Application Of Attachment Theory

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Theory Into Practice: Four Social Work Case Studies In this course, you select one of the following four case studies and use it throughout the entire course. By doing this, you will have the opportunity to see how different theories guide your view of a client and that client’s presenting problem. Each time you return to the same case, you use a different theory, and your perspective of the problem changes—which then changes how you ask assessment questions and how you intervene. These case studies are based on the video- and web-based case studies you encounter in the MSW program. Application Of Attachment Theory

Table of Contents Tiffani Bradley ………………………………………………………………………………………………….. 2 Paula Cortez ……………………………………………………………………………………………………. 9 Jake Levey …………………………………………………………………………………………………….. 10 Helen Petrakis ………………………………………………………………………………………………… 13

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Tiffani Bradley Identifying Data: Tiffani Bradley is a 16-year-old Caucasian female. She was raised in

a Christian family in Philadelphia, PA. She is of German descent. Tiffani’s family consists of her father, Robert, 38 years old; her mother, Shondra, 33 years old, and her sister, Diana, 13 years old. Tiffani currently resides in a group home, Teens First, a brand new, court-mandated teen counseling program for adolescent victims of sexual exploitation and human trafficking. Tiffani has been provided room and board in the residential treatment facility for the past 3 months. Tiffani describes herself as heterosexual. Application Of Attachment Theory

Presenting Problem: Tiffani has a history of running away. She has been arrested on

three occasions for prostitution in the last 2 years. Tiffani has recently been court ordered to reside in a group home with counseling. She has a continued desire to be reunited with her pimp, Donald. After 3 months at Teens First, Tiffani said that she had a strong desire to see her sister and her mother. She had not seen either of them in over 2 years and missed them very much. Tiffani is confused about the path to follow. She is not sure if she wants to return to her family and sibling or go back to Donald.

Family Dynamics: Tiffani indicates that her family worked well together until 8 years

ago. She reports that around the age of 8, she remembered being awakened by music and laughter in the early hours of the morning. When she went downstairs to investigate, she saw her parents and her Uncle Nate passing a pipe back and forth between them. She remembered asking them what they were doing and her mother saying, “adult things” and putting her back in bed. Tiffani remembers this happening on several occasions. Tiffani also recalls significant changes in the home’s appearance. The home, which was never fancy, was always neat and tidy. During this time, however, dust would gather around the house, dishes would pile up in the sink, dirt would remain on the floor, and clothes would go for long periods of time without being washed. Tiffani began cleaning her own clothes and making meals for herself and her sister. Often there was not enough food to feed everyone, and Tiffani and her sister would go to bed hungry. Tiffani believed she was responsible for helping her mom so that her mom did not get so overwhelmed. She thought that if she took care of the home and her sister, maybe that would help mom return to the person she was before. Application Of Attachment Theory

Sometimes Tiffani and her sister would come downstairs in the morning to find empty beer cans and liquor bottles on the kitchen table along with a crack pipe. Her parents would be in the bedroom, and Tiffani and her sister would leave the house and go to school by themselves. The music and noise downstairs continued for the next 6 years, which escalated to screams and shouting and sounds of people fighting. Tiffani remembers her mom one morning yelling at her dad to “get up and go to work.” Tiffani and Diana saw their dad come out of the bedroom and slap their mom so hard she was knocked down. Dad then went back into the bedroom. Tiffani

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remembers thinking that her mom was not doing what she was supposed to do in the house, which is what probably angered her dad.

Shondra and Robert have been separated for a little over a year and have started dating other people. Diana currently resides with her mother and Anthony, 31 years old, who is her mother’s new boyfriend.

Educational History: Tiffani attends school at the group home, taking general education classes for her general education development (GED) credential. Diana attends Town Middle School and is in the 8th grade.

Employment History: Tiffani reports that her father was employed as a welding

apprentice and was waiting for the opportunity to join the union. Eight years ago, he was laid off due to financial constraints at the company. He would pick up odd jobs for the next 8 years but never had steady work after that. Her mother works as a home health aide. Her work is part-time, and she has been unable to secure full-time work.

Social History: Over the past 2 years, Tiffani has had limited contact with her family

members and has not been attending school. Tiffani did contact her sister Diana a few times over the 2-year period and stated that she missed her very much. Tiffani views Donald as her “husband” (although they were never married) and her only friend. Previously, Donald sold Tiffani to a pimp, “John T.” Tiffani reports that she was very upset Donald did this and that she wants to be reunited with him, missing him very much. Tiffani indicates that she knows she can be a better “wife” to him. She has tried to make contact with him by sending messages through other people, as John T. did not allow her access to a phone. It appears that over the last 2 years, Tiffani has had neither outside support nor interactions with anyone beyond Donald, John T., and some other young women who were prostituting.

