Download Symposium 1A: Amae and Attachment Representations in Children

Symposium 1: August 19th 2 pm – 3.30 pm
Symposium 1A: Amae and Attachment Representations in Children
Chair: Blaise Pierrehumbert (Switzerland)
Presenters:
Keumjoo Kwak (Korea)
Rejean Tessier (Canada)
Stéphanie Habersaat (Switzerland)
Maryline Monnier (Switzerland)
Hélène Miyuki Turpin (Switzerland)
According to the theory of attachment, social experiences, as early as in infancy, contribute to
the construction of Internal Working Models (IWMs) of attachment, which will late guide the
individual’s expectations and behaviors in close relationships, all along his or her life. The
qualitative, individual characteristics of these models reflect the specificity of the individual’s
early experiences with attachment figures. Procedures to evaluate IWMs in adulthood have
been well established, based on narrative accounts of childhood experiences. Narrative
procedures at earlier ages (e.g., in the preschool years) have been proposed, such as
Bretherton’s Attachment Story Completion Task (ASCT), to evaluate attachment
representations. The attachment literature globally suggests that the quality of IWMs are not
cultural specific. This symposium will explore possible cultural particularities of
preschoolers’ representations of relationships with caregivers, using the ASCT procedure
supplemented with several additional stories. These supplementary stories have a special
focus on the representation of affiliation and of autonomy in relationships with caregivers.
The study is in progress in two occidental countries (Canada and Switzerland), and in two
oriental countries (South Korea and Japan). Data will be compared regarding attachment
IWMs and representations of affiliation/autonomy. Cultural specificities regarding
preschoolers’ representations of children-caregivers relationships are expected, in association
with specific cultural values regarding affiliation and autonomy. Namely, the Japanese
concept of amae (“need love”), somehow opposed to the occidental education values
regarding autonomy, might indeed imprint caregiving attitudes, hence influence children’s
representations. The issue of the specificity of Japanese culture regarding attachment
behaviors and representations has already been discussed in the literature, some authors
having challenged the universality of Bowly’s theory. The present symposium, comparing
representations of attachment and of affiliation/autonomy in children from oriental and from
occidental cultures, should contribute to the debate on the universality versus the cultural
specificities of attachment.
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Symposium 1B: Attachment and Pregnancy
Presenter 1: Natasa Hanak (Serbia)
The psychic landscape of mothers-to-be: The role of attachment organization in
pregnancy
Inspired by the notion of motherhood constellation and numerous efforts in describing the
core ingredients of the transition to motherhood on the mental level, this research explores
differences in representations, expectations, anxieties and prenatal attachment in pregnant
women with secure and insecure organizations of attachment. The women were examined
between 20th and 32nd week of gestation with self-report measures. Attachment organization
was assessed, measuring seven aspects of attachment: Use of secure base, Anxiety about
losing the secure base, Unresolved family traumatization, Negative working model of self,
Negative working model of others, Poor anger regulation and Capacity for mentalization.
Three lists of 11 opposite adjectives were given for rating of perceived individual
characteristics of self-as-a-mother, own-mother-as-a-mother and partner-as-a-father. Another
list of opposite adjectives was used for rating the characteristics of the future child. The
anxieties about the future maternal role were measured. The expectations about the role of the
child in the personal and family life were assessed. The prenatal attachment was measured.
The results demonstrate significant differences between four attachment categories in all
measured aspects of the internal world. Pregnant women with secure attachment organization
can be discriminated from the fearful women; less anxiety about loss of freedom and
insufficient self-realization in the maternal role; perceiving self-as-a-mother higher on
dimensions of commitment and emotional regulation; perceiving their mother-as-a-mother
higher on dimensions of competence, commitment and serving as a secure base; perceiving
partner-as-a-father higher on dimension of commitment; and perceiving the child as more
socialized. Pregnant women with preoccupied attachment differ from dismissing by having
higher unrealistic expectations from the child; they perceive the child as lower on activity and
positive affects, and experience more anxiety about having a difficult baby and being
incompetent in the maternal role. The results of the study confirm complex interrelations of
examined aspects of the internal world during pregnancy and point to possible risks for
optimal transition to motherhood, specific for each unsecure attachment organization.
Presenter 2: Christine Kern (Germany)
Maternal fear of loss and infant anxiety of physical pain: Special triggers in
mothers and former preterm infant
Very low birth weight preterm infants are at risk for developmental problems. Is there a
relation between preterm birth, attachment development and the unresolved trauma state?
Children’s attachment pattern was measured in Ainsworth’s strange situation and with the
Story Stems. Parent’s attachment pattern was tested with the Adult Attachment Projective. In
addition we assessed parents with the Reaction to Diagnosis Interview. Parent’s traumatic life
events are measured in the Posttraumatic Stress Diagnostic Scales their intensity of fear was
assessed with the State Trait Anxiety Inventory (STAI). Children’s attachment representation
and behavior are significantly connected. Parent’s attachment unresolved representation in the
cemetery story was above average. The correlation between parent’s unresolved category in
the AAP and the unresolved status in the RDI was significant. Between Mother’s PTSD
diagnosis and the unresolved RDI state, as well as between their STAI score and their PDS
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score we found a significant correlation. Six years after preterm birth most of the parents and
children remained unresolved and burdened concerning stories dealing with death in the AAP
on the one hand and about children’s diagnosis in the RDI on the other hand. In addition to
that, most of the children who remained unresolved about the story stems showed
disorganization in their overestimation of the hurt knee story, e.g. followed by stories about
death or serious illnesses treated in hospital.
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Symposium 1C: Early development and emotions
Presenter 1: Cristina Riva Crugnola (Italy)
Affective states and coordination between mother and infant at 9 months and
infant attachment
Attachment patterns are considered styles of emotional regulation which the infant acquires in
interaction with his mother. A number of studies have shown that the quality of infant
attachment is related to the ways in which the mother mirrors and regulates infant emotions.
Mother and infant quality of co-regulation and of reciprocal contingency in the development
of infant attachment is of importance. Nevertheless, the data is not unequivocal with respect
to the association between the emotions expressed by the infant and its mother and infant
attachment. The aim of this study is to evaluate the relationship between mothers and infants’
affective states and coordination/miscoordination and the quality of infant attachment.
Mother-infant dyads were recruited, interactions were video-recorded, coded and then
calculated. When the infants were 14 months old, their attachment to their mothers was
evaluated using the Strange Situation Procedure. Maternal positive affective states are
associated with security of infant attachment and maternal and infant negative states with
insecurity. The dyadic expression of positive coordinated affective states is related to security
of infant attachment and of negative coordinated affective states to insecurity. The mean
frequency by minute of the passages by the dyads from mismatching to matching states as a
measure of repair is associated with security of attachment. With reference to mismatches, the
expression of positive affective states by the mother when the infant is neutral is related to
security of attachment. The expression of maternal negative states when the infant is neutral
and when the infant is positive is associated with insecurity of attachment as is the expression
of maternal positive states when the infant is negative. The quality of affective states and
coordination of mother and infant at 9 months proved to be a specific indicator for the
development of infant attachment, which is also useful for identifying mother-infant
relationship risk conditions
Presenter 2: Raquel Costa (Portugal)
Attachment Security at 12 months: Do the infant psycho-physiological profiles
and the quality of mother-infant interaction matter?
Assess the effect of infant’s psycho-physiological profile early in life on the quality of
mother-infant interaction and on later attachment and to explore the mediation and
moderation effects of the quality of mother-infant interaction on the association between the
infant’s psycho-physiological profile and attachment security. A longitudinal prospective
design was conducted. Eight weeks-old infants were assessed with the Neonatal Behavioral
Assessment Scale and the Alarm Distress Baby Scale. At 8 to 12 weeks old, cortisol levels
were measured both before and after routine inoculation. Mother-infant interaction was
evaluated at 12-16 weeks, using the Global Rating Scales. The strange situation procedure
was performed at 12 months. Infants were identified according to their psycho-physiological
functioning: (1) “Withdrawn”; (2) “Extroverted”; (3) “Underaroused”. Differences between
them were found regarding both infant and mother behaviors in the interaction and the overall
quality of mother-infant interaction. The identification of psycho-physiological profiles in
infants is an important step in the study of developmental pathways. Additionally, the co-
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construction of the mother-infant relationship has bidirectional origins on the infant
characteristics and on patterns of interaction.
Presenter 3: Inés Brock (Germany)
Bonding between siblings – sibship as a mental health factor in families –
transition after birth
This contribution deals with the special bonding between siblings. The paper argues that daily
encounters with siblings influence every child emotionally. The lack of sociological research
about early childhood sibship leads to insistence on old beliefs like the trauma of
dethronement. This paper helps in setting aside this old prejudice. Communication and
sympathy between siblings have a very special character and exist along side parental
intervention. Changing coalitions strengthen the siblings regardless of age and lead to a
further understanding of equivalence and empathy. Successful exchange and negotiation
generates emotional referencing amongst siblings even in the early childhood. New findings
will be presented on sibship from a qualitative case-study, stating that siblings develop a
specific dynamic relationship, which positively impacts their emotional development.
