one’s reactions to situations, and one’s interpretation of events.
It is not a matter of the emerging psyche being scarred by early experience;
14 L. Alan Sroufe

rather, it is the initiation of a developmental pathway that if continually

followed leads to a certain outcome. When a pathway is initiated, there is
a tendency to continue along it because, in addition to the fact that there is
some stability in the environment, being on that pathway itself engenders
further experiences that support that course.
One notable experiment may be used to illustrate this idea of self-
sustaining pathways. Children with histories of “avoidant” attachment,
a pattern associated with chronic rebuff and rejection when the infant
expresses a tender need, later tend to manifest more aggression in school
settings. The presumed mechanism is internalized expectations of hostility
and malevolent relationships. Suess, Grossmann, and Sroufe (1992) sup-
ported this idea in a study using cartoon strips. The first picture showed a
child building a tower. Then, in the second frame, another child is walk-
ing past. Finally, in the third picture, the tower has fallen down. When
asked to explain what happened, children with secure attachment histories
usually said something like “the [second] child must have accidentally
knocked that down. He’ll probably help him fix it.” Those with avoid-
ant histories commonly said the child had knocked it down on purpose,
although there was nothing in the picture to suggest that. In another study,
children watched three puppets in a variety of vignettes. Afterwards, the
child was asked about the protagonist puppet’s feelings. Children with
secure attachment histories showed greater emotional understanding than
children without secure attachment histories, suggesting that an internal-
ized secure attachment history allows children to better understand the
emotional point of view of others (Laible & Thompson, 1998). There are
now numerous studies linking early attachment to later representations,
and it seems likely that, as Bowlby suggested, such experience-based rep-
resentations are the carriers of experience and a core feature of personality
(Bretherton & Munholland, 1999; Carlson et al., 2004).
The role of early attachment in formation of the person also can be con-
ceptualized in terms of five bases or foundations. The first foundation is a
motivational base. From a history of responsive care (secure attachment),
one develops positive expectations concerning relationships, a basic
sense of connectedness with others, and a belief that relationships will be
rewarding. Second and closely related, is an attitudinal base. This refers
to the belief that one may elicit responses that are needed from others and
expectations of personal mastery in the social world. The third founda-
tion is the instrumental base. Because the attachment relationship supports
 Attachment theory: A humanistic approach 15

exploration, those with secure histories develop object mastery skills and
a capacity to enjoy play and discovery. This makes them attractive play
partners in the preschool and launches them on their way to social compe-
tence (Sroufe, 1983). It also undergirds a positive problem-solving attitude
(Sroufe et al., 2005). Those with secure histories think if they try hard they
will succeed. Fourth is the emotional base. Attachment is fundamentally
dyadic emotion regulation. Infants cannot well regulate their own emo-
tions, but they can be well regulated within a supportive caregiving con-
text. In a real sense, within the attachment relationship, young children are
being trained in emotion regulation (Sroufe, 1996). The capacity for self-
regulation springs from this training. Many scholars have described this
base in neurophysiological terms, how excitatory and inhibitory systems
in the brain are developed and balanced in the context of relationships.
(for example, Schore, 1994; Siegel, 1999). Finally, we have the relational
base. This concerns the notion of reciprocity in relationships and, in gen-
eral, how relationships work. For example, from empathic care comes the
capacity for empathy (Kestenbaum, Farber, & Sroufe, 1989).
It is through such foundations that attachment lays the groundwork for
healthy personality development in the case of secure attachment, or for
disturbed behavior and personality disturbances in the case of anxious
attachment. In addition, more specific predictions are derived from attach-
ment theory. The outcomes based most clearly in theory include (1) self-
esteem, (2) self-reliance, (3) social competence, including the capacity for
empathy, and (4) self-regulation and self-management (relative absence of
anxiety or behavioral and emotional problems). High self-esteem derives
naturally from having been treated as worthy. Self-reliance has its roots
not in having been pushed early toward independence, but in experienc-
ing effectiveness within the relationship. Social competence, empathy and
self-regulation were all discussed in the previous paragraph. Each of these
outcomes has been well supported in the Minnesota longitudinal study, as
well as other research (see Carlson & Sroufe, 1995; Cassidy & Shaver, in
press). Before presenting some key results from this study, crucial features
of the study will be described.

The Minnesota Longitudinal Study of Risk and Adaptation

The Minnesota study began in the mid-1970s with the recruitment of more
than two hundred economically disadvantaged women who were pregnant
16 L. Alan Sroufe

with their first child; the study continues to this date. Families living in
poverty were selected for two reasons. First, all previous long-term lon-
gitudinal studies of development had been conducted with middle-class
families, and it was deemed important to understand disadvantaged fami-
lies as well. Second, it was well known that poverty places children at
risk for a range of problems. We wanted to understand both the processes
through which many children developed problems and at the same time to
understand how some children developed well despite poverty.
Assessments began before birth and were very frequent and detailed
in the first 18 months of life. Before the birth of the child, we assessed
both the prenatal context (quality care for the mother including prenatal
physician visits) and parents’ attitudes and expectations. Attitudes toward
a child can, of course, be responses to the child, so it was important to tap
these before a child was present. We found that indeed negative expecta-
tions and lack of understanding regarding the child as a complex separate
being (who must not be expected to meet parental needs) were related
to later negative outcomes. Early and frequent direct observations of the
child and of the parent-child interaction were a major strength of the study.
Only within such a strategy can one determine whether child characteris-
tics are determining parent behavior, or vice versa. Likewise, if one wishes
to study change over time, dense measurements are required. We gathered
extensive observational data right in the hospital and at seven and ten days
of life, then every three months for the first eighteen months. We found,
for example, that mothers’ interest in the baby in the hospital was predic-
tive of numerous outcomes.
Our assessments were not only frequent; they were comprehensive.
Quality of care was assessed at multiple ages. In addition, all age-relevant
domains of child functioning were assessed, including, for example, tem-
perament, language and cognitive development, IQ, curiosity, role taking,
peer relationships, school achievement and, later, work, romantic relation-
ships, and parenting. We measured behavioral and emotional problems
at each age, using multiple independent sources of information, includ-
ing parent and teacher reports, self-reports, and clinical interviews. Such
comprehensive measurement was important to fully examine the impact
of attachment relationships. For example, only by having such data can we
know that the link between anxious attachment and later behavior problems
is not due to temperamental differences of infants. When we conclude that
we can predict dropping out of school with 77 percent accuracy by the time
 Attachment theory: A humanistic approach 17

