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A Secure Base by John Bowlby

As Bowlby himself points out in his introduction to this seminal childcare book, to be a successful parent means a lot of very hard work. Giving time and attention to children means sacrificing other interests and activities, but for many people today these are unwelcome truths. Bowlby’s work showed that the early interactions between infant and caregiver have a profound impact on an infant's social, emotional, and intellectual growth. Controversial yet powerfully influential to this day, this classic collection of Bowlby’s lectures offers important guidelines for child rearing based on the crucial role of early relationships. - A Secure Base

Contents

PREFACE TO THE ROUTLEDGE CLASSICS EDITION

John Bowlby's "A Secure Base" (1988). His final contribution to Attachment Theory, summarizing his life's work and acknowledging the next generation of researchers and clinicians. Key themes include:

  • Attachment behavioral response essential for protection from predation and foundation for psychological health.
  • Sensitive caregiving crucial for secure attachment throughout the life cycle.
  • Real-life adversity origin of subsequent psychopathology, opposed to endo-psychic entities.
  • Systematic scientific observation important for understanding attachment phenomena.
  • Secure base for patients therapists providing a safe space for emotional exploration.

Recent advances in Attachment Theory

  1. Attachment to Fathers vital contribution to psychological health, not just security of attachment as measured in Strange Situation. Elicited through exploratory dimension and observed in SCIP measure.
  2. Mentalization and theory of mind enables differentiation between reality and perspective, vital for social interaction and survival.
  3. Interpersonal aspects of psychotherapy parallels between secure parenting and good therapy; therapist's role as a companion for patients.

CARING FOR CHILDREN

  • Desire to have healthy, happy, self-reliant children with great rewards for success
  • High stakes as successful parenting contributes to next generation's mental health
  • Ethological approach: child's tie to mother (attachment) is a result of preprogrammed behavior patterns
    • Activated by pain, fatigue, frightening situations, or inaccessibility
    • Terminated by sight/sound of mother or physical contact
    • Biological function: protection from predators
  • Attachment behavior not limited to children; seen in adolescents and adults under stress
  • Intensity of emotion accompanying attachment behavior varies based on relationship with attachment figure
  • Parenting behavior also influenced by experiences in family of origin or out of it
  • Parenting behavior has strong biological roots but detailed form depends on individual experiences
  • Ethological approach: observe and describe parenting behavior, conditions that activate/terminate, changes as child grows older, organization in different individuals, and influences on development.

Social Context

  • Engaging in parenthood is a lot of hard work and requires assistance from others
  • Society's organization affects the availability of help for parents
  • Modern society overlooks the importance of man and woman power devoted to childcare.

INITIATION OF MOTHER–INFANT INTERACTION

Mother-Infant Interaction

  • Mother's behavior towards newborns:
    • Immediately after birth, mothers pick up and stroke their babies' faces with finger tips, leading to quieting.
    • Within minutes, they move on to touching heads and bodies with palms, and put the baby to breast for prolonged licking of nipple.
  • Mothers are in a state of ecstasy after delivery, and attention is riveted on the baby.
  • Mother-infant interaction:
    • Phases of lively social interaction followed by disengagement.
    • Initiation and mutual greeting lead to animated interchange with facial expressions and vocalizations.
    • Infants initiate and withdraw from interaction based on their own rhythm, while mothers regulate their behavior to mesh with the infant's.
  • Mothers adapt their responses to suit the infant: gentle voice, slowed movements, and adjusted timing.
  • Mutual enjoyment and efficient dialogue development indicate preadaptation for engagement.
  • Examples of mother-child interaction:
    • Mother-infant feeding: mothers interact in synchrony with infant's sucking and pausing.
    • Mother-infant exploration: infants lead, mothers follow and elaborate on shared focus of interest.
    • Preverbal vocal interchange: turn-taking ability present in infants as young as 12 months.
  • Sensitive mother's attunement to infant's natural rhythms makes the infant contented and enlists cooperation.
  • Infants are preprogrammed to develop in a socially cooperative way, depending on how they are treated.
  • Different view of human nature and parenting role compared to traditional western perspectives.

ROLES OF MOTHERS AND FATHERS: SIMILARITIES AND DIFFERENCES

  • Studies using the strange situation procedure have primarily focused on infants' attachment with mothers.
  • A study by Main and Weston:
    • Similar percentage distribution of secure and insecure attachment patterns between mothers and fathers when looked at as a group.
    • No correlation between individual children's attachment patterns with each parent.
    • Secure relationship with one parent but not the other, secure relationship with both parents, or secure relationship with neither resulted in varying levels of confidence and competence for children.
  • The pattern of attachment a child develops with their father is likely influenced by how their father has treated them.
  • Fathers provide a secure base for their children, offering emotional and physical support, encouragement, and intervention when necessary.
  • Parents' role as a secure base allows children to explore the world and return knowing they will be welcomed and supported.
  • The significance of the secure base is apparent when one or both parents become ill or die.
  • Parents play various roles, including influencing their child's behavior through techniques that can be encouraging or restrictive/disciplinary.
  • Techniques used by parents vary greatly from largely helpful and encouraging to largely restrictive and punitive.

PERI-AND POST-NATAL CONDITIONS THAT HELP OR HINDER

Peri-and Post-Natal Conditions

  • Ordinary sensitive parents are attuned to their child's actions and signals, respond appropriately, and monitor the effects of their behavior
  • Adequate time and relaxed atmosphere are necessary for a parent to behave in these ways
  • Practical help and emotional support from female companions during labor, delivery, and early post-natal period can significantly improve mother's ability to bond with her baby
  • Constant friendly support during labor and delivery can lead to shorter labor, increased maternal interaction with the baby, and better maternal behavior towards the baby in the first year of life
  • Studies have shown that peri-and post-natal experiences play a significant role in either assisting or impeding a mother's development of a loving and sensitive relationship with her baby

Influence of Parents’ Childhood Experiences

  • A mother's feelings for and behavior towards her baby are influenced by her previous personal experiences, especially those related to her own parents
  • Systematic studies of young children show that the influence of parents on their children's caring patterns starts very early
  • Children whose mothers respond sensitively to their signals and provide comforting bodily contact are more likely to respond appropriately to others in distress
  • Women who have had disrupted childhoods tend to engage less with their infants, particularly during the critical period when interaction is determined almost entirely by the mother
  • Studies of parents known to have abused their children physically show a common pattern of erratic or absent parental care, frequent criticism and blame, and violent behavior towards family members
  • Women with these childhood experiences are more likely to engage in unfavorable parenting attitudes and behaviors if they experience adverse events during the peri-and early post-natal periods.