Dynamics of the existentially relevant affiliation system, the family of origin, will be
described. The results will be demonstrated with an explanation of siblings’ inner notions of
the family dynamics with the help of nonverbal projective diagnostic methods and semistructured interviews with the parents. The qualitative approach towards the data follows the
grounded theory. The siblings in the study develop a unique intimacy and affection. Changing
coalitions strengthen the siblings regardless of age. In fact, encouragement enriches them
mutually. One of the main results of the study is the conceptualization of symmetrical
reciprocity and dyadic coping in the horizontal level of the family. It could be described that
assisting and enhancing each other from the beginning of life onwards generates emotional
capital between siblings. This sociological phenomenon is a positive factor in promoting
resiliency. The ability to encounter the challenging situation of instability during the transition
stage around the birth of a sibling generates capacities and resources to cope with similar
situations later on such as the transition into kindergarten. Therefore, we can assume that
sibling relationships first and foremost enrich the individual siblings in the area of mental
health.
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Symposium 1D: Religion
Chair:
Pehr Granqvist (Sweden)
Presenters:
Rosalinda Cassibba (Italy)
Mario Mikulincer (Israel)
Recent advancements in religion-as-attachment research
Based on the idea that religious believers tend to utilize God as a symbolic attachment figure,
attachment theory has guided an expanding body of research in the psychology of religion for
about two decades. Many core theoretical proposals have been confirmed in empirical
research. Likewise, a number of studies have addressed the implications of individual
differences in attachment for understanding corresponding, and sometimes compensating,
individual differences in religion and spirituality. With this panel, we hope to illustrate recent
advancements in attachment and religion research, both concerning the research questions
asked, and the methodologies employed to test them. First, the studies included in this panel
address important questions that have been previously overlooked. For example,
characteristics of attachment are known to “travel” across generations via aspects of
caregiving, and aspects of caregiving received by children are in turn reflected in their
perception of God. Cassibba and co-workers present an intergenerational study that addresses
whether - and how – mothers’ attachment states of mind are related to their children’s
perception of God, and what role is played by the mothers’ own representation of God. Also,
activation of the attachment system is known to increase people’s mental accessibility to their
human attachment figures, and mental representations of human attachment figures are in turn
known to infuse positive affect. Drawing on the idea of God as a symbolic attachment figure,
Mikulincer and colleagues present two experiments addressing whether similar effects are
observed among religious believers in relation to God and – if so – what role is played by
their romantic attachment styles. Moreover, individual differences in attachment security have
been found to have distinct correlates in relation to aspects of traditional, organized religion
on the one hand and to more privatized forms of spirituality on the other. Based on the
observation that such aspects of religion and spirituality are typically orthogonal, Granqvist
explores whether groups of people who endorse both, neither, or one of the two forms of
religious-spiritual orientations differ with regard to attachment states of mind. He also
presents findings on these groups in relation to the compensation and correspondence aspects
of religion/spirituality that have been uncovered in the literature. Secondly, the panel has been
set up to pave the way for methodological advancements in this line of research. The extant
research literature often suffers from methodological shortcomings related to correlational
research designs and sole reliance on self-report questionnaire methodology. This limits our
ability to draw conclusions about cause-effect relations and to rule out self-report biases. In
this panel, one presentation is based on studies using experimental designs, which are ideal
for uncovering cause-effect relations. Also, two presentations are based on studies utilizing an
attachment assessment, the semi-structured Adult Attachment Interview, which has been
thoroughly developmentally validated, partly because it does not take the content of selfreports at face value. Moreover, two presentations are based on studies using implicit
measures also of the religion-related constructs. Finally, one presentation represents the first
study to uncover intergenerational links in attachment-religion research
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Symposium 1E: Child abuse and neglect, the impact on attachment
Presenter 1: Carla Alexandra Paiva (Portugal)
Developmental trajectories, attachment to a partner and violence in intimate
relationships: Gender as moderator?
Attachment insecurity and partner abuse in adulthood had been theoretically and empirically
recognized. Individual differences in power and violence toward an intimate partner, deriving
from the anger of protest had been hypothesized as a theoretical model of comprehension of
violence among intimates. The present investigation refers to the victimization experiences
during childhood and adolescence, its implication on attachment to a partner, quality of
intimate relationships with a partner and partner violence perpetration and victimization in
early adulthood. Distal factors like personal history of victimization and deviant behaviors,
and proximal factors like the attachment anxiety, and the quality of intimate relationship with
a partner were found to be significantly associated with the perpetration and victimization of
dating violence in our sample of young adults, independently of gender. This study refers to
violence in the context of intimate relationships considering the gender, delineating the impact
of developmental history and current attachment dimensions on the explanation of violence
to/from a partner. A comprehensive model of partner violence as an attachment process was
tested, involving individual differences in dyadic regulation needs and individual factors of
each element like child abuse and neglect victimization. This study highlights the complexity
of partner violence as a constellation of personal and interpersonal dynamics and
strengthening the "psychological and relational paradigm.
Presenter 2: Carla Alexandra Paiva (Portugal)
Gender-differentiated effects of child abuse and neglect, attachment, quality of
intimate relationships and partner violence
This study strengthens the importance of the quality and processes related to significant
relationships on physical and psychological health of individuals during young adulthood,
examining the relative contribution of different proximal and distal pathways, attending to a
gender specific model. Attachment anxiety is the main predictor of psychological health for
both genders. Though for males this is the only predictor, for women early experiences,
particularly neglect and history of physical violence, as current quality of intimate relationship
with a partner and partner abuse contributed to the prediction of psychological health status.
When physical health status was considered, males and females revealed some important
differences. History of physical abuse in childhood and adolescence is a common predictor
for both genders, attachment dimensions are evidently different in the prediction of physical
health status, the main predictors for males are avoidance and for females it is anxiety, when
all other variables are taken into account. Gender and attachment have an important
implication in physical and psychological health status of young adults, when proximal and
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distal factors are taken into account, raising the question of gendered differentiated attachment
effects on psychobiological regulation
Presenter 3: Piroska Sándor (Hungary)
Attachment anxiety as reflected in dreams
Aspects of attachment insecurity have gained interest in association of sleep parameters,
especially sleep disorders. Most studies are carried out on children using subjective measures
of sleep assessed by parents. Little attention is given to REM sleep and dreams in relation to
attachment security, which could provide a reasonable association considering the presumed
role of REM sleep and dreams in emotion regulation and offline emotional reprocessing.
According to some studies, daytime distress and trait anxiety measures are directly associated
with sleep features and dream emotions, especially nightmare frequency. If attachment
insecurity is related to dream affects and negative dream frequency is investigated in this
study. Results showed significant connections between negative dream affect and attachment
categories, which was especially true for preoccupied and fearful attachment, both
characterized by high attachment anxiety. According to post hoc testing attachment groups
with high attachment anxiety differed significantly from the groups with low attachment
anxiety. Attachment anxiety turned out to be connected to nightmare frequency and the
intensity of dream affect’s impact on daytime mood. As attachment insecurity is associated
with less effective emotional and behavioral responses to stress, poorer coping mechanisms
and altered illness behavior, results can be interpreted as the appearance of these qualities in
nighttime symptoms. Diminished coping with negative emotions or enhanced negativity in
subjects with high attachment anxiety could emerge in form of negative dreaming and higher
nightmare frequency. As a consequence, negative dream emotions turn down daytime mood,
which is less likely to be regulated by compensatory coping mechanisms. Early traumatization
might be a mediator between attachment and nightmares, as both nightmares and insecure
attachment are often connected to early trauma of the child. Another possible explanation of
the connection between attachment anxiety and negative dreams is rooted in McNamara’s
attachment theory of REM sleep, which describes diversified evidence to support the essential
role of REM sleep in the conformation and subsistence of attachment behavior.
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Symposium 1F :Attachment and the Body
Presenters:
Miriam Steele (USA)
Bernadette Buhl Nielson ( Denmark)
Kristin Tosi ( Denmark)
Esther McBirney ( USA)
Attachment organization in both adults and children refers to specific strategies linked to
regulation of affect, mental representations of relationships and overall mental health across
the lifespan. Despite the burgeoning interest in attachment theory from both research
investigators and clinicians, relatively little empirical research has taken place exploring
attachment and aspects of body representation. The goal of this symposium is to report on the
link between aspects of attachment and body esteem in 4 unique but related studies.
The main innovation of this study is the use of “The Mirror Interview” (Kernberg & BuhlNielsen, 2007) and the Mirror Interview Coding System (Buhl-Nielsen, 2007). This novel
assessment provides an opportunity to explore an individual’s narrative responses to a series
of questions regarding thoughts and feelings concerning one’s body in the context of viewing
themselves in a mirror. The first presentation will be focused on the Mirror Interview used
with 130 adolescents, half of whom were diagnosed with a personality disorder, with a
structured interview SCID –II. In addition subjects were assessed with the Adult Attachment
Interview, The Identity Consolidation Inventory, The Child Behaviour Checklist, & Defense
Style Questionnaire. Preliminary results highlight specific contributions from both the AAI
and Mirror Interview in understanding unique facets of this vulnerable population.
The second presentations will focus on 40 mother-toddler daughter pairs in a study
investigating the intergenerational transmission of attachment and body esteem. In addition to
the original Mirror Interview, a supplemental set of interview questions and coding was
formulated by a group of senior clinicians and researchers to explore the added influence of
culture on women’s body esteem. Preliminary findings indicate significant positive
correlations between several of the variables within the AAI and the MI including Coherence,
Reflective Functioning, and Global Esteem.
The third presentation will focus on this same sample but will present data on the Toddler
Mirror Interview (Kernberg, 2006) which assesses attachment behavior and patterns in
mother-child interactions in relation to children’s behavior in front of the mirror. This study is
the first of its kind to relate maternal Adult Attachment Interviews with unique aspects of
toddler behavior involving their self-awareness, agency, and aspects of body representations.