the child is 3 years old, based on our measures of early care, we must be
able to show that this is not simply a reflection of IQ differences (with high-
IQ parents giving better care and having children who are simply smarter).
Neither parent nor child IQs account for our findings, and IQ drops out as a
predictor when assembled in a statistical test with early care. These children
did not drop out of school because they were stupid (Jimerson et al., 2000).
It was also important in this study to not only measure parenting and
child characteristics but also the context of stresses and supports within
which the parents were operating. At every age, we specifically measured
the life stress the parents were experiencing and the social support avail-
able to them. This was critical for two major reasons. The first was that
this completely removed the issue of blaming parents. Stress and support
predict the quality of parenting. Once this fact is recognized, one can see
that it is incumbent upon society to provide better support for parents in
poverty rather than blaming them for the poor-quality care. The second
reason is that tracking such measures, as well as parental depression, gave
us traction with regard to understanding change. As depression, stress, and
support changed over the years, the quality of the child’s functioning went
up and down in commensurate fashion (Sroufe et al., 2005).
Finally, of course, we assessed attachment at 12 and 18 months, as well
as many other aspects of parenting keyed to the age salient issues of devel-
opment (for example, guidance and limit setting in the toddler period).
We wanted to know not just whether early attachment predicted later out-
comes, but also how attachment worked with other aspects of parenting
and other developmental influences, such as peer relationships. While we
did not assess attachment per se beyond the infancy period, we did meas-
ure representations of attachment in every developmental period. These
measures included story completions in the preschool period, family
drawings in early elementary school, a variety of projective and narrative
techniques in pre-adolescence and adolescence, and the Adult Attachment
Interview in late adolescence and early adulthood. This allowed us to track
the interplay between early attachment, later experience, representations
and behavior problems (Carlson et al., 2004).
Earlier longitudinal studies had demonstrated very little stability or pre-
dictability of functioning from the first two years of life to later periods of
development (for example, Kagan & Moss, 1962). This was problematic
for psychoanalytic theories because, if anything, this early period might be
expected to be most important of all. Not only is development expected to
18 L. Alan Sroufe

be built upon early foundations, the early period could have more lasting
effects because, being pre-verbal, it is not subject to conscious examina-
tion. As Freud indicated, there is no law of effect for the unconscious;
it is not open to revision in light of reality (Loevinger, 1976). However,
these early studies were seriously flawed in having a too simple view of
continuity—that is, that traits of babies would simply persist. For example,
stability of dependency or aggression from infancy should not be expected.
All infants are necessarily dependent and hostile aggression is not yet in
their repertoire. Yet, we now know that variations in aggressiveness and
dependency may be strongly predicted by looking at their origins in rela-
tionship experiences. Our developmental model gave us impetus to begin
our study even in the face of the previous failures.

Major findings

We found that age-by-age the history of infant attachment relationships

and early care had consequences for individual functioning. Results were
strong with regard to individual characteristics, such as self-esteem,
agency, and self-reliance, as well as for social competence and behavior
problems. I will briefly review findings on personal characteristics and
social competence in each developmental period; then I will provide an
overview of our findings on psychopathology and resilience. (For a more
complete account of all of this see Sroufe et al., 2005.)

Toddler adaptation

Several studies have found that those with histories of secure attachment
are more compliant with caregiver requests as toddlers (Londerville &
Main, 1981; Matas, Arend, & Sroufe, 1978). This compliance is not based
in fear, but is what Grazyna Kochanska calls “committed compliance”
(Kochanska et al., 2004). Toddlers with a history of secure attachment and
responsive care want to maintain a coordinated relationship with their car-
egivers. In addition, in our studies of both a middle-class (Matas, Arend, &
Sroufe, 1978) and our poverty sample, we found that those with histories
of secure attachment were more enthusiastic and affectively positive in
approaching problems, were less easily frustrated, and were more persis-
tent. All of this reflects the early roots of executive function and a sense of
effectiveness (Sroufe et al., 2005).
 Attachment theory: A humanistic approach 19

Adaptation in the preschool

Many aspects of functioning were assessed during the preschool period in

our longitudinal study, both in our laboratory and, with subsamples, the
preschool setting (see Sroufe, 1983; Sroufe et al., 2005, for more com-
plete summaries). In the laboratory, those with secure histories showed
more agency and persistence in struggling with a challenging problem and
showed more curiosity in the face of novel objects than those histories
of anxious attachment. As directly observed or rated by teachers, they
showed more positive affect, more self-reliance, higher self-esteem, and
better self-management. To detail one specific finding: during circle time,
those with anxious attachment histories, including the avoidant group, sat
next to teachers or on their laps much more frequently than did those with
secure histories, even though the secure group showed great facility in
seeking out teachers in times of need (Sroufe, Fox, & Pancake, 1983).
Moreover, they were better able to flexibly adjust their behavior to the
demands of the situation, playing with exuberance in the play yard, but
being quiet and attentive during story time or demonstrations (showing
what Block & Block, 1980, refer to as high “ego-resiliency”).
Other powerful links to attachment history appeared in the realm of
early peer relationships (Sroufe, 1983; Sroufe et al., 1984). Those with
histories of secure attachment were more actively involved in the peer
group, were less frequently isolated, and were able to sustain interactions
longer. They more frequently approached and responded to other children
with positive affect. All of this made them attractive play partners, lead-
ing to higher popularity rankings. In interactions with play partners, they
neither victimized their partners, nor allowed themselves to be victimized,
whereas those with histories of avoidant attachment more likely to bully
and those with resistant histories were more likely to be their victims (Troy
& Sroufe, 1987). All of these experiences prepared those with secure histo-
ries for the more complex social world of middle childhood.
It should be noted that attachment history also predicted the reactions
of teachers to the children, although they were uninformed regarding that
history. From randomly sampled video recordings made in the classroom,
coders with no knowledge of other information rated teachers as treating
children with secure histories with higher expectations for compliance, less
control, and higher standards. In other words, they treated them in a warm,
but age-appropriate manner, expecting them to behave properly. With those
20 L. Alan Sroufe

having resistant histories, teachers had low expectations, made allowances

for immature behavior, and controlled and guided their behavior a great
deal. With those having avoidant histories, teachers had low expectations,
but also were controlling, demanding, and at times even angry. No doubt
these varied reactions were in response to the way children in these different
groups behaved. Nonetheless, we viewed these patterns as confirming the
inner models that the children brought with them to the preschool.

