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ATTACHMENT THEORY AND MOTHER-CHILD
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ATTACHMENT THEORY AND MOTHER-CHILD RELATIONSHIPS
FROM A PHENOMENOLOGICAL PERSPECTIVE

By

Victoria Ann Fitton

A DISSERTATION
Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
School of Social Work

2008

ABSTRACT

ATTACHMENT THEORY AND MOTHER-CHILD RELATIONSHIPS
FROM A PHENOMENOLOGICAL PERSPECTIVE

By
Victoria Ann Fitton

Attachment theory was developed by John Bowlby and ﬁrst explicated in,
The Nature of the Child’s Tie to His Mother (1958). Bowlby believed that
attachment behaviors must exist and be reciprocated for the infant to survive
both physically and psychically, which presupposes evolutionary biological
necessity. Attachment is deﬁned as an enduring relationship between a young
child and her mother (Ainsworth, Blehar, Waters, & Wall, 1978). It is an emotional
and affective bond or tie that reﬂects the enjoyment, the attraction, that one
individual has for another speciﬁc individual (Ainsworth, 1969; Bowlby, 1958;
Cassidy, 1999; Sroufe, Fox, & Pancake, 1983).

This is a multiple manuscript dissertation. Chapter 1 provides a general
introduction to and overview of attachment theory and a brief description of
previous mother-infant/child research and outcome interpretations. Additionally,
Chapter 1 explicates the connection of the successive papers to attachment
theory and offers a rationale for the inclusion and links between the manuscripts.

Chapter 2 is the attachment theory literature review. Attachment
deﬁnitions are delineated and then attachment as a construct is broken down into
components for clariﬁcation. The early history and development of attachment
theory and its theoretical grounding are examined. Attachment research areas

and interests, strengths and weaknesses of previous research, and implications

for future research are discussed. Implications for policy making, program
development, and clinical social work treatment are offered.

Chapter 3 is a case study of a young mother and her infant. Depression,
ambivalence, attachment, and culture are examined, but the case is grounded
fundamentally in the attachment disturbances experienced by the mother: with
her baby, her dead husband, her parents, and her own internal working models.

Chapter 4 is a paper based on an observational study designed to
determine indicators of healthy and pleasurable attachment between women
caregivers and young toddlers. Six indicators of healthy and pleasurable
attachment evolved from the coding process: reciprocity and mutuality, proximity,
verbal communication, affect and emotion, physical affection, and play. These
indicators were then linked to similar elements in the therapeutic relationship that
may be utilized in attachment reparation.

Chapter 5 is a paper based on semi-structured, phenomenological
interviews with women as mothers of young children. The study was designed to
explore the attachment relationship between mothers and their infants/toddlers to
gain an understanding of the meanings women attribute to being a mother and
participant in an attachment relationship with their infant/toddler.

Chapter 6 provides an overall conclusion to the multiple manuscript
dissertation. The case study, observational study, and interviews are linked to the
literature review. The strengths and weaknesses of the research designs are
discussed. And the results of the two studies, along with the literature review, are

linked to implications for practice, treatment, and education.

DEDICATION

This dissertation is dedicated to all of the women in my life. To my
grandmothers who showed me that grandmother love lasts a lifetime. To my
mother, and all the mothers I’ve known over the years, for what they’ve taught
me about mother-infant attachment. To my daughter who taught me by example
that attachment relationships can be healed. To my sister who was a second
mother to my children and showed me that attachment has many faces. To all of
my friends and the sisterhood of women, those who have had and those who
have not had children of their own, who love children deeply and showed me that
maternal love transcends mere biology. And to my granddaughters who showed

me unconditional love and taught me that children love intensely and forever.

iv

ACKNOWLEDGMENTS

I wish to acknowledge and thank Dr. Rena Harold, Dr. John Mooradian,
Jo Ann McFall, and Dr. Joyce Ladenson for their service on my guidance and
dissertation committees and for their invaluable advice, support, and
encouragement during the doctoral program. I am grateful to Jo Ann McFall for
her teaching and mentoring which led to the writing of the clinical case study
(Chapter 3). I am indebted to Dr. John Mooradian for his advice and guidance in
the design of the observational study (Chapter 4). I am appreciative of Dr. Joyce
Ladenson for her expertise in women’s studies that set the stage for the feminist
perspective in my work. And I am profoundly thankful to Dr. Rena Harold for her
guidance in the design of the phenomenological interviews (Chapter 5) and for
her invaluable role as Dissertation Chair. An exceptional committee provides the
framework and impetus for a doctoral student to perform at maximum potential.
This exceptional committee made it possible for me to write this dissertation and
complete the doctorate in a spirit of professionalism and friendship mixed with
pleasure.

I also wish to acknowledge and thank the women who participated in the
phenomenological interviews that informed Chapter 5. This project was a
genuinely pleasurable experience. A debt of gratitude is owed these mothers for
the admittance they offered into their personal lives and a glimpse of the world

they share with their child/ren, a world that ﬁlls their days and their hearts.

TABLE OF CONTENTS

LIST OF TABLES ................................................................................................ ix

LIST OF FIGURES ............................................................................................... x
CHAPTER 1

Introduction and Overview .................................................................................... 1

A Brief Overview of Attachment Theory ..................................................... 3

Brief Description of Previous Mother-lnfant/Child Research ...................... 5

Overview and Rationale of the Links Between the Manuscripts ................ 8

Conclusion ............................................................................................... 10

References .............................................................................................. 12
CHAPTER 2

Attachment Theory Revisited: Its Roots and Research with Implications for Policy

and Practice ....................................................................................................... 15

Abstract ................................................................................................... 16

Attachment Deﬁnitions ............................................................................. 18

Attachment Components ......................................................................... 19

Physical Security Component ....................................................... 21

Behavioral Component ................................................................. 21

Psychic Component ...................................................................... 23

Affective Component .................................................................... 23

Kinesthetic/‘I'actile Component ..................................................... 24

Holding Environment .................................................................... 24

History, Development, and Epistemological Legacy ................................ 25

Theoretical Grounding ............................................................................. 31

Category 1 — Behavior .................................................................. 31

Category 2 — Positivism ................................................................ 32

Category 3 - Systems .................................................................. 32

Category 4 - Instinct ..................................................................... 33

Category 5 - Life Models .............................................................. 34

Category 6 — Learning .................................................................. 34

New Research Areas and Interests ......................................................... 35

Strengths and Weaknesses In Past Research ........................................ 39

Implications for Future Research ............................................................. 42

Implications for Policy Making and Program Development ...................... 44

Implications for Clinical Social Work Treatment ...................................... 46

Conclusion ............................................................................................... 49

References .............................................................................................. 51

vi

CHAPTER 3
A Case Study: A Discussion of Depression, Ambivalence, Attachment and

Culture Portrayed in the Therapeutic Environment ............................................ 63
Abstract ................................................................................................... 64
Background ............................................................................................. 66
Depression .............................................................................................. 67
Ambivalence ............................................................................................ 70
Attachment .............................................................................................. 76
Culture ..................................................................................................... 82
Conclusion ............................................................................................... 87
References .............................................................................................. 89

CHAPTER 4

Attachment: Indicators from Caregivers and Toddlers — Implications for Adult

Treatment ........................................................................................................... 91
Abstract ................................................................................................... 92
Research Questions ................................................................................ 95
Study Purpose ......................................................................................... 95
Literature Review and Theoretical Framework ........................................ 99
Method ................................................................................................... 105
Subject Selection .................................................................................... 107
Data Collection ....................................................................................... 108
Data Analysis ......................................................................................... 109
Discussion .............................................................................................. 1 10

Reciprocity ................................................................................... 1 10
Mutuality ...................................................................................... 1 12
Proximity ...................................................................................... 1 13
Verbal Communication ................................................................ 1 14
Affect and Emotion ...................................................................... 1 15
Physical Affection ........................................................................ 1 15
Play .............................................................................................. 1 16
Environmental Space ................................................................... 1 17
Signaling Behaviors ..................................................................... 1 19
Aversive Behaviors ...................................................................... 120
Active Behaviors .......................................................................... 121
Applicability of Study Findings to Practice Settings ................................ 121
Trustworthiness ...................................................................................... 125
Study Limitations .................................................................................... 125
Conclusion .............................................................................................. 127
References ............................................................................................. 128

vii

CHAPTER 5

Women as Mothers of Children in the Attachment Relationship ....................... 132
Abstract .................................................................................................. 133
Literature Review .................................................................................... 137

Physical Security Component ...................................................... 140
Behavioral Component ................................................................ 142
Psychic Component ..................................................................... 143
Affective Component ................................................................... 144
Kinestheticl'l'actile Component .................................................... 144
Holding Environment ..................................... , .............................. 145
Method ................................................................................................... 145
Subject Selection .................................................................................... 148
Data Collection ....................................................................................... 149
Data Analysis ......................................................................................... 153
Interpretations ........................................................................................ 155
Relationship ................................................................................. 156
Attachment ................................................................................... 157
Secure Base ................................................................................ 158
Attachment Indicators ............................................................................. 159
Reciprocity and Mutuality ............................................................. 159
Proximity ...................................................................................... 160
Verbal Communication ................................................................ 161
Affect and Emotion ...................................................................... 163
Physical Affection ........................................................................ 164
Play .............................................................................................. 165
Education ..................................................................................... 166
Responsibility ............................................................................... 168
Childcare ...................................................................................... 170
Time Management ....................................................................... 171
Trustworthiness ...................................................................................... 174
Limitations .............................................................................................. 175
Conclusion .............................................................................................. 176
References ............................................................................................. 179

CHAPTER 6

Conclusion ........................................................................................................ 184
Mother-Child Attachment Relationships Across Papers ......................... 187
Papers Connected to the Literature Review ........................................... 189
Implications for Practice and Education .................................................. 191
Strengths and Weaknesses of the Research Designs ............................ 195
Further Areas of Study ........................................................................... 198
Conclusion .............................................................................................. 200
References ............................................................................................. 202

viii

LIST OF TABLES

Table 4-1. Categories of Attachment Indicators in

Attachment Relationships .............................................................. 1 1 1
Table 5-1. Interview Questions ........................................................................ 152
Table 5-2. Categories and Themes ................................................................. 155

ix

Figure 2-1.

Figure 4-1.
Figure 4-2.
Figure 4-3.

Figure 4-4.

Figure 5-1.

LIST OF FIGURES

Holding Environment of Mother-lnfant/Child

Attachment Relationship ................................................................. 20
The Observation Check List ............................................................ 97
Caregiver-Child Interaction in Natural Environment ........................ 98
Caregiver-Child Interaction in Built Environment ............................. 99

Holding Environment of Mother-lnfant/Child
Attachment Relationship ............................................................... 1 03
Holding Environment of Mother-Infant/Child

Attachment Relationship ............................................................... 141

CHAPTER 1

Introduction and Overview

We’re getting close, and his hands are going up. He’s starting to
reach when he wants to be held.... I feel like I’m still getting to know
who he is. And it’s still all that excitement. You know, in the morning
when they wake up and see you and they’re grinning from ear to
ear and they’re just delighted that you’re back.... He calls us... he
has a deﬁnite little sing-song call when he’s upset and he’s wanting
us to come in to get him.... He’ll call out to us and we’ll come in, so
the conversation has started and it just feels good. It just feels good

that he’s responsive (Amy).

Attachment behaviors serve different functions. Signaling behaviors such
as smiling, waving, vocalizing, calling, and laughing alert the caregiver that the
infant desires interaction and woos the mother to the child. Aversive behaviors
like crying, kicking, and screaming trigger a quick maternal response to terminate
the infant or child’s problem or provide protection and safety. And active
behaviors like approaching, holding, touching, and following take the child to
closer proximity with the mother and secure base (Ainsworth, 1967; Ainsworth &
Bell, 1970; Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1958, 1982; Seifer
& Schiller, 1995). The mother, quoted above, is describing signaling behavior by
her infant.

Women are primary caregivers, though not the only caregivers of children,
and women as mothers with their infant/child are typically the objects of

attachment research, therefore women as mothers form the cornerstone of this

dissertation. (Feminine pronouns are utilized throughout this work in deference to
the preponderance of childcare provided by women, even though some men are
very or exclusively involved in caring for their children.) The case study is written
about a mother and her infant and their struggle toward attachment. The
observational study focuses on women caregivers and toddlers, although the
vast majority of the subjects were mothers as opposed to nannies or
grandmothers. The phenomenological interviews were conducted exclusively
with mothers of infants and children to offer mothers an opportunity to attribute
particular meaning to their personal stories and experiences. This purposive
sampling highlights the positive interactions between mothers and their children
and the stories of these women as mothers. It is meant to create an optimistic
and afﬁrmative Counterbalance to the 50 years of research about women from a

somewhat pejorative perspective.

A Brief Overview of Attachment Theory

John Bowlby (1958, 1982, 1988) developed attachment theory over 50
years ago as a perspective on the secure base functions of close relationships
that operate to promote child development, personality development, and affect
regulation. Attachment is a physiological, emotional, cognitive, and social
phenomenon that manifests in the holding environment of the mother-infant
attachment relationship. “Whoever is caring for a child must know that child and
must work on the basis of a personal living relationship with that child” (Winnicott,

1993, p. 99). Attachment is the deep and enduring connection established

between a child and caregiver in the ﬁrst several years of life that sets the stage
for all future human relationships (Bowlby, 1958). Attachment is created in an
ongoing reciprocal relationship between children and their caregivers.

Attachment to a protective and loving caregiver who provides guidance,
support, and a secure base is a basic human need. There is an instinct to attach,
a biological necessity, what Bowlby (1982) referred to as evolutionary
adaptedness. Attachment behaviors must exist and be reciprocated for the infant
to survive both physically and psychically (Bowlby, 1958). Babies instinctively
reach out for the safety and security of the secure base with caregivers. The
instinctive attachment behaviors in the baby are activated by cues or signals from
the caregiver, for example, smiling, feeding, reaching for, and gazing at the
infant. Parents instinctively protect and nurture their children. The instinctual
attachment behaviors in the parents are activated by cues or signals from the
infant, for example, smiling, following, calling, and crying. The attachment
process is deﬁned as a mutual regulatory system where the baby and the
caregiver inﬂuence one another over time (Tronick, 1989).

Attachment is deﬁned as an enduring relationship between a young child
and her mother (Ainsworth, Blehar, Waters, & Wall, 1978). Attachment
relationships vary widely across mother-infant/child pairs (Ainsworth & Bell,
1970) but are always permanent and irreplaceable (Barnett & Vondra, 1999).
Attachment relationships teach individuals how to be in relationship with
signiﬁcant others and inﬂuences all subsequent relationships through to

adulthood. Attachment, ﬁrst and foremost, occurs in the holding environment of

the mother-infant attachment relationship. All other deﬁnitions or systems of

understanding must stand upon that principle.

Brief Description of Previous Mother-Infant/Child Research

For more than 50 years, attachment research has been predominantly
focused on two ﬁgures (mother and infant or child), from one hierarchical
perspective (researcher toward subject), viewed in one setting (the laboratory
observation room) and subject to scientiﬁc empiricism and rigorous experimental
design (Ainsworth & Bell, 1970; Ainsworth, Blehar, Waters, & Wall, 1978; Barnett
& Vondra, 1999; Cassidy & Berlin, 1994; Forbes, Bento, & DeOliveira, 2003;
Matas, Arend, & Sroufe, 1978; Seifer & Schiller, 1995; Sroufe, 1985; Steier &
Lehman, 2000). The research methods deﬁned women by their role as mothers,
attributing deﬁnition to role rather than to the broad, deep, full, and rich lives of
unique individuals. These studies also deﬁned caregiver as mother, placing the
responsibility for infant/child care and rearing on women.

The researcher—subject relationship was hierarchical rather than
collaborative in nature, tending to place women in an objectiﬁed position. The
behaviors of mothers and infants/children in laboratory settings were observed
and tediously and copiously documented. Certainly implications were
extrapolated from the data, replicated, and validated over time, but personal
insight and reﬂection from the point of view of women, as mothers were never

considered. Laboratory settings, which might increase replication and external

validity, can never replace the natural environment of the lived experience of
women and their children.

The majority of reported studies claimed to be ﬁrmly established in
scientiﬁc, positivist, experimental, normative, and empirically based methodology
(Ainsworth & Bell, 1970; Blehar, Lieberman, & Ainsworth, 1977; Cassidy, 2000;
Main, Kaplan, & Cassidy, 1985; Sroufe, 1985; Waters & Cummings, 2000). Data
were coded, measured, and analyzed. Meaning was extrapolated. Classiﬁcation
lists were meticulously assembled. Children were assigned to categories.
Mothers’ behaviors were distilled into dichotomized variables. This kept the
research focused on empiricism and left out natural environmental settings. Even
when research was conducted in family homes (Blehar, Lieberman, & Ainsworth,
1977), it was done from a scientiﬁc point of view. Time was broken into
segments. Behaviors were counted. Observers were silent. Mothers (and fathers)
were ignored. No personal stories were gathered; rather, the stories were
interpreted from the acquired data. The lived experience of each dyad was
ignored; worse, the stories of their experiences were lost.

The relatively new interest in atypical attachment is at least refreshing. An
interest in difference or uniqueness is always valuable especially in conjunction
with culture. But the studies continue to categorize and label infants, children,
mothers, and caregivers (Forbes, Bento, & DeOliveira, 2003). In light of basic
social work principles, it seems important to challenge the historical pattern of
assigning labels to individuals and families. A strengths perspective is sadly

lacking (Lum, 2004; Rogers, 1961; Saleebey, 1996).

These methodological factors (narrow subject focus, hierarchical
perspective, the classic laboratory observation room, and an emphasis on
empiricism) maneuvered research toward the atypical and at—risk and fostered
the creation of pejorative infant and child attachment classiﬁcation systems and
tended to blame the woman for maternal insensitivity and insecure attachment.
Additionally, Caucasian, middle-upper middle class and well-educated families
were investigated (Lay, Waters, Posada, & Ridgeway 1995; Matas, Arend, &
Sroufe, 1978; Sroufe, Fox, & Pancake, 1983; Steier & Lehman, 2000) skewing
study results, hampering external validity, and colluding with previous
multicultural schisms in feminism.

Attachment research has faded from its early roots when Bowlby (1958)
and Wmnicott (1957) utilized the term enjoyment in deﬁnitions of attachment and
Ainsworth (1967) focused on the pleasurable mother-infant relationship, and
emphasis was placed on the secure base (Bowlby, 1988). This dissertation aims
to return to the basic principles of attachment theory through observation and the
lens of postmodern, qualitative and feminist methodologies and, speciﬁcally,
interpretive phenomenology that emphasizes the personal meaning attributed to
the lived experiences of women as mothers and their children. It is simply vital to
give voice and body to the experiences of women and their children, to honor the

sacred power of their words and stories.

Overview and Rationale of the Links Between the Manuscripts

This dissertation as a whole focuses on attachment theory, therefore the
ﬁrst paper (Chapter 2) is a literature review of attachment theory covering the ﬁve
decades since its inception by John Bowlby and explicated in, The Nature of the
Child’s Tie to His Mother (1958). The paper concentrates on the origins, history,
and development of attachment theory, past and current research topics as well
as new and developing research agendas, and on implications for the ﬁelds of
policy and practice as they relate to women and children. This paper forms the
foundation for the dissertation and sets the stage for the successive three
chapters.

The second paper (Chapter 3) is a case study derived from a case
experience in a maternal-infant program based in a local community mental
health agency. An 18-year—old woman and her infant, in an attachment
relationship, are the subjects of the case study. The study addresses the
mother’s depression, ambivalence, attachment, and culture and how those
components played out in the therapeutic alliance. Although other factors are
addressed in the paper, attachment is the focal point of the case: the mother’s
inadequate attachment to her child, the mother’s faulty attachment to her own
parents, the mother’s tentative attachment to the therapist, and the mother’s
growing attachment and connection to her self as object. The paper stands as a
bridge between the attachment literature and the observational study (Chapter
4). It is cases like this, and many others like it, that drive the research questions

behind the following two papers (Chapters 4 and 5).

The third paper (Chapter 4) is the culmination of an observational study
completed in London, Great Britain. The ethnographic study was conducted to
return attachment research to its positive and pleasurable roots and to observe
indicators of healthy attachment that exist in the context of relationship,
especially the relationship between women caregivers and toddlers as they occur
in natural environments. Obviously women are not the only caregivers of
children, but women as mothers (in tandem with their infant/child) are typically
the objects of attachment research studies and are, therefore, the subjects of the
observational study. The study focused on mothers and toddlers outside of the
laboratory room and entered into places of safety, play, and relationship instead.
This perspective helped to eliminate the pejorative child attachment classiﬁcation
system and set aside the tendency to blame the mother for insensitivity and
insecurity and looked at the mother-child dyad from a fresh and dynamic vantage
point.

The fourth paper (Chapter 5) focused on in-depth, semi-structured
phenomenological interviews in a collaborative process between a woman
researcher and women interviewees to minimize the hierarchy inherent in
empirically based research designs. The phenomenological interviews that
formed the basis of the paper focus on what works for each mother-child
relationship dyad and offered each woman in the study an opportunity to speak
her truth about that attachment relationship. The interview method was
purposefully chosen as a straightforward application of feminist values and

beliefs (Waller, 2005) that ground research in the experiences of women. A

feminist methodology values women and points of view from women’s
perspectives since their voices have not typically been heard (Waller, 2005).
Attachment research efforts to date have been conducted about women
as mothers but not in collaboration with women to reveal their stories as mothers.
It is of paramount importance to introduce narrative and storytelling methods in
conjunction with social and cultural deconstruction from a feminist perspective to
the experiences of women as mothers. This is not intended to negate the
sacriﬁcial care given to children by those who are not women but stems from a
speciﬁc interest on the stories of women as mothers. Western cultures and
societies attribute the child caregiving role to women; therefore it is particularly
important to deconstruct that attribution by giving women an opportunity to relate
the meaning behind their personal construction of being a woman and a mother

simultaneously.

Conclusion

It is important to apply what can be gleaned from healthy attachment
relationships to policy-making, program development, social work education, and
therapeutic environments where new treatment protocols could be introduced to
enhance attachment relationships and repair disrupted attachments that naturally
develop as a result of trauma. A renewed and optimistic attachment research
agenda has signiﬁcant implications for child trauma prevention across disciplines:
social work, nursing and medicine, education, child welfare, health and human

services, and juvenile justice.

10

Policies, programs, and treatment techniques that are introduced to
mediate child welfare issues are typically aimed at women as mothers from a
pejorative stance (Berlin, Ziv, Amaya-Jackson, & Greenberg, 2005). This must be
altered. Childcare is not the sole purview of women. Others must share in the
responsibility. Motherhood is not synonymous with womanhood. A broadened
perspective is needed. The objective is to strive to hear the narrative experiences
of women as mothers in all of their complex identities and discover how they

name themselves and tell their stories.

11

References

Ainsworth, M. D. S. ( 1967). Infancy in Uganda: Infant care and the growth of
love. Baltimore, MD: Johns Hopkins Press.

Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and
separation: Illustrated by the behavior of one-year-olds in a strange
situation. Child Development, 41(1), 49-67.

Ainsworth, M. D. S., Blehar, M. 0., Waters, E., & Wall, S. (1978). Patterns of
attachment: A psychological study of the strange situation. Hillsdale, NJ:
Lawrence Erlbaum Associates.

Barnett, D., & Vondra, J. l. (1999). Atypical patterns of early attachment: Theory,
research, and current directions. Monographs of the Society for Research
in Child Development, 64(3), 1-24.

Berlin, L. J., Ziv, Y., Amaya-Jackson, L., & Greenberg, M. T. (Eds). (2005).
Enhancing early attachments: Theory, research, intervention, and policy.
New York: The Guilford Press.

Blehar, M. C., Lieberman, A. F., & Ainsworth, M. D. S. (1977). Early face-to-face
interaction and its relation to later infant-mother attachment. Child
Development, 48(1), 182-194.

Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal
of Psycho-Analysis, 39, 350-373.

Bowlby, J. (1982). Attachment (2nd ed., Vol. I). New York: Basic Books.

Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. New
York: Routledge.

Cassidy, J. (2000). The complexity of the caregiving system: A perspective from
attachment theory. Psychological Inquiry, 11(2), 86-91.

Cassidy, J., & Berlin, L. J. (1994). The insecure/ambivalent pattern of
attachment: Theory and research. Child Development, 65(4), 971-991.

Forbes, L., Bento, 8., & DeOliveira, C. A. (2003). Classifying mother-toddler
attachment relationships in the interesting-but-scary paradigm: Scoring
system for interactive behavior. London, Ontario: University of Western
Ontario.

12

Lay, K. L., Waters, E., Posada, G., & Ridgeway, D. (1995). Attachment security,
affect regulation, and defensive responses to mood induction.
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Lum, D. (2004). Social work practice and people of color: A process-stage
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Main, M., Kaplan, M, & Cassidy, J. (1985). Security in infancy, childhood, and
adulthood: A move to the level of representation. Monographs of the
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Matas, L., Arend, R. A., & Sroufe, A. (1978). Continuity of adaptation in the
second year: The relationship between quality of attachment and later
competence. Child Development, 49(3), 547-556.

Rogers, C. R. (1961). On becoming a person: A therapist’s view of
psychotherapy. Boston: Houghton Mifﬂin.

Saleebey, D. (1996). The strengths perspective in social work practice:
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Seifer, R., & Schiller, M. (1995). The role of parenting sensitivity, infant
temperament, and dyadic interaction in attachment theory and
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Sroufe, L. A. (1985). Attachment classiﬁcation from the perspective of infant-
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Sroufe, L. A., Fox, N. E., & Pancake, V. R. (1983). Attachment and dependency
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Steier, A. J., & Lehman, E. B. (2000). An observational measure of children’s
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Tronick, E. (1989). Emotions and emotional communication in infants. American
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Waller, A. A. (2005, October). Work in progress - feminist research
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close relationships. Child Development, 71(1), 164-172.

13

Wmnicott, D. W. (1957). Mother and child: A primer of first relationships. New
York: Basic Books.

Winnicott, D. W. (1993). Talking to parents. Reading, MA: Addison-Wesley.

14

CHAPTER 2

Attachment Theory Revisited:

Its Roots and Research with Implications for Policy and Practice

15

Abstract
Attachment theory, developed by John Bowlby and ﬁrst explicated in, The Nature
of the Child’s Tie to His Mother (J. Bowlby, 1958), is the subject of this literature
review. Research deﬁnitions are offered and the attachment concept
operationalized by: physical security, behavioral, psychic, affective, and
kinesthetic/tactile components. These components are examined in light of the
holding environment of the mother-infant/child attachment relationship.
Attachment theory and its history, development, and epistemological legacy are
addressed. Research areas and interests are explored and critiqued and future
research agenda issues and topics offered. A renewed and optimistic attachment
research agenda has signiﬁcant implications for child trauma prevention across
disciplines. Therefore, it is important to apply attachment research to policy-
making, program development, and therapeutic environments. Attachment theory
has stood the test of time because the premises are based in an enduring pattern

of relatedness that exists, not only for survival, but also for connection.

Key Words: Attachment; Attachment Theory; Mother-Infant Attachment

I6

Attachment, as a theoretical construct, is more than 50 years old. It
evolved from Bowlby’s early work experiences in London and then with the World
Health Organization (S. R. Bowlby, 2004). Attachment theory is a perspective on
the way close relationships can provide a secure base (Ainsworth, 1967, 1969; J.
Bowlby, 1988). It assumes that maternal sensitivity, responsiveness, and
attunement are major factors in the quality of a child’s attachment to her mother
or attachment ﬁgure (Ainsworth, 1969; Ainsworth, Blehar, Waters, & Wall, 1978).
The other, nearly equal component is the caregiver’s own mental representation
of attachment, her own internal working models experienced and developed in
her infancy and childhood (Harris, 2003). (Feminine pronouns are utilized in this
work in deference to the preponderance of childcare provided by women, even
though some men are very or exclusively involved in caring for their children.)
Attachment and secure base functions operate to promote child and personality
development and affect regulation. Attachment theory also presupposes
evolutionary biological necessity. Attachment behaviors must exist and be
reciprocated for the infant to survive both physically and psychically (J. Bowlby,
1958).

Attachment theory was developed, in part, as an alternative to
psychoanalytic theory to explain why separation caused anxiety in young
children, to explain the similarities between childhood and adult loss and
mourning, to explain the process of defenses in the human psyche, and to
explain the mechanisms of social behavior from infancy that affect and inﬂuence

the development of the personality along a continuum from healthy to debilitating

17

(Barnett & Vondra, 1999; Bretherton, 1985; Cristobal, 2003; Waters, Crowell,
Elliott, Corcoran, & Treboux, 2002). Attachment theory was a move away from
the dominance of drive and dependency theory related to satisfaction of
physiological needs. Attachment theory invoked primary instinctual responses
that function to promote social interaction, comparatively independent of

physiological needs, and tie the infant to the mother (J. Bowlby, 1958).

Attachment Deﬁnitions

Attachment theorists deﬁne attachment independently but the similarities
are striking, including the concepts of proximity, speciﬁcity, and necessity.
Additionally, Ainsworth (1967), Bowlby (1958), and Winnicott (1964, 1987, 1993)
include the terms enjoyment and pleasure when describing the mother-infant
attachment dyad. Bowlby’s work formulated attachment theory therefore; one
must begin with his words.

Unless there are powerful in-built responses which ensure that the

infant evokes maternal care and remains in close proximity to his

mother throughout the years of childhood he will die. The instinctual

responses... serve the function of binding the child to mother and

contribute to the reciprocal dynamic of binding mother to child (J.

Bowlby, 1958, p. 369).