Preliminary findings indicate that Mothers’ who display over involvement or intrusiveness
during the Child Mirror Paradigm were more likely to have Preoccupied attachment patterns
while mothers’ disinterest or avoidance in relation to their toddler were correlated with a
Dismissing attachment pattern as rated in their AAI. Children with mothers whose AAI’s
were independently coded as secure fell in between the two types of insecurity.
The fourth presentation will present data from a study using the Mirror Interview with a group
of female undergraduate students (N=80), half of whom answered the questions while in front
of the mirror and half who were interviewed face to face. Preliminary results show Self9
Representation, Maternal Representation, and Body Esteem on the MI had statistically
significant negative correlations with the EAT-26 and that narrative responses were perturbed
by the experience of responding in front of the mirror.
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Symposium 2: August 20th 11am – 12.30 pm
Symposium 2A: Attachment measures
Presenter 1: Paola Molina (Italy)
The standardization of the Ca-mir Italian Version
Adult attachment is evaluated by a great number of different tools, both narrative and selfreport. AAI is considered the reference tool but its coding requires time and a specific
training. On the other hand; self-report are easier and more economic, but sometimes too
simple and don't permit to highlight unconscious aspects, e.g. for the dismissing profile. The
need of an economical tool that overcomes these limits is expressed both in clinic and
research. The Ca-Mir is a Q-sort self-report questionnaire created to describe the attachment
representations. The questionnaire encompass past experience, present ones, and questions
about general ideas on relationships. The French original version has been translated in to
Italian, discussed and reviewed together with the Swiss authors. Two distinct versions, the
masculine and feminine, were developed. Data were gathered with a snowball sampling. To
attenuate the potentially distortion of people linked whit other subjects within the sample, the
sample size was reduced. Each subject fulfilled the paper form trough both likert and q-sort
procedures. On the likert data we perform explorative and confirmatory factor analysis to
investigate the structure of the test and to verify the fit of the original model proposed by the
authors. To analyze the q-sort data we constructed the Italian prototype correlation indexes,
involving reliable coders of the Adult Attachment Interview. Each specialist answered to the
ca-mir q-sort version fulfilling three different prototype responses: the Free, the Preoccupied
and the Dismissing. Due to the expressed need of better self-report measure for adult
attachment, the results confirm the importance of specific Ca-mir norms to better evaluate the
Italian subject responses and encourage the use of this tool in both clinical and research
purposes.
Presenter 2: Maria Kazmierczak (Poland)
The Symbiotic Bond – introducing the construct
Results of multiple studies indicate that secure and insecure attachment styles are associated
with various personality traits as well as different functioning in close relationships.
Ambivalence and avoidance are linked with lower quality of interpersonal relations, whereas
security is connected with relational satisfaction, intimacy, and personality traits facilitating
contacts with others. The presented research is part of a larger scientific project aimed at
creating a tool to measure the strength of the symbiotic bond formed by a person’s
personality, which is dependent and shaped by the expectations of others. The Symbiotic
Bond Questionnaire for adults, which is currently used in Poland in multiple studies, appears
to obtain satisfactory parameters. The questionnaire consists of 62 items, which compose four
subscales. One of the main issues to be explored is the theoretical and empirical link between
symbiosis and security/insecurity of attachment. Associations of SBQ with romantic
attachment styles were analyzed. Symbiotic bond is positively associated with two insecure
attachment styles. In detail, participants who display high avoidance, high ambivalence, and
low security are very sensitive to others’ emotions and suppress their feelings, desires or
needs to please their close ones. Further analyses indicate that empathy is associated with the
symbiotic bond and romantic attachment. Cognitive empathy is positively associated with
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creating bonds on the basis of trust and the sense of security. On the other hand, empathic
experiences of others’ negative emotions are correlated with bonding in an ineffective way.
Results of the research indicate that symbiosis might be considered as a valuable construct
within the area of attachment studies.
Presenter 3: Yoav Bergman (Israel)
Attachment to Home - Conceptualization and Development of the Home
Attachment Scale
An enormous wealth of research has examined the importance of attachment figures
throughout life for maintaining a sense of attachment security, mental health, and adjustment.
In recent years, attempts have been made to conceptualize and assess non-human attachment
figures, such as God or a beloved pet, and to examine their relationship both to interpersonal
attachment and well-being. In this presentation, we follow this line of research and propose
that one's home can serve attachment-related functions and act as a symbolic attachment
figure. Then, we will present findings from four studies that examine the reliability and
validity of a new self-report scale tapping individual differences in attachment orientations
toward a home along dimensions of anxiety and avoidance, the Home Attachment Scale,
(HAS). These findings validate the two-factor structure of the HAS and show that the two
HAS scales have adequate internal consistency and test-retest reliability as well as
theoretically-derived associations with various aspects of home appraisal and relationship,
interpersonal attachment, high-order personality traits. The implications of these findings for
the dynamic interplay of interpersonal and home attachments will be discussed.
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Symposium 2B: Attachment representations in middle childhood
Presenter 1: Turid Suzanne Berg-Nielsen (Norway)
An early voice of the inner working model? Preschoolers’ accounts of parenting
related to child attachment classification in a population based study
Adults’ as well as older children’s attachment representations are preferably measured with
interviews about past and present relationships with attachment figures (Adult Attachment
Interview, Child Attachment Interview). In this study, preschoolers’ attachment classification
and perceptions of parental behavior were investigated to see if such early accounts of
parenting are related to their attachment classification in the same way as adults and older
children’s reports of parenting are. In a community sample of 796 Norwegian four-year olds,
attachment representations were assessed with the Manchester Child Attachment Story Task.
The children were also interviewed with the Parenting Scale of the Berkeley Puppet Interview
which measures preschoolers’ perceptions of parental behavior. It has six subscales: Positive
Affect, Warmth, and Enjoyment; Negative Affect, Anger, and Hostility; Responsiveness;
Emotional Availability; Structuring; Autonomy and Control. Covariates included in the
analyses were measures of parents’ self-reported psychopathology and parent-reported child
psychosocial problems. Secure attachment representations were found in 55% of the children,
21,7% were classified as Avoidant, 6,5% were Ambivalent and 16,8 % were Disorganized.
General Linear Modeling showed that preschoolers classified as secure perceived their parents
to have more Positive Affect, Warmth and Enjoyment more Emotional Availability and more
Structuring. The four-year olds classified as C perceived more parental Negative Affect,
Anger and Hostility and less Autonomy granting. Avoidant children reported more parental
Structuring. The only measure of parents’ psychopathology related to the BPI parenting
subscales was parents’ anxiety, the more anxiety a parent had, the less parental Negative
Affect the four-year old reported. CBCL was only related to one PBI parenting subscale, the
more problems the parent reported the child had, the less Autonomy granting parental
behavior the four-year old perceived. Four-year olds’ accounts of their parents’ behavior are
not merely random and unreliable; they communicate rather coherently in a BPI setting, and
their accounts are consonant with research using attachment interviews with older children
and adults. Preschoolers’ attachment classifications predict their perceptions of parenting in a
way that reflects their working models of attachment figures.
Presenter 2: Ines De Bartolo (Argentina)
Attachment representations and emotional/behavioral problems in at- risk
Argentinean children
The basic objective of this study was to appraise attachment representations in an at-risk
sample of Argentinean school aged children and to correlate attachment styles with emotional
and behavioral symptoms. The hypothesis of the study was that the effect of a risk condition
on problematic outcomes would be less evident in those children whose attachment
representations were secure and/or organized, and more evident in those whose
representations were insecure and/or disorganized. The children of the sample, aged 6 to 8
years, with an equal distribution of boys and girls, were at risk for mental health on account of
the presence of at least three individual, familiar, social or environmental risk factors.
Attachment representations were assessed using the Manchester Child Attachment Story
Task. Children were classified as secure, insecure and disorganized. A large proportion of the
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children of the sample were classified as disorganized, as has been previously found in at-risk
samples. Emotional and behavioral problems were measured using the Child Behavior Check
List. Children who had secure attachment representations were found to have a mean
frequency of problems that was significantly lower than the two other groups of children, and
that remained within the normal range of problems, thus showing resilient capacities in the
face of adverse conditions. The frequency of problems of the other two groups was within the
clinical range. A significant difference was found between the levels of emotional and/or
behavioral problems between each of the three groups. A significant increase was observed as
representations of attachment shifted from secure to insecure, and then from insecure to
disorganized. According to these results, the effect of the risk condition as reflected on
emotional or behavioral problems was enhanced when the children’s attachment
representations were insecure, and significantly more so when representations were
disorganized. These results yield support to the mediating role of attachment representations
in the context of risk for mental health. This role is discussed in terms of differential
susceptibility. In the face of risk, attachment representations can function “for better and for
worse”: buffering the negative consequences of adverse conditions when such representations
are secure, and enhancing negative consequences when they are disorganized.
Presenter 3: Christine Kern (Germany)
Traumatic Events, ADHD Symptoms and Attachment
The development of ADHD compasses different etiologies whereas psychosocial parameters
have not been examined adequately in this context. The state of the art postulates a connection
between disorganized attachment and externalizing behavior problems. Since traumatic life
events effect attachment, we hypothesize that early trauma is related to the development of
ADHD symptoms. Boys with ADHD symptoms and their mothers were assessed
longitudinally. The boys were assessed at the level of attachment representation with Story
Stems. Their attachment behavior with mother was measured in Ainsworth’s strange situation.