Adaptation in middle childhood

By every key measure, children with secure histories were better adjusted
during the elementary school years (Sroufe et al., 2005). Their teachers
(again with no knowledge of the child’s history) rated them as higher
on both peer competence and self-esteem/emotional health. They also
obtained higher achievement test scores and were, in general, more aca-
demically successful. Both teachers and independent observers rated them
as less dependent and less isolated than those with histories of anxious
attachment, as well as being better able to flexibly adjust their behavior to
various circumstances. Teachers were a primary source of data on behav-
ior problems, and this will be presented in a later section.
Our richest data on social relationships came from a series of summer
camps (Elicker, Englund, & Sroufe, 1992). Counselors rated children who
had secure histories as more socially competent than those with anxious
histories. In addition, both counselor nominations and direct observation
confirmed that they were more likely to form stable, reciprocated friend-
ships. At the same time, they were better integrated into the peer group,
participating actively in activities and adhering to peer group norms.
Most significant, they were able to coordinate friendship and peer group
demands, a complex task (Shulman, Elicker, & Sroufe, 1994). For exam-
ple, if chosen to be on separate teams in a sporting event, one could observe
them maintaining contact with their friend. They might congratulate them
on a good play or banter with them when in proximity. Their friendship
was not threatened by the presence of other children. In contrast, those
with avoidant histories, in those rare instances where they developed a
friendship, stayed isolated with their friend, being unable to integrate
friendship and group activities and appearing “lost” and unable to function
on days when their friend was not present. It should again be noted that
every piece of data was contributed by people blind to developmental his-
tory and unaware of any other data.
 Attachment theory: A humanistic approach 21

Adaptation in adolescence

Interviews with the children at the end of middle childhood showed that
those with secure histories had a deeper understanding of social relation-
ships; for example, that arguments with a friend could lead one to feel
closer due to enhanced understanding of one another. Such understanding
expanded dramatically in the adolescent years. In interviews, those with
secure histories showed a deep understanding of the nature of friendships
and of group dynamics. They accurately described who associated with
whom, as confirmed by our behavioral observation. Counselors at a series
of camps again rated those with secure histories as more socially compe-
tent and less isolated. Moreover, ratings on “capacity for vulnerability,” an
age-salient scale we developed just for this age period, strongly discrimi-
nated those with secure and anxious histories. This was mainly revealed in
circumstances in which strong feelings would be aroused (trust exercises,
the last-night dance, etc.).
Direct observation by independent observers confirmed the contin-
ued social competence of those with secure histories. Observers agreed
that those with secure histories were more central to the group and
more actively involved. They were more frequently selected as lead-
ers in small group settings by their peers, and they were rated as more
interactive and influential in groups. By this age, the network of social
relationships is extraordinarily complex. The young person must now
coordinate same-gender friendships, cross-gender friendships, same-
gender peer group functioning and mixed-gender group functioning, all
when they have an increased understanding of their own vulnerability.
It was those with secure histories that were best able to master this
complex task.

Adaptation in adulthood

Early attachment experiences were also related to functioning in intimate

adult relationships. Not only do adults describe their relationships in a
more coherent and open manner (Roisman et al., 2005), they have higher-
quality romantic functioning as observed in standard conflict and collabo-
ration tasks. For example, Simpson and colleagues (2007) found that infant
attachment variations predicted the degree to which people experienced
negative emotions in their romantic relationships at age 20–21. Moreover,
individuals who had been securely attached at 12–18 months of age were
able to recover from conflict more effectively than those with insecure
22 L. Alan Sroufe

attachment histories (Salvatore et al., 2011). As we stated in a previous

paper: “the individual projects his/her representation of relationships onto
future social contacts, leading to a repetition and confirmation of expected
cycles of behavior. All in all, this process leads to the carry-over of basic
relationship styles into future relationships” (Shulman, Elicker, & Sroufe
(1994, p. 343).
Other measures of adjustment to adulthood also are related to attachment
history. One summary measure, called “global adjustment,” was based on
interviews and involved three major criteria: (1) adequate progress in work,
education, or training; (2) meaningful relationships with family, friends,
and partners, and (3) a functional level of self-awareness (including clarity
with regard to goals and pathways to those goals). Security of attachment
was related to this outcome, although as we will discuss below, predictions
were much stronger when we combined attachment with other measures of
early functioning and with functioning in childhood (Sroufe et al., 2005).
One further note: we found attachment history to be related to represen-
tations of attachment, to parenting, and to attachment in the next generation.
Here, the significant finding was that disorganized attachment in infancy
predicted disorganized attachment in the next generation. Moreover, we
found that this was mediated by a history of dissociation.

Attachment and psychopathology

Attachment theory and research was influential in launching a new view of

psychopathology; namely, that pathology is an outcome of development.
Like all development, pathology is a cumulative process, a step-by-step
confluence of multiple influences over time. In such a view, early anxious
attachment relationships are not viewed in themselves as pathological or
even as direct causes of later disturbance. Their connection with distur-
bance is seen in probabilistic terms; that is, they initiate developmental
pathways that if pursued lead to a greater likelihood of disorder. We did
find that both avoidant and resistant attachment were modestly associ-
ated with later problems and with some specificity. Logically, because
of alienation, avoidance was associated with conduct problems (Renken
et al., 1989), and resistant attachment, because of heightened vigilance and
uncertainty, was linked to anxiety disorders (Warren et al., 1997). Both
were linked to depression (Duggal et al., 2001), we believe via different
pathways.
 Attachment theory: A humanistic approach 23

Disorganized attachment was an especially potent predictor of psycho-

pathology (Carlson, 1998). In fact, no other single measure from the infancy
period was as strong. Disorganized attachment represents a profound dis-
turbance in the organizing core of the self, and it predicted a wide range
of pathological outcomes, from conduct problems to borderline personal-
ity symptoms. Because this pattern is built upon an irresolvable paradox
(the simultaneous impulse to flee both to and away from the attachment
figure), these infants are later prone to dissociation. It was indeed the case
that the disorganized pattern predicted dissociative tendencies through
adolescence and into adulthood. Such dissociation lay underneath the ten-
dency of these individuals to show a myriad of disturbed behaviors and to
be unable to resolve experiences of loss or trauma (Sampson, 2004).

Resilience

Just as with pathology, resilience is seen as a developmental outcome

within the attachment framework, not as a characteristic that some indi-
viduals simply have. It is constructed, step-by-step, with sensitive, respon-
sive care and secure attachment as the important foundation. We were
able to demonstrate the role of attachment in promoting resilience in two
ways. First, a classic definition of resilience is the capacity to function well
even in the face of adversity. Our measures of high family stress served as
an adversity indicator, and indeed, high stress was associated with child
behavior problems in our sample. But not all children facing high stress
showed problems and, thus, could be called “resilient.” Note that this term
is merely a description of the phenomenon, not an explanation. Rather
than simply assuming an inherent characteristic, we sought to determine
antecedents of this capacity. What we found was that children with secure
attachment histories were significantly less likely to show behavior prob-
lems in the face of high family stress than were children with histories of
anxious attachment (Pianta, Egeland, & Sroufe, 1990).
The second way we explored attachment and resilience was by defin-
ing groups of children who recovered from a period of difficulty. This is
in keeping with dictionary definitions of the term as “bouncing back.” In
the first analysis, we defined a group of children with consistent behavior
problems aged 3–4½ years (across three assessments). When we followed
them to age 8, some had remitted their problems and therefore could be
called “resilient.” Such “remitters” were significantly more likely than
24 L. Alan Sroufe

those who continued to have problems to have histories of secure attach-

ment (Sroufe, Egeland, & Kreutzer, 1990). We repeated this analysis at
several age points, always with the same general results (Sroufe et al.,
2005). It was also the case that intervening changes in family stress or
support also accounted for positive change in the children. When history
and current supports were taken into account, the mystery and magic in the
term “resilience” virtually disappeared.
A final note here concerns the way attachment history inf luences the
capacity to utilize opportunities for growth (Supkoff, Puig, & Sroufe,
2012). In the adult literature, it has been known that certain major events,
such as marrying or having children, offer potential turning points in the
life course. We too found that forming stable partnerships was associated
with remission of depression, for example, between adolescence and early
adulthood. But, in addition, we found that those with secure early attach-
ment were more likely to remit than those with anxious histories given
similar opportunities. In other words, those with secure histories were bet-
ter able to take advantage of this new partnership.

