By John Fallowfield
Date Posted: Monday, 15 June 2009
John Fallowfield is half way through his two years Master of Social Work degree at Royal Holloway University in Egham. Formerly an outreach worker on a leaving care project, John is now a trainee social worker with the London Borough of Richmond and he works within the Children Looked After Team.
Attachment theory and social work with ‘looked after’ children and their families
This paper offers a critical consideration of the ways in which a knowledge of attachment theory can usefully inform social workers. Within the context of statutory education and children’s services in England it examines the relevance of attachment theory to informing decisions and work with regard to : ‘looked after’ children and their parents, detrimental parent-child relationships, and placing children with substitute carers, such as foster carers or adopters. In doing all this the paper introduces the language, core concepts and the research which underpins attachment theory. Throughout this essay the terms “carer”, “caregiver” and “parent” are used interchangably to reflect the diverse nature of modern families that children experience.
Attachment theory offers an understanding of personality development and behaviour in close relationships and provides an account of the difference in people’s emotional and relationship styles. In its earliest form, it concentrated on the dynamics and quality of relationships between children and their parents but it has since been expanded to cover the lifespan (Howe, 2000).
Attachment theory draws insight from evolutionary theory, ethology, systems theory and psychodynamic perspectives of developmental psychology (Howe, 2001). Many social work commentators label attachment theory as a psychosocial theory as it explores the area of human experience which is formed by the interaction between the psychological condition of the individual and the social environment (Howe, 2002; Coulshed and Orme, 1998). It is worth noting that as with all individual theories, attachment theory does not seek to explain, nor is it able to, cover all dimensions of the complexity of human development and interaction.
The child psychiatrist John Bowlby is considered the creative genius behind the development of attachment theory. Since the early 1950s, Bowlby worked alone and with colleagues such as James Robertson, Robert Hinde and Mary Ainsworth on a number of different studies. Bowlby (1960 & 1973) suggested that children suffer loss when they are separated from their caregivers because of the attachments between them. Bowlby’s study with the ethologist Robert Hinde, inspired the idea that certain attachment behaviours have evolved as a survival mechanism (Bergen, 2008). Over the years research on attachment has been extended and applied. The central tenets of the theory today are that the quality of close relationships (or attachments) has a bearing on personality, emotional and social development not only in childhood but across the lifespan (Howe, 2001). This highlights that attachment theory is effectively a biological, psychological and social theory of human development.
The human infant is born with poor vision and an inability to move, and as a consequence is vulnerable to environmental factors and absolutely dependent upon a carer for survival (Winston, 2003). To enhance survival, the baby is born with a number of pre-programmed and automatic behavioural systems which are elicited by environmental stimuli (Bergen, 2008). Bowlby highlighted that when the young child feels distressed, frightened or confused, these feelings trigger attachment behaviour which serves to bring the infant closer to their mother who provides the desired comfort, care and protection (Bowlby, 1988). Although early studies focused on the ‘mother’, it is now widely recognised that fathers, grandparents and other key persons in a child’s life can also perform the role of a ‘primary carer’.
For most children the attachment behaviour, which consists of regular interaction with carers, results in the child forming an ‘attachment bond’ which allows infants to learn to regulate their emotions and is the source of psychological and social understanding (Howe, 1995). Secure children who form this bond are confident, use the carer as a ‘secure base’ while they explore the world (Bowlby, 1988). The quality of the external world of the infant and their developing internal psychological make-up results in the development on what is labelled the child’s ‘internal working model’. This is a cognitive representation of the self and involves the development of a set of expectations about social interactions with others (Bergen, 2008).
It is recognised that children have different temperaments which may affect how their social relationships develop and that our experiences as we go through life influence and change the way we relate to others (Payne, 2005). However, it is the way in which our attachment figures respond to us that determines our capacity to relate healthily to others and results in the theory that early childhood relationships are the prototypes for our subsequent subsequent relationships throughout our lives (Winnicott, 1965).