HOW WE CAN BEST HELP

First principles for helping young people become sensitive, caring parents:

  • Teach by example, not precept or instruction
  • Provide opportunities for young people to observe sensitive, caring parents
  • Discuss with them the difficulties and rewards of parenting
  • Enlist active cooperation of sensitive, caring parents

Pregnancy and Childbirth:

  • Increased desire for care reported in women during pregnancy (Wenner, 1966; Ballou, 1978).
  • Importance of sensitive parenting: Stern (1977), Sander (1977), Brazelton et al. (1974), Schaffer (1977).
  • Heightened sensitivity in women during pregnancy (Winnicott, 1957).
  • Secure attachment to mother develops through close physical contact during infancy (Ainsworth et al., 1978).
  • Studies on effects of early mother-infant contact: Klaus et al. (1986), Svejda et al. (1980).
  • Studies on mother-infant contact and labor duration (Lamb, 1977; Parke, 1979; Clarke-Stewart, 1978; Mackey, 1979; Klaus et al., 1986)
  • Role of close physical contact with mother during infancy (Ainsworth et al., 1978)

Caution:

  • Discrepancies in findings on early mother-infant contact (Svejda, Campos, and Emde, 1980)
  • Not certain that in every case the child's mother was always the abusing parent in two studies.

THE ORIGINS OF ATTACHMENT THEORY

  • In 1981, John Bowlby recounted the history of attachment theory in a speech for the American Orthopsychiatric Association.
  • He acknowledged the support from the Josiah Macy Junior, Ford, and Foundations Fund for Research in Psychiatry.
  • During the 1930s and 40s, clinicians like Lauretta Bender, John Bowlby, Dorothy Burlingham & Anna Freud, William Goldfarb, David Levy, and René Spitz observed the negative effects of institutional care and frequent mother figure changes on personality development.
  • In 1950, Ronald Hargreaves, a British psychiatrist, invited Bowlby to contribute to a UN study on homeless children, leading to the publication of "Maternal Care and Mental Health" in 1951.
  • Films like "Grief: A Peril in Infancy" (René Spitz, 1947) and "A Two-Year-Old Goes to Hospital" (James Robertson, 1952) had a significant impact on the field.
  • Controversy continued throughout the 1950s with criticisms from traditional psychiatrists, learning theory psychologists, and some psychoanalysts.
  • Research continued, including Sally Provence and Rose Lipton's study of institutionalized infants (Provence & Lipton, 1962), Christoph Heinicke and Ilse Westheimer's studies at the Tavistock Clinic, and Harry Harlow's rhesus monkey studies.
  • The field evolved with the publication of Mary Ainsworth's review (1962) and Harry Harlow's experimental results, which helped to silence criticism.
  • Questions remained regarding the long-term effects, responsible features, and accountability for persistent ill effects, as well as misunderstandings about the theory.

A NEW LOOK AT THEORY

Maternal Care and Mental Health:

  • Part 1 reviews adverse effects of maternal deprivation
  • Part 2 discusses prevention methods
  • Missing explanation for how experiences under "maternal deprivation" affect personality development
  • At that time, theories focused on food as primary drive and personal relationship (dependency) as secondary
  • This theory did not fit observations of children's ties to their mothers
  • Alternative theory from Hungarian school of psychoanalysis postulated mother's breast as first object with emphasis on food and orality
  • None of these theories fully explained human experience
  • Discovered Lorenz's work on ducklings and goslings, revealing new world of studying relationships in non-human species
  • Decided to apply ethological principles to understanding child's tie to mother
  • From 1957 to 1980, focused on developing attachment theory as an alternative to traditional psychoanalysis
  • Attachment theory accommodates various phenomena Freud addressed and offers new perspective

Child's tie to mother

  • Previously held that child develops close tie due to maternal feeding (primary drive) and personal relationship (secondary dependency)
  • Alternative theory: attachment behavior, distinct from feeding or sex motivation
  • Attachment behavior is any form of behavior aimed at attaining/maintaining proximity to a specific individual perceived as better able to cope with the world
  • Most obvious when person is frightened, fatigued, or sick; assuaged by comforting and caregiving
  • Provides strong feeling of security and encourages relationship continuation
  • Observed throughout life cycle, especially in emergencies
  • Integral part of human nature shared with other species
  • Biological function: protection

Attachment behavior

  • Disposition to seek proximity to and contact with a specific individual
  • Persisting attribute that changes slowly over time and is unaffected by the situation of the moment
  • Attachment behavior refers to various forms of behavior engaged in to obtain/maintain desired proximity
  • Preference hierarchy of attachment figures present, even in absence of primary attachment figure
  • Enduring attachment bond is confined to very few individuals
  • Theory attempts to explain both episodic attachment behavior and enduring attachments

Behavioral system

  • Conceived as a psychological organization with specific features, including representational models of self and attachment figures
  • Similar to other structural theories, such as psychoanalysis, in having well-defined properties that differentiate it from behaviorism

Separation anxiety

  • Anxiety about losing or becoming separated from someone loved
  • Mystery why mere separation causes anxiety
  • Many hypotheses proposed by psychoanalysts and other researchers
  • Ethological approach reveals it's a basic human disposition, triggered by an increase of risk
  • Threats of abandonment can cause intense anxiety and anger