Mental Health History: On many occasions Tiffani recalls that when her mother was

not around, Uncle Nate would ask her to sit on his lap. Her father would sometimes ask her to show them the dance that she had learned at school. When she danced, her father and Nate would laugh and offer her pocket change. Sometimes, their friend Jimmy joined them. One night, Tiffani was awakened by her uncle Nate and his friend Jimmy. Her parents were apparently out, and they were the only adults in the home. They asked her if she wanted to come downstairs and show them the new dances she learned at school. Once downstairs Nate and Jimmy put some music on and started to dance. They asked Tiffani to start dancing with them, which she did. While they were dancing, Jimmy spilled some beer on her. Nate said she had to go to the bathroom to clean up. Nate, Jimmy, and Tiffani all went to the bathroom. Nate asked Tiffani to take her clothes off and get in the bath. Tiffani hesitated to do this, but Nate insisted it was OK since he and Jimmy were family. Tiffani eventually relented and began to wash up. Nate would tell her that she missed a spot and would scrub the area with his hands. Incidents like this continued to occur with increasing levels of molestation each time. Application Of Attachment Theory

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Bringing practice into theory: Reflective practice and attachment theory Maree Foley, Mary Nash and Robyn Munford

Maree Foley is a PhD candidate in the Department of Management and International Business at the University of Auckland Business School, a NZ Registered Psychotherapist and full member of NZACAP.

Mary Nash is a Life Member of ANZASW and lectures at Massey University.

Robyn Munford is co-leader of a FRST-funded research project on young people’s pathways to resil- ience and works in the School of Health and Social Services, Massey University. Application Of Attachment Theory

Abstract

The relationship between social work practice and attachment theory has been longstand- ing across decades. While much attention has been paid to the use of attachment theory within specific social work practice settings, less attention has been focused on the use of attachment theory to guide the social worker in their practice based reflections. This article explores the potential relevance of attachment theory for use within a reflective practice set- ting. This exploration is based on key findings from a recent study conducted in Aotearoa New Zealand. A proposed beginning framework of attachment theory informed reflective practice is offered for practitioners to explore in their reflective practice.

Introduction

Exploration of the relationship between theory and practice has been a longstanding endea- vour within many disciplines including social work (Longhofer & Floersch, 2004; D’Cruz, Gillingham, & Melendez, 2007, p.74). This paper explores the use of attachment theory to inform reflective practice and, in turn, to potentially inform social work practice. This explo- ration is based on a recent Aotearoa New Zealand Masters research study that explored the relationship between theory and practice, from the vantage point of the social worker (Foley, 2007). This paper begins by providing a brief overview of this study, including a review of current attachment theory literature for social work practitioner use. Next, a summary of the study’s findings is reported.

The remainder of this paper attends to the authors’ reflections on how the raw findings might usefully inform reflective practice. It is postulated that knowledge of attachment theory can be useful for the practitioner to increase understanding of both shared and unique protective and adaptive behaviours within a practice setting where their capacity to think, reflect and make meaningful connections may become compromised. Based on these postu-

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lations, an exploration of bringing key dynamics of social work practice with children and families into attachment theory is explored. This exploration is followed by the beginning formulations of an attachment theory informed reflective social work practice. Application Of Attachment Theory

Overview of the study

This study began with a review of the literature on attachment theory and social work prac- tice, where it was clear that interest in attachment theory as a relevant social work practice theory has been sustained over a number of decades (Bowlby 1969, 1973 and 1980; Ainsworth & Bowlby, 1991; Cassidy and Shaver, 1999). As such a plethora of relevant literature for this study was found (Fahlberg, 1991; Howe, 2005; Howe, Brandon, Hinings & Schofield, 1999; Nash, Munford, & O’Donoghue, 2005; Atwool, 2006). Surprisingly, studies that investigated social work practitioners’ knowledge of attachment theory to inform their practice, found that attachment theory knowledge was not as prominent as expected (Hesse, 1982; Grigsby, 1994; Hendemark, 2004). In addition, recommendations from these social work practice specific studies each implied a view that advocating for increased attachment theory ori- ented education would equate with the capacity to use this theory in practice. As such there seemed to be an underlying assumption within the recommendations of these studies that theoretical knowledge equates with use, and use amidst the real time and moments of the social work-client relationship.