Attachment and other influences

Variations in attachment are more impressive when considered in the

context of other developmental influences. For example, when we con-
sider a combination of early care influences (quality of stimulation, guid-
ance and limit setting, support for problem solving), predictions to an
array of outcomes became notably stronger. This included relations with
social relationships in childhood, adolescence and adulthood, as well as
school performance and other aspects of personal functioning (Sroufe
et al., 2005). Likewise, considering both attachment and peer experiences
greatly enhanced predictive power. For example, predictions concern-
ing adolescent and adult social competence from combined measures of
attachment history and peer competence were very powerful. Sometimes
it was the case that peer measures predicted outcomes better, and some-
times early attachment predicted better. For example, in adult relation-
ships, attachment predicted emotional aspects of relationships better
(capacity for trust, hostility), and sometimes peer experiences were more
powerful (ability to negotiate and resolve conflicts). Thus, attachment
appears to prepare certain motivational and attitudinal expectations, but
the actual practice one gains from negotiating in more equal relationships
also is important.
 Attachment theory: A humanistic approach 25

Similarly, with regard to psychopathology outcomes we found that,

when combined with other influences, predictions involving early attach-
ment were greatly strengthened. This was true for every pathological out-
come we studied. In particular, when those with early anxious attachment
encountered subsequent stresses or adversity, they were notably vulner-
able in terms of developing disturbance. As one example, those having
disorganized attachment in infancy, who later experienced abuse or other
trauma, were much more likely to develop dissociative symptoms in late
adolescence than those with similar trauma but not disorganized attach-
ment or those with disorganized attachment but not subsequent trauma
(Ogawa et al., 1997). Thus, just as secure attachment history promotes
the capacity to withstand or recover from adversity and take advantage of
opportunities for growth, anxious attachment history (especially the disor-
ganized pattern) leaves individuals more vulnerable.
Change, of course, does occur in light of later experience and other
influences. We documented this in a number of ways in our study, and
have shown it to be possible at every phase of development (Sroufe
et al., 2005). Of particular note, as family stress decreases, as social sup-
port increases, and as parental depression lessens, child, adolescent and
adult problems decrease. Having said that, it is also true that the longer a
pathway is followed, the more difficult change becomes, and it appears
that one’s early attachment history is never lost.
We summarize this state of affairs previously in the following way:

Variations in infant–caregiver attachment . . . are related to outcomes only

probabilistically and only in the context of complex developmental sys-
tems and processes. Still, the importance of attachment is not trivialized
by such considerations. Within a systemic, organismic view of develop-
ment, attachment is important precisely because of its place in the initia-
tion of these complex processes. It is an organizing core in development.
(Sroufe, 2005, p. 365)

Conclusion
Attachment theory has fomented a revolution in psychology because of its
general applicability across all human groups, its clinical relevance, and
its openness to empirical test. Early attachment relationships not only are
theoretically of great importance, they have proven to be absolutely foun-
dational for later development. As I concluded in a previous paper:
26 L. Alan Sroufe

While it is not proper to think of attachment variations as directly causing

certain outcomes, and while early attachment has no privileged causal
status, it is nonetheless the case that nothing can be assessed in infancy
that is more important. Infant attachment is critical, both because of its
place in initiating pathways of development and because of its connec-
tion with so many critical developmental functions—social relatedness,
arousal modulation, emotion regulation, and curiosity, to name just a few.
(Sroufe, 2005, p. 365)

Thus, because development is cumulative, always building upon itself,

early attachment relationships set an initial direction for development.
Because individuals seek, select, and react to later experiences within the
framework of attitudes and expectations forged in attachment relation-
ships, there is a tendency for these early pathways to be followed in a
cascading manner. Of course, early attachment experiences are open to
change. Still, they are not discarded. They remain either as factors that
promote growth or leave individuals more vulnerable to adversity and
developmental challenge.

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 Attachment theory: A humanistic approach 29

Simpson, J. A., Collins, W. A., Tran, S., & Haydon, K. C. (2007). Attachment and the
experience and expression of emotions in romantic relationships: A developmental per-
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Wachs, T. D. (Julio 2009). La naturaleza y las

consecuencias del estrés sobre las familias que

viven en países con bajos ingresos. In El estrés familiar:

Protegiendo el bienestar de los

más pequeños. Espacio para la Infancia (pp. 3–10). Bernard

van Leer Foundation.

Poster 2: The father as attachment figure

Patricia González Duarte, Seminario de Sociopsicoanálisis

A.C. SEMSOAC,

Mexico

The role of the father as an important attachment figure

has not received

the attention it deserves. Nevertheless, as women have

began to work

outside of the home, the participation and presence of the

father in the

family has increased. Fathers are beginning to play larger

and more rel

evant roles, while developing their own styles for relating

to and raising

their children. These modern conditions are also making

psychoanalysis evolve

and incorporate the findings of attachment theory and the

importance

of having a secure base and haven of security for

development, and the

enormous importance of having close emotional connections

in human

relations. Attachment theory becomes a particularly useful

tool for clinical work

to shed light onto the important role of fathers during

child development. I

use clinical examples to illustrate the father’s role by

describing the case of

two adolescent girls who were 15 and 19 years of age

respectively when I

began working with them. Both of these adolescents had

developed a close

and safe bond with their fathers during a critical phase of

adolescence. The

close bond served as a supplementary alternative to the

relation established

with the mother, who had been the main caregiving figure
during child

hood. In both cases, being able to use the father as a

secure base and an

emotional support became enormously helpful for these two

adolescents,

as the family faced adverse situations and traumatic events

that affected

the quality of the mothers’ ability to respond to their

daughters’ needs and
communications. One of the adolescent girls I worked with,
Amira, recalled the following

memory during the course of treatment. When she was four

years old, her

mother stopped being available for her after her mother

lost one of her par

ents. Amira turned to her father for support during this

critical time. While

the mother was unavailable or walked about the house

crying, Amira’s

father was able to comfort and soothe her, greatly

diminishing her anxiety.

Without denigrating her mother, the father sensitively told

Amira: “Mom

is sad, she can’t play with you, but I’m here for you,”
letting Amira know

that she would be OK. During the therapeutic process, she

used her own

memories of her relation to her father as examples of

gratifying, happy

and vital experiences that allowed her to regulate her

emotions and create

a solid and safe attachment with him during Amira’s

turbulent adolescent

years. From the perspective of traditional psychoanalysis,

and according to

its interpretation of the Oedipus complex, this case could

be seen as an

instance of an unresolved Oedipus complex or, according to

Fromm’s

social character theory, as a case of father fixation. An

uncritical and

un-empathic use of these theoretical interpretations would

limit our clini
cal scope and they could lead us to encourage the patient
to sever the bond

with the father or to separate from him. In contrast,

attachment theory

allows us to consider that the patient established a bond

with the father as

an alternative to an attachment with her mother. This

secure attachment

prevented her own emotional collapse, and was used as the

basis to rescue

and recover the bond with the mother.

