The Meandering Social Worker

wandering : wondering : learning

6.THEORY & ANALYSIS

ATTACHMENT THEORY IN A NUTSHELL

Karen’s story is not specifically about attachment theory and there are too many good books on the market to want to try and compete with them.  However a simple explanation of the development of attachment never goes amiss, and the theory is classic social work.  It is also where Karen’s story began.

Attachment is sometimes referred to as ‘bonding’, the connection made between mother (usually) and child at birth, but it is more than that.  That is only the beginning.  Attachment is something that usually develops over time.

Although different cultural experiences and variations in abilities and disabilities may affect the development of a child’s attachment, a good attachment between child and carer(s) is a universal need.

Parents generally tend to repeat the kind of parenting they were given as a child.  Sometimes the new parent makes a conscious effort to do some things differently.  But more often attachment models tend to run in families, they are generational, handed down from parent to child.

Secure

The child with the secure attachment is the easiest to describe.  They have learnt to trust from infancy, even before they knew what trust was.  As a tiny baby they had needs but could only communicate those needs by crying.  When they cried their adult carer quickly identified their needs and put things right for them.  The problem might have been hunger, an uncomfortable nappy or just wanting a cuddle, but the adult recognised their need, met their need, and they were soon comfortable and sleeping again.

In the ‘strange situation’ research by Mary Ainsworth, the evidence showed that a securely attached year old child will play and explore their environment while their carer is present, but if left either alone or with a stranger will cry until their familiar carer returns.  They will be quickly comforted and return to whatever play was occupying them before their carer left them.  They have already begun to develop trust and confidence in their primary carer(s). (Mary Ainsworth – this research is referenced in many publications on Attachment Theory and on the Internet.)

As the child developing a secure attachment gets older their carers continue to meet their needs, responding to their calls for help, recognising when the child needs to be encouraged to develop new skills but still being there to help the child if he or she needs it.

The older child with a secure attachment, when given the first few lines of a story (story stem) designed to activate the child’s attachment system, perhaps where a disaster is about to happen or there is a separation from carers, may tell a long or short story, that may have all sorts of disasters and events, but will ultimately end with someone taking control and bringing everything to a safe ‘happily ever after’ ending. (MacArthur story stems –  this research is referenced in many publications on Attachment Theory and on the Internet.)

The end result is an adult who has learned to value themselves, trust others, love and be loved.  They are secure in their relationships and in who they are.

Ambivalent

The child with the ambivalent attachment has not had the same consistency of care the secure child has benefitted from.  His or her carers may not always have responded in a consistent way.  He may have had to cry for longer to get attention, to get his needs met.  But eventually something would have happened, some response would have been gained, and usually his needs were met in some way or another.

In the Ainsworth research, the year old child developing an ambivalent attachment, when left by their carer, either with a stranger or alone, will cry inconsolably not just until the carer returns but long after.  This child does not have the confidence they will not be left again and is keeping up the attention seeking behaviour to ensure the carer stays with them.

The mixed responses this child experienced in infancy would have continued as he moved through into childhood.  Sometimes his carers’ responses would be what he wanted.  At other times he might not get a response, or the response might be something different to what he wanted.  By now though he has learned that if he keeps up his attention seeking behaviour he will eventually get some attention.  It might not be the attention he wants but with persistence he’s in with a chance of getting his needs met.

In the MacArthur story stem illustrations, if this child is given the beginning of a story, one which potentially involves separation from carers or other disasters, he will typically continue the story with many more crises, never quite reaching a safe conclusion where everyone is safe and well.  He has not learned to trust that his carers can provide the safety and boundaries he needs.

The end result of an ambivalent attachment in a child is an adult who has not learned to value themselves, who can be described as having low self esteem.  They still need high levels of attention all the time, because they have learned that there is no guarantee when the right kind of attention will be available.  As parents they may be unable to focus on the needs of their child as they still struggle to get their own needs met.