Mourning

  • Response to a loss after it has occurred
  • Identified as playing a causal role in emotional disturbance since early years of psychoanalysis
  • Controversy over whether children can mourn and nature of mourning
  • Mourning responses in adults last longer than assumed, include anger, disbelief, and search for lost person
  • Similarities between mourning responses in adults and children

Defensive Processes

  • Crucial step to conceptualize defensive processes
  • Young child's detached behavior after being away from mother is a result of some defensive process
  • Information about attachment behavior is failing to reach the behavioral system responsible for it, suggesting signals are being blocked off and behavior system immobilized
  • Mental structures responsible for routine selective exclusion are being employed for a special and potentially pathological purpose (defensive exclusion)

RESEARCH

Maternal Deprivation Research

  • Extensive research on maternal deprivation's impact on children's psychological development has been comprehensively reviewed by Rutter (1979)
  • Principal finding: Interactive effect of adverse experiences leading to increased risk of psychological disturbances
  • Example: Recent studies, like those of Brown and Harris (1978), have shown that the risk of psychological disturbance following adverse experiences is often multiplied when two or more occur.
  • Adverse childhood experiences make individuals more vulnerable to later adverse experiences and increase the likelihood of encountering them
  • Effects on parental behavior and next generation are potentially the most serious
  • Theory essential for guiding research, interpreting findings, and developing preventative measures

Psychoanalysis as Art and Science

  • Psychoanalysis as both art (therapy) and science
  • Distinction between practitioner and research scientist
  • Practitioner: Focuses on individual cases, applies scientific principles, uses personal experience, attends to unique features of each patient
  • Scientist: Ignores the particular in favor of general patterns, simplifies, risks over-simplification
  • Advantages and disadvantages for each role
  • Practitioner advantages: Access to information not available to scientists, ability to intervene and observe consequences
  • Scientist advantages: Enlists new methods to cross-check observations and hypotheses, devises new ways to observe phenomena
  • Misunderstanding of psychoanalysis as only appropriate method for psychoanalytic science advancement is harmful.

SCEPTICISM AND FAITH

  • The role of criticism and self-criticism in science: scientists must challenge and question data and theories, no place for authority
  • In clinical practice, faith and hope are important for effective treatment
  • Scientists have faith in the application of scientific method to expand reliable knowledge
  • Some psychoanalysts believe problems lie outside scope of science, but there may be unsolved problems
  • Differences between roles of practitioner and scientist: practitioners deal with complexity, scientists strive to simplify, etc.
  • In author's own work, focus on interaction of internal and external experiences in child development
  • Pioneering work in direct observation of children in psychoanalysis not widely accepted as essential for advancing science

Mary Ainsworth's study of mother-infant interaction during first year of life

  • infants use mother as base to explore when conditions are favorable.
  • Ainsworth and her team studied the attachment behavior of infants towards their mothers at 12 months old, observing them both at home and in a strange test situation.
  • They classified infants into three main groups based on two criteria: exploration behavior and treatment of mother.
  • Group X infants were active explorers who used mother as a secure base, returning to her for contact when needed.
  • Group Z infants were either passive or ambivalent, exploring little and showing anxiety towards mother's absence and return.
  • Group Y infants showed intermediate behavior.
  • Mothers of group X infants were rated highly sensitive, while mothers of group Z infants were rated low in sensitivity.
  • Sensitive mothers are "tuned in" to their babies' signals, interpret them correctly, and respond promptly and appropriately.
  • Insensitive mothers often do not notice or misinterpret their babies' signals, responding tardily, inappropriately, or not at all.
  • Ainsworth's findings suggest that a sensitive, responsive mothering style is associated with a child who trusts his mother, enjoys her company, and develops self-reliance by the first birthday.
  • Conversely, insensitive mothering can lead to an unhappy, anxious, or difficult child.
  • Further research is necessary to draw conclusions with high confidence, but the patterns of personality development and mother-child interaction at 12 months are similar to what is seen in later years.

mother’s responsiveness and infants behavior

  • Ainsworth's findings Ainsworth found a correlation between a mother's responsiveness and an infant's behavior towards her at 12 months, which has been confirmed by subsequent studies.

  • Infant's role in interaction development Some argue that infants determine how interaction develops, but observations during the first three months showed no correlation between crying and maternal treatment. By the end of the first year, mothers who attended to crying babies had less crying infants than those who did not.

  • Mother's role in interaction development Mothers play a significant role in setting the pattern of interaction with their babies. Reliable observation methods reveal how different children's experiences can be and lead to highly significant correlations between child development and parental treatment.

  • Effects of insensitive mothering Insensitive mothering, including rejection and separations, can have deplorable effects on children, increasing fear, demands, anger, and despair.

  • Schizoid/borderline personality disorders These conditions are characterized by assertive independence, emotional self-sufficiency, and a reluctance to seek treatment. Debate continues about the role of early environmental failure, particularly "not good enough mothering," in their development.

  • Analytic treatment and observation Analytic treatment and direct observation of young children with their mothers are valuable sources for understanding these conditions and their potential causes.

data obtained during treatment

  1. Winnicott's theory: Suggests that emotionally self-sufficient patients with psychosomatic symptoms had disturbed childhoods marked by inadequate mothering.
  2. Case reports: Illustrate findings from three analysts influenced by Winnicott's views.
  3. Clare Winnicott's patient: A professional woman of 41, whose emotional life dried up after being left alone at age 2½ and taken to a boarding school.
  4. Jonathan Pedder's patient: A young teacher in her mid-twenties who felt more connected to her aunt than her mother and was terrified of separation.
  5. Elizabeth Lind's patient: A young graduate of 23 who felt rejected, hated his parents, and had a philosophy of life that saw depression as normal.
  6. Commonalities: All patients had recent breakdowns following the collapse of relationships and developed intense attachments to their analysts during therapy.
  7. Winnicott's technique: Permitting free expression of dependency feelings led to recovery of emotional life and a sense of 'real self'.
  8. Controversies about aetiology: Relying solely on retrospective evidence from patients is insufficient; direct observations of young children and their mothers are needed for cross-checks.
  9. Direct observations: Children can develop defensive numbing in response to rejection or lack of mothering, leading to avoidance of attachment.
  10. Research: Studying parents and children interacting and keeping detailed records during analysis could yield valuable insights.

