We are grateful to Kate Wells for this piece outlining the basics of ‘attachment theory’. This is a very important concept in care proceedings as often conclusions reached about a child’s attachment or lack of will be very influential in determining the direction of a case. But it is often  a concept which seems poorly understood and misapplied by many. 

I think it is absolutely essential that social workers have a basic understanding of attachment theory and the importance of the early relationship between baby and mother (again used as shorthand) from the first moments of birth, and even in utero as there is evidence that babies can be adversely affected if there is tension, hostility, domestic violence etc., and how this insecure attachment pattern will affect the children as they grow through the ages and stages of childhood.

Attachment theory in psychology originates with the seminal work of John Bowlby (1958). In the 1930’s John Bowlby worked as a psychiatrist in a Child Guidance Clinic in London, where he treated many emotionally disturbed children. This experience led Bowlby to consider the importance of the child’s relationship with their mother in terms of their social, emotional and cognitive development. Specifically, it shaped his belief about the link between early infant separations with the mother and later maladjustment, and led Bowlby to formulate his attachment theory.
Evolutionary theory of attachment (e.g. Bowlby, Harlow, Lorenz) suggests that children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate innate caregiving responses from adults. The determinant of attachment is not food but care and responsiveness.

Bowlby suggested that a child would initially form only one primary attachment (monotropy) and that the attachment figure acted as a secure base for exploring the world. The attachment relationship acts as a prototype for all future social relationships so disrupting it can have severe consequences.

This theory also suggests that there is a critical period for developing an attachment (about 0 -5 years). If an attachment has not developed during this period then the child will suffer from irreversible developmental consequences, such as reduced resilience and aggression
I don’t propose to give any further background details as there is so much more information since Bowlby’s works in the 1950s that it would be a mammoth task and as my aim is to provide some very BASIC information on attachment theory, further detail would not be helpful.

However there is a huge amount of published information on Attachment Theory readily available for anyone wishing to gain a greater understanding of the theory.

I do NOT claim to be any sort of expert in this theory, although I do have a basic understanding of the theory and have in the past been involved in collaboration with a clinical psychologist and play therapist, in delivering training to prospective foster carers and adopters.

 

‘Attachment’ is often used in a meaningless way

The word “attachment” is often used by social workers in my experience in a way that is meaningless e.g. “He’s attached to his mother” I ask “In what way?” and the usual response is along the lines of “well he goes to her at contact and isn’t upset by seeing her…” I then ask “Is he upset when the mother leaves at the end of contact?” “Oh no, he’s fine, sometimes he waves bye bye” Hence there is a misunderstanding of attachment theory. The word is used in almost the same way as “I am attached to these old slippers.” We read of “strong” attachments, “good” attachments, and even “solid” attachments. Sometimes the term “bonding” is used in much the same way we read “There is a good bond between X and his mother.”

Incidentally I am using the term “mother” as shorthand, but of course it could be father or any other caregiver.

Attachment theory holds that within close relationships young children acquire mental representations or internal working models of their own worthiness based on other people’s availability and their ability and willingness to provide care and protection (Ainsworth et al 1978).

 

Attachments can be SECURE or INSECURE/ANXIOUS

A SECURE attachment pattern between baby and mother develops when the mother has an ability and willingness to try to understand behaviours and emotions from her baby’s point of view. She is attuned to his needs, e.g. responds to his crying by picking the baby up and soothing him, either by feeding, or changing him, or simply holding him. She learns to differentiate his cries, sometimes hunger, pain, boredom, tired etc and responds appropriately. She talks to the baby, maybe sings to him and smiles at him and as the baby grows she is rewarded by his response, in that he smiles back and they can engage in “conversation” e.g. the baby “coos” and laughs/gurgles in response to the mother’s attention and often tries to mimic her sounds. Within this attuned, coordinated relationship, the baby learns to regulate his own feelings and behaviours. The mother’s love is unconditional, and this provides the growing child with a sense of security and trust in his mother (often referred to as his attachment figure)

Babies can of course have secure attachment patterns with fathers, and other adults, so long as those adults are able to be emotionally available to the child (as outlined above) as well as physically present.

