Attachment & Loss

2 Attachment Theory ✤D✤Definition of Attachment: ✤A✤An enduring emotional tie to a special person, characterized by a tendency to seek and maintain closeness, especially during times of stress.

3 Roots of Attachment Theory ✤ John Bowlby applied ethology to infants ✤ Influenced by Konrad Lorenz ✤ Infant’s innate behaviours are evolved responses which promote survival ✤ These behaviours include: sucking, crying, smiling, clinging, and following. ✤ Behaviours are modified from inception by the behaviour of the Primary Care Figure (PCF).

5 PCF reactions... ✤ Bowlby found that temporary separations from PCF evoked distinctive type of reactions (separation anxiety) from infant, toddler, etc. ✤ More importantly, he showed how infant/toddler’s reactions upon PCF return may evoke the very behaviour the infant/toddler intended to prevent.

Enter: Mary Ainsworth Made the distinction between strength of attachment and security of attachment. The natural question that had to be asked was: “Is the child who clings to his mother - who is afraid of the world and the people in it, and who will not move off to explore other things or other people - more strongly attached or merely more insecure?” Ainsworth Ainsworth

Secure Attachment Infant / toddler uses caregiver as a secure base May show distress at separation, but the baby can be soothed at reunion Parents of these children display sensitivity to infants/toddlers needs Some parents report having attachment issues of their own from the past, but have gotten over them. Interestingly, their marriages are also less likely to be conflicted than those of the parents of insecurely attached children.

8 Insecure - Anxious / ambivalent ✤ Infant/toddler(s) (IFT) found on the SST who have PCF’s who are over-anxious, insensitive to their child’s needs, and discourage exploration. ✤ (IFT) ✤ Shows great distress during separation ✤ Clings and cries angrily upon return ✤ Distress continues after reunion for much longer than securely attached infants

9 Insecure / avoidant ✤ Are infant/toddler(s) (IFT) found on the SST who have MFC’s who do not show feelings, cannot tolerate closeness, punish child’s attachment behaviour. ✤ (IFT) then learns to: ✤ Inhibit their tendency to cling and cry ✤ During the SST when (MFC) re-appears (IFT) appears indifferent and uncaring will even ignore (MFC). But this is not the true case as inside they are physiologically aroused. ✤ Research has showed that (MFC’s) can be responsive to (IFT’s) under low levels of stress, but under high levels become less responsive.

10 Disorganized / disoriented ✤ In this case the IFT has a MFC who often feel helpless, and are frightened by their own children. ✤ The MFC often lacks in confidence with respect to their ability to care for and control their child and they may see their child as more powerful than themselves. ✤ Ultimately, this conditions the (IFT) to develop disorganized and contradictory behaviour. ✤ (IFT’s) may cry during separation but avoid the MFT upon return or they may approach the MFT upon return then freeze/fall, hit themselves, rock back and forth, etc. ✤ This group shows the greatest distress and in adult life have the most problems in living.

The Disorganized / Disoriented MFC: Why? Experience of their own childhood trauma Active addictions Loss of parent before birth of child Currently experiencing a trauma / related problem

Function of Insecure Attachments WHY WOULD CHILDREN CONTINUE TO ACT APPARENTLY INSECURELY ? ANXIOUSNESS / AMBIVALENCE (Cling / Stay close / Protest) AVOIDANT (Stands of own two feet / seek dependence / inhibit feelings) DISORGANIZED / DISORIENTED (Stands of own two feet / seek dependence / inhibit feelings / act inconspicuous / withdraw / freeze / ) Thoughts folks?

Attachments in later childhood what do we think we know? Attachments patterns that have been established by two years of age appear to remain stable and predict quality of relationships in later childhood Anxious / ambivalent school children seem to lack confidence and assertiveness necessary for interaction with peers. Avoidant children show more aggression to other children and teachers rate them as more hostile, impulsive, and withdrawn. Meanwhile, disorganized children appear to be a risk for psychiatric problems in later childhood (12 and beyond). Further research has demonstrated that attachment patterns are indeed hard to break and that the assumptive world that the child experienced between is the lens in which they view world as older children. This is important because... It’s all about building trust!

Four Categories of Basic Trust Self Trust Other Trust High Secure Attachment Insecure Anxious / Ambivalent Avoidant Disorganized Low High Low High Low

Determinants of Outcome after Bereavement: Research says... Risks factors for chronic bereavement 1. Personal vulnerability of the bereaved 2. Attachment to the deceased 3. Events / circumstances lead up to and including death 4. Social supports and other circumstances taking place after death 5. Dependent relationships 6. Ambivalent relationships

Bereaved participants 181 patients who attended Royal London Hospital 43 men 138 women 74% had been bereaved for over a year before entering into the study average age 41

Relationship of the dead person to the respondent Spouse or partner Mother Father Child Stillbirth Miscarriage Sibling Other Multiple n = 34 n = 31 n = 9 n = 25 n = 1 n = 3 n = 12 n = 33

FINDING YOUR ATTACHMENT TYPE: INSECURE / SECURE If you score 11 or less attachment style = secure More than 21 attachment style = insecure Average score from bereaved study participants was 17 Other subcategories scoring to follow

ANXIOUS / AMBIVALENT SCORE 10 MORE = INDICATES ANXIOUS AMBIVALENT ATTACHMENT SCORE = 7 WAS AVERAGE SCORE FOR BEREAVED PARTICIPANTS

SCORING AVOIDANT ATTACHMENTS SCORE OF 6 OR MORE INDICATES AVOIDANT ATTACHMENT SCORE 3.8 WAS AVERAGE SCORE FOR BEREAVED PARTICIPANTS

SECURE ATTACHMENTS The more reported security of attachment the less severe distress reported AFTER BEREAVEMENT Why?

Correlations Low Secure Attachment Low Problematic Coping Score Low Marital Disharmony Score Low Overall Distress Score = secure parenting harmonious adult relationships

Securely Attached will still seek and Sometimes need treatment Securely attached are not free from distress, but more likely to cope better and have lower levels of distress Those that sought help and who had low insecure scores suffered from Obsessional symptoms, sleep disorders, symptoms of post-traumatic stress, depression and anxiety Causes of the latter symptoms: unexpected, untimely, or violent bereavements Ultimately, it appeared secure attachments sometimes leave us unprepared for traumatic events that occur over a lifetime.

Summary secure Attachments = Less distress after bereavement Secure attached are: 1. More self-confident 2. Seek out support and help when needed 3. Have a reasonable sense of autonomy 4. Marriage is more harmonious and provide a buffer from distress

Anxious / Ambivalent Remember these are the folks who scored high on Parental Unusual closeness and/or Overprotection along with Childhood timidity and/or high ‘Dresden Vase scores. Results showed that participants who scored high on Anxious/ Ambivalence bereaved for protracted periods of time and had difficulty with loneliness. However, anxious/ambivalent attachment in childhood and long lasting severe grief after bereavement could not be explained by the anxious/ambivalent dependence on the lost person. So what explains the persistence of grief for these folks? Shows great distress during separation Clings and cries angrily upon return Distress continues after reunion for much longer than securely attached infants

Persistence of Grief? Long lasting grief appeared to be entangled with anger and resentment - freezing the ability to let go the deceased. What else do folks think is going on here?

Correlations Anxious/Ambivalent Disagreements with deceased Marital Disagreements Cling = insecure parenting conflicted adult relationships Chronic Grief attach to / push away

Anxious / Ambivalence: In light of bereavement Summary People who experience anxious / ambivalent relationships in childhood and people who make dependent attachments in adult life are both likely to suffer severe and lasting grief and loneliness after bereavement. It appears that these persons do not see love as something that is given, but is demanded - a la from parents. In adulthood then so-called love is lost (via death) and their fear and rage complicates and magnifies grief They are caught in a web of needing to cling and holding back from clinging = high anxiety. So when their loved one dies - who do they cling to or go for support?

Avoidant Attachments Parents intolerant of closeness / do not mirror IFT inhibit their tendency to cling and cry During the SST when (PCF) re- appears (IFT) appears indifferent and uncaring will even ignore / avoid (PCF). Avoidant attachments in childhood were highly correlated in adult life with difficulty in showing affection and with high scores on emotional Inhibition/Distrust and Aggression /Assertiveness Avoidant attachments was also highly correlated with Marital Disagreements. Avoidant attachments were also found to correlate with Disagreements with the now deceased and that the bereaved person never cries - and the prediction of delayed grief... Interestingly, the avoidant attached person did say that they would like to cry more. Inability to express grief

The Avoidant Griever Five out of 10 participants who said they never cry received diagnosis as having a psychosomatic disorder. However, psychosomatic diagnosis was not a key ingredient to the avoidant griever. Inability to grieve and delayed grief, although related to avoidant attachments, appeared to also be correlated with need to control...

Avoidance and Need to Control The bereaved delayed grief because: They were holding grief in check because need to look after a parent / child Lifelong neurosis Past bouts with depression Post-traumatic stress reactions Alcoholism Personality disorders

The Avoidant Griever Ultimately, the findings confirm that children of parents who discouraged the expression of attachment (hugging/cuddling, sharing feelings) will find it difficult to acknowledge and express both grief and affection. This was found to persist in adult life, to increase the risk of interpersonal conflicts and to inhibit the expression of grief.

Mapping the Avoider Continuous lines indicate significant correlations Interrupted lines indicate non-significant trends

Why Do Patterns of Childhood Remain into Adulthood A clinical insight: We return to old conditioning under stress and in times of survival... Avoidant attachments only make children independent of their parents, they have not survived because of keeping away, but because they have found a safe proximity and they are rewarded for it (are continued to be fed and protected). Thus, they will find people who perpetuate assumptive world, but upon death this separateness is “forever” - thus what do I do and who do I turn to.

Disorganized Attachments These are participants who scored high on Parental Depression / Psychiatric Problems; Parental Violence; Childhood Unhappiness; Compulsive Caregiving; Family Persecution. During childhood these folk often felt helpless / hopelessness and may have become caregivers for their parents / siblings. The PCF lacks in confidence with respect to their ability to care for and control their child and they may see their child as more powerful than themselves. (IFT’s) may cry during separation but avoid the PCF upon return or they may approach the PCF upon return then freeze/fall, hit themselves, rock back and forth, etc.

Disorganized Findings and Patterns of Behaviour Findings revealed that disorganized type after bereavement suffering from depression, anxiety, and panic and use alcohol to self medicate. There is also a tendency for these folk to feel extreme guilt and report suicidal behaviour Interestingly, findings did indicate the disorganized type would seek help from a professional, but not turn to family members for support. Findings also revealed that the disorganized type indeed has characteristics of the avoidant and anxious/ambivalent type.

Disorganized Findings and Patterns of Behaviour Clinical Insight Findings also reveal that the disorganized type display a serious need to protect oneself and distrust others. But, interestingly enough, the disorganized type can trust enough in so much as their trust leads to a confirmation of their assumptive world - (refer to Mollie’s Story pg. 111)

Mapping the Disorganized Continuous lines indicate significant correlations Interrupted lines indicate non-significant trends Influence of disorganized attachments on psychological problems is not limited to the years of childhood.

Task and Questions Let ’s Look at disordered Attachment and the therapeutic process