PSYCHOANALYSIS AS A NATURAL SCIENCE

  1. Freud's Intentions for Psychoanalysis as a Natural Science

    • Freud's intention from 1895 was to establish psychoanalysis as a natural science.
    • He believed psychology should be a natural science once the concept of unconscious mental processes is granted.

  2. Controversy over Psychoanalysis as a Natural Science

    • Critics label psychoanalysis a pseudoscience due to its unfalsifiable theories.
    • Some analysts abandon Freud's aims and claim it should be considered one of the humanities.

  3. New Initiatives in Developing Psychoanalysis as a Natural Science

    • Analysts are attempting to replace Freud's metapsychology with new conceptual frameworks consistent with current scientific thinking.
    • Others are extending the discipline's database by studying children's social and emotional development using direct observations.

  4. Attachment Theory

    • Human infants come into the world genetically biased to develop proximity-keeping behaviors.
    • A secure base provided by a caregiver enables a child to explore confidently.
    • The availability of a responsive attachment figure remains the source of a person's feeling secure throughout life.

  5. Theoretical Model for Attachment Behavior

    • Proximity-keeping behavior is mediated by a set of behavioral systems organized cybernetically.
    • Exploratory behavior and attachment behavior are incompatible, with exploration only occurring when attachment behavior is relatively inactive.

  6. Development of Attachment Systems

    • The development of attachment systems during individual development is attributed to natural selection.
    • A disposition to show attachment behavior is an intrinsic part of human nature.

  7. Solution to the Problem of Purposiveness in Behavior

    • Activation, termination, and change of emotional state are caused by a system receiving specific information.
    • The biological function of activation is the one that evidence suggests has led to the system's evolution.
    • In the case of attachment behavior, the function postulated is diminishing the risk of harm to the individual.

At this level of analysis...

  • At this level of analysis, individual awareness and motivation have no relevance for biological systems serving vital functions.
  • Awareness of terminating conditions for behavior emerges in human children by the end of their first year.
  • Once a child is aware of terminating conditions, concepts like intention, goal, satisfaction, pleasure, and frustration arise.
  • Function served by a behavior and awareness of terminating conditions are distinct criteria that separate the biological realm from the psychological.
  • Human personality develops along one of many possible pathways determined by interaction between the organism and environment.
  • Attachment behavior is a distinct characteristic present throughout life, with parental treatment being a significant determinant of the chosen pathway.
  • Freud's theories on motivation and development were influenced by outdated biological ideas like Lamarck's inheritance of acquired characteristics and Haeckel's biogenetic law.
  • Current work in developmental psychology and human information processing provides a more accurate framework for understanding emotional and social development.

Californian analyst's account

  • illustrates the distressing personal problems arising from experiences following parents' divorce and long institutional stays.
  • The woman patient, Mrs. G, felt irritable, depressed, filled with hate and evil, and emotionally detached from her husband.
  • Mrs. G was extremely reluctant to recall painful childhood memories but was encouraged to reflect on them in detail for therapeutic purposes.
  • Her relationship with her analyst also revealed interpersonal difficulties she had experienced in other close relationships.
  • Mrs. G's childhood was marked by painful experiences, including being parted from her pets and sent to an orphanage
  • At the orphanage, she felt small, there were no toys, harsh treatment, and she deliberately misbehaved for attention

After four years of analysis

  • financial difficulties led to ending treatment in six months
  • Emotional conflicts with her analyst intensified, leading to dreams and daydreams about him
  • Fear of abandonment and anger towards those who denied her love and care increased
  • Before the analysis, Mrs. G was emotionally detached and indifferent to loss
  • Analysis restored feeling life and ability to make improved relationships, but she remained vulnerable to situations that arouse anxiety and sadness
  • Traditional explanations for her condition include schizoid, false self, or narcissistic disorders
  • Explanation based on early development of affectional bonds: prolonged frustration of attachment behavior led to deactivation and defensive exclusion of related information
  • Therapeutic change due to patient developing courage to allow excluded information to be processed

Analyst drew on knowledge of childhood conditions that can lead to disturbed development, such as prolonged separation from mother during early years

Systematic study of children's development essential for progress in understanding personality development and psychopathology.

This is but one way in which...

  • Psychoanalysis as a body of knowledge about personality development and psychopathology can move towards becoming a natural science, with a framework that accommodates a substantial proportion of psychoanalytic data and guides research
  • Framework is compatible with evolutionary biology and neurophysiology, promises greater economy and internal consistency than traditional ones
  • Extensive testing needed to determine strengths and weaknesses, especially in areas like sexual development and deviation
  • Critics argue that psychoanalysis cannot be a natural science due to belief in logical positivism and reductionism
  • Evolutionary epistemology holds that all knowledge is conjectural and science progresses through new theories replacing older ones if they explain more phenomena and make more accurate predictions
  • Reductionism, explaining complex phenomena with concepts from lower levels of complexity, is now recognized as fallacious
  • Science deals in generalities but has little to say about singular specific events
  • Psychoanalysis deals with both general principles (natural sciences) and individual problems (historical sciences), each approach contributes to understanding but clear distinction necessary.