A secure attachment pattern will be a protective factor for the child throughout the lifespan. He will have learned that he is loved, effective, autonomous and competent and will have an expectation that other people will be available, co-operative and dependable, as he progresses through life.

INSECURE/ANXIOUS ATTACHMENTS.

These attachment patterns are broken down into Avoidant or Ambivalent attachments. Children who show these insecure attachment patterns have learned that there are conditions attached to their gaining proximity to their mother.

Interestingly these children develop appropriate strategies that a) increase the mother’s emotional availability and do not cause her to withdraw and b) bring care and protection. These strategies are of course devised for survival and can be effective, but the feelings of anxiety and insecurity remain in relation to the mother.

However both secure and insecure attachment patterns represent efforts by children to ORGANISE their behaviour, to achieve some kind of proximity to their mother and with it a “felt security” – and when there is an insecure attachment pattern, these behaviours in children have varying degrees of success.

AVOIDANT ATTACHMENT

This attachment pattern is sometimes referred to as dismissive. The mother (or parents) of these babies are often rejecting and controlling. If the baby cries it annoys or agitates the parents, and they lack sensitivity to the child, are unreliable and largely disinterested in the baby. These babies are often “prop fed” a bottle put into their mouth propped up by a towel (or something similar) while they are lying in the pram. The parents do not get any pleasure from the baby.

Hence at times when the baby is in need of comfort, care, protection, and this is manifested by crying, clinging, following, demanding, it actually brings the opposite reaction to what the child needs, in that the parents are rejecting or controlling.

The child’s strategy in this attachment pattern is often to minimise their needs and deny or not communicate their distress. Strong feelings are defensively excluded and emotional self-containment is established. This allows the child to stay in reasonable proximity to the attachment figure without causing him or her too much irritation, thus reducing the chances of being rejected. This strategy can be seen as the psychological defence of flight, rather than fight, e.g. a child may sit close to his mother, gradually moving nearer and if not rejected, attempting some kind of physical contact. Maybe they sit on the floor next to their mother’s chair, and then stand up and lean on the arm of the chair, and eventually chance getting into a mild form of physical contact e.g. putting their arm around their mother or laying their head on her arm. If they are not rejected they may try to sit on their mother’s lap and if the mother is not rejecting but not responsive either, the child will usually remain as long as possible.

These children are often described by foster carers and adopters as difficult to “reach” emotionally, “detached” “can’t make him out” “never know what he’s thinking” and in extreme cases, unable to show any affection other than very superficially. One adopter described her child as “fine on the outside, mostly pleasant and co-operative, but “hollow” – he has no middle.” Emotional self-containment was learned very early on in his life as a way of survival.

 

AMBIVALENT ATTACHMENT

This attachment pattern forms when parents are insensitive, unreliable and inconsistently responsive. Children very often adapt the psychological defence of fight, and show angry behaviour, crying, whining, fretting, clinging, demanding, shouting and tantrums. This is an attempt to break through the emotional neglect, unavailability and lack of responsivity. Needless to say this generally doesn’t bring the desired response, and these children grow up feeling that they are not worthy of automatic interest. Other adults are seen as inconsistent and not always able to soothe and provide comfort. These children grow up to be particularly vulnerable to stress and are very frustrated (sub consciously of course) that the mother is emotionally desired but emotionally unreliable. At any one times these children’s relationships with their mother are guided by strong feelings of either love or anger.

It’s important to recognise that even when children are insecurely or anxiously attached to their mother, they can adapt their behaviour (or organise themselves) in an attempt to get physically and emotionally close to their attachment figure, with varying degrees of success.

There is however a type of insecure attachment that is so severe that children are unable to organise their behaviour or develop a defensive strategy to achieve proximity or security, and their distress remains heightened and unregulated. The parents of these children are often dangerous (abusive) or emotionally unreachable because of severe mental illness, and/or abuse of drugs and alcohol. If one parent is the abuser, the other fails to protect. Children are severely neglected and/or abused. Without an organised strategy children may freeze, either physically or psychologically. These children have an attachment disorder and are going to need a great deal of understanding and resilience by the foster carers or adopters, who have a full understanding of how their early life experiences have affected these children.

By definition therefore ALL children who are removed from their parents by a Court Order are going to have one type or another of insecure or anxious attachments with their mother or parents/step-parents.