Mother’s attachment representation was tested with the Adult Attachment Projective.
Traumatic life events were measured in the Trauma Antecedents Questionnaire and
Children’s Trauma Symptoms Questionnaire. Children’s behavior was assessed with the
CBCL. We found 21.2% boys with D behavior in the Reunion procedure and 38.5% with D
representation in the story stem assessment, which correlated significantly. Mother’s U
category in the AAP correlated significantly with both attachment levels of the child. There
was a significant connection between ADHD symptoms, children’s and parent’s traumatic life
events and attachment representation. Consistent with our attachment transmission
hypothesis, children’s attachment styles were highly correlated with the mother’s attachment
representation moderated by traumatic life events.
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Symposium 2C: Parenting in challenging situations
Presenter 1: Stephanie Habersaat (Switzerland)
Specific patterns of early mother-child interaction in orofacial cleft children and
influence on child attachment
Orofacial cleft is one of the most frequent craniofacial anomalies, with an incidence of
approximately 2 per 1000 newborns in Europe and USA. Even if functional problems have
been recognized as playing a part in the development of these children, many studies showed
that orofacial clefts also influence the child social and emotional development and the family
life. The sample is composed of families who have children with orofacial clefts, and a
control group. Children and their mothers were assessed at 2 and 12 months after childbirth
for both groups (cleft group and controls). At two months, the mother was asked to play freely
with her child during 10 minutes. The interaction was video-taped for later coding. At twelve
months, the strange situation was assessed to the mother and her child. The research has put
forward a lack of emotionality from the mother in a game situation in the case of children
born with orofacial cleft, compared to controls. Indeed, a significant number of mothers of
children with orofacial cleft are more directive and "effective" in their game that control
mothers, even more if the cleft is severe. We find a strong link between the style of interaction
and attachment, whatever the group is. A strong association concerns difficult children of
controlling mothers and insecure – avoidant category in the Strange Situation.
Presenter 2: Beata Pastwa-Wojciechowska (Poland)
Analysis of attachment patterns, empathy and emotional bond with a child
among the group of women in prison with their children
Prison isolation is a specific situation for a convicted person, both at the individual and social
levels. In case of mothers who serve their sentence in Polish penitentiary system, they have
the right to endure their imprisonment with their children till the child reaches the age of 3.
This means that both the mothers and the children who are with them in prison have to deal
with all the restrains, as well as prepare for the separation that awaits them. This is why, from
the point of view of effective re-socialization it is crucial to get to know the attachment
patterns, empathy and emotional bond created between the mother and the child that
experience the incarceration together. Case studies were conducted with 10 women who look
after their children while staying in a prison. The children were at toddler age. Methods used:
Bond with child evaluation scale, Attachments Patterns Questionnaire, Emphatic Sensitivity
Questionnaire and SWLS. Female participants turned out to differ from the general population
in terms of secure attachment and anxious-avoidant insecure attachment. In-depth
investigation of documents and interviews with prisoners, show the specific pattern in respect
of attachment – high security of attachment as declared by women themselves, whereas not
confirmed by clinical assessment. Well-being of the participating women turned out to have a
strong negative relation to insecure attachment patterns. As for the empathy, the women differ
from the general population for the variable perspective-taking
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Presenter 3: William Whelan (USA)
Caregiver Patterns That Moderate the Effects of Child Abuse and Neglect
An opportunity for children to heal from the effects of early maltreatment may occur in the
context of their new relationships with foster or adoptive parents and in exposure to protective
factors in the caregiving patterns of the new parents. In this regard, a child’s part of the
relationship “dance” may change and become more synchronous with the more sensitive and
protective caregiving patterns existing in the foster or adoptive home. The aim of the study is
to answer two questions. In a clinic-referred sample of foster and adoptive child-caregiver
dyads, which caregiver patterns are associated with better relationship functioning in
children? And, is the type and severity of pre-placement maltreatment associated with a
child’s behavior and attachment patterns in a foster or adoptive home? All children with
secure attachment patterns have caregivers with secure caregiving patterns. Most children
with Anxious-Avoidant patterns have caregivers with matching patterns, although 6
caregivers have secure patterns and one has a high-risk Insecure-Other (IO) pattern. Most of
the children with high-risk Disorganized and Insecure-Other patterns have parents with
Anxious-Avoidant patterns, or the matching caregiver pattern. Children with the healthiest
attachment patterns, and the lowest reported behavior problems, are those who have foster or
adoptive parents with secure caregiving patterns. This finding suggests that these children
have experienced the most healing in their foster and adoptive placements. Results also
indicate that there is little or no effect of child maltreatment history on subsequent child
attachment patterns. These findings are similar to those in the preliminary studies, and lend
more support to the hypothesis that the effect of the caregiver-child “dance” that develops in
foster and adoptive care tends strongly to overcome the effects of earlier maltreatment
experienced by the child. The results indicate that secure caregiving patterns are strongly
associated with secure child patterns and also with better child emotional and behavioral
functioning. This is consistent with previous research in this area finding that effective
treatments tend to be those focusing on child attachment security and caregiver sensitivity.
Symposium 2D: Parent – children relationship
Presenter 1: Silvia Vianzone (Switzerland)
Mother-child relationship development in the first three years of life
The quality of attachment style is related to the quality of early mother-infant interactions and,
above all, to various aspects of the child's functioning in childhood and adulthood. The view
that there is intergenerational continuity in the quality of parental behavior is explicit in
Bowlby’s theory of attachment. However, parental attachment representation predicts only
part of children attachment security. In fact, many other different factors have an indirect
effect on attachment security, on the way mother-child dyads interact and, therefore, on the
future development of the child. In particular, one aspect that is still largely unexplored is
whether and how some representational dimensions of mother and child in the relationship are
related with and play a determinant role in the quality of mother-child relationship and in the
child’s future development. The purpose of this longitudinal study is to understand the
development, stability and change in the dynamics of mother-child interaction in the first 2
years of life and the possible mechanisms underlying these developmental trajectories. In
particular, the aim of this study is to investigate the role of some specific indicators,
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individual and/or relational, to assess how they emerge and interact within the mother-child
relationship and how these aspects contribute to the cognitive, emotional and social
development of the child, as considered as a possible source of weakness in the path of child
development. The participants are mother and child groups, all coming from Switzerland.
Preliminary data and clinical implication will be discussed.
Presenter 2: Parisa Mousavi (Iran)
Mothers’ perception of motives underlying children’s behavior in attachment
situations and its role on mothers’ response
Quality of child- caregiver relationship is a basic concept in association with child
development factors. A mother’s positive response to child is one important factor in forming
secure attachment, mothers’ perception of motives is of great importance. The purpose of this
study was to evaluate Iranian mothers’ perception of motives underlying their children’s
behavior in attachment situations and their view about proper response to these behaviors, and
also cultural comparison of this phenomenon. This qualitative descriptive study was
performed on Iranian mothers who had 3 to 5 year old children. Five situations included nap
time, walking with child, visiting a friend, play and cleaning up. They were described for the
participants and they were asked to tell the reason of the child’s behavior and the proper
response to it from their point of view. Data was analyzed using qualitative method. Result
showed there is a relationship between mothers’ perception of children’s motives and their
proper response to it. In nap time situation, safety and independence was of more importance
than other situations and received more positive response from mothers. The cultural
comparison showed more similarity between perception of Iranian and Japanese mothers and
they paid more attention to safety and interdependence than American mothers who paid
attention to independence and self autonomy. The results showed that there are differences in
mothers’ perception of child’s motives and responses to them. It seems the religious beliefs
are important factors in determining the perception of Iranian mothers and their response so
they try to consider both safety and autonomy needs according to the age of the child.
Presenter 3: Catarina Pinheiro Mota (Portugal)
Relationship with Parents and Individuation Process in Portuguese Emerging
Adults: The Role of Depression and Self-Esteem
The purpose of this study is to analyze the relationship between relationship with parents and
individuation process in a sample of Portuguese emerging adults. It is expected that quality of
relationship with parents is associated with successful individuation. The mediational role of
self-esteem and the moderation role of depression in the association between relationship with
parents and individuation process were tested. Finally the moderation effects of age, gender,
family configuration and academic degree were also tested in this association. Participants´
self-reports were collected using the Munich Individuation Test of Adolescence, the Network
Relationship Inventory, the Depression Scale and the Rosenberg’s Self-Esteem Scale. All
questionnaires present adequate reliabilities. Results will be discussed according to
attachment theory, in terms of the particular separation-individuation processes that occur in
Portuguese emerging adults, and effects of self-esteem and depression. Some reflections will
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be done around quality of attachment to mother and father according to family configuration,
in what concerns to the role of each figure in individuation process of emerging adults.
