Susan S. Woodhouse

Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility

This randomized controlled trial examined (a) the efficacy of a brief intervention designed to increase the rate of secure infant attachment, (b) the differential susceptibility hypothesis, and (c) whether maternal attachment styles moderated the expected Treatment x Irritability interaction in predicting infant attachment outcomes. Although there was no main effect of treatment, a significant Treatment x Irritability interaction revealed intervention effects for the highly irritable infants only, thus supporting one of two predictions of the differential susceptibility hypothesis: highly irritable infants would have disproportionately better outcomes than moderately irritable infants in better conditions (i.e., with intervention). When separate analyses were conducted with maternal attachment styles, we found significant three-way interactions among treatment, irritability, and each of the examined maternal attachment style dimensions (i.e., secure-fearful and dismissing-preoccupied). Specifically, with more secure mothers, beneficial effects of intervention emerged for highly irritable infants. For more dismissing mothers, the results revealed support for both predictions of the differential susceptibility hypothesis: highly irritable infants, compared to moderately irritable infants, were both more likely to be secure with intervention and less likely to be secure when in the control group. It is interesting that, for more preoccupied mothers, a treatment effect emerged only for moderately irritable infants. We discuss the implications of these findings for the differential susceptibility hypothesis as well as for early intervention.

Client attachment to therapist: Relations to transference and client recollections of parental caregiving

This study examined the relations between client attachment to the therapist and therapist perceptions of transference, as well as between client attachment and recollections of parental caregiving. Participants were 51 client-therapist pairs in ongoing therapy. After a therapy session, clients completed a measure of their attachment to their therapists and a measure of their perceptions of parental caregiving during childhood. Therapists rated levels of positive and negative, and amount of, client transference. Both secure and preoccupied-merger attachment were positively related to both negative transference and amount of transference. Level of avoidant-fearful attachment was not correlated with any type of transference. Insecure attachment to the therapist was associated with more negative recollections of parental caregiving.

The Role of Adolescent Attachment in Moderating and Mediating the Links Between Parent and Adolescent Psychological Symptoms

The present study examined whether adolescent attachment security and attachment-related representations moderate and mediate, respectively, the link between parent symptoms (depressive and anxiety) and adolescent depressive symptoms. Participants were 189 (118 girls) eleventh graders and their parents in a community sample. Results showed that adolescent attachment moderated the connection between parent and adolescent symptoms; in most cases attachment security was more protective if both parents were high on anxiety symptoms or if one parent was high on anxiety but the other parent was low on depressive symptoms. Mediational analyses indicated that representations of their mothers as a secure base mediated the link between maternal and adolescent depressive symptoms. Perceptions of fathers as a secure base did not play a mediating role, although paternal depressive symptoms were associated with lower perceptions of the father as a secure base. Neither parents anxiety symptoms were related to perceptions of the parent as a secure base or to adolescent depressive symptoms.

Volunteer client adult attachment, memory for in-session emotion, and mood awareness: An affect regulation perspective.

In this study, the authors examined relations between volunteer client adult attachment and both (a) memory for negative affect occurring within the first session of therapy and (b) mood awareness (mood labeling and mood monitoring). Participants were 80 volunteer clients (students with a personal issue who volunteered to participate in the research for credit) who participated in 2 counseling sessions with a counselor trainee. As hypothesized, higher levels of attachment anxiety were associated with (a) greater memory for negative affect and (b) more mood monitoring but, contrary to expectation, were not associated with mood labeling. Also contrary to expectation, attachment avoidance was not associated with a minimizing strategy with respect to memory for emotion or monitoring of mood, but it was negatively related to mood labeling. As hypothesized, some evidence emerged for an Attachment Anxiety X Avoidance interaction in predicting memory for negative affect. There were no significant Attachment Anxiety X Avoidance interactions in predicting mood labeling or mood monitoring.

Attachment status and mother–preschooler parasympathetic response to the strange situation procedure

BACKGROUND Early attachment relationships are important for childrens development of behavioral and physiological regulation strategies. Parasympathetic nervous system activity, indexed by respiratory sinus arrhythmia (RSA), is a key indicator of self-regulation, with links to numerous developmental outcomes. Attachment-related changes in and associations between mother and child RSA during the Strange Situation procedure (SSP) can elucidate individual differences in physiological response to stress that are important for understanding the development of and intervention for psychopathology. METHODS A sample of 142 at-risk mothers and preschool-age children participated in the SSP and provided time-synchronized RSA data during the 7 episodes, which included 2 separations and 2 reunions. Attachment classifications were obtained using the Cassidy et al. (1992) coding system. Linear mixed-effects models were constructed to examine attachment-related change in RSA during the SSP and the concordance between mother and child RSA over time. RESULTS Findings demonstrated attachment-related differences in childrens RSA. Secure childrens RSA was relatively stable over time, whereas insecure-avoidant children showed RSA increases during the first separation and insecure-resistant childrens RSA declined across the SSP. Mothers showed RSA withdrawal during separation regardless of childs attachment classification. Mother-child RSA showed a positive concordance that was strongest in the insecure-resistant group, compared with the other groups. CONCLUSIONS Results support attachment theories concerning parasympathetic response to stress and the role of the mother-child relationship in physiological regulation. Our findings advance previous research by focusing on at-risk mother-preschooler dyads within diverse attachment classifications.