Frozen Awareness

I appreciate that this notion of babies and children being able to organise their behaviours in order to get the best they can from their mothers, might seem strange, even bizarre. However I have observed this happening and it can be very chilling. I remember reading about “frozen awareness” in a very young child and was I admit sceptical, until I actually saw a 4 month baby lying quiet and still in the pram but with eyes wide open, like a rabbit caught in the headlights, fearing (quite rightly) that danger was nearby. I was to see this many more times, but the memory of that first baby has never left me. The step-father had been shaking the baby and twisting her arms (this was relayed to me by the mother who had a mild learning difficulty and was afraid of her partner.) Fortunately the court agreed that the baby should be removed and she was subsequently adopted and thrived in the care of the adopters.

Likewise I have seen the “frozen” child crouched in the space between his bed and the wall. This was a little boy not yet 2 years, and the bruising to his face and ears was very visible. When I picked him up the child was rigid, frozen, traumatised. I have observed toddlers sitting still on a chair, casting fearful glances at the abuser, again keeping very quiet so as not to attract the attention of the abuser. These are definite strategies that the child sub-consciously employs for survival.

I recall a 6 year old boy after a phone call from his mother, dancing around the room of the foster carer, repeatedly calling out “she loves me, she loves me” – clearly the mother had said this to him on the phone and it may well be the first time that the child had heard this from his mother and his delight was both sad but very moving. When one of the foster carer’s older children returned home, the little boy immediately pounced on him and said “my mom loves me….” And of course the older child looked bewildered, failing of course to understand the significance of the little boy’s delight.

Obviously I could go on to give many more examples but I don’t think that is necessary.

 

Attachment patterns throughout childhood

Looking at attachment patterns through the ages and stages of childhood Robert Karen (Becoming Attached) provides a chart of typical patterns of secure and anxious attachment. Before doing so he makes a very important point:

The following chart is meant only as a convenient guide and does not take into account many of the complexities and exceptions found in the research. It should be remembered that insecure attachments (avoidant and ambivalent) is not always associated with the style of parenting described here, but can sometimes come about for other reasons; that a child often has a different pattern of attachment to mother and father; and that attachment patterns can change, so that while many avoidant babies for example, continue in their early pattern, others do not end up behaving like an avoidant 6 year old or develop later into a dismissive adult and parent.

I believe this is largely because these babies are adopted at a young age and the adopters have a good understanding of attachment theory and practice, and can therefore help the child to develop a secure attachment pattern. This takes time, patience and resilience. The adopters need to understand that there will be a gap between the child’s emotional and chronological age, (sometimes called arrested development) and that they will need to allow the child to regress and gradually gain confidence and a sense that he is in fact loved and valued by his parents, and this is unconditional.

Robert Karen’s chart is extensive and so I don’t propose to reproduce it in full. But he describes a secure attachment pattern between mother and baby – mother is warm, sensitively attuned, and consistent. Readily attends to baby’s cries. Baby readily explores, using mother as secure base, compliant with mother. Pre-school: easily makes friends, popular, resilient under stress, good self esteem. Teachers treat him in warm, matter of fact, age appropriate way. Aged 6 with parents: Warm and enthusiastic, comfortable with physical contact. Middle childhood: Forms close friendships and is able to sustain them in larger peer groups. In adulthood: Easy access to wide range of feelings and memories, positive and negative. Balanced view of parents. If insecure in childhood has worked through hurt and anger. Usually has securely attached child.

Avoidantly attached baby. Mother is often emotionally unavailable or rejecting. Dislikes neediness, may applaud independence. By end of 1st year baby seeks little physical contact with mother, randomly angry with her, unresponsive to being held, but often upset when put down. Pre school: Often angry, aggressive, defiant, may be isolated/disliked by peers. Teachers become controlling and angry. Age 6 with parents: Abrupt, neutral, unenthusiastic exchanges. Absence of warm physical contact. Middle childhood: No close friends or friendships marked by exclusivity, jealousy. Often isolated from group. In adulthood: Dismissing of importance of love and connection. Often idealises parents, but actual memories don’t corroborate. Shallow if any self-reflection. Usually has avoidantly attached child.

