The use and abuse of attachment theory in clinical practice with maltreated children, part II: treatment

Recent years have witnessed a growing debate about the role of attachment theory in the treatment of maltreated children. Many professional organizations have issued statements against physically restraining children as some attachment therapists promote; however, often lost in these debates is the fundamental issue of what attachment theory and research proposes as the appropriate form of treatment. Given that these attachment therapies are often directed toward maltreated children, it becomes critical for clinicians working with abused and neglected children to understand these issues and recognize unethical and dangerous treatments. This article provides a summary of the theoretical and empirical bases for the use of attachment theory in the treatment of maltreated school-age children, an examination of the ways questionable approaches to treatment have misinterpreted and misapplied attachment theory, and a conceptualization of attachment-based intervention grounded in current theory and research.     

Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications

TOPIC: Attachment theory and reactive attachment disorder (RAD). PURPOSE: To highlight current perspectives on attachment theory, RAD, and treatment implications using a case study of an 8-year-old patient with RAD. SOURCES: Selected multidisciplinary literature related to attachment theory and RAD. CONCLUSIONS: The literature provides a body of work that substantiates the importance of early attachment relationships to human development and highlights gaps in our knowledge related to treatment of children with RAD. The quality of early attachment relationships is correlated with future personality and brain development. Attachment disturbances are associated with psychopathology in childhood and adulthood. Although evidence for the effective treatment of children with attachment disorders is minimal and inconclusive, the two major perspectives, developmental psychology and neuropsychoanalysis, offer guidelines for practice.     

The use and abuse of attachment theory in clinical practice with maltreated children, part I: diagnosis and assessment

Debate has ensued regarding the appropriate assessment and diagnosis for school-age children who display severe behavioral problems as a result of previous abuse and neglect within the primary attachment relationship. The current nomenclature recognizes reactive attachment disorder and some clinicians have suggested broader categories of attachment disorder. These attempts at classification are often criticized on empirical grounds; however, often lost in these criticisms is the fact that that these diagnostic approaches often misapply attachment theory and research. This article summarizes the original contributions of John Bowlby and other attachment researchers to our understanding of child development, examines misguided attempts to apply attachment theory to the diagnosis and assessment of maltreated children, and offers a diagnostic conceptualization and assessment recommendations consistent with the available attachment research.     

Differentiation of self and attachment among adult daughters.

The relation among the variables differentiation of self, attachment to mother, and two indicators of mental health were studied in 83 nonclinical adult daughters from a Southern community. An a priori causal model was proposed and tested. Bowen's (1976) theory of differentiation of self and Bowlby's (1969) attachment theory provided the conceptual framework. An operational Daughter Model was tested using the statistical program LISREL. Compared to mothers, daughters scored significantly lower on differentiation of self. Daughter's attachment to mother and daughter's level of self-differentiation were not causally related, supporting the view that differentiation of self and attachment are separate variables in personality development. The daughters' levels of differentiation of self were positively related to positive energy, thus supporting Bowen's theory. These findings affirm the value of attachment behaviors and differentiation of self in adulthood, challenge therapists' bias against attachment behaviors of women, and provide a focus for mental health promotion among women.     

Attachment theory and baby slings/carriers: technological network formation

Healthcare providers recognize the important role played by attachment theory in explaining the close relationship between mental health and social behavior in mothers and their children. This paper uses attachment theory in a socio-cultural context to ascertain the mechanism by which baby slings/carriers, a new technology, produced and reproduced the scientific motherhood. It further applies a social history of technology perspective to understand how baby carriers and attachment theory are socially constructed and historically contingent on three major transformations. These transformations include the use of attachment theory-based baby carriers to further scientific motherhood; the use of baby slings/carriers to further the medicalization of breastfeeding and enhance mother-infant attachment; and the use of baby slings/carriers to transform woman's identities by integrating scientific motherhood, independence and fashion. Implications for nursing clinical policy are suggested.     