Mary Ainsworth worked with many of Bowlby’s ideas to formulate an attachment classification system. Ainsworth et al (1978) conducted a study that is famously known as the “strange situation” test in which she examined individual differences in children’s use of the attachment figure as a secure base from which to explore the environment. Types of attachment between parent and child were then described and used to inform her classification system. Although there have since been many refinements, the Ainsworth attachment classification system identifies four patterns of attachment experience; secure, insecure/avoidant, insecure/ambivalent and insecure/disorganised (Ainsworth et al, 1978, cited in Howe, 1995). Below is an outline of these patterns, focusing on the child-parent dyad. Schofield and Beek (2006) offer a more detailed description of these patterns as part of a developmental pathway from birth to adulthood.
Children who have relationships with parents whose caregiving is on the whole loving, sensitive, responsive, consistent, available and accepting, develop healthy secure relationships. Children who are securely attached will develop an internal working model of the self as lovable and secure in relationships with others. In turn such a child mentally represents others as reliable, caring, available and trustworthy. On the whole, children who are securely attached are able to manage stress appropriately, are not overwhelmed by negative feelings and develop a positive identity, self esteem and self-efficacy. They develop a secure base from which they feel safe to explore the world (Daniel, 2000). Research also demonstrates that people who have developed secure attachment have the highest levels of social competence across the lifespan which includes satisfactory relationships with peers, partners and their own children (Howe, 1999; Daniel, 2000).
The first of three patterns of insecure attachment is avoidant attachment. This pattern is indicative of children who have experienced carers as irritated, anxious and who have distanced themselves when their children display attachment behaviour. These carers demonstrate a ‘rejecting’ or ‘dismissing’ style of caregiving and as a result their children develop avoidant attachments which downplay their emotions and feelings of need. Children with avoidant attachments tend to be emotionally independent and feelings of need increase feelings of anxiety (Howe, 1999).
In contrast, children who experience their carers as inconsistently responsive and relatively insensitive to their attachment behaviours typically develop insecure and ambivalent patterns of attachment. These children increase their attachment seeking behaviour in an attempt to overcome the carer’s insensitivity. It is known as ambivalent because the child seeks an increase in their carer’s responsivity but also feels angry that this care is not consistent. This causes a hypersensitivity to the emotional availability and interest of others. The child becomes easily distressed if they feel the availability of others is going to be lost. Ambivalently attached children attempt to control other people’s attention through coercive behaviour such as threats, anger, need and seduction which often causes those others to attempt to withdraw. This serves to confirm the ambivalent child’s view that other people cannot be relied upon (Howe, 1999).
Although they cause insecurity, both the avoidant and ambivalent patterns are an attempt by the child to maximise the carer’s availability. However, some children experience their carers as frightening which presents a psychological dilemma. Fear usually activates attachment behaviour which brings them closer to their carer but if they are the source of fear the child cannot organise an attachment strategy to increase feelings of care and protection, hence the behaviour is labelled disorganised. These attachments are often associated with children who have suffered severe maltreatment. These children often seek control, can be violent, self-abusive, fearful, helpless and are very difficult to look after as they avoid being cared for (Howe, 1999).
Attachment theory across the lifespan
It is often difficulties in making and sustaining healthy relationships that bring so many children and families into contact with social workers and welfare agencies. As outlined above, it is recognised that a carer’s own approach to care-giving is a product of their history of early and subsequent relationships. This highlights the application of attachment theory across the lifespan and its relevance when examining parenting capacity. Peter Fonagy (2001) has shown that our early attachment experiences influence our own capacity as parents to attach satisfactorily to our children.