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Symposium 2E: Trauma and Attachment
Presenter 1: Doris D`hooghe (The Netherlands)
Early childhood trauma in an attachment relationship
There is a range of stressful events occurring in attachment relationships that may impair the
development of a secure attachment. The necessity to broaden our vision on attachment
trauma imposes itself. If we regard as attachment trauma, interpersonal trauma in an
attachment relationship, it is important to identify several risk factors. Risk factors, such as
aspects of parent- child relationship, parental psychopathology, emotional and behavioral
problems, and relationship difficulties interfere with the parent’s ability to form a secure
attachment. Research has documented reductions in brain volume and neurochemical changes
following traumatic experiences in early childhood. These neurobiological changes can affect
cognitive, behavioral and emotional functioning. The presentation elaborates on the
importance of the personal history of the parents and their expectations and attitudes towards
the child. The physical and psychological condition of parents and relational aspects play an
important role and can result in stressful reactions in the child. Here we stress the importance
of a proper assessment with regard to the personal history of the parents, the history and the
relational history of the child. The traumatic experiences have effect on the different levels of
the developing personality of the child: physical, emotional, cognitive, relational,
transpersonal, self-esteem, social skills. Treatment for traumatic reactions has generally been
sequenced and progressive. It is also important to involve parents, so that the relationship with
the child is positively affected if they come to terms with their personal issues. Expanding our
view on the existing criteria for traumatic experiences, considering the timing of the
experience and the development phase of the child to whom the experiences take place, give
us the opportunity to get a more accurate view on and to establish an appropriate treatment.
Presenter 2: Raffaella Torrisi (Switzerland)
Response to stress, attachment, and oxytocin in non-clinical adults and in adults
with child trauma
One of the most salient responses of a stressful situation is the activation of the hypothalamicpituitary-adrenal (HPA) axis. According to Bowlby's attachment theory, social engagement
behaviors promote emotion regulation under stress. A significant association between: (1)
anxious attachment and cortisol dysregulation; (2) attachment anxiety and a higher cortisol
response to an acute stress and (3) reduced hippocampal cell density and attachment
insecurity has been evidenced. Both HPA axis responses and attachment are known to be
influenced by early life conditions. Oxytocin (OT) is a hypothalamic neuropeptide implicated
in the regulation of social functions among humans and is apparently secreted under stress,
which suggests a mediating function between the stress system and consequently in biobehavioral and psychological implications of stressful experiences. Indeed, plasma OT levels
are positively associated with different aspects of attachment. The present study evaluated OT
plasma levels in adults: a clinical group having been victims of potentially traumatic
experiences during childhood and/or adolescence such as sexual abuse or to a potentially
lethal illness, and a control group. Those two groups were confronted to the Trier Social
Stress Test (TSST). Furthermore, attachment style was evaluated. The stress responses
presented specific patterns according to attachment classifications: subjects with a dismissing
state of mind presented an increased response on the HPA axis; subjects with disorganized
attachment representations presented a suppressed HPA response, and simultaneously
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reported elevated subjective stress; subjects with enmeshed representations presented a low
level of oxytocin, and finally subjects with a secure attachment presented a heightened level
of oxytocin, and low subjective stress. By analyzing OT secretion under stress it may be
possible to strengthen our understanding of the underlying mechanisms to the attachment
system. It is interesting to find specific patterns of secretion of the OT hormone, which is
deeply implicated in social functions, in individuals who have experienced adverse life
events.
Presenter 3: Yee Jin Shin
Brain PET findings of young children with severe attachment disturbance and
quasi-autistic behavior patterns
The clinical problem of impaired reciprocal social interaction in young children is seen in
autistic disorder in its most extreme form, whereas mild form of "autistic-like"
psychopathologies may be seen in other clinical conditions. Among various clinical entities
related to impaired reciprocal social interaction in young children, autistic spectrum disorder
and reactive attachment disorder are two diagnostic categories included in DSM-IV and ICD10 diagnostic system, clearly requiring "impaired social relatedness" as a key feature of the
disorders. As yet, there has not been much academic interest in unraveling how two such
widely differing etiologies - autism and RAD - can lead to similar developmental
psychopathologies. In this study, we use brain positron emission tomography (PET) scan to
see whether there is subtle differences of brain development between control children and
patients. Subjects were young children who meet the criteria of Korean attachment disorder.
Extensive medical and psychological assessments including strange situation procedure were
carried out. Controls were patients in similar age ranges. Caudate and Putamen were found to
show significantly hypo-activity in RAD group. Other brain regions showed no difference
between two groups. This study is the first attempt to explore the characteristics of brain
development in children with serious attachment problems and quasi-autistic symptoms. We
need more studies to include more subjects, to see correlation between symptoms and brain
function and to see developmental changes of brain function in these young patients.
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Symposium 2F: Personality Disorders and attachment
Presenter 1: Ingeborg Eikenæs (Norway)
Experiences in close relationships (ECR) in patients with Avoidant Personality
Disorder and Social Phobia
Avoidant Personality Disorder (APD) is one of the most prevalent personality disorders in
clinical settings as well as in the general population. Despite evidence that APD is associated
with significant psychosocial impairment and poor treatment progress, there is still little
research that focuses directly on APD. A main hypothesis is that APD is a more severe form
of Social Phobia (SP). Results from later research do not uniformly support this hypothesis
and more studies are needed. This study aims to provide more knowledge about the core
pathology of APD and the relationship between APD and SP. We assume that attachment and
adverse childhood experiences will be predictors of APD vs SP. The present study focus’ on
peoples experiences in close relationships. A cross-sectional multi-site study of patients with
SP and/or APD, recruited from units treating PDs or anxiety disorders, they are assessed by
diagnostic interviews, AAI and self report questionnaires. Hypotheses of similarities and
differences between APD and SP regarding attachment by use of the ECR will be tested.
Preliminary results points to substantial differences in self-pathology and interpersonal
functioning, in line with the proposal for DSM-5. Analyzes of the Attachment data are in
progress. The results will be presented and discussed.
Presenter 2: Øyvind Urnes (Norway)
An investigation of attachment styles in patients with avoidant personality
disorder
In DSM-IV avoidant personality disorder and in the proposed avoidant prototype in DSM-5,
intimate relationships are conceived to be avoided because of a general fear of attachments
and intimacy. What is the empirical basis for this proposal? Is this kind of attachment
problems more typical for patients with avoidant personality disorder than for patients with
other personality disorders? Patients applying for psychotherapy in a specialized unit for
treatment of personality disorders filled out the questionnaire Experiences in Close
Relationships (ECR). The patients were diagnosed according to DSM-IV with SCID-II. The
relationship between avoidant PD and the level of anxiety and avoidance in close
relationships will be compared to those of borderline PD and other personality disorders.
These relations will also be explored on trait levels. The results will be discussed.
Presenter 3: Theresa Wilberg ( Norway)
Attachment in Patients with Avoidant Personality Disorder
Personality Disorder (PD) develops as a result of interactions between biological factors and
environmental influences. Experiences during early years of life are viewed as particularly
important for personality functioning, as the emotional interaction with early attachment
figures is assumed to be central for the development of affect regulation, empathy,
mentalization, and representations of self and others. There are few empirical studies of
attachment relations in patients with PDs. The characterization of attachment strategies is
theoretically and methodologically complex, and at present there are two different coding
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systems for the classification of attachment based on the Adult Attachment Interview (AAI).
There are indications that a majority of patients with severe PDs may not have a well
established or predominant attachment strategy, and thus may fall within the Cannot Classify
category in the Mary Main coding system. Avoidant PD is one of the most prevalent PDs, it is
associated with severe psychosocial dysfunction, but has been overshadowed by other PDs,
both regarding clinical theory and empirical research. Avoidant PD is a disorder characterized
by avoidance of intimate and social relationships, indicating attachment difficulties, but
surprisingly, the attachment strategies associated with this disorder has to a little degree been
studied empirically. This presentation aims to throw light on these issues by discussing a
study comparing the coding systems of Mary Main and Patricia Crittenden applied on the
AAI with two patients with Avoidant PD.
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Symposium 3
August 20th 4.30 pm – 6 pm
Symposium 3A: Culture and Attachment
Presenter 1: Mohhamad Ali Mazaheri (Iran)
Investigating the perception of Iranian mothers of desirable and undesirable
characteristics which associated to secure and insecure attachment: A cultural
study about attachment
In recent years wide spread studies were carried out about cultural differences in attachment
phenomena. The purpose of this study was to explore the perception of Iranian mothers of
desirable and undesirable characteristics in their childhood and adulthood. The study tries to
compare Iranian results with those in Japanese and American cultures. For this qualitative
study Iranian mothers were asked individually through a semi–structured interview about
characteristics which they like and dislike their children to have in their childhood and
adulthood. Results were analyzed by qualitative method and show that positive mood and
naughtiness in childhood, and socially desirable behaviors, good academic achievement and
independency in adulthood were the most frequently mentioned desirable characteristics.
Maladjustment, negative mood and isolation in childhood, and aggression, negative mood and
socially undesirable behaviors in adulthood were the most frequently mentioned undesirable
characteristics. The Iranian results were also compared with the results of the Rothbaum et al.
report, and revealed cultural similarities as well as differences in this field. Faith, modesty and
patience as desirable characteristics, and disability in expressing demands, low academic
achievement and pertinacity as the undesirable characteristics were found as new categories in
this study, which were not mentioned by American and Japanese mothers. These results are
discussed in the context of Iranian culture.
Presenter 2: Renu Narchal (Australia)
Attach me if you can: Migration, loneliness, attachment and close relationships
It is important to accentuate that migration is not a simple process of relocating; it involves
leaving behind familiar social networks, peers, close relationships and above all a family that
bestowed a secure base. The process of migration is in itself stressful, which can lead to loss
of self and cultural identity; loss of close relationships; loneliness and disruptions in
attachment patterns due to extended periods of separation from parents and significant others.