Attachment Theory and Violence Toward Women by Male Intimate Partners

Purpose: Explore whether understanding of violence toward women by their male intimate partners is enhanced by attachment theory.
Organizing Framework: This review was focused on the evidence that men prone to intimate partner violence were insecurely attached as infants, and as a consequence, their internal working models of attachment relationships include the use of aggression to gain power and control. These internal working models are brought to their adult relationships with intimate partners. The intergenerational transmission of violence occurs when children who witness episodes of violence in their homes, or experience violence directly as victims, become aggressive in adult relationships. Parallels between concepts of infant attachment and adult romantic attachment, such as maintaining proximity to attachment figures, were examined.
Methods: The literature on attachment theory and intimate partner violence was reviewed. References were identified from electronic databases and from a manual search of the literature.
Conclusions: Evidence about intimate partner violence is consistent with attachment theory. This framework is a base for extension of knowledge of intimate partner violence. Changes in practice, research, and policy to support an attachment perspective are discussed.     

Hypnosis,Attachment, and Oxytocin:An Integrative Perspective 1

This article considers links between clinical hypnosis, attachment theory, and oxytocin. First, it proposes that commonalities between clinical hypnosis and attachment theory may improve our understanding of the hypnotherapeutic process. Then, it suggests that an integrative model unifying clinical hypnosis and attachment theory may constitute a link between clinical hypnosis and a neurobiological factor such as oxytocin. Finally, it discusses the implications of these hypotheses for clinical practice and future researches.     

Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment.

BACKGROUND AND STUDY AIMS: Among colorectal neoplasms, laterally spreading tumors (LSTs) are lesions over 10 mm in diameter that are low in height and grow superficially. As most LSTs are adenomas or mucosal carcinomas, endoscopic resection is desirable, but this has been not easy because of their flat and wide shape. The aim of this study was to explore the usefulness of a distal attachment to the endoscope in the endoscopic resection of LSTs. PATIENTS AND METHODS: The study population consisted of 23 patients with an LST of the large intestine. Using a distal attachment fitted to the distal end of the endoscope, saline solution with a low concentration of epinephrine was injected underneath the lesion. The lesion was snared and drawn into the cap using the suction function of the endoscope, and then ligated and resected using electrocautery. RESULTS: The size of the lesions ranged from 1 cm to 5cm. Endoscopic resection was completed in 22 of 23 patients. Resection in one segment was successful in 15 of 22 patients; in the remaining seven patients, piece-meal resection was done. Pathological investigation showed hyperplasia in one patient, adenoma in 20 (with mild atypia 1, moderate atypia 11, severe atypia 8), and mucosal carcinoma in one patient. Complications occurred in two patients, with one instance of perforation and another of bleeding. Both were successfully treated with endoscopic clipping. Recurrent adenoma was detected in one patient. CONCLUSION: We conclude that the distal attachment was very useful for endoscopically resecting LSTs of the large intestine.     

Toward a theory of holistic needs and the brain

This article reviews Maslow's theory of motivation wherein he proposes a hierarchy of human needs. First, it describes the principal elements of Maslow's theory and discusses considerations relating to the flexibility of the hierarchy. Second, it explains the relationship among Maslow's theory of human needs, attachment theory, and evolutionary threat assessment system theory. Third, it provides an overview of the brain structures posited to be involved in attachment and evolutionary threat assessment system theory and their relation to Maslow's hierarchy. Finally, it explains how the 3 theories converge to form a theory of holistic needs.     

Using attachment theory in mentoring

Attachment theory is a useful way to understand the bond between children and the people with whom they have emotional ties--usually caregivers. The theory can also help us to understand any adult relationship that provides closeness and a sense of attachment, especially in times of stress or need. Understanding the nature, cause and effect of the role and function of attachment from a training and development perspective, and different styles of attachment, may improve the quality of the mentoring experience for both mentors and mentees.     

