Attachment theory in adult psychiatry. Part 1: Conceptualisations, measurement and clinical research findings

Abstract

Since its original conception by Bowlby to explain an important evolutionary function of the childcaregiver relationship, attachment theory has been supported by much empirical research in a variety of settings. However, although attachment theory began as a clinical enterprise, its wider application to the everyday clinical understanding of adult mental health problems has lagged behind the available research. The theory can afford valuable insight not only into the developmental nature of common psychiatric disorders, but also into the development of the therapeutic relationship. This article gives an overview of (a) the current conceptualisations of attachment and the measurement of attachment for clinical research purposes and (b) the application of attachment theory to different psychopathologies. The importance of attachment to the therapeutic relationship will be discussed in a future article.Ken Ma is a Specialist Registrar in Child and Adolescent Psychiatry at The Blakesley Centre (102 Blakesley Road, Birmingham B25 8RN, UK. Email: kenkkma@yahoo.co.uk), and is also an Associate Clinical Teacher at the University of Warwick. His interests include the contribution of attachment theory to personality development and the help-seeking literature, and the assessment of attachment in adolescents and adulthood.

Attachment theory in adult psychiatry. Part 2: Importance to the therapeutic relationship

“…'s case vignette illustrates the provision of a corrective experience. Judging from her upbringing in an anxiety-ridden family, and her premorbid personality, it is quite possible that Mrs A. might be 'preoccupied' in her state of mind with respect to attachment (Main & Goldwyn, 1998) (see Ma, 2006: Table 2). Clinicians might regard patients such as Mrs A. as 'clingy' and 'overdependent', as demonstrated by the feelings of Ms T.'s colleague.…”

“…Psychiatric staff who function as caregivers may play an important role in providing both a secure base for patients whose attachment needs are activated during periods of distress and corrective experiences that disconfirm patients' insecure 'internal working models' of attachment relationships (see Ma, 2006), thus enabling more secure ways of interacting with others. The case vignette of Mr G. with which I opened this article illustrates the secure base function that can be fulfilled by individual keyworkers.…”

“…This is the second of two articles by Kenneth Ma discussing attachment theory in general adult psychiatry. The first article (Ma, 2006), which should be read in conjunction with the current one, gave an overview of attachment theory, and outlined some of the latest research into the relationship between attachment and different psychiatric disorders. …”

Rethinking placebo in psychiatry: how and why placebo effects occur

“…Attachment style can be secure, insecure or disorganised, depending on early infant-carer interactions. Attachment style influences vulnerability to psychiatric disorders and patterns of engagement with professional caregivers (Ma 2006(Ma , 2007. Studies in diabetes have shown that attachment style influences how individuals adhere to treatment to such an extent that it is predictive of the degree of diabetic control that they achieve (Ciechanowski 2001(Ciechanowski , 2004.…”

Mental health nurses’ perceptions of attachment style as a construct in a medium secure hospital: a thematic analysis

“…Insecure attachment styles are associated with a wide range of negative outcomes including increased risk for depression, anxiety disorder, poor social functioning, stressrelated disorders, substance abuse disorders, eating disorders, and personality disorders (Berry et al, 2008;Bifulco et al, 2006;Ma, 2006;Goodwin, 2003;Ravitz et al, 2010). A high proportion of mental health service users (with adverse childhood experiences) are described by clinicians as displaying insecure and dysfunctional patterns of attachment Schuengel et al, 2001;van Ijzendoorn et al, 1997).…”