VIOLENCE IN THE FAMILY

  • Family violence, especially parental violence, has been neglected in mental health field and psychoanalysis
  • Reasons for neglect include focus on fantasy and reluctance to examine real-life events
  • Freud's decision to dismiss childhood memories as imaginary set a precedent against attributing psychopathology to real experiences
  • Parental adverse behavior towards children was taboo subject in analytic circles when author started professional work, leading her to focus on separation and loss
  • Today, it is widely recognized that many children are physically or verbally battered by parents, and understanding of their backgrounds evokes compassion rather than blame
  • Goal is now to help and prevent violent patterns in new families.

CONCEPTUAL FRAMEWORK

  • Anger is a common response to threats to special relationships, especially those of a sexual, familial nature
  • Anxiety and anger are linked responses to potential loss
  • Anger can be functional in deterring dangerous behavior, driving off rivals, or coercing partners to protect valuable relationships
  • Freud proposed libidinal relationships result from individual needs for food and sex, later proposing a death instinct to explain puzzling manifestations of anger
  • Some clinicians have abandoned Freud's metapsychology due to its remoteness from clinical observation
  • Modern biology, specifically ethology and evolution theory, provide insight into the importance of relationships in emotional life
  • Three main types of relationships that can arouse strong emotions: sexual partners, parents, and offspring
  • Emotional state is determined by these long-term relationships, with anxiety or anger arising when they are threatened
  • Attachment behavior results in an individual maintaining proximity to or communication with another seen as better able to cope, elicited by pain, fatigue, fear, or caregiver's absence
  • Sensitive loving care leads to confidence and self-reliance, while neglect or rejection can result in anxious attachment or avoidant behavior with angry outbursts
  • Attachment behavior is a human characteristic throughout life, despite being less intense in adolescents and adults
  • Caregiving behavior, or parenting, is also influenced by biology but learned through interaction and observation.

RESEARCH FINDINGS

  1. Women who physically assault their children: Research findings suggest agreement on the occurrence of this issue in all socio-economic classes, with common emotional traits including anxiety, impulsivity, distrust, and isolation. Many have had miserable childhoods and some were battered as children.
  2. Effects on children: Children of abusive mothers may experience high levels of anxiety and anger towards separation situations, yearning for care but expecting rejection.
    • A significant number had experienced repeated threats of abandonment or violence from their parents. Few could turn to their mothers for help during distress.
  3. Men who batter wives or children: Less researched area, but findings suggest similar emotional patterns in men, including anxiety and impulsivity. Socio-economic status is also a factor.
  4. Attachment theory: Suggests women suffering from an extreme degree of anxious attachment due to experiences of long or repeated separations and/or threats of abandonment during childhood.
  5. Study by Pauline DeLozier (1982): Confirmed high levels of anxiety and anger towards separation situations in abusive mothers, as well as a high incidence of reported threats of abandonment from parents. However, actual separations from parents were not more common in the abusive group.

I began seeing this woman...

  • Mrs. Q brought her son to see a doctor due to his refusal to eat and weight loss
  • Mrs. Q was intensely anxious and depressed since her son's birth, had impulses to harm him, and sometimes became hysterical
  • Her childhood was marked by bitter quarrels between her parents, threats of desertion, and her mother's suicide attempts
  • She grew up terrified of displeasing her mother and was forbidden to speak about the incidents outside the home
  • Mrs. Q had violent and destructive outbursts towards less dangerous targets like crockery, pram, and almost but not quite her son
  • The angry outbursts were understood as an expression of long-suppressed anger generated by her mother's threats
  • Children who are assaulted by parents often show depressed, passive, inhibited, anxious, and angry behavior
  • They may also exhibit aggressive behavior towards other children and adults, particularly in response to friendly overtures
  • Abused toddlers have a reputation for finding it difficult to make relationships and being very aggressive in nursery settings
  • Abused toddlers were three times more likely than controls to take avoiding action towards caregivers, and all ten of them showed approach-avoidance behavior towards other children
  • Aggressive behavior was more common in the abused group, with five of them assaulting or threatening an adult
  • Abused toddlers also exhibited a particularly disagreeable type of aggression called 'harassment' which has the sole intent of making the victim show distress
  • Abused toddlers are unsympathetic to age-mates in distress and do not show concern or make moves to comfort them
  • The behavior of abused children leaves no doubts about what types of family experience influence development in one direction or another.
  • Some children recover with improved conditions of care, while others suffer serious brain damage or continue to have adverse conditions of care.
  • Once a child has developed disagreeable patterns of behavior, it is challenging for adults to provide them with continuous affectionate care and psychotherapy is taxing.
  • Emotionally disturbed children may reach psychiatric clinics where the origin of their condition often goes unrecognized.
  • Some abused children grow up to perpetuate the cycle of family violence by responding in social situations with the same patterns of behavior they developed during early childhood.
  • Abusive parents often respond to a crying infant with less sympathy, more annoyance, and anger.
  • The profound and far-reaching effects of childhood abuse and rejection are often suppressed and falsified by parents and overlooked by clinicians.

Men who abuse

  1. Mr S was a man who unpredictably and inexplicably attacked his wife. He loved her but feared his own violence, which he saw as madness.
  2. Childhood experiences: Mr S described harsh treatment in his large working-class family where parents were constantly quarreling. He felt anger and despair, explaining his violent behavior.
  3. Trigger for violence: Outbursts occurred soon after the birth of their first child due to intense jealousy over wife's attention to the baby.
  4. Characteristic of abusive men: Sudden, inexplicable outbursts are common among men who batter wives. Five out of 19 cases investigated by Marsden and Owens (1975) exhibited this behavior.
  5. Intergenerational cycle of violence: Men who were battered children now grown up make up a significant proportion of abusive husbands. Studies show that most violent offenders come from homes with cruel treatment. Wives often come from similar backgrounds and have been battered as children, leading to quick pregnancies and increased problems for the unprepared mother.
  6. Patterns of interaction in disturbed families: Violence or threats occur daily in these families, but partners are deeply attached and use coercive techniques to control each other and prevent departure.
  7. Coercive techniques: Threats of desertion or suicide, imprisonment, and battering were common methods used by both men and women to keep their partners from leaving. These techniques aroused guilt and anger but ensured attention in the short term.
  8. Desire for caregiving figure: Each partner believed the other needed them more while denying their own need for companionship to avoid loneliness.

