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Attachment Theory was developed by Bowlby and Ainsworth and are useful concepts for understanding the psychodynamic causes of emotion dysregulation, adverse childhood experiences, trauma, early relationship traumas, negative thinking and behaviours, coping and defence mechanisms.

Bowlby established three central postulates:

1. When individuals trust the attachment figure there will be reduced anxiety.
2. Trust in the early attachment figure leads to secure attachment expectations throughout life.
3. Availability of the attachment figure in early years, childhood and adolescence leads to positive expectations of attachment figures throughout life.

Children’s behaviours based on the four main types of attachment are:

1. Secure Attachment – socially oriented, relationship competent, empathic, popular, express impulses, wishes, feelings and negative feelings, resilient under stress.
2. Insecure-Avoidant Attachment – less likely to express wishes to people, elicit more punishing reactions from adults, less empathic, supportive, behaviour is inappropriate and/or hurtful, hostile, aggressive, distanced, take advantage, devalue and punish others and are often the perpetrator.
3. Insecure-Ambivalent Attachment – seek proximity of adults, wait for adults initiative rather than initiate contact themselves, relinquish leadership roles and initiative, prefer to be followers, accept being teased and exploited, often take role of victim, perpetuate pattern from home.
4. Insecure-Disorganised – more rare than above types, attachment needs have been violated more severely.

Manifestation of adult symptomology based on childhood insecure attachment:

• increased risk of personality disorder, depression, anxiety, negative relationships, anti-social behaviours.
• mental disorders are more likely to be preceded with insecure attachment from childhood.
• insecure attachment style is viewed as the single risk factor for development of mental disorder.
• increased emotion dysregulation, automatic perceptual tendencies, automatised aspects of relationship regulation, avoidance reactions all stored in implicit memory (unconscious).

Supporting clients with insecure attachment:

• CBT is less effective
• Need to address avoidance and conflict schemas in current relationship and interpersonal experiences
• Explore direct consequences of attachment need violations in early years of life where stress tolerance was reduced, poor emotional regulation was established, reduced self-efficacy expectancies, reduced self-esteem were all created.
• Identify goals for Problem Mastery/Symptom Reduction, Interpersonal Goals, Well-being improvements, Orientation Meaning, Self-actualisation/Self-Esteem, Seeking Joy and Avoiding Distress.
• Identify disorder-specific therapy
• Interpersonal therapy must focus on problematic avoidance schemas, reduced stress tolerance, reduced emotion dysregulation, unfavourable consistency-securing mechanisms, reduced self-esteem regulation, basic needs.
• Need for control in goal-achievement, creating positive control experiences in session and outside session.
• Develop coping mechanisms.
• Therapist must be a model of positive attachment: being available, sensitive, responsive.
• Avoid focusing on anxiety and focus on positive outcomes – reframe, positive suggestion, visualisation, meditation, relaxation, energisation, exercise, nature, arts, music, social engagement, service to others.
• Address shame and guilt thoroughly as possible.

Attachment and Mental Disorders

Mental disorders may be determined before birth leading to a tendency to experience negative emotions and increased sensitivity and high responsiveness to avoidance. This may be caused by multiple genes . One of these genes is called the serotonin-transporter gene. The reduced expression of this gene leads to a decreased level of serotonin functioning which leads to reduced calming effect. Children may be harder to calm down and be very demanding.

Individuals with insecurely-attached mothers are more likely to develop insecure attachment and to pass this onto their own children. There may also be a risk factor for a child to have an inherited tendency toward an avoidant temperament. Another risk factor is the presence of mental disorders among parents such as severe depression.

Life experiences of a child leaves deep traces in implicit/unconscious memory. The child may or may not be able to access their needs/goals.

