Time in Grief: How do Bereaved Parents Mentalize It?

In this multimethod study, we examine bereaved parents’ capacity for mentalizing the temporal dimension of their grief. The theoretical assumptions of our study draw on the clinical and anthropological perspectives on the passage of time in grief. Parents’ mentalization of their experience of grief was measured both in the attachment context, using the Adult Attachment Interview (AAI) and using the narrative Child Loss Interview (CLI). We used thematic analysis to code parents’ mentalizing utterances in order to categorize time-related changes during the grieving process. Parents generally mentalize their grief-related experiences at a lower level of reflective functioning than their general attachment experiences. However, a higher general ability to mentalize contributes to a higher level of RF and greater coherence in mentalizing their grief. Parents experience time in grief through oscillation between the past with the deceased child and a restricted form of existence in the present reality.

Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child’s Attachment

Background: This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child’s attachment at 15 months after childbirth. Methods: Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index—Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child’s 15 months of age (Time 3). Results: Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months. Conclusions: Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk.

Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study

Objective: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant–parent attachment classification at 12 months postpartum. Methods: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant–parent attachment was measured using the Strange Situation Procedure at 12 months. Results: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. Conclusion: While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.

Patient’s and the Therapist’s Attachment Representations, Attachment to Therapists, and Self-Esteem-Change Through Psychotherapy

Objectives: The present naturalistic study aims to investigate the differential effects of the patient’s and the therapist’s attachment representations on the attachment to the therapist as perceived by the patient, and their impact on self-esteem-change through psychotherapy.Methods: Attachment variables of N = 573 patients as well as N = 16 therapists were assessed. Attachment representations were measured for therapists and patients via the Bielefelder Questionnaire for Client Attachment Exploration, the Relationship Specific Attachment to Therapist Scales and the Adult Attachment Interview. The patient’s attachment to therapists was evaluated and patients’ self-esteem was measured via the Frankfurter Selbstkonzeptskalen at the beginning and end of psychotherapy.Results: Although there were significant effects of the patient’s attachment representations on the perceived attachment to the therapist as well as between the perceived attachment to the therapist and the amount of self-esteem-change, the therapist’s attachment style had no significant influence on the perceived attachment to the therapist.Conclusion: Self-esteem-change through psychotherapy is influenced by the actually formed attachment relationship as perceived by the patient. The patient’s attachment representations but not the therapist’s attachment style contributes to the actual patient’s attachment to the therapist.

Attachment State of Mind and Trauma in Mother and Baby Home Adoptees

Objectives. This study two had two aims: (i) to establish participant’s state of mind (SOM) with regards to attachment using the Adult Attachment Interview (AAI) (George, Main, and Kaplan,1985-1996) and to explore the experiences and impact of adoption amongst adults adopted from mother and baby homes in the UK and Ireland.Methods. The current study made use of all information gained by the AAI by analysing the interview transcripts in two ways: (i) by using the AAI scoring system (Main, Goldwyn and Hesse, 2003) to assess each participant’s SOM (ii) thematic analysis of the transcripts producing an inductive set of themes. Results. All participants had an insecure SOM with regards to attachment. Three out of the five participants had an unresolved SOM, and preoccupied was the highest represented three-way classification. Qualitative analysis of transcripts identified four overarching themes: (i) Identity and Belonging; (ii) Trauma; (iii) ‘Silenced’ Coping and (iv) Adverse Parenting which reflected their experiences of adoption.Conclusion. Findings indicate that mother and baby home adoptees may be more susceptible to trauma associated with loss. This highlights the importance of suitable adoption placements and vetting of potential adopters. Mental health professionals should be aware that there may be multiple causes contributing to trauma experienced by mother and baby home survivors. These results have clinical and research implications and add to the broader discussion of trauma related to adoption.

