Monday, February 10, 2014

Attachment Explained

John Bowlby published his theories on attachment in the 1950’s.  They took some time to catch on, especially in the child welfare arena.  Attachment, Bowlby said, is the relationship that develops between child and parent.  More basic than love, it is essential to survival.  Attachment sets the stage for functioning in the world.  Another word used for attachment is bonding; attachment is the noun, bonding is the verb.  Attachment is a one-to-one and directional relationship, from child to parent.  Parents do not depend on their children for survival, and to the extent that a parent depends on a child to meet his or her needs, it is dysfunctional and damaging. We are not attached to our family.  We are attached to each member of our family in individual and unique ways.  There need be no competition for attachment because there are few limits to the number of relationships we can establish, each of different quality, some closer, some distant, some comforting, some contentious.  Each adult drives this connection primarily through the commitment and care provided the child.  Attachment is a neuro-bio-psycho-social interaction that forms the template for all future relationships.  So attachment is driven by and subsequently drives brain, biological, psychological, and social functioning.  It is a brain-based connection in that, when we are building attachment, we are forming new brain pathways.  The “prime time” for attachment is conception to the first three to four years of life.  This, Bruce Perry, M.D. teaches, is when 67% of brain formation is happening.  The human infant and brain are quite underdeveloped.  The brain has billions of neurons ready to connect through interaction.  This explains why young children learn so quickly.  Then the available unused brain cells begin to fall away.  The human brain is 90% of adult size by age six.  There are still billions of available brain cells, but school and adult learning requires repetition and immersion, much like learning a foreign language.  Perry says abused and neglected children can be thought of as having been raised in an environment of relational poverty without the experiences that build brain cells.  This is probably the most startling point for parents of traumatized children both because the original abuse may have happened during this attachment period and because that window of opportunity seems to have closed.  Yet we know the brain is a malleable organ capable of growth until death.  So, we hold out hope that we can change the brain through nurturing interaction and heal the child through relationship.

            Daniel Siegel calls this “The Dance of Attunement”.  The parent leads this dance by responding to the child’s basic needs which contributes to brain development leading to basic trust, self esteem, and character.  The child is empowered to make his or her needs known developing a sense of agency in the infant and a sense of effectiveness and satisfaction in the parent.  The child perceives herself to be important because the adult demonstrates it.  The infant experiences himself subjectively as good or bad depending on the adult responses.  This intersubjectivity means the parent holds a representation of the child in his or her mind and the infant holds an image of the parent in his or her mind.  Further, this attunement is not just about feeling, it is about action, what parents do, not what they say.  Attachment is developed through experience in all five senses, the most important of which is touch.  In World War II Germany, doctors set up hospitals to care for orphan children.  Despite professional care the infant lost weight and died for lack of touch.  To touch, we would add gaze, smell, taste, and tone.  I note tone of voice because infants do not understand language early on and re-parenting traumatized children requires a focus on tone and not on words for communicating.

            In the simplest terms, attachment is formed through the arousal/relaxation cycle.  As an organism and species we have basic needs in order to stay alive.  Infants need, at basic, nourishment, elimination, interaction, soothing, and sleep.  The need causes a physiological discomfort or arousal in the infant that is usually expressed in crying.  While attachment is directional and driven by the primary caregiver, it is also a reciprocal relationship.  The infant’s role is to make his or her needs known to the extent possible.  When the caregiver reads the child effectively and meets the need for food, clean diaper, attention, and soothing, the infant’s biological and psychological responses are relaxation until the next need appears.  Of course, in early infancy through toddlerhood, the needs are nearly constant.  If the primary caregiver is able to meet the needs in a “good enough” way, healthy or secure attachment forms.  As important as consistent care is the way in which it is delivered.  Infants take us in through all five senses.  Our body language, demeanor, intent and tone are as important to attachment as food and diapers.  The attachment figure brings comfort in its presence and distress in its absence.  The essential ingredients, then, are basic needs, physical and emotional distress, an expression of discomfort, an appropriate reading of the arousal, and an adequate response that meets the needs resulting in relaxation. 

            This means that “distress” is necessary to secure attachment.  The body, if it is healthy, has the ability to signal need through discomfort.  It is not always the most pleasant experience, especially for stressed out parents, but we need the baby to cry.  This begins in utero as the fetus is forming and the womb and the umbilical cord deliver basic needs in the environment of the mother’s body.  We will talk about pre-birth attachment insults later.  But in healthy pregnancy birth it self is the first major stress of the child’s life.  It is a literal separation from the mother’s body and constant care.  According to Daniel Siegel, the infant experiences birth as a life threatening event.  From this point on the new infant begins to develop coping strategies around separation from mother.  Years ago, and sometimes still in the case of caesarian births, the infant is removed from the mother at birth to be cleaned and weighed and cared for by others.  Nowadays, as you can see in the video from the First Five Years collection, we quickly respond to this distress and repair this break by bringing the newborn directly into the waiting arms of the mother.  We will come back to this theme of break and repair as we talk about parenting.

            If repeated successful completion of the arousal/relaxation cycle leads to secure attachment, then frequent interruptions in the arousal/relaxation cycle lead to compromised attachment.  Instead of breastfeeding or formula, hunger is met with unsatisfying water, Kool Aid, or nothing.  Diapers go unchanged and painful rashes develop.  Medical conditions go unchecked.  The need for attention is met with anger or ignored.  The child who seeks soothing is on his own if not physically assaulted.  Even if the care is adequate, it is delivered with little commitment or enthusiasm if not down right contempt and resentment.  In any case, the child is left in a constant state of chronic stress.  This is the kind of psychological and physiological stress that does not go away. 
The causes and reasons for abuse and neglect are many; lack of education, mental illness, poverty, substance abuse, and family discord.  Often parents manage to meet the needs of their children despite struggling with mental illness, substance abuse, and family violence, and do so with determination and support.  However, many children come to the attention of child welfare services investigating abuse and neglect.  Some half million children are subject to the interventions of the U.S. child welfare system.  Parents are offered services to overcome their problems while their children are in foster care.  While the parent-child relationship is of concern, it is not generally the target of intervention even though it is the most important measure of child safety, well being, and permanency.
          Children often enter the child welfare system during the first three years of life interfering with
the development of attachment.  If they enter the system after the age of three the attachment
pattern has generally already been established.  Certainly, many children have developed secure
attachments before their parents are overwhelmed by drugs and conflict.  Then, the intervention
of the system itself in the form of multiple caregivers and multiple placements in foster care can
cause compromised attachment.  This is in contrast to multiple caregivers among various

     In many families, mothers, grandmothers, older siblings, aunts and uncles, and friends of the
family all share in the care of children.  The difference between this family style and foster care is
that the caregivers do not change.  Despite wide cultural differences in parenting styles, what
most cultures have in common is that the life of a child is marked by consistent care and routine.