Poster 3: The “Triple Stance” as a conceptual

and methodological frame in psychosocial

interventions

Christian Herreman, Ibero American Attachment Network RIA

Psycho

analytical Society of Mexico, International

Psychoanalytical Association,

Mexico

The “Triple Stance” is a particular way of framing clinical

and community

work by paying close attention to attachment needs, social

context, and

reflective functioning. This triple focus allows the team

of educators and

therapists to better understand and plan each particular

intervention. For

instance, our experience shows that participants with poor

reflective func

tioning are best served by building more secure attachment

and trust, and
focusing on improving cooperative attitudes and skills. The
model has its

roots on the work on the emergence and maintenance of human

coopera

tion (Tomasello, 2009; Novak, 2011; Sober & Wilson, 1998),

and the field

of attachment (Shaver & Mikulincer, 2007), as well as

psychodynamic

community interventions (Twemlow, 2006). Mentalizing,

attachment,

and cooperation have an intimate and complex relationship

(Bateman

& Fonagy, 2006; Barudy & Dantagnan, 2005; Baruch, 2001),

The triple

stance attempts to integrate these three dimensions in

order to promote

better clinical and communitarian interventions.

Pro Niños de la Calle has worked with street population for

more than

twenty years, and five years ago it developed a residential

program for

young adults. The Transitional House for Independent Life

(THIL) has

allowed us to evaluate the impact of the Triple Stance

within the program

(Herreman, 2012). The usefulness of working with the Triple

Stance relies

on the recognition that all three dimensions are

intertwined and thus each

one is accessible through the remaining two. This allows

the educators and

therapists to address attachment issues from a cooperative

perspective or
through reflection. When the main anxiety is caused by
having to comply

with cooperative norms, the Triple Stance can help these

young adults to

recognize their biased understanding of these norms by

building trust and

a sense of belonging. The present poster presents the

theoretical premises

that sustain the Triple Stance as well as an example of a

prototypical inter

vention within the THIL.

Bateman, A., & Fonagy, P. (2006) Mentalizationbased

treatment for borderline personal ity disorder. A
practical guide. Oxford: Oxford University Press.

Baruch, G. (2001) The routine evaluation of mental health

outcome at a community-based psychotherapy center for
young people. In B. G. Brunner (Ed.), Communitybased psy
chotherapy with young people. London: Routledge.

Barudy, J., & Dantagnan, M. (2005) Los buenos tratos a la

infancia. Parentalidad, apego y resiliencia. Edn. Gedisa.

Fonagy, P. (2000) Attachment and borderline personality

disorder. Journal of the American Psychoanalytic
Association, 48, 1129–46.

Fonagy, P., & Target, M. (1997). Attachment and reflective

function: their role in self organization. Development and
Psychopathology, 9, 679–700.

Herreman, C. (2012) Apego, mentalización y cooperación

dentro de la CTVI. Presented in the Ibero American
Attachment Network Congress in Santiago, Chile.

Nowak, M. (2011) Supercooperators. New York: Free Press.

Shaver, P., & Mikulincer, M. (2007) Attachment in

adulthood. New York: Guilford Press.

Tomasello, M. (2009) Why we cooperate. Boston, MA: Boston

Review Books.

Twemlow, S. (2006) Might Freud’s legacy lie beyond the

couch? Psychoanalytic Psychology, 23(2), 430–51.

Sober, E. & Wilson, D. (1998) Unto others. Cambridge, MA:

Harvard University Press.

Wallin, D. (2007) Attachment in psychotherapy. New York and

London: Guilford Press.

Poster 4: An investigation of the attachment

formation and organization of infants living in

Chilean institutions

Francisca Herreros, Ph.D., Instituto Neuropsiquiatrico de

Chile, Santiago,

Chile

Institutional care is an important phenomenon in Chile,

where foster care

practice is very scarce. There is a great lack of research

in Chile on the field

of attachment, specifically in institutionalized children,

with no published

studies utilizing the Strange Situation procedure to assess

attachment in

these infants. However, there is a growing interest in both

government

and non-governmental organizations to improve attachment

security in

these institutionalized infants. This study examines

attachment security,

attachment organization, and level of attachment formation

among all

children between the ages of 10 and 47 months living in two

Chilean

orphanages (N = 41). This poster also provides a brief

description of insti

tutionalization in Chile that contextualizes the current

research. Quality

of attachment was assessed in this study using Ainsworth’s

Strange

Situation procedure (Ainsworth et al., 1978), and

Attachment Formation

Rating (Carlson, 2002). As expected, analyses show a higher

prevalence

of disorganized attachment among infants living in

institutions, in com

parison with non-institutionalized infants from Chile

(Lecannelier et. al.

2008). Surprisingly, half of the sample (51.2%) of

institutionalized infants

in Chile displayed secure attachment during the Strange

Situation, well

above the 17.1% average reported on a recent meta-analysis

on attach

ment in institutionalized children (Bakermans-Kranenburg

et. al., 2011).

Furthermore, 63.5% of Chilean infants show a fully formed

attachment

system of response towards their primary caregiver, and

were rated as 5

on the Attachment Formation Rating, significantly higher

than the per

centage of attachment organization showed by infants from

orphanages in

Romania (3%—Zeanah et al., 2005) and Ukraine

(24%—Dobrova-Krol

et. al., 2009) (see Figure A.1). Family visits to the

institutions appeared as

an important factor related to infants’ attachment

development. Specific
characteristics of attachment behavior of this Chilean
sample will be

described. Figure A.1 Distributions of presence or absence

of fully formed attachment behaviors in institutionalized
infants of three samples compared in this study

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S.

(1978). Patterns of attachment: A psychological study of
the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum.

Bakermans-Kranenburg, M. J., Steele, H., Zeanah, C. H.,

Muhamedrahimov, R.J., Vorria, P., Dobrova-Krol, N. A.,
Steele, M, van IJzendoorn, M. H., Juffer, F., & Gunnar, M.
R. (2011). Attachment and emotional development in
institutional care: Characteristics and catch-up.
Monographs of the Society for Research in Child
Development, 76(4), 62–91.

Carlson, E. (2002). Attachment Formation Rating. Institute

of Child Development, University of Minnesota,
Minneapolis, MN. Unpublished coding system.

Dobrova-Krol, N. A., Bakermans-Kranenburg, M. J., Van

IJzendoorn, M. H., & Juffer, F. (2010). The importance of
quality of care: Effects of perinatal HIV infection and
early institutional rearing on preschoolers’ attachment and
indiscriminate friendliness. Journal of Child Psychology
and Psychiatry, 51(12), 1368–76.

