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  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
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?
Fabulous question. Attachment Disorder (AD) is a diagnosis in DSM and ICD. Mental health professionals, including clinical psychologists and psychiatrists can use DSM/ICD to diagnose. But experience is key. AD can look like many other things, such as autism.
— Dr Helen Rodwell (@DrHelenRodwell) July 17, 2019
I agree with Helen and it's not just the qualification it's the method. The consensus statement says children should be observed with ALL carers. That means an hour with a psychologist or a paper assessment of reports from contact is NOT an assessment.
— Sue White (@ProfSueWhite) July 17, 2019
I'd also add that it takes wide clinical experience to discriminate an Attachment Disorder from other neurodevelopmental conditions. If a professional's experience is wholly in the 'attachment world' then they may miss neurodevelopmental stuff such as autism and FASD .
— Dr Helen Rodwell (@DrHelenRodwell) July 17, 2019
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.
Absolutely agree Lydia! Worth adding, Attachment assessments are not linked to a specific profession – what matters is that they are not relying on their undergrad teaching in a field that has progessed massively in recent yrs.
— Dr Anne (@SolutionPsych) July 17, 2019
Educational Psychologist with experience? Paediatric Consultant who has worked in child development setting
— OhBondageUpYours (@JaneQuaife) July 17, 2019
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’.
Yes, I agree. I just think it’s a more clear sighted way of making sense of bad experiences than those which seek to medicalise the consequences of disadvantage.
— Roger Smith (@rogerssmith37) July 17, 2019
And of course I could rely on the lawyers to continue the proud tradition of Mostynesque cynicism
This used to be a social work issue. Why does it need a different type of expert?
— Stuart Fuller (@Stufuller1) July 17, 2019