PREVENTIVE MEASURES

Preventive measures in violent families: Home-Start service is promising for some families

  • Home-Start is an independently organized home-visiting scheme in the UK, now spreading in the US
  • Offers support, friendship, and practical assistance to young families experiencing difficulties
  • Staffed by volunteers who are mothers, working in close liaison with statutory services
  • Visits are by invitation of the family, no contracts or time limits
  • Volunteers attend a preparatory course and receive ongoing training
  • Advantages: volunteers have time, meet families on equal terms, can compare notes, and provide availability outside regular hours
  • Families visited have difficulties present or imminent, not specifically aimed at abusing families
  • Many advantages for families: encourages mothers, provides example, offers assistance in acquiring skills
  • Key to relationship: volunteer is a mother who understands the problems from inside
  • Success reported in evaluation of first four years' work of pioneer service (van der Eyken, 1982)
  • Random sample of families assessed using a three-point scale: no change, some change, considerable change
  • Volunteers were most pessimistic, social workers and health visitors were more hopeful, families themselves reported the highest success rate (85%)

ON KNOWING WHAT YOU ARE NOT SUPPOSED TO

  1. The text discusses the importance of acknowledging adverse childhood experiences in causing cognitive disturbances.
  2. Eric Wittkower's paper, focusing on this topic, was expanded for a volume on Cognition and Psychotherapy.
  3. Neglect of this field can be attributed to:
    • Focus on fantasy within psychoanalytic thought.
    • Difficulty in doing systematic research due to clinicians' lack of knowledge or experience with childhood experiences.
  4. Three categories of scenes and experiences that tend to become shut off:
    • Those parents wish their children not to know about.
    • Those in which parents have treated children in ways they find unbearable.
    • Those in which children have done things they feel unbearably guilty or ashamed about.
  5. Evidence shows that parents sometimes press their children to shut off information about events they wish had never occurred, leading to cognitive disturbance.
  6. Instances include survivors of parental suicide being pressured to believe the death was due to something other than suicide.
  7. Children may develop problems such as chronic distrust, inhibition, distrust of their senses, and a tendency to find everything unreal.
  8. Parents may wish to keep secrets about their sexual activities, leading children to be instructed not to remember certain scenes.
  9. Renewed attention has been paid to incest, with common problems including withdrawal from relationships, sleep disturbances, and suicidal intentions.
  10. Prepubertal children are especially susceptible to cognitive disturbance due to adverse childhood experiences.

Father-daughter incest

  1. Incestuous relationships between fathers and adolescent daughters often go unacknowledged by the father during daily life, with secret glances, touching, and innuendoes.
  2. Younger children may not experience such acknowledgements and their father behaves as if no nighttime episodes occurred even after the daughter has reached adolescence.
  3. In cases of incest, the cognitive split between the respected father of daytime and the very different father of the night can confuse the child, leading to distrust of all men and a belief that no one would believe their story.
  4. When a parent dies, surviving parents or relatives may provide children with inadequate or misleading information and encourage them not to express feelings of sadness or cry.
  5. Children are often expected to be grateful for care from a mother who herself had a childhood deprived of love, resulting in a one-sided picture of her as wholly loving and generous, shutting away feelings of anger.
  6. Parents, having had traumatic childhoods, may require their children to appear happy and avoid expressing sorrow or anger, leading to feelings of loneliness being shut away.
  7. Pressure from parents, including threats of abandonment, can result in acute and chronic anxiety and depression in later life.
  8. Pre-adolescent children are especially vulnerable to outside influence and may fail to report sexual themes or other sensitive information due to the climate they experience at home.
  9. The minds of pre-adolescent children are prone to the influence of parents, with children's responses to pictures correlating with how parents discuss them.
  10. Information can be selectively excluded from perception through a multistage process of human information processing.

Studies of human perception

  • a large proportion of sensory inflow is excluded before awareness due to limited capacity of advanced processing channels.
  • Selection of inflow is under central control to ensure relevance and prevent overload.
  • Dichotic listening experiments demonstrate continuous, advanced processing of unattended messages without awareness, especially for personally significant information.
  • Criteria for accepting or excluding sensory inflow are based on what's in a person's best interests and can change depending on the situation.
  • Selective exclusion happens unconsciously.
  • Experiences that tend to be shut off and forgotten include those where parents treated children unbearably, leading to disorders of personality such as narcissism, false self, fugue, psychosis, or multiple personality.
  • These experiences often involve repeated rejection, contempt, physical violence, and sexual exploitation during childhood, usually starting around the first two or three years and continuing for several years.
  • Patients with less severe disorders may make progress in treatment but remain sensitive to further misfortune.
  • More severe disorders result in personality splitting.
  • An example of a patient labeled as 'false self' had a severely depressed young graduate who recalled his mother's consistent rejection and ignored crying, while another patient experienced institutionalization starting at age 4.
  • Patients with similar experiences but more severe disorders have been described by therapists in the past decade, such as Geraldine, an 11-year-old girl who lost memory of her mother's terminal illness and subsequent years.
  • Geraldine described feeling scared to disobey her mother, witnessing her attacking family members, and blotting out feelings to keep going.
  • These experiences were more than she could endure, and she feared the consequences if she had let them hit her.