Clinical writing: Additional ethical and practical issues.

The recommendations by Sieck (2011, Obtaining clinical writing informed consent versus using client disguise and recommendations for practice, Psychotherapy, 49, pp. 3-11.) are a helpful starting point for considering the ethical issues involved in the decision to seek or not to seek informed consent from clients before writing about them. Sieck makes a compelling case for the idea that there are circumstances in which the most ethical choice would be to engage in clinical writing about a client without seeking informed consent, but instead disguising the clients identity. The present response raises a number of questions not considered in the article by Sieck. First, how should one disguise a case? Moreover, how should one assess whether the disguise is sufficient to preserve confidentiality while not distorting the clinical material to the point that the material is no longer useful to the field? Second, how can we estimate the likelihood of clients reading clinical writing, particularly in the age of the Internet? Given that psychologist-authored blogs that include reference to clinical material are beginning to emerge, it is crucial that we engage in a much deeper dialogue about the ethics of clinical writing. Third, how does the presentation of clinical material influence public perceptions of psychotherapy and confidentiality? If these public perceptions, in turn, could influence the likelihood of seeking psychotherapy, might these attitudes be important to consider in ethical thinking about clinical writing? Finally, where do we draw the line between clinical writing and single case study research (which requires informed consent)?

Dyadic interactions as precursors to attachment security: implications for intervention and research

This commentary focuses on the important contributions of the Beebe et al. (present issue) study to understanding precursors to attachment, including the addition of a particular focus on infant contributions to the dyadic interactions related to attachment outcomes, as well as a better understanding of the precursors specific to insecure-ambivalent attachment and attachment disorganization. In addition, limitations of the time series methodology for interpreting the meaning of maternal interactive contingency findings from an attachment perspective are discussed. Finally, implications of the present study for both clinical work and research are highlighted throughout.

Psychotherapy process and relationship in the context of a brief attachment-based mother-infant intervention.

The present study investigated links between the observer-rated process of psychotherapy and 2 key psychotherapy relationship constructs (i.e., working alliance and attachment to the therapist) in the context of a brief, attachment-based, home-visiting, mother-infant intervention that aimed to promote later secure infant attachment. Additionally, links between observer ratings of intervener and mother contributions to process were examined. Participants included 85 economically stressed mothers of first-born, 5.5-month-old, temperamentally irritable infants. Therapists included 2 doctoral-level and 4 masters-level home visitors. Observer-rated therapist psychotherapy process variables (i.e., warmth, exploration, and negative attitude) were not linked to maternal ratings of working alliance. Therapist warmth, however, was positively associated with maternal ratings of security of attachment to the therapist, and therapist negative attitude was positively related to maternal ratings of preoccupied-merger attachment to the therapist. As expected, both therapist warmth and exploration were positively associated with both maternal participation and exploration. Therapist negative attitude was inversely related to maternal exploration, but not to maternal participation. Results support the idea that attention to the psychotherapy process and relationship may be important in the context of a brief home-visiting parenting intervention with a nonclinical sample.

Attachment-based interventions for families with young children

Given a large body of research indicating links between child attachment and later mental health outcomes, interventions that promote childrens secure attachment to their caregivers have the potential to contribute to prevention of psychopathology and promotion of well-being. A number of attachment-based interventions have been developed to support parents, enhance caregiving quality, and promote childrens attachment security with the aim of improving childrens mental health. There is now a growing evidence base to support the efficacy of a number of these interventions. The present literature review and introduction to the special issue on attachment-based interventions for families with young children describes key aspects of attachment theory and research that form the theoretical and empirical background for attachment-based interventions, and introduces seven case studies illustrating five different attachment-based interventions. The case studies represent a variety of attachment-based models, including both group and individual treatments, and show applications across a range of caregiver contexts.

Attachment Security Priming Decreases Children's Physiological Response to Threat

Ninety 6- and 7-year-olds (49.3% White, mostly middle class) from greater Washington, DC were randomly assigned to a subliminal priming condition (secure, happy, or neutral) to determine if attachment security priming decreases physiological, expressive, and self-reported fear reactions to threatening stimuli. Dispositional attachment security was also assessed. Secure priming and attachment security each decreased electrodermal reactivity, increased vagal augmentation, and decreased fearful facial expressions compared to control conditions. Examination of a statistical interaction between security priming and child attachment indicated that, although secure children had increased vagal augmentation and fewer fearful expressions than insecure children, the effects of priming were constant across secure and insecure children. There were no priming or attachment effects associated with childrens self-reported fear.