Child and Adolescent Psychiatry

262 Chapter 32

Secure and insecure attachment

Although nearly all children develop attachments, the quality of these
attachments varies greatly. Much research on this subject has used the
Strange Situation Procedure (SSP) devised by Mary Ainsworth to inves-
tigate the attachment of 12–18-month-old children. In this procedure,
an infant is observed via a one-way screen or television camera while
spending about 20 minutes in an unfamiliar room. One of the child’s
attachment figures and an unfamiliar adult enter and leave the room in a
predetermined sequence (see Box 32.1). This highly artificial procedure is
not supposed to be representative of the child’s ordinary experiences. Just
as cardiologists and endocrinologists use ‘stress tests’ to unmask pathology
that may not show up in ordinary circumstances, so the SSP is a stress test
designed to show how the child copes with the triple challenge of a strange
setting, the presence of a stranger, and separation from the attachment
figure. When the SSP was first introduced, a lot of emphasis was placed on
how distressed the child became during the separations (phases 3 and 5 in
Box 32.1). It has subsequently become clear, however, that the degree of
distress about separation is primarily related to the child’s temperament
and not to the security of the child’s attachment. Consequently, more
attention is now paid to the child’s response to the reunions (phases 4
and 7 in Box 32.1).

Box 32.1The strange situation procedure

Seven phases are illustrated by the time lines below. Each phase usually lasts

three minutes, though the separation phases are cut short if the child is really

distressed. The sequence generates two separations and two reunions in about

20 minutes.

1

12–18-month child

Caregiver/attachment figure

Unfamiliar adult

2

1st

separation

1st

reunion

2nd

separation

2nd

reunion

34

Phase

(number of 3-minutes phases)

567

The original ABC classification used information from the SSP to classify
children as securely or insecurely attached to that particular caregiver:
type B is secure attachment, while insecure attachments are divided into
type A (avoidant) and type C (resistant–ambivalent). (Mnemonic: Ay for