If you’re a therapist, are you attachment-informed? Therapists need to know about the attachment research of Mary Main and her colleagues at UC-Berkley. If you’re a client, are you attachment informed? Given that effective psychotherapy is all about “the relationship,” both therapists and clients need to be attachment-informed. So here are some attachment basics.
Mary Main was a student of attachment researcher Mary Ainsworth. Mary Main’s attachment research in the mid 90’s showed that 80 – 90% of those who seek counseling have Disorganized Attachment (DA). Unfortunately, Main’s research isn’t “Main Stream.” Very few therapists, even the most experienced, know about her work OR the implications it has for conducting effective, non-harming psychotherapy.
Most mental health practitioners are not aware of their clients’ attachment style or the amazing statistics about DA. Even more importantly, therapists are not aware of their own attachment template. Based on my own clinical and professional observations, I believe there is a high probability that most therapists also have Disorganized Attachment. Much psychotherapy, therefore, could involve “the blind leading the blind,” and conditions in which professionals can violate their Code of Ethics to “do no harm.”
The Dynamics of Disorganized Attachment
Individuals with DA often have a history of relational or developmental trauma during the first year of life that involve experiences of physical and/or emotional abuse, and rejection. When near an attachment figure, they experience two conflicting signals from their brains that cause them to fragment psychologically and dissociate.
The first brain signal comes from fear-based relational experiences infants have with their mothers or primary attachment figures during their first year of life. They instinctively react with fear when their mothers dissociate or show facial expressions or behaviors that make them appear scary or dangerous. Infant’s brain stems automatically activate protective reactions that help them quickly retreat from their “scary mother.”
The second brain signal comes from the mammalian part of infants’ brains that wires them to attach to an adult figure for protection and safety. This mammalian wiring to attach is ancient and fires unconsciously. When children fear their attachment figure, they face an irresolvable paradox: the mother becomes both the source of protection and the source of alarm
These two conflicting messages short-circuit the child’s brain and nervous system. This short-circuit is visible in children’s eyes as a “freeze” or shock reaction. The child’s body stops moving, and they loose their ability to communicate. The Andrenal Stress Response causes the blood to be pulled from their extremities and into their core. Their skin color turns white, and their eyes bulge and stop blinking. When the signals from the brain to both flee and to attach are intense, the freeze reaction actually sends infants out of their bodies into dissociation.
Characteristics of Disorganized Attachment
Main’s Strange Situation Protocol (SSP) research instrument was designed to test the quality of the parent-child relationship. Main saw children in research settings who had DA who displayed bizarre and unpredictable kinds of behavior when they were reunited with their mothers. Main was unable to explain their puzzling behavior until she developed the Adult Attachment Inventory (AAI), an instrument for identifying the attachment style of mothers. This instrument showed that children with DA had mothers with DA. Main’s subsequent research with mothers and infants indicated a high correlation between mothers with DA and children with DA, and with its intergenerational transmission.
Main’s SSP research on Disorganized Attachment identified the following typical behaviors in infants.*
- Sequential display of contradictory behavior patterns, such as strong attachment behavior suddenly followed by avoidance, freezing, or dazed behaviors.
- Simultaneous display of contradictory behaviors, such as strong avoidance with strong contact-seeking, distress, or anger.
- Undirected, misdirected, incomplete, and interrupted movements and expressions; for example, extensive expressions of distress accompanied by movement away from rather than toward the mother.
- Stereotypic, asymmetric movements, mistimed movements, and anomalous postures such as stumbling for no apparent reason and only when the parent is present.
- Freezing, stilling, and slowed “underwater” movements and expressions
- Direct indices of apprehension regarding the parent, such as hunched shoulders and fearful facial expressions.
- Direct indices of disorganization and disorientation, such as disoriented wandering, confused or dazed expressions, or multiple, rapid changes in affect.
The Long-Term Implications of Attachment
Main and her research colleagues were able to identify children’s attachment strategy by the age of 12 months. They also saw that infants’ attachments fell into three categories: 1) secure (55%), 2) insecure (31%) or 3) disorganized (15%). More contemporary attachment researchers who have been working with Main’s two research tools, The Strange Situation Procedure and the Adult Attachment Inventory, believe that these percentages have changed, that the Secure Attachment percentage has dropped, and that the DA percentage has risen.
Main’s research validated children’s 12-month attachment strategy again at six years and 19 years. She found that their baby attachment strategy stays constant and carries into adulthood unless there is some major relational event or psychotherapy intervention that modifies it.
One of Main’s most interesting findings is that by age six, children with DA have developed one of three common behavior patterns. All patterns involve “parentizing,” in which the child gives up his or her needs and focuses on giving either physical or emotional support to the mother or primary attachment figure. The purpose of this “reversal process” is to make the mother more organized so that she becomes more capable of caring for the child.
I have given names to the three common behavior patterns that Main identified in six-year olds who have DA: 1) the Lost Child, 2) the Little General and 2) the Solicitous Caregiver. I use these names (they aren’t Main’s) because they capture the heart of children’s valiant effort to provide support for their mothers so that they can take care of them.