Avoidant

The child with an avoidant attachment has learned to avoid emotion for some reason.  Usually it is because their carer does not cope well with emotional outbursts.  Crying might have got their needs met in early infancy but before long they will have learned that crying and other emotional displays only cause their carers distress.  They will learn that being independent and developing skills that will earn them praise is the best way to get positive attention.

In the Ainsworth research, at one year of age, if this child’s carer leaves them in a room either alone or with a stranger they will likely show no visible reaction but will typically continue with whatever play they were engaged in.  When their carer returns they will again show little or no reaction.  Yet, a closer observation of their behaviour will reveal they were fully aware of when their carer left and when they returned and they were distressed during their carer’s absence, they just didn’t outwardly show it.  They have already learned that outward displays of emotion do not elicit positive responses from their carers.

[Karen’s description of hyper-awareness in the Ed Psych’s room, talking to her mum about finding the family cat dead in the gutter, or while opening presents, but without showing any emotion, fit the Ainsworth pattern of behaviour, albeit at a later age.]

Their lack of emotional awareness will make it hard for them to make friends and be sociable, although they may do well academically at school.

In the MacArthur story stem situation, if this child is given the beginning of a story in which a separation or disaster is about to happen and they are asked to complete the story, their responses are likely to be short, factual and to the point, without fear or emotion or excitement; in some cases they may even shrug and be unable to offer an ending to the story.

The end result for a child with an avoidant attachment is an adult who does not cope well with displays of emotion, someone who may be socially withdrawn or very independent.  They are likely to have problems with low self-esteem.  As a parent they are likely to repeat the process as they too will struggle to cope with the emotional demands of an infant and young child.

The organised spectrum

These three attachment patterns do not fit into simple boxes.  They are generally described as being on a spectrum.  The more extreme behaviours relating to each attachment type being represented as the furthest from the centre.  Few people can be considered to be absolutely in the centre.

The milder versions of ambivalent and avoidant, or non-secure, attachment are not a particular problem for most people.  In fact they could even be said to be essential for the development of a society with a broad range of skills and talents.

Party planners and politicians, jobs and careers with the need for a gregarious nature, are more likely to be drawn from the ambivalent side of the spectrum.

Computer enthusiasts, mathematicians, scientists, academics, may benefit from not needing emotional human contact and found among those with a more avoidant attachment.

Disorganised

There is one more category of attachment.  The first three are described as ‘organised’ because the child has found a behavioural method that (eventually) gets them the attention they want and need.  Whatever it may look like to the adults around the child there is an organised pattern to their behaviour.

Of far more concern is the child with no organised patterns of behaviour.  These children tend to represent the most extreme cases of neglect or abuse.  Their experiences have been so inconsistent and traumatic they have not had the opportunity to learn how to get the attention to get their needs met.  Their behaviours can be found in both the ambivalent and avoidant attachment models, and even sometimes in the secure attachment.  And they will inevitably be found on social workers’ caseloads, in foster care and sometimes with adopters.

THE SOCIAL-MEDICAL CONUNDRUM

Diagnosing attachment disorders is often complicated by the conflicts between the social and medical models of diagnoses and is far from an exact science.

Whilst I believe that ADHD is a genuine condition that can be diagnosed and alleviated with appropriate medication, it is also often criticised as being an excuse for ‘bad parenting’, and in some situations this is undoubtedly the case.  In my own social work practice I have worked with families where from my own observations and compiled case histories there has been evidence of parenting styles to show clear ambivalent or disorganised attachment model.  Yet the parents have obtained a diagnosis of ADHD.

I have also worked with families where a social work case history has pointed clearly towards the child having an avoidant attachment.  Yet the carers have been adamant their child has autism, and they have obtained the support of other parents with children with autism.  In some of these cases the medical profession has found and diagnosed the child’s behaviour as being a Pervasive Development Disorder, usually followed by Not Otherwise Specified (PDD-NOS), generally accepted as indicating that the child has difficulties with communication and play but too sociable to be considered autism.