Attachment Theory and the Milieu Treatment of Children

This article examines some of the advances, particularly those in the area of attachment theory, that have been made in understanding the developing child. The implications of attachment theory for understanding of developmental psychopathology are discussed. The role played by parents in the child's development is briefly outlined. The implications that attachment theory presents for the milieu treatment of children are discussed.     

Adult attachment variables predict depression before and after treatment for chronic pain.

The complex relationship between chronic pain and depression has long been of clinical and empirical interest. Although attachment theory has been described as a "theory of affect regulation", and has been lauded as a developmental framework for chronic pain, surprisingly little research specifically considers the links between adult attachment variables and pain-related depression. A sample of 99 participants with chronic pain of non-cancer origin was evaluated before and after pain rehabilitation. Results demonstrated that two attachment dimensions (comfort with closeness and relationship anxiety) were related to pre- and post-treatment depression. Of particular interest was the finding that comfort with closeness was the unique predictor of lower levels of post-treatment depression, usurping pain intensity and pre-treatment depression. These results are discussed in terms of clinical implications, and suggest that adult attachment theory may prove a valuable perspective in pain treatment programs.     

Continuing bonds in bereavement: an attachment theory based perspective

An attachment theory based perspective on the continuing bond to the deceased (CB) is proposed. The value of attachment theory in specifying the normative course of CB expression and in identifying adaptive versus maladaptive variants of CB expression based on their deviation from this normative course is outlined. The role of individual differences in attachment security on effective versus ineffective use of CB in coping with bereavement also is addressed. Finally, the moderating influence of type of loss (e.g., death of a spouse vs. child), culture, and religion on type of CB expression within an overarching attachment framework is discussed.     

CONTINUING BONDS IN BEREAVEMENT: AN ATTACHMENT THEORY BASED PERSPECTIVE

ABSTRACT

An attachment theory based perspective on the continuing bond to the deceased (CB) is proposed. The value of attachment theory in specifying the normative course of CB expression and in identifying adaptive versus maladaptive variants of CB expression based on their deviation from this normative course is outlined. The role of individual differences in attachment security on effective versus ineffective use of CB in coping with bereavement also is addressed. Finally, the moderating influence of type of loss (e.g., death of a spouse vs. child), culture, and religion on type of CB expression within an overarching attachment framework is discussed.     

Parent-Child Interaction in the First Year Of Life

The first year of life traditionally refers to the growth and development of an infant. Recent studies have disclosed the powerful effects exerted by young babies upon their parents. These influences depend upon distinct, measurable personality and temperamental factors present in the infant from birth. Parent/child attachment has been observed, in both normal nurseries and premature intensive-care units, and appears to comprise a series of species-specific behaviors. Inadequate or incomplete bonding has been strongly correlated with subsequent ‘disorders of parenting’, including non-organic ‘failure to thrive’ and the abused child syndrome. The implications of these current discoveries for family physicians are discussed.     

Irreversible Effects of Serum Proteins on Beta-Lactam Antibiotics

The chromogenic cephalosporin nitrocefin (87/312) demonstrates rapid and visible instability to serum from many species. This phenomenon was distinct from serum binding, being significantly slower. Destruction of another cephalosporin, 10485, by serum appeared to account for some anomalous results during investigation into its human pharmacokinetics. Many cephalosporins of very different structures also showed serum instability, unrelated to their degrees of serum binding as measured by plate assay. Extrapolation could not be made from one species to another with regard to either binding or instability. Small changes in the chemical structures of the 3- and 7-substituents of the cephalosporins made profound changes in their susceptibility to serum attack. The decomposition is pH dependent, occurring more slowly at acid pH, and is due to a high-molecular-weight component of serum that resists boiling for several minutes. Isoelectric focusing of serum from several animal species gave various species-specific bands that decomposed nitrocefin. The inactivation of nitrocefin was not entirely parallel with that of 10485 and was inhibited by it. All other beta-lactam compounds tested also inhibited the reaction, much greater concentrations usually being necessary when the inhibitor was stable to serum. The complex that causes breakdown of the beta-lactam compounds is not necessarily the same as the one causing serum binding. It is postulated that serum may affect most other beta-lactam antibiotics in a similar way, although in most cases, this only occurs to a very slight extent.     