Migration thus affects family links, close relationships and attachment. A continual global
growth in migratory trends has prompted an increased interest in migration process related to
consequences for attachment and family ties, autonomy, close relationships, socialization
demands, gendered expectations and self identity. Taking a single case narrative approach and
applying the attachment paradigm from a lifespan perspective, this paper examines the
settlement experiences of an India-born migrant student in Australia. Power balance in the
Indian social system is more formal and structured in Indian society, and considered as a
protective factor. Therefore attachment securities of children, born into traditional joint family
systems in India experience a special closeness with the joint-family and multiple caregiving.
Consequently, individuals’ migrating from such families undergoes multiple losses in
attachment security and a greater sense of loneliness and alienation. However, the ability to
access their secure base when distressed helps in affect regulation and coping. This paper
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focuses on her constant endeavors to be linked to her ‘remote secure base’, family and
parents; her ability to regulate affect and distress as a securely attached person; her quest to
retain family links and a continual struggle to preserve a balance between dependency and
autonomy. The paper raises some important concerns related to cultural adaptation and
acculturative stress; the process of migration and loss of close relationships, attachment,
loneliness and family links; diverse cultural expectations and parenting practices.
Presenter 3: Jin-Young Chae (Korea)
Intergenerational Transmission of Attachment in Korean Father-Child Dyads: Examining
Fathers’ Parenting Behaviors as Mediators
Little attention has been paid to father-child relationships in Korea and there have been
inconsistent findings regarding fathers’ influence on children’s attachment representations of
fathers. This study examined the intergenerational transmission of attachment in Korean
father-child dyads, examining the father’s parenting behaviors as mediators. To measure the
impact of both fathers’ childhood attachment representations and the mediating effect of
fathers’ parenting behavior on five-year-old children’s attachment representations of their
fathers, Korean fathers cohabiting with their children answered questionnaires related to
attachment representations of their parents based on their retrospective childhood memories
and their own parenting behavior as fathers of preschoolers. Given that fathers’ parenting
behavior as influenced by their childhood attachment representation had a direct impact on
boys’ attachment representations of their fathers; it served as a partial mediatory variable for
the impact of fathers’ childhood attachment representations on boys’ attachment
representation of their fathers. The model for father-girl showed that fathers’ childhood
attachment representations of their parents had neither a direct nor an indirect impact on girls’
attachment representations of their fathers, whereas fathers’ parenting behavior had a direct
impact on girls’ attachment representations of their fathers. These results demonstrate that the
boys in this study were more likely to have secure attachment representations when the
fathers recalled the attachment representations of their parents as secure. In the same vein, the
boys’ attachment representations of their fathers were secure when the fathers’ parenting
behavior was positive which was affected by their secure childhood attachment
representations of own parents. In short, our findings suggest that the intergenerational
transmission of attachment is seen in father-boys dyads but not in father-girl dyads in Korea.
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Symposium 3B: Attachment in adopted adolescents
Chair: Blaise Pierrehumbert (Switzerland)
Presenters:
Ana Muntean (Romania)
Mihaela Tomita (Romania)
Marie Stievenart (Belgium)
Zoé Rosenfeld (Belgium)
Rachel Wuyts (Belgium)
Paola Molina (Italy)
Barbara Ongari (Italy)
Josefina Escobar (Chile)
Natalia Barcons (Spain)
Neus Abrines Jaume (Spain)
Réjean Tessier (Canada)
Violeta Stan (Romania)
Roxana Ungureanu (Romania)
Isabella Roskam
Discussant: Miriam Steele
This symposium is presented by the Attachment Adoption Adolescence Research Network
network (AAARN). It will confront the first data of a multi-site study on attachment
representation in adopted adolescents and their parents. More precisely, the study will
envisage adopted and non adopted adolescents’ socio-emotional development and behavior
problems and their association with the adolescents’ attachment representations, as well as the
adoptive parents’ attachment representations about their children.The purpose is to assess the
respective role of age at adoption, country of origin, parental and child attachment
representations on behavior problems in adolescents from national and international adoption,
or from institutions, in several countries. Instruments used by the different teams are: (a)
adolescents’ representations of attachment (Friends and Family Interview); (b) parents’
representations of attachment (Parental Development Interview); (c) adolescents’ behavior
problems (Child Behavior Chacklist); (d) retrospective exploration of reactive attachment
disorders (Disturbance of Attachment Interview). The study is in progress; data from several
countries (Romania, Belgium, Italy, Chile, Spain, Canada) will be presented and compared.
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Symposium 3C: Implementation and intervention: Circle of Security
Presenters:
Marit Bergum Hansen ( Norway)
Kari Slinning ( Norway)
Heidi Jacobsen ( Norway)
Robert Marvin ( USA)
William Whelan (USA)
Heine Vihovde Vestvik ( Norway)
Astrid Lindberg ( Norway)
Tori Mauseth ( Norway)
Presentation of a Norwegian training and implementation project
The Circle of Security Intervention (COS) was originally developed as a framework for
understanding and intervening when problems in the parent – child relationship have been
identified (Marvin, Cooper, Hoffman & Powell, 2002). The intervention helps parents learn
and practice a user-friendly model for understanding children’s behavior and emotional
development. The intervention has the following aims: 1. Providing parents with experiences
that may help them to feel secure and able to soothe and organize their child; 2. Welcoming
the parents and helping them to organize their thoughts and feelings about parenting, and
supporting them in being as good enough parents as possible; and 3. Helping parents protect
their children and support them in competent exploration. This presentation will describe a
large-scale dissemination project in Norway designed to organize, train, supervise and
monitor the implementation of two versions of the Circle of Security Virginia Model
developed at The Mary D. Ainsworth Child-Parent Attachment Clinic, Charlottesville, USA,
by Robert Marvin and William Whelan. The first is the Circle of Security Attachment
Therapy—Group Model, and the second is the Circle of Security Attachment Therapy—
Family Model. The first is a group intervention and second focuses on one family at a time.
Previous research shows that the Circle of Security Intervention is associated with more
secure attachments in children living either in troubled families or with foster parents
(Hoffman, Marvin, Cooper & Powell, 2000), and further research is currently underway at
The University of Michigan using the Virginia group model, while this Norwegian project
will include a research component for the group and family models. This presentation will
have four main topics. First, a short introduction will be given concerning why RBUP Eastern
& Southern Norway made the Virginia Model the first choice, including components of
training and certification, post-training support, and organizational consultation. Second, a
short introduction to both versions of the intervention will be given. Third, two case
presentations will illustrate work done with the both the group and the family versions. The
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case presentations will include video clips showing important changes in the parent – child
relationships. The importance of supervision in learning the intervention and developing
ethically good standards for the therapist will be highlighted. Fourth, the symposium will end
with a presentation of the systemic organization of the Norwegian implementation project.
This implementation could serve as a model for further implementations in other countries
interested in using the COS as an intervention for fostering secure child-parent relationships.
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Symposium 3D: Foster care and adoption
Presenter 1: Catherine Kay (United Kingdom)
Attachment Disorder Behaviour in Non-Institutionalised Samples: Recent
Evidence from Maltreated Adolescents in English Local Authority Care
Recent evidence from studies of children raised in severely depriving institutions suggest high
prevalence attachment disorder behavior following early deprivation, which persists
throughout childhood and adolescence and is associated with psychopathology, functional
impairment and high levels of service use. Key questions remain regarding the relevance of
AD concepts to non-institutionalized populations. Further characterization of AD behavior in
children who have experienced maltreatment and forms of environmental deprivation more
commonly seen in western societies has important implications for assessment and
intervention with these groups. A study used a newly developed instrument; the carer report
Development and Wellbeing Assessment – Attachment Disorder (DAWBA-AD) to conduct
the first systematic investigation of AD behavior in a sample of maltreated adolescents in
English local authority (LA) care. All analyses controlled for age, gender, ethnicity and SES.
Carers of maltreated adolescents reported high rates of AD behavior overall. Principle
components analysis of the DAWBA-AD revealed four distinct factors: Disinhibited
Behavior, Superficial Relationships, Attention Seeking and Unpredictable Behavior. Items
associated with DSM-IV inhibited and disinhibited AD subtypes generally loaded on different
factors. Maltreated adolescents scored significantly higher than community controls on each
of the DAWBA-AD scales. The experience of multiple forms of maltreatment predicted
attention seeking behavior whilst younger age at entry to LA care was associated with higher
Superficial Relationships and DAWBA-AD total scores. All DAWBA-AD scales were
associated with elevated externalizing and internalizing forms of carer reported
psychopathology. The Superficial Relationships scale was associated with more additional
broad functional impairment than any other DAWBA-AD scale; suggesting particular
developmental significance. This study is the first to show high levels of AD behavior in noninstitutionalized maltreated adolescents and provides empirical support for the existence of
the nosological subtypes of attachment disorder. We conclude that AD behavior is a relevant
marker of developmental impairment, has significant clinical implications and is deserving of
further study within non-institutionalized high-risk populations.
Presenter 2: Maria Zaccagnino (Italy)
Using Child Attachment Interview in a group of high risk scholar children
Foster care children are at heightened risk for poor psychosocial outcomes. However, it has
been demonstrated that some subjects who reported negative childhood experiences are later
able to interpret and recount these experiences in a coherent and integrated way. Furthermore,
adults who succeed in breaking the intergenerational cycle are found to have received, in
childhood and/or adulthood, consistent emotional support from at least one significant figure.