“Bumps in the Road”: A Pilot Study of a Therapeutic Technique for the Integration of Unresolved Family Loss and Trauma

The ability to sustain a coherent narrative about experiences of trauma and loss is a prominent feature of secure-autonomous attachment states of mind as assessed in narrative tasks such as the Adult Attachment Interview. The current study examines the clinical application of the concepts of narrative coherence and discourse segregation within a therapeutic intervention for whole families. Bumps in the Road is a family drawing task, which aims to facilitate the co-construction of family narratives about adversities such as trauma, loss and hardship. The technique aims to increase the family’s narrative coherence about such challenging events. The paper first presents a description of the task itself together with the discourse theories of defensive processing of adverse events. The study also presents pilot quantitative findings from 19 parents on the psychometric properties of a coding system of the families’ discourses in undertaking the task and the therapist’s techniques in administering the task. The predictive association of coding of the narratives were examined as predictors of change in internalising and externalising symptoms in the referred child, using the Child Behaviour Checklist. Findings showed that therapist competence in administration of the task did significantly predict the magnitude of treatment efficacy. The current study is the first presentation of this novel therapeutic task and sets a platform for further research on the use of narrative tasks and the formal coding of discourse in therapeutic work with children and families.

Reconceptualizing attachment-related differences: From Proximity-seeking to Epistemic trust

Theoretical models of personality and interpersonal relationships often concern themselves with the impact of early relational experiences on later development. Research inspired by attachment theory has addressed this question by focusing on how early experiences of being soothed when distressed give rise to attachment-related differences of lifelong significance. However, though most psychological researchers and practitioners are familiar with attachment-related differences, we currently do not understand how they influence the breadth of later outcomes with which they are associated. This knowledge gap is increasingly felt by researchers as threatening the validity of the theory. To support the continued vitality of attachment research, we propose a reconceptualization of attachment-related differences as broader differences in epistemic trust, which we define as the expectation that overtly communicated information is relevant to oneself. Our reconceptualization weaves together research on how infants learn from testimony, research in linguistic pragmatics (in particular, Relevance Theory), and attachment research. Specifically, we put forward four related theses: 1) that infant attachment patterns reflect differences in epistemic trust vis-à-vis the caregiver; 2) that these differences contribute to biases in interpreting and producing communication after infancy 3) that the so-called measures of “attachment” after infancy, such as the Adult Attachment Interview, capture a special case of these generalized biases; and finally, 4) that the inter-generational transmission of attachment-related differences can be viewed as resulting from infants adapting their own communication style to the communication style of the caregiver.

Feeling ‘like you’re on … a prison ship’ – Understanding the caregiving and attachment narratives of parents of autistic children

This study explored the caregiving and attachment relationships of parents of autistic children, analysing 16 Parent Development Interviews conducted as part of a larger project. The interviews were analysed using attachment theory–driven discourse analysis, namely, the Adult Attachment Interview and Meaning of the Child Interview methods of evaluating relational discourse for transformations of meaning with a self-protective function. A multiple case-study approach was used to build an explanatory model of the caregiving and parent–child relationships of the whole sample. The study found a high level of trauma in the parents’ early childhood that shaped the way they interpreted their child and the parent–child relationship, often undermining these parents’ intentions to form more positive relationships with their own children. An interpersonal understanding of the problems of these families is suggested, seeing difficulties as residing in relationships, maintained by a circular process of ruptures, as parent and child seek to protect themselves from the pain and shame inherent in the experience of ‘disconnection’, and the apparent failure of the parents’ hope for a better relationship with their children than they experienced as children. This may be exacerbated by commonly available autism narratives, which tend to essentialise problems, mechanise parental understanding of their children and encourage parents to experience their child as fundamentally separate, challenging the caregiving system. Clinicians supporting families with autistic children may be assisted by attending to this meaning-making process, seeking creative alternatives to help these parents realise their positive intentions that do not support a shame-based cycle.

Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder

Introduction: Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment. Objective: We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored. Methods: The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous. Results: As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals. Conclusions: Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.