Ambivalently attached baby: Mother is unpredictable or chaotic. Often attentive but out of sych with baby. Baby cries a lot, is clingy, demanding, often angry, upset by small separations, chronically anxious in relation to mother. Limited in exploration. Pre School: Fretful and easily over whelmed by anxiety. Immature, overly dependent on teacher, maybe be bullied. Teachers indulge, excuse, and infantalize. Age 6 with parents: Mixes intimacy seeking with hostility. Affectedly cute or ingratiating. May be worried about mother when apart. Middle childhood: Trouble functioning in peer groups. Difficulty sustaining friendships when in larger groups. In adulthood: Still embroiled with anger and hurt at parents. Unable to see own responsibility in relationships. Dreads abandonment. Usually has ambivalently attached child.

WHAT THEN DOES ALL THIS MEAN FOR SOCIAL WORKERS IN THEIR WORK WITH CHILDREN WHO HAVE INSECURE/ANXIOUS ATTACHMENTS WITH MOTHERS, FATHERS, STEP-PARENTS/CAREGIVERS.

I think it is absolutely essential that social workers have a basic understanding of attachment theory and the importance of the early relationship between baby and mother (again used as shorthand) from the first moments of birth, and even in utero as there is evidence that babies can be adversely affected if there is tension, hostility, domestic violence etc., and how this insecure attachment pattern will affect the children as they grow through the ages and stages of childhood. They need to understand that attachment patterns are secure or insecure/anxious, not “strong” or any of the other adjectives that are often used. However it is only by observing the interaction between the mother and child that can demonstrate the attachment pattern. Having said that, great care should be taken not to jump to conclusions, and indeed I don’t think it fair that social workers should be expected to determine the exact attachment pattern between mother and child. This is more the work of clinical psychologists and play therapists, often working collaboratively.

The other important point is that LAs should make it a priority to ensure that all prospective and approved foster carers and adopters are given the opportunity to learn about attachment theory and practice. These children with insecure attachment patterns, or an attachment disorder are going to be in their care, and it can only be positive for them to have an understanding of the reasons for the child’s often difficult and challenging behaviour.

Adopters need to know that “love is not enough” (a commonly held view, and not unreasonable) but the child who has an insecure/anxious attachment with his mother, or an attachment disorder is going to prove a huge challenge for the adopters, especially in the case of the attachment disordered child. Indeed these children should be able to receive play therapy and the adopters should be assisted/guided by the therapist as to the best way of caring for the child, to enable the adverse effects of his early life to be minimised, and for him to begin to feel loved and valued for who he is, and that love and care is not conditional. There is no “quick fix” and sadly LAs are so cash strapped that they are highly unlikely to pay for play therapists. Some LAs have clinical psychologists who are able to offer training on attachment to social workers, managers, foster carers and adopters.

Many foster carers and adopters in the LA in which I worked said that it was “like the scales falling from their eyes” as they recognised the child who was insecurely attached to his mother, and the behaviours that were manifested as a result. Many of them went on to read and study the topic further and in turn were able to share their knowledge with other foster carers and adopters.

REPORT WRITING.

I have only been able to give a very basic introduction to the topic in this piece, and it is not within the social worker’s remit in my view to be able to define the particular type of insecure attachment pattern between mother and child in written or oral evidence in court. To do so would require a thorough understanding of the topic in order to be credible and able to handle cross examination.

I think the best way of dealing with this matter is for social workers to talk of children who have “learned that adults can’t always be trusted to care for them” and be able to give an example of a mother not attending to the cries of the baby or failing to give him attention and this in turn causing the baby to feel insecure and anxious, and these feelings may well persist throughout his childhood and into adulthood. I am sure a lawyer acting for birthparents would challenge such an assertion and this could be problematic for an inexperienced social worker who was nervous in court in any event.

I once had a barrister say something like “So you’re saying Ms W that unless a baby is picked up the moment he cries, his future is doomed to failure – is that what you’re saying….” I was experienced and competent enough to deal with this kind of comment, but I can imagine it could be intimidating for a newly qualified social worker.

This piece is far longer than I anticipated but I hope it has provided a very basic understanding of the importance of the mother/child relationship and what can go wrong in the absence of a secure attachment pattern established between mother and child. ……………..Kate Wells.

 

Further reading

See the guidelines from NICE published in November 2015: Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care.