The goal of the present study is to investigate the attachment representations and the social
skills of a at risk sample of scholar children, using a new measure, the Child Attachment
Interview, a semi-structured interview, which seeks to bridge the measurement gap identified
in middle childhood. Data analysis is in progress. The clinical implications of preliminary
data will be discussed and it may help in developing effective intervention for the foster
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children’s caretaking. The results will help in knowing and understanding the value of the
instrument in risk sample.
Presenter 3: Lavinia Barone (Italy)
Attachment and emotional competence: A study with late-adopted children and
their parents
Despite early attachment experiences of adoptees are often characterized by severe neglect,
physical abuse and/or maltreatment, a catch-up along various domains has been found.
Questions remain open about both individual differences and identification of variables
implied in children’s adjustment to adoption. Aims of this study are twofold: Firstly to inquire
how parents’ mental representations concerning attachment are consistent with those of their
adopted children and secondly to assess if children’s attachment pattern are associated with
their emotional competence. Adoptive families participated in the study. At children’s arrival
into adoptive families, parents’ mental representations were assessed using the Adult
Attachment Interview. After 12-18 month from adoption, children’s patterns of attachment
were evaluated using a Story Stem Technique. Two years after adoption children were
individually tested for assessing their emotional understanding. Parents’ and children’s
correspondence of attachment mental representations showed different values in mothers and
fathers. Moreover, although adoptees showed an impaired performance concerning emotional
competence if compared with normative children’s data, those classified secure performed
better than those classified disorganized. Adoptive parents’ states of mind appeared to be an
essential factor on adoptees’ subsequent emotional competence. Inquiring attachment in
adoption seems a fruitful way for welfare policies concerning adoption, suggesting new
assessment methods and areas of vulnerabilities for parenting support interventions.
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Symposium 3E: Apparitions on adolescent in-patient units: Working with
nested systems of attachment strategies
Presenter:
Simon Wilkinson ( Norway)
In-patient admissions require a focus on the attachment strategies of the referring agent and
the staff of the unit, in addition to the stratgeies of the adolescents and their parents. This
symposium addresses how this nested dynamic system can be worked with from preadmission to discharge. The unit primarily in focus uses both Adult attachment interviews of
the parents and Transition to adulthood attachment interviews of the adolescents. These will
be used to inform how we work. The symposium presents no research data but invites to
discussion with the aim of facilitating clinical practice informed by attachment theory.
Symposium 4 August 21 10 pm – 11.30 pm
Symposium 4A: Treatment intervention
Presenters:
Joakim Löf (Sweden)
Michael Cleryd ( Sweden)
Effects of mentalization-based treatment in a Swedish clinical setting on
symptom distress, suicide attempts and alexithymia, and predictors of treatment
outcome
Our first data show a significant reduction in symptom distress, suicidal ideation and
alexithymia following the treatment period. There was a reduction in suicide attempts and
emergency hospital visits which was stable for 12 months after treatment completion. We are
analyzing inpatient care, conducting follow-up data collection as well as looking at a contrast
group for comparisons with regard to service use to give an indication to the effects of
treatment. Clinically, we have found substance abusing and very phobic patients to be the
most problematic. We have started to develop some clinical practices to help identify
potential treatment-resistant individuals and, in the case of substance abuse, recruit adjunctive
treatment, which we would like to share with the symposium. There are indications that our
patients improved in their ability to identify and describe emotions, two subcomponents of
alexithymia, a mechanism of change in mentalization-based treatment coherent with the
concept of mentalized affectivity. We have found one symptom severity factor and two
personality factors corresponding to low extroversion/ avoidant / internalizing traits and high
neuroticism/ dependent/ externalizing traits. Our research so far invites the question if the
personality factors seen in our patients could in part be explained by insecure attachment
patterns. The next step in our research is planned to focus on a health-economical analysis on
the one hand and on the other hand rating reflective functioning and attachment
representations. The question we would like to investigate is if and how personality/character
traits change in mentalization-based treatment and if this is related to changes in reflective
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functioning and attachment representations and to improved interpersonal and social
functioning. From the perspective of validity, overcoming hindrances with regard to
evaluating personality and attachment changes in MBT seems to be a crucial step. We would
like to discuss with the symposium how the research community can come together to tackle
this issue.
Presenter 2: Megumi Kitagawa (Japan)
The Circle of Security Intervention to Japanese mothers and effect evaluation by
use of the modified Strange Situation, the COS Interview, and the projective
method to assess attachment representation
Two mothers participated to the Circle of Security (COS) Intervention Program of 11 sessions
weekly. Both mothers were strongly motivated to improve their relationship with their first
child, and registered to participate spontaneously. The COS, originated in the United States, is
an early intervention program for parents and children, and it is evidence based that integrates
attachment research into video based intervention. We are applying this program for the first
time in Japan, with supervision by Bert Powell, who is one of the originators of this
intervention program, and the participating group was our second experience to conduct COS
group in Japan. Assessment was conducted through the modified Strange Situation and the
COS Interview. We also used projective method, in which we show them attachment
stimulating pictures and have them make story freely, to evaluate intervention effect in
representation level. From the Interview, one mother revealed her desire for her son to be
independent. We didn’t challenge her desire, but we helped her to learn that the easiest way to
let him be independent was to respond to his attachment needs. We could also evaluate one
mother as esteem sensitive and she showed idealization toward her own mother. We could say
both the parent education approach about what is important for child to grow secure
attachment to mother and the relationship oriented psychotherapy approach to explore their
unregulated affect that made them uncomfortable to specific needs from child were critical for
their change.
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Symposium 4B: Three Programs of Intervention
Presenter 1: Jonathan Green (United Kingdom)
Parental sensitivity, child attachment behaviour and autism: longitudinal
relationships during a parent-mediated intervention
The relationship between parental sensitivity, attachment status and autism symptoms has
been the subject of considerable recent interest, with parental sensitivity showing
relationships to attachment status not seen in other areas of development, and attachment
status found to be influenced by autism severity, language ability and IQ. Studies to date have
generally been confined to cross-sectional designs. The longitudinal relationship between
parental sensitivity, child attachment behavior and autism symptoms in the context of the Preschool Autism Communication Trial has been investigated, a large RCT of parent-mediated
communication-focused intervention for families and children with autism. Children with core
autism were assessed in a standard setting on the Brief Attachment Screening Questionnaire
for autism as well as measures of autism symptoms, language and social communication. The
carer involved in the intervention was assessed during interaction with their child on the
Coding of Attachment-Related Parenting, modified for autism. Measures were made at
baseline, 7 months midpoint and 13 months endpoint of the trial. Analysis will be presented of
the baseline relationship in this large cohort between parental sensitivity, child attachment
behaviors, autism symptoms and developmental status. Longitudinal analysis will then be
presented of the relationship between these variables over the course of 13 months, including
analysis of the impact of the intervention on parental interactive behavior, child attachment
and general development. This analysis within the PACT trial represents probably the most
extensive investigation to date of the relationship between parental functioning, attachment
behavior and development in pre-school autism. Analysis in this way of the effect of
intervention within a longitudinal analysis of parental and child behaviors can illuminate
causal influences over time.
Presenter 2: Christine Puckering (United Kingdom)
Attachment and Biobehavioural Catch up (ABC): Falling in love with your baby
ABC is a ten-week evidence-based program devised by Mary Dozier to help abused and
neglected children to make secure relationships with their foster parents. The program was
further extended to birth families where parents were struggling to make and sustain good
relationships with their babies. This presentation will describe the program and focus on the
first family to go through this in the UK. The program covers five topics in ten sessions. The
first is providing nurturance even when the child gives unclear signals of need and the second
is allowing the child to take the lead in interaction. The following sessions cover the way in
which parents can frighten their child and how the parent’s own attachment messages may
interfere with the ability to read and respond to the child and ending with the importance of
physical touching. Throughout the sessions didactic material is interspersed with opportunities
to learn about attachment, video feedback to parents of their own interaction with the baby
and home based tasks to reinforce the messages of the program. Video recording of the
intervention will be used to trace the journey of the family.
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Presenter 3: Michael Zilibowitz (Australia)
Watch Wait and Wonder a Parent-Child Education Program and Video
WWW is a well researched and highly effective intervention that uses a child led approach to
heal troubled relationships between parents and young children. By learning to watch and not
intervene parents become more attuned and sensitive to their child’s communication.
Supported in their play, yet unrestricted by adult instruction the child is allowed to express
their inner life and develop a sense of self while the parent begins to appreciate their child’s
individuality. This allows a new rhythm to develop in the attachment relationship. By being
given the freedom to explore while held in the safety net of the parents benign presence and
attention children develop the capacity to be alone. It is these kinds of aloneness with ones
own inner world that Winnicott proposes is the foundation of all creativity. My experience as
a Developmental and Behavioral Pediatrician is that WWW is a concept applicable to children
and parents in the general community and that it has the potential to be part of a universal
approach to parenting. I have adapted the original WWW concept and developed a video
which demonstrates how to do Watch Wait & Wonder in the home setting. The video
discusses its many uses which include settling difficult behaviors such as tantrums and
aggression, fostering children’s imagination and creativity in play , settling difficult sibling
rivalry situations, triggering a surge in general development including speech and language
and helping parents to enjoy their children more. Some parents report “falling in love” with
their child for the first time. Used in this way WWW can be used in a wide variety of
pediatric and community child health settings. This includes group work for parents
struggling with behaviour / attachment problems in their children. I have conducted pilot
research in regular Long Day Care Centres which demonstrates that a significant number of
the parents who used www found it enormously helpful.
