Skip to main content Accessibility help
×
Home

Psychiatric staff as attachment figures: Understanding management problems in psychiatric services in the light of attachment theory

  • Gwen Adshead (a1)

Abstract

Background

Attachment theory argues that psychological development and functioning are affected by our earliest attachments to care-givers. Failed or pathological attachment in childhood may give rise to repetition of maladaptive attachment patterns in adulthood.

Method

Analysis of therapeutic relationships in the light of attachment theory.

Results

Relationships between patients and both psychiatric care-givers and institutions may resemble attachment relationships.

Conclusion

An attachment perspective may be useful for understanding common behavioural disturbances in general psychiatric settings, and support the use of clinical strategies which focus on containment of arousal and the management of anxiety states.

Copyright

Corresponding author

Dr Gwen Adshead, Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG

Footnotes

Hide All

The Royal College of Psychiatrists and the British Journal of Psychotherapy awarded the author a Psychotherapy Prize for an earlier version of this paper.

Footnotes

References

Hide All
Ainsworth, M., Blehar, M. C., Waters, E., et al (1978) Patterns of Attachment: A Psychobiological Study of the Strange Situation. Hillsdale, NJ: Erlbaum.
Bion, W. (1962) Learning from Experience. London: Heinemann.
Bowlby, J. (1979) On knowing what you are not supposed to know and feeling what you are not supposed to feel. Canadian Journal of Psychiatry, 24, 403408.
Bowlby, J. (1984) Violence in the family as a disorder of the attachment and care-giving systems. Amencan Journal of Psychoanalysis, 44, 927.
Bowlby, J. (1988) A Secure Base: Clinical Applications of Attachment Theory. London: Routledge.
Bremner, J. D., Southwick, S., Johnson, D., et al (1993) Child physical abuse and combat related PTSD in Vietnam veterans. American Journal of Psychiatry, 150, 235239.
Brown, G. & Harris, T. (1978) The Social Origins of Depression. London: Tavistock.
Dozier, M. (1990) Attachment organisation and treatment use for adults with serious psychopathological disorders. Development and Psychopathology, 2, 4760.
Firth Cozens, J. (1992) The role of early family experiences in the perception of organisational stress: fusing clinical and organisational perspectives. Journal of Occupational and Organisational Psychology, 65, 6175.
Fonagy, P., Steele, M., Steele, H., et al (1996) The relationship of attachment status, psychiatric classification and response to psychotherapy. Journal of Consulting and Clinical Psychology, 64, 2231.
Gabbard, G. (1989) Sexual Exploitation in Professional Relationships. Washington, DC: Amencan Psychiatric Press.
Garland, C. (1991) External disasters and the internal world: an approach to psychotherapeutic understanding of survivors. In Textbook of Psychotherapy in Psychiatric Practice (ed. Holmes, J.), pp. 507532. London: Churchill Livingstone.
Kraemer, G. (1992) A psychobiological theory of attachment. Behavioural and Brain Sciences, 15, 493511.
Linehan, M., Armstrong, H. E., Suarez, A., et al (1992) Cognitive–behavioural treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 10601064.
Main, M. & George, C. (1985) Responses of abused and disadvantaged toddlers to distress in age-mates: a study in a day care setting. Developmental Psychology, 21, 407412.
Main, M., Kaplan, N. & Cassidy, J. (1985) Security in infancy, childhood and adulthood: a move to the level of representation. Monographs of the Society for Research into Child Development, 50, 66104.
Main, M. & Goldwyn, R. (1989) Adult attachment rating and classification system. Department of Psychology. University of California, Berkeley, CA.
Main, T. (1977) Traditional psychiatric defences against close encounters with patients. Canadian Psychiatric Association Journal, 22, 457466.
Mullen, P. E., Martin, J. L., Anderson, J. C., et al (1993) Child sexual abuse and mental health in adult life. British Journal of Psychiatry, 163, 721730.
Ogata, S., Silk, K., Goodrich, S., et al (1990) Childhood sexual abuse and physical abuse in adult patients with borderline personality disorder. American Journal of Psychiatry, 147, 10081013.
Parker, G. (1983) Parental “affectionless control” as an antecedent to adult depression. Archives of General Psychiatry, 40, 956960.
Parkes, C. M. (1991) Attachment, bonding and psychiatric problems after bereavement in adult life. In Attachment Scross the Life Cycle (eds Parkes, C. M., Stevenson-Hinde, J. & Marris, P.), pp. 268292. London: Routledge.
Patrick, M., Hobson, P., Castle, D., et al (1994) Personality disorder and the mental representation of early social experience. Development and Psychopathology, 6, 375388.
Persaud, R. D. & Meux, C. J. (1994) The psychopathology of authority and its loss: the effect on a ward of losing a consultant psychiatrist. British Journal of Medical Psychology, 67, 111.
Rutter, M. (1988) Attachment and the development of social relationships. In Scientific Foundations of Developmental Psychiatry (ed. Rutter, M.), pp. 267279. Washington, DC: American Psychiatric Press.
Rutter, M. (1995) Clinical implications of attachment theory: retrospect and prospect. Journal of Child Psychology and Psychaitry, 36, 549571.
Vaillant, G., Sobowale, N. & McArthur, B. (1972) Some psychological vulnerabilities in physicians. New England Journal of Medicine, 287, 372375.
Van der Kolk, B. (1989) The compulsion to repeat the trauma: re-enactment, revictimisation and masochism. Psychiatric Clinics of North America, 12, 389411.
Van der Kolk, B., Perry, C. & Herman, J. (1991) Childhood origins of self-destructive behaviour. American Journal of Psychiatry, 148, 16651671.
van Ijzendoorn, M. H. & Bakermans Kranenburg, M. (1996) Attachment representations in mothers, fathers, adolescents and clinical groups: a meta-analytic search for normative data. Journal of Consulting and Clinical Psychology, 64, 821.
Weiss, R. (1991) The attachment bond in childhood and adulthood. In Attachment Across the Life Cycle (eds Parkes, C., Stevenson-Hinde, J. & Marris, P.), pp. 6676. London: Routledge.
Winnicott, D. (1965) Ego distortion in terms of true and false self. In The Maturational Process and the Facilitating Environment (ed. Winnicott, D.), pp. 140152. London: Hogarth.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychiatric staff as attachment figures: Understanding management problems in psychiatric services in the light of attachment theory

  • Gwen Adshead (a1)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *