Avoidant (A)
Spends majority of time in exploratory behavior but quality of exploration and play is relatively poor. The baby is not distressed during separation when the stranger is present. Ignores parent’s return, often by feigning interest in toys. Avoids proximity to mother during reunion
A1
Conspicuous avoidance of parent during reunion. If picked up by parent, tends to look away and not mold to parent
A2
The baby displays some greeting on parent’s return but it is mingled with avoidance
Table 7.2
Description of avoidant attachment in preschooler-parent dyads. (Source: Cassidy and Marvin 1992)
Avoidant (A) | Child is focused on exploration. Interactions do not seem warm or special |
Avoidant ignoring (A1) | During reunion, child ignores parent |
Avoidant neutral (A2) | During reunion, child may interact with parent but interactions do not appear relaxed or comfortable |
Parenting Behavior Associated with Avoidant Attachment
The parenting behavior associated with avoidant attachment is lack of sensitive responsiveness to infant distress (Ainsworth et al. 1978; van den Boom 1988, 1989, 1994). As seen in Tables 7.3 and 7.4, a parent coaching intervention that improves maternal sensitive responsiveness to infant distress and positive attachment signals in a sample of Dutch, irritable infants is clearly effective in reducing rates of avoidant attachment (van den Boom 1994) while interventions targeting sensitive responsiveness in maltreatment populations do not appear to significantly reduce avoidant attachment in these populations. Given the significant stressors in these populations, it may be difficult for these dyads to overcome a tendency to turn away when they feel vulnerable or distressed once this pattern has been established. Circle of Security protocols which educate parents about secure attachment and prompts them to reflect on barriers to responding to their child’s attachment signals, are associated with reduced rates of avoidant attachment
Table 7.3
Rates of avoidant attachment in intervention studies
Population | Model | Rate of avoidant attachment | Reference |
Infants in maltreating families (United States) N = 137 | Child-Parent Psychotherarpy (CPP) Nurse-Family Partnership (NFP) Community Standard Care (CS) | Pre CPP: 6 % Post CPP: 7 % Pre NFP: 12 % Post NFP: 0 Pre CS: 4 % Post CS: 18 % | Cicchetti et al.2006 |
Toddlers of mothers with Postpartum Major Depressive Disorder (United States) N = 130 | Child-Parent Psychotherapy (CPP) Control (Con) | Pre CPP: 36 % Post CPP: 17 % Pre Con: 28 % Post Con: 35 % | Toth et al. 2006 |
At-risk Head Start and Early Head Start group (N = 65) (United States) | Circle of Security (COS) | Pre COS: 17 % Post COS: 11 % | Hoffman et al. 2006 |
First born, irritable infants in economically stressed households (United States) N = 220 | Circle of Security—Home Visiting-4 Intervention (COS-HV4) Control (Con) | COS-HV4: 11 % Con: 17 % | (Cassidy et al. 2011) |
Table 7.4
Rates of avoidant attachment in parent coaching interventions
Population | Model | Rate of avoidant attachment | Reference |
|---|---|---|---|
First born, irritable, low SES infants (Netherlands) N = 100 @ 12 mos.; 82 @ 18 mos. | Skills-Based Intervention (SBI) Control (Con) | SBI @ 12 mos.: 24 % SBI @ 18 mos.: 19 % Con @ 12 mos.: 52 % Con @ 18 mos.: 51 % | van den Boom 1994 |
Maltreated infants and preschoolers (French Canadian) (N = 67) | Relationship Intervention Program (RIP) Community Services (CS) | Pre RIP: 14 % Post RIP: 14 % Pre CS: 12 % Post CS: 6 % | Moss et al. 2011 |
Dismissing State of Mind
Characteristics of dismissing state of mind are summarized in Table 7.5. Approximately one-third of adolescents and adults in community samples have a dismissing state of mind (Bakermans-Kranenburg and van Ijzendoorn 2009; Booth-LaForce and Roisman 2014). A similar rate is found in parents participating in parent management treatment for disruptive disorder (Routh et al. 1995), patients receiving psychotherapy for borderline personality disorder, adults who had been adopted as infants (Caspers et al. 2007), foster mothers (Dozier et al. 2001b), and adoptive fathers (Steele et al. 2008). Populations with lower than typical rates of dismissing state of mind (12 to 16 %) include low income mothers participating in a preventive home visiting intervention (Erickson et al. 1992), adoptive mothers (Steele et al. 2008), and parents of children with autism (Seskin et al. 2010).