A medical diagnosis is often easier for parents and carers to accept.  The fact that ADHD and Autism are considered disabilities and have historically attracted additional welfare benefits has made them a more popular option than the behaviour being classified as a social or parenting problem.  For the busy and harassed front line practitioner, as frustrating as it is and as unwilling as they may be to admit it, a medical diagnosis is often a blessing in disguise, making it easier to secure funding for additional services that will benefit the child and family.

When Karen read a clear description of the behaviours of someone with a severe avoidant attachment she recognised herself in that description.  Yet there is some debate as to whether it is possible for a problem with attachment to be the result of a single event.  An alternative suggestion, another medically diagnosable option would be to consider PTSD as a cause for Karen’s childhood behaviour and ongoing impact on her adult thinking.

While the theoretical debates continue, and should continue to aid the development of professional understanding, front line medical and social practitioners know that the line is blurred at the interface where the medical and social models meet and do battle.

THOUGHTS FOR THE CARERS

Anyone already involved in fostering or adoption will know there are no easy answers: each child is different; even when those children are siblings their experiences of their received parenting will be different depending on their developmental age, position within the family and other external factors.

Whether considering Karen’s development and behaviour from a social (attachment) or medical (PTSD) perspective, her reactions might seem less unusual when placed in the context of her age at the time.  Karen was five or six, an age when her thinking was still primarily egocentric.  In her thinking she was still very much at the centre of her universe.  Learning that was not the case came before Karen was ready to make that developmental step.  Even just a year later her reactions might have been different and the outcome of her life completely different.

Understanding a child’s history, what happened and when, and putting significant events into the context of normal child development is the first essential step to understanding how to care for a child whatever their attachment model.

The ambivalent child in both foster care and adoption

Although initially their behaviours may present as more extreme, the child with the ambivalent attachment is often the easiest to work with over time.  They are generally louder, more active and readily visible in placement.  Their behaviours demand attention, and regularly.  Carers are likely to find this exhausting.  In a busy fostering household where they are not the only child they will be vying with others for attention and this may initially escalate their attention seeking behaviour.  Learning to trust, developing self esteem, all take time; the greater the damage the longer it can take to repair.  But good results can be achieved with firm parenting and with clear boundaries and consistent responses.  Each child is of course different, and many different ‘tactics’ may be employed, but in a stable placement, whether within the family, fostering or adoption, there is a good chance the behaviour of the ambivalent child will become more appropriate and they move into a more stable adulthood.

The avoidant child’s conundrum

Foster carer assessments tend to favour carers with an outgoing approach, offering plenty of opportunities for the child(ren) in their care to be sociable and take part in activities.  Carers who have more than one child in placement (including children of their own) are also likely to be offering a busy home life with lots of activity and opportunity for social interaction.

For a child with an avoidant attachment, a placement in a typical busy foster home, with sociable and outgoing carers, is likely to be their worst nightmare.  It is an environment in which they have no previous coping strategies.  Their first reaction is likely to be one of withdrawal, a moving even further away from that which is unfamiliar and scary, low levels of co-operation with social activities, and their behaviour possibly deemed passive-aggressive in their refusal to co-operate.

The avoidant child will benefit from the opportunity to observe normal family interactions and expressions of emotion without being forced or encouraged to express those same emotions.  They will need time to come to terms with responding to physical displays of affection such as cuddles (if deemed appropriate).

The avoidant child may already be a high-achiever in some areas, those which they have already found pleased their primary carers, or even just that which they were naturally good at.  However they will probably need encouragement to take part in activities outside of their previous experience.  In the first instance consideration should be given to activities that involve small social groups.

The avoidant child is unlikely to cope well with failure, which may affect their willingness to take on new activities.  They should be encouraged to see failure as a learning opportunity and be given as much praise for trying as they would have for succeeding.

There is no reason to withhold emotion from the child.  They should know that expressions of emotion and affection are a normal part of life.

The avoidant child may appear on paper (Form E) more compliant, easier to manage, and may be easier to place with adopters, but adopters who have hoped for a child who would become a part of their family may find themselves caring for a child who is distant and aloof.  In extreme cases some adopters have commented that it is more like having a lodger than a child in the family.