Nurses learn caring theory by being co-researchers in a surgical setting

This paper present findings from research on the following issues: How nurses from surgical unit learn a caring theory by being co-researchers in a research group. The aim was to describe the learning process of the nurses when they were co-researchers in a research group. The study has a qualitative design and a hermeneutical approach. Data were collected through interviews with seven registered nurses in hospital in mid Sweden. The study shows that nurses learn caring by listening to each other. Four sub-themes emerged through the interpretation: Nurses learn caring theory by listening to each other when they are; giving time to talk to one another, expressing their actions in words, sharing thoughts with others and allowing themselves to be touched by each other's stories. The new understanding highlights that learning in research groups can be understood as a learning process, where nurses listen to one another and thereby create an expression and meaning of their experiences through caring theory, while at the same time developing their profession. Nurses learn caring theory by being co-researchers in a research group. In order for this to happen, the research collaboration should be characterized by realism and engagement.     

Detection ofPlasmodium ovalemalaria parasites by species-specific 18S rRNA gene amplification

A polymerase chain reaction (PCR) assay was developed for the specific detection ofPlasmodium ovale, one of the four malaria parasites that infect humans. On the basis of sequence variation of thePlasmodium18S ribosomal RNA (rRNA) gene, oligonucleotide primers for PCR were designed to amplify various fragments of theP. ovalegene. Using a recombinant plasmid with the completeP. ovale18S rRNA gene as target, 59 primer combinations were tested so that at least one of the pairs was species-specific while the other primer was either genus conserved orP. ovalespecies-specific. Three primer pairs yielding DNA fragments at stringent conditions were further tested against genomic DNA of four human malaria species. This approach yieldedP. ovalespecies-specific primer pairs that may be useful for further field testing.     

Continuing Bonds and Reconstructing Meaning: Mitigating Complications in Bereavement

Drawing on attachment theory and constructivist conceptualizations of bereavement, the authors assessed the relation between continuing bonds coping and meaning reconstruction following the death of a loved one and complicated grief symptomatology. Five hundred six young adults in the first two years of bereavement from a variety of losses completed the Inventory of Complicated Grief along with measures of the strength of their ongoing attachment to the deceased and their capacity to make sense of the loss, find benefit in the experience, and reconstruct a progressive sense of identity following the death. Several variables concerning the survivor, his or her relationship to the deceased, and the nature of the death functioned as risk factors for heightened distress, but their role was generally moderated by meaning-making, often to the point of non-significance. In contrast, higher levels of benefit-finding and positive identity change were associated with lower levels of bereavement complication. Finally, an interaction emerged between sense-making and ongoing attachment to the deceased, suggesting that strong continuing bonds predicted greater levels of traumatic and especially separation distress, but only when the survivor was unable to make sense of the loss in personal, practical, existential, or spiritual terms.     

Continuing bonds and reconstructing meaning: mitigating complications in bereavement

Drawing on attachment theory and constructivist conceptualizations of bereavement, the authors assessed the relation between continuing bonds coping and meaning reconstruction following the death of a loved one and complicated grief symptomatology. Five hundred six young adults in the first two years of bereavement from a variety of losses completed the Inventory of Complicated Grief along with measures of the strength of their ongoing attachment to the deceased and their capacity to make sense of the loss, find benefit in the experience, and reconstruct a progressive sense of identity following the death. Several variables concerning the survivor, his or her relationship to the deceased, and the nature of the death functioned as risk factors for heightened distress, but their role was generally moderated by meaning-making, often to the point of non-significance. In contrast, higher levels of benefit-finding and positive identity change were associated with lower levels of bereavement complication. Finally, an interaction emerged between sense-making and ongoing attachment to the deceased, suggesting that strong continuing bonds predicted greater levels of traumatic and especially separation distress, but only when the survivor was unable to make sense of the loss in personal, practical, existential, or spiritual terms.