The Lost Child‘s behavior is primarily dissociative. This child lack the internal resources to do much for the mother other than to stay close. The appear disconnected, act dreamy and seem compliant. Mostly, they are not in their bodies and float about, following both the emotional and social flows in the environment around them.
The Little General is directive, telling the mother what to do, when to do it, and how to do it. This child provides physical organization in the environment around the mother, and becomes quite proficient as a manager for the mother’s world. Unfortunately, neither the mother nor the Little General ever focuses on identifying or meeting the child’s needs. So the child may become quite effective and efficient in organizing the lives of others, but have virtually no skills or understanding about how to organize their own life.
The Solicitous Caregiver provides emotional support for the mother, often being the peacemaker and smoothing out any upsets or conflicts in the environment. These children are often empathic and overly sensitive, and become emotionally hypervigilant to the mother’s needs. They become highly skilled in identifying other people’s emotional needs, but have virtually no skills in understanding their own. These children become the ultimate caretakers and rescuers.
The hallmark trait of individuals with Disorganized Attachment is freeze/dissociation behaviors. They lack the ability to self-regulate and self-soothe, and they aren’t aware of their emotional needs, let alone how to get them met. These individuals lack the skills needed to organize their own lives, so their behavior is often chaotic and unpredictable irregardless of their intelligence.
The Biology of Disorganized Attachment Syle
Infants respond to stress by activating a wide array of behavioral and physiological responses that are commonly known as the Adrenal Stress Response (ASR). An ASR not only activates the adrenal glands, but also the pituitary gland and the hypothalamus glands. Developmental traumas during infancy are also a factor in infants’ efforts to regulate their emotions.
A growing body of attachment research findings suggests that hypothalamic-pituitary-adrenocortical (HPA) axis activity in emotionally neglected infants and young children varies according to their caregiving environment and the quality of their caregiver relationships. Research conducted by Spangler and Schieche on infant adrenocortical function after being separated from a parent indicates that securely attached infants do not show elevations in their cortisol levels. The pattern typically observed is one of decreasing cortisol levels from the beginning to 30 minutes after the end of the procedure.
In contrast, studies showed that children with DA produce larger increases in cortisol in response to separation and reunion than children classified as securely or insecurely attached. Other attachment research by Ashman and colleagues showed that a mother’s depression during the first two years of the child’s life is the best predictor of cortisol elevations at age seven years. Another study of 282 4,5-year-old children by Essex and colleagues showed that maternal depression that began during her child’s infancy was the most potent predictor of their cortisol levels at 4.5 years of age.
Disorganized Attachment is a MindBody Experience
It’s not possible to compartmentalize children’s social/emotional/relational experiences from their biology/physiology/brains. As infants, their minds and bodies operate as one integrated system. As adults, they require support from an integrated care model, where their physical and emotional issues are considered not only equal, but interrelated.
Much of the healthcare industry is moving to an integrated care model, which is great. The single most supportive factor for moving to this integrated care model is recognizing that DA and it’s long-term impact on human development. The research on adverse childhood experiences, particularly those caused by DA, really demands an integrated approach for treating both physical and behavioral health issues.
Childhood abuse and neglect are clearly associated with adult depression, anxiety disorders and chronic fatigue syndrome (CFS), according to Dr. Christine Helm at Emory University. Early and excessive stress on children’s the HPA axis systems and keeps them in a constant state of fight/flight/freeze. This sets the stage for adrenal stress, fatigue and exhaustion later in life.
Healing Disorganized Attachment in Adults
Individuals with DA syle can heal with the right kind of support. Early childhood memory is often disorganized, chaotic, and filled with misperceptions that form deeply held beliefs. The healing involves a step-by-step process that begins with them making sense of their early developmental history.
The next step involves forming their early memories into a coherent narrative. They also find ways to face and feel the full pain of their experiences, allowing them to move beyond their unresolved trauma and loss. Hiding from the past or burying their unexpressed emotions isn’t effective, as old and painful feelings get triggered during moments of stress.
Psychological help for resolving early trauma can take many forms. The most important step is finding a person with whom they can form a healthy relationship that exists over time. This relationship, which can be with a romantic partner, a friend or a therapist, allows a person to develop trust and resolve his or her disorganized attachment issues. A trusted relationship with a person who is fully present can help a person experience presence, which is critical for breaking the cycle of loss often associated with disorganized attachment.
Presence is a state of being that allows a person with the DA style to consolidate fragmented parts of Self into an ever-emerging whole. Presence allows cellular functions, multiple parts of the brain, and the MindBody to integrate. Integration is visible in kindness, compassion, wisdom and connection. It is at the heart of wholeness.
Physical help for resolving early trauma requires support for stressed adrenals, including diet, nutrition, exercise and hormone rebalancing. When one part of the endocrine system, such as the adrenals, becomes stressed, it starts to pull energy from other endocrine organs–the testes/ovaries, thymus, hypothalamus, thyroid and pancreas. The longer the endocrine organs are depleted, the higher the chances of both emotional and physical dis-ease. Only an integrated healthcare model can really help people clear the effects of Disorganized Attachment.
*Adapted from Main M, Solomon J. Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation. In: Greenberg M, Cicchetti D, Cummings EM, editors. Attachment in the preschool years: theory, research and intervention. Chicago: University of Chicago Press; 1990. p. 121–60.