Lecannelier F., Kimelman, M., Gonzalez, L., Nuñez, J. C.,

and Hoffman, M. (2008). Evaluaciones de patrones de apego
en infantes durante su segundo año en dos centros de
atención de Santiago de Chile.[Assessment of patterns of
attachment of two-year-old infants in two primary care
centers in Santiago de Chile] Revista Argentina de Clínica
Psicológica, 17, 197–207.

Zeanah, C. H., Smyke, A. T., Koga, S., & Carlson, E.

(2005). Attachment in institutionalized and community
children in Romania. Child Development, 75(5) 1015–28.

Poster 5: Attachment system, and response to stress

in former pre-term young adults: Study of Adult

Attachment Interview variables

M. Ibáñez, M. Ferro, V. Fernández, and C. Tello,

psychologists; M. Cancelas,
methodologist; T. Agut, neonatologist, and P. Poo,
neuropediatrician. High

risk Babies Followup Program, Hospital Sant Joan de Deu,

University of

Barcelona, Spain

In a study of the stress response in young adults who were

born prema

turely, we study their Internal Working Model (IWM) through

the Adult

Attachment Interview (AAI) and compare them with a group of

young

adults born at term. In part, this study explores the

relationship between

AAI variables, and longitudinal risk factors stressors in a

clinical group. Research has shown that young adults born
prematurely present less

optimal cognitive and neurophysiologic response in stress

situations. In normal populations, it was found that
insecure and disorganized

attachment is associated with a higher rate of basal

cortisol and slower

recovery of these levels after a stressful situation

(Lemche et al., 2006;

Rifkin, 2006). In a population with past experience of

maltreatment, secure

attachment is associated with low levels of subjective

stress, and moderate

cortisol activation (Pierrehumbert, 2012).

The aim

1 Study the variables of AAI in the clinical group n = 34,

very prematurely born infants born without handicaps, and a
control group n = 20 born at term.

2 Study the relationship between AAI variables and the

longitudinal variables risk factors stressors in the
clinical group.

Hypothesis

1 The clinical group will have a larger number of insecure

classifications.

2 In the clinical group, longitudinal variables of risk

factors stressors will be related to the AAI variables.

Sample

• Clinical group: 34 premature, 19–24 years old;. 17 of

them present LMS at 7 years and 17 without LMS.

• Control group: 20 born at term, 22–25 years old.

Data analysis

Prevalence analysis, means comparisons:

Results:

1 Overall State of mind AAI: Clinical g.: Ds 52, 63%,

Control g.: Ds 36%, (sig. 0.041)

2 AAI States of Mind: Clinical g.: greater presence of

trauma (sig. 0.047)

3 AAI States of Mind: Clinical g.: L M S: more Idealizing

Mother (sig. 0.006)

4 Longitudinal variables and AAI variables: Use of

psychological services is related with presence of trauma
in AAI (sig. 0.035).

Conclusion

Subjects with a history of very severe prematurity present

more dismiss

ing attachment strategies than control group, particularly

lack of memory,

idealizations of caregivers, less representations of

suffering as child, but

not derogation of attachment. They also present more

traumas in AAI. We
think these results are interesting because they show that
stressful experi

ences due to developmental and parenting variables during

the first years

of life leave traces in their attachment narrative in

adulthood. They do

so chiefly by evoking experiences that have a traumatic

impact (medical

type) and by the development of dismissing strategies,

characterized by

lack of memory and idealization of caregivers.

Lemche, E., Giampietro, V. P., Surgulazde, S. A., Amaro, E.

J., Andrew, C. M., William, S. C. et al. (2006). Human
attachment security is mediated by the amygdala: Evidence
from combined fMRI and psychophysiological measures. Human
Brain Mapping, 27, 623–35.

Rifkin, A. E. (2006). Individual differences in responses

to the adult attachment interview predict responses to
neuropsychological testing, as well as both basal and
laboratory cortisol. Dissertation Abstracts International,
66(10-B), 5726 (UMI No. AAI31908).

Pierrehumbert, B., Torrissi, R., Ansermet, F., Borghini,

A., & Halfon, O. (2012) Adult Attachment Representations
predict cortisol and oxcytocin responses to stress.
Attachment and Human Development, 14(5), 453–76.

Poster 6: Secure base childcare and socio-

cognitive development

Fernando SalinasQuiroz, Ph.D,. National Pedagogic

University (UPN),

Mexico City, Mexico

Problem and justification

Children develop bonds with parents or parental substitutes

for protec

tion, comfort, and support. The attachment figure

represents a secure base

from which to explore the environment and is a haven of

safety for the

individual in times of stress (Ainsworth et al., 1978;

Waters & Cummings,

2000). The association between attachment and sensitive

responsiveness

is clearly supported by correlational and

quasi-experimental evidence (for

meta-analytic reviews, see De Wolff & van IJzendoorn, 1997;

Bakermans

Kranenburg, van IJzendoorn, & Juffer, 2003). Four research

teams from

Australia, Israel, the Netherlands, and the US suggested,

unequivocally,

that quality of non-maternal care is critical for

children’s development

(Love et al., 2003; Sagi et al., 2002).

Early attachment experience is represented in the form of a

temporal

causal script structure organized around components of the

secure-base

phenomenon (Waters, Rodrigues, & Ridgeway, 1998).

Attachment theory

predicts strong links between the caregiver’s attachment

representations

and an infant’s attachment behavior.

Secure Base Childcare (SBC)

Secure Base Childcare involves a reliable and protective

network of sensi

tive, available, and responsive Professional Secondary

Caregivers (PSC)
who offer children a variety of opportunities for
exploration and interac

tion (Byng-Hall, 1999; Salinas-Quiroz, 2013), and shared

awareness that

attachment relationships need to be protected and not

undermined. The

shared working model of the SBC is of PSC and main

caregivers support

ing each other to care for their children.

Aim

To explore possible associations between quality of care

elements and

socio-cognitive child development.

Hypothesis

Quality of care is associated with children’s

socio-cognitive development

and facilitates Secure Base Childcare environments.

Participants

• Professional Secondary Caregivers (N = 34): Work in a

IMSS childcare facility; as educators or education
assistants in maternal A (19–24 months), B1 (25–30
months), or B2 (31–36 months).

• Infants (N = 34): 18–36 months of age; in good health

according to childcare reports (overall health,
vaccination, hygiene, nutrition, weight and height,
psychology, and social work).

Assessment

• PSC-child interaction: Attachment Q-set, AQS 3.0 (Waters,

1995; Salinas-Quiroz, 2013): PSC Behavior Q-Set, PSCBQS
2.1 (Pederson & Moran, 1995; Salinas-Quiroz, 2013).

• PSC’s characteristics: Narrative Assessment Procedure (H.

