Critical Values Based Practice Network

C-VBP-N

Adult Attachment and Mental Health

Written by Steven Coles on . Posted in Clinical Psychology Bite-Size

Adult Attachment and Mental Health

Issue 18 – September 2009

Author: Emma Bodfield (c/o jenny.poole@nottshc.nhs.uk)

Key points

  1. Attachment Theory concerns the way we relate to others. It includes a person’s view of themselves as deserving of support and whether others are able to meet their needs.
  2. Insecure attachment is linked to mental health problems. Such insecurity can be developed through childhood trauma, adversity and neglect.
  3. The coercive aspects of services may limit their ability to provide safe, trusting relationships to service users and impact on our ability to meet their attachment needs.

Implications for practice

  • It is important to consider how people relate to others and the role of personal history and context within this process.
  • Supervision could be helpfully used to reflect upon staff and service user’s patterns of relating, the feelings these evoke and the potential impact upon engagement.  

What is attachment?

Attachment theory considers how we develop patterns of relating to others. Based upon early experiences of how those close to us (usually a parent) respond to our distress, individuals form ideas about whether they are deserving of support and care, and whether others are able to meet their needs in times of distress1. Attachment strategies appear to effect behaviours throughout the life cycle. They are thought to be relatively stable but do have the ability to change due to life events, including loss or formation of key relationships or interpersonal traumas2. In response to early experiences people develop ways of adapting to their environments (e.g. rejecting others, seeking constant closeness, affection or reassurance). Secure attachments deriving from consistent, caring responses to early distress help people become confident and comfortable with intimacy and dependence within relationships. Insecure attachment can be caused by childhood adversity, neglect, trauma or inconsistent responses from caregivers to distress. 

Attachment and mental health

Individual differences in attachment can contribute positively or negatively to mental health and to the quality of relationships with others. People differ in the way they cope with distress and regulate feelings of security, and these differences are thought to be partially due to ones relationship with caregivers3. Studies have shown insecure attachment to be significantly related to indices of psychological distress such as depression, anxiety, psychosis, personality disorders as well as general psychiatric symptomology4 

Relationships between staff and service users

Staff have the potential to provide positive attachment experiences that disconfirm insecure attachments. This can be provided through sensitive and appropriate responses to distress, consistency, and emotional containment through empathic listening. In light of this, the role of individual professionals such as key workers could be viewed as potentially very positive, as meaningful relationships with professionals are well known as a key factor in recovery5. Difficulties in forming positive relationships with service-users are likely to be due to a wide number of factors. The therapeutic alliance between staff and service users will be influenced by the individual attachment styles or strategies of staff members as well as service users5. The above highlights the role of one-to-one relationships; however, service-users often come into contact with multiple professionals and services. It has been suggested that a service itself may be perceived as a ‘secure base’6. However, the control function of services means that staff may be limited in their ability to provide a secure base or positive relationship. This understandably could discourage service users from engaging with services, the coercive nature of services may also reinforce negative experiences of control during childhood. A study showed service users scored psychiatric in-patient services much lower in their ability to meet their attachment needs in comparison to community health teams, psychological services and day services6. This suggests how services are organised or structured could have a big impact on our ability to meet service user’s attachment needs. 

Clinical Implications

Relationships between staff and service users have long been considered an important aspect in recovery. Attachment theory emphasises the importance of understanding how people relate to others and the important role of personal history and context within this process. Importantly, this should include consideration of staff’s patterns of relating and the effect this has on relationships with service users. Relationships with service users may evoke many feelings and supervision should be used to explore and reflect upon these feelings and potential ways of relating, particularly with complex cases. Attachment theory highlights the importance of positive relationships in all of our lives. The theory emphasises that our circumstances and history shape the way we all approach relationships and respond to others. Therefore increased attention and understanding should be given to the reasons why service users may not want to engage with services, particularly if they are seen as coercive and controlling.

REFERENCES

  1. Bowlby, J. (1973). Attachment and Loss: Vol. 2 Separation. New York: Basic Books.
  2. Hamilton, C. (2000). Continuity and discontinuity of attachment from infancy to adolescence. Child Development, 71, 690-694.
  3. Holmes, J. (1994). Attachment theory: A secure theoretical base for counselling? Psychodynamic Counselling, 1(1), 65-78.
  4. Ma, K. (2006). Attachment theory in adult psychiatry. Part 1: Conceptualisations, measurement and clinical research findings. Advances in Psychiatric Treatment, 12, 440-449.
  5. Dozier, M., Cue, K. & Barnett, L. (1994). Clinicians as caregivers: Role of attachment organisation in treatment. Journal of Consulting and Clinical Psychology, 62(4), 793-800.
  6. Goodwin, I. (2003). The relevance of attachment theory to the philosophy, organisation and practice of adult mental health care. Clinical Psychology Review, 23, 35-56.
 

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