Bowlby’s words refer to biological, physical, affective, and behavioral
responses that an infant exhibits in order to initiate maternal biological, physical,

affective, and behavioral responses in turn. This pattern exists to create the

18

attachment bond between mother and infant. The bond serves to protect the
infant/child from fear and harm and sets the stage for the formation of the
caregiver as the secure base thereby offering the developing child a safe place
from which to explore the world. The behavioral aspect of attachment serves
infant survival instincts (J. Bowlby, 1958). But attachment is more complex than
behavior stimulus and response mechanisms.

Attachment is also an emotional and affective bond or tie that reﬂects the
enjoyment, the attraction, that one individual has for another speciﬁc individual
(Ainsworth, 1969; J. Bowlby, 1958; Cassidy, 1999; Sroufe, Fox, & Pancake,
1983). “From an emotional perspective, attachment is the creation of a mutual
bond in which the mother shapes infant development through her interactions
and relationship with her child” (Porter, 2003, p. 2). One can observe and
quantify attachment behaviors. One must infer and interpret attachment in its
affective and emotive forms. Smiles and touches can be counted, measured, and

plotted. Delight and enjoyment, however, must be lived.

Attachment Components
Attachment is a broad and complicated concept with multiple layers of
meanings and interpretations. No single deﬁnition or set of constructs can
contain all of the signiﬁcant elements of attachment as a concept. However, one
vitally important foundational observation must be stated. Attachment, regardless
of the deﬁnition, occurs in the holding environment of the mother-infant/child

attachment relationship that begins in the earliest moments of an infant’s life.

19

This holding environment is both physical and psychic. Caregivers must be able
to create a good enough facilitating environment at the earliest stages of
development to provide for the optimal emotional and mental growth of the child
(Wrnnicott, 1971).

The existing deﬁnitions were synthesized and a systematic attempt made
to operationalize the term attachment. Therefore, for the purposes of this paper,
with an emphasis on implications for clinical practice, the author developed a
conceptual map (Figure 2-1) of the holding environment of the mother-infant/child
attachment relationship that includes: physical security (secure base function),
behavioral, psychic, affective, and kinesthetic/tactile components.

Figure 2-1. Holding Environment of Mother-Infant/Child Attachment Relationship

Mother-Child Attachment Relationship

  
   
 
  

Psychic Component

 
     
   
       
    
   

Forming Psychic
Component

   
  
 
  
    
     

 

Mother

 

 

 

 

 

 

 

: n 3
a o T. _O
=- _ c o

E g g g .2 Infant-Child 0%;
3 Behavioral g 8 1 g ,_ . -. = j ‘5 30 I t' t' 8 E-
6 Component 3 """" -, . 5 g "5 "‘9'“ 2 3i
°’ 0 a Behavrors g =
8: n. o
< :-

 

 
 

...........

\ ..........,,=
\

............

Forming Secure Base

Physical Security/Secure Base
Component

20

Physical Security Component

Attachment has a physical security component — “a tie that binds together
in space and endures over time” (Ainsworth & Bell, 1970, p. 50). This secure
base is deﬁned as the attachment ﬁgure. The attachment ﬁgure must be
consistently physically present and psychically available to the infant/child to
create the security of the secure base for the infant/child where growth and
development occur. The caregiver, typically the mother, provides a physically
secure environment of her presence for the infant. This happens, not only
through physical handling and holding, but also, through consistent sensitivity to
the needs of the infant and her availability and capacity to meet those needs in a
timely manner. A particular and substantial someone, to whom the child can
attach, must exist and have a speciﬁc location, therefore, attachment has a solid .
human context within time, space, and situations (Posada, Gao, Wu, et al., 1995;
Waters & Cummings, 2000). “Without adequate environmental reliability the

personal growth of a child can’t take place” (Wmnicott, 1993, p. 99).

Behavioral Component

Attachment has a behavioral component. Attachment behavior on the part
of the infant/child operates to increase proximity and contact with the maternal
caregiver (Ainsworth, 1967, 1969; Ainsworth & Bell, 1970; Ainsworth, Blehar,
Waters, & Wall, 1978; J. Bowlby, 1958, 1982a; Porter, 2003; Seifer & Schiller,
1995). These instinctive attachment behaviors serve different functions. Signaling

behaviors alert the caregiver that the infant desires interaction. Aversive

21

behaviors trigger a quick maternal response to provide problem solving or
protection and safety. Active and contact-seeking behaviors promote proximity to
the mother and secure base (Ainsworth, 1967; Ainsworth & Bell, 1970;
Ainsworth, Blehar, Waters, & Wall, 1978; J. Bowlby, 1958, 1982a; Seifer &
Schiller, 1995). Exploratory behavior decreases proximity with the maternal
caregiver and promotes interaction with the environment and individuation
(Ainsworth, 1967, 1969; J. Bowlby, 1958, 1982a; Field, Gewirtz, Cohen, Garcia,
Greenberg, & Collins, 1984; Mahler, Pine, & Bergman, 1975; Porter, 2003; Seifer
& Schiller, 1995). Attachment behavior, especially when strongly activated by
stress or distress, is incompatible with exploratory behavior.

Attachment behavior on the part of the mother operates to meet the
physical, emotional, psychic, and tactile needs of the infant/child. Paradoxically,
these behaviors, which are unreciprocated by infants in the early weeks, work to
build the attachment bond and relationship. Bowlby (1958) suggested that, “It is
fortunate for their survival that babies are so designed by nature that they beguile
and enslave mothers” (p. 368). As babies’ signaling behaviors have different
meanings, mothers’ behaviors meet different needs. Feeding and diapering are
physical necessities. Holding, snuggling, and rocking meet emotional needs of
connection and safety. Touching, caressing, and stroking meet tactile and
kinesthetic needs. And anticipatory actions and behaviors by the mother to meet
her infant’s unexpressed needs and wishes, serve two psychic functions. They
establish the psychic availability of the mother and maintain the necessary

illusion of omnipotence for the baby. These behaviors do not operate

22

independently but function as an organic whole to provide optimal support to the

infant.

Psychic Component

Attachment has a psychic component. Attachment is “the psychological
availability of a caregiver as a source of safety and comfort in times of child
distress” (Barnett & Vondra, 1999, p. 5). Attachment is “the inferred internal
bonds that form between infants and their caregivers” (Seifer & Schiller, 1995, p.
147). Another aspect is the caregiver’s own mental representation of attachment,
her own internal working models experienced and developed in infancy and
childhood. Those early mental representations inﬂuence later development and
relationships (Freud, 1935, 1966). The psychic component, the knowing and
trusting of the other, grows developmentally from the physical security of the
secure base. The mother must also be psychically available to her child and
mentally carry a positive internal representation of her own attachment ﬁgures

and relationships. These functions create a secure base for the infant/child.

Affective Component

Attachment has an affective component. Attachment bonds are the
demonstrable and observable affectionate gestures between infants and their
caregivers (Ainsworth, 1967, 1969; J. Bowlby, 1958; Porter, 2003; Nnnicott,
2002). Ainsworth (1969) used the term affectional tie to describe the bond that

forms between two speciﬁc individuals. Bowlby (1958) spoke of the attachment

23

relationship as a reﬂection of pleasure and enjoyment demonstrated in smiling,
laughing, happiness, and love. Stress occurs from sudden or prolonged
separation from the attachment ﬁgure and permanent loss causes grief and
mourning (Barnett & Vondra, 1999). The security of the attachment relationship
also provides a space for affective reactions to stress and fear indicated by
crying, clinging, anger, and frustration. Emotions and “the foundation of
emotional regulation [are] also established within the context of the attachment

relationship” (Sroufe, 2003, p. 205).

Kinesthetic/Tactile Component

Attachment has a kinesthetic/tactile component (J. Bowlby, 1958).
Attachment develops through body contact between caregiver and infant/child
demonstrated in caresses and touches (Cristobal, 2003). “You [mother] just
adapt the pressure of your arms to the babies’ needs, and you move slightly, and
you perhaps make sounds. The baby feels you breathing. There is warmth that
comes from your breath and your skin, and the baby ﬁnds your holding to be
good” (Wmnicott, 2002, p. 21). Gazing, touching, holding, rocking, stroking, and

nuzzling are examples of kinesthetic and tactile body contact.

Holding Environment
Attachment exists in the reciprocal holding environment of the mutual
mother-infant/child attachment relationship. “Whoever is caring for a child must

know that child and must work on the basis of a personal living relationship with

24

that child” (Wmnicott, 1993, p. 99). Attachment is deﬁned as an enduring
relationship between a young child and her mother (Ainsworth, Blehar, Waters, &
Wall, 1978). Attachment relationships vary widely across mother-infant/child pairs
(Ainsworth & Bell, 1970) but are always permanent and irreplaceable (Barnett &
Vondra, 1999). Attachment relationships teach individuals how to be in
relationship with signiﬁcant others and inﬂuences all subsequent relationships
through to adulthood. Attachment, ﬁrst and foremost, exists, and is held together,
in the holding environment of the mother-infant/child attachment relationship. All

other deﬁnitions or systems of understanding must stand upon that principle.

History, Development, and Epistemological Legacy

In the 1950s, attachment theory emerged as a valuable working model in
child development and mental health through the joint yet independent efforts of
John Bowlby and Mary Ainsworth (Ainsworth, 1967, 1969; J. Bowlby, 1951,
1958, 1973, 1982a; Bretherton, 1992; Porter, 2003; S. R. Bowlby, 2004). Bowlby
outlined the conditions needed for the healthy development of children in
Maternal Care and Mental Health (1951) from his work with the World Health
Organization. (It is signiﬁcant to note that this early work was multicultural and
multinational in nature.) He then revolutionized the view of the mother-infant
bond and relationship and its disruption through deprivation, separation, and loss
when he wrote, The Nature of the Child’s Tie to His Mother (1958), and outlined

attachment theory.

25

Bowlby believed the mother must achieve attunement with her baby to
create healthy attachment. It was the attunement of the mother to her child in
stressful and distressing situations that established self-regulation for infants, a
biological necessity since babies do not inherently possess self-regulatory
systems. The mother-induced regulation worked to keep the baby in balance and
emotionally regulated. Infants relied on the relationship with their mother to keep
dysregulation at bay (Porter, 2003). Thus, healthy attachment was the
development of that attuned relationship.

Freud (1935, 1966) set the stage for attachment theory when he
established the importance of the early maternal-infant relationship and
recognized the signiﬁcance and similarities between the mother-infant
relationship and adult-adult relationships. He emphasized the life long impact of
early relationships and experiences and how the mental representations of early
life mediate later development. He established the role defenses play in affect
regulation and that mourning a signiﬁcant loss serves an adaptive purpose (Lay,
Waters, Posada, & Ridgeway, 1995).

Yet, psychoanalytic theory and the early stages of evolutionary theory
imposed dramatic parameters on the study and evaluation of attachment and
attachment behaviors, especially under the constructs of determinism and
instinctive behavior. These constructs were also subsumed under a hierarchical
and authoritarian umbrella as a worldview, residue of which still permeates the
scientiﬁc community and culture today. Bowlby (1958) however, challenged and

replaced Freud’s drive reduction model of relationship motivation with one that

26

emphasized the role relationships play in support of exploration and competence
(Bretherton, 1985; Waters, et al., 2002). Bowlby managed to maintain key
features of Freudian early work modiﬁed to withstand the new wave of scientiﬁc
empiricism (Cristébal, 2003).

The Strange Situation was developed by Ainsworth following her work in
Uganda, for the longitudinal Baltimore study (Ainsworth, 1978; Ainsworth, Blehar,
Waters, & Wall, 1978). She introduced a stressful event and situation that
activated the infant’s attachment system while, at the same time, provided for the
caregiver to act as a secure base. This was inspired by Bowlby’s (1982a)
conception of the protective function of attachment ﬁgures and Ainsworth’s
(1967, 1969) emphasis on the caregiver as a secure base for the infant’s
exploration, learning, and development of the skills necessary for self-protection
and intimacy (Bretherton, 1992; Forbes, Bento, & DeOliveira, 2003; Porter,
2003).

Separation and reunion research was extensively conducted and has
been somewhat adapted over the years to include a wider range of ages and
unfamiliar situations in an attempt to simulate stressful or distressing
environmental situations for the infant or child while in close proximity to her or
his mother or caregiver (Ainsworth & Bell, 1970; Ainsworth, Blehar, Waters, &
Wall, 1978; Field et al., 1984). For example, researchers introduced an electronic
spider into the Strange Situation to heighten the alarm for slightly older toddlers

(Forbes, Bento, & DeOliveira, 2003). The Strange Situation, as originally

27

designed, was considered insufﬁcient to activate attachment behavior for
toddlers.

Edward Tronick (Gusella, Muir, & Tronick, 1988) created the well-known
experimental situation of the Still-Face where a mother engaged in play with her
baby in a face-to-face encounter and then was asked to stop the play interaction
for a very brief period of time. The Still-Face episode created upset for all babies
but was repaired when the mother began the interaction again. Researchers
were interested in uncovering how the mother-infant interaction was repaired, the
most important indicator of attachment security in their relationship (Bergman &
Harpaz-Rotem, 2004).

Margaret Mahler, with a team of psychoanalysts, began a naturalistic
study in 1959, designed to investigate early mother-child interaction during the
separation-individuation process (Mahler, Pine, & Bergman, 1975). Mahler’s
interest was on the internal forces that drove a toddler toward the realization of
the separate self, even in circumstances of less than optimal availability of the
mother. While her interest was less about attachment and the optimal
circumstances for development of the self, the research strongly supported the
attachment framework of affect regulation, mutuality, proximity, and relatedness
(Bergman & Harpaz—Rotem, 2002).

Anna Freud (1979), in her psychoanalytic work with children, held that the
establishment of rapport and the therapeutic relationship, what she referred to as

the affectionate attachment of the transference, was the basis for all work. She

28

provided toys and play material for the child to create an environment in her or
own way to play out internal, unexpressed fantasies.

Melanie Klein (1982) equated the child’s play activities with the free
associations of the adult. She stressed that action or play was more natural for
the little child than speech. Each child had a drawer of toys chosen especially for
her, which became an individual experience for that child, symbolic of the private
and intimate relationship that existed between the child and the therapist. The
child became aware of her own uniqueness and that no one else had access to
her toys (self).

Infant mental health and child development enjoyed rapid growth for a
period of time following the work of Bowlby, Ainsworth, and others. The body of
work, formed from the efforts of multiple disciplines, created explanatory
variables in attachment formation, maintenance, and renewal (Bronfenbrenner,
1979; Lay, Waters, Posada, & Ridgeway, 1995; Osofsky, 1979; Piaget, 1951;
Wright, 1986, 1997). These cross-disciplinary efforts impacted the models
developed for play therapy. The cornerstone of play therapy intervention is
attachment theory, creating a foundation for the formulation, maintenance, and
renewal of attachment that also includes reparation of disrupted attachment
through the play therapy treatment process (Axline, 1969, 1982; Bettelheim,
1976; Carroll, 1998; Cattanach, 1992; Gil, 1994; Ginott, 1979, 1982a, 1982b;
Greenspan, 1981; Klein, 1982; Krall, 1989; Landreth, 1982, 2002; Lebo, 1982;

Moustakas, 1953, 1959, 1982; Singer, 1993; Webb, 1991, 2003).

Bowlby (1958) challenged the secondary drive theory held by Sigmund
Freud (1935, 1966), Anna Freud, and Melanie Klein (1986) that focused on
physiological dependence and satisfaction. Freud’s conception of the infant in
relation to her mother was a source of drive reduction. Infant behaviors were
seen as needy, clingy, and dependent. The secondary drive theory explained the
mother—infant bond through the process of feeding. As the child was fed,
nourished, and orally satisﬁed, pleasure was experienced. Satisfaction was then
associated in a positive way with the mother’s presence. Bowlby, on the other
hand, believed the mother-infant attachment was primary and exclusive. He
portrayed infants as competent, curious, and fully engaged with their caregivers
and the environment (Waters, et al., 2002). Attachment theory is based in the
secure holding environment of the mother-infant attachment relationship and not
in physiological dependence and satisfaction.

Bowlby (1958, 1973, 1982a, 1982b) offered a coherent, formulated
theoretical alternative to Freud’s secondary drive theory based on the dynamic
forces of evolutionary biology and ethology. He came to believe that the
mechanisms that underlie the infant’s attachment tie to the maternal ﬁgure
originally emerged as the result of evolutionary pressure, a biologically based
need for proximity that equated with survival and natural selection (Cassidy,
1999). Two key constructs evolved from Bowlby’s formulation: attachment is a
biological necessity and the mother-infant/child bond is the primary and essential

force in infant and child development (J. Bowlby, 1958, 1975, 1982a).

30

Theoretical Grounding
The theoretical grounding and models that exist behind attachment theory
have a broad base. They have been loosely sorted into six descriptive
categories. The theories identiﬁed create a backdrop and context for the
formation and research behind attachment theory. The purpose of this exercise is
to illuminate context not to make direct connections across theories and

frameworks.

Category 1 — Behavior

The ﬁrst category includes behaviorism, behavior systems theory, and
behavior systems in evolutionary adaptedness, evolutionary theory, and ethology
(Ainsworth, 1969; Ainsworth & Bell, 1970; J. Bowlby, 1982a; Cassidy, 2000;
Grossmann & Grossmann, 2006; Hazan & Shaver, 1994; Main, Kaplan, &
Cassidy, 1985; Simpson & Rholes, 2000; Waters & Cummings, 2000). This is
based in the fundamental construct that attachment exists in a behavioral
system. The biological function of that system has a predictable outcome that
creates a survival advantage in the “environment of evolutionary adaptedness” (a
term coined by Bowlby, 1982a). Evolutionary theory is based on the trial-and-
error process of variation and natural selection of systems at all levels of
complexity. Ethology is the perception of behavior in an evolutionary context. The
motivation behind attachment is evolutionary survival. However, it must be
remembered, from the conceptual map (Figure 2-1), that attachment is a broad

concept and impacted by more than behavior.

Category 2 — Positivism

The second category includes empirical methods, classic scientiﬁc
methods, and experimental methods (Ainsworth & Bell, 1970; Blehar, Lieberman,
& Ainsworth, 1977; S. R. Bowlby, 2004; Cassidy, 2000; Main, Kaplan, & Cassidy,
1985; Sroufe, 1985; Waters & Cummings, 2000). These methods were used
nearly exclusively to research attachment theory, neglecting qualitative studies
and narratives. Naturalistic studies to observe behavior in the environment were
time consuming and costly. The Strange Situation was developed to simulate the
activation of attachment behavior in a controlled setting that was reﬂective of a
child’s normative environment (Ainsworth, 1978; Ainsworth, Blehar, Waters, &
Wall, 1978). Current meta-analyses utilize the hundreds of empirically based
studies completed over the last decades. And still the literature makes demands
for more rigorous theoretical and empirical analysis (Waters & Cummings, 2000).
These methods must be balanced with postmodern and feminist methodologies
that challenge the hierarchical and patriarchic manifestations of the positivist

worldview.

Category 3 — Systems

The third category includes general systems theory, control systems
theory, and dynamic systems perspective (Ainsworth, 1969; J. Bowlby, 1982a;
Hsu & Fogel, 2003; Porter, 2003; Waters & Cummings, 2000). Bertalanffy’s
general systems theory, designed to identify and describe the principles that

guide system functioning and interaction with other systems, impacted the

32

development of attachment theory. Bowlby also “introduced concepts from
control systems theory to highlight and account for the complex monitoring of
internal states, relationship experience, and context that shapes proximity
seeking, communication across a distance, and exploration away from
attachment ﬁgures” (Waters, et al., 2002, p. 230). These broad system theories
augment biological and behavioral systems to explicate attachment behavior and
theory. But again, a mother-infant attachment relationship is more than a system
and the narrative of that relationship greater than the explanation of how that

system operates and self-regulates.

Category 4 — Instinct

The fourth category includes instinctive behavior, ontogenetic theories,
and psychobiology (Ainsworth, 1969; Ainsworth, Blehar, Waters, & Wall, 1978; J.
Bowlby, 1982a; Cardoso & Sabbatini, 2001; Cassidy, 2000; Grossmann &
Grossmann, 2006; Harlow, 1958; Harlow, Dodsworth, & Harlow, 1965; Main,
Kaplan, & Cassidy, 1985). Instinctive behavior is considered to be genetically
based and typically species-speciﬁc, behavior that is innate, complex, adaptive,
and unlearned. Ontogenetic theory is based in biology and genetics. It studies
the course of development of an individual organism. Psychobiology interprets
personality, behavior, and mental illness in terms of responses to interrelated
biological, social, cultural, and environmental factors. These interrelated factors
are foundational to early attachment theory that can now be moderated by

postmodern interpretation.

33

Category 5 — Life Models

The ﬁfth category includes life-span models and life history theory
(Bronfenbrenner, 1979; Cassidy, 2000; Erikson, 1964; Piaget, 1951; Rothbard &
Shaver, 1994; Simpson & Rholes, 2000; Waters & Cummings, 2000). Life-span
models typically describe the course of an individual’s life by sequential tasks to
be completed and/or stages, like hurdles, to be mastered. Life history theory is
based in biology from a systems perspective and attempts to explain the
physiological traits and behaviors of individuals in terms of key maturational and
reproductive characteristics that deﬁne the life course. Attachment theory was for
decades much more clearly articulated for infancy and childhood than for
adulthood. This has changed signiﬁcantly in the past twenty years especially with
the introduction of the Adult Attachment Interview (Hesse, 1999; Main &
Goldwyn, 1998). Attachment beyond infancy, and the development and
maintenance of close relationships across the life span, are growing areas of

research in attachment theory.

Category 6 — Learning

The sixth category includes learning theories (Ainsworth, 1969; Bandura,
1977; Sroufe, Fox, & Pancake, 1983). Social learning theory attempts to explain
human behavior from the integrated perspective of cognitive, behavioral, and
environmental inﬂuences. These inﬂuences are seen as being continuously
reciprocated through modeling. Bandura’s (1977) work emphasized the

importance of observing and modeling the behaviors, attitudes, and emotional

34

reactions of others from the assumption that most human behavior is learned
observationally through modeling. Social learning theory encompasses attention,
memory, and motivation, but misses the biological and instinctual survival
components that are foundational to attachment theory. Social learning theory
relies heavily on nurture and favors post-natal environmental learning.
Attachment theory relies on a balance of nature or instinctive behavior and
nurture or environmental learning to explain the forging of the affectional bonds
utilized as survival and protective functions and for affect regulation and social

development.

New Research Areas and Interests

Attachment theory has a strong empirically based research history
beginning with and evolving from Freud’s (1963a, 1963b) clinical observations
and case studies. Bowlby (1973, 19823, 1982b) focused on animal studies
through the lens of evolutionary biology while Ainsworth (1967), in her early work,
concentrated on naturalistic ﬁeld observation of maternal-infant dyads, and then
moved to a laboratory setting with the development of the Strange Situation
(1978). The ﬁeld has burgeoned since and the areas of interest have grown
dramatically.

Freud (1935, 1966) linked the mother-infant relationship to adult-adult
relationships. Attachment theory research has upheld that connection
demonstrating that attachment behavior plays an active role across the life span

(J. Bowlby, 1979; Hesse, 1999; Main, Kaplan, & Cassidy, 1985). Current adult

35

dating patterns include speed dating and Internet dating relationships. These
factors, when viewed together, may explain the strong thread of research being
developed on adult love relationships (Berman & Sperling, 1994; Bleichmar,
2003; Porter, 2003; Shane, Shane, & Shane, 2003; Steele, & Steele, 2003; van
lJzendoorn, 1995).

Infant and child attachment continues to be studied, particularly in light of
the positive correlations between secure attachment and self-esteem and self-
conﬁdence (Field et al., 1984). More recent work has focused on atypical
patterns of attachment that has been used to identify infants and children who
might be at risk for delays or distortions in attachment (Forbes, Bento, &
DeOliveira, 2003). This research history has been used to identify diagnostic
criteria for attachment disorders (Greenberg, 2005). This research area is
particularly under-developed as can be seen from the paucity of diagnostic
categories for attachment difﬁculties across the life span in the Diagnostic and
Statistical Manual of Mental Disorders (APA, 2000).

Attachment has also been shown to correlate with maternal sensitivity and
maternal adaptation to infants and children (Ainsworth & Bell, 1970; Cassidy,
Woodhouse, Cooper, Hoffman, Powell, & Rodenberg, 2005; De Wolff & van
lJzendoorn, 1997; Field, 1991; Field, et al., 1984; Seifer & Schiller, 1995; Sroufe,
1985; van lJzendoorn, Bakermans—Kranenburg & Juffer, 2005). However,
maternal sensitivity has typically been plotted as a dichotomous variable —
sensitive or insensitive (De Wolff, & van lJzendoorn, 1997). Recent research on

maternal sensitivity questions the dichotomous assignment as rigid and

36

restricting. The results of newer studies detect only a slight correlation for
sensitive mothers with securely attached infants and insensitive mothers with
insecurely attached infants (Cassidy, et al., 2005).

A pattern that emerged in the First Year Project (Cassidy, et al., 2005)
indicated that infants could meet insensitivity from their mothers yet remain
securely attached. In one case, an infant had an insensitive and rejecting mother
who initially and persistently resisted her infant’s pleas to be comforted.
However, the mother eventually relented and held her baby. The baby was
considered securely attached though she worked hard to gain access to her
mother. It is believed that babies can tolerate a certain amount of insensitivity
when some other positive feature exists in the relationship, for example, the
mother’s fundamental willingness to act as the infant’s secure base (Cassidy, et
al,2005)

Currently in research studies of infant-mother attachment, the mother is
classiﬁed as sensitive or insensitive. The baby is observed for attachment
behavior and utilization of the secure base, presumably offered by the mother.
The baby is then attributed an attachment classiﬁcation that, in some mysterious
way, predicts her future school achievement, relationship patterns, self-esteem,
and self-conﬁdence.

Researchers of the First Year Project (Cassidy, et al., 2005) believe that a
shift should be made in the research design to focus on maternal secure base
provision rather than on dichotomous classiﬁcation of maternal sensitivity. They

hypothesize that mothers would demonstrate elements of maternal sensitivity

37

across a continuum. The nuances of the behaviors could then be observed and
coded. They suggest that the baby be classiﬁed as securely or insecurely
attached and the mother observed for nuance, attunement, acceptance, affect
regulation, etcetera, and whether or not the mother helped create a secure base
(or offered herself as a secure base) to her infant (Cassidy, et al., 2005).

Mother-infant/child attachment classiﬁcation systems (Forbes, Bento, &
DeOliveira, 2003) and atypical patterns of early attachment continue to be
studied (Barnett & Vondra, 1999). Pre-school leave-taking and reunion
experiences with caregivers (Field, et al., 1984), early separation from parents
and peers (Field, 1991), and complex caregiving systems (Cassidy, 2000) are
foci of research studies especially in light of secure base functioning and close
relationships (Waters & Cummings, 2000). Childhood dependency behaviors
(Sroufe, Fox, 8 Pancake, 1983), competency and adaptive behaviors (Matas,
Arend, & Sroufe, 1978), mood induction (Lay, et al., 1995), and transitional
objects (Steier & Lehman, 2000) have all been examined in studies. Other areas
of interest include infant temperament (Seifer & Schiller, 1995) and enhancing
early attachment (Berlin, 2005). And more recently, adult love relationships and
adult sexuality have become areas of interest and research in the attachment
literature (Berman & Sperling, 1994; Bleichmar, 2003; Cassidy, et al., 2005;
Porter, 2003; Shane, Shane, & Shane, 2003; Steele, & Steele, 2003; van
lJzendoorn, 1995).

Also, on a more positive and hopeful note, research interests have begun

to highlight the importance of nonmaternal caregivers in children’s lives and the

38

affectional bonds that are created between nonmaternal caregivers and infants
and children. Some of those relationships being studied include, for example,
nannies and daycare providers, preschool and Head Start teachers, foster care
workers and especially partners or fathers and other close family members and
friends (Porter, 2003).

Present day research is integrated and interdisciplinary, adding to the
historic compilation of attachment theory from the ﬁelds of neurology, psychiatry,
biology, genetics, and psychology. This evolving research offers compelling,
cross-discipline evidence that attachment is the cornerstone of infant and child
development. Some of this new research is also focused on how caregivers can
create the kind of healthy atmosphere and secure environment that has the
power to guide infants and children into a full revelation of their potential selves.
As disciplines and methods are blended, attachment theory is more fully

explicated and validated.

Strengths and Weaknesses In Past Research
Attachment theory evolved out of the mid-twentieth century white culture
that esteemed stay-at-home mothers as primary caregivers and leveled the
responsibility for infant attachment, development, and health at mothers. But
secure attachment does not occur in a vacuum, nor is it the privilege of the
middle class white community. Relational attunement and developmental
assistance are key features of attachment relationships. Therefore, it is not only

the role of mother, but also the role of every other primary ﬁgure that plays a part

39

in the life of the infant and child’s development, to aid in the attunement and
developmental processes. Thus, complex caregiving systems, relationships
across generations, and parental relationships in foster care settings are growing
concerns in attachment research (Cassidy, 2000; Cassidy & Berlin, 1994;
Cassidy & Shaver, 1999; Cassidy, et al., 2005; Height, Kagle & Black, 2003;
Kretchmar & Jacobvitz, 2002).

