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Family systems theory, attachment theory, and culture.

Family systems theory and attachment theory have important similarities and complementarities. Here we consider two areas in which the theories converge: (a) in family system theorists' description of an overly close, or "enmeshed," mother-child dyad, which attachment theorists conceptualize as the interaction of children's ambivalent attachment and mothers' preoccupied attachment; (b) in family system theorists' description of the "pursuer-distance cycle" of marital conflict, which attachment theorists conceptualize as the interaction of preoccupied and dismissive partners. We briefly review family systems theory evidence, and more extensively review attachment theory evidence, pertaining to these points of convergence. We also review cross-cultural research, which leads us to conclude that the dynamics described in both theories reflect, in part, Western ways of thinking and Western patterns of relatedness. Evidence from Japan suggests that extremely close ties between mother and child are perceived as adaptive, and are more common, and that children experience less adverse effects from such relationships than do children in the West. Moreover, in Japan there is less emphasis on the importance of the exclusive spousal relationship, and less need for the mother and father to find time alone to rekindle romantic, intimate feelings and to resolve conflicts by openly communicating their differences. Thus, the "maladaptive" pattern frequently cited by Western theorists of an extremely close mother-child relationship, an unromantic, conflictual marriage characterized by little verbal communication and a peripheral, distant father, may function very differently in other cultures. While we believe that both theories will be greatly enriched by their integration, we caution against the application of either theory outside the cultures in which they were developed.

Adult↗

[The physician-patient relation in the light of the attachment theory. Attachment counseling].

INTRODUCTION: The doctor-patient relationship has always played a key role in the patient's treatment and recovery process. However, it is still difficult to interpret its dynamic healing aspects. Above all, the mechanisms that enable the patient to improve and to change are not still sufficiently clear. WORKING THEORY: The attachment theory assumes an emotional support of the doctor towards the patient. According to this, the patient completely "invests" the doctor of his emotions as in the ancestral model of family relationship. The possibility of obtaining success seems to be strictly linked to the doctors' capacity of accepting this "mandate" offered by the patient who autonomously takes this decision. CURRENT SITUATION: Physicians deal with the complexity of pathologies every day and this shows an increasing necessity of a "doctor-patient relationship", enabling the physician to identify the patients symptoms in a more extended way which involves pain and suffering as well. As for the pharmacological intervention, the patient's attitude and expectations of recovery have a definite effect on the simple assumption of medicine. CONCLUSION: Today's physicians' scientific education would be extremely insufficient, if it were not encouraged by the awareness that his/her duty goes beyond the simple medical prescription. It has to reach the patient's heart as well as arouse the understanding of events related to him/her. This is not just a cultural factor but also a precise way of interacting with the patient according to one's own Counselling models.

Counseling↗

Comparison of Attachment theory and Cognitive-Motivational Structure theory.

Attachment theory and Cognitive-Motivational Structure (CMS) are similar in most respects. They differ primarily in their proposal of when, during development, one's sense of the self and of the outside world are formed. I propose that the theories supplement each other after about age seven years--when Attachment theory's predictions of social function become unreliable, CMS theory comes into play.

Adult↗

Separation-individuation theory and attachment theory.

Separation-individuation and attachment theories are compared and assessed in the context of psychoanalytic developmental theory and their application to clinical work. As introduced by Margaret Mahler and John Bowlby, respectively, both theories were initially regarded as diverging from traditional views. Separation-individuation theory, though it has had to be corrected in important respects, and attachment theory, despite certain limitations, have nonetheless enriched psychoanalytic thought. Without attachment an infant would die, and with severely insecure attachment is at greater risk for serious disorders. Development depends on continued attachment to a responsive and responsible caregiver. Continued attachment to the primary object was regarded by Mahler as as intrinsic to the process of separation-individuation. Attachment theory does not account for the essential development of separateness, and separation-individuation is important for the promotion of autonomy, independence, and identity. Salient historical and theoretical issues are addressed, including the renewed interest in attachment theory and the related decline of interest in separation-individuation theory.

Adolescent↗

Toward the next quarter-century: conceptual and methodological challenges for attachment theory.

