Child and Adolescent Psychiatry

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Insecure Attachment 261

heaters can serve the purpose of keeping a house warm enough). The
child’s ability to crawl or walk towards an adult is the most obvious sort of
attachment behaviour, but calling out, smiling sweetly, or crying are also
effective methods for bringing a caregiver closer. A child’s anger at being
separated from a caregiver can also serve a similar role: angry outbursts
may motivate caregivers to maintain even closer contact in future to avoid
further outbursts. Anger is rather a risky strategy, however, since it may
make a reluctant caregiver even less likely to stay close to the child in
future. A better strategy, when the caregiver is reluctant, is for the child to
keep demands to the minimum since a reluctant caregiver is better than
no caregiver at all.
Children generally develop clear attachments to a relatively small num-
ber of people, often described as attachment figures, in the second half
of their first year of life. Many children have a hierarchy of attachment
figures, for example, a child who is attached to both parents may usually
turn to the mother rather than the father for comfort and security if both
are present. While separation from familiar caregivers is relatively well
tolerated in early infancy if the substitute care is good, separation from
attachment figures at later ages is more stressful, particularly for children
aged between about 6 months and 4 years. The impact of separation from,
or loss of, an attachment figure is discussed in Chapter 33.
Attachment theory has been such a dominant theme in developmental
psychology that other components of parent–child relationships have
sometimes been underplayed, for example, play, teaching and limit-
setting. The relative prominence of these different aspects of parent–child
relationships varies between and within cultures.
Bringing together elements from cognitive psychology and psycho-
analytic object relations theory, Bowlby proposed that young children
internalise their experiences with attachment figures to generate internal
working models of themselves, of other people, and of the relationship
between themselves and others. Children who have experienced sensitive
and responsive caregiving typically come to see others as caring and
reliable, and themselves as loveable and worthy of care. Conversely,
children who are rejected or ignored typically come to see others as
uncaring and unreliable, and themselves as unlovable and unworthy.
In later childhood and adulthood, the individual’s behaviour to others
will often create new relationships in line with prior expectations. For
example, if you assume that other people are uncaring and then treat
them accordingly, this will make it less likely that they will care for you –
your expectations have been self-fulfilling. This is one factor that reinforces
your expectations. Another factor is our tendency to selectively attend to
and remember precisely those aspects of our experience that reinforce our
internal working model, ignoring or forgetting contradictory experiences.
The notion thatinternal working modelsof attachment figures play a key role
in linking early attachment experiences to later social and psychological
sequelae is appealing but confirmatory research is only beginning.

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