The complex psychological state of Geraldine

  • Geraldine's psychological state and childhood experiences resemble those of multiple personality patients.
  • Bliss (1980) described 14 female patients with multiple personality, attributing subordinate personalities to distinct roles created by the principal personality during distressing childhood events.
  • Roles include companions/protectors, anesthetics, and those shouldering responsibility for unbearable thoughts, feelings, and actions.
  • Findings from hypnotic procedures are controversial, but similar conclusions reached by University of California at Irvine research group using conventional procedures.
  • Child psychiatrists and psychotherapists have described children with paranoid ideas and violent behavior due to abusive parental treatment.
  • Children may fear imaginary monsters as a reflection of real-life parental attacks.
  • Childhood experiences of near-psychotic children resemble those believed characteristic of adult patients with multiple personality.
  • Therapeutic approaches involve recognizing "fantasy" as a reflection of reality and identifying the experiences behind the deceptive camouflage.
  • The hypothesis is that emotionally significant events and experiences that have become shut away from conscious processing influence current cognition, affect, and behavior.
  • The therapeutic task is to help patients discover and ponder on these past scenes and experiences to reappraise their responses and potentially restructure them.
  • Convergence in therapeutic principles seen across different approaches, including traditional psychoanalysis, behavior therapy, and bereavement therapy.

THE ROLE OF ATTACHMENT IN PERSONALITY

  • Attachment theory was developed in the 1980s to explain patterns of behavior related to intimate emotional bonds

Distinctive Features of Attachment Theory:

  • Explains patterns of behavior regarding intimate emotional bonds, not subordinate to or derivative from food and sex
  • Biological function of attachment: protection, comfort, and support
  • Emphasizes the powerful influence of parents' treatment on a child's development
  • Reformulation of psychoanalytic metapsychology in line with modern biology and psychology

The Primacy of Intimate Emotional Bonds:

  • Basic component of human nature, present from birth to old age
  • Infants form bonds with parents for protection and support
  • Communication between infant and mother is initially emotional
  • Caregiving is a basic component of human nature, complementary to attachment behavior
  • Exploration is a third basic component, antithetic to attachment behavior

Attachment Behavior:

  • Organized system that keeps proximity or accessibility to a discriminated mother-figure
  • Infants develop cognitive capacity to keep mother in mind when she's not present around nine months old
  • Infants respond to being left with a strange person by protesting and crying during the second half of the first year

Attachment Control System:

  • Maintains a person's relation to their attachment figure within certain limits using communication methods
  • Gives attention to conditions terminating behavior as well as initiating it
  • A fruitful framework for empirical research

Advantages of Attachment Theory:

  • Contains a theory of motivation that replaces traditional theories invoking energy or drive build-up
  • Central features of personality functioning throughout life: attachment control system and working models of self and attachment figures.

PATTERNS OF ATTACHMENT AND CONDITIONS

  • Attachment theory focuses on the role of parents in determining how a child's attachment pattern develops
    • Three principal patterns of attachment identified: secure, anxious resistant, and anxious avoidant
  • Secure attachment: individual feels confident parent will be available, responsive, and helpful
    • Promoted by readily available, sensitive, and lovingly responsive parents
  • Anxious resistant attachment: individual uncertain if parent will be available or responsive
    • Promoted by inconsistent availability and threats of abandonment
  • Anxious avoidant attachment: individual has no confidence in receiving help from parents
    • Expects rebuffs and attempts emotional self-sufficiency
    • Result of constant rejection and repeated rejections
  • Disorganized attachment patterns also identified, often seen in infants with physical or sexual abuse, severe bipolar affective illness, or mourning mothers
  • Mothers' treatment of children at 2½ years old correlates with child's pattern of attachment assessed earlier
    • Mother of secure infant is attentive and sensitive; mother of insecure infant less so
  • Influences on a mother's style of mothering: emotional support or lack thereof, own childhood experiences
    • Therapeutic approach replaces blaming parents with understanding their past and current emotional needs.

PERSISTENCE OF PATTERNS

  • Patterns of attachment developed in one-year-olds tend to persist due to consistent parental treatment and self-perpetuating behavior
  • Secure children are happier and less demanding, while anxious-ambivalent and anxious-avoidant children elicit unfavorable responses from parents, leading to vicious circles
  • Patterns of attachment are a property of the relationship during the first two or three years, but become increasingly a property of the child as they grow older
  • Securely attached children at 12 months are cooperative, popular, resilient, and resourceful in nursery groups; anxious-avoidant children are emotionally insulated, hostile, antisocial, and seeking attention; anxious-resistant children are also seeking attention but may be tense, impulsive, passive, or self-conscious
  • Children classified as disorganized or disoriented at 12 months tend to control or dominate parents at age 6
  • Interactions with mothers are more influential on personality development during the early years than interactions with fathers
  • Effective interventions for 6-year-olds should take both child and parent influences into account, such as family therapy or parallel help for parents and children.

A THEORY OF INTERNALIZATION

  1. Attachment Theory: Explains how patterns of attachment become a property of the child himself through the concept of working models of self and parents.
  2. Working Models: Built during first few years of life based on real-life experiences with parents. Influence feelings, expectations, and behavior towards parents and self.
  3. Securely Attached Child: Builds free-flowing models of self and parents, allowing for gradual updating as parents' treatment changes.
  4. Anxiously Attached Child: Patterns of interaction persist despite different treatments in later life due to defensive exclusion of discrepant experience and information.
  5. Communication Variable: Crucial for understanding why one child develops healthily and another becomes disturbed. Freely flowing communication between parent and child is characteristic of securely attached pairs.
  6. Mothers of Securely Attached Children: Continuously monitor infant's state, respond promptly to signals, and engage in free-flowing communication.
  7. Mothers of Insecurely Attached Children: Monitor infant's state sporadically, respond tardily or inappropriately, and limit communication.
  8. Impact on Child's Development: Differences in freedom of communication from early days lead to secure or insecure attachment patterns. Obstruction to communication between different parts of a personality can result in major parts becoming split off from recognized parts.

