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Yet, attachment-based therapies and studies are not nearly as well represented or regarded in the scientific literature as they are in contemporary children’s services practice (e.g. see O’Connor & Zeanah 2003). A search for papers citing attachment therapy including those concerned with ‘holding therapy’ yielded four such articles in ISI, with only one being a modest, albeit positive, evaluation of therapeutic outcomes (Myeroff et al. 1999). One of the papers was a warning about the dangers of holding therapy (Mercer 2001). Mary Dozier (2003), an American researcher of early childhood foster care and attachment, wrote a paper opposed to holding therapy. Her paper explains that holding therapy, sometimes known simply as ‘attachment therapy’, does not emanate in any logical way from attachment theory or from attachment research. In addition, the psychoanalytic underpinnings of attachment theory have generally not provided a strong basis for effective treatment of children (Weisz et al. 1987). Rutter’s (1996) review of the attachment literature also concludes with an argument to reject these traditional psychoanalytic theories of development, on which some proponents of attachment theory rely, and to reorient our current emphasis on ‘maternal bonding’ to infants and disorders of attachment.
However, as O’Connor & Zeanah (2003) recently summarized with regard to diagnosis and treatment interventions: ‘Despite more than 20 years since the establishment of "disorders of attachment" . . . there is still no consensual definition or assessment strategy; nor are there established guidelines for treatment or management’ (p. 241).
The Limits of What Attachment Theories Can Tell Us
The following half century has taken the concept much further, and endeavored to reify toddlers’ reactions to separation from their caregivers during controlled experiments into discrete types of secure and insecure attachment (Ainsworth 1989). This work was followed by predictions about how children classified as being securely or insecurely attached as toddlers would develop differentially in early childhood (Sroufe 1983) and later, classification of adults according to attachment types (Main & Hesse 1992). The challenges to attachment-based theories of development have come more recently, as the emergence of longitudinal studies offers a basis for checking the reliability of predictions based on attachment theory. Sroufe, Egeland, and colleagues (Roisman et al. 2002), following a sample of high-risk and maltreated children to adulthood, find substantial discrepancies between predictions based on early childhood assessments of attachment and adult relationship outcomes. They suggest that their results provide evidence that, although attachment has been found to be stable over time in other samples, attachment representations are vulnerable to difficult and chaotic life experiences and thus lack predictive power when considering the future life chances of the sorts of children needing child welfare services (Weinfield et al. 2000). Sroufe et al. (1999) summarized the difficulties in using attachment theory to make predictions:
Early experience does not cause later pathology in a linear way; yet, it has special significance due to the complex, systemic, transactional nature of development. Prior history is part of current context, playing a role in selection, engagement, and interpretation of subsequent experience and in the use of available environmental supports. Finally, except in very extreme cases, early anxious attachment is not a direct cause of psychopathology but is an initiator of pathways probabilistically associated with later pathology. (p. 1)
Other studies have found little or no evidence of a link between psychological problems in older adopted children and insecure attachment relationships in infancy. Singer et al. (1985) found a similar quality of attachment between adoptive and non-adoptive families. These researchers also found that for middle class families, lack of early contact with an adopted child does not predict anxious adoptive mother–infant attachment. In addition, the authors argue that higher rates of psychological and academic problems among adopted children cannot be traced to insecure attachment patterns between adoptive mothers and children in infancy. Juffer & Rosenboom (1997) found that 74% of the adopted infants were securely attached to their parents, irrespective of country of origin or whether parents also had biological children. These findings suggest that the adoption experience itself, and all that the pre- and post-adoptive experiences may mean for the child and caregiver, is not a predictor of negative parent–infant relations, outside of other factors such as early emotional or physical deprivation.
More generally, although much legitimate research evidence is accumulating about attachment in early childhood and adjustment in later childhood, these studies are characteristically short-term and descriptive, and mostly based on children in non-adoptive families. Attachment theory cannot be used with any confidence to predict how children will develop over longer periods of time. Those professionals who would convince parents that their children may have attachment impairments – and that these will vex their children and families forever – are not reading the caveats from developmental scholars. While attachment problems may predispose a child towards future behavior problems, these problems must be evaluated and treated within the context of the child’s current environment. Such scholars would also forewarn against confusing evidence of risk as a strong basis for prediction.
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