Attachment theory and research have offered fundamental insights into early sociopersonality development for the past quarter-century. As its scope expands throughout the life course with applications to developmental psychopathology, however, attachment work faces important conceptual and methodological challenges. These include (a) expanding Bowlby's theoretical formulations to address developmental changes in the nature of attachment organization beyond infancy, the converging influence of multiple attachment relationships, and the nature and development of internal working models: (b) systematically validating assessments of attachment security for older ages in the context of enhanced theoretical understanding of how attachment itself changes with age; (c) new methodological approaches to understanding the relations between attachment and later behavior in light of empirical evidence of stability and change in attachment security and the need for explicit theoretical predictions of the sequelae of attachment security; and (d) more complex conceptualizations of the associations among attachment, contextual risk, and later behavior. These are similar to the challenges facing the original pioneers of attachment theory and research, suggesting that familiar problems must now be reconsidered against the landscape of new applications of attachment work and the insights of contemporary developmental science.

Child↗

Integrating systems theory and attachment theory: the use of radio communication to modify attachments in a patient with psychogenic vomiting.

A case is presented that shows the usefulness of integrating systems theory and attachment theory in the formulation and treatment of a clinical problem. The 5 year old son of East Indian immigrants presented with persistent psychogenic vomiting associated with pathological family attachments. It was evident that the precarious family equilibrium was stabilized by the child's psychogenic vomiting. The therapeutic team suggested to the family that their problems might be more satisfactorily resolved if the mother and child maintained their link by two-way radio. Three weeks later the vomiting had ceased, the child no longer felt that he needed the radio and both parents had established new patterns of relating to their child, whose attendance and peer socialization at school showed marked improvement. To some extent the rapid resolution of the problems was facilitated by the cultural strengths of the family.

Acculturation↗

Psychiatric staff as attachment figures. Understanding management problems in psychiatric services in the light of attachment theory.

BACKGROUND: Attachment theory argues that psychological development and functioning are affected by our earliest attachments to care-givers. Failed or pathological attachment in childhood may give rise to repetition of maladaptive attachment patterns in adulthood. METHOD: Analysis of therapeutic relationships in the light of attachment theory. RESULTS: Relationships between patients and both psychiatric care-givers and institutions may resemble attachment relationship. CONCLUSION: An attachment perspective may be useful for understanding common behavioural disturbances in general psychiatric settings, and support the use of clinical strategies which focus on containment of arousal and the management of anxiety states.

Caregivers↗

A review of interventions in the parent-child relationship informed by attachment theory.

Bowlby's attachment theory has inspired a dramatic shift in the way we understand the development of the early relationship between infant and caregiver(s). Though almost all infants develop an attachment relationship to their primary caregiver(s), not all of them are able to use their caregiver(s) as a secure base or haven of safety from which to explore the world. Mary Ainsworth was the first to describe in detail the aspects of the caregiving system that are most important for the development of the attachment relationship. During the last decade several studies have started to evaluate the possibility that insensitive and perhaps even inadequate parenting can be effectively ameliorated by interventions. The present article sketches the theory behind attachment-based interventions and reviews the evidence for the effectiveness of such interventions. Finally, the article gives examples of successful preventive as well as therapeutic interventions.

Child, Preschool↗

Healing factors of psychiatry in light of attachment theory.

Bowlby's attachment theory is an evolutionary biological model of human affectional bonding. Secure attachment to a parental figure has survival value and is necessary for normal development of the young. When secure attachment was lacking during formative years, the adult remains anxious about the availability of attachment figures in time of need. Persons seeking psychotherapy usually have such anxious attachment. Frank has pointed out features common to all psychotherapies. These common features describe a relationship which has the characteristics of a secure attachment. Strupp notes that specific technical skills are necessary for the success of psychotherapy. The therapist directs these techniques toward changing the patient's anxious attachment to a secure one. In the context of a secure attachment, the patient is able to change his attitudes, try new behaviors, and find fresh meaning in his world.

Adolescent↗

Continuing bonds in bereavement: an attachment theory based perspective.

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

Adaptation, Psychological↗

Attachment theory.