Establishing and maintaining positive intrapersonal regulation of emotion and need states can be difficult around dysregulation like anxiety in the first few years of life. Early childhood establishes experience of negative emotions, avoidant motivational schemas, strong inconsistency tension (basis for avoidance learning) – the child is motivated to avoid negative states. Unpredictable parenting leads to approach-avoidance schema conflict. 80% of children severely abused/neglected will develop insecure attachment usually of the disorganised type and go onto develop serious mental disorders.

Stress response in early childhood can reduce the size of the hippocampus due to increased cortisol thus reducing explicit memory contents which protect the individual from clear memories about their abuse. Hippocampus is also responsible for placing experiences in contest (time and space). Therefore incongruence persists and in adulthood what we may perceive as moderate stressors in the environment are amplified for clients like this which can lead to severe depression.

Because the motivational system is rooted in implicit memory clients cannot recall the process in which their personalities were formed such as our beliefs and behaviours. Clients suffer by their disorders which are the result of insecure attachment and abuse. The explicit/conscious self has to endure the implicit/unconscious self. For healthy people we can control our needs and goals, behaviours and thoughts. For people with mental disorders they cannot. They are not in control of their behaviours, thoughts and motivational schemas. These disorders are not experienced as being controlled by the conscious ‘I’ as Grawe (2007) states. They suffer. The mental disorder presents experiences and behaviours that are contrary to one’s wishes. As a therapist we explore with the client the reasons and explanations for their behaviour now that was created in the past which satisfies one of their goals. Then it may reveal something they need to change.

Moving into Adulthood from Childhood with Mental Disorder

Insecurely attached children may have decreased self confidence, reduced self-efficacy expectancies, increased negative self-esteem, reduced resilience to stress and challenges, decreased social skills to have positive relationships, reduced empathy, unpopular with others. They may not be able to express impulses, wishes or feelings. They will carry all of this forward into school, with their peers and teachers. They will have motivational avoidant schemas and attachment styles. They often do not ask for help, they elicit punishing reactions from teachers, increased control-discipline from teachers,  less willingness to comply, less warmth and more anger.  If they see other children in distress an insecure-avoidant child will react with little empathy and support and will behave inappropriately and hurtfully. Their relationships with peers are often hostile, aggressive and distanced. In play they exploit, derogate others and act with hostility, hitting and punishing them. They assume a role of perpetrator perpetuating the rejection and isolation they incur when they’re at home.

Insecure-ambivalent children seek proximity of the teacher. They always wait for the teacher to initiate tasks and choices. They don’t display initiative and decision-making. Teachers are more attentive and tolerant to these types of children and will excuse their minor transgressions more than insecure-avoidant children. They help them more. With other children the insecure-ambivalent child will let them take initiative again. If other children tease or exploit them they will let them. Again they perpetuate the patterns from home.

By 10-15 years old they develop mental disorders, presenting with negative emotions, autonomic arousal, dysregulation, anxiety/depressive mood episodes. High comorbidity rates with anxiety, social relatedness, eating disorders, substance misuse. Disorders like social relatedness and anxiety precedes depressive disorders among teenagers.  Original experiences of violations of attachment and control needs, self esteem all lead to increased risk of mental disorder. Increased insecure attachment leads to attachment disturbances.

Helpful and healing interventions:

• a single loving relationship with someone can heal the attachment hurt from the past
• interpersonal relatedness with positive attachment and authority figures.
• Consistency approach – focusing on the persons endeavours, meeting their needs and values and goals. Inconsistency is the most influential factor in the emergence of mental disorders.
• Congruence approach – forming motivational approach schemas that lead to positive experiences. Congruence and consistency are the motivational aspects of mental functioning.

Their autonomic nervous system is hyper-aroused at an early age forming neural circuits where the amygdala is easily and strongly triggered, reducing emotion regulation and stress tolerance accompanied with poor coping mechanisms, increased inconsistency tension, increased need violation, increased avoidance schemas all leading to poor satisfaction. Insecurely attached people encounter challenging peer relationships creating new mental injuries and need violations. Interpersonal relationships are the source of problems rather than satisfactions.

© Martin Handy 2022