Attachment and youth at risk
Mark Tomlinson was a child care worker at Oranjia Children’s Home in Cape Town. He completed his Diploma in Child Care Administration through the NACCW in 1993. When he completed his Masters degree in Clinical Psychology, he was director of the Thula Sana mother-infant project in Khayelitsha (Cape Town) and he completed doctoral studies based on a study of mother infant attachment and the long term outcome of postnatal depression. Today he is a Professor at the University of Stellenbosch and has just been awarded a Five Million Rand grant toward further studies in this area. This interview was conducted in about 1985.
What are you learning about attachment, and what is its connection with child and youth care work today?
Mark: First of all, there have of course been many longitudinal studies which link early infancy experiences to what happens later in childhood and adolescence and into adulthood. Retrospective studies of young people in care often point to issues around the way in which they managed attachment. To gauge how well very young children manage attachment many still make use of Ainsworth’s “Strange Situation” which is a frequently used experimental method used to assess the attachment between an infant and its caregiver. Many studies have found the procedure to be valid and reliable, although some recent studies have found low stability between the test when used at 12 months and then repeated at 18 months. This has important implications in terms of whether the procedure is actually measuring attachment behaviour (the concept of attachment between infants and caregivers is not questioned, merely the method by which we measure this).
The Strange Situation involves exposure of the infant sequence of episodes. The room is one which the infant and its caregiver has not seen before and episodes would include a stranger entering the room, the mother leaving, the infant being left alone, mother returning, etc. What is coded is the reunion behaviour between mother and infant, and this leads to assigning the quality of attachment to three categories:
secure attachment, where the baby is naturally upset to some degree but nevertheless approaches and is comforted by the mother upon her return, quickly resumes its composure and resumes exploration of the room;
avoidant attachment, where the infant does not react noticeably to the departure or the return of the mother;
resistant attachment or ambivalent attachment, where the baby is upset by the separation, and approaches the mother upon return, but remains unsettled. When calm, the baby may be put down by the mother, but then starts crying again, perhaps even attacking the mother or behaving destructively with the toys, frequently angrily pushing them away.
Ainsworth makes the important point that each of these ‘attachment styles’ as it were are indicative of adaptive behaviour. They make perfect sense in terms of the child’s experience and view of the world. Secure attachment shows the child being distressed by separation or a stranger, but seeking and expecting comfort from the mother. Avoidant attachment indicates a child who may have given up on expecting reliable support and comfort and does not even seek it. Resistant attachment reflects the infant’s ambivalent experience of the mother’s availability and his on-going unsureness.
The essential link between these early experiences and the older child is what Bowlby called the child’s “internal working model of the world”. When we see these children later in our child and youth care practice, perhaps as adolescents, we recognise the avoidant ones, those who have given up on significant adults and who seem remote and detached, often inappropriately independent; and the resistant or ambivalent ones who continue to interact without reassurance — demanding, unsatisfied, distrustful, angry. Their view of the world is an angry one, often resorting to a form of ‘using of people’ and objects. A sort of “let me try and get as much as possible for me, before it is withdrawn”. We have all worked with youth whose primary preoccupation is with things and material goods (either from us as child and youth care professionals or from their parents when visited). This may reflect a resistant attachment and an internal working model of the world in which the child or adolescent has learned to take from, never knowing when what they want will be withdrawn.
Children who come into our programs are usually these avoiders and resisters, and their experience has confirmed their negative expectations, their “internal working models of the world”. As a result they are often challenging, pessimistic, hostile. In fact, many will behave in such a way as to draw negative responses from others and so confirm and strengthen their worldview.
Often concomitant with resistant attachment is the presence of aggression in young children. This is important because it has been found (Alan Sroufe) that one of the most stable human characteristics over time is aggression. A pre-school child who is aggressive is likely to be aggressive in his early school years, and aggression then is even a stronger predictor of aggression in high school. Sroufe also suggests that the longer the developmental path of a child diverges from the more healthy alternative, the more difficult it is to bring the two back together. This suggests that the earlier the intervention, the better.
All of which is bad news for child and youth care workers, who often only get to meet the kids in their teens?
Mark: I am sure that child care workers do what they do because they believe they can make a difference — and the starting point is the child’s internal working model of the world. Essentially, through the environments they build and the relationships they offer, child and youth care workers have to expose the child to data that does not confirm their theory of other people and the world. I suppose the positive thing is that they do have a theory — and even an adaptive theory — and we need to participate consistently in this “theory-building”.
(I may add that Mary Main who is one of the leading attachment theorists has suggested a fourth mode to add to Ainsworth’s three — namely disorganised attachment. While Ainsworth’s three modes were adaptive and coherent, making sense to the child in his circumstances, Main’s ‘disorganised attachment’ does not make sense, is irrational and unsystematic, and is often distressing to observe. The theory is that these infants may have been abused and their attachment behaviour is incoherent for the most part. For more seriously disturbed kids we may have first to build the sequences for them. Perhaps more about this later.)
The whole point for child and youth care workers is that children who are caught up in a distrustful or despairing view of the world are not helped when we force them to behave in a certain way. Explaining ‘how to behave’ or giving kids long speeches about the pitfalls of their behaviour, or trying to argue them into seeing things our way, will simply not work. They must have a living experience of a different world, a more trustworthy and nurturing world. The words of adults have in the past been extremely cheap – what on earth do we have to do to convince the child that our words are any different now. The only way is by combining those words with a lived experience of a consistently nurturing world.
