Child Development: Case Study Of Attachment Theory

In this essay, I will start by describing the family history, presenting concerns and my thinking around Joe. I shall then briefly describe my understanding of attachment theory, focusing on Joe’s attachment behaviours and Winnicott’s concepts of the “Good enough Mother”, True/False sense and regression to Dependency.

I will then show evidence for some of my clinical skills in light of these theories and demonstrate that using these concepts has enabled me to help Joe get in touch with his feelings.

Introducing Joe

Joe is a 10-year-old boy, dad is of Spanish origins and mum English. Joe was born in Spain and moved with his family to the UK when he was 1. He has a younger sister. Mum and dad had separated in 2017 but lived together, in the family home, both with new partners. A year later, mum decided to move out with the children. They now see dad once every 2 weeks. Mum and the children are in the process of being evicted.

Mum referred Joe to the Counselling service and when I met with her she described him as full of frustration, anger, tends to lash out at mum and be extremely close to her at the same time, depressed, dislikes school, doesn’t have friends, possible bullying at school, worried about his mum dying and people dying in general.

There is a history of clinical depression on mum’s side, maternal grandma, great-grandma, and mum; mum was suspected of being bipolar, but mum refused to have this investigated further.

When I first went to collect him from the classroom and walked towards the therapy room, he went running ahead of me, to then turn back and take few steps towards me and run ahead again as soon as I caught ground. When we covered the contract, he took charge of the presentation of it and was silently taking the paper towards him and writing or drawing, without allowing me to see, then offering me the paper back and inviting me back into contributing towards the contract.

In supervision, reflecting on the family history and when asked to use the arts to represent the feeling when being with him, I drew a maze. In reflection, I realised that my feelings, in the countertransference towards him, were almost like a push-pull sort of dance or trance, constant wander into a maze-like type of space, where I was either being pushed closer towards the centre of pushed further away, I thought there was an initial presentation of ambivalence. Which brings me to introduce the first theory as attachment theory.

John Bowlby – Attachment Theory

John Bowlby was a psychologist in the 20th century who drew on from different ideas trying to make sense of love, loss, and separation, his focus was on the quality of the child-parent relationship, seen as crucial to his healthy development. He believed that the ‘…observation of how a very young child behaves towards his mother, both in her presence and especially in her absence, can contribute greatly to our understanding of personality development. When removed from the mother by strangers, young children respond usually with great intensity; and after reunion with her, anxiety or else unusual detachment’ (Bowlby, 1969, p. 3).

He proposed his theory of attachment and within the concept of a secure base. This is provided through a relationship with one or more attuned and responsive attachment figures who meet the child’s needs and to whom the child can turn to for comfort, warmth, and protection at a time of stress, tiredness, hunger, discomfort and when anxious or afraid. Having a secure base is crucial for the development of a secure attachment.

A person who has experienced a secure attachment is “likely to possess a representational model of the attachment figure (s) as being available, responsive, and helpful and a complementary model of himself as … a potentially lovable and valuable person. “ (Bowlby 1980, p.242) And is likely to “approach the world with confidence and, when faced with potentially alarming situations, is likely to tackle them effectively or to seek help in doing so. (Bowlby 1973, p.208).

Bowlby believed that failure to initiate, or a breakdown of, the maternal attachment would lead to serious negative consequences on the child’s ability to form relationships later in life and would refer to this as maternal deprivation. (Bowlby, 1969, 1980) As described by Bowlby (1979) and further developed by Mary Ainsworth’s research (1969) and Main and Solomon (1990), the attachment behaviours appear in patterns. For this assessment, I shall discuss the anxious/ambivalent attachment style, as I believe this is the most relevant for my client. In his book, Attachment Across the lifecourse, David Howe describes the caregiving of these children as random, sometimes comforting, sometimes intrusive, sometimes angry, sometimes pointless with poor synchrony between the parent and the child. Thinking of his life data, mum, suffering with clinical depression would have been consumed by her own thoughts and feeling, would have struggled to observe and feel what her baby was feeling and communicate that back, through her facial expressions, tone of voice, to give her baby an idea of what he is feeling. She would have also struggled to communicate her feelings, thoughts, plans, expectations to her baby. Bowlby believed that if this is not done effectively and enough times, it would impair the child’s ability to understand, how the world of people, relationships and social behaviour works. (Howe, 2011)

The teacher described him as easily distracted, moves quickly from task to task, constantly needing the teacher’s/adult’s attention, with his peers, he tends to show off and act silly. This is what I saw when I observed him in the classroom too. The teacher believes that he likes to be the centre of attention but because he comes across as very demanding, controlling, it’s hard for him to make and maintain relationships. When things don’t go his own way, he tends to become impulsive towards the teacher when frustrated but can easily switch to becoming very tearful, very apologetic and poses as a victim by complaining that no-one likes him and that he is being unfairly picked on, nobody likes him.