Sixty years ago, Winnicott gave weekly radio talks to British mothers
(parents) of infants to give insight, increase enjoyment, and help normalize the
mother-infant relationship. Some of those broadcasts have been collected into
small books: Babies and their Mothers (1987), Talking to Parents (1993) and The
Child in the Family (2002). Recently research on mothers and infants has begun
to include the impact of positive emotional and play states in the mother-child
relationship (Porter, 2003), very reminiscent of VIﬁnnicott in the 405 and 50s. This
research indicates that when a mother-infant dyad has the ability to create joy,
elation, interest, and excitement together, they establish early healthy child
development and set the stage for a lifetime of physical and mental health for the
child (Porter, 2003). This research demonstrates a much-needed movement
away from the negative and pejorative aspects of neglect, avoidance, stress,
hostility, rejection, deprivation, and insensitivity and emphasizes instead the
enjoyment of the mother-infant/child attachment and all the positive beneﬁts that
ensue.

Attachment research is thriving but experiments continue in the laboratory

with predominantly white middle and upper-income families (Barnett & Vondra,

40

1999; Lay, et al., 1995). Recruitment is often through newspapers, parenting
magazines, postings on daycare and preschool bulletin boards, and through
pediatric ofﬁces (Steier & Lehman, 2000; Waters, Hamilton, & Weinﬁeld, 2000),
which are weighted to the Western white culture. Meta-analyses are evident in
the literature, which increases the reliability and validity of the ﬁndings but when
those studies cull information from the predominant white culture in a
multicultural world, those ﬁndings must be viewed as limited.

Researchers do not yet understand how individual temperament or the
personalities of the mother and infant, or the ﬁnances and economic structure of
families, or the ethnic and cultural characteristics of families inﬂuence what is
observed in attachment studies (Cassidy, et al., 2005). Dichotomous maternal
sensitivity classiﬁcations and pejorative infant attachment classiﬁcations are still
widely utilized in research along with Ainsworth’s Strange Situation (Ainsworth,
1978; Ainsworth, Blehar, Waters, & Wall, 1978) and Edward Tronick’s Still-Face
(Gusella, Muir, & Tronick, 1988). However, attachment theory is not to be
equated with the Strange Situation or the Still-Face (or the Adult Attachment
Interview [Hesse, 1999; Main & Goldwyn, 1998] for that matter). The theory
stands on its own regardless of the introduction of these experiments and
assessments.

Race, culture, and gender may or may not validate the assumptions of the
Strange Situation. However, Caucasian, middle-upper middle class and well-
educated families (presumably a married husband and wife), but most distinctly

women (mothers) and their children, have nearly exclusively been the subject of

41

investigation in attachment research (Lay, et al., 1995; Matas, Arend, & Sroufe,
1978; Sroufe, Fox, & Pancake, 1983; Steier & Lehman, 2000) skewing study
results, hampering external validity, and colluding with cultural schisms and
gender bias. In light of globalization and Bowlby’s (1951) early work with the
World Health Organization, it is necessary to expand attachment research across
diverse populations regardless of how the term diversity is deﬁned (Corey, 2005;
Corey, Corey, & Callanan, 2007; Laird, 1998).

It is also important to return to the basic principles of attachment theory
through the lens of postmodern, qualitative and feminist methodologies and
speciﬁcally interpretive phenomenology (Reid, Flowers, & Larkin, 2005) that
emphasizes the personal meaning attributed to the lived experiences of women
as mothers and their children. It is important to give voice to the experiences of

women and their children through narrative and storytelling.

Implications for Future Research

Race, culture, and gender are not the only missing pieces in attachment
research. Attachment theory could inform work with orphaned, institutionalized,
and foster children around the world and have an impact on therapeutic work
with issues of bereavement, suicide prevention, substance use and abuse, child
abuse and neglect, terrorism, parenting, and adult love relationships (Dozier,
Lindhiem, & Ackerrnan, 2005; Haight, Kagle & Black, 2003; Hindy & Schwarz,
1994; Juri & Marrone, 2003; McDonough, 1992; Wohl & Kaufman, 1985).

Individuals may form multiple attachments across the lifespan, each of which is a

42

distinct relationship. Those, typically long lasting relationships, can mediate the
effects of social issues in the lives of children, adolescents and adults. The
nature of the attachment relationship is to provide a sense of security because of
the secure base function, and promote conﬁdence and competence in interaction
with the social environment.

Harlow (1958) ﬁrst studied the neurobiological and behavioral
consequences of disrupted attachment in his research with primates. Over the
following decades, controlled animal studies of disrupted attachment in
conjunction with clinical studies of maltreated children demonstrated that early
adverse experiences, such as child abuse and neglect and other attachment
disrupting traumas, had lifelong effects on subsequent responses to stressors
(Putnam, 2005). This research must continue. Healthy parenting and child abuse
prevention programs must also be evaluated to most effectively impact cases of
child maltreatment and trauma (Applegate & Shapiro, 2005; Lieberman &
Amaya-Jackson, 2005; Miller, 2005; Putnam, 2005; Siegel, 1999). But it must
also be remembered that Ainsworth (1967) and Bowlby (1979) believed and
demonstrated that attachment develops despite repeated punishment and abuse
from primary attachment ﬁgures. This has also been supported by more current
research (Cassidy, et al., 2005) and must be taken into consideration in cases of
child maltreatment and trauma.

Researchers and clinicians must begin to look carefully at how mothers
and infants/toddlers can repair the disruptions that occur in their relationship and

particularly how disruption and reparation can enrich rather than disturb a

43

mother-infant or mother-toddler way of being together (Bergman & Harpaz-
Rotem, 2004). And attachment principles as potential reparative features through
therapeutic venues in adolescent and adult disrupted attachment need to be
added to research agendas to bring healing and hope to disrupted lives.

Research is needed that uses the mother-child attachment relationship to
enlighten therapeutic intervention across the life span to help assess, and then
repair, attachment trauma and increase the social functioning of hurting
individuals regardless of age or life circumstances. Attachment research on
attachment therapy across the life span and across culture is sadly lacking and
desperately needed in a third millennium world characterized by extended life
and globalization.

The majority of reported studies claimed to be ﬁrmly established in
positivist, scientiﬁc, experimental, normative, and empirically based methodology.
But any research focused on the internal affective and cognitive structures of
infants and young children and the relationships and connections to the adults
who care for them, face difﬁculties in design and methodology. Laboratory
settings increase replication and external validity but laboratory settings cannot

replace the natural environment.

Implications for Policy Making and Program Development
Many services do exist to enhance the lives of infants and children, to
offer safety and protection, and to create treatment opportunities for those

children suffering from the effects of attachment deprivation. Currently more than

44

400 Healthy Families and 700 Head Start/Early Head Start programs are in
existence in the United States, all heavily dependent on attachment theory
(Berlin, Ziv, Amaya-Jackson, & Greenberg, 2005).

A wide variety of attachment-based techniques and intervention programs
are being designed and implemented aimed at promoting and enhancing positive
attachment relationships between infants and children and their caregivers. It is
necessary that these intervention techniques and programs be evaluated for
efﬁcacy, effectiveness, and efﬁciency (Berlin, 2005; Greenberg, 2005; Nagle &
Wrghtkin, 2005; Osofsky, 1979; van IJzendoom, Bakermans-Kranenburg &
Juffer, 2005; Ziv, 2005). Intervention protocols indicate that enhancing early
attachment has implications for current policy development (Nagle & Wightkin,
2005; O’Connor & Nilsen, 2005).

Evidence based treatment interventions and protocols have already been
developed that work to reestablish attachment relationships and reduce
attachment disturbances in children (Berlin, 2005; Brisch, 1999; Cassidy &
Shaver, 1999; Fraiberg, Adelson, & Shapiro, 1975; Fraiberg, Shapiro, & Spitz-
Cherniss, 1994). In that case, it is imperative that similar protocols be created for
efforts with adolescents, adults, and seniors (Antonucci, 1994). This would lead
to research, treatment, and policy in the areas of child abuse and neglect,
parenting, substance use and abuse, suicide prevention, bereavement, adult love
relationships, elder care, and death and dying. Obviously infants and young

children are especially at risk for attachment disruptions.

45

Currently most of the programs and pilot studies in place to intervene in
infant/child attachment, operate at the adult level. These interventions target the
caregivers (even prior to the birth of the infant) to protect the infant and child,
strengthen sensitivity, attunement, and listening behaviors, build support
systems, and add services as needed (Cassidy, et al., 2005; Cooper, Hoffman,
Powell, & Marvin, 2005; Olds, 2005). The treatment protocols demonstrate an
increase in maternal-infant/child secure attachment and those are solid and good
results. However, sometimes the attachment trauma is severe and sustained,
creating life-long relationship and behavior problems for many people.
Intervention in these circumstances must be more intense and sustained.

Prevention, intervention, and policy needs are great. Yet policy makers,
while they do not hesitate to create policies to protect children, do hesitate to
provide adequate ﬁnancial support for those policies. Time and effort must be
expended to educate policy makers on the speciﬁc attachment needs of infants
and children and the prevention beneﬁts of ensuring secure attachment

relationships.

Implications for Clinical Social Work Treatment
“It is believed that observation of how a very young child behaves towards
his mother, both in her presence and especially in her absence, can contribute
greatly to our understanding of personality development” (J. Bowlby, 1982a). An
understanding of personality development connected to attachment behavior in

the context of the holding environment of the mother-infant attachment

46

relationship can be of tremendous importance in the therapeutic environment
(Diamond, Clarkin, Stovall-McClough, Levy, Foelsch, Levine & Yeomans, 2003;
Fairbairn, 1952; Lott, 2000; West & Keller, 1994; Zanardi, 1990).

It is the accessibility, sensitivity, and responsiveness of the mother or
primary caregiver (the principal attachment ﬁgure) that typically determines
whether a child exists in a state of security, anxiety, or distress (S. R. Bowlby,
2004). And these affective states can endure across the life span. However,
healthy maternal-child relationships demonstrate life-afﬁrming and beneﬁcial
attachment behaviors that can be extrapolated to the therapeutic environment for
healing and repair of disrupted attachment (Cristébal, 2003; Slade, 1999; Weiner,
2003)

An understanding of the mother-child attachment relationship can be
utilized for attachment reparation in treatment settings. The therapist is not the
mother a mother substitute. Rather, the therapist utilizes herself as a temporary
therapeutic attachment ﬁgure for the client (J. Bowlby, 1975) and with great
sensitivity and care, balances being both the internal representation of the
maternal caregiver and the external therapist/stranger. The therapist uses
mother-child attachment principles to educate and guide the client to self-
observation and reﬂection, understanding of the nature of attachment
relationships, and reparation of disrupted attachment. Therefore, in treatment,
the clinician in concert with the client must be able to develop and maintain a
therapeutic attachment relationship similar to the therapeutic alliance but

informed by attachment principles, utilizing the characteristics of accessibility,

47

sensitivity, attunement, and responsiveness to further the exploration of
signiﬁcant attachment relationships. This helps the client forge a link between the
historic attachment ﬁgures (mothers and other caregivers) and present adult
attachment ﬁgures (therapist, lover, relatives, and friends).

Several key principles of attachment theory are at stake in this scenario.
The attachment system is active across an individual’s entire lifespan (J. Bowlby,
1958; Weiner, 2003). Attachment behaviors may decrease, diminish, or even
disappear over the course of an extended absence (even over the course of a
lifetime) from the maternal object of attachment but the attachment itself is not
necessarily diminished (Ainsworth & Bell, 1970). The principle holds true even in
cases of adverse care. “Indeed, an attachment can develop despite repeated
punishment from the attachment ﬁgure” (J. Bowlby, 1979, p. 203).

It is the primary force of the mother-child bond that the therapist helps the
client cull from the chaotic fragmentation of the past. It is the affectional tie, even
a hoped-for affectional tie, which clients utilize to recreate attachment and secure
base functions in their lives. In therapy, the clinician teaches the client, through
psychoeducation and modeling, to utilize the bounded attachment relationship
and secure base with the therapist to forge new patterns of attachment behavior
in current life relationships (Cortina & Marrone, 2003; Diamond, et al., 2003).

Clinicians are responsible for creating a safe and bounded holding
environment (Wmnicott, 1971) that prevents harm to or loss of the client and a
ﬂexible therapeutic attachment relationship with the client to foster attachment

reparation. Clinicians can act as the secure base for clients as they struggle to

48

differentiate and integrate the self through the proximity and elasticity of the
therapeutic relationship (Diamond, et al., 2003). And the security of the
therapeutic attachment relationship can help the client learn social and
relationship skills, build or enhance internal regulatory systems, and experience
success and mastery in their adult environments (Diamond, et al., 2003; Harris,
2003)

Clinicians can be trained to enhance, therapeutically repair, and solidify a
client’s affectional bond with the historic, initial maternal attachment ﬁgure
thereby creating a safe and more effective internal secure base for the adult
client to promote health and healing for the client. And clinicians can be trained to
utilize the person of the therapist to promote and enhance attachment reparation
and establish and reinforce the internal working models of attachment
relationships and secure base functions (Cortina & Marrone, 2003; Diamond, et

al., 2003; Harris, 2003).

Conclusion
Attachment theory has stood the test of time because the premises are
based in an enduring pattern of relatedness that exists, not only for survival but
also, for connection. Attachment is not static or deterministic. Attachment is
dynamic, complex, and ever evolving. It has both an internal, psychic
organization and an external, observable manifestation. That may explain why it

is so difﬁcult to deﬁne and study, but it also explains why the theoretical

49

principles are elastic and adaptable to current culture and trends. Attachment

theory has a place in social work for the twenty-ﬁrst century.

50

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CHAPTER 3

A Case Study: A Discussion of Depression, Ambivalence, Attachment and

Culture Portrayed in the Therapeutic Environment

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Abstract
This paper uses Object Relations Theory to conceptualize and manage the
complexities of a home-based case, followed for a period of six months. It
discusses maternal depression in relation to the caregiver role, self-harm, and
self-determination. The client’s ambivalence issues are addressed, with particular
emphasis on transference and countertransference issues in the relationship and
the use of transitional space and objects. Also discussed is the effect of maternal
depression and ambivalence on mother-infant attachment, with the introduction
of Interaction-Guidance as a treatment modality. There is a discussion of cultural
differences and the concomitant ethical implications that arose in the treatment

process. And ﬁnally, therapeutic implications and reﬂexivity are addressed.

Key Words: Depression; Ambivalence; Attachment; Culture

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Now when Job’s three friends heard of all these troubles that had
come upon him they met together to go and console and comfort
him. When they saw him from a distance, they did not recognize
him, and they raised their voices and wept aloud; they tore their
robes and threw dust in the air upon their heads. They sat with him
on the ground seven days and seven nights, and no one spoke a
word to him, for they saw that his suffering was very great (Job

2:11-13).

When I ﬁrst saw her, I don’t think I saw her at all. Rather, I reacted to her,
to her pain. I experienced her body as being wrapped tightly in a dark cloak of
grief, loss, desperation, and anguish. Her eyes were wounded slits. As she sat,
small and hunched, l was ﬂooded by feelings of loneliness, heartache,
hopelessness, and despair. And like Job’s friends, I could only sit with her in
silence to acknowledge, on some level, her desperate suffering. I did not speak. I
did not touch. I held her in the space that was created between us.

On the surface, the referral appeared to be uncomplicated. The presenting
problems were maternal depression, and mother-infant attachment deﬁciencies.
The primary ﬁgures were few: one young mother, an infant, and a set of maternal
grandparents. The referral notice was typed neatly and information given
concisely, brieﬂy, and orderly. But lives are not lived in neat, straightfonivard and

orderly lines. Life is often messy, full of crashes and afﬂictions.

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This young woman suffered from multiple collisions. She ran away from
home with a young man when she was ﬁfteen. She was married, but not legally.
She conceived a child, but her husband died before the birth of their baby. Her
parents stepped into the picture to provide support and a place to live, but she
found herself thousands of miles away from the home and friends she had
created with her husband. She was enfolded into family and a culture, but one
she had rejected. She was isolated, lonely, grief-stricken, and tormented. She
had no education, no driver's license, no income, no friends, no husband, and no
home. She’d lost her created life and independence and gained an infant who
was utterly dependent. She was trapped. Those were the unwritten words that, if
typed on the referral note, might have smudged the paper and tom the edges in

a dim reﬂection of the brokenness they represented.

Background

Susan is eighteen years old, Caucasian, and the mother of a six-month-
old male, Caucasian infant. She lives with her parents in a middle-class home in
a medium-sized, Midwestern community. I met her six months ago and have
seen her on a weekly basis.

My orientation to this case, particularly in reference to mother-infant
attachment, has been predominantly from Object Relations Theory inﬂuenced by
Bowlby, Fairbairn, Klein, Mahler, Sandler, and Wrnnicott (Buckley, 1986), bearing
in mind Erikson’s (1964, 1968) developmental stage theory and ego psychology.

Object Relations Theory shapes the way I conceptualize the case within the

66

therapeutic endeavor. I hold those formulations simultaneously with an attitude
grounded in humanistic psychology, particularly as shaped by Carl Rogers
(1961) and what has come to be called Person-Centered Therapy (Corey, 2005).
If I am able to bring to the therapeutic relationship personal congruence,
unconditional positive regard and an accurate empathic understanding, I believe
that I will be able to provide a space in which the client is free to become herself

(Corey, 2005; Rogers, 1961).

Depression

Susan’s depression had a profound impact on me, from the ﬁrst moment
of our meeting. I was forced to listen at a deeper level, dependent on nonverbal
cues and transference and countertransference to hear the story she was so
afraid to tell. In our early sessions, she communicated through demonstration
and dramatization of her despair. She sat in a corner of the couch holding the
baby loosely across her arms and barely moved. Her motions were excruciatingly
deliberate and contained. If she spoke at all, it was slowly and with great effort,
as though it was difﬁcult to form the words and push them past her lips: words of
grief wrapped in sadness. She never looked at me. She rarely moved. The baby
was still, nearly lifeless. Her vacant eyes couldn’t see him as she held a dead-like
baby in her arms, a dead baby shrouded in the same dark despairing gloom that
covered her, and made me shudder.

Sometimes mother and baby were so still I wondered if they were

breathing. And, I wondered if they were so connected in this dance of death that

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their breathing was in tandem. If baby died, would mother die? If mother died,
would baby die? Could they pass through a life together sharing this deadness?
If she came back to life, was she afraid the baby would join his father in death
and leave her more alone? And, did the baby have enough living, breathing life
around him to keep him vital and help him thrive?

Susan wished she had died with her husband, but the power of that wish
dwindled with the birth of her baby. Even in the midst of the terrible grief, much of
her unconscious wished to live, and most of her conscious mind wished to stay
alive for the sake of the baby. The life and death ambivalence was a function of
boundary confusion among her, her husband, and their child. Who was dead?
Who was alive?

Susan was resistant to antidepressants. When she discovered that she
was pregnant, she quit drugging and drinking. She still smoked a pack of
cigarettes daily, but desired to live cleanly for the sake of the baby. She
perceived that taking antidepressants was defeating. I believe she also derived
unconscious pleasure from the pain and suffering she experienced and was
unwilling to give it up. Suffering was an indication to her of being alive. Suffering
represented a defense against death. In the mourning process, a time ﬁnally
came when that suffering became productive (Klein, 1986).

I found a seductive pleasure in the depression melodrama. She cast me in
the role of observer-participant. My own abandonment fears created a mutual
desire to play out the scenario. It took tremendous effort on my part not to

succumb to the invitation to play dead and to drown in the darkness with mother

68

and baby. Someone needed to project hope into the fragile space between us.
Susan wanted desperately to keep that space blank, ﬁlled with nothingness, but
that space, as I believe Wrnnicott (1982) envisioned, was intended to be a
playing ﬁeld for life, not death. I had to choose life. I had to be the mother
container, the bearer and supporter of life, in order to create a space that was
safe enough and strong enough to hold the grief while we practiced living, one
breath at a time. Eventually, Susan began to test the space.

Susan’s depression afforded opportunities for me to explore some of the
more subtle ramiﬁcations of the therapeutic self in the process. How safe was
Susan from self-harm? My intuitive self believed that she would not suicide. Why
did I trust that? What was it about my experiences that resonated with Susan to
accept her word? Did I hear her voice clearly, or did I superimpose myself, and
what I wished to hear, over her words? Did I believe too strongly in my own
strength and hope or was that strength and that hope good enough (Wrnnicott,
1982) to support Susan?

I remembered the advice of a clinician I heard speak many years ago in a
family therapy context. It is important to understand the character and strength of
the adolescent, believe them to be true, and act toward the adolescent out of that
truth (J. Young, personal communication, 1988). I believed that Susan spoke the
truth and clearly wished to stay alive for her child. I accepted that truth, validated
her wish and strength, and portrayed that I believed her. This undergirded her
resolution and multiplied the hope and trust within the therapeutic space. I

believe it was imperative that I rely on my intuition and believe in Susan’s

69

strength, which allowed her to move forward toward the light and out of the
darkness. It also became clear to me that Susan knew her way out, would
struggle to climb out of the depths in her own way and time, and that I needed to

listen and follow, but not impose or direct.

Ambivalence

Ambivalence is another salient feature in my work with Susan. She tests
my tenacity and the working alliance at every session. In some ways, I was
prepared for that challenge. I realized that a depressed adolescent who has
birthed a child and who has just lost her life’s soul mate would be struggling with
ambivalence and abandonment, with no place to safely play those out. She never
outright canceled a session, but at the ﬁrst assessment session I arrived at her
home to ﬁnd her in bed sleeping. I had time in my schedule so I left her a card
and returned later the same day. She was up and ready to receive me then.
However, as I described earlier, depression and ambivalence were tightly
connected during the assessment phase.

Once as I arrived, Susan was on her way out the door, but she asked her
mom to tell me about her childhood development. Mom thought it strange that
Susan waited until I arrived before leaving the house, but it didn’t seem quite so
strange when I remembered Susan had revealed a great deal about herself in
the previous session. She now felt the need to back away and give herself some
space. I thought it noteworthy she actually waited for my arrival before leaving,

as if to notify me, and to reassure herself that she didn’t need me.

70

During another session, she walked out of the room to nurse the baby and
never returned. I waited the length of the session, left her a note and an
appointment card setting up a session for the same time the following week. I
never invaded her space unless invited. It was important to our work. She
perceived her life as out of control. I thought it consistent and valid from a
strengths perspective for Susan to have control over inviting and rejecting. l was
never sure why she felt the need to leave the session at that precise moment. It
might have been the topic of her conversation, or the feeling attached to it, or the
dependence and attachment she was beginning to feel for me.

Eventually the pattern softened; the ambivalence began to give way. At
another scheduled session, she kept me waiting ﬁfteen minutes before she came
up from her room. A short time into the session she walked out with baby for
several minutes, but managed to return. When she prepared to leave the room
again to smoke on the deck, she ﬁnally invited me to go with her. That felt like a
major breakthrough.

This new pattern continued. First she invited me to go with her when she
smoked, then it was while she changed the baby’s diaper, or to show me her
room, or to sit someplace quieter so we could talk. Finally, after ﬁve months, she
asked me if I would like to hold the baby. lnstinctively I felt she was asking if I
would like to hold her. I remarked to the baby as I gathered him in my arms, that
since he was so closely connected to his mother, it was like hugging both of them

at the same time. She smiled and leaned her head ever so slightly closer to me.

71

It might have been an overly imaginative state of wishful thinking on my part, but
I think not.

I made sure to be on time. In the early sessions I brought her something
concrete, such as an article, a magazine, or notes about infants, development, or
depression. I tried to communicate that l was prepared to accept the relationship
on her terms, and not abandon her. I believed my calmness, promptness, patient
waiting, and physical continuity through the use of concrete reminders of my
presence created a space between us that was secure and trustworthy. I
founded this practice on Wrnnicott’s (1982) conception of transitional space: the
intermediate area of experiencing that lies between the subjective inner reality
and external life, which is objectively perceived. These attributes ﬁnally began to
have a powerful affect on Susan. She used the alliance, the transitional space, in
small doses until she began to trust the permanent quality and texture of the
space. She eventually used the sessions to tell her story.

Susan began to play out and work through some of her ambivalence to a
therapeutic alliance. She resolved part of her defensive stance against
connectedness. Through playing “come here/come here - get away/get away,”
she tested the edges and boundaries of my symbolic promise not to abandon
her, a reenactment of the practicing subphase of differentiation in which the
exploring child uses mother as a stable home base for refueling, conﬁrmation,
and comfort through physical contact (Corey, 2005; Mahler, Pine, 8 Bergman,
1975). But the underlying issue of separation-individuation has yet to be

addressed. “An old, partially unresolved sense of self-identity and of body

72

boundaries, or old conﬂicts over separation and separateness, can be
reactivated (or can remain peripherally or even centrally active) at any and all
stages of life” (Mahler, Pine, 8 Bergman, 1975, p. 4). Clearly, Susan has strong
ambivalence issues attached to being a daughter/mother, a child/woman, and
alive/dead. It is also true she may not be able to tolerate termination and will
prematurely abandon the process as a preemptive strike. I am afraid she will run
away to prevent feeling abandoned. I need to be cautious, and cannot let the
expectation that she may ﬂee determine a course and pace of treatment that is
not in Susan’s best interests.

We have only ﬁve sessions remaining. Susan is planning an extensive trip
to visit friends and relatives that will effectively end our time together. She has
been resistant to discussing her feelings attached to our permanent physical
separation. I ask how she will take care of herself in my absence. We discuss
options and alternatives, two words that are new to her vocabulary, along with
ﬂexibility and creativity. I remind her of the time limits at each session and
reinforce her insights, attachment behaviors, and changes in thought patterns.
Susan has incorporated parts of me. This has created a shift in her reality testing
and ego function (Fairbairn, 1952).

Her ambivalence has generally failed to provoke a strong reaction in me.
Perhaps because the alliance is inherently unequal, I have been able to maintain
a tolerant stance with her. She cast me in the role of rejecting mother, but I
refused to take it up. Basic trust was at stake. Vital elements of the therapeutic

alliance needed to be established. Hope must be secured, love reciprocated, and

73

ﬁdelity proven reliable (Erikson, 1964). When she left, I remained. When she
approached, I drew near. When she pushed away, I came back. Sometimes I felt
like the proverbial rubber ball secured to a paddle by an elastic string. Susan
held the paddle. How far could she push, or how hard could she bounce me
before the string broke or she broke? It was my job to make sure the string did
not break. That is a clear re-enactment of a toddler learning to separate from
mother, a going away and coming back for reassurance. I have attempted to
establish a corrective relationship in the separation-individuation phase, acting as
a bridge between child-Susan and her mother, in order to facilitate an increase in
awareness of both the separateness and differentiation of her self from the other,
and of a reality in the outside world (Mahler, Pine, 8 Bergman, 1975).

Susan came to appreciate the fact that there are no easy or perfect
solutions to the paradoxes life offers. She is a child with a child of her own. The
question is how to meet her own dependency needs, and at the same time, meet
the dependency needs of her infant? Her trapped feeling comes when she is
unable to hold both positions simultaneously: both a child, with unmet needs, and
a mother with the responsibility to meet needs.

Unpleasant experiences and the lack of enjoyable ones, in the

young child, especially lack of happy and close contact with loved

people, increase ambivalence, diminish trust and hope and conﬁrm

anxieties about inner annihilation and external persecution;

moreover they slow down and perhaps permanently check the

74

beneﬁcial processes through which in the long run inner security is

achieved (Klein, 1986, p. 150).

The lack in Susan’s early life prevents her from achieving inner security. Susan’s
fear of annihilation impedes her ability to care for her infant son.

In a similar manner, she is afraid to both love and hate her dead husband.
She concentrates on and idealizes the good about her husband, Sam, while she
denies the anger and hate boiling inside her because he abandoned her and the
baby by using the drugs that were so dangerous to his health and life. She
displaces her anger onto his parents for abandoning Sam when he chose
another lifestyle. Unfortunately for her, that line of thought has brought her up
against another paradox. She hates his parents for denying Sam their love and
leaving him so alone when he was often deeply in need of support, but she is
beguiled by the love these same parents have for their grandchild. She
desperately needs to tell them how angry she is, how she despises their past
behavior, but at the same time, doesn’t want to add to the guilt and remorse they
feel over the death of their son and the grief they caused him.

Over and over she collides with her ambivalence crashing into love and
hate, black and white, yes and no. However, the tolerance she has experienced
in the push-pull relationship of the therapeutic alliance has given her insight and
drawn her to reach the intellectual conclusion that it is necessary to reject the
polarity of either/or and accept the inclusive nature of the paradox. She needs to

regain trust in external objects, realizing that they are not perfect. She needs to

75

regain and strengthen her conﬁdence and trust in the love she has for her

husband and the love he had for her (Klein, 1986).

Attachment

John Bowlby (1958, 1969) formulated Attachment Theory 50 years ago.
He deﬁned attachment as an emotional and affective bond that reﬂected the
enjoyment, the attraction, that one individual had for another individual (Bowlby,
1958; Cassidy, 1999). Bowlby (1958) and Wrnnicott (1968, 1987, 1993) included
the term enjoyment when describing the mother-infant attachment dyad. Bowlby
described the pleasurable mother-infant connection as a process of attachment
that he considered nearly identical to the idea of love. He believed proximity to
mother (or a mother ﬁgure) was essential to survival, that the mechanisms that
underlie the infant’s attachment tie to the maternal ﬁgure originally emerged as
the result of evolutionary pressure, a biologically based need for proximity that
equated with survival and natural selection (Cassidy, 1999). Therefore proximity
seeking and maintaining and renewing behaviors led to a secure base and
feelings of love, self—assurance and joy. However, disruption in the process
produced anxiety, grief and depression (Karen, 1994).

A grave concern from the initial assessment was Susan’s minimal
involvement and attachment to her infant. She had an intellectual capacity for
nurturing, but failed to respond physically or emotionally to her baby’s needs.
She did not cuddle the baby, rather held him openly and loosely in her arms,

almost exclusively turned away from her. The baby did not follow her, rather

76

turned or arched away, and was more interactive with either of his grandparents.
Babies need physical stimulation, sensitivity, eye contact, affective responses,
and adjustment to their own level of sensitivity. These maternal characteristics
are necessary for optimal mother-infant interactions but maternal depression
interferes with the likelihood that these qualities will be present (Rukstele, 1997).

Susan struggled with boundary confusion. She projected characteristics of
her dead husband onto the baby that distorted her perceptions of the infant, her
self, and the attachment and affection between them (Wright, 1997). On a
conscious level she desired to meet the needs of a live, functioning baby.
However, on an unconscious level, Susan held a dead baby/husband in her
arms. This unconscious fantasy kept her from connecting with her baby, a belief
that the baby was as dead as his father. “Under favorable circumstances... the
baby makes his own imperative claim upon parental love and, in strict analogy
with the fairy tales, the bonds of love protect the child and his parents against the
intruders, the malevolent ghosts” (Fraiberg, Adelson, 8 Shapiro, 1975, p. 387).
Unfortunately, in this case, the infant was unable to make that imperative claim
upon his mother’s love.

During case consultation, a colleague suggested the Interaction-Guidance
Technique (McDonough, 1992) to boost the attachment process and promote
boundary deﬁnition between Susan and her baby. I videotaped Susan and the
baby as they interacted at the next session. We than watched the tape together.
We used her responses and insights to seeing herself interact as a mother as a

basis for further communication and education.

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The intervention itself had a powerful impact on Susan. She is a very
bright young woman and quickly realized the videotaping was more than an
opportunity to take pictures of the baby. Placing herself in front of the camera
gave Susan an opportunity to critically evaluate her vision of and responses to
the baby. Over a three-month period I videotaped Susan and her baby three
times for a total of 90 minutes of tape. “If there were tenderness and deep love
for the baby, the presence of the baby evoked the most poignant expressions of
love. If there were conﬂicting emotions toward the baby, the conﬂict seemed to
surface with his physical presence” (F raiberg, Shapiro, 8 Spitz-Cherniss, 1994,

p. 50).

Susan had an intellectual grasp of what it was to be a mother, but her
behaviors as a mother in response to her infant were discrepant and incongruent.
She quickly perceived the deﬁcits and made alterations and adaptations. Susan
holds, feeds, diapers, plays, and interacts with her baby kindly, generously, and
non-sadistically in front of the camera and in my presence. In response, the baby
clings, smiles, giggles, gazes, and plays appropriately for his age.

We used the Interaction-Guidance Technique over the course of treatment
to have an outcome measure at termination. The video is a powerful and
compelling portrayal of mother-infant movement toward attachment. The
videotape will also serve as a concrete transitional object between Susan and me
following termination. All of the transitional objects utilized over the course of
treatment can be handled in moments of stress and separation to alleviate

anxiety and fear of separation (Vtﬁnnicott, 1957).

78

I continue to have grave concerns for Susan and her baby. As Susan
climbs out of the depression and begins to feel her feelings, she may again
become overwhelmed. She no longer has the luxury of mastering childhood and
moving on to the complications and problems of adulthood. These two worlds
have collided in the person of her baby. The myriad issues surrounding the birth
of the baby and his presence in her life, on multiple levels, bring a vast array of
treatment problems to the discussion. I resonate with Wrnnicott’s work. This
extraction from one of his papers helps me a great deal in comprehending and
holding Susan’s unconscious hate for her baby.

Let me give some of the reasons why a mother hates her baby: The

baby is not her own (mental) conception. The baby is not the one of

childhood play. The baby is not magically produced. The baby is a

danger to her body in pregnancy and at birth. The baby is an

interference with her private life, a challenge to preoccupation. He

is ruthless, treats her as scum, an unpaid servant, a slave. After an

awful morning with him she goes out, and he smiles at a stranger,

who says, “Isn’t he sweet?” If she falls him at the start she knows

he will pay her out for ever.... A mother has to be able to tolerate

hating her baby without doing anything about it. She cannot

express it to him.... The most remarkable thing about a mother is

her ability to be hurt so much by her baby and to hate so much

without paying the child out, and her ability to wait for rewards that

may or may not come at a later date (Wrnnicott, 1958, p. 201-202).

79

I do not think Susan has developed the capacity “to tolerate hating her
baby without doing anything about it.” I wonder if her sadistic tendencies are too
close to the surface. Two sessions previously Susan came up from her room in a
rage. She cursed and swore, threw cups and pans around the kitchen, knocked
over several chairs, and eventually stomped back downstairs. Her parting
comment from the lower level was, “Tell her to get the f_ out and never come
back.” She may have consciously intended the remark for me, but, intuitively, I
felt it was directed toward the baby. “I love him. I hate him.” It formed a singsong
echo in my head.

I instinctively felt that she harbored an unconscious desire to kill the baby,
simply because she was so terriﬁed that he would die (Bowlby, 1958; Karen,
1994). Closely aligned with the love/hate dilemma toward the baby is the same
dilemma toward her own sense of self. “I love her. I hate her.” Unfortunately, this
has created a great deal of confusion and chaos for Susan. She insists she loves
Sam, she loves the baby, and she hates herself. The opposite of that statement,
“I hate Sam, I hate the baby, I love myself,” is inconceivable to her. And holding
the paradox simultaneously is also impossible for her at this point in time. It
makes her incredibly vulnerable to her own hate and rage, because she denies
they exist. For that reason, I carry concern for the baby.

Susan has many suppressed feelings and representations about this
infant, as well as herself as an infant. This has created a transference-
countertransference dance within our relationship, especially given the maternal

role she created for me. It helps me stay more accurately attuned to Susan in the

80

therapeutic moment believing that the countertransference is an immediate
reﬂection of her internal sensitivities and unconscious communication (Wright,
1986, 1997). I listen to Susan more carefully with my mind and heart. But the
dance has also created havoc with what I hold near and dear about the care and
comfort of an infant.

Susan’s ambivalent attachment to her baby triggers maternal anxiety
within me and prompts a destructive urge to ﬁx the problem, and ﬁnd a perfect,
quick solution. I desire Susan to ﬁnd her way out of the darkness, face her
demons, establish effective coping skills, and learn to be a perfect parent. In
other words, “Susan, would you please grow up and learn to take care of yourself
and the baby. And could you speed that up, because you’re leaving at the end of
April.” These thoughts, and others like them, scare me. I very much believe in the
strengths perspective. Susan demonstrates time and again tremendous internal
strength, resources, and determination. I need to step out of the way and act as
her mirror. I trust her. I have hope in her. I need to act on what I know to be true
aboutheL

Susan has tremendous personal strength, environmental support, and an
alliance with a therapist (Saleebey, 1996). My expectation is that her innate will
to heal, mixed with hope, will prove to be a strong catalyst for forward movement,
but that movement must be self-directed. I must be able to keep my personal

values, desires, and wishes where they belong - in my head.

81

Culture

I mentioned in the introduction that I did not really see Susan when I first
met her. It wasn’t until I viewed the ﬁrst videotaped session with colleagues that
the vast cultural gulf that existed between Susan and me began to take shape
and form before my eyes. In the ﬁrst sessions, listening for her underlying
communication was important. As sessions progressed, listening to her narrative
was imperative. But, my listening to her in an invisible and blind state was a
handicap for both of us, as well as a disservice to her person.

What the videotape revealed was not a new Susan. I was conscious of
how she looked; I wrote a description of her appearance for a mental status
exam. But for unconscious reasons of my own, I missed the impact of Susan’s
appearance and, therefore, participated in the silent conspiracy of invisibility that
was part of the family pattern. Susan was assigned the role of the lost, invisible,
and secret child in the family.

Susan exhibits little visual conformity to the middle-class, white culture in
which she now ﬁnds herself. She wears extremely tattered black Goth clothes
that usually bear a graphically violent slogan or logo. She wears a variety of
metal jewelry, but is partial to one particular black leather and metal, spiked
choker that is several inches wide with inch long spikes. She has dark, navy-blue
facial tattoos that she says are tribal markings she designed herself, but look
very much like a navy-blue goatee. Under her lip at the crease of her chin, in the
middle of the goatee, she has a large silver metal piercing. She has an extra-

large, heavy, metal nose ring shaped like an upside down U, emphasized by

82

heavy metal balls at the ends. Horizontal bones, one inch in diameter, run
through her stretched and pierced ear lobes. She easily puts her index ﬁnger into
the holes to stretch her ear lobes. She has many other body tattoos and
piercings and frequently designs new ways to burn and cut herself.

She enjoys talking about the steps to burn, color, cut, scab, and heal a
tattoo or piercing. Her natural hair color is nearly black and, until recently, she
wore her hair in a fairly traditional manner, even though she often chopped at it
with scissors to blunt the ends. Two weeks ago she made a radical change to her
appearance. She shaved parts of her head, bleached or vividly colored parts of
her hair, and created dread locks in other parts Her baby showed no reaction to
this visual change in his mother. Her parents continued the invisibility theme by
failing to notice the dramatic difference. Fortunately I noticed right away which
brought a sigh of relief from her.

In contrast, the room she shares with the baby is neat, orderly, and
spotless. The baby has a new crib piled high with toys and decorated with a
colorful mobile. She has a new stereo to play an amazing stack of records that all
sport covers depicting graphic physical and sexual violence. Next to the records
is a camera. She takes many pictures of the baby dressed in his designer
fashions. At our last session she showed me a picture album of her friends:
smoking, drinking, vomiting, running, bleeding, beaten, and jailed. She brought
out an album of herself as a baby and little girl. It was crammed with pictures of a
beautiful child on her birthdays, at Christmas, playing, smiling, and riding bikes

and ponies, alone and with her sister, playing sports, and taking dance lessons.

83

The photos were charming and beguiling. She ended the session by sharing an
album of her photographs of her own baby that she had started. I wondered how
long she could pay the emotional price of this compartmentalization.

When Susan was ﬁfteen years old, she met Sam who was eight years
older than she. Susan dropped out of school, and she and Sam left town
together, identifying themselves as travelers. They lived on the fringe of society,
train hopping and hitchhiking, eating in city missions, sleeping in rail yards, and
were in constant trouble with the law. They identiﬁed solely with the hobo and
drug cultures. Susan was a chronic, daily user of alcohol and street drugs. Sam
was in worse shape, suffering from chronic liver disease, and living in a constant
state of chemical dependence. When they needed a little money for more dope
or food, Susan took part time jobs, usually in a tattoo and piercing salon. Sam
died from a drug overdose two months before the birth of his son.

Culture and ethnicity shape the self and the human story in powerful ways.
It is vitally important to seek individual cultural stories, to know enough to ask
good questions, and to notice culture in the appearance of clients (Laird, 1998).
Susan narrates stories that give me insight into her character and her lifestyle,
her philosophy of life and her goals and dreams. Sometimes we talk about her
writing a book. She is a wonderful storyteller, imaginative and creative. I often
feel as though I am running beside her as she ﬂees from the police, or sitting
beside her as she eats in an inner city mission, or sleeping beside her in the

open country, drunk or high, and covered in leaves or vomit depending what the

84

last waking moments held. I am often spellbound, and I wonder what it is that
attracts me, mesmerizes me.

A primitive element of freedom ﬂows through her stories. She is
unencumbered with belongings; she stuffs only what she can carry into a tattered
backpack. She has no money to waste on necessities, much less frivolous
accouterments. An unnecessary purchase can be a wasted expense if she
decides it is too much weight to bear and has to dispose of the object. What is
and is not essential in belongings is distilled into necessities.

The same can be said of friendship, of relationship. She carries a
connection to only one person, Sam, and that because she is the one in control.
She is the caregiver, the supporter, the lookout, and the anchor. All other
friendships are transitory, based in mutuality or usefulness, which ebb and ﬂow
by train schedules and jail sentences. Who is and is not essential in relationships
is distilled into nothingness.

What attracts "and fascinates me is merely illusion. Deprivation is not
freedom. Freedom manifests itself in choice. Over time deprivation creates a tight
ﬁst of grinding misery from which there is often no escape. What begins as a
perception of choice, reveals itself, ultimately, as a desperate trap. She has
nothing because she is attached to nothing. She loves no one because she is
terrified of intimacy. She carries nothing and desperately seeks freedom in ﬂight,
but is tragically unaware she carries her personal and private baggage with her

wherever she goes like weighted locks and chains.

85

I listen, I sigh, I wonder, and I wait. I have been brought deeply into
another culture and gained insight. I have gleaned more information than Susan
intended to reveal. I hold that knowledge carefully. I do not want her to feel
invaded and violated. I am aware that I ﬁnd her stories provocative to my intellect
and my emotions. I must not pry for selﬁsh and voyeuristic fulﬁllment. A fragile
and brittle young woman sits with me in trust and in hope, session after session,
and desperately seeks to understand herself, and reframe her narrative, and ﬁght
for the ability to breathe again with utter unselfconsciousness. I must nurture that
work by understanding the meaning she ascribes to her life and culture, and not
contaminate her experience by imposing my own interpretation or expectation.

While I am intrigued by Susan’s experiences, I am simultaneously
appalled and repelled. She has been drunk or high more days than not, been
arrested and jailed, been brutally beaten and left for dead, suffered from broken
bones and internal injuries that were never treated, had friends murdered and
slept with murderers, experienced malnutrition and near starvation, been spat
upon, shunned, reviled, and suffered through the death of her husband. As
Susan reveals these facts through the stories she tells, they were delivered with
an air of suppressed excitement. She enjoyed these experiences. She deﬁnes
herself by mutilation, torture, and death.

In the face of this excruciating pain, | ask myself what I can do to help her:
how I can ﬁx her myriad problems: where I can ﬁnd the resources to meet her

needs? The answer: I can do nothing, ﬁx nothing, and ﬁnd nothing. What I can

86

offer is myself, fully present with her, and a good enough holding environment

(Wrnnicott, 1987) for Susan to do, ﬁx, and ﬁnd as she determines.
If I can create a relationship characterized on my part: by a
genuineness and transparency, in which I am my real feelings; by a
warm acceptance of and prizing of the other person as a separate
individual... then the other individual in the relationship: will
experience and understand aspects of h[er]self... become better
integrated... more similar to the person [s]he would like to be...
more self-directing and self-conﬁdent... more of a person, more
unique and more self-expressive... able to cope with the problems
of life more adequately and more comfortably (Rogers, 1961, p. 37-

38).

Conclusion

I have culled from my experiences with Susan those moments that were
particularly signiﬁcant or poignant. Most of what I have communicated about
Susan is my interpretation of her insight. Her narrative is in stories, stories she
tells as though standing outside herself, detached and disconnected. Yet, buried
beneath, is a part of Susan she keeps hidden from her self; the young woman I
ﬁnd so charming and irresistible. Susan has communicated to me those
dimensions of her personality and her ego which she has denied: the split off and
lost parts of her that have created her ambivalence. My hope is that I held,

carefully and lovingly enough, and mirrored that brokenness accurately enough,

87

so Susan can begin the process of integration. My hope is that she will
successfully mourn her loss, ﬁnd a secure internal home base, attach to her
infant, and use the termination process as a reparative function in which she is
free from the fear of abandonment and annihilation.

Susan has taught me much. I love deeply and connect strongly.
Therefore, I am susceptible to hurt. My capacity for holding suffering is immense,
but not bottomless. My senses are acute and my intuition trustworthy, but not
infallible. I learned again that this work is not for the fainthearted. I learned again
that all I have to offer is my self, in the very basic and primitive sense of the word.
But above all, I learned that I must be scrupulous about examining my self, my
pain, my biases, my weaknesses, and my strengths at all times. I alone am
responsible for the state of my self as I am called to sit in the presence of

another’s suffering.

88

References

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of Psycho-Analysis, 39, 350-373.

Bowlby, J. (1969). Attachment and loss (Volume 1). London: Hogarth Press.

Buckley, P. (Ed.). (1986). Essential papers on object relations. New York:
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(Eds), Handbook of attachment: Theory, research, and clinical
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Fraiberg, S. H., Shapiro, V., 8 Spitz-Cherniss, D. (1994). Treatment modalities.
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bond and its impact on later life. New York: Warner Books.

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in clinical practice (pp. 20-36). New York: Guildford Press.

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Mahler, M. S., Pine, F., 8 Bergman, A. (1975). The psychological birth of the
human infant: Symbiosis and individuation. New York: Basic Books.

McDonough, S. C. (1992). Interaction guidance: Understanding and treating early
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psychotherapy. Boston, MA: Houghton Mifﬂin.

Rukstele, R. (1997). Treatment of infants and their families. In J. R. Brandell
(Ed.), Theory and practice in clinical social work (pp. 501-528). New York:
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Saleebey, D. (1996). The strengths perspective in social work practice:
Extensions and cautions. Social Work, 41(3), 296-305.

Wrnnicott, D. W. (1957). Mother and child: A primer of ﬁrst relationships. New
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psychoanalysis. New York: Basic Books.

V\ﬁnnicott, D. W. (1968). The child, the family, and the outside world. Cambridge,
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CHAPTER 4

Attachment: Indicators from Caregivers and Toddlers —

Implications for Adult Treatment

91

Abstract
An ethnographic study was conducted to observe indicators of healthy and
pleasurable attachment between women caregivers and toddlers in natural
environments. Nineteen dyads were observed for an average of 20.3 minutes.
Data were collected in three ways: ﬁeld notes, sketches, and reﬂexive writing. Six
indicators of healthy and pleasurable attachment evolved from the coding
process that can provide categories for clinicians to consider in adult treatment
settings: reciprocity and mutuality, proximity, verbal exchange, affective features,
physical affection, and physical activity and play. One other fundamental
component that emerged from the study concerned caregiver use of
environmental space for toddler safety and exploration that supports the secure

base functions of the maternal-infantlchild attachment relationship.

Key Words: Attachment; Attachment Relationship; Environmental Space

92

The story of a human being does not start at ﬁve years or two, or
at six months, but starts at birth — and before birth if you like; and
each baby is from the start a person, and needs to be known by

someone (Wrnnicott, 1964, p. 86).

Attachment issues form a foundation for what underlies the difﬁculties
many adults struggle to overcome. In private practice, clinicians observe the
effects of disrupted attachment in the lives of clients and bear witness to the
difﬁcult and lengthy healing process necessary for them to establish mature,
adult relational patterns. These clients did not experience an affectional tie
(Ainsworth, 1969) with a signiﬁcant someone in their childhood world or an
affective bond (J. Bowlby, 1958) between self and other, nor were they securely
held against mother’s skin to feel her heart beat and to hear her breathe
(V\ﬁnnicott, 2002). Their experiences were of crying in frustration, clinging to
nothing, following and smiling but receiving no response in return, and suckling
from nothingness. Their overwhelming sense of hopelessness and despair stems
from these unmet attachment needs because a child’s tie to the mother/caregiver
is disrupted through experiences of separation, deprivation, and bereavement (J.
Bowlby, 1958; Bretherton, 1985).

The antecedents to the formation of a secure or insecure attachment base
with an attachment ﬁgure and how attachment behaviors (or lack thereof) are
triggered in an individual is unique to each person. However, it does seem

consistent from a therapeutic point of view, that clients who report having serious

93

relationship difﬁculties also report a distant, cold, rejecting, and/or neglectful
mother/caregiver, a mother/caregiver without sensitivity and attunement (Harris,
2003; Wrnnicott, 1993). They also report that no other signiﬁcant individual in
their immediate childhood environment met protective and nurturance needs
either. Certainly the lack of maternal sensitivity toward these clients when they
were children plays a part in the relationship problems that plague their adult
lives (Ainsworth, 1967, 1969; Ainsworth 8 Bell, 1970; Ainsworth, Blehar, Waters,
8 Wall, 1978; Anna Freud Centre, n.d.; Sroufe, Fox, 8 Pancake, 1983; Wrnnicott,
1993). Other factors can impact adult relationship issues but attachment is the
focus and concentration of this study.

These clinical and educational experiences and hypotheses formed the
basis of the research objectives. Other signiﬁcant inﬂuences came from the early
roots of attachment theory and research. Bowlby (1958) and Wrnnicott (1957)
utilized the term enjoyment in deﬁnitions of attachment. Bowlby portrayed infants
as competent, curious, and fully engaged with their caregivers and the
environment (Waters, Crowell, Elliott, Corcoran, 8 Treboux, 2002). Ainsworth
(1967) focused on the pleasurable mother-infant relationship followed by
development of the concept of the secure base in the attachment relationship. In
addition, the earliest research activities were ﬁeld observation techniques
(Ainsworth, 1967; Bretherton, 1985). Therefore, this study aimed to return to the
basic principles of attachment theory, to enjoyment and pleasure in the
attachment relationship, to the secure base function of behavior, and to ﬁeld

observation.

94

Research Questions

The ﬁrst question then is: What are the observable indicators of a positive,
healthy attachment relationship between women caregivers and toddlers? It is
assumed that attachment behavior and attachment theory are stable over time
and that present indicators are similar to the earliest ﬁeld observations
(Ainsworth, 1967). The second question is: What happens in the space between
a woman caregiver and a young child? Vtﬁnnicott (1971) postulated that the
transitional space between mother and infant/child is where the relationship
occurs. He conceived of that transitional space as psychic space. The space that
exists between people is also visible, measurable, and usable space that can
serve the function of dynamic and purposeful interaction. And ﬁnally, the third
question is: What are the implications of the indicators of a positive, healthy
attachment relationship in treatment settings? Understanding elements of what
creates positive, healthy attachment relationships can offer valuable information
in clinical settings to aid in emotional, developmental, and attachment reparation.
If those indicators, extrapolated from caregiver/mother-infantlchild attachment
relationships, can be utilized for beneﬁt in therapeutic treatment, then the

principles can be taught in a social work clinical curriculum.

Study Purpose
This observational study was designed to focus on indicators of healthy
and pleasurable attachment and attachment behaviors between women

caregivers and young toddlers in natural environments. It was carried out in

95

London, Great Britain, public parks and spaces. It was hypothesized that
observable elements of healthy attachment could be documented and coded in
public settings just as early researchers observed and coded attachment
signaling behaviors, for example, clinging, smiling, crying, and following in ﬁeld
research and laboratory settings (Ainsworth, 1967; Ainsworth 8 Bell, 1970;
Ainsworth, Blehar, Waters, 8 Wall 1978; J. Bowlby, 1958, 1982; Seifer 8 Schiller,
1995). However, in order to categorize elements of positive, healthy attachment
relationships to extrapolate meaning into the therapeutic venue, subject selection
was purposely biased toward playful, interactive, and positively engaged women
caregivers and toddlers.

A second purpose of the study was to test and modify an Observation
Check List (OCL) created by the researcher for use in the ﬁeld as a shorthand
aide to note taking and data sorting. This method evolved from work as a play
therapist, where a similar tool was created as a session observation and
process-reporting tool. From that idea, and with a similar purpose in mind, the
OCL was created as a tool for ﬁeld observation. It is a shorthand method
developed to maximize the observation data and make the process more efﬁcient
because taking notes can be tedious when done for long minutes over many
observations. It was hypothesized that the shorthand tool would minimize
interruption of visual contact with the caregiver-toddler during observation and

maximize data gathering.

96

Figure 4-1. Observation Check List

OBSERVATION CHECK LIST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am 1 2 4 8pm
observe X park book store McDonalds
cocl warm rain shine
woman -teen 60 child-toddler 2 3
short------------tall thin heavy short----------tall thin-~---------chubby
blond red brown-«m—mblack blond red brown-mu-«black
strt ------ crly shrt---—-long braids_ pony_ strt----crly shrt—---long braids_ pony_
clothes —dirty clean clothes —dirty clean
clothes — casual formal clothes — casual formal
dress suit slacks jeans t-top shirt dress suit slacks jeans t-top shirt

sweater jacket phone purse jewelry hat
high shoes low shoes sandals sneaker
glasses hearing chair braces crutches
cane other

touch —nose eye ear mouth cheek chin
neck haw

woman affect
ﬂat smile laugh frown cry tears mobile

sweater jacket hat shoes sneakers
sandals hair accessories

glasses hearing chair braces crutches
cane other

touch -nose eye ear mouth cheek chin
neck haﬁ

blanket paciﬁer toy
child affect

ﬂat smile laugh frown cry tears mobile

 

woman actions

whisper speak yell command discipline
redirect scold hit slap remove stop
kiss hug snuggle carry hold

 

child actions

toddle walk run skip jump hop
swing legs swing arms

run to.... run from...

 

 

 

diagram space of caregiver/child interaction

 

 

97

The OCL (see Figure 4-1) has place markers to circle the day of the week,
kind of weather, time of day, gender, general appearance of woman and child,
affects like smile, laugh, frown, scold, and actions like hug, hold hands, and
snuggle. The OCL includes a rectangle drawing box so that sketches of the
space where the interactions occur can be diagrammed and recorded. This
drawing box was designed to help answer the study question of what happens in
the space between a woman caregiver and toddler. (Sample sketches can be
seen in Figures 4-2 and 4-3.) And ﬁnally, lined pages are included for writing ﬁeld
notes or for jotting thoughts, feelings and interpretations during reﬂexive writing

following the observation.

Figure 4-2. Caregiver- Toddler Interaction in Natural Environment

 

 

 

 

diagram space of caregiver/toddler interaction

 

 

 

98

Figure 4-3. Caregiver- Toddler Interaction in Built Environment

 

 

diagram space of caregiver/toddler interaction

 

 

, , glasswall

 

 

Literature Review and Theoretical Framework

Attachment theory was developed by John Bowlby (1958, 1982, 1988) 50

years ago, in part, as an alternative to psychoanalytic theory to explain why

separation caused anxiety in young children, to explain the similarities between

childhood and adult loss and mourning, to explain the process of defenses in the

human psyche, and to explain the mechanisms of social behavior from infancy

that affect and inﬂuence the development of the personality along a continuum

from healthy to debilitating (Barnett 8 Vondra, 1999; Bretherton, 1985; Cristébal,

2003; Waters, Crowell, Elliott, Corcoran, 8 Treboux, 2002). Bowlby did not intend

that the attachment concept substitute for social bonds or be attributed to all

aspects of the parent-child relationship. He intended that the roles of attachment

ﬁgure and playmate be conceptually distinct. When a child feels stress, distress,

99

or fear, she seeks an attachment ﬁgure for safety, protection, and regulation.
However, when a child is happy, content, and playful, she seeks a playmate.
(Feminine pronouns are utilized in this work in deference to the preponderance of
childcare provided by women, even though some men are very or exclusively
involved in caring for their children.)

Attachment theory is a perspective on the secure base functions of close
relationships that operate to promote child development, personality
development, and affect regulation. The theory assumes that maternal sensitivity,
responsiveness, and attunement are major factors in the quality of a child’s
attachment to her mother or attachment ﬁgure (Ainsworth, 1967, 1969;
Ainsworth, Blehar, Waters, 8 Wall, 1978). Attachment theory also presupposes
evolutionary biological necessity. The needs of infants and small children are not
variable; they are inherent and unalterable (Vtﬁnnicott, 1964). Attachment
behaviors must exist and be reciprocated for the infant to survive both physically
and psychically.

Unless there are powerful in-built responses which ensure that the

infant evokes maternal care and remains in close proximity to his

mother throughout the years of childhood he will die. The instinctual

responses... serve the function of binding the child to mother and

contribute to the reciprocal dynamic of binding mother to child (J.

Bowlby, 1958, p. 369).

Attachment theorists deﬁne the term attachment independently but the

similarities are striking, including the concepts of proximity, speciﬁcity, and

100

necessity. “‘Attachment’ refers to an affectional tie that one person (or animal)
forms to another speciﬁc individual” (Ainsworth, 1969, p. 971). [A]ttachment
refers to the relationship... the affective bond between infant and caregiver”
(Sroufe, Fox, 8 Pancake, 1983, p. 1616).

Several distinctions of attachment theory are mentioned here.
Dependence and attachment are separate and different constructs (J. Bowlby,
1958). Attachment relationships are permanent and irreplaceable (Barnett 8
Vondra, 1999). Attachment behavior is heightened in situations perceived as
threatening but attachment itself is not necessarily strengthened (Ainsworth,
1969). Attachment behavior, especially when strongly activated by stress or
distress, is incompatible with exploratory behavior. A distressed child seeks
comfort, not stimulation and exploration. Following a prolonged absence from the
maternal or primary attachment ﬁgure, attachment behavior may diminish or
even disappear, but the attachment itself is not necessarily diminished
(Ainsworth 8 Bell, 1970). This is a particularly relevant concept in therapeutic
relationships. Attachment relationships vary widely across mother-infantlchild
pairs (Ainsworth 8 Bell, 1970). Stress occurs from sudden or prolonged
separation from the attachment ﬁgure and permanent loss causes grief and
mourning (Barnett 8 Vondra, 1999).

Attachment is a broad and complicated concept with multiple layers of
meanings and interpretations. No single deﬁnition or set of constructs can
contain all of the signiﬁcant elements of attachment as a concept. However, one

vitally important foundational observation must be stated. Attachment, regardless

101

of the deﬁnition, occurs in the ﬂexible holding environment of the mother-
infantlchild attachment relationship that begins in the earliest moments of an
infant’s life. This holding environment is both physical and psychic. Caregivers
must be able to create a good enough facilitating environment at the earliest
stages of development to provide for the optimal emotional and mental growth of
the child (Vanicott, 1971).

The caregiver, typically the mother, provides a physically secure
environment of her presence for the infant. This happens, not only through
physical handling and holding, but also, through consistent sensitivity of the
needs of the infant and her availability to meet those needs. The mother must
also be psychically available to her child and mentally carry a positive internal
representation of her own attachment ﬁgures and relationships. These functions
create a secure base for the infant/child.

The existing deﬁnitions were synthesized and a systematic attempt made
to operationalize the term attachment. Therefore, for the purposes of this paper,
with an emphasis on implications for clinical practice, the author developed a
conceptual map (Figure 4-4) of the holding environment of the mother-infant/child
attachment relationship that includes: physical security (secure base function),
behavioral, psychic, affective, and kinesthetic/tactile components.

Attachment has a physical security component. The secure base is
deﬁned as the attachment ﬁgure. This attachment ﬁgure must be present and
available to the infant/child. A particular and substantial someone, to whom the

child can attach, must exist in a speciﬁc location, therefore attachment has a

102

Figure 4-4. Holding Environment of Mother-Infant/Child Attachment Relationship

Mother-Child Attachment Relationship

  
 
 

  

Psychic Component

V

  

Forming Psychic
Component

    

    
  

 

   

 

 

   

 

   

 

 

 

 

   

2 Mother ‘x
C 7< ‘i
9" "‘ '1: I
3 .._ .
U 3 S’- 234' Infant-Child e a“ r
0 - (D '. 0-0 = .
> Behavroral '8 2. , 1 5'; , , o g}, a- 2. g
"3 Component 5’, S i: "-3 i = i E; 32 . . Z 3 i
8:) a g i 'i a Instinctive g F,
< f? Behaviors 5'

        
   

 

............

...........

Physical Security/Secure Base
Component

    

solid human context within time, space, and situations (Posada, Gao, Wu, et
al.,1995; Waters 8 Cummings, 2000). “V\ﬁthout adequate environmental reliability
the personal growth of a child can’t take place” (Vtﬁnnicott, 1993, p. 99).
Attachment has a behavioral component. The instinctive attachment
behaviors “serve to create the attachment bond, protect the child from fear and
harm, and assist in the safe exploration of the world” (Porter, 2003, p. 2).
Attachment behaviors serve different functions. Signaling behaviors alert the
caregiver that the infant desires interaction. Aversive behaviors trigger a quick

maternal response to provide problem solving or protection and safety. And

103

active behaviors promote proximity to the mother and secure base (Ainsworth,
1967; Ainsworth 8 Bell, 1970; Ainsworth, Blehar, Waters, 8 Wall, 1978; J.
Bowlby, 1958, 1982; Seifer 8 Schiller, 1995).

Attachment has a psychic component. Attachment is “the psychological
availability of a caregiver as a source of safety and comfort in times of child
distress” (Barnett 8 Vondra, 1999, p. 5), “the inferred intemal bonds that form
between infants and their caregivers” (Seifer 8 Schiller, 1995, p. 147). Another
aspect is the caregiver’s own mental representation of attachment, her own
internal working models experienced and developed in infancy and childhood
(Harris, 2003). The psychic component, the knowing and trusting of the other,
grows developmentally from the physical security of the secure base.

Attachment has an affective component. Ainsworth (1969) used the term
affectional tie to describe the bond that forms between two speciﬁc individuals, a
mother and her infant. Bowlby (1958) spoke of the attachment relationship as a
reﬂection of pleasure and enjoyment: smiling, laughing, clapping, happiness, and
love. The security of the attachment relationship also provides a space for
affective reactions to stress and fear: crying, clinging, anger, and frustration. A
full range of emotional affect and “the foundation of emotional regulation is also
established within the context of the attachment relationship” (Sroufe, 2003, p.
205)

Attachment has a kinesthetic/tactile component (J. Bowlby, 1958).
Attachment develops through body contact between caregiver and infant/child

demonstrated in caresses and touches (Cristobal, 2003). “You [mother] just

104

adapt the pressure of your arms to the babies’ needs, and you move slightly, and
you perhaps make sounds. The baby feels you breathing. There is warmth that
comes from your breath and your skin, and the baby ﬁnds your holding to be
good” (Vtﬁnnicott, 2002, p. 21). Gazing, touching, holding, rocking, stroking, and
nuzzling are examples of kinesthetic and tactile body contact.

Attachment occurs in the holding environment of the mother-infant/child
attachment relationship. “Whoever is caring for a child must know that child and
must work on the basis of a personal living relationship with that child” (Wrnnicott,
1993, p. 99). Attachment is deﬁned as an enduring relationship between a young
child and her mother (Ainsworth, Blehar, Waters, 8 Wall, 1978). Attachment
relationships teach individuals how to be in relationship with signiﬁcant others
and inﬂuences all subsequent relationships through to adulthood. Attachment,
ﬁrst and foremost, exists, and is held together, in the ﬂexible holding environment
of the mother-infantlchild attachment relationship. All other deﬁnitions or systems

of understanding must stand upon that principle.

Method
The research method utilized in the study was naturalistic-ethnographic
observation. The OCL was used to help guide the ﬁeld note process in the
observation, diagram the environmental space created by the woman, and to
sketch the dyadic interaction.
The constant comparison method was used to guide the coding process

and emergent themes (Echevarria-Doan, 8 Tubbs, 2005; Richards, 2005;

105

Wolcott, 1990). Each new case was compared to previously analyzed cases. The
study was strengthened by triangulation: observations, sketches and diagrams,
reﬂection, external coders, and peer debrieﬁng. It is believed that the drawings
and diagrams can be used to illustrate not only the natural and built
environmental features of the interaction, but the manifest and latent expressions
of the relationship.

Naturalistic qualitative research methods stand upon interpretive
techniques utilized to understand the meanings behind phenomena that naturally
occur in the social world (Riessman, 1994). This method was prescribed by the
research questions. Naturalistic observation allows the observer/researcher to
view what occurs naturally in the environmental and relational context and focus
on particular phenomena of interest, in this case, indicators of positive, healthy
attachment relationships. The distinction between observer and participant can
be subtle and inﬂuential in ﬁeld observation even when the study has been
designed as observational research. As an observer of dyads in parks, the
researcher participates in the activities and enjoyment of the park and is,
therefore, subject to the same conditions of the environment and may overlook
potentially valuable sources of data (Richards, 2005).

Taking notes, interpreting and analyzing notes, and constantly comparing
against previous data are time-consuming processes (Agar, 1996; Echevarria-
Doan, 8 Tubbs, 2005; Richards, 2005). However, there are many beneﬁts of
direct observation. Direct observation precludes participation in the observed

context, assumes a detached perspective, can be more focused, and is typically

106

less time-consuming than participant observation. These factors mean that the
direct observation is much less obtrusive and therefore less likely to impact the
interactional behavior of the dyad and change or alter the phenomena being

observed.

Subject Selection

Women are primary caregivers, though not the only caregivers of children,
and women as mothers (in tandem with their infant/child) are typically the objects
of attachment research studies and are, therefore, the identiﬁed subjects in the
study. Women caregiver-toddler dyads, though randomly observed in public
places, were speciﬁcally chosen for observation when elements of pleasure and
play were evident in the dyadic relationship. This was based upon Bowlby’s
(1958, 1982) early theoretical formulation that the attachment relationship was an
emotional and affective bond that reﬂected the enjoyment and the attraction that
one individual had for another individual. Subject selection was purposely biased
toward playful, interactive, and positively engaged women caregivers and
toddlers.

The observations, lasting anywhere from 10-45 minutes, were completed
in public parks and spaces in London, Great Britain. London was chosen for its
convenience (the researcher was living in London for the summer), diverse
population, and sheer numbers of people and places for women caregivers with
toddlers to be observed. Four locations were selected intentionally: Regent’s

Park, St. James’ Park, Hyde Park, and Leicester Square. The three parks have

107

open green spaces, sports areas, hedged gardens, and bodies of water, walking
paths, eateries, and both ﬁxed and movable seating. Leicester Square is much
smaller and enclosed but a notable gathering place. Observations were
conducted in each setting on different days of the week at different times of the
day. The observations were done randomly based on chance encounters with

women-toddler dyads in public spaces.

Data Collection

The original sample estimate was for 25 observations. However, when 19
observations were completed, the observer believed a level of saturation useful
to the original intent of the study had been reached. No new or unusual physical
features, affective components, or play behaviors were demonstrated. Each dyad
was unique and a pleasure to observe, but no new data were being collected.

Data were collected in three ways. First, a sketch was made of the
caregiver-toddler dyad in the natural and/or human-made environment where the
observation occurred. This was done ﬁrst so that the sketch and diagram were as
objective as possible, to minimize observational bias. Second, ﬁeld notes were
written as quickly and as thoroughly as possible during the observation and for
the full 10-45 minutes. Sketches and notes were drawn and written on the OCL.
And third, reﬂexive thoughts and comments were written in a personal journal at

the end of each day’s ﬁeld observations.

108

Data Analysis

Data analysis was done in a three-part, inductive process established in
the constant comparative method (Echevarria-Doan, 8 Tubbs, 2005; Richards,
2005; Wolcott, 1990). The decision was made to begin with case analysis rather
than cross-case analysis. First, each observation was evaluated independently
for themes. A line-by-line and word-by-word analysis was performed. In this
process, primary patterns in the data were identiﬁed and coded. Each successive
case was compared to previously analyzed cases. This process generated codes
of spatial, behavioral, and affective data.

Second, from the identiﬁed codes, major categories or themes emerged.
As themes emerged, the observations were examined a second and third time
for examples of those themes and any additional emergent characteristics or
themes. Category generation from qualitative data has a subjective basis. In this
case, category generation may have been inﬂuenced by the researcher’s
inferences from the data, initial research questions, theoretical perspective,
interpretation, and previous experience and knowledge.

Third, two colleagues were recruited to code three representative
observations to establish coding reliability. Each colleague took the same three
observations and independently coded those observations, Iine-by-line and word-
by-word, and created independent lists of emergent themes. The two colleagues
created category lists very similar to each other, which were in turn similar to the
original categories culled by the researcher. With the added information and a

three-way collegial debrieﬁng conversation, the categories were ﬁnalized at the

109

end of the third level of coding. Table 1 highlights the six categories and provides

a sample of the completed coding.

Discussion

Nineteen woman-toddler dyads were observed for an average of 20.3
minutes. The observations included 11 boys and 8 girls with an estimated age
range of 12-24 months (5 children around 12 months; 6 children around 18
months; and 8 children around 24 months). Six indicators of healthy and
pleasurable attachment and attachment behaviors between women caregivers
and young toddlers evolved from the coding process: reciprocity and mutuality,
proximity, verbal communication, affect and emotion, physical affection, and play.
These indicators demonstrate key principles of attachment theory. All of the
dyadic observations included elements in every coded category indicating that
the relationship demonstrated a full range of positive, healthy attachment

behavior.

Reciprocity

Reciprocity is a hallmark feature of relationship presuming two participants
where one initiates and the other receives. In the observations this typical
behavior was demonstrated by the caregiver reading as the toddler listened, the
toddler hiding and the woman ﬁnding, or one of the dyad performing an action
(kicking a ball toward the other) and the other imitating (kicking the ball back). In

these observational instances reciprocity foreshadows the give and take, the

110

reciprocity, of a mature relationship. The caregiver models culturally appropriate
social and relational skills. In this scenario, as a child offers to the caregiver and
the caregiver responds adequately, the child begins to learn self-conﬁdence and
self-efﬁcacy because her offerings are acceptable to the recipient, her caregiver

and attachment ﬁgure (Moustakas, 1992).

Table 4-1. Categories of Attachment Indicators in Attachment Relationships

 

 

 

 

Reciprocity and Proximity Verbal Affect and Physical Play
Mutuality Communication Emotion Affection
reading - listening sit knee to knee happy screech smiling arm round child climbing
pull on w - lifts c walk side by side oohhh and aahhh wistfulness pull mom’s leg wandering
give food -accepts sitting together protesting request concentrate plays wl c feet swinging arms
action - imitation run away - back jabbering to w waving smooth lotion chasing squirrel
speak - respond directly behind c w calls child back indulgent kissing playing wl ball
leave - following lean toward 0 ma, ma, ma laughing snuggling drop, kick ball
hiding - finding swivel to face c name - repeat crying hugging turning in circles
looking - finding hand in hand uh oh clapping holding clapping hands
washes child face each other saying bye - wave following fall in w’s lap splashing water
child washes self laying together teach - model giggling patting child play wl objects
c counts - w claps wander - return tandem chatter scared touching climbing inlout
laughing together running ahead giggling relaxation crawl over w crawling
run toward other dragging behind gibberish freedom holding hands bouncing
w calls - c turns hiding in bushes jabbering frustration twirling child master balance
chatter together hover over child laughing rejection w hold 0 on lap chasing pigeons
move in tandem touching distance mimicking patience tousle c’s hair running
playing together run after child whispering delight hold and rock falling
jabber in tandem stoop to child cheering playful take pictures rolling
offering -accepting c limits distance counting watchful cany in arms picking flowers
eating together walk - hold hands reprimanding protection run hand-hand rocking
holding - taking c stands over w woman said no competence swinging child swinging
offering - reaching child sits on lap groaning engagement cuddling swaying
mutual touching c looks for w come, come encourage tuck in stroller exploring
tandem feed bird 0 in mom’s arms calling name kindness stroking back playing airplane
both cheering moves c to safety giving directions adventurous stroking arm playing wl dolls
follow child calmness swaying into w
w = woman holding tight
c=cmw

 

 

 

 

 

 

111

 

Mutuality

Mutuality manifests in the shared experience or expression of the
relationship. In the observations this was expressed by eating together, moving
in tandem, laughing and jabbering together, and mutual touching. Mutuality is not
a separate category from reciprocity but an extension of the feature. Mutuality is
the fulﬁllment of reciprocity as teaching leads to togetherness. The caregiver both
feeds herself (modeling behavior) and feeds the child (both sustenance and
nurturance). The child accepts the food (building trust), begins to feed the
caregiver (mimicking), and eventually participates in the mutuality of eating
together. The toddler learns to trust that her needs will be met. The ability to trust
in the presence of the other leads to a mitigation of existential isolation (Buber,
1965) and solidiﬁes the development of the secure base function of the
attachment relationship (J. Bowlby, 1988).

Reciprocity and mutuality include physical, verbal, and affective features
so some aspects of this construct cross categories. The physical feature includes
walking, eating, and playing together and the offering and receiving of food and
gifts that can be initiated by either the caregiver or the toddler. The verbal feature
includes jabbering in tandem or a pattern of speaking and responding. Naming
objects and repeating the name is a mimic game initiated by the caregiver and
crosses between categories of'verbal communication and play. Affect and
emotion, which crossed all categories, were added to reciprocity and mutuality
when caregiver and toddler expressed pleasure together in laughing, giggling, or

cheering. Otherwise, when the child or caregiver smiled, laughed, or giggled

112

independently it was coded in the affect and emotion category, for example,
when a caregiver smiled while watching the toddler from a distance or the toddler

giggled while chasing a squirrel.

Proximity

The category of proximity was demonstrated in the observations through
the dynamic tension of the physical connectedness and distance exhibited by a
woman caregiver-toddler dyad. For example, all of the dyads maintained close
physical contact during part of the observation. They sat knee-to-knee, walked
side-by-side or hand-in-hand, lay on the grass together, or the child climbed on
the caregiver, sat on her lap, or was held in her arms. As the physical contact
was broken, the caregiver typically exhibited hovering, standing over, leaning in,
stooping down, and watching behaviors. When the toddler ran away, hid from, or
wandered off it triggered a different set of behaviors in the caregiver, for
example, following, running after, and ﬁnding. Caregiver behavior ﬂowed
effortlessly between contact, alertness, and active containment. The toddlers, by
contrast, exhibited behaviors of connection (hugging caregiver) and exploration
(wandering away).

The proximity feature of the observation related to the practicing subphase
of separation-individuation (Mahler, Pine, 8 Bergman, 1975) and to the secure
base function of the attachment relationship (Ainsworth, 1969; J. Bowlby, 1988).
The toddler used the caregiver as a home base resembling a game of “tag.” She

touched, sat upon, or lay on the caregiver before wandering or running away

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from the woman only to return again in a short period of time. Some toddlers ran
ahead or alternatively dragged behind but always within a prescribed distance
that was speciﬁc to the caregiver-toddler dyad. Sometimes the caregiver
established the perimeter with physical boundaries and/or verbal calling or
command. Sometimes the toddler self-limited the distance she wandered from

the home base. Often the distance was negotiated between the pair.

Verbal Communication

Negotiating distance led directly to verbal communication. The caregiver
called the child’s name or said “no” or “stop” and the child responded, sometimes
with words although most often with groaning, gibberish, or screeching because
the majority of children observed were very young toddlers with limited language.
Sometimes there was a call from the caregiver for the child to return, or to notice
a potential danger. Another form of verbal communication between the pair was
a spontaneous outburst of laughing or giggling in response to engagement in
physical activity and play. Reciprocity occurred when a caregiver named objects
(tree, pond, duck, or book) and the child mimicked the words.

Nonverbal communication was also present in the caregiver-toddler
interactions. This was evident, for example, in large motor activity like a toddler
intentionally running away from a caregiver when called to return. The researcher
maintained signiﬁcant physical distance from the dyad to prevent intrusion into
the space of the relationship. This made it difﬁcult to distinguish ﬁne motor or

facial nonverbal cues between the woman and toddler. Therefore, speciﬁc to this

114

sample, nonverbal expressions of communication were excluded from the
categories. The term communication could easily be substituted for verbal
communication in the categorical list for future research providing observation

was proximate enough to register nonverbal communication accurately.

Affect and Emotion

The anticipated attachment indicators of enjoyment and pleasure
(Ainsworth, 1967; J. Bowlby, 1958, 1988; Wrnnicott, 1957) were demonstrated in
the affects and emotions smiling, laughing, giggling, waving, clapping, watching,
and following. Some of the subtle affective and emotional features displayed by
the caregiver were indulgence, patience, encouragement, kindness, calmness,
and responsiveness. The subtle features exhibited by the child were
concentration, freedom, frustration, delight, competence, and adventurousness.
The shared affective features included relaxation, playfulness, happiness, and
delight. These affective and emotional labels were subject to interpretation of the
nuance in the attachment relationship between the woman caregiver and the
toddler but studies demonstrate reliability of visual indicators of affective states

(Martin 8 Clore, 2001).

Physical Affection
Physical affection was another anticipated sign of attachment organization
indicative of enjoyment and pleasure. Physical affection was demonstrated in the

dyad by hugging, kissing, snuggling, cuddling, rocking, holding hands, touching,

115

and carrying. When a toddler tugged on her caregiver’s leg and was lifted into
her arms to be snuggled or carried, this was an example of a toddler’s way of
signaling a desire for closer contact with the caregiver. The child initiated this
action, but the caregiver’s positive response indicated a heightened level of
attunement and sensitivity to the child’s needs in the moment (Ainsworth, 1967,

1969; Hsu 8 Fogel, 2003).

Play

Play was the last category included but stands out as integral to positive,
healthy attachment relationships between women caregivers and toddlers. A
child must be in a reciprocal, mutual, proximate relationship in an affective
environment of safety and freedom to engage in play. Without those aspects of
the attachment relationship, a child’s engagement with the environment is
restricted (Axline, 1969).

In all of these observations, toddler play was free and spontaneous. The
caregiver provided minimal props or toys for the child. In two cases, a ball was
introduced, in one case a doll was found in a stroller, and in one case a wading
pool was brought to the park. In all other cases the toddler improvised with the
environment: climbing in and out of folding chairs, chasing pigeons, squirrels, or
other children, and ﬁnding, collecting, dropping, and throwing stones or sticks.
Other evidence of sheer physical delight in self included swinging arms and legs,
swaying or rocking back and forth, twirling round and round, rolling in the grass,

bouncing up and down, and running to and from. “[R]esearch shows that the

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capacity to create joy, elation, interest, and excitement together with [the] baby is
a key to early healthy development and lifelong physical and mental health.
Thus, the focus... recognizes the central importance of happiness and joy”

(Porter, 2003, p. 7).

Environmental Space

Another fundamental component that emerged from the observational
study concerned the caregiver use of environmental space. Caregivers naturally
created bounded spaces, even in huge wide-open parks, that contained their
child as they played and set the stage for a relaxed interaction that optimized the
child’s exploration of the world and the relationship with the caregiver. Women
were incredibly resourceful with both natural and human-made boundaries in the
environment to contain their child. For example, fencing, hedges, benches,
gates, a border of trees, tables, chairs, strollers and their own body placement
relative to the external markers to contain the child. The similarity of those
created spaces across women was remarkably consistent (Wrnnicott, 1964).
They typically maintained the original contrived containment setting to maximize
child safety and caregiver relaxation while, at the same time, providing a ﬂexible
area for the child to explore. The distance a toddler wandered from a caregiver
was not very different by child whether the space was restricted or wide open. In
parks or open spaces, the child maintained contact within roughly a 20-yard

radius.

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The use of environmental space related directly to the attachment feature
of proximity. Women arranged the space to curtail the youngster and prevent
personal harm to or loss of the child. Women used their bodies as the secure
base, setting themselves as the center (though not necessarily the geographic
center) of the space, creating a womb-like environmental chamber for the child in
which they were safe to explore but within easy reach or sight of their secure
base. This holding environment (Wrnnicott, 1971, 1986) supported the proximity
and elasticity of the relationship, which offered the child an opportunity to go and
come back, leave and return as they practiced separation and individuation
(Mahler, Pine, 8 Bergman, 1975). These securely attached toddlers were able to
use the attachment ﬁgure as a secure base for exploration of the environment
and as a safe haven to which to return for reassurance (Bretherton, 1985).

If the attachment ﬁgure has acknowledged the infant’s needs for

comfort and protection while simultaneously respecting the infant’s

need for independent exploration of the environment, the child is

likely to develop an internal working model of self as valued and

reliable. Conversely, if the parent has frequently rejected the

infant’s bids for comfort or for exploration, the child is likely to

construct an internal working model of self as unworthy or

incompetent (p. 782).

Aspects of positive, healthy woman caregiver-young child interactions
reﬂected features known to promote healthy child development (Berk, 2007; J.

Bowlby, 1982; Bretherton, 1985). Mutual and reciprocal relationship building

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happened in the space. A gentle but steady introduction of the world to the child
occurred (V\ﬁnnicott, 1964, 1986). The supportive stance of the caregiver offered
a secure base for the child. The teaching and modeling of the caregiver offered
the toddler an opportunity to practice, master, and succeed at competency skills
within the frame of the attachment relationship. This kind of caregiver-child
interaction, in developmental terms, would help to instill autonomy in the child
and build self-conﬁdence and self-esteem. In the process of these interactional
exchanges the child would learn social skills, build internal regulatory systems for
behavior and affect, and increase competency skills (Bandura, 1977; Matas,
Arend, 8 Sroufe, 1978; Waters, Hamilton, 8 Weinﬁeld, 2000).

Speciﬁc attachment behaviors were observed in the woman-toddler
holding environment that relates to early attachment theory that had its beginning
in biological behavior predicated on evolutionary survival and adaptedness (J.
Bowlby, 1958, 1975, 1982). These evolutionary and biological behaviors as
instincts caused the child to seek the attachment ﬁgure in times of distress or
danger and also served as protective and survival mechanisms (Ainsworth, 1967,
1969). Attachment behavior was determined to be predictable and worked to
increase the proximity of the infant with the mother or attachment ﬁgure (Cassidy,

1999). These attachment behaviors served different functions.

Signaling Behaviors

Signaling behaviors such as smiling, waving, vocalizing, calling, and

laughing alerted the caregiver that the infant desired interaction and wooed the

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mother to the child. This was demonstrated in the observations by the reciprocal,
verbal, and physical affection categories.

Child toddles to caregiver; looks/gazes at caregiver; lifts own shirt

and giggles; points to own belly; giggles again; caregiver sits on her

feet; child stands in front of caregiver; face each other; toddler pulls

own shirt back down; caregiver and child giggle together

(Observation #13).

Aversive Behaviors

Aversive behaviors like crying, kicking, and screaming triggered a quick
maternal response to terminate the infant or child’s problem or provided
protection and safety. Caregivers demonstrated alertness to potential dangers
the environment could present to the child. They anticipated harm as well as
reacted quickly in dangerous circumstances to provide protection.

Child indicates desire to throw bread in water fountain; pigeons in

fountain; caregiver lifts child; stands child on edge of fountain lip;

caregiver stretches far to hold child in place; caregiver never lets go

of child; other pigeons ﬂy to fountain; abruptly child shows fear by

pulling back; caregiver reacts immediately; swinging child down

onto the grass a safe distance from fountain; caregiver holds child’s

hand (Observation #15).

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Active Behaviors

Active behaviors like approaching, holding, touching, and following took
the child to closer proximity with the mother and secure base. The behaviors
demonstrated the relationship and interconnectedness, the system of
attachment, between the infant/child and the mother/attachment ﬁgure with the
ultimate goal of protection.

Caregiver turns to easily watch toddler; child runs to caregiver,

turns in circles, and falls in her lap; caregiver holds child up;

caregiver sits child down and pats his head; toddler lays his head in

caregiver’s lap; child climbs onto caregiver; caregiver snuggles

child (Observation #2).

These examples highlight the caregiver’s construction of the holding
environment, the physical and psychic space where the child is held in security
and safety. In this space, the toddler is free to express a full range of intuitive
behavioral responses to her own internal environmental pressures as well as to

stimuli from the external environment.

Applicability of Study Findings to Practice Settings
One premise of the study is that it is possible to gain an understanding of
the nature and dynamics of attachment relationships to inform clinical thinking
and intervention (Cristobal, 2003; Slade, 1999). The six indicators of healthy and
pleasurable attachment and attachment behaviors between women caregivers

and toddlers and the caregiver use of environmental space can be used to

121

validate, enhance, and inform attachment work clinicians engage in with clients.
Attachment behavior indicators in conjunction with Wrnnicott’s (1971, 1986)
construction of the holding environment and transitional space relate directly to
adult treatment and speciﬁcally to the therapist-client alliance and attachment
relationship (Diamond, Clarkin, StovaIl-McClough, et al., 2003).

The positively engaged caregiver-toddler dyads observed in this study
demonstrated positive attachment behaviors, highlighted attachment
relationships, and reinforced the concept of the secure base, therefore the
purpose of the enclosed space created by the caregiver was to protect the child
not the relationship. The boundaries of the natural and built environment
strengthened and utilized by the caregiver were designed to enhance the
patterns of the attachment relationship and the child’s exploration of the external
environment and offer a safe arena for the child to practice separation and
individuation (Mahler, Pine, 8 Bergman, 1975) with the inviolate security of the
visible secure base of the caregiver. Everything about the pattern and place of
the observations powerfully portrayed positively engaged, nurtured, and attuned
attachment relationships between caregivers and toddlers.

In a similar manner, a therapist is responsible for the physical and psychic
space in which treatment occurs, but for an opposite reason. In attachment work,
the therapist must create a safe holding environment (Wrnnicott, 1971, 1986) and
secure base (J. Bowlby, 1958, 1982) for the client that prevents harm or loss
because an attachment relationship does not yet exist either in the client’s past

or within the present therapeutic environment. And just as dyads remain in the

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same created place, treatment occurs in the continuous, steady, created space
to maximize safety, familiarity, and consistency. This creates a ﬂexible area for
the client to explore their internal historical landscape similar to a toddler
exploring the environmental landscape.

In both the caregiver-toddler scenario and the clinician-client scenario, the
holding environment is where the relationship occurs and develops. The
contained space allows the clinician to relax and be fully present with the client in
the therapeutic alliance and attachment relationship (Diamond, et al., 2003) in a
similar way that the caregiver is able to relax and be fully present with the toddler
in the attachment relationship. This maximizes availability, sensitivity, and
empathic attunement (Ainsworth, 1967, 1969; Ainsworth 8 Bell, 1970). The
relaxed interaction in conjunction with an optimal attachment relationship allows
the therapist to provide a space or secure base for the client to examine and
repair historic attachment ﬁgures and relationships and to forge a new
attachment relationship with the therapist that fosters new patterns of positive
and healthy reciprocal, mutual, and proximate relationships with others (J.
Bowlby, 1977; Cortina 8 Marrone, 2003; Harris, 2003).

A related feature to the holding environment and transitional space is the
dynamic tension between connectedness and distance. Proximity in the
therapeutic relationship means creating optimal closeness without triggering
symbiosis or dependence. Connectedness, boundaries, and distance are
typically of particular difﬁculty for clients who have experienced attachment

disruptions that often lead to trust issues and fear of abandonment. The therapist

123

prescribes the space and distance until the client is able to self-regulate optimal
distance and connection in healthy mutual relationships.

It is the accessibility, sensitivity, and responsiveness of the mother or
primary caregiver (the principal attachment ﬁgure) that typically determines
whether a child, or adult, exists in a state of security, anxiety or distress (S. R.
Bowlby, 2004). Therefore, in treatment, the clinician, in concert with the client,
must be able to develop and maintain an attachment relationship, utilizing the
characteristics of accessibility, sensitivity, attunement, and responsiveness to
further the exploration of other signiﬁcant attachment relationships in the life of
the client (Diamond, et al., 2003). This helps the client forge a link between the
historic attachment ﬁgures (mothers and other caregivers) and present adult
attachment ﬁgures (therapist, lover, relatives, and friends). In adult reparative
work, the therapist must, with great sensitivity and care, balance being both the
internal representation of the maternal caregiver and the external
therapist/stranger. The therapist utilizes herself as a temporary attachment ﬁgure
for the client (J. Bowlby, 1975; Diamond, et al., 2003).

When behavioral indicators of positive, healthy attachment relationships
can be ﬁrmly established and then modiﬁed appropriately for therapeutic
environments, social workers can be educated and trained in attachment
reparation protocols. This would mean that a client in a bounded attachment
relationship with a trusted clinician could moderate retroactively disrupted
childhood attachment and actually ﬁnd, understand, and utilize the attachment

beneﬁts underlying the original attachments. If those original attachments were

124

weak, it would be possible, in the present therapeutic relationship, to strengthen
the original maternal connection/bond in the internal representations or object
relations. This could offer access to the positive affectional tie for the client

(Harris, 2003).

Trustworthiness

Trustworthiness was addressed in several ways within the study. An audit
trail was created and maintained throughout the study process that included:
literature review, hypotheses building, method selection, Institutional Review
Board process, data gathering procedures, reﬂexive writing, coding procedures,
and data analysis. The study was designed for maximum data gathering ability
with minimal bias that utilized extensive ﬁeld notes, sketches and diagrams, and
reﬂexive writing. And data analysis was strengthened with external coders and

peerdebneﬂng.

Study Limitations
Field observation has obvious strengths. First and foremost, the goal is to
observe rather than interpret behavior. This serves to limit interpretation and bias
related to theoretical framework and personal experience. On the other hand,
ﬁeld observation has limitations. The nature of the study, the observation
process, precludes meaning attribution by the subjects involved because
subjects are not included directly. The features of attachment delineated here are

subject to cultural expectations of the researcher, even though the study was

125

placed in a multicultural setting. Peer debrieﬁng, after the fact, acts as a control
against theme bias, but the ﬁeld notes, already collected, came from one
perspective and that perspective may have been clouded by theoretical
orientation, clinical practice experience, and teaching clinical practice in social
work education. And it may be that the sketches of the environmental space and
position of the dyad within that space were subject to researcher bias because
the theoretical framework might precipitate expectable behavior of caregiver-
toddler dyads.

The study focused on a relatively small sample and that sample was
selectively biased toward women as caregivers and then dyads who
demonstrated pleasure and enjoyment in their relationship. Those criteria met the
goals of the study and corroborated early ﬁeld research on attachment behavior
but the criteria do not reﬂect the diverse population of individuals currently
associated with child caregiving. The focus on women as caregivers obviously
eliminated men from the study. The study ﬁndings are a tentative beginning to
understanding the therapist-client attachment relationship separate from the
alliance, and attachment reparation protocols in therapeutic treatment. But it may
be presumed that men and women react differently and uniquely both to

attachment disruptions and therapeutic treatment.

126

Conclusion

The observable indicators of a positive, healthy attachment relationship
between women caregivers and toddlers were identiﬁed as: reciprocity and
mutuality, proximity, verbal communication, affect and emotion, physical
affection, and play. These indicators are consistent with the basic principles of
attachment theory. The sketches and diagrams demonstrate that caregivers use
environmental space to support the secure base functions of the maternal-
infantlchild attachment relationship. These two outcomes (attachment indicators
and use of environmental space) have implications in clinical practice, not only
with children, but also with adults who did not have healthy, positive attachment
relationships early in their lives. The six indicators of positive, healthy attachment
relationships provide categories for clinicians to consider in treatment settings.
And clinician use of environmentalltransitional space and secure base functions
of the attachment relationship continue to have critical meaning in adult treatment

of attachment disruptions.

127

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CHAPTER 5

Women as Mothers of Children in the Attachment Relationship

132

Abstract
Attachment and attachment relationships that mothers have with their children
are examined through semi-structured, in-depth phenomenological interviews.
The study method and data analysis were driven by interpretive
phenomenological analysis (IPA) and feminist theory and method. Attachment
theory and attachment constructs provide a background for the study questions,
literature review, and interview instrument development. Mothers were the
identiﬁed subjects and selection was purposely biased toward playful, interactive,
and positively engaged mothers and children. Each case was speciﬁcally
analyzed for data related to the research questions and the attachment
categories delineated in a previous observational study: reciprocity and mutuality,
proximity, verbal communication, affect and emotion, physical affection, and play.
In addition, themes with rich supportive data across cases were identiﬁed as:
education; responsibility; childcare; and time management. These mothers spoke
lovingly and authentically about the attachment relationship with their children.
Every woman addressed the multiple roles that are a reﬂection of being a mother
with a breadth and depth of emotive language that not infrequently brought her to
tears. The mothers were articulate and vulnerable, fully engaged in the
collaborative process of the interviews with the researcher. The narratives are

rich and ﬂow with language of love, tenderness, pleasure, and attachment.

Key Words: Attachment; Mother-Child Relationship; Childcare; Secure Base

133

I feel it very strongly now; there’s no going back and that’s okay....
Attachment is forever. Attachment that you just can’t anticipate and
I can’t deny either. I can’t walk away from her. I think that’s

surprising too, the strength of that [attachment] (Beth).

John Bowlby outlined attachment theory and revolutionized the view of the
mother-infant bond and relationship when he wrote, The Nature of the Child’s Tie
to His Mother(Bowlby, 1958). Bowlby (1958, 1973, 1982a, 1982b) believed that
attachment was primary and exclusive. He held that the mother must achieve
attunement with her baby to create healthy attachment. It was the attunement of
the mother to her child in stressful and distressing situations that established self-
regulation for infants, a biological necessity since babies do not inherently
possess self-regulatory systems. The mother-induced regulation worked to keep
the baby in balance and emotionally regulated. He outlined the conditions
needed for the healthy development of children in Matemal Care and Mental
Health (Bowlby, 1951).

[W]hat is believed to be essential for mental health is that the infant

and young child should experience a warm, intimate and

continuous relationship with his mother, or permanent mother

substitute, in which both ﬁnd satisfaction and enjoyment (p. 368).

Two key constructs evolved from Bowlby’s early research. First,
attachment is a biological necessity. Bowlby came to believe that the

mechanisms that underlie the infant’s attachment tie to the maternal ﬁgure

134

originally emerged as the result of evolutionary pressure, a biologically based
need for proximity that equated with survival and natural selection (Cassidy,
1999). And second, the mother-infantlchild bond is the primary and essential
force in infant and child development (Porter, 2003). It is the accessibility and the
sensitivity and responsiveness of the mother, or primary caregiver, that typically
determines whether a child exists in a state of security, anxiety or distress.
Attachment theory premises are based in an enduring pattern of relatedness that
exists, not only for survival but also for connection between mothers and their
children. These premises form the backdrop and impetus for this study.

The study was designed from an interest in the attachment relationship
between mothers and their infants/children to gain a detailed understanding of
the personal deﬁnition of attachment and the meanings women attribute to being
a mother and participant in an attachment relationship with their child/ren. The
major research question is, what meanings do women as mothers ascribe to their
attachment relationships with their infants/toddlers? The ancillary follow-up
questions include: How will mothers describe interactions with their child? Will
those descriptions relate to the basic constructs of attachment theory? Will those
descriptions relate to the indicators of healthy attachment coded from a previous
observational study (Fitton, 2008): reciprocity and mutuality, proximity, verbal
communication, affect and emotion, physical affection, and play?

Previous attachment research deﬁned women by their role as mothers,
attributing deﬁnition to role rather than to the lived experience of unique

individuals (Ainsworth, 1969a; Ainsworth 8 Bell, 1970; Ainsworth, Blehar,

135

Waters, 8 Wall, 1978; Lay, Waters, Posada, 8 Ridgeway, 1995; Matas, Arend, 8
Sroufe, 1978). These studies also deﬁned caregiver as mother placing the
responsibility for infant/child care and rearing completely on women. The
research concentrated on negative and pejorative aspects of neglect, avoidance,
stress, hostility, rejection, deprivation, and insensitivity on the part of the mother.
This study was designed to focus on the perceptions, interpretations, and
expressions of meaning women give to their own experiences of being a mother
(Riessman, 1994). And, since attachment research had a tendency to blame the
mother for insensitivity, this study emphasized the enjoyment of the mother-
infantlchild attachment and all the positive beneﬁts that ensued from a positive,
healthy attachment relationship.

This study is a logical follow-up to a previous observational study (Fitton,
2008) because it enhances the data already gathered by looking at attachment
phenomena from a different perspective, ﬁeld observation to phenomenological
interviews. Rather than attempting to establish objective descriptions, interpretive
phenomenological analysis (IPA: Smith, 1996) is used in conjunction with
feminist methods to take a subjective approach and focus on the uniqueness of a
woman’s thoughts and perceptions, the phenomenology of her experience in
relationship with her children.

Understanding the phenomenological experiences of women with their
children in attachment relationships can be utilized for beneﬁt in therapeutic
treatment. The stories can be used to impact understanding in the ﬁelds of

women’s studies, child development, and clinical practice across the life span. It

136

is also important to return to the basic principles of attachment theory through the
lens of postmodern, qualitative and feminist methodologies and speciﬁcally

interpretive phenomenology (Reid, Flowers, 8 Larkin, 2005; Smith, 1996). These
methods emphasize the personal meaning of the lived experiences of women as
mothers with their children and honor the sacred power of their words and stories

(Marshall 8 Rossman, 1999).

Literature Review

Attachment theory was developed by the psychiatrist, John Bowlby (1958,
1973, 1982a, 1982b, 1988), 50 years ago, in part, as an alternative to
psychoanalytic theory to explain why separation caused anxiety in young
children, to explain the similarities between childhood and adult loss and
mourning, to explain the process of defenses in the human psyche, and to
explain the mechanisms of social behavior from infancy that affect and inﬂuence
the development of the personality along a continuum from healthy to debilitating
(Barnett 8 Vondra, 1999; Bretherton, 1985; Cristobal, 2003; Waters, Crowell,
Elliott, Corcoran, 8 Treboux, 2002). Bowlby did not intend that the attachment
concept substitute for social bonds or be attributed to all aspects of the parent—
child relationship. He intended that the roles of attachment ﬁgure and playmate
be conceptually distinct. When a child feels stress, distress, or fear, she seeks an
attachment ﬁgure for safety, protection, and regulation. However, when a child is
happy, content, and playful, she seeks a playmate. (Feminine pronouns are

utilized throughout this work in deference to the preponderance of childcare

137

provided by women, even though some men are very or exclusively involved in
caring for their children.)

Attachment theory is a perspective on the secure base functions of close
relationships that operate to promote child development, personality
development, and affect regulation (Bowlby, 1977). The theory assumes that
maternal sensitivity, responsiveness, and attunement are major factors in the
quality of a child’s attachment to her mother or attachment ﬁgure (Ainsworth,
1967, 1969b; Ainsworth, Blehar, Waters, 8 Wall, 1978). Attachment theory also
presupposes evolutionary biological necessity. The needs of infants and small
children are not variable; they are inherent and unalterable (Winnicott, 1964).
Attachment behaviors must exist and be reciprocated for the infant to survive
both physically and psychically.

Unless there are powerful in-built responses which ensure that the

infant evokes maternal care and remains in close proximity to his

mother throughout the years of childhood he will die. The instinctual
responses... serve the function of binding the child to mother and
contribute to the reciprocal dynamic of binding mother to child

(Bowlby, 1958, p. 369).

Attachment theorists deﬁne the term attachment independently but the
similarities are striking, including the concepts of proximity, speciﬁcity, and
necessity. “‘Attachment’ refers to an affectional tie that one person (or animal)

forms to another speciﬁc individual” (Ainsworth, 1969b, p. 971). “[A]ttachment

138

refers to the relationship... the affective bond between infant and caregiver"
(Sroufe, Fox, 8 Pancake, 1983, p. 1616).

Several distinctions of attachment theory are mentioned here.
Dependence and attachment are separate and different constructs (Bowlby,
1958). Attachment relationships are permanent and irreplaceable (Barnett 8
Vondra, 1999). Attachment behavior is heightened in situations perceived as
threatening but attachment itself is not necessarily strengthened (Ainsworth,
1969b). Attachment behavior, especially when strongly activated by stress or
distress, is incompatible with exploratory behavior (Bowlby, 1982a). A distressed
child seeks comfort, not stimulation and exploration. Following a prolonged
absence from the maternal or primary attachment ﬁgure, attachment behavior
may diminish or even disappear, but the attachment itself is not necessarily
diminished (Ainsworth 8 Bell, 1970). This is a particularly relevant concept in
therapeutic relationships. Attachment relationships vary widely across mother-
infantlchild pairs (Ainsworth 8 Bell, 1970). Stress occurs from sudden or
prolonged separation from the attachment ﬁgure and permanent loss causes
grief and mourning (Barnett 8 Vondra, 1999).

As these statements indicate, attachment is a broad and complicated
concept with multiple layers of meanings and interpretations. No single deﬁnition
or set of constructs can contain all of the signiﬁcant elements of attachment as a
concept. However, one vitally important foundational observation must be stated.
Attachment, regardless of the deﬁnition, occurs in the holding environment of the

mother-infant attachment relationship that begins in the earliest moments of an

139

infant’s life. This holding environment is both physical and psychic. Caregivers
must be able to create a good enough facilitating environment at the earliest
stages of development to provide for the optimal emotional and mental growth of
the child (Winnicott, 1971).

The existing deﬁnitions were synthesized and a systematic attempt made
to operationalize the term attachment. Therefore, for the purposes of this paper,
with an emphasis on implications for clinical practice, the author developed a
conceptual map (Figure 5-1: F itton, 2008) of the holding environment of the
mother-infant/child attachment relationship that includes: physical security
(secure base function), behavioral, psychic, affective, and kinesthetic/tactile

components.

Physical Security Component

Attachment has a physical security component — “a tie that binds together
in space and endures over time” (Ainsworth 8 Bell, 1970, p. 50). This secure
base is deﬁned as the attachment ﬁgure. The attachment ﬁgure must be
consistently physically present and psychically available to the infant/child to
create the security of the secure base for the infant/child where growth and
development occur. The caregiver, typically the mother, provides a physically
secure environment of her presence for the infant. This happens, not only
through physical handling and holding, but also, through consistent sensitivity to
the needs of the infant and her availability and capacity to meet those needs in a

timely manner. A particular and substantial someone, to whom the child can

140

attach, must exist and have a speciﬁc location, therefore, attachment has a solid
human context within time, space, and situations (Posada, Gao, Wu, et al., 1995;
Waters 8 Cummings, 2000). “Without adequate environmental reliability the

personal growth of a child can’t take place” (Winnicott, 1993, p. 99).

Figure 5-1. Holding Environment of Mother-Infant/Child Attachment Relationship

Mother-Child Attachment Relationship

 
    

Psychic Component

 
     
     
         
 
   
   
 

Forming Psychic

 

 

 

   

 

 

 

 

 

Component \.\

'\

0-1 I!
g: ‘.
é Mother 7; ‘.
a 5' ‘-
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E r‘ g ... c O 3 I
0 3 5 2 2 . a ‘5, i
O . 8 g '3‘ , g g Infant-Child g 5' j
3 BehaVioral ._., a a, it. 3', o g}, a E. ;
._ ‘ - ' -. : -. t 1 '
5 Component 3 in "-.§ '=. E; SE . . z E i
553 ~ g , a: '3‘ Instinctive 8 g ,-
< 5‘ Behaviors 0’ -'-" '

 

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/

    
     
 

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' Forming Secure Base

Physrcal Security/Secure Base

Component

' Holding Environment ,,-'

n a
~ a
-‘_‘ ’-,-
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141

Behavioral Component

Attachment has a behavioral component. Attachment behavior on the part
of the infant/child operates to increase proximity and contact with the maternal
caregiver (Ainsworth, 1967, 1969b; Ainsworth 8 Bell, 1970; Ainsworth, Blehar,
Waters, 8 Wall, 1978; J. Bowlby, 1958, 1982a; Porter, 2003; Seifer 8 Schiller,
1995). These instinctive attachment behaviors serve different functions. Signaling
behaviors alert the caregiver that the infant desires interaction. Aversive
behaviors trigger a quick maternal response to provide problem solving or
protection and safety. Active and contact-seeking behaviors promote proximity to
the mother and secure base (Ainsworth, 1967; Ainsworth 8 Bell, 1970;
Ainsworth, Blehar, Waters, 8 Wall, 1978; J. Bowlby, 1958, 1982a; Seifer 8
Schiller, 1995). Exploratory behavior decreases proximity with the maternal
caregiver and promotes interaction with the environment and individuation
(Ainsworth, 1967, 1969b; J. Bowlby, 1958, 1982a; Field, Gewirtz, Cohen, Garcia,
Greenberg, 8 Collins, 1984; Mahler, Pine, 8 Bergman, 1975; Porter, 2003; Seifer
8 Schiller, 1995). Attachment behavior, especially when strongly activated by
stress or distress, is incompatible with exploratory behavior.

Attachment behavior on the part of the mother operates to meet the
physical, emotional, psychic, and tactile needs of the infant/child. Paradoxically,
these behaviors, which are unreciprocated by infants in the early weeks, work to
build the attachment bond and relationship. Bowlby (1958) suggested that, “It is
fortunate for their survival that babies are so designed by nature that they beguile

and enslave mothers” (p. 368). As babies’ signaling behaviors have different

142

meanings, mothers’ behaviors meet different needs. Feeding and diapering are
physical necessities. Holding, snuggling, and rocking meet emotional needs of
connection and safety. Touching, caressing, and stroking meet tactile and
kinesthetic needs. And anticipatory actions and behaviors by the mother to meet
her infant’s unexpressed needs and wishes, serve two psychic functions. They
establish the psychic availability of the mother and maintain the necessary
illusion of omnipotence for the baby. These behaviors do not operate
independently but function as an organic whole to provide optimal support to the

infant.

Psychic Component

Attachment has a psychic component. Attachment is “the psychological
availability of a caregiver as a source of safety and comfort in times of child
distress” (Barnett 8 Vondra, 1999, p. 5). Attachment is “the inferred internal
bonds that form between infants and their caregivers” (Seifer 8 Schiller, 1995, p.
147). Another aspect is the caregiver’s own mental representation of attachment,
her own internal working models experienced and developed in infancy and
childhood. Those early mental representations inﬂuence later development and
relationships (Freud, 1935, 1966). The psychic component, the knowing and
trusting of the other, grows developmentally from the physical security of the
secure base. The mother must also be psychically available to her child and
mentally carry a positive internal representation of her own attachment ﬁgures

and relationships. These functions create a secure base for the infant/child.

143

Affective Component

Attachment has an affective component. Attachment bonds are the
demonstrable and observable affectionate gestures between infants and their
caregivers (Ainsworth, 1967, 1969b; J. Bowlby, 1958; Porter, 2003; Winnicott,
2002). Ainsworth (1969b) used the term affectional tie to describe the bond that
forms between two speciﬁc individuals. Bowlby (1958) spoke of the attachment
relationship as a reﬂection of pleasure and enjoyment demonstrated in smiling,
laughing, happiness, and love. Stress occurs from sudden or prolonged
separation from the attachment ﬁgure and permanent loss causes grief and
mourning (Barnett 8 Vondra, 1999). The security of the attachment relationship
also provides a space for affective reactions to stress and fear indicated by
crying, clinging, anger, and frustration. Emotions and “the foundation of
emotional regulation [are] also established within the context of the attachment

relationship” (Sroufe, 2003, p. 205).

Kinesthetic/Tactile Component

Attachment has a kinesthetic/tactile component (J. Bowlby, 1958).
Attachment develops through body contact between caregiver and infant/child
demonstrated in caresses and touches (Cristébal, 2003). “You [mother] just
adapt the pressure of your arms to the babies’ needs, and you move slightly, and
you perhaps make sounds. The baby feels you breathing. There is warmth that

comes from your breath and your skin, and the baby ﬁnds your holding to be

144

good” (Winnicott, 2002, p. 21). Gazing, touching, holding, rocking, stroking, and

nuzzling are examples of kinesthetic and tactile body contact.

Holding Environment

Attachment exists in the reciprocal holding environment of the mutual
mother-infantlchild attachment relationship. “Whoever is caring for a child must
know that child and must work on the basis of a personal living relationship with
that child” (Winnicott, 1993, p. 99). Attachment is deﬁned as an enduring
relationship between a young child and her mother (Ainsworth, Blehar, Waters, 8
Wall, 1978). Attachment relationships vary widely across mother-infantlchild pairs
(Ainsworth 8 Bell, 1970) but are always permanent and irreplaceable (Barnett 8
Vondra, 1999). Attachment relationships teach individuals how to be in
relationship with signiﬁcant others and inﬂuences all subsequent relationships
through to adulthood. Attachment, ﬁrst and foremost, exists, and is held together,
in the holding environment of the mother-infant/child attachment relationship. All

other deﬁnitions or systems of understanding must stand upon that principle.

Method
The qualitative research method utilized in the study was a semi-
structured, in-depth, phenomenological interview. Eight to ten interviews were
planned with an interview time of one to one and a half hours in duration.
Institutional Review Board (IRB) approval was granted, informed consent

procedures followed, and both conﬁdentiality and privacy maintained.

145

The semi-structured in-depth, phenomenological interview was used to
expand the understanding of what women hold to be true about their thoughts,
feelings, and behaviors as demonstrated toward their child (Echevarria-Doan, 8
Tubbs, 2005; Marshall, 8 Rossman, 1999; Smith 8 Osborn, 2003). The semi-
structured, interview has a pre-set format of questions to guide the interview but
allows for freedom to occasionally ask spontaneous questions as indicated by
the direction of the collaborative interview which can be described more as a
dialogue between researcher and participant. The semi-structured interview was
chosen as an appropriate methodology to address the research questions.

The semi-structured interview helps to guide the collaborative
conversation. The structure places boundaries on the topic and offers form to the
narrative content. The structure implies a destination (a narrative of the
attachment relationship) and a purpose (giving voice to women as mothers). And
yet the semi-structured interview offers enough ﬂexibility to adapt to the individual
characteristics and temperaments of women in conversation. The respondent, in
a semi-structured interview, shares in the direction of the interview (Smith 8
Osborn, 2003).

Interpretative phenomenological analysis (Reid, Flowers, 8 Larkin, 2005;
Smith, 1996; Smith 8 Osborn, 2003) was used to help understand how women
perceive their attachment relationship with their child in their personal world. It is
believed that, in dynamic collaboration, women as mothers can be heard, seen,
and validated. IPA is also interpretive. The researcher utilizes personal skills and

abilities of interpretation to make sense of the women’s experiences in a way that

146

addresses the research questions (Smith 8 Osborn, 2003). IPA is an inductive
method similar in approach to grounded theory or data-driven theoretical
formulation (Reid, Flowers, 8 Larkin, 2005). The researcher is not expected to
begin data collection with hypotheses already established (although this is a
difﬁcult task given all the preconceived ideas from a review of attachment
literature and the attachment indicators that emerged from the observational
study). The data are intended to deﬁne how the research questions are
answered. IPA is used to answer questions about what it is like for women to be
mothers of infants and toddlers and how they attribute meaning to being mothers
in an attachment relationship with their child.

Feminist methodology was also used to ground the research in the
experiences of women. Feminist methodology can lead to the empowerment of
women and is designed to work explicitly toward meaningful social change
(DeVault, 1999). Traditionally men have been the focus of research. A feminist
methodology values women and points of view from women’s perspectives since
their voices have not typically been heard (Waller, 2005). This methodology
moves researcher and interviewees into a mutual and collaborative relationship.
Feminist methodology embraces narrative, in the forms of personal life
experiences, life histories, and stories, as critical to understanding social
interaction and therefore rejects the mandate that research is objective.
Feminists understand that research questions, methods, measurement, and the
language used in written reports all reﬂect subjective and political choices. So

interview methods are purposefully chosen as a straightforward application of

147

feminist values and beliefs (Waller, 2005).

The semi-structured, in-depth interviewing technique is a fundamental
data gathering method encouraged in IPA and feminist methodology. The open-
ended dialogue fosters a collaborative relational experience between the
researcher and the participant that can lead to new ideas and perspectives on
the research questions (Smith 8 Osborn, 2003). IPA is remarkable for its demand
of the detailed and nuanced responses and reﬂections of participants that are not
possible to collect from written notes, therefore, all interviews were digitally
recorded. The written analysis includes substantial verbatim excerpts from the
data. And the use of IPA highlights the personal and cultural meanings of each

woman’s constructed existence.

Subject Selection

Mothers are primary caregivers and, along with their children, are typically
the objects of attachment research studies. Women as mothers are, therefore,
the identiﬁed subjects in this study. Initially mothers were speciﬁcally recruited as
participants when elements of pleasure, enjoyment, and play were evident in the
relationship with their children. This was based upon Bowlby’s (1958, 1982a)
early theoretical formulation that the attachment relationship was an emotional
and affective bond that reﬂected the enjoyment and the attraction that one
individual had for another individual.

Participants of the study were chosen by convenience and availability.

Two colleague acquaintances and one neighbor acquaintance were approached

148

with information regarding the study, as prescribed by the institutional review
board process, and each agreed to be a study participant. Contacts for
successive interviews were gleaned from each previous participant to give
access to a larger number of mothers. Subsequent women participants met the
preferred selection bias of playful, interactive, and positively engaged mothers.
This biased sample may have occurred because women participants referred
sisters, friends, and colleagues whom they assumed would enjoy participation in
the study. It seems reasonable to assume that a woman participant who enjoyed
participating in an interview/narrative about their relationship with their child/ren,
would be playfully, interactively, and positively engaged in that attachment
relationship.

The interviews, lasting anywhere from one to two hours, were completed
in quiet, private places, either at a School of Social Work ofﬁce or the
participant’s home. The location was designated by the participant and conﬁrmed
by the researcher to maximize conﬁdentiality and privacy. The researcher
conducted all seven interviews, transcribed each interview, hand-coded the data,

and was the only one with access to all information and records.

Data Collection
An original eight to ten interviews were planned but access to mothers and
time constraints limited the number of interviews to seven. Interviews ranged
from 52 - 112 minutes with an average time of 76 minutes. The mothers ranged

in age from 28 — 38 with an average age of 31 years. Four of the mothers

149

interviewed, Beth, Carol, Donna, and Grace, have one child each: 7 months, 7
months, 17 months, and 25 months. One mother, Amy, has two children: 48
months and 8 months. And two mothers, Eva and Fran, have three children
each: Fran’s children are 7 years, 33 months, and 17 months and Eva’s are 6
years, 30 months, and 4 weeks. All of the children are birth children. (All of these
names are ﬁctitious to protect the identity of the mother participants.)

All mothers are Caucasian and in long-term, committed relationships with
a signiﬁcant other. Amy, Beth, Eva, Fran, and Grace all have male partners,
identify as heterosexual, and are married. Four of those men are Caucasian.
Eva’s husband is Cuban. Carol and Donna self-identify as lesbian and have
female partners who are Caucasian. These couples are prevented from having a
legal marriage. All of the families represented live together and partners
described as involved in the childcare process. Amy and Eva, who have multiple
children, have one child (their ﬁrst child) from a previous heterosexual
relationship. Both mothers have full custody of their children.

Amy, Beth, Donna, and Eva have graduate degrees, Carol and Grace are
in graduate school, and Fran is completing a baccalaureate degree. Beth, Carol,
and Fran work part-time. Amy, Donna, Eva, and Grace work full-time. These
demographics highlight small aspects of the context to these mother-child
relationships and yet hint at their diversity. The mothers are similar in that they all
desired to have children and love their children.

Caucasian, middle-upper middle class and well-educated families have

nearly exclusively been the subject of investigation in attachment research (Lay,

150

et al., 1995; Matas, Arend, 8 Sroufe, 1978; Sroufe, Fox, 8 Pancake, 1983; Steier
8 Lehman, 2000), therefore, in this study, all of the women and their children are
Caucasian, middle-upper middle class and well-educated. Current subject
selection was intended to reﬂect previous subject demographics for two reasons.
Attachment research has historically been empirically and quantitatively based.
This qualitative approach adds another reﬂective dimension to previous
attachment research and logic dictated the use of similar subjects. Second, a
multicultural approach to attachment research is sadly lacking therefore a model
for evaluating attachment within culture is unavailable. Race and culture were
intentionally excluded as variables in the study.

Data were collected from the transcribed phenomenological interviews.
The interview was developed with the study questions in mind, to maximize the
mothers’ reﬂections and perceptions related to their attachment relationship with
their child/ren and phenomenological experiences as women and mothers. The
semi-structured interview consisted of 10 major questions with multiple prompts
designed to elicit information across a wide range of thoughts, feelings, and
reﬂections (Table 5-1). Once the interview outline was established, it was not
altered. The process of the interview provided ﬂexibility to follow the women
through the pattern of their narrative. The collaborative nature of the semi-
structured interview increased the connection between researcher and
participant and presumably increased full involvement by the mothers with the
interview process (Smith 8 Osborn, 2003). Mothers with more than one child

(Amy, Eva, and Fran) were encouraged to respond to the interview questions

151

Table 5—1. Interview Questions

 

Question

Probes

 

1. What are the ﬁrst things that come to
mind about your relationship with
your child?

1a.

1b.

1c.

Can you remember your ﬁrst moments
with your child?

How would your family and friends
describe your interactions?

What would you like me to know about
your relationship?

 

2. How would you describe attachment?

2a.
2b.
2c.

What does it look like?
What kinds of activities does it include?
What does attachment feel like?

 

3. What are your favorite things to do
with your child?

3a.
3b.
3c.

3d.

How do you play together?

What do you play with?

What are your favorite things to do
together?

Where do you go together?

 

4. How do you and your child show
affection to each other?

4a.

4b.

Do you show affection in the same
ways?

Are your affectionate gestures more
physical or more verbal, e.g., pet
names?

 

5. How do you and your child
communicate with each other?

5a.
5b.

What kinds of language to you use?
What non-verbal cues exist between
you?

 

6. What else would you like people to
know about your experience with
yourchﬂd?

 

7. How has your life changed since you
had your child?

7a.

7b.

Has anything surprised you about
yourself?

Has anything surprised you about your
child?

 

 

 

7c. What are some of the hard things?
7d. What are some of the positive things?
8. What helped you manage and/or 8a. What supports you?
cope with having an infant/child? 8b. Who supports you?
8c. What keeps you going?
9. How do you manage to be both a 9a. How do you deﬁne yourself as a

woman and a mother?

9b.

9c.

9d.

9e.

woman?

How do you deﬁne yourself as a
mother?

How have your roles changed since
becoming a mother?

How have you been successful as a
mother?

How have you been successful as a
woman?

 

 

10. What else would you like people to
know about your experience as both
a woman and a mother?

 

 

152

 

with their infant and/or toddler-aged child in mind. These mothers spontaneously
answered some of the questions about all of their children, thinking back to the
toddler age of their older children. Narrative was not interrupted. Prompts were
used when participants hesitated or in the case of more reticent subjects to
encourage engagement with the process.

Interviews were digitally recorded. The researcher took copious notes on
both content and process as each participant responded. To maximize narrative
accuracy, the researcher transcribed each interview. Therefore, the researcher
enjoyed a four-fold engagement with the data: listening to the initial interview
responses, taking process notes during the interviews, detailed listening for
transcription, and reading completed transcripts for analysis. Reﬂexive thoughts
and comments were written in a personal journal at the completion of each
interview and revisited during coding. lnfonnation logs and an audit trail were

maintained throughout the interviews, transcription, and coding processes.

Data Analysis
Data analysis was completed using interpretive phenomenological analysis
(Smith 8 Osborn, 2003). Initial coding began with an idiographic approach that
analyzed each interview as a single case. Each transcribed interview was
searched in detail and independently for signiﬁcant themes. A line-by-line and
word-by—word analysis was performed using a color-coding technique with
keywords written in the right hand margin. Each transcript in its entirety was

treated as data and no passages were selected or omitted for speciﬁc

153

interpretation (Smith 8 Osborn, 2003). In this process, emergent themes were
identiﬁed and coded and then connections sought between them, creating
clusters. The researcher relied on personal interpretive technique while balancing
the sense of that interpretation with the actual words of the participant, what
Smith and Osborn (2003) call evidence of convergence. The clustered themes
were then examined for evidence of convergence across the transcripts to
identify overarching concepts relevant to all participants. A list of themes was
generated and clusters grouped and given an identiﬁer. Over time, themes were
dropped from the list when supportive data were minimal in a single transcript
and/or had no supportive data from subsequent transcripts.

Themes from the ﬁrst case oriented the subsequent analysis (Smith 8
Osborn, 2003). Special care was taken to both acknowledge repeating patterns
and identify new themes. Each transcript was analyzed using the interpretive
process and compared across cases. When themes and clusters were identiﬁed,
the transcripts were examined a second and third time for examples of those
themes and any additional emergent characteristics or themes. Additionally, each
transcribed interview was examined a minimum of three times for speciﬁc
examples of material related to the study questions and the attachment indicators
and then a table of categories developed.

The categories selected for discussion in this paper (Table 5-2) were
chosen for the richness of the data in transcription passages as well as how
those data work to illuminate the broader narrative. These passages were well

represented within the transcripts and reﬂected the understood meanings that

154

thread the participants’ accounts rather than the researcher’s expectations. Each
case was speciﬁcally analyzed for data related to the research questions and the
attachment categories delineated a previous observational study (F itton, 2008):
reciprocity and mutuality, proximity, verbal communication, affect and emotion,
physical affection, and play. Those themes with rich supportive data across
cases were identiﬁed as: education; responsibility; childcare; and time
management.

Table 5-2. Categories and Themes

 

 

 

 

Attachment Indicators Emergent Themes
Reciprocity and Mutuality Education
Proximity Responsibility
Verbal (8 Non-Verbal) Communication Childcare
Affective Features Time Management
Physical Affection
Physical Activity and Play

 

 

And ﬁnally, the interpretations and conclusions derived by the researcher
were discussed with study participants. To maintain conﬁdentiality, dialogue was
limited to conversations with each woman individually. However, one wonders
what might be the effect of a group interaction and conversation among these

intelligent, thoughtful, and engaging women.

Interpretations
This section of the paper is devoted to the words and images mothers
used to describe their experiences, thoughts, and feelings about the attachment
relationship with their child/ren. It begins with descriptive language of their

relationships and then moves to their personal deﬁnitions of attachment and the

155

secure base. The six attachment indicators ﬂowed through all interviews.
Representative data are matched to those indicators. And ﬁnally, four emergent

themes are identiﬁed and interview quotations offered to support those themes.

Relationship

Attachment, which occurs in the holding environment of the mother-infant
relationship, is the foundation of all relationships and inﬂuences all subsequent
relationships through to adulthood. Bowlby believed the mother-infant attachment
was primary and exclusive and portrayed infants as competent, curious, and fully
engaged with their caregivers and the environment (Waters, Crowell, Elliott,
Corcoran, 8 Treboux, 2002). In this study, mothers’ responses regarding their
relationship with their childlren were warm and tender, full of attachment
language, unconditional love, protectiveness, and personal vulnerability.

He’s my little snuggler, my little snuggle guy.... It [is] wonderful....

He’s just squeezable. He’s so soft and sweet... I love just holding

that little body. Ah, it feels so good. They’re so warm. They’re just

like little furnaces. I love it (Amy).

In the beginning I held her all the time.... I don’t know what I would

do without her.... Or I will get up early in the morning just so I can

be the one to feed him or I’ll just hold him.... I love my children. I

love them to death. I hope every mother does (Eva).

She’s made my life so much more rich.... You can’t explain to

someone else your connection to your child very well, at least I

can’t, and have them understand the sheer joy that it brings... I

feel a lot more protective than I used to and nervous at the same

time (Donna).

Obviously there were some really positive feelings around [the ﬁrst

moments], but also a certain sense of fear. You know, fear of

opening that door of being vulnerable to loving someone else, and
that could be painful at times (Beth).

156

I didn’t understand how dynamic and beautiful our relationship
could be, which is silly because I have a beautiful relationship with
my mother, but it’s actually incredible... The profundity of what the
relationship between a mother and a daughter is, just hits me
sometimes. I get bashed by it (Grace).

Attachment

Attachment is described in the literature as a deep and enduring
connection between a child and maternal ﬁgure. “From an emotional perspective,
attachment is the creation of a mutual bond in which the mother shapes infant
development through her interactions and relationship with her child” (Porter,
2003, p. 2). Mothers described this bond as life long, connected, intertwined,
supportive, physically and emotionally close, and as unconditional love.

The way I understand attachment is the idea of being a base for my
child’s emotional needs and self-esteem and almost like this island
where she can come back to and ﬁnd what she needs but then be
able to kind of reach out from that and explore and see new things
and do new things, but to come back to something that’s familiar
and something that’s safe (Beth).

[Pleople who are attached to each other enjoy spending time with
each other.... If you’re attached to someone you care about their
well being. You care about whether or not or how they’re
experiencing the world and that they feel loved and supported, free
to express whatever emotion that happens to be.... I don’t feel like
her attitude necessarily affects the level of attachment that I have
(Carol).

It’s just that bear part of me, that bear part, that I just have to hold
my young and I’ll kill anyone who tries to hurt my baby, kind of
thing... It looks like holding a baby. Just holding them. Keeping
them close.... It’s just the feelings and the love, and whatever other
emotions, are beyond everything else (Amy).

Attachment to me is life long. It feels like you’re connected, you’re

interconnected and intertwined. I want her to also feel attached to
me. I’m sure I’ll always feel attached to her.... It feels like she’s

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holding my heart. That’s what it feels like to be attached. She could
do anything and it just makes me melt.... As soon as she came out
of the womb though I was attached to her. I knew I would be
attached to her until I died, unconditional love. That’s how I feel
(Donna).

Attachment is like your heart breaking into a hundred million little
pieces and then exploding in joy and bewilderment... Like a

simultaneous explode and implode of your whole being. She’s
absolutely everything, and absolutely everything is at risk (Grace).

Secure Base

Babies instinctively reach out for the safety and security of the secure
base with caregivers. The secure base is deﬁned as the attachment ﬁgure, a
particular and substantial someone in a speciﬁc location, to whom the child can
attach, therefore attachment has a solid human context within time, space, and
situations (Posada, Gao, Wu, et al., 1995; Waters 8 Cummings, 2000). The
holding environment (Winnicott, 1971) supports the proximity and elasticity of the
mother-child relationship and offers the child an opportunity to go and come
back, leave and return as they practice separation and individuation (Mahler,
Pine, 8 Bergman, 1975). These securely attached children were able to use their
mother, the attachment ﬁgure, as a secure base for exploration of the
environment and as a safe haven to which to return for reassurance.

Attributes of the secure base would be if, while she’s exploring, and

something doesn’t go right or if she’s hurt or if she feels like she

doesn’t do something right or failure or whatever, that there’s still

acceptance, that there’s this unconditional love and acceptance

that she can have which gives her the conﬁdence to do those
things in the ﬁrst place (Beth).

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She just can entertain herself for a good while. If you put a few toys
within her reach, she may occasionally look up to see if you’re
around... but she’s pretty secure (Carol).

I really feel like she trusts me a lot. I feel like she knows that I’m
available to help her. And it’s been really, really fun to watch her
start to assert that independence of toddlerhood. She says things
like, “No mommy. [I] will do it. I can do it. I can take care of it.” And I
know that I kind of helped facilitate that. It’s deﬁnitely not some kind

of rejection. It’s a taking over of some responsibility that’s deﬁnitely
appropriate (Grace).

Attachment Indicators
Elsewhere, six indicators of healthy and pleasurable attachment and
attachment behaviors between women caregivers and young toddlers were
delineated: reciprocity and mutuality, proximity, verbal communication, affect and
emotion, physical affection, and play (Fitton, 2008). These indicators
demonstrate key principles of attachment theory. All of the interviews included
elements of every coded category indicating that the relationship demonstrated a

full range of positive, healthy attachment behavior.

Reciprocity and Mutuality

Reciprocity is a hallmark feature of relationship presuming two participants
where one initiates and the other receives. Reciprocity is demonstrated through
behaviors such as giving and receiving, reading and listening, hiding and ﬁnding,
or imitation. Mutuality manifests in the shared experience or expression of the
relationship through such activities as eating together, moving in tandem,

laughing and jabbering together, and mutual touching. Reciprocal and mutual

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behaviors were evident through all the interviews.
She’ll watch you and what you’re doing. If I have a toy, and I’m
showing it to her, she’ll watch me. If we’re eating, she’ll watch us as
we’re eating. She really watches us all the time (Carol).
She runs off and goes here or there. I can leave her for a minute
but when she leaves my sight, I have to stop and go and look for
her (Beth).
At this point it’s more like a teaching relationship. She knows who I
am. I know who she is. I’d like to think our relationship is very tight
and some day it will be. But right now we’re just getting to know
each other, seeing what she likes and what she doesn’t like. I’m
sure she’s checking me out too, seeing how I react to certain
situations. We have just a great relationship (Donna).
We love to go to the park. And we went to a play park. She’s so
fun. It was Friday afternoon and we were both out of school and
just kind of unwinding. She said she wanted to sit in the red swing.
It’s kind of a big infant swing contraption thing. So I put her in there.
She’s just so sweet. She pointed to the swing next to it and said,

“Mama sit in blue one.” “Alright, you’d like mama to swing too?”
“Mama swing too” (Grace).

Proximity

Proximity is demonstrated through the dynamic tension of the physical
connectedness and distance exhibited by a mother and her child. Close physical
contact is the feature characteristic of proximity, for example, sitting close
together, holding hands, climbing on or clinging to mother, or being held in her
arms. As the physical contact is broken, mothers typically exhibit hovering,
standing over, leaning in, stooping down, and watching behaviors. Proximity
relates to separation-individuation (Mahler, Pine, 8 Bergman, 1975) and to the
secure base function of the attachment relationship (Ainsworth, 1969b; Bowlby,

1988). The child uses the mother as a home base.

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And I think, probably on the more literal level, it’s just that I want
them close to me. I don’t want them far from me (Amy).

I like to hold him. We have this little wrap thing. It’s called a mobi-
wrap and you can put him in there so it frees up your hands. I love
to wear that when we’re going for a walk or going to the mall or
somewhere that we’re going to be out for a while as opposed to
having him sitting in the car seat, in the stroller or something (Eva).

I think of proximity, of being able to wander further away. You
know, the whole idea of her looking back and seeing myself or my
partner and feeling conﬁdence to try something new or to play with
another child that she maybe doesn’t know very well (Beth).

In the very beginning she wanted to be right on our chests and that
was great (Carol).

She wants to be right in the middle of everything so we take her
everywhere... It’s the best job in the world and it’s fun and I never
want them to move away (Eva).

They grab onto my leg and not let go.... I usually let them stick with
me. They’d stick like glue. . .. The easiest thing for me was to bring
him along from room to room, upstairs, downstairs... I want my
babies with me (Fran).

She initiates the sweetest interactions. Like the other day, my
partner was out of town and l was giving her a bath and she was
splashing around. And she points to me, “Mama shirt off.” “What
are you thinking?” “Mama pants off.” “What’s your plan?” She goes,
“Plan having mama in tubby too.” So pants off, shirt off, sure
enough. So we played in the tubby. And she wanted to help me get
my hair washed. We were having a blast in there. It was really fun.
Being able to be ﬂexible and receptive to the things she wants too
is really important because they are often the most beautiful
moments (Grace).

Verbal Communication
Communication occurs when mothers call their child’s name and the child
responds, sometimes with words although most often with groaning, gibberish, or

screeching because many of these children have limited language. Verbal

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communication also occurs in a spontaneous outburst of laughing or giggling in
response to engagement in physical activity and play. Some of the mothers
interviewed had young infants so verbal communication is translated to basic
communication and the knowing that exists between a mother-infant dyad.

I was getting all frustrated because I was telling my partner, “I don’t
know if he’s getting enough food,” because we were nursing. “Do
we give him a bottle? Is he getting enough? Is he tired?” It was like
ahth And my partner would say, “No, you guys are
communicating.” “What are you talking about?” To me it wasn’t
showing, but to my partner it was showing that I would be talking to
baby and [baby] would be sort of talking back with me (Amy).

Just last night, my mom was here, and [baby] would squeal, my
mom would squeal. It went back and forth for ﬁve minutes at least.
We try to encourage her to have a conversation with us. We give
her time to respond. And if she doesn’t respond then we do it again
and if not then we give her a couple of times to see if she’s
interested and if not then give her some space to have quiet time if
she wants it (Carol).

I tell her that I love her and she tells me that she loves me (Eva).

He’ll call out to us and we’ll come in, so the conversation has
started and it just feels good. It just feels good that he’s responsive
(Amy).

She does communicate a lot. If she doesn’t want to go somewhere
she will run away from you. And if she’s upset about something,
she’ll stamp her feet. She’s a little bit of a drama queen at times. It’s
clear but it’s short-lived, too.... She gets over it pretty quickly but
she’ll let you know if she’s not happy about it (Beth).

I think we communicate mostly through touch and through facial
expressions. She could not be smiling and you make an excited
face and she’ll just light up. She knows it’s time to be happy. We’re
going to do something exciting (Donna).

We started signing with her when she was 9 months old. She was
13 months old when she really exploded into it, but then she was
picking up four and ﬁve signs a day and that changed our
relationship. That was the point at which the relationship really
started to blossom. She’s so intense that as soon as she could

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communicate her needs, even ifl wasn’t able to meet them,
understanding that someone was thinking about her and
understanding what she wants was very important to her (Grace).

Affect and Emotion

Attachment behavior also manifests in affect and emotion. The
affectionate bond of the relationship reﬂects pleasure and enjoyment and is
demonstrated in smiling, laughing, giggling, waving, clapping, watching, and
following. But subtle affective features can be displayed, such as those indicated
below with italics, by mothers and demonstrated in children of all ages.

I enjoy snuggling, giggling, playing and making her laugh (Eva).

There’s nothing better than her laugh. There’s nothing better in this
world. I love to make her giggle and belly laugh (Donna).

He watches me when I come in to care... He likes to watch. He
wants to watch what you’re doing (Amy).

If you’re playing with her, she’ll laugh and giggle and she’ll watch
you and what you’re doing.... She just loves it. She giggles and
laughs (Carol).

She’s 18 months old and she desires to be more independent and
is able to be more independent so it’s exciting and frightening at the
same time. It’s like that’s the goal and yet it’s frustrating at times
too.... Everything feels new to some degree and trying to make
decisions without having past experience, that feels challenging to
some degree (Beth).

It’s still all that excitement. You know in the morning when they
wake up and see you and they’re grinning from ear to ear and
they’re just delighted that you’re back (Amy).

She’s very relaxed and she kind of does her own thing whenever

she wants to. We’ve been able to accommodate that for the most
part (Carol).

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l was jealous about having to leave the home [and baby]... If
something would have happened to her, I’m sure I would have
been devastated (Donna).

I don’t really have the words for it but they are stronger feelings
than I’ve ever had in any other part of my life... It’s just the feelings

and the love and every other emotion are beyond everything else
(Amy).

Physical Affection

Attachment has a strong tactile component (Bowlby, 1958) and develops
through body contact between mother and infant/child demonstrated in caresses
and touches (Cristébal, 2003). Physical affection is indicative of enjoyment and
pleasure and is demonstrated by hugging, kissing, snuggling, cuddling, rocking,
holding hands, touching, and carrying. Children often signal a desire for closer
contact by tugging on their mother’s leg or clothes. The mother’s positive
response, by lifting the child into her arms, indicates a heightened level of
attunement and sensitivity to the child’s needs in the moment (Ainsworth, 1967,
1969b; Hsu 8 Fogel, 2003).

I love to snuggle with them at night. We’ll put pillows and blankets

on the ﬂoor and they’ll all cuddle me and we’ll watch cartoons. I

love it when they all snuggle me. That’s my favorite... We give

hugs all the time. Lots of kisses. It’s so wonderful because they are

so affectionate to each other too so it melts my heart. [The baby]

goes to bed, I take her up to her crib ﬁrst, and she gives me a kiss,

and then she gives [her sister] a kiss and gives [her brother] a kiss.

I mean we cannot go to bed unless we give everybody a kiss.

We’re really affectionate. I love it (Fran).

Lots of hugs. We do lots of squeezes. Lots of kisses. She’s very

physically cuddly so she likes to sit on our laps and we read to her
(Beth).

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Play

He’s into his feet because he grabs his feet and so if he’s grabbing
his feet you watch him and agree that you like his feet. He likes
that. He’s doing the talking to the hands thing. And it’s just that
we’re sort of joining in with him and letting him know that his little
hands are so fabulous. He just loves them, loves those hands.
Loves those feet. Maybe, he’s on the change table, we have that
sort of time that’s full of affection like, “Oh yeah, you are fabulous.”
Skin to skin. That’s part of the bath I love, just holding that little
body. Ah, it feels so good. I love it (Amy).

We do a lot of normal physical stuff. I can’t keep my hands off her.
She’s going to make me stop really soon. I just can’t stop. I can’t let
her go. Hugging her all the time and playing with her hair and
touching her feet. She’s getting to the point she’s like, “Mama stop
it.” “I can’t, I’m sorry.” I hug that baby every second. I just love her
to pieces (Grace).

Kissing and hugging. She’s extremely loving. Telling her all the time
that I love her (Eva).

Hugs, believe it or not. She’ll sit on my lap and she’ll make eye
contact. And she’ll lean in and I’ll give her a big hug and she’ll sit
back up and she’ll do it again. Or lots of kisses. Or if I’m feeding her
and she reaches up and touches my face or lips. When she falls
asleep on me. I like to tickle her feet. I like to kiss her cheeks, take
hold of her hand, give her baths, and play (Donna).

Attachment behavior includes play. A child must be in a reciprocal, mutual,

proximate relationship in an affective environment of safety and freedom to

engage in play. Without those aspects of the attachment relationship, a child’s

engagement with the environment is restricted (Axline, 1969). In all of these

interviews, mothers described their child’s play, and their interactive play, as free

and spontaneous.

Love to play. That’s my favorite thing to do. It’s my favorite thing to
do.... I want to play with her up until she’s grown, and after. And I
want her to come and say, “Let’s just play. I just want to play with

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you, mom.” I think it’s a great learning experience. The best way
they can learn is through play.... All she needs right now is play.... I
think more people should learn to play. I think as people grow up
they forget that (Donna).

I had both the kids and they needed baths so we all got naked. We
ﬁlled up the tub, my daughter, mom and baby.... Baby is this
mellow kid, but he gets loud. He started splashing. And you know
splashing around makes a noise. He started howling, this sort of
laugh howling thing. And he’s just ﬂapping, a four-point flap, all
arms and legs going.... The baby was laughing, splash, splash,
splash. And so that was fun playing. That was fun playing. He loved
the water. He loved the splashing (Amy).

Sometimes we play really aggressive. Not rough, but I think that
kids need physical play sometimes, that hard physical play,
especially with [my son]... So I kind of started with that and
continued along. We’ll play tug-a-rope, push/pull activities and
things like that... I love to play (Fran).

I like playing tea party with her because it’s very funny who she
invites to the tea party. I love the animals that are invited... I love
going to the beach with her, too. She’s very playful and pretty
daring in the water so far (Beth).

She can draw me into her world and we can play together.... Play
has everything to do with attachment because her existence
fostering a sense of play in me has been so fulﬁlling... I love being
silly with her (Grace).

Educaﬁon

One of the themes that emerged in the data analysis process was a

construct related to education and new experiences, for example,

learning, teaching, and modeling. Every one of these mothers mentioned,

with great fascination, a remarkable pleasure in the experiential learning

that happened with their children. “We show her things and sort of watch

what she is looking at. It’s fun to watch her improve and react to new

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experiences” (Carol). Mothers spoke to the inﬂuence they have over
children. “There’s something really cool about that. You get to have that
inﬂuence over this little person” (Beth). Mothers mentioned the
responsibility to model positive and appropriate behaviors for children.
“Even walking around the block would help our energy level as parents
and help be a positive model to our kids” (Amy). Mothers also spoke to the
role teacher plays in the attachment relationship and the responsibility
they feel to have a variety of tangible and intangible objects and
experiences to offer to their children. “I try to initiate a lot of interesting
things. And I try not to be too dorky and not too didactic but it’s pretty bad.
I’m really a teacher” (Grace). And, not only did mothers accept the role as
teacher of their children but they often mentioned the process of Ieaming
from their children in the reciprocal nature of the relationship. “I think of a
lot of learning. As I say that a lot of learning on my child’s part but also a
lot of learning on my part” (Beth). “Nobody told you how to be a mom but I
tell my daughter she was a very good teacher because we deﬁnitely
learned a Iot” (Eva).
I ﬁnd it fascinating to see her little mind be a little sponge where she
is just taking things in. You get to show them certain things for the
ﬁrst time. They see a little butterﬂy outside for the ﬁrst time or
whatever and they’re really excited because they never saw it
before. Or when she saw a plane and she’s like, “Oh, what’s that.”
There’s something very rewarding about providing her those new
experiences... Just seeing her really seeing new things, always
seeing new things, experiencing new things, and kind of seeing her

take it all in (Beth).

We’re learning as we go and we’re teaching each other (Donna).

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[S]he’s so inquisitive and she’s at an age where she’s learning so
much. You can see her pick up an object and turn it around and
look at it and try to ﬁgure it out. So to watch her with all of these
new experiences and think about what her brain is maybe thinking
about and what she’s learning is really fun (Carol).

Absolutely every night we would review the day and I would tell her
the things that I remembered and enjoyed about the day and how
we spent time together. And every night I would tell her what I was
proud of that she accomplished that day (Grace).

[I want to] be patient and set good examples (Eva).

I tell her the things that I see that she does that I feel are positive.
Like she is often very affectionate with her baby [doll]. She will pat it

and pat baby’s back while baby’s sleeping and I tell her how sweet
she is and that’s so nice to be helpful and to be caring (Beth).

Responsibility

Another theme that emerged out of the analysis was the responsibility
mothers feel for the health and welfare of their children. Mothers mentioned
being more aware of safety issues when driving a car occupied by a child or the
vulnerability and risk involved in air travel. “Now I’m terriﬁed of ﬂying because... if
the plane went down my kids wouldn’t have a mother” (Fran). Some mothers
talked about the risky behaviors to which some children are drawn. “She’s
already fallen... stuck a bead up her nose... cut open her ear... and smashed
her ﬁnger. She’s just not cautious at all.... I’m afraid what’s going to happen
when she goes to school and playing on the playground, what she’s going to do
out there” (Eva). And most mothers spoke to their awareness of potential
dangers and harms that could befall their child and the helplessness they felt in

the face of those fears. “You watch the news and hear so many bad things, so I

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make sure the door is locked one more time” (Donna).

I remember feeling just very emotional and feeling... both my
husband and I had this overwhelming sense of, “Oh my gosh here
is this child that we’re both responsible for now.” It was really
bizarre because we were both feeling it at the same time. When we
were in the hospital we were kind of like... It was this actually weird
thing that there was almost this sense of fear. “Oh my goodness my
child could be hurt.” All of a sudden life became more complicated
(Beth).

I called my partner. Didn’t get through so I called right over to the
baby center and the kids hadn’t been picked up yet. And it was,
part of me wanted to start crying. “Oh my God, where’s the baby
and where’s my partner? And if he’s not there, I should be there.” It
was so physical.... I’m talking about it because I’m so upset even
though in my brain I knew that the children were safe They were
with caretakers who love them. Someone was coming. None of that
was going on. I think the fear of them feeling left or alone. I’m sure
was some kind of projection or something. But he’s just an infant,
an infant alone. It was just like, panic (Amy).

My focus is so external now. . .. It’s so important to get her needs
met before mine. But then I do understand that you have to make
sure that you respect your own self so that you can make sure
you’re available for that kind of attachment. If you’re so caught up in
your own martyrdom, or whatever it is, then you can’t be available
for forging really solid relationships (Grace).

She’s just not cautious at all, so he said, “Be ready. This is going to
happen and you can’t freak out every time and panic. You need to
be stronger for her.” And he’s right. I’m trying. She scares me but
we just need to teach her the right thing to do.... I don’t want her to
suffer or have any kind of pain, but I don’t think that she’ll be careful
until she experiences that pain and then goes out to do it again
(Eva).

That ﬁrst experience was amazing... I was overjoyed but at the
same time I knew I had a big responsibility from that point on.... I
feel a lot more protective than I used to and nervous at the same
time (Donna).

l was just really young and immature. I was a really good person, I
was just really confused about what I wanted to do with my life and
then along came my daughter and everything changed. I, not grew
up, but I really matured when I had her. I wanted to be a better

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person. I wanted to go back to school. I saw things differently. I got
real paranoid. That’s the one thing my husband doesn’t care for. All
of my actions, I don’t think of how it’s going to affect me, I think
about how it’s going to affect my children. It changed completely,
everything, every aspect (Fran).

Childcare

Women had particularly strong feelings around the issue of childcare. The
initial experience of leaving a child was fraught with emotion. “When I was
leaving her and she was upset, I felt guilty” (Beth). Differences existed among the
women about expectations related to childcare dependent on their personal
childhood experiences with external childcare. “She’s been in daycare since she
was four months old. I didn’t have any concerns about that in the beginning. My
partner did just because she did not grow up in daycare whereas I did” (Carol).
Yet, overwhelmingly, women agreed that, if their child was comfortable, content,
and happy in the childcare setting, it relieved maternal anxiety about working.
“Knowing that they’re in good hands is the ﬁrst and best thing” (Fran).

I feel like it takes so much to carve out... the space that it’s okay to

be at work, that it’s okay for your child to be cared for somewhere

else... It’s very much a process to have that be an okay thing. And

my mom helped me with it. I mean my mom saying, “Working is

taking care of your child.” With baby... the women who are taking

care of him in childcare are wonderful. I call them day mamas. And

one of them.... baby loves her, loves her.... Baby sees her and he

lights up from ear to ear and does his little penguin [ﬂap]. And that’s

all I needed. It’s like, “You know what? This little baby is delighted

with you.” I can go to work now. It’s okay and so that’s huge (Amy).

I’m thinking about my own feelings around having somebody else

be inﬂuential in my child’s life and how that feels and actually the

experience when I initially brought her to daycare and her reaction

to me leaving, and now her reaction to me leaving is just very
different... I think when l was leaving her and she was upset, I felt

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guilty. I questioned, Should I be going? Should I be leaving her? Is
this really okay for her? I kind of went through my own feelings
around working and whether or not that was okay.... Knowing that
she’s okay with [daycare], I don’t feel threatened by that. I don’t feel
like, “Oh no, she doesn’t need me anymore.” Which is nice because
I do feel like she still needs me. It’s very evident that she needs me,
that she needs me in different ways (Beth).

We both wanted me to be able to stay home with her the ﬁrst few
months if at all possible and prolong her age when she started
daycare... That ﬁrst week at daycare was hard... But I think now
we both really see it as an extremely valuable experience for her
because she’s in a place where the daycare providers are really
attentive to her and they really try to keep a small ratio of infants to
teachers (Carol).

Deﬁnitely going back to work was good because it put me in a
place where l was feeling competent and in control for most of the
day. Although I really wrestled with the guilt that I should be home
with her but that was hard even though I didn’t want to be and then
I felt double guilty for not wanting to be with her as I should (Grace).

Their nanny is just fantastic and she loves them like they’re her own
children. That makes it easy. If it wasn’t for that I don’t think it would
be as easy for me, but I know that as soon as I walk out the door....
Like this morning, baby cries, but as soon as I’m in the car I know
she’s ﬁne and everything is great (Fran).

