Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Saturday, August 4, 2012

That Old Basic Trust Concept: Peddling the "Attachment Cycle"

NOTE: A more formal and complete version of this post appears at http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier.html.



Over the decade or so that I’ve been looking at Attachment Therapy and other unconventional treatments, I’ve puzzled many times over the idea of a “first-year attachment cycle” that culminates in something called basic trust , followed by a second-year cycle that sets limits for toddlers. The two of these are said to add up to secure attachment. But although conventional developmental psychology certainly uses the concept of attachment and different security statuses, the other ideas are not part of conventional, evidence-based child development studies.

The Attachment Therapist Foster Cline described an “attachment cycle” in some of his work in the 1990s. He apparently picked up the idea from Vera Fahlberg, who was a visitor in Evergreen, CO (home of Attachment Therapy as a cottage industry), and Fahlberg in turn attributed a diagram of the “attachment cycle” to Rene’ Spitz, a psychiatrist who studied young children separated from their mothers and who spoke of anaclitic depression as a result of such separation. According to Fahlberg, the “attachment cycle” involved a child’s repeated experiences of need for food or other care, followed by a parental response. Parents who responded quickly and sensitively fostered the development of secure attachment, while neglectful or abusive parents did not. Somewhere along the line--  and I have yet to figure out where--  someone inserted the idea that secure attachment depended on limit-setting that convinces the toddler that parents are powerful and authoritative, and therefore trustworthy.

This set of beliefs is promulgated in the writings of Foster Cline, Nancy Thomas, and other related authors, and is repeated in popular books about adoption and fostering and on Internet sites advising on those subjects .

Where did these ideas come from? Once again, the “attachment cycle” theory, as described by Cline and others, is not derived from any aspect of conventional developmental psychology. Like many “alternative psychologies”, it shares some terminology and some ideas with conventional work, of course. The ideas that infants and toddlers develop emotional attachment to caregivers and that their attachment serves as the foundation for later social relationships is part of the work of John Bowlby, a British psychiatrist whose approach is a foundation of present-day developmental psychology. The idea that attachment can be secure or otherwise was suggested by Bowlby’s colleague Mary Salter Ainsworth, who in her turn had derived it from the security-focused work of her dissertation adviser. Bowlby associated attachment with the social aspects of caregiving, rather than with feeding and physical care--   and in this he disagreed with Freud’s earlier “cupboard love” theory of attachment as resulting from feeding experiences. However, except in very unusual cases, social aspects of caregiving are combined with physical aspects, and the person who feeds, cleans, and comforts a baby is usually also the one who smiles, tickles, plays peek-a-boo, and so on, so it’s difficult to separate these two factors and see how each influences attachment.

It looks as if proponents of the “attachment cycle” also picked up some ideas from Erik Erikson, a student of Freud, and tutor at one time to Jung’s children. In Erikson’s book Childhood and society he offered a re-framing of Freud’s psychosexual stages of development as  psychosocial stages aligned with the demands maturation and society make on an individual at different ages. In Childhood and society, and later in Identity, youth, and crisis, Erikson offered the idea of a life cycle (not an “attachment cycle”) in which life presents repeated crises (points at which old ways of doing things no longer work) to the developing person, forcing changes in personality and functioning. As discussed in Identity, youth, and crisis, these crises separate stages of personality development that are characterized by specific concerns such as the development of a sense of trust. Earlier stages foreshadow later ones, as Erikson described in a famous table in Identity, youth, and crisis which indicates relationships between infant and adolescent issues as well as the foreshadowing of concerns of later life by adolescent development.