There are a number of research studies that demonstrate an association in adults between their attachment patterns and depressive disorder (Bilfulco et al, 2002). Specific research by Antonia Bifilco and her colleagues at the Lifespan Research Group shows a relationship between clinical depression and degrees of insecure attachment style (Bilfulco et al, 2002). These studies link with different measurement tools that have been developed to identify patterns of attachment in adults. For example, the Adult Attachment Interview (George et al, 1984) is a research tool that is used for assessing attachment style in adults by exploring their early life experiences. More recently, Bilfulco et al (2008) have developed the Attachment Style Interview which is an assessment tool used to identify patterns of attachment in adults which has been used effectively in the adoption and fostering assessment process.
Attachment theory and working with ‘looked after’ children
Children come into the public care system because somebody, usually a social worker, has assessed that it is no longer viable for them live within their existing family. There are many reasons why such an assessment is made but research shows that a history of physical, sexual or emotional abuse are present in the backgrounds of a very large proportion of such children (Cocker, 2008). Whatever the reason there will often have been a long history of family problems which has resulted in extremely turbulent lives from an emotional point of view. Their personal development may have been severely disrupted, and their capacity for basic trust in other people severely compromised (Department of Health, 1998). This highlights the concern that social workers have with patterns of secure and insecure attachment when working with these children.
The ability for carers to provide secure attachment and emotional warmth are at the heart of any assessment by children’s services in the United Kingdom as per policy guidance contained in the Framework for the Assessment of Children in Need and their Families (Department of Health, 2000). Attachment theory is therefore important in order to make links between children’s emotional development and behaviour and the quality of their relationships with their carers (Trevithick, 2000). It is used by social workers to guide and inform a range of interventions, many of which recognise the need for therapeutic relationships that are supportive, consistent and attuned (Howe, 2000). It is important to stress that entry into care is a process entailing difficult and uncertain judgements by professionals. Social workers rely on theory, research and proven practice to guide assessments, as well as to inform and justify decisions.
Attachment theory offers a framework of theory and research about patterns of thinking, behaviour and relationships but social workers must consider each individual service user’s life uniquely. The assessment triangle (Department of Health, 2000) that is used by social workers takes an ecological approach to assessment (Bronfenbrenner, 1979). This stresses the complex and interweaving aspects of a child’s life which come together to form an individual’s world, including a broad range of developmental needs, provision of care and the wider family and environmental factors. Information regarding the child’s physical and mental health, education, experiences of racism, socio-economic background and much more is taken into consideration (Schofield and Beek, 2006). This highlights that attachment to carers is central to the assessment triangle but must be understood within the range of other key factors that interact to form the individual.
The framework which attachment theory offers is used to inform social workers as to the likely impact on individuals of their experience of problematic parenting, especially the impact of abuse, neglect, separation and loss. This can be used to teach parents or carers to care for children in a way that promotes a secure base and which will in turn assist children to develop healthy internal working models and compensate for previous negative experiences. This has implications for supporting parents to improve the parenting skills in order to prevent children becoming looked after as well as informing decisions for children to be removed from their families. It is important to stress that although social workers are often asked by agencies and courts to ‘assess the attachment between’ a child and their carer they would not rely solely on assessment of attachment to justify removing a child from a current care environment. Assessment of attachment is part of a more holistic assessment of the child’s life and there would need to be clear evidence of neglect and/or abuse as prescribed by the Children Act 1989 in order to remove a child (Allen, 2005).
Once a child enters public care the most likely destination will be either a foster placement, residential children’s home or adoption. There are a wide range of ways in which attachment theory can be applied in practice when working with looked after children to identify potential placements. It can be used to understand and manage behaviour problems, assist children’s social workers in assessing, matching and working with children, the management of birth family contact and by family placement social workers in assessing potential foster carers and adopters and supporting placements (Schofield and Beek, 2006).
Under the previous circumstances in which these children have been cared for, challenging behaviours often emerge and may place their new carers under severe pressure. Attachment theory can be used to help substitute carers understand these behaviours, identify areas of support they require and as a result decrease the chances of placement breakdown. For example, a child’s challenging behaviour can be understood in terms of an attempt to test out whether these adults are any more reliable and consistent than those they have previously experienced or an attempt to communicate to other people what it has been like for the child in the past (Payne, 2005).
