Caregivers in dyads with this pattern of attachment tend to respond inconsistently to their child’s attachment needs. Longer work hours, parenting stress, and placement in group day care have also been associated with ambivalent infant-mother attachment (Scher and Mayseless 2000). Mothers in dyads with ambivalent attachment report more separation anxiety than mothers of securely attached dyads (Scher and Mayseless 2000). Dyads with ambivalent/resistant attachment at 15 months have significantly more episodes of a pattern described as “chase and dodge” during face-to-face interactions at four months of age (Beebe et al. 2010). That is, when the infant looked away from the mother to modulate arousal, the mother would “chase” the child to make eye contact by moving her head towards the infant’s face. Mothers of infants who develop ambivalent/resistant attachment use more intrusive touch (scratching, pulling, pushing, poking, pinching) with their infants and, by four months of age, their infants are not emotionally organized by their mother’s touch (Beebe et al. 2010). Thus, while physical contact typically contributes to the development of a secure attachment, for young children who have experienced excessive intrusive touch from their caregivers, physical contact with their caregiver may be dysregulating. Infants with an ambivalent/resistant attachment with their caregiver cannot count on their caregiver’s availability so need to maintain constant vigilance rather than exploring. However, they are also on guard against intrusive interactions with their caregiver so are unable to relax and accept comfort from her when she is available.

It has been hypothesized that inconsistent responding in some caregivers in ambivalent/resistant dyads may result from an unconscious desire to heighten the child’s attachment behavior (Beebe et al. 2010). In other caregivers, the inconsistent responding may be the result of parenting stress (Scher and Mayseless 2000).

As shown in Tables 6.3 and 6.4, the relatively low rates of ambivalent/resistant attachment make conclusions about which attachment-based interventions are especially effective at reducing ambivalent/resistant attachment tentative. However, a variety of approaches focusing on providing parents with support and increasing parents’ sensitive responsiveness to attachment signals seem to be associated with reductions in ambivalent/resistant attachment. In families with a history of maltreatment, interventions that provide support to parents and reinforce maternal sensitive responsiveness are associated with improvements in ambivalent/resistant attachment (Cicchetti et al. 2006; Moss et al. 2011). In dyads with irritable infants, a skills-based intervention focused on improving sensitive responsiveness (van den Boom 1994) is associated with improvement in ambivalent/resistant attachment while the Circle of Security home visiting approach (Cassidy et al. 2011) is not. One of the strategies used for intrusive mother of irritable babies in van den Boom’s (1994) approach is having the mother describe what her infant is doing which may reduce the pattern of chase and dodge reported in ambivalent/resistant dyads. The Circle of Security (COS) protocol used in an at-risk Head Start group also fails to lead to a decrease in the rate of ambivalent/resistant attachment (Hoffman et al. 2006).

Characteristics of preoccupied state of mind are summarized in Table 6.5. Preoccupied state of mind occurs in 3–10 % of adolescents and adults (Bakermans-Kranenburg et al. 2009; Booth-LaForce and Roisman 2014; Caspers et al. 2007) . Rates are also relatively low in parents seeking help with parenting (1–5 %) (Korfmacher et al. 1997; Routh et al. 1995). Rates are somewhat higher among patients receiving psychotherapy for borderline personality disorder (15 %) (Levy et al. 2006).