Waters & Rodrigues-Doolabh, 2004); Parent Behavior
Checklist (ECMP, SolísCámara, et al., 2002; Salinas-Quiroz,
2013); PSC Attribution Scale (de Castro & Mayes, 2006;
Salinas-Quiroz, 2013).

• Childcare facility’s characteristics: Childcare

Environment Rating Scale (EECS/A versión 6.0, UPN/2011).

• Socio-cognitive development: Social and Cognitive

Evaluation Scale for 12–23 and 24–35 months children (UPN,
2013).

Data analysis

Descriptive statistics for all scores and correlations

among variables.

Parenting beliefs correlated positively with negative

attributions, and with

parenting practices with positive attributions. Security of

children cor

related with socio-cognitive development and with social

and personal

identity. The lack of association between interactive

elements (sensitivity-

security) brings forth the hypothesis that the variables

that influence

the construction of secure-base relationships are different

from the ones

involved in the PSC-child relationship. The protective

network of sen

sitive, available, and responsive PSCS that offer children

a variety of

exploratory and interactive opportunities (that is,

learning experiences) is

defined as Secure Base Childcare (SBC). The SBCC becomes an

indicator

of education quality for early childhood.

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S.

(1978). Patterns of Attachment. Hillsdale, NJ: Lawrence
Erlbaum.
Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., &
Juffer, F. (2003). Less is more: Meta-analyses of
sensitivity and attachment interventions in early
childhood. Psychological Bulletin, 129, 195–215.

Byng-Hall, J. (1999). Family and couple therapy: Toward

greater security. In J. Cassidy & P. Shaver (Eds.),
Handbook of attachment: Theory, research and clinical
applications (pp. 625–45). New York: Guilford Press.

de Castro, F., & Mayes, I. C. (2996). Maternal Attribution

Scale. Unpublished manuscript, Yale University.

De Wolff, M. S., & van IJzendoorn, M. H. (1997).

Sensitivity and attachment: A metaanalysis on parental
antecedents of infant attachment. Child Development, 68,
571–91.

Love, J. M., Harrison, L., Sagi-Schwartz, A., van

IJzendoorn, M. H., Ross, C., Ungerer, J. A., et al.
(2003). Child care quality matters: How conclusions may
vary with context. Child Development, 74, 1021–33.

Sagi, A., Koren-Karie, N., Gini, M., Ziv, Y., & Joels, T.
(2002). Shedding further light on

the effects of various types and quality of early child

care on infant–mother attachment

relationship: The Haifa Study of Early Child Care. Child

Development, 73, 1166–86.

Salinas-Quiroz, F. (2013). Vínculos de apego con cuidadores

múltiples: la importancia de

las relaciones afectivas en la Educación Inicial. Memorias

Electrónicas del XII Congreso

Nacional de Investigación Educativa.

http://dx.doi.org/10.13140/2.1.1043.8083.

Solís-Cámara, R. P., Díaz, R. M., Medina, C., Barranco, J.

L., Montejano, G. H., & Tiscareño,

L. A. (2002). Estructura factorial y propiedades de la

Escala de Comportamientos para

Madres y Padres con Niños Pequeños (ECMP). Psicothema, 14,

637–42.
Waters, E. (1995). Attachment Q-set items. In E. Waters, B.
Vaughn, G. Posada, &

K. Kondo-Ikemura (Eds.), Caregiving, cultural and cognitive

perspectives on secure

base behavior and working models: New growing points of

attachment theory and

research. Monographs of the Society for Research in Child

Development, 60 (2–3,

Serial No. 209), 255–265.

doi:10.1111/j.1540-5834.1995.tb00214.x.

Waters, E., & Cummings, E. M. (2000). A secure base from

which to explore close rela

tionships. Child Development, 71, 164–72.

Waters, H. S., Rodrigues, L. M., & Ridgeway, D. (1998).

Cognitive underpinnings of nar

rative attachment assessment. Journal of Experimental Child

Psychology, 71, 211–34.

Waters, H. S., & Rodrigues-Doolabh, L. (2004). Manual for

decoding secure base narra

tives. Unpublished manuscript, State University of New York

at Stony Brook.

Poster 7: Reflective function in a Spanish adolescent

population with a history of maltreatment

C. Tello, Ph.D., D. Barrio, psychologist, S. Rotger,

psychologist, L. Batlle,

psychologist, R. Mangues, psychologist, T. Pera,

psychologist, all from

the Center for Child and Youth Mental Health (CSMIJ), Sant
Joan de

Deu Lleida and University of Lleida, Spain, and J. Pifarre,

psychiatrist

from the Institut de Recerca Biomedica de Lleida

(Biomedical Research
Institute of Lleida) IRB Lleida, University of Lleida, Spain

Introduction

We focus on the analysis of Reflective Function (RF) in a

population with

a history of abuse, in order to assess whether such

background is a risk

factor for repeating abusive behavior to others.

Objective

Our objective was to study the relation between the levels

of RF in adolescents

with a history of abuse, using the method of transversal

observational study.

Assessment of RF was carried out with Herreros’ (2009)

Spanish version of

the Friends and Family Interview (FFI) (Steele et al.,

2009), in a sample of

100 subjects, aged 12–17 years: 50 with history of abuse

(RCEA: Residential

Centres of Educational Action) and 50 control sample (SS:

Secondary

Schools), matched for age and gender. For the analysis of

the sample, Fisher’s

exact test and Pearson’s Chi-Squared test of independence

were used.

Results

Comparing the distribution of scores of RF between RCEA

versus SS,

showed: RCEA have a higher proportion of subjects with low

RF (58%:

Negative-Nonexistent) than the SS (26%), the observed

differences being
statistically significant (p value <0.05). When comparing
RF by gender,

the distribution of scores did not differ significantly

between genders,

although male subjects presented a higher percentage of Low

RF. Males

of the RCEA center get a lower percentage of Normal-Marked

RF than

females (7.7% versus 20%). The RF distribution of RCEA

males and

females proved significantly different (p-value = 0.045).

Conclusions

The results seem to suggest that there is some relationship

between RF

and a history of having suffered abuse, neglect, and/or

sexual abuse.

These results agree with the literature reviewed, which

states that there

would be a close relationship between RF ability with the

possibility of

having organized secure attachments in infancy. In this

population, it was

observed that the mothers presented substance abuse

problems (40%),

which were considered as an important risk factor in the

development of a

insecure attachment (Fonagy, Bateman, & Bateman, 2011;

Fonagy et al.,

2002; Fonagy, Gergely, & Target, 2007; Slade et al., 2005).

The difference

observed between genders in relation to the RCEA group

suggests that,

possibly, they were girls with greater resilience than

their peers, which

allowed them to make attachments with protection figures

that their male

peers weren’t able to establish (Luthar, 2006).

Fonagy, P., Bateman, A., & Bateman, A. (2011). The widening

scope of metalizing: a discussion. Psychology and
Psychotherapy, 84(1), 98–110.

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002).

Affect regulation, metallization: developmental, clinical
and theoretical perspectives. New York: Other Press.

