reason 2: attachment

Why Infant Mental Health?

Three Reasons:1) Fetal Programming2) Attachment3) Therapy

Reason 2: Attachment

Neil W. Boris, MDTulane Institute of Infant and Early Childhood Mental Health

Infant Psychiatrist?

Reaching for Meds?!

via Flickr user ThomasThomas

http://www.flickr.com/photos/74078214@N00/268846488/

• Sense of self• How to view/relate to others• How to regulate behavior and emotions

• Done in the context of relationships• Starts before birth

What Makes for Healthy Emotional Development?

via Flickr user LadyDragonflyCC

http://www.flickr.com/photos/19646481@N06/4121739977/

Developmental Theories

What sets Attachment Theory apart?

– Linked to natural selection as driving force:

Protection of young = protection of genes

via Flickr user ROSS HONG KONG

http://www.flickr.com/photos/27302727@N03/5188594987/

Developmental Theories

What sets Attachment Theory apart?

• Linked to natural selection as driving force.

• Based theory on observations

• De-emphasized the role of “meeting oral needs”

Protection of young = protection of genes

Ethology and Harry Harlow’s monkeys

The concept of imprinting as a cross-species phenomenon

Who is THIS guy????

Konrad Lorenz

Nobel Prize in Medicine, 1973

http://www.nobelprize.org/nobel_prizes/medicine/laureates/1973/lorenz-lecture.pdf

When imprinting studies go awry…

• Inborn system – feedback loop

• Operative throughout life

• External goal in infancy is to balance exploration and proximity to caregiver (“the secure base”)

• Internal goal to achieve sense of felt security

Definition of Attachment:

http://www.psychology.sunysb.edu/attachment/online/inge_origins.pdf

Circle of Security“The Feedback Loop”

· Protect me · Comfort me· Delight in me· Organize my feelings

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

· Watch over me· Help me· Enjoy with me• Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell

2 Roles of Attachment Figure

SECURE BASE SAFE HAVEN

2 Roles of Attachment Figure

SECURE BASE Facilitate child’s exploration of

physical environment Emotionally available Physically available

ALLOWING THE CHILD TO GO INTO THE ENVIRONMENT TO EXPLORE

SAFE HAVEN

2 Roles of Attachment Figure

SECURE BASE Facilitate child’s exploration of

physical environment Emotionally available Physically available

ALLOWING THE CHILD TO GO INTO THE ENVIRONMENT TO EXPLORE

SAFE HAVEN

Responding sensitively in stressful/alarming situations

Provide reassurance Provide comfort Provide protection

WELCOMING THE CHILD BACK FOR COMFORT/PROTECTION

Secure Base

Safe Haven

Why All The Fuss?1. Selection of neuronal

pathways

2. Emotions – development and regulation

3. Shaping of Internal Working Models/Representations

Schore, 1999

Attachment:The “Internal Working Model”

Story of the Relationship

Attachment: The “Internal Working Model”

• Relationship template (‘structure of the mind’)

• Formed by experience (influenced by temperament genes)

• Accessible in adults by interview

• Predicts later patterns of behavior in relationships (stable though malleable)

Disorganized Attachment

I need you but you are so frightened or

frightening that I have no one to turn to and I don’t know what to do.

Disorganized Attachment

I need you but you are so frightened or

frightening that I have no one to turn to and I don’t know what to do.

The Clinical Power of Attachment

• Tools to assess internal working models– In caregivers and in children

• Reliable ways to pick out disorganized attachment

• Therapies that are attachment-based

• Promoting security is protective

Thank you for your attention!

Neil W. Boris, MDTulane Institute of Infant and Early Childhood Mental Health