Erikson’s view of basic trust identified trust as a foundation for a healthy personality able to deal with both gratifying and distressing aspects of the world. However, he did not equate basic trust with attachment. On the contrary, he noted the need for an appropriate balance of basic trust and basic mistrust in the world. In addition, he stated the following about adults who show basic mistrust: “a radical impairment of basic trust is expressed in a particular form of severe estrangement which characterizes individuals who withdraw into themselves when at odds with themselves and with others. Such withdrawal is most strikingly displayed by individuals who regress into psychotic states in which they sometimes close up, refusing food and comfort and becoming oblivious to companionship. What is most radically missing from them can be seen from the fact that as we attempt to assist them with psychotherapy, we must try to ‘reach’ them with the specific intent of convincing them that they can trust us to trust them and that they can trust themselves” (Identity…, p. 97). Although Erikson identifies “total rage” as an infant response to frustration and an aspect of mistrust, he does not include rage, interpersonal aggression, or violence as part of adult mistrust--  unlike authors who cite the “attachment cycle” and attribute adult criminality to attachment problems.

What about that “second-year attachment cycle”? Authors who use this concept have claimed that secure attachment is not simply a matter of early experience with sensitive, socially- responsive care, but that secure attachment can result only from setting of limits and the clear identification of caregivers as powerful and authoritative figures on whom the child must depend entirely (and whom, by extension, he had better not offend).  If secure attachment is present and measurable at age 12 months, as Ainsworth and others have reported, it is difficult to see how events in the second year come into the picture. It may be that authors referring to the “second-year attachment cycle” found themselves searching for a rationale for their claim that child obedience was indicative of secure attachment, when in fact the emphasis on obedience emerged from other values (for example, those of American fundamentalist Protestantism, with their sources in early Calvinism).

How does Erikson’s work jibe with the “second-year attachment cycle”? Erikson was of course aware that the toddler period is one in which parents all over the world seek to curb young children’s impulsiveness, keep them and others safe, and begin the task of socializing them into acceptable members of family and society. These parental efforts can and do trigger the resistance so characteristic of this age group. However, Erikson’s concerns were not about periods of resistance, but instead about the potential outcome of toddler experiences, which he saw as a “choice” (to over-simplify) between a sense of autonomy and a sense of shame and doubt about the self.  Erikson, whose personal and political experiences led him to favor individualism, saw a confident autonomy as advantageous to the individual, and a sense of a self threatened by shame and disapproval as disadvantageous to mature personality development. Although both autonomy and shame would be played out in a social context, especially within the family, Erikson did not focus on a need to emphasize parental power or authority during the toddler period, except in the sense that consistency and sensitivity to the child’s needs were critical. (Bowlby, similarly, considered this period as one of negotiation between parent and child rather than of parental power assertion.)

Basic trust, although an important part of Erikson’s theory and a good answer to a lot of exam questions, is by no means the same thing as attachment. Autonomy is by no means equivalent to any posited “second-year attachment cycle”. If you see these assumptions made in any material about attachment, adoption, or child psychotherapy, you may have wandered into an alternative psychology universe. Be sure to read and make choices with care.


4 comments:

  1. Vera Fahlberg was more than a visitor to Evergreen, Colorado. She married Russ Colburn, the medical director of Forest Heights Lodge. She held this same position at Forest Heights for 13 years and served as a consultant for this Attachment Therapy center thereafter.
    http://www.forestheightslodge.org/our-history.html

    Forest Heights Lodge is an expensive residential treatment center for boys that specializes in "attachment disorder."

    It appears that early on, Forest Heights was involved with Zaslow and "rage reduction therapy." Various infamous Attachment Therapists have worked and/or trained at Forest Heights over the years.

    A few years ago, Forest Heights refused my requests for details about their current treatment approach and would not let me see their recommended reading list for parents and staff.

    ReplyDelete
  2. Thanks-- I never realized she was there for such a long time.

    ReplyDelete
  3. I REALLY like these blogs! They are very thought provoking. We were looking at getting an attachment therapist, because someone e respect uses one. We have changed our minds and going to look for one that does the child - parent interactive therapy (or something like that). We had no idea what it as about... Until we read some of your blogs. Thank you for taking the time educate foster & adoptive parents.

    One more thing. I think there are more unethical therapists out there - rioting reports to fit their "client's" desired outcome than people

    ReplyDelete
  4. Whoa! Did I change someone's mind?! That's amazing. This carrot will keep the little donkey trotting along!

    ReplyDelete