Dismissing of attachment (Ds) | Dismisses the importance of early attachment relationships by failing to recognize negative early experiences and/or negative effects of difficult early experiences. Generalized descriptions of relationships with parents (semantic level) are not supported by specific memories, attachment figures are devalued, or adult reports he was not affected by early experiences or negative experiences made him stronger |
Dismissing of attachment (Ds1) | Discrepancy between generalized picture of parent as excellent or normal and descriptions of childhood interactions that do not support or actively contradict this picture. Insists they have no memory for childhood and presents this as normal |
Devaluing of attachment (Ds2) | Parents or attachment-related experiences are described with contempt |
Restricted in feeling (Ds3) | Difficult childhood attachment experiences are mentioned but followed by an upbeat description of parents or the positive impact of difficult experiences. Childhood is described as normal or typical but there are no specific memories consistent with this description |
Cut-off from the source of fear of death of the child (Ds4) | Fear of child’s death that parent fails to connect to any specific source |
Research on Dismissing State of Mind
Mothers with dismissing state of mind tend not to attune to their infant’s negative affect (Haft and Slade 1989). In a recent study of pregnant women’s physiological response (heart rate, skin conductance, and respiratory sinus arrhythmia) to brief video segments of mother-infant interactions, women with a dismissing state of mind exhibit physiological responses associated with aversive consequences when watching a video of a mother unable to soothe her crying infant (Ablow et al. 2013). Surprisingly, watching a video of a mother and infant playing contentedly evokes a similar physiological response. This study helped me realize that while early interventionists typically consider playing with children a positive experience, for parents with a dismissing state of mind it can be akin to nails on a chalkboard.
During individual therapy sessions, adults with dismissing state of mind are less likely to express distress to their therapist, ask for help, or express gratitude to the therapist (Talia et al. 2014). They are more likely to directly avoid the therapist’s questions by responding briefly and then becoming silent, downplay distress by laughing after recounting a distressing experience, or disqualify negative feelings by conveying self-sufficiency (Talia et al. 2014). During interactions with their case managers, adults with dismissing state of mind and a diagnosis of schizophrenia or bipolar disorder, spent more time off task (Dozier et al. 2001a). Interestingly, this was due to the case managers changing the topic more frequently, presumably in response to nonverbal cues indicating the person was uncomfortable. During interactions with their significant others, adults with Dismissing state of mind and a diagnosis of schizophrenia or bipolar disorder used more active distancing strategies when sensitive topics were raised, e.g. sighing and making sarcastic comments. The significant others of individuals with dismissing state of mind reported more sadness following problem-solving interactions with their partner.
Clinical Observations and Recommendations
Countertransference Reactions
In dyads with an avoidant attachment/parents with a dismissing state of mind, parents and children tend to be critical of each other and of the provider, leading the provider to feel he needs to protect himself from challenges and criticisms. Parents who drop out of behavioral parenting interventions criticize their child more often during the pre-treatment behavioral assessment than parents who complete treatment (Fernandez and Eyberg 2009) and parent coaches are more critical and directive of parents who criticize their child more during child-led play sessions (Barnett et al. 2014). These two studies remind me that when faced with a parent who frequently criticizes me and their child, I need to remain aware of how this affects me so I am not pulled into a negative cycle. I focus on identifying the parent’s strengths so I can give them genuine praise during coaching sessions. (I sometimes need to seek consultation from another therapist in order to identify these strengths and why this parent gets under my skin). I often use the code the coach form in Chap. 4 to evaluate whether I am giving them enough positive feedback during sessions. With preoccupied parents the criticism of the provider tends to be more nattering and whiny (Yes, but) while with dismissing parents it tends to be more pointed and sarcastic (You may have gone to school for a long time but you don’t know what you’re talking about.)
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