Maternal-infant attachment theory is another example of a theory borrowed from one discipline and adapted to another. Ethological observations of species-specific behavior exhibited by animals at the time of birth generated the hypothesis that perhaps humans also had species-specific behaviors which could have lasting effects on the relationship between mother and baby. While one cannot generalize the attachment theory, it has opened the way for a more humanistic approach to birthing.

Animals↗

Abuse and violence in intimate adult relationships: new perspectives from attachment theory.

Previous attachment writing about violence between intimate adult partners has implicated the role of insecure attachment. This paper proposes that insecure attachment is not sufficient to explain intimate partner violence. Instead, it is suggested that recent evidence leads to the conclusion that such violent behavior is best explained in terms of attachment disorganization, a more profound form of relational insecurity. We discuss the contributions of this perspective to intervention.

Adult↗

Charisma and attachment theory: a crossdisciplinary interpretation.

The attachment theory of Bowlby and his followers has not previously been applied to the interpretation of charismatic phenomena in the bonding of large numbers of people with their leaders in crisis. This essay, which builds on the author's 'Surviving trauma: loss, literature and psychoanalysis', attempts to use attachment theory and sociological concepts such as homogamy, anomie, negative imprinting and de-individuation, as well as classical Freudian concepts such as transference and splitting of the ego, in interpreting the charismatic bond. It is argued that charismatic homogamy becomes viable at the point of intersection between the inner world of the charismatic leader and social and political reality. The bonding of the individual and the public may be based partly upon a symbolic link between public crisis and the charismatic's experience of trauma that has deeply scarred or even ended the affectional bonds in his family of orientation. This trauma, however, is a source of insight and power as well as of disability, for it has schooled him in crisis and given him the capacity to offer directional leadership. The charismatic and his society are bonded in crisis through a mutual attempt to break free of anomie and alienation, and a sense of powerlessness and despair.

Defense Mechanisms↗

Attachment theory and group processes: the association between attachment style and group-related representations, goals, memories, and functioning.

Four studies examined attachment-style differences in group-related cognitions and behaviors. In Studies 1-2, participants completed scales on group-related cognitions and emotions. In Studies 3-4, participants were divided into small groups, and their performance in group tasks as well as the cohesion of their group were assessed. Both attachment anxiety and avoidance in close relationships were associated with negative group-related cognitions and emotions. Anxiety was also related to the pursuit of closeness goals and impaired instrumental performance in group tasks. Avoidance was related to the pursuit of distance goals and deficits in socioemotional and instrumental performance. Group cohesion significantly moderated the effects of attachment anxiety. The discussion emphasizes the relevance of attachment theory within group contexts.

Adult↗

Parents and children: facts and fallacies about attachment theory.

John Bowlby's attachment theory has had a profound effect on the way we think about parent-child relationships and the way young babies are cared for. Bowlby observed that children appear to do better if they grow up with a sense that someone cares about them and that someone will be there to help them when they are anxious or distressed. He explained why attachment relationships are so important for social and emotional wellbeing, and argued that good maternal care was essential for psychological health. Bowlby's ideas have been gaining strong support again recently, although it is important to distinguish between what he actually wrote and the many myths and misunderstandings about his work.

Child↗

Parents' perspectives of asthma crisis hospital management in infants and toddlers: an interpretive view through the lens of attachment theory.

Interpretive phenomenology and attachment theory were used to discover the underlying concerns of parents and children during children's hospitalization for asthma. Home interviews were conducted with families of low income and with Latino and African-American infants and toddlers with severe persistent asthma. Narratives revealed that asthma crises were fearsome situations for parents and children. Hospital procedures escalated fear in children. Parents, agonized by their children's suffering, were embarrassed by feelings of helplessness. Results imply that effective, efficient care depends on addressing parents' fears, being aware of their sensitivity to the suffering of their children, and supporting their desire to alleviate it.

Adult↗

Attachment theory and research: application to clinical practice.

Although Bowlby's attachment theory has had a profound effect on research in developmental psychology, its application to clinical practice has barely been explored. The theory and its origins are outlined, and attachment-theory concepts that may have clinical applicability are explored, with particular attention to the construct of internal working models. In addition, psychotherapeutic approaches using attachment-theory concepts are summarized.

Adolescent↗