Caring for the disorganised child

If no organising patterns have been observed in the child’s behaviour, the possibility of a disorganised attachment should be considered in conjunction with the child’s social worker and other professionals. The individual nature of the child’s experience and resulting behaviour may well necessitate a personalised care plan.  Foster carers should already be supported by their fostering social worker, however adopters in particular may benefit from additional support in caring for the child.

ANALYSIS

Listening to and reading Karen’s story I wonder what might have been done to help her as a child.  Could her life have turned out differently, been more emotionally fulfilling from a younger age?

It’s easy to look at a case history, to theorise about the impact of neglect and abuse on a child.  Even though Karen was not neglected or abused, through the clarity of her memories, what her story gives us is an insight into the workings of the mind of this particular child.  Below are some of the factors that could be taken into consideration in reviewing Karen’s story.

Aspects of her behaviour were bizarre yet by observing how others behaved or responded to her in certain situations and by tailoring her reactions she managed to replicate normal behaviour enough of the time to conceal her real thoughts and feelings.  And she knew she was doing it.  She changed the behaviour of those around her as her parents stopped trying to give her happy surprises such as holidays and birthday parties.  Her description of her visit to the Educational Psychologist suggests there was no-one, or no adult at least, whom she would have trusted.  And she would not have been likely to trust another child because she would have seen that mostly other children trusted adults.  It would have taken a lot more determination on the part of an adult in her life to get through that level of distrust.  But who would try when to all intents and purposes she seemed ‘within the bounds of normal’ most of the time?

Karen was clearly an intellectually capable child (she passed the 11+ for all its faults and attended grammar school).  Her thinking was rational even at the age of five, as she worked through the analysis of the existence or non-existence of Father Christmas.  Her final release from her self-imposed emotional void was through education.  That kind of education would not normally be available to her when she was a child or teenager.

Karen herself recognised features of severe avoidant attachment in her own adult behaviour and responses.  Had a social worker observed Karen as a child they may have come to the same conclusion, although from Karen’s description her primary caregiver did not have an avoidant attachment and this would have caused some doubt.  Had the root of Karen’s thinking been discovered and the events when she was five revealed then an attachment disorder diagnosis would have been further questioned, given that the development of an attachment model is generally considered the result of sustained parenting experience rather than a single event cause.  Could such a diagnosis or discussion have made any difference to Karen?  Given the story here, the answer remains unclear.  Although emotionally withdrawn Karen was not a typically avoidant child.  She was not responding to ‘avoidant parenting’ she was choosing to resist ‘secure parenting’.  [There is no guarantee that Karen’s received parenting was ‘secure’, but her recollection of her mother’s response to both the finding of the dead cat and to Karen’s matter of fact acceptance of her apparent leaving suggests maternal parenting within the bounds of ‘secure’.  Karen’s description of her father’s response to her cancer diagnosis suggests, however, that his parenting style was less emotionally demonstrative and possibly closer to avoidant.]

An alternative diagnosis of PTSD, given that there was a single event cause to Karen’s behaviour, would have been unlikely in Karen as a child as she had apparently suppressed the memory and it did not resurface until she was 30.

There is an old training video used in fostering and adoption, called Jayney.  It shows in three parts the story of a girl of around primary school age.  In one part you see the interactions between the adoptive mother and child from the adoptive mother’s perspective – she gets frustrated by the strange behaviours and unexpected reactions of the child to what she thinks are normal parenting and circumstances, such as asking about her day at school.  In another part you see the younger child with her birth mother, how similar events, such as making a cup of tea, are handled differently.  And in the remaining part you hear Jayney’s internal voice, her thoughts as she handles the situations with her birth mother and how she carries forward her previous experiences into her new relationship with her adoptive mother.

As social workers we never know what really happens between a child and their carer, we never quite know how the child sees those interactions.  What we can see is that something is not right and whatever happens we need to keep trying everything we know to help and support that child, whether that is in working with their birth parents who are caring for them or with foster carers or adopters, or in direct therapeutic work.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: