Attachment – Who Makes the Diagnosis?

Sarah Phillimore writes

My post on a general guide to attachment theory – what it means and its importance in care proceedings, remains one of the most popular posts ever on this site. There is also a useful discussion from the perspective of a social worker by guest poster Kate Wells. 

Basically ‘attachment’ is a theory developed by psychologists to explain how a child interacts with the adults looking after him or her. If a child has a healthy attachment, this means the child can be confident that the adults will respond to the child’s needs, for example if he is hungry, tired or frightened, the adult caregiver will respond to meet his needs or reassure and comfort him.

This gives the child confidence to explore his environment and develop a good sense of self-esteem. This will help the child grow up to be a happy and functioning adult.

If a child can’t rely on his carers to look after him and respond consistently, this has been noted to have potentially very serious and damaging consequences for the adult that child will become. If adults are seriously inconsistent or unresponsive in their behaviour to the child, he may become very anxious as he is not able to predict how the adults around him will act; the child may even give up trying to get his needs met.

So Its clearly an issue of interest; unsurprisingly as it often takes centre stage in discussions about children’s welfare in care proceedings.  In this post I will look at at more particular question – who are the people the court rely on to give evidence about attachment?

I am grateful to everyone who took the time out to consider my question – there is clearly a lot to think about and I am increasingly concerned that the knowledge base of the lawyers may not be sufficient to allow us to navigate this area with ease.

Assessing attachment for the court.

Mostyn J was pretty dismissive about the idea that he needed an expert (or indeed anyone!) to help him understand a child’s attachments – see his judgment in GM v Carmarthenshire County Council & Anor [2018] EWFC 36 (06 June 2018). He said at para 18

Second, the theory is only a theory. It might be regarded as a statement of the obvious, namely that primate infants develop attachments to familiar caregivers as a result of evolutionary pressures, since attachment behaviour would facilitate the infant’s survival in the face of dangers such as predation or exposure to the elements. Certainly, this was the view of John Bowlby, the psychologist, psychiatrist, and psychoanalyst and originator of the theory in the 1960s. It might be thought to be obvious that the better the quality of the care given by the primary caregiver the better the chance of the recipient of that care forming stable relationships later in life. However, it must also be recognised that some people who have received highly abusive care in childhood have developed into completely well-adjusted adults. Further, the central premise of the theory – that quality attachments depend on quality care from a primary caregiver – begins to fall down when you consider that plenty of children are brought up collectively (whether in a boarding school, a kibbutz or a village in Africa) and yet develop into perfectly normal and well-adjusted adults

For my part I would say with all due respect that I do not need a social worker to give me evidence based on this theory to help me form a judgment about L’s attachments.

I am not sure I would share Mostyn J’s confidence that he was able to assess a child’s attachment without any help. I have certainly had my fair share of cases where opinions about attachment were bandied around the court and often relied upon as very important. If what is being discussed is some serious psychological problem which is having a detrimental impact on the child’s ability to live happily in the world, then I think most would agree we need some clear and reliable evidence about the how, the why, and what can be done to remedy this – if anything.

Which raises the interesting and particular question of this post – what expertise precisely?  I asked the experts of Twitter this question.

One poster helpfully provided a link to the Family Relations institute They offer a guide to assessments and reporting to the court which look very useful. They note:

Attachment has long been considered relevant to care proceedings. Nevertheless, its usefulness, as compared for example to medical evidence, has been limited by the diverse ways in which attachment is assessed, the different training of experts, and the lack of verifiable evidence upon which to base opinions. In an effort to move from expert opinion to verifiable evidence, The International Association for the Study of Attachment (IASA) has developed a protocol for assessment and formulation of issues related to attachment. The purpose of the protocol is to act as a guide to good practice and to begin a process of improving the application of attachment to family court proceedings.

So it does seem clear that the situation about who assesses and how is currently a little opaque.    What was the general advice from the Twitter experts?

This was opening doors into worlds I hadn’t anticipated – that ‘attachment disorders’ may not actually be anything to do with ‘attachment’ in the classic Bowlby sense but more a problem with neurodevelopment – which clearly needs expertise to identify and assess.

The point was echoed by others – assessment of attachment is not linked to a specific profession.

I received an interesting message from a student on a MSc course in attachment studies

You definitely need to have undertaken specialist training in attachment to state what ‘type’ of attachment a child has in relationship with their primary carer. You’ve already been sent links to some, such as the Anna Freud centre and I’m doing my training at Roehampton University who use Pat Crittendens Dynamic Maturation Model (DMM). It’s a funny area though as we don’t really have a specific title. I’m on a course with social workers, psychologists and OT’s. We will all come away being able to use and possibly code the attachment procedures but will all still come from and work within different professions. We won’t belong to a different ‘attachment’ profession as such but will have had specific training in the area of attachment. (I suppose a bit like social workers can be trained to undertake ABE interviews and so can the police. I couldn’t however ‘diagnose’ an Attachment disorder. It’s a very different thing to diagnose a psychiatric disorder to being trained to observe and analyse a specific type of attachment strategy.

Which in turn leads to the even wider question about the point and purpose of diagnosis – as Roger Smith pointed out, an ‘attachment disorder’ could be seen as a rational choice to avoid relationships after a life time of being ‘let down’.

 

And of course I could rely on the lawyers to continue the proud tradition of Mostynesque cynicism

 

2 thoughts on “Attachment – Who Makes the Diagnosis?

  1. Angelo Granda

    A Parent’s View.

    Putting upon one side my view that any expert assessment of attachment is bound to be that expert’s own opinion based on theory even when the assessment is made following some sort of agreed protocol , I believe it would not hold little value at all if the
    clinical evaluation were made after the perceived attachment (?) to a parent had , in reality, already been severed by physical,enforced removal into care.
    There is much research which proves that removal from family is extremely traumatic to children and,of course,this is why the Children Act commands such action should be taken as a very last resort in the most dire cases only. There is an argument that a fair appraisal of the need for removal cannot be taken until and if the Family Court takes a final decision about how dire the situation is after having seen all the evidence; interim removal is over the top because of the severe emotional damage caused to a child by the physical detachment from the primary carer. Mums and babies should be kept together at least until the final hearing.
    At present ,by the time specialist assessments are made on observation s of contact sessions and so on , those assessments cannot be reliable. If the baby or child is being fostered ,i guess he or she has already begun to form new attachments especially when very young.
    However ,having said all this,the real problem is that attachment theory is only used during proceedings by Local Authorities insincerely in order achieve its illegitimate aims. If the expert decides that a child IS securely attached to Mum, the Local Authority just ignores the assessment. It doesn’t cite the assessment in favour of keeping the family together,it simply ignores it and keeps quiet.

    Reply
  2. Angelo Granda

    Correction: First paragraph cocked-up completely,my apologies to readers.
    It should say:-

    I believe it WOULD hold very little value at all if the
    clinical evaluation were made after the perceived attachment (?) to a parent had , in reality, already been severed by physical,enforced removal into care.

    Reply

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