The analogy in psychotherapy is the transference — where the client is playing you out in terms of their views and expectations of their world, and the therapist is doing something different — is not judging or punishing or rejecting.
Child care people are familiar with very erratic and anxious children who improve almost spontaneously when they come into a rational and fair environment.
Mark: We may not be talking about attachment there. I want to say something, which I believe, is very important. The mistake so commonly made when we begin talking about attachment is that it somehow becomes a catch-all for everything. Attachment is not necessarily central to all the issues we have to work with. Temperament is important, as is resiliency, cognitive development, resources and relationships. A child coming into a program may simply get access to some helpful or supportive feature in the environment, which helps him or her to become functional again. Often a kid has had some good relationship, perhaps with a teacher in the past, and that experience can be rekindled in a new situation.
When the Strange Situation first began gaining respectability, one of the problems encountered was that there was no measure of adult attachment. In an attempt to improve upon this Mary Main developed a retrospective technique, the Adult Attachment Interview (AAI) which looked at how adults remembered their childhoods. The most important element here was how realistic they were about what had happened to them. A totally negative recollection usually indicated a resistant attachment while a totally positive view showed avoidance. Secure attachment was shown in the balance, and realistic reports which reflected the rough and the smooth. Main’s work also shows a strong concordance across generations, which probably partially reflects attachment modes — along with role-modelling and other things.
A child who comes into our program today may therefore have had a poor or unsuccessful attachment experience — or one or more other backlogs or unfinished tasks, which show themselves in “relationship resistance”. What advice can we glean from your work with attachment?
Mark: From years and years in child and youth care work we have seen that where there is a trust problem or a security problem which hampers development or function, we have to build or rebuild trust. It is through our consistent attention to the youngster that we build the platform from which they can easily move on — or on which we can see that we have more work to do. When we eventually manage to make some contact, and especially at a verbal or cognitive level, we get an insight into the young person’s current “internal working model of the world”, and so we begin to understand more about what he or she is responding to or defending against.
Again, the point is that a youth who has carried a severe attachment problem deep inside and who is referred to your program for troubling behaviour is not going to respond to a “talking to” or to an external behaviour regimen or to punishment. It is the experience we offer in our program, which has the capacity to modify a child’s internal view of the world. Through that a kid may get to feel OK about reciprocating with another person, may be interested in another and come to trust another.
Adolescence, though, for all sorts of other developmental and social reasons, is an opportunity in itself for stirring up interpersonal attachment?
Mark: Adolescence is often called a “second chance” — Winnicott called adolescence a “second infancy”— and this is indeed a moment when this worldview can become fluid again. Too many people see adolescence just as “a problem”, a time when all there is the potential for bad things to happen — the time when all that has gone wrong in the past “comes home to roost”. Certainly many adolescent behaviours are reminiscent of infancy, they are regressive, irrational, hitting out. The difference in adolescence now is that the individual now has the verbal and cognitive skills (as well as insight – however limited) to co-opt in the process of “reattaching” — which we have to overlay on top of the consistent attention, the acceptance and support and reassurance.
You’re suggesting that there’s more than “mother love” needed here: there’s hard work involved.
Mark: There’s hard work from both sides. Violins don’t often play, with mother love with infants. The “irrational love” which a mother has for her baby is severely tested — infants are often extremely unlovable — but she does what she must anyway. And more importantly, because of the media and cultural images of the ‘natural mother’ and the ‘instinctual love’ between mother and infant, mothers who may initially have ambivalent feelings towards their infants are often unable to say so. Were they able to do this and talk through these feelings, they might be able to come to a resolution that these feelings are normal and other more nurturing and loving feelings will surely follow.
When difficult adolescents come into our program they can be equally unlovable. But remember that the mother’s love for her infant is more often in the concrete tasks, the doing of necessary things, than in being sentimental and schmaltzy. Children are resilient. (I am reading the book Mother Nature right now, and the writer argues that it is a Darwinian miracle that any of us are here – that we have survived the last million years of evolution and epochs in history which were far more difficult than the one we are living in now.)
Attachment, along with the mother-child relationship which develops over time, is always a highly complex amalgam of light and dark, smiles and tears, generosity and quid pro quos. It is the bottom line which really matters — the fact that even though we spend happy and rewarding times together, and even though I get tired and lose my patience and express my frustration with you, we are in this together, I will continue with you.
There is a strong set of messages here for child care workers. Attachment, reassurance, security, these things are built by what we do more than by what we feel. We can do our work well with both loveable and unlovable kids — by doing what we have to do: by attending, responding, seeing to safety, correcting. I believe that the most powerful interactions between people (not just those between mothers and infants) are those, which reflect this complexity, rather than those, which are superficial and sentimental. I hear a good child care worker saying “Johnnie I get really cross when you do that — come here, let me straighten that out for you.”
Child and youth care workers are often sold down the river by program directors or boards who expect politeness and “good behaviour” from kids — and warm, sunshiny interaction between staff and youth all the time. The young people who come into our programs are precisely those with avoidant, resistant or disorganised attachment histories, and approaches from adults which don’t ring true or which simply seem to repeat the experiences of the past, will only confirm their “internal working model of the world”. Our job is to seriously challenge that view with consistent, real and different experience.
This is extremely hard for them, and their hard work is to be open to and be able to reflect on that experience, to be able to stitch words and ideas into that reflection — and helping with that is another whole ball game of child and youth care skills.