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Symposium 4C: Attachment and Psychopathology
Presenter 1: Johanna Behringer
Representations of Past and Current Attachment Relationships as Predictors of
Emotional Experience and Emotion Regulation Strategies in Patients Presenting
with Burnout Syndrome
The burnout syndrome is theorized to result from a displacement of unsatisfied relational
needs from close relationships into the professional domain. This suggests a particular
relevance of attachment and emotional dynamics in the development as well as the treatment
of this kind of psychopathology. Attachment representations of both past and current
attachment relationships were investigated as predictors of emotion experience and emotion
regulation over the course of treatment in patients undergoing between 6 and 8 weeks of
psychodynamically-oriented in-patient treatment in a specialist unit for burnout symptoms. At
intake, the Adult Attachment Interview was conducted to assess attachment representations of
childhood relationships with parents, and the Current Relationship Interview was used to
capture the patients’ representations of their current attachment relationship with their partner.
82% of the participants were classified as insecure in the AAI; 79% received an insecure
classification in the CRI. In the AAI 61% of the sample were found to be ‘unresolved’
regarding loss and/or trauma. As compared to non-unresolved participants, those classified as
unresolved reported more helplessness in terms of their emotional experience, and more
dysfunctional strategies to deal with difficult emotions such as withdrawal and dissociation.
The CRI scales of anger and derogation regarding the current partner were strongly associated
with negative emotions such as loneliness. Over the course of treatment, emotional experience
improved. After treatment, patients who were AAI-unresolved, reported increased use of
reflective strategies to deal with difficult emotions as compared to intake. Patients with
burnout syndrome are characterized by severe attachment disturbances and dysfunctional
emotion regulation strategies. Patients suffering from unresolved loss and/or trauma were
found to benefit particularly from psychodynamic psychotherapy in terms of improving their
reflectiveness as a strategy to deal with negative emotions.
Presenter 2: Sarah I. F. Daniel (Denmark)
Attachment in Bulimia Nervosa: Stability and Change of Attachment States of
Mind in a Randomized Clinical Trial of Psychoanalytic and Cognitive
Behavioral Psychotherapy
Theoretically as well as empirically, eating disorders have been related to insecure attachment
states of mind. Thus, part of a successful treatment of eating disorders may involve changing
client attachment in the direction of increased security. In the Copenhagen Bulimia Trial a
randomized controlled trial of two-year psychoanalytic psychotherapy (PPT) versus 20
sessions of cognitive behavioral therapy (CBT), client attachment was assessed with the Adult
Attachment Interview (AAI) at intake, after 6 months, and after 24 months. At intake, the
sample exhibited roughly equal proportions of the three organized attachment states of mind,
with only a few clients categorized as unresolved or cannot classify. There was more change
in attachment states of mind from intake to 6 months, than from 6 months to 24 months.
Change in attachment states of mind seemed related to being in therapy, in that change
continued throughout PPT, whereas attachment was more stable for CBT clients following the
termination of therapy. In terms of eating disorder symptoms, the symptoms were not related
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to change in attachment states of mind or to change in AAI coherence. CBT was more
effective than PPT in alleviating eating disorder symptoms, whereas PPT was associated with
slightly more improvement in attachment security, although the latter effect was not
statistically significant. Implications of the findings will be discussed with a particular
emphasis on the relation between attachment states of mind and eating disorder symptoms and
on the use of the AAI as a measure of therapeutic change.
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Symposium 4D: Intervention
Presenters:
Stig Torsteinsson (Norway)
Ida Brandtzæg (Norway)
Lars Smith (Norway)
Enhancing attachment: treating disrupted affective parent-child communication
This presentation addresses the empirical foundation and clinical implications of an approach
to attachment-related phenomena that could be construed as micro separations; i.e. disrupted
affective parent-child communication. Micro separations also refer to a historical change of
focus that has taken place in the area of attachment research and applications, away from the
impact of trauma and loss (macro separations) toward a more subtle, and harder-to-find
manifestation of maternal disrupted affective communication (micro separations). New
research suggests that children who experience extensive level of disruptive affective
communication in their childhood are in even higher risk than children who experience
trauma and loss. The present symposium addresses attachment-related treatment guidelines.
We discuss how one may differentiate attachment-related needs from other communications
of the child through psych education of the parents of young children. We emphasize how one
can foster parental internal working models of attachment and mentalizing capacity by
revealing experiences in past and present close relationships and by establishing and
maintaining a conscious process in the therapeutic alliance between the parent and the
therapist. In this endeavor we emphasize the importance of making implicit relational defense
behavior explicit, and how one can increase parental openness to a wider range of affective
experiences. The treatment goal is to develop new skills for balancing the needs of the
parent’s self and the psychological needs of the young child, so that the caregiver can be able
to enhance attachment and be more emotionally available in interacting with the child. The
presenters at this symposium are co-authors of a recently published book by Ida Brandtzæg,
Lars Smith and Stig Torsteinson entitled Microseparations; attachment and treatment.
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Symposium 4E: Attachment issus in daycare and school
Presenter1: Birthe Hagström (Sweden)
Complementary attachment person in preschool
Children whose parents suffer from mental illness are a neglected group. The child´s need for
stable and sensitive parents, is not always compatible with the parents abilities to care for the
child. The objective of my thesis is to study and analyze preschool teacher´s development in
relation to in-service training for a period of three years and the development of teacher´s
work during these years as complementary attachment persons. The in-service training was
inspired by the Illeris model for professional development. In this model the learning process
is based on three dimensions: contents, motivation and teamwork. The in-service training
consisted of lectures, literature studies together with colleagues, daily work with the children
and supervision. To capture the results of the teacher´s learning and development and the
effects on the children´s development, the teachers’ oral and written narratives were used. The
narratives were analyzed. The following areas in the development of teachers´ roles as
complementary attachment person were specifically highlighted: The will to do good, From
believing to understanding, Learning through collaboration, Understanding the child´s
perspective, Understanding of the whole, Educational aspects, and Self reflection. The
teachers’ development and learning in relation to the in-service training were mirrored in their
daily work together with their attachment child. According to the teachers, important areas in
the attachment children´s development were: Continuity, Care and sensitivity, Trust, Turning
points, Development of relations, Playing together with other children, Relations between the
parents and the teachers, The ability to say no and Separation. The results are discussed in
relation to 1) the function of the preschool for children with the need for a complementary
attachment person in pre-school, 2) teachers education and in-service training and 3) the need
for cooperation between child and adult psychiatrists, social service, maternity health, baby
health care, and the preschool sector.
Presenter 2: Christine Kern (Germany)
Is unresolved loss in day care teachers a risk factor for insensitive behavior?
The development of infant day care units will expand in Germany within the next years. Since
educators will have a huge influence on the development of children’s attachment patterns a
group training program for day care teachers SAFE® (Safe Attachment Formation for
Educators) was implemented in 12 infant day care units in the city of Munich. The training is
targeted on the modulation of behavior that leads to a secure partnership between teachers and
children as well as parents and their children. Preliminary data will be presented. Children’s
attachment behavior with mother and educator is measured in Ainsworth’s strange situation.
Educator’s and parent’s attachment representation are tested with the Adult Attachment
Projective before and after day care entry. Their traumatic life events are measured in the
Posttraumatic Stress Diagnostic Scales. We assessed educators with the AAP. 45.2%
displayed the U category and unresolved in the cemetery story dealing with stories about
death and loss. All of the babies we assessed with the mother in the strange situation were
organized attached. Preliminary data will be presented. Contrary to our expectation, a high
percentage of educators displayed the category for unresolved status of attachment
representation. This could have an impact on the attachment quality of the infants in day care.
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Presenter 3: Ingrid Erhardt
Attachment representation and traumatic experience in mothers and their
infants attachment quality
In a longitudinal randomized controlled trial an attachment-based parenting program, SAFE®
- Safe Attachment Formation for Educators is compared with a control group with parenting
program as usual. The program aims to promote secure parent-child attachment relationships.
As a primary prevention the program starts during pregnancy. Non-clinical becoming parents
are allocatd into two groups, SAFE® or control group. We investigate a) whether the
attachment-based primary prevention SAFE® promotes secure attachment relationships
according to mothers attachment representations at baseline and the infants attachment quality
post-intervention and b) which traumatic life events of becoming mothers are associated with
mothers unresolved and insecure attachment representations. SAFE® is conducted by health
care professionals who were trained in attachment theory and its implications for early
development during 10 full days in a group of 5 to 8 parents-to-be. The Adult Attachment
Projective was applied at baseline and at the end of the intervention to identify the parents’
attachment styles and unresolved traumatic experiences. Trauma questionnaires are applied at
baseline. The infants attachment quality was assessed using the Strange Situation Test at the
age of 12 months. Preliminary data will be presented.
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Symposium 4F: Clinical Workshop
Presenter :
Karl Heinz Brisch (Germany)
Attachment-based intensive psychotherapy care unit. A model to treat children
with very severe early traumatization in their attachment relationships
The concept of an attachment-based intensive psychotherapy care unit for the in-patient
treatment of very severely traumatized children will be presented. Most patients had
experienced severe violence and neglect during infancy and early childhood by their primary
care-takers. In the Dr. von Hauner Children’s Hospital of the University of Munich, this
concept was developed especially for children with attachment disorders and early
developmental trauma disorders. Treatment cases will be demonstrated with video clips from
therapy to elaborate the conceptual approach and the course of the treatment. Further
information of follow-up examinations after discharge of the patients will be provided,
especially about the positive changes in the attachment representations of the children.
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