A piece of that attachment is when I see his connection to the
people taking care of him. I can get in the car and drive to work. If
that wasn’t there, I swear I don’t know what I would be doing. That
would be a nightmare (Amy).

Time Management

The last theme to emerge from the coding process revolved around the

issue of time and time management. Some women expressed the feeling that

time slowed down. “I do feel like it’s forced me to slow down in a lot of ways”

(Beth). Other women felt that time sped up. “It seems like there’s more to do. My

semester, this semester is very busy. And I still have a million things to take care

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of when we get home” (Carol). While one woman expressed a sense of being
trapped in time. “I felt like this is how it’s going to be. I got myself into this. I
guess I’m going to spend 15-hour days walking circles around the dining room
table That’s how it’s going to be” (Grace). All of the women interviewed felt that
managing their work time for maximum impact was crucial to maintain enough
quality time to be a mother. “I always wanted to be a mom and now I am and it’s
perfect. I just wish I could spend more time with her. You gotta. You just gotta. If
she’s going to go to daycare, you just gotta” (Donna).

It gives you a different perspective on things. It seems like there’s
more to do.... And I still have a million things to take care of when
we get home... but it’s emphasized the factor of time management
and needing to get things done. I feel like there’s less room for me
not to get things done because I know it’s going to mean less time
with my partner and with the baby when I get home. So I try really
hard to make my work hours productive. It doesn’t always happen
but I feel like I put more pressure on myself to try to do that
because I want to try to have work at work and then be able to
enjoy the stuff at home too (Carol).

[H]aving a child makes me think a lot about my own way of doing
things, my own agenda and how my agenda and her agenda don’t
always match and how I manage it well or don’t always manage it
well, and then how that may come across to her.... My agenda
versus her agenda and being willing to not necessarily get done all
the things that I want to get done or that I planned to get done in my
own head because I think it requires me to be a lot more ﬂexible...
I do feel like it’s forced me to slow down in a lot of ways. It’s weird
though, it’s forced me to slow down but then also it feels very busy.
It’s a different sort of pace (Beth).

Everyone kept saying, “Oh, baby changes your life.” Baby number
one doesn’t feel like anything compared to baby number two. It’s
pace and timing and how to keep the attention with my daughter
and keep up with her and her needs. But because my time with
baby is... it’s very physical. It’s very literal. It’s very right there... All
the roles need to be done more carefully. Like at work, the job
description hasn’t changed, but I just need to be more vigilant
because I don’t have the stopgaps that I used to have (Amy).

172

Giving voice to women’s stories was a fundamental goal of this paper,
based on the fact that attachment research methods have deﬁned women by the
role of mother, attributing deﬁnition to role rather than to the broad, deep, full,
and rich lives of unique individuals. It was a pleasure and an honor as a
researcher to be given access to these wonderful stories, memories,
experiences, and feelings. The mothers interviewed felt similarly. Amy addressed
this clearly.

This was a treat. I can’t believe how selﬁsh I feel that I got to sit

around and talk about being a mom to my babies. And this is just

like a present. There isn’t a lot of space to sit here and talk about

kids. That would bore the hell out of people. The experience itself is

just everything.

The meanings mothers ascribe to their attachment relationships with their
children are eloquently stated in the above passages. What is not so easily
communicated on paper were the non-verbal gestures, the tears, and body
language of the participants as they spoke about their children. Amy, as she said,
“I want them close to me. I don’t want them far from me” put her hands up on her
chest over her heart. When mothers talked about hugging, snuggling and
cuddling with their child, they often wrapped their own arms around their body in
that hugging motion. Carol, as she said, “She was reaching for my hair and
touching my hair” put her hand to her head and gently touched her own hair,
reminiscent of her child. And Grace, in her response to the ﬁrst things that came

to mind about her relationship with her child, said, “I’m ovenrvhelmed with how

dynamic it is and how ﬂuid it is and how easy it is for it to change as she changes

173

in ways that I think are awesome and beautiful.” Her eyes ﬁlled with tears and
she said, “I’m going to cry in the ﬁrst sentence.”

Mothers described interactions with their child with powerfully emotive
language that held positive connotations for Western Caucasian culture:
unconditional love, joy, adore, excitement, delighted, wonderful, successful,
comforting, fabulous, fantastic, pleasure, overwhelmed, attached, vulnerable,
acceptance, warmth, encouraged, ﬂexible, happy, awesome, fortunate, enjoying,
amazing, surprised, supported, relaxed, secure, connection, and engaged. They
also used powerful emotive language that has connotations of stress: anxious,
scared, tense, afraid, nervous, frightening, worried, fear, painful, conﬂicted, guilty,
upset, frustrating, stressful, struggle, exhausting, jealous, devastated, and
uneasy. Maternal descriptions of attachment relationships with their children
related directly to the basic constructs of attachment theory as evidenced by the
connection to the literature review. And, as detailed above, the mother
participants in this study provided beautiful descriptions of their attachment
relationships directly related to the indicators of healthy attachment coded from
the previous research: reciprocity and mutuality, proximity, verbal

communication, affect and emotion, physical affection, and play.

Trustworthiness
Trustworthiness was addressed in several ways in the study. An audit trail
was created and maintained throughout the study process that included:

literature review, hypotheses building, method selection, IRB process, data

174

gathering procedures, reﬂexive writing, coding procedures, and data analysis. A
semi-structured phenomenological interview was designed for maximum data
gathering through a researcher-participant collaborative discourse that was
digitally recorded to capture exact words and nuance.

The reduction of bias in a qualitative study is a difﬁcult process.
Cooperative inquiry was established as part of the collaborative interviewing
relationship to offer each woman the opportunity to concur with or challenge the
interpretations following completion of data analysis. Multiple researchers for
data collection and comparison of analyses were not practical but peer debrieﬁng
was incorporated into the process to reduce bias and address researcher
triangulation. Interpretive phenomenological analysis (Smith, 1996) was the
primary method utilized in this study but it was mixed with feminist methodology
(DeVault, 1999; Waller, 2005) and therefore method triangulation was addressed
to some extent. Analysis triangulation was addressed by incorporating features of
the constant comparative method (Echevarria-Doan 8 Tubbs, 2005) in

conjunction with IPA.

Limitations
Category generation from qualitative data, particularly from a feminist
perspective, has a subjective basis. This is intentional. In this case, category
generation was inﬂuenced by the researcher’s inferences from the data, initial
research questions, theoretical perspective, interpretation, previous experience

and knowledge, and the dynamic interaction with the study participants. Another

175

possible limitation is quoting out of context to support interpretation and
generalization (Riessman, 1994) though every effort was made to be cautious in

this regard.

Conclusion

This study has implications for research, policy, and treatment. The
earliest attachment research focused on theory development, explaining
attachment and its primary function of bonding and security for biological survival
(Ainsworth, 1967; Bowlby, 1958). In the decades following, attachment research
focused on mother-child behavior and the creation of attachment classiﬁcation
systems utilizing quantitative methods (Ainsworth 8 Bell, 1970; Ainsworth,
Blehar, Waters, 8 Wall, 1978; Barnett 8 Vondra, 1999; Cassidy 8 Berlin, 1994;
Forbes, Bento, 8 DeOliveira, 2003; Gusella, Muir, 8 Tronick, 1988).

There is a need, in future research, to work toward understanding and
enhancing the development of healthy attachment between infants and children
and their caregivers. This study demonstrates that mothers feel a bond form with
their infants either before or following birth. They articulate a clear understanding
of the need for an attachment relationship with their children. And these mothers
know how to use that relationship for the growth and development of their child.
This rich and detailed information is a missing piece of previous attachment
research indicating the addition of qualitative methods to future attachment

research.

176

The current policy environment has fostered programs and pilot studies to
intervene in maternal-infant/child attachment, however, these programs operate
almost exclusively at the adult level. The interventions target caregivers who are
typically considered at-risk young mothers (even prior to the birth of the infant) to
protect the infant and child, strengthen maternal sensitivity, attunement, and
listening behaviors, build caregiver support systems, and add services for the
family as needed (Cassidy, Woodhouse, Cooper, Hoffman, Powell, 8
Rodenberg, 2005; Cooper, Hoffman, Powell, 8 Marvin, 2005; Olds, 2005). The
intervention protocols and models have demonstrated an increase in maternal-
infantlchild secure attachment. But as this study demonstrates, attachment is
reciprocal, mutual, and proximate and occurs in the holding environment of the
mother-infantlchild attachment relationship. Any protocol or model that focuses
solely on one half of an attachment relationship denies the vital offering of the
other half of the relationship and the dynamic interchange that happens in the
transitional space (Winnicott, 1971) of the mother-infant dyad. Infants and
children, who live in relationship with their mothers and/or caregivers, need to be
added to the treatment protocols.

This study also has implications for treatment.

A feature of attachment behaviour of the greatest importance

clinically, and present irrespective of the age of the individual

concerned, is the intensity of the emotion that accompanies it, the

kind of emotion aroused depending on how the relationship

between the individual attached and the attachment ﬁgure is fairing.

177

If it goes well, there is joy and a sense of security. If it is threatened,

there is jealousy, anxiety, and anger. If broken, there is grief and

depression (Bowlby, 1988, p. 4).
Healthy maternal-child relationships demonstrate life-afﬁrming and beneﬁcial
attachment behaviors that can be extrapolated to therapeutic environments
(Cristobal, 2003; Slade, 1999; Weiner, 2003) to help repair what may have been
threatened or broken in the relationship. Clinicians, educators, and students who
have a strong understanding of secure, healthy attachment relationships can use
that knowledge to mediate the symptoms of disrupted attachment (Bowlby,
1977)

The mother participants in this study have much to offer the ﬁeld of
attachment research through the words and narratives of their dynamic and

interactive relationships with their children.

178

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CHAPTER 6

Conclusion

184

Making the decision to have a child is momentous. It is to decide
forever to have your heart go walking around outside your body
(Elizabeth C. Stone, Professor, Department of Anthropology, Stony

Brook University).

Current research indicates that when a mother-infant dyad has the ability
to create joy, elation, interest, and excitement together, they establish early
healthy child development and set the stage for a lifetime of physical and mental
health for the child (Porter, 2003). This research demonstrates a much-needed
movement away from the negative and pejorative nature of earlier attachment
research and emphasizes instead the enjoyment of the mother-infantlchild
attachment relationship and all the positive beneﬁts that ensue. It also reﬂects
more clearly the picture Bowlby painted as the author of attachment theory when
he deﬁned attachment as an emotional and affective bond that reﬂects the
enjoyment, the attraction, that one individual has for another speciﬁc individual
(Bowlby, 1958, 1977).

“In the case of human personality the integrating function of the unique
mother-ﬁgure is one the importance of which I believe can hardly be
exaggerated; in this I am at one with Wrnnicott” (Bowlby, 1958, p. 369). Winnicott
(2002), a pediatrician and child psychoanalyst for 40 years speaks gently,
thoughtfully, and positively about mothers, children, and families and never labels
or uses pejorative or derogatory language. During radio talks to British parents of

infants his words were typically uplifting and beautiful. “You just adapt the

185

pressure of your arms to the babies’ needs, and you move slightly, and you
perhaps make sounds. The baby feels you breathing. There is warmth that
comes from your breath and your skin, and the baby ﬁnds your holding to be
good” (p. 21). This is a powerful reﬂection of the lived experience of a mother and
her infant. From another broadcast, he adds,

Whoever is caring for a child must know that child and must work

on the basis of a personal living relationship with that child, not on

the basis of something learnt and applied mechanically. Being

reliably present and consistent to ourselves we provide the stability

which is not rigid but which is alive and human, and this makes the

infant feel secure (Winnicott, 1993, p. 89).

This dissertation as a whole was meant to reﬂect Bowlby’s (1958) and
Winnicott’s (1993, 2002) formulations of the maternal-child attachment
relationship and the inherent enjoyment and pleasure reﬂected in those
relationships. The literature review, the case study, and the two qualitative
research studies illuminate the early roots of attachment theory.

Attachment theory evolved out of the early to mid-twentieth century
Western, white culture that esteemed stay-at-home mothers as primary
caregivers and leveled the responsibility for infant attachment, development, and
health at mothers. Women continued to be deﬁned as the angel in the house, a
Victorian era construction that emerged and solidiﬁed from Coventry Patmore’s

(1854) popular poem, The Angel in the House, of the ideal wife and woman.

186

Women were expected to live in a separate sphere from men and the outside
world.

This binary spilled over into attachment research. Mothers and infants
were observed in homes and laboratories, their behaviors scrutinized and
categorized, but personal stories and narratives never gleaned. Therefore, this
dissertation focused on women as mothers in the attachment relationship from
the perspectives of phenomenology and feminist theory. The case study was
added because it told the story of two women from a phenomenological
perspective, the young mother and the therapist. Field research was selected for
the observational study as a reﬂection of Ainsworth’s (1967) early attachment
work in Uganda. And the in-depth, semi-structured interviews were designed and
analyzed using both interpretive phenomenological analysis (Reid, Flowers, 8
Larkin, 2005; Smith, 1996; Smith 8 Osborn, 2003) and feminist theory (DeVault,

1999; Waller, 2005).

Mother-Child Attachment Relationships Across Papers
The case study and the two qualitative studies demonstrate the powerful
connection between mothers and their children. Bowlby (1958) suggested that, “It
is fortunate for their survival that babies are so designed by nature that they
beguile and enslave mothers” (p. 368). Unfortunately, as can be seen in the case
study, life events, whether perceived as positive or negative, have the power to
disturb the maternal-child bond. In this case, suffering and loss hampered the

development of the young mother’s attachment to her child. Indeed, the baby

187

was so attuned to his mother that he played dead for her in representation of the
father/husband.

In contrast, the visual depiction of mother-toddler attachment in the
observational study revealed not only positive and healthy attachment indicators
but also optimal settings for that attached connection to foster personal growth of
the toddlers. The ﬁeld study provided an opportunity to observe mothers and
their children from an objective perspective. And the purposive sampling of
positively engaged dyads offered an opportunity to investigate aspects of
emotionally healthy mother-child behaviors for optimal transfer to treatment
settings in cases of attachment reparation.

Mother-child attachment relationships were the focus of the second
qualitative study but sought from the perspective of the mother’s voice. In the
phenomenological study, mothers described their lived experience as
participants in an attachment relationship with their children. These narratives
were full of attachment language and emotion that reﬂected positive, healthy
indicators of attachment between mothers and their children. These rich data
highlight once again early attachment research that focused on those behaviors
that drew mother to child and child to mother in a relational dance that was
biologically necessitated but ensured through pleasure and joy. This has deep
and speciﬁc meaning in the treatment of attachment disruption in therapeutic

venues.

188

Papers Connected to the Literature Review

Brieﬂy put, attachment behaviour is conceived as any form of

behaviour that results in a person attaining or retaining proximity to

some other differentiated and preferred individual, who is usually

conceived as stronger and/or wise. While especially evident during

early childhood, attachment behaviour is held to characterize

human beings from the cradle to the grave (Bowlby, 1977, p. 203).

The case study (Chapter 3: F itton, 2008b) is a good example of
attachment across the life span. The case is founded in attachment principles
and relationships. The young mother struggled to create an attachment bond with
her child. The therapy was directed most pointedly to this issue, utilizing the
interactive guidance technique (McDonough, 1992) to boost the mother’s insight
regarding the faulty attachment with her child, and to promote sensitivity toward
her child and his needs. The young mother’s own faulty childhood attachment
was an understood element of the treatment, especially as it related to her
inability to bond with her child. The sudden and permanent loss of the attachment
relationship she had with her husband caused tremendous grief and mourning
(Barnett 8 Vondra, 1999) which also negatively affected the bond between
mother and child. The therapist also wrestled with attachment during the course
of treatment. The collaborative attachment and therapeutic relationship between
client and therapist was tenuous but served as the foundation for client change in

the process of treatment.

189

The ﬁeld study (Chapter 4: Fitton, 2008a) was conducted to observe
indicators of healthy and pleasurable mother-toddler attachment. Six attachment
indicators were conﬁrmed from the analysis: reciprocity and mutuality, proximity,
verbal communication, affect and emotion, physical affection, and play. These
were also observed to exist in the context of a secure relationship with a secure
base for child exploration and maternal adaptation of the external environment.
The six attachment indicators with the secure base functions and environmental
adaptedness demonstrate key principles of attachment theory (Bowlby, 1958,
1973, 1977, 19823, 1982b, 1988). The study features align closely to the
attachment constructs outlined in the literature review: physical security including
the secure base; behavioral, psychic, affective, and kinesthetic/tactile
components; and all within the holding environment of the mother-infantlchild
attachment relationship (F itton, 2008a).

The phenomenological interviews (Chapter 5) were designed to elicit
narratives from mothers concerning their attachment relationships with their
infants and children. This was intended to return attachment research to the
basic principles of attachment theory through the lens of postmodern, qualitative
and feminist methodologies and speciﬁcally interpretive phenomenology (Reid,
Flowers, 8 Larkin, 2005; Smith, 1996; Smith 8 Osborn, 2003). These
methodologies emphasize the personal meaning individuals attribute to their
lived experience. The words and stories represented in Chapter 5 help to
illustrate the breadth and depth of attachment theory. These data reﬂect not only

the principles of attachment theory as ﬁrst outlined by Bowlby (1958) but the

190

growth of attachment theory and its constructs as it has been expanded over the
past 50 years.

Mothers spoke poignantly of the attachment relationship with their
children. They expounded the basics of attachment theory as they related stories
of interactions with their children. These women were so engaged in the process
of storytelling that voice inﬂection, emotional reaction, and body language
heightened the narrative. They spoke their stories with words, gestures, tears,

and feelings, and offered their stories with wide-open abandon and vulnerability.

Implications for Practice and Education

Attachment behavior indicators in conjunction with Winnicott’s (1971)
construction of the holding environment and transitional space relate directly to
adult treatment and speciﬁcally to the therapist-client alliance and attachment
relationship (Diamond, Clarkin, Stovall-McClough, Levy, Foelsch, Levine, 8
Yeomans, 2003). The six indicators of a secure attachment relationship must
occur in the holding environment of the mother-infant/child attachment
relationship that also includes secure base functions and use of environmental
space (Fitton, 2008a).

Reciprocity presumes two participants where one initiates and the other
receives. This relates directly to collaboration and participation in treatment.
Mutuality manifests in the shared experience or expression of the relationship. In
this case, both the client and the clinician invest in the experience of the

therapeutic relationship and alliance creating pleasure and enjoyment in the act

19]

of being together in a shared space and connection. A word of caution: the
therapeutic holding environment must have physical and psychic boundaries in
order to create a place for the client to explore, experience, and express in
safety.

A dynamic tension exists in all relationships between connectedness and
distance in the process of forging interdependence and maintaining
independence. Proximity in the therapeutic relationship means that the clinician
is responsible for creating optimal closeness without triggering symbiosis or
dependence in the client. The therapist helps prescribe the space and distance
through boundary deﬁnition until the client is able to self-regulate optimal
distance and connection in healthy mutual relationships.

Verbal communication can be minimal in an attachment relationship where
mutual understanding creates a process whereby each individual feels known,
heard, and understood by the other. Words in verbal exchange between mothers
and their children are typically used for protection, education, and spontaneous
outbursts of joy. In treatment, similar exchanges exist. It is the responsibility of
the therapist to create safety and protection, to provide psychoeducation, and to
teach and participate in a genuine and spontaneous relationship with the client. It
is important to understand that communication is key, not speciﬁc words or
conversations.

Attachment disruption often manifests in restricted or incongruent affect
for clients. Therefore treatment in these cases focuses on helping the client

create and maintain congruency, increase the ability to experience and label a

192

full range of emotions, and moderate negative affect that can lead to self-hami
and/or damaged interpersonal relationships. The therapist teaches these
constructs to the client through psychoeducation, modeling, role-play, and
supportive relationship building.

Touch is paramount in attachment relationships. Physical affection is the
demonstrable outcome of relationship and must exist to balance other features.
Physical touch is both tactilely and psychically necessary for all individuals
across the entire life span. And physical affection is typically the single greatest
loss and the most profound missing element in attachment disorder. Clinicians
must understand the need for and use of touch in attachment treatment and
judiciously introduce physical touch for clients to learn to appreciate their own
tactile needs within prescribed boundary limitations. Touch is a critical element of
attachment reparation; yet, touch is taboo in current therapeutic environments.

Play is a behavioral feature of attachment relationships. This construct
represents the freedom and spontaneous exploration that are hallmarks of
secure attachment for children. Attachment disruption leads to restriction,
flatness, and the vegetative symptoms of depression. Traditional talk therapy
often ignores the element of play.

Psychotherapy takes place in the overlap of two areas of playing,

that of the patient and that of the therapist. Psychotherapy has to

do with two people playing together. The corollary of this is that

where playing is not possible then the work done by the therapist is

directed towards bringing the patient from a state of not being able

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to play into a state of being able to play (Winnicott, 1968).

Therefore, physical activity and playfulness must be encouraged as treatment
goals.

Children depend on the secure base function of the maternal attachment
relationship to explore their world and individuate as persons. The purpose of the
enclosed space created by the caregivers in the observational study was to
protect the child, not the relationship. In attachment work, the therapist must
create a safe holding environment (Winnicott, 1971) and secure base (Bowlby,
1988) for the client that prevents harm or loss because an attachment
relationship does not yet exist either in the client’s past or within the present
therapeutic environment. The secure holding environment is characterized by
continuous, steady and secure holding to maximize safety, trust, familiarity, and
consistency that eventually helps the client forge new patterns of behavior and
create positive and healthy adult attachment relationships.

It is also important to educate future clinical social workers in the
foundations of human experience. That includes attachment theory because, as
Bowlby (1977) states, “[A]ttachment theory is a way of. .. explaining the many
forms of emotional distress and personality disturbance, including anxiety, anger,
depression and emotional detachment, to which unwilling separation and loss
give rise” (p. 201). These are fundamental treatment issues in clinical social work
practice for which students must be prepared.

Attachment theory also complements developmental theories, theories of

personality development, and family systems theory typically taught in the human

194

behavior in the social environment curricula. The durable “internal working
models” of relationships (Bowlby, 1982a) develop through the experience of the
mother-infantlchild attachment relationship, affecting the child’s security, trust,
and functioning in all other relationships throughout life. This has life-long
implications for the individual. It has life span implications for the social worker.
The six indicators of positive, healthy attachment relationships provide categories
for social work educators to consider in clinical education and training and for
clinicians to consider in treatment settings.

Attachment indicators, secure base functions, and use of environmental
space have implications in clinical practice, not only with children, but also with
adults who have not had healthy, positive attachment relationships early in their
lives. And since early attachment relationships set the stage for all future
relationships, the implications of attachment research across the life span and
across social systems are remarkable. These are foundational elements of social
work education, the life span and transitions of individuals and families in the

social environment.

Strengths and Weaknesses of the Research Designs
The papers presented in this dissertation are exploratory in nature. The
single case study highlights the difﬁculties attachment disruption creates in the
formation a of maternal-child bond. The case also illustrates how a faulty
childhood attachment relationship impacts the self through the life span. And,

while this is illustrative of damaged attachment and the difﬁcult work that goes

195

into reparation, the case study does not lead to new information on attachment
theory or therapy. The case exempliﬁes how attachment research was drawn into
classifying insecure attachment styles. Researchers, educators, clinicians, and
mothers know what secure attachment looks like, and understand the behavioral
dimensions of faulty or broken attachment. What is not so clearly understood, is
how to utilize the knowledge of secure attachment to remediate disrupted
attachment, but the case study sheds no particular light on that subject. The case
study does, however, indicate the necessity for attachment reparation protocols.
Attachment indicators emerged from the observational study and, unlike
the case study, offer attachment features to consider in attachment reparation
therapy. The study returns to, and reinforces, early attachment theory research
and what it was designed to accomplish, but also, in the present environment of
evidence based treatment, lacks the experimental rigor suggested in such a
stance. This may call into question the efﬁcacy of evidence based treatment in all
circumstances or at least what evidence means for treatment purposes. The
indicators from the ﬁeld study (F itton, 2008a) align closely to attachment theory
and research. From a strengths perspective, it makes sense to seriously consider
attachment indicators from healthy attachment for attachment reparation therapy.
The phenomenological interviews serve as a foil to the quantitative
research methods historically used in attachment research and stands on its own
merits. Phenomenology, from a feminist perspective, is the key to weakness in
quantitative methods. Its very strength is giving voice to the lived experience of

those subjects whose behavior was so exquisitely detailed through quantitative

196

methodology. Qualitative methods breathe life into those dry and brittle data. And
feminist methods speciﬁcally highlight the thoughts and experiences of women
who have been so neglected in male dominated research. Feminist methodology
also highlights “women’s experience in terms of their own imagery of
relationships... and also provides a nonhierarchical vision of human connection”
(Gilligan, 1993, p. 62).

One of the strengths of these two studies is the fresh view of attachment
behavior and relationship from a positive, healthy, and life-afﬁrming perspective.
Other strengths are the stories and the vivid descriptions of what it feels like from
mothers’ perspectives to be attached to their children and to live day by day in
those attachment relationships. Weaknesses in the study designs include:
cultural homogeneity, small sample sizes, and restricted caregiver sampling. The
ﬁeld study might have been enhanced by adding photographs to the design for a
pictorial view of the caregiver-toddler interactions that could further validate the
attachment indicators that emerged from the study. And ﬁnally, videotaping the
interviews with mothers would have added non-verbal body language and an
extra level of narrative communication as women told the story of their lives with
their children. A poignant element of each interview was missed through the one-

dimensional audiotape.

197

 

Further Areas of Study

Attachment theory has a strong empirically based research history but
experiments continue in the laboratory with predominantly white middle and
upper-income women and children (Barnett 8 Vondra, 1999; Lay, Waters,
Posada, 8 Ridgeway (1995). As policy decisions are affected by attachment
research and programs developed to prevent attachment disruption, especially
for young children, demographics are changing to at-risk categories that
stereotypically focus on women of color from low socioeconomic status (Cassidy,
Woodhouse, Cooper, Hoffman, Powell, 8 Rodenberg, 2005; Cooper, Hoffman,
Powell, 8 Marvin, 2005; Olds, 2005). Attachment research clearly needs to be
expanded to include qualitative methods to enrich data gathering techniques, and
to include diversity by adding gender, sexual orientation, race, culture,
socioeconomic, and age factors to study designs (Corey, 2005; Corey, Corey, 8
Callanan, 2007; Laird, 1998).

Researchers and clinicians must look carefully at how mothers and
children can repair the disruptions that occur in their relationship and particularly
how disruption and reparation can enrich rather than disturb a mother-infant or
mother-toddler way of being together (Bergman 8 Harpaz-Rotem, 2004).
Research is needed to help understand how individual temperament or the
personalities of the mother and infant inﬂuence what is observed in attachment
studies (Cassidy, et al., 2005). Research is needed to understand ethnic and
cultural characteristics of families in attachment relationships. Research is

needed that enlightens therapeutic intervention across the life span to help

198

assess, and then repair, attachment trauma and increase the social functioning
of hurting individuals regardless of age or life circumstances. And longitudinal
studies are needed to gain an understanding of how positive and healthy
attachment relationships affect the biopsychosocial development of children over
time and across settings and environments.

The interviews (Chapter 5) generated enough data to write a second
paper on women’s perceived roles as mothers. While these data focus on the
role of mother and represents a shift away from childhood attachment per se, the
material is still steeped in relationship and those relationship factors continue to
shed light on attachment across the life span. For example, women spoke of the
physical and emotional support they received from their adult relationships in
meeting the demands of being a woman with an added role of mother: their own
mother/parents, signiﬁcant other, sisters, women friends, and work associates.
Attachment research and intervention protocols indicate that enhancing early
attachment has positive life long implications for children and adults (Nagle 8
Wightkin, 2005; O’Connor 8 Nilsen, 2005) and sets the stage for all future
relationships (Bowlby, 1977; Hesse, 1999; Main 8 Goldwyn, 1998; Main, Kaplan,
8 Cassidy, 1985; Freud, 1935, 1966), therefore, it is important to understand the
connection between positive and healthy childhood attachment and subsequent

relationships across the life span.

199

Conclusion

Attachment theory has stood the test of time. Fifty years after Bowlby,
attachment across constructs (e.g., secure base functions; affective, behavioral,
psychic, and kinesthetic/tactile components; and attachment styles) and the life
span continues to be the focus of research and operates to inform clinical
education, practice, and policy decision-making and program development.
Social work is in a unique position to strengthen the effects of attachment theory
on research, policy, education, and practice by adding two of its basic principles,
empowerment and the strengths perspective (NASW, 1999), to attachment
theory research. This dissertation was an attempt in that direction. The clinical
case was formulated from a strengths perspective, designed to empower a
young mother to work toward healthy self-identity in order to offer a secure base
to her child and create a healthy attachment bond. Both qualitative studies
focused on positive, healthy attachment indicators and relationships. And the
interviews were designed to give voice to and empower women as mothers.

This dissertation represents a move away from negative and pejorative
attachment classiﬁcation systems. It reﬂects instead positive and healthy
attachment relationships and those indicators that may be used to help form
early attachment bonds between mothers and infants or used to help repair
disrupted attachment across the life span. This hopefully, echoes the attachment
theory legacy of Bowlby, the optimistic object relations perspective of Winnicott,
and the empowerment and strengths perspective inherent in today’s social work

environment. In sum, current research indicates that when a mother-infant dyad

200

has the ability to create joy, elation, interest, and excitement together, they
establish early healthy child development and set the stage for a lifetime of
physical and mental health for the child (Porter, 2003). Thus, it is imperative to
focus attachment research on those life-afﬁrming elements and maximize
developmental health of all children and their subsequent life relationships. The

work in this dissertation offers testimony for this approach.

201

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