Fonagy, P., Gergely, G., & Target, M. (2007). The

parent-infant dyad and the construction

of the subjective self. Journal of Child Psychology and

Psychiatry, 48(3–4), 288–328.

Luthar, S. S. (2006). Resilience in development: a

synthesis of research across five dec

ades. In D. Cicchetti & D. J. Cohe (Eds.), Development

psychopathology: Risk, disor

der and adaptation, Vol. 3. New York. Wiley.

Slade, A. (2005). Parental reflective functioning: An

introduction. Attachment and Human

Development, 7(3), 269–81.

Slade, A., Grienenberger, J., Bernbach, E., Levy, D., &

Locker, A. (2005). Maternal reflec

tive functioning, attachment, and the transmission gap: a

preliminary study. Attachment

and Human Development, 7(3), 283–98.

Steele, H., Steele, M., & Kriss, A. (2009). The Friends and
Family Interview (FFI) Coding

Guidelines Centre for Attachment Research, New School for

Social Research. Draft 3.1:

July 29, 2009. Unpublished manuscript, London. All queries

to: steeleh@newschool.edu.
Poster 8: Feasibility of early interventions to

enhance attachment—Preliminary evaluation of

a group program in Spain

Bárbara TorresGómez and Itziar AlonsoArbiol, University

of the Basque

Country, Spain, M. José Cantero, University of Valencia,

Spain, and

Amina Abubakar, Tilbury University, The Netherlands

Introduction

We aimed at developing and implementing a group

intervention to pro

mote secure attachment of children, acknowledging the

specificity of the

Spanish context. First, the Spanish Health System allows

the whole popu

lation to receive service regardless of individuals’

income, which makes

it the perfect setting for delivering this kind of

intervention. Second, the

wide coverage of the Spanish Health System does not allow

for an indi

vidualized format, so one dyad-tailored interventions are

not feasible and

sustainable in the long run in that context.

Participants

The sample was composed of 24 Spanish pregnant women, who

after

wards became mothers, and their 25 babies (there was one

set of twins).

Instruments
A sheet was created to collect basic socio-demographic
variables. The Adult

Attachment Interview (George et al., 1985) was used to

assess women’s

attachment mental state, and the Strange Situation

(Ainsworth et al., 1978)

was used to assess infants’ attachment patterns.

Procedure

Mothers were interviewed in the last months of their

pregnancy. A

researcher blind to AAI classifications assigned mothers to

the control

or intervention group based on: a) possibility of attending

the group ses

sions in the fixed timetable, and b) their pregnancy

status—those who

were close to the expected delivery date were placed in the

control group.

Mothers in the control group (n = 16) received a written

booklet with gen

eral advice about baby caring. Mothers in the intervention

group (n = 8)

attended 22 sessions from the seventh month of pregnancy

until the baby

was 12 months old. When the children were 16 months old,

they were

observed in the lab with the Strange Situation. Mothers in

the two groups

were comparable regarding their attachment status. The

group interven

tion was designed to address these four types of aims: a)

enhance parental

sensitivity; b) change parents’ internal working models; c)

provide and

enhance parents’ social support, and d) improve mothers’

mental health

and well-being. Moreover, the intervention also pays

attention to other

relevant factors of childrearing context, such as the

father’s role in healthy

child attachment, marital support, parental stress, etc.

Results

To check possible intervention effects in children’s

attachment patterns,

control and intervention groups were compared using a

chi-square test.

There was a trend favoring the intervention group but it

fell short of sta

tistical significance due to the small size of the sample.

The effect size of

the intervention on attachment security was medium, with

higher rates

of secure attachment in children in the intervention group

than in the

control group.

Conclusions

We can tentatively answer affirmatively to the question of

whether group

intervention can enhance the security of the infant

attachment. Since the

effect of the intervention is medium, some individual

sessions might be

added to further improve the efficacy of the intervention.

Future studies

should increase the size of the participants in the

intervention to avoid the

limitations of the present study regarding statistical

significance.

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S.

(1978). Patterns of attachment:

A psychological study of the Strange Situation. Hillsdale,

NJ: Lawrence Erlbaum.

George, C., Kaplan, N., & Main, M. (1985). Adult Attachment

Interview. Unpublished

manuscript, University of California, Berkeley.

Poster 9: Strange situation paradigm applied to

infants with visual impairments and their

caregivers—Initial results

A. Urqueta, V. Morash, and D. OrelBixler, all from the

School of

Optometry, Department of Psychology, University of

California, Berkeley,

and P. J. Meinz, University of Western Ontario, London,

Canada

This study applied the Strange Situation Paradigm (SSP) to

a sample

of 20 infants with various degrees of visual impairments,

without addi

tional disabilities. Visual impairments encompass a wide

range of visual

abilities, including no light perception (total blindness),

low vision (war

ranting accommodations like Braille), and visual impairment

(reduced

visual acuity requiring large print). Only a minority of

children with visual

impairments are totally blind.

The SSP presents the child with information aimed to
trigger attachment

behavior and exploratory behavior. If this information is

not presented in

a way that is perceivable by infants with visual

impairments, the SSP will

fail to trigger these behaviors, which would impede its use

for attachment

classification in this population. The review of the

literature found one

study that applied the SSP to visually impaired infants,

however 79% of

the sample had additional disabilities and 25% could not be

classified.

This study added instructions to the SSP protocol to make

the relevant

information more salient and perceptible to infants with

visual impair

ments. For instance, caregivers were told to say good-bye

to their infants

before leaving the room, as they would normally do.

The first coder, who has no clinical experience with

infants with vis

ual impairments but is a certified and experienced SSP

coder, coded all

collected SSPs. The second coder—a trained SSP coder who

has six years

of clinical experience with these children—coded 30% of the

sample

(N = 8). The obtained Kappa values were 1 for security of

attachment, and

0.6 for disorganization. Observers’ accuracy was estimated

to be above
.99 for security, and between 0.9 and 0.95 for
disorganization. Nine infants (6 females, 3 males)
underwent the SSP at age 1, average

fractional age of 1.05 (SD = 0.11). Of these infants, 56%

(N = 5) were

classified as secure; of these, one infant had sub-type B1,

and four had

sub-type B2. Twenty-two percent (N = 2) of the infants’

patterns were

classified as insecure-avoidant subtype A2, and 22% (N = 2)

of the pat

terns were coded as insecure-ambivalent; of these 1 had

subtype C1 and 1

had subtype C2. Eighteen infants (10 females, 8 males)

underwent the SSP at age 2, aver

age fractional age of 1.61 (SD = 0.24). Seven of these

infants (6 females,

1 male) were also assessed at age 1. At age 2, all but 1

SSP were deemed

codable. Seventy percent (N = 12) were classified as

secure. Of these,

4 children had sub-type B2, 4 had sub-type B4, 3 had

subtype B3, and 1

had sub-type B1. Of the insecure patterns, 18% (N = 3) were

avoidant, 2 of

them A2 and 1 A1; and 12% were resistant (N = 2), both C1.