He needs to know mum is available, but would constantly criticize her, that she is not spending enough time with him, clingy to mum, maximises his distress (mum describes him as depressed) he prefers mum and would often say “I only like mum, I don’t like to spend time with dad”. He finds it hard to share mum and separate from her, refuses to go on school trips because of his fear of separation from mum, and tends to end up sleeping in her bed most nights. He tends to smell mum’s clothes and needs to carry mum’s smell with him.

As described by Geddes as one of the characteristics of ambivalent children, in her Attachment in the classroom book and seen in Joe, he seems to be preoccupied with anticipating the attention and availability of the others, tends to continuously adjust to others, in a way that allows him to anticipate and control the people around him in order to reassure himself of their presence. (Geddes, 2006) Within the therapeutic relationship, I experienced this as his need to almost become merged with me. At home, school and sometimes in the therapy room would often claim to be unwell, have headaches or being extremely tired (in the therapy room), I believe he uses this as a distress signal to trigger other’s care and attention. (Howe, 2011). This has helped me understand the long-term implications of being unreliable and inconsistently cared for by his mother, who suffers from clinical depression and the implications of the absence of his father and to understand his feelings of despair, doubt, confusion and inadequacy, which I felt in the countertransference and has helped me to reflect on my feelings towards his behaviours in order to give Joe the experience of being deeply understood and help him to regulate his feelings. When thinking in the supervision of ways to help build a therapeutic relationship with Joe and following Geddes’ advice, I knew reliability and consistency was key. I was aware that he may see any task as an intrusion on to our relationship and that he needed help to take responsibility for a task, rather than for me, I use sand timers to help control his anxiety during short, independent tasks, like when going to select the figurines for the sand tray.

I use board games to provide separation from me, I provide him with a special object whilst I go and get the paint out, I pay close attention to beginnings and endings of the sessions and using stories, staying within metaphor to facilitate thinking and emotional development around his issues of separation, identity and independence have been one of the main interventions with him. In the therapy room, Joe is often drawn to using the sand tray and clay and can be very expressive with it. Using the metaphor of the image to talk about feelings safely has been a key intervention. War/fighting, characters changing sides/mixed feelings has been a key theme in the work and when I think of the family situation, conflict springs to mind. As the work continued journeys and helpers along the way were introduced. In the stories that were developed, there was a clear need of Joe to “take care of” his vulnerable parents, which preoccupies him and intrudes into his way of feeling and being around others. Mum dragon controlled the Tiger and the Soldier. The tiger fed the dragon the spider. Tiger and the Soldier attack Mum dragon to only discover that the Dragon was so fierce and needed food because it was protecting its egg. Tiger and Soldier looked after the mum dragon. When Mum dragon gets better, she realises her egg is gone. She destroys everything around her. When she found the egg and brought it back, she got a tiger and the soldier to look after it so it can go and fight a pirate.

There are multiple meanings to this story but I believe he was trying to make sense of his relationship with his mum, where his (or parts of himself) need to look after/feed mum and help her protect the egg (possibly his sister). It also made me think of how Mum remembered him as a very aggressive toddler, he would have massive meltdowns and it was dealt with by mum pinning him to the floor until he would eventually stop. His nursery teacher described him as “a little monster”.

Dad snake and son snake. The story followed dad snake, who was very happy living on his own, in his comfortable seat and going down in his cave for food (fish). After a while, he grew sadder and sadder so a son snake appears, now they eat pizza together. Dad snake grew more tired and got heavier so son snake had to run to pizza hut to get the pizza for dad snake, to make him stronger. Son snake had to grow legs and arms to run faster. Until one day, as somebody was cutting the grass with a lawnmower, son snake had his leg chopped off. He runs back to dad snake but dad snake could not move to help his son. They had to go back to eating fish together but when the son snake gave his scales to his dad to make him stronger because he was not eating pizza anymore, the scales didn’t grow back on son snake. The Octopus that grew strong muscles to be able to carry the “he” Octopus and the “she” Octopus and how it found its flow: “to help others”. Although he was consumed by feelings of despair, when talking about his feelings or of the symbolic representation of himself in play, he used to pick the following feelings cards, this is from Margot Sunderland’s Emotion Cards.