In addition, social workers can use attachment theory to make sense of the way in which service users engage with services. Most social workers have worked with service users who communicate a need for support but cannot make use of the services on offer. This difficulty can indicate experience of ‘failures’ in early childhood and can be understood in terms of their history of attachment bonds (Howe, 1999). For example, some service users seek to exert control in the relationship with a social worker, perhaps refusing support on offer and making unrealistic demands. Social workers could view this as the service user being ‘difficult’ and ‘undeserving’ of support. Alternatively with consideration to attachment theory this could be understood in terms of the service users previous experience of rejection from their carers which has left them cautious of accepting help (Trevithick, 2000).
In practice social workers generally assess a child’s attachment to their carers through reading of files, information gathering, unstructured interviews with past and present carers, direct observation, direct work with the child and self-report questionnaire’s (Howe et al, 1999). Some of these methods, such as self-report questionnaire’s, are evidence based but much is left to professional judgement that without specific training can lead to misinterpretation (Milner and O’Byrne, 2002). For example, assessment observations of insecure-anxious children who have been neglected may witness children who retreat to the caregiver when they are upset and cling to the caregiver most of the time. The relationship may in error, be described as a “strong attachment bond”, whereas in fact the relationship is not providing a secure base from which to explore, play and learn (Schofield and Beek, 2006).
Commentators highlight that social workers using attachment theory to analyse children’s presenting issues can lead to superficial assessments that are couched in vague terms and resulting in largely ineffective interventions (Milner and O’Byrne, 2002). It is also highlighted that although attachment theory offers an in depth analysis of a person’s individual problems and promotes ‘indirect’ interventions, it does not necessarily provide enough direction for planning direct work (Milner and O’Byrne, 2002). At present social workers tend to refer children and families on to ‘specialists’ if they have a high degree of concern regarding the current care environment and attachment. Therefore most social workers are making an approximate assessment of attachment style to inform the need for a referral.
In response there is a growing trend in assessment work to promote evidence based practice and there are a number of tools that can be utilised by social workers. For example, the Adult Attachment Interview (George et al, 1984) and the Attachment Style Interview (Bifulco et al, 2008) are research tools that are used for assessing attachment style in adults. However, the overwhelming majority of social workers do not have the training to use these tools in everyday practice. Bifulco et al (2008) have been working with a number of Local Authorities to train social workers on how to use the Attachment Style Interview (ASI) with positive results and feedback. The use of ASI by fostering and adoption social workers has demonstrated that with appropriate training and resources social worker can also be ‘specialists’ in assessing attachment style and using this to inform planning and interventions.
It can also be argued that attachment theory does not incorporate enough consideration of issues of oppression that result from differences of gender, race, sexuality and class (Milner and O’Byrne, 2002). This is a valid criticism and highlights that assessment of attachment must not be used in isolation but in addition to other assessments. Human nature is such that no one theory can account for the infinite range of difference amongst individuals. For example, difference in learning difficulties and other problems in development such as autism can be mistaken for insecure attachment styles if considered in isolation.
Although the term attachment is used in everyday language, it is not a simple or common sense term. Initially attachment theory appears to have a simple appeal for social workers but as this paper has demonstrated applying its detail in the context of other developmental experiences it is both more complex and revealing. This paper highlights the significance of attachment relationships as fundamental in social work practice. Attachment theory can help social workers make sense of behaviour of service users across the lifespan that otherwise seems unfathomable and it provides a framework for understanding relationships in the lives of service users.
Attachment theory is a well-researched and evidence based area of study that can be effectively used in working with service users across the lifespan. If a well-informed and well-resourced approach is taken, attachment theory can be used by social work practitioners in undertaking assessments, planning, informing interventions and making decisions that can improve the quality of service users lives. However, caution must be emphasised as it should never be used in isolation as a basis for planning. On the contrary, it should be used to integrate an understanding of attachment as part of a holistic approach to psychosocial development.
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