VARIATIONS IN A MOTHER’S WAY OF RECALLING HER CHILDHOOD EXPERIENCE

  1. Main's longitudinal study found a strong correlation between a mother's description of her childhood relationships and her child's pattern of attachment.
  2. A mother of a secure infant can freely and coherently discuss her happy childhood, giving due place to unhappy events.
  3. A mother of an insecure infant may respond differently:
    • Mothers of anxious resistant children describe difficult, unhappy relationships with their own mothers, still disturbed and entangled mentally.
    • Mothers of anxious avoidant children claim a happy childhood but are unable to provide detail or recall specific episodes.
  4. Exceptional mothers, who had an unhappy childhood but have securely attached children, can tell their story in a fluent and coherent way, integrating positive experiences with negative ones.
  5. Free access to and the coherent organization of information relevant to attachment play a determining role in the development of a secure personality in adult life.
  6. For someone who suffered much unhappiness or whose parents forbade her to notice or remember adverse events, access to such memories is painful and difficult but can be regained with help.

PATHWAYS TO PERSONALITY DEVELOPMENT

  1. Attachment Theory: Differentiates from traditional psychoanalytic theory by rejecting the model of development through fixed stages and replacing it with a model of various developmental pathways.
  2. Rejection of Traditional Model: Traditional models assume that an individual shows signs of pathology during certain phases of normal development, such as anxious clinging or deep withdrawal. However, these features are not present in healthy infants.
  3. Model of Developmental Pathways: Infants are socially responsive from birth and have an array of potential pathways for personality development. The one taken depends on the interaction between the individual and the environment.
  4. Healthy vs Deviant Pathways: Some pathways lead to mental health, others deviate in ways that are incompatible with it. Parental treatment plays a significant role in determining which pathway an infant follows.
  5. Sensitive Parents: Sensitive and responsive parents enable children to develop along a healthy pathway. Insensitive, unresponsive, neglectful, or rejecting parents can lead children down a deviant pathway.
  6. Continuing Potential for Change: The capacity for developmental change diminishes with age but continues throughout the life cycle, allowing for effective therapy and potential shifts in either a more favourable or less favourable direction.

ATTACHMENT, COMMUNICATION, AND THE THERAPEUTIC PROCESS

Attachment theory's therapeutic implications were discussed in a 1976 Maudsley Lecture, "The making and breaking of affectional bonds" (1977)

  • Therapist aims to help patient reconstruct working models of self and attachment figures
  • Five therapeutic tasks for individual therapy:
    1. Provide a secure base for exploration of past and present unhappy experiences
    2. Encourage examination of current relationships, expectations, and unconscious biases
    3. Examine the relationship between patient and therapist
    4. Help patient consider origins of perceptions and expectations from childhood or misleading messages
    5. Enable recognition and reevaluation of inappropriate images of self and others
  • Therapist's role is to provide a secure base, similar to Winnicott's "holding" or Bion's "containing"
  • Patient may misunderstand therapist due to past experiences or unrealistic expectations
  • Counter-transference is important and requires therapist awareness of own contribution to the relationship
  • Focus on interactions in the here and now, with exploration of past for insight into current ways of feeling and dealing with life.

INFLUENCE OF EARLIER EXPERIENCES ON THE TRANSFERENCE RELATIONSHIP

  • The patient's apprehension towards therapists can stem from past experiences of rejection, criticism, or humiliation by parents
  • Some patients have been instructed to keep family issues secret, creating a dilemma for them when therapists insist on open communication
  • Inverted relationships in childhood, where a parent seeks the child as an attachment figure and caregiver, can lead to wariness of close contact with therapists
  • Patients may reenact past experiences towards therapists, such as hostility, contempt, or sexual advances
  • Anxiety, distrust, and criticism can dominate the therapeutic relationship for some patients
  • Gratitude, admiration, and affection may idealize the therapist for others
  • Unrealistic expectations and compliance enforced in childhood can lead to unconscious assumptions of therapist's expectations and methods
  • Parents' misguided behavior often results from their own difficult childhood experiences
  • Therapists should avoid moral judgement and encourage patients to understand parents' behaviors and motivations.

SOME PATHOGENIC SITUATIONS AND EVENTS OF CHILDHOOD

  1. Threats not to love a child: A mother or father threatening to withhold affection, comfort, help, or encouragement if a child behaves in certain ways can lead to intense anxiety and guilt in the child.
  2. Threats to abandon a child: More frightening than threats not to love, threats to abandon involve a parent's threat to leave or disappear, often with idiosyncratic phrases that serve as code words for the child.
  3. Threats to commit suicide: Distraught parents may use suicide threats during quarrels or directly to their children, instilling great fear.
  4. Disclaimers and disconfirmations: Parents who deny or disconfirm what they have said or done can lead to uncertainty and guilt in the child about family episodes.
  5. Invalid accounts of parents: Sweeping and extreme accounts of parents, lacking detail or contradicting known facts, should be examined closely.
  6. Pathological lying: Rare cases where a patient is a pathological liar should be suspected when inconsistencies and improbabilities emerge in their story.
  7. Other adverse events: A child may never have been wanted, be of the wrong sex, made the family scapegoat, subjected to guilt-inducing techniques, identified with a difficult relative, physically or sexually abused.
  8. Unregistered influential events: The best a therapist can do is infer the nature of events from the transference situation and available information, resorting to reconstruction based on wider knowledge of family influences on personality development.

THE THERAPIST’S STANCE

  1. Therapeutic Stance: Therapist's role as a companion, encouraging patient to discover their models and understand past experiences leading to current behaviors.
  2. Secure Base: Therapist provides acceptance, respect, reliability, attentiveness, empathy, and sympathy for the patient.
  3. Active Role: Therapist takes initiative when necessary, drawing attention to avoidance or encouraging exploration of past memories.
  4. Patient's Reactions: Respectful response to patient's reactions to interruptions, considering underlying causes based on attachment theory.
  5. Communication During Breaks: Balancing sympathy and boundaries in meeting a patient's desire for communication during breaks.
  6. Physical Contact: Making decisions about physical contact based on the situation, aware of potential sexual feelings and maintaining professional boundaries.