In Countertransference, I felt a disconnect between what he was saying and the feelings of his experiences and the low affect he was presenting. This leads me to introduce Donald Winnicott’s idea of False Self. He was paediatrician and psychoanalyst in the 20th century who had a particular interest in the maternal relationship and its similarity to the therapeutic setting. Winnicott believed that during pregnancy a mother enters “a state of heightened sensitivity” sustained for some weeks after the birth. This is followed by a “flight into sanity” as the mother begins to be aware of the world which exists outside of her state of “primary maternal preoccupation” with her infant (Winnicott,1975). The good-enough mother continues to provide an environment that enables healthy development in her baby. She does this by being the person who defends against the unpredictable and who actively provides care in the holding, handling and in general management of the child and meets her baby’s need for emotional warmth and love. By containing her hateful feelings about her baby scream or cry, and using them to intuit the baby’s despair and hate, the good-enough mother facilitates her baby’s feelings and expressions of great strength by adapting to his needs until he can gradually begin to feel safe enough to relinquish these feelings. At this stage, the process of integration can start and the baby begins to develop a sense of “me” and “not me” (Winnicott, 1975). To achieve this transition from the baby’s total dependence to relative dependence the good-enough mother has, by a gradual process, to fail to adapt to her baby’s needs so that the baby can begin to learn to tolerate the frustrations of the world outside of himself and his mother (Winnicott,1965). Little by little, the baby is separated from his mother and she must adapt to this change. The child has spontaneous gestures that are part of his development as an individual. If the mother welcomes them, he experiences the feeling of being real. If she doesn’t, then a feeling of unreality is created.

Winnicott (1954) described maternal failures as “impingements” upon the infant’s experience, affecting its sense of “going on being”. When the impingements are too severe, the infant begins to hide his true self to protect himself. This led me to think that he may have learned to suppress the parts that have not been welcomed by his mother and that he perceives as shameful and too weak to survive, his vulnerable, needy and love-seeking self. His mother, suffering from clinical depression, unsure of her own worth and value, preoccupied with her own need for love and approval, an anxious mother would lose confidence when her baby would appear unresponsive or upset and even feel confused when her baby is self-occupied and would have seen this as an act of rejection coming from her baby. The fact that she was carrying him in a sling, breastfeeding until 18 months and only introducing solids when stopping breastfeeding because she was heavily pregnant with her second child, made me think of somewhat intrusive, insensitive behaviour, where the baby was constantly fed as mum would have struggled to manage her feelings of hate towards her baby when he baby screamed or cried. Furthermore, the mother would have struggled to constantly adapt to the baby’s needs when the second baby arrived and possibly the transition from dependence to relative dependence would have been severely hindered.

Winnicott points out that in these circumstances, the baby becomes “his mother”. This is illustrated in my client’s struggles to separate from his mother’s feelings and beautifully illustrated in the metaphor of the dragon being fed a part of himself (the spider) and also through the following drawing, called The water and fire dragon, where the water dragon is inside the fire dragon, with no beginning, or no end of the other, just being in a continuum, where sometimes the dragon breathes fire, sometimes the dragon breathes water.

Winnicott recognised that for therapy to the successful, there had to be a regression to the dependence stage of emotional development in search of the true self. In his course of therapy, Joe regressed to an early developmental stage. At first, I would hold him in silence and slowly start wondering about what he was doing, just as a good enough mother would try to understand behaviours and emotions from her baby’s point of view. My countertransference at this point involved maternal feelings and a willingness to meet his needs, through eye contact, the expression of understanding, constant wonder about his behaviour or silence. As time went on, the dance between us on the way to the therapy room stopped, we would walk together and it almost felt like our footsteps were in sync. As time went on, his needs became more relational, and we moved from a symbolic place of a merger to a relationship where he could distinguish between “me” and “not me”. This was achieved through stages of extremes of need, pain, vulnerability, anger, rage, and shame, previously seen as dangerous feelings, as they have never been normalised for him. This has put me in contact with my feelings of loss of love, being failed by my mother, the loss of my dog and the sudden departure of my dad through suicide. I feel my experiences have given me a better understanding of what Joe needed in the therapy room and my process of regression to a developmental stage in my therapy has helped me understand the process and to recognise what Joe needed at each stage, to allow for the separation to happen.

This was beautifully illustrated when he chose the following emotion card. Through empathy and acceptance, I was able to hold onto the feelings of vulnerability, needing of love, his wounded self, feelings that he denied himself from feeling, as it would have made him too weak to survive. Through providing reliability and consistency I have demonstrated that I am not only robust enough to validate his phantasies, withstand attacks and survive intense feelings but also vulnerable enough to invite a sincere relationship. By creating a holding environment, acknowledge and validate the initial resistance, to our attempts at communication, regulate my own impulse to rescue, and instead remain firm, fair and grounded when disagreed with, this slowly allowed the False (strong) Self to contact the wounded self (true self), which sometimes comes up in play as the injured son snake that needed comfort from dad snake or the Octopus needing help to eat and look after the eggs.

The work in therapy is to help him reconnect and acknowledge feelings and thoughts he had been defended against, develop empathy for the unlived part of the psyche, narrow the gap between his divided selves, and gradually bring about healing and a sense of feeling good in his internal world.

I feel that Bowlby’s attachment theory helped me understand how Joe relates to himself, others and the world and Winnicott’s idea of the good enough mother has helped me get a better understanding of the mother-child relationship and through regression to “provide the opportunity of correction of inadequate adaption-to-need in the past history” of my child. (Winnicott 1958/1984, p 261).