The Attachment Theory was first formulated by the British psychiatrist John Bowlby when he was studying the behavior of young children who were separated from their parents. Bowlby often collaborated with an American-Canadian developmental psychologist Mary Ainsworth who helped him in developing the theory. Attachment Theory is a concept that describes emotional bonds between people, especially between an infant child and a caregiver, and suggests that this bond has lasting effects on the child’s emotional and behavioral development. The key assumptions of the theory are that attachment is an evolutionary mechanism needed for survival; that it forms through regular and repeated interactions with a caregiver and there is no inherent preference; and that the attachment tendencies are primarily developed in the first few years of a child’s life (Howe, 2012). Some of the characteristics of attachment are the need for comfort and safety, the desire to be in the proximity of the caregiver, and the distress that occurs when separated from the attachment figure (Cherry, 2017).
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There are considered to be four types of attachment. Secure type is when a child knows that they will be comforted in the case of any distress and can express their need for comfort directly and positively. Securely attached children generally have a high self-esteem, trust others, and can have healthy relationships later in life. When caregivers reject or dismiss the displays of attachment, children might develop the avoidant type of attachment. Avoidant children do not communicate well and mask their distress, in order to keep the caregiver in proximity. The fear of rejection might be taken into adulthood, and avoidant individuals tend to be untrusting and emotionally distant. Ambivalent type occurs when the response to the attachment displays is inconsistent. Ambivalent children tend to exaggerate their distress and carry the emotional imbalance into adulthood, which increases the risk of mental health issues. When the cause of a child’s distress is the caregiver themselves, because they are abusive or neglectful, a child develops the disorganized type of attachment. That type will most likely lead to some behavioral and mental health problems (Howe, 2012).
The Adult Attachment Scale (AAS) was developed based on the works of Cindy Hazan and Phillip Shaver, as well as the works of Marc Levy and Keith Davis. The scale is used to measure adult attachment. It can be used as an instrument for psychosomatic researchers. Some studies were conducted to provide evidence for the scale. The AAS has high reliability and validity as a measure of attachment (Ravitz, Maunder, Hunter, Sthankiya, & Lancee, 2010).
The Patient Health Questionnaire (PHQ-9) was developed by doctors Robert L. Spitzer, Janet B. W. Williams, and Kurt Kroenke. It is used as a diagnostic, monitoring, and measuring tool for depression. The PHQ-9 is appropriate for clinical use and is evidence based. Studies prove reliability and validity of the PHQ-9 (Kocalevent, Hinz, & Brähler, 2013). It should be used often enough to track improvement or regression of the patient’s condition.
The Adult Attachment Interview (AAI) is used to assess attachment in adults through childhood memories that might indicate a person’s parenting style. It is appropriate for family therapists and developmental psychologists. The interview includes questions like “Which parent did you feel closest to and why?”, “When you were upset as a child what would you do?”, “What is the first time you remember being separated from your parents?”, “Did you ever feel rejected as a young child?” (James, 2010). A special training course is required to learn how to properly administer and score the AAI. The effectiveness of the AAI is evidence based as it is attested in research. Studies provide supporting evidence for reliability and validity of the AAI.
Interpersonal Therapy was developed in New England in 1969 by Gerald L. Klerman, Myrna M. Weissman, and their colleagues. It should be utilized by psychotherapists treating depression or other disorders, such as a social anxiety disorder, a borderline personality disorder or PTSD. The purpose of this therapy is to relieve the symptoms of depression and to improve social functioning (Markowitz & Weissman, 2012). Interpersonal Therapy is based on the idea that psychological issues might be a result of problems in interpersonal relationships, and that those problems can, in turn, aggravate the issues, thus creating a cycle. Some tools used in this therapy are helping a patient acknowledge and accept painful feelings, pointing out logical implications or contradictions in what a patient is saying, analyzing patient’s communication with other people, and facilitating the change in patient’s behavior. Normally, a therapist would listen to a client to help them identify specific issues and work through them. There is a number of techniques that can be used in interpersonal therapy, such as identification of emotions, expression of emotions, and analyzing issues from the past that might be affecting a patient in the present. According to Markowitz and Weissman (2012), “The demonstrated efficacy of IPT in treating major depression and bulimia has led to its incorporation into professional and national treatment guidelines”. Therefore, the therapy is evidence based.
The Developmental Needs Meeting Strategy (DNMS) was developed for the treatment of trauma by Shirley Jean Schmidt. It is based on the Adaptive Information Processing model created by Francine Shapiro. This approach might be appropriate for those who were not satisfied by the standard trauma treatment. The DNMS is specifically used to treat attachment-related traumas, usually referred to as attachment wounds. Attachment wounds can create gaps in a person’s development, which might lead to psychological issues later in life. The tools used in the DNMS therapy are represented by so-called Resource parts of self: Core Self, Nurturing Adult Self, and Protective Adult Self that are used to address unmet needs. Generally, a therapist would help a client break away from the maladaptive state inflicted by the traumatic memories. Some techniques used in the DNMS are drawing from inner Resources, identifying and diffusing maladaptive introjects, and separating from the past issues. However, there are not enough studies yet to evaluate the efficiency of the DNMS therapy.
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The General Systems Theory (GST) was first proposed by the Austrian biologist Ludwig von Bertalanffy in 1928. It is a concept used to describe and understand complex systems through their structure, rather than their purpose, based on the idea that systems share organizational principles which can be understood. The assumptions of the theory are that there can be similar models and concepts in different fields, that all of the sciences can be unified and integrated, and that parts of the system and their interaction give meaning to the system as a whole. Some of the characteristics of the theory are that it uses a universal approach to different sciences, it provides a consistent framework for evaluation, and allows for the same theoretical structure to be used in different fields. Using the GST in the treatment of depression implies putting emphasis on the social circle and environment of a depressed individual, especially their spouses and children (Gotlib, 2012). In this type of therapy, an active, problem-solving approach might be used, and the family of a patient might be included in the therapeutic process.
Cherry, K. (2017). Attachment theory – styles and characteristics. Web.
Gotlib, I. H., (2012). An interpersonal systems approach to the conceptualization and treatment of depression. In R. E. Ingram (Ed.), Contemporary psychological approaches to depression: Theory, research, and treatment (pp. 137-155). Berlin, Germany: Springer Science & Business Media.
Howe, D. (2012). Attachment theory. In M. Gray, & S. Webb (Eds.), Social work theories and methods (75-87). Thousand Oaks, CA: SAGE Publishing.
James, D. (2010). Adult attachment interview. Web.
Kocalevent, R. D., Hinz, A., & Brähler, E. (2013). Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. General hospital psychiatry, 35(5), 551-555.
Markowitz, J. C., & Weissman, M. M. (2012). Interpersonal psychotherapy: Past, present and future. Clinical psychology & psychotherapy, 19(2), 99-105.
Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B., & Lancee, W. (2010). Adult attachment measures: A 25-year review. Journal of psychosomatic research, 69(4), 419-432.