Given the above paradoxical findings above, Foley (2007) conducted a study that sought to gather Aotearoa New Zealand data regarding the practice status of attachment theory and research developments as experienced by social workers within their social work practice with children and their families. While keeping in mind socio-cultural- contextual issues, the primary focus of this study was the microsphere of practice. This study endeavoured to understand the journey of a theory, attachment theory, through the vehicle of the social worker in their practice descriptions of using attachment theory to inform their practice.

In this qualitative phenomenological study (Van Manen, 1990), eight social workers who

self-identified as being interested in and knowledgeable about attachment theory were in- terviewed and were invited to reflect on their experiences of putting attachment theory into social work practice with children and families. One of the interview questions included: ‘What aspects of attachment theory have made the most sense to you as a social worker?’ That is, most of the social workers in this study began their reflections not with accounts of attachment theory knowledge, but with their own responses to the theory. Application Of Attachment Theory

Application of Attachment Theory in Clinical Social Work

Thomas Joseph Blakely and Gregory M. Dziadosz

This article proposes the use of attachment theory in clinical social work practice. This theory is very appropriate in this context because of its fit with social work concepts of person-in-situation, the significance of developmental history in the emergence of psycho- social problems, and the content of human behavior in the social environment. A literature review supports the significance of the theory. Included are ideas about how attachment styles and working models may be used in assessment and treatment to help clients achieve a secure attachment style.

KEY WORDS: attachment styles; attachment theory; clinical practice; working models

This article was written to promote the use of attachment theory as a framework for assess-ment and treatment in clinical social work practice. The relationship between mental health and attachment is discussed, followed by the history of the theory. Then, the key concepts of the theory are pre- sented, and some examples of its application for social work practice are followed by our proposals for its use in assessment and treatment.

LITERATURE REVIEW Attachment theory was first formulated by John Bowlby. He wrote a report for the World Health Organization titled Maternal Care and Mental Health that contributed substantially to understanding the concepts of mental health and mental ill-health ( Bowlby, 1951). In this monograph, he made it very clear that deprivation of the mother–child relation- ship, depending on the length and type, contributed to psychopathology.

For the moment it is sufficient to say that what is believed to be essential for mental health is that the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother- substitute) in which both find satisfaction and enjoyment. ( Bowlby, 1951, p. 11)

His work at the London Tavistock clinic with chil- dren, along with the research evidence presented by other psychiatrists and mental health workers around the world, convinced him that the attachment of the

child to the mother or permanent mother substitute was essential to mental health. Bowlby (1969, 1973, 1980) has written extensively on the subject of sepa- ration and loss of the primary caretaker that has a seriously negative effect on mental health, interper- sonal relationships, and social functioning. Application Of Attachment Theory

Mikulincer and Shaver (2012) described the rela- tionship between attachment theory and mental health: “Attachment theory has proven to be a very fruitful framework for studying emotion regulations and mental health” (p. 11). These authors reviewed a large number of clinical and nonclinical studies and noted that attachment problems occurred frequently with people with mental disorders.

Sonkin (2005) proposed that attachment style (which is discussed later) can be changed during psychotherapy. He commented further that adult attachment research suggested that there is continu- ity in the style from childhood through adolescence and into adulthood in the way a person learns to manage anxiety arising from a lack of a positive at- tachment experience to the primary caretaker early in life. He added that a therapist can become a secure base and fulfill the position of attachment figure so that a client can be helped to achieve a secure at- tachment style that is characteristic of mental health.

One’s mental health is inextricably linked to one’s general health. Thus, attachment theory, as it con- tributes to successful psychotherapeutic interven- tions, also contributes to maintenance of good health. Salovey, Rothman, Detweiler, and Steward (2000) linked emotional states and physical health: “Psychotherapists and practicing physicians similarly

283doi: 10.1093/hsw/hlv059 © 2015 National Association of Social Workers

have recognized the co-morbidity of psychological and physical disorders” (p. 110). Sarah Pressman re- ported on an investigation with Gallup of the effect of human emotion on physical health. “According to Pressman, positive emotions unmistakenly are linked to better health, even when taking into account a lack of basic needs. The inverse holds true as well. Neg- ative emotions were a reliable predictor of worse health” ( University of Kansas, 2009, p. 1).

Based on the foregoing, it is reasonable to conclude that there is a relationship between physical health and mental health and that attachment theory, as one approach to clinical services for people with mental health problems, has a bearing on physical health as well.

Attachment theory already has been broadly used by therapists in various ways. Blatt and Levy (2003) elaborated on the “synergistic relationships between psychoanalysis and attachment theory and research, especially for understanding the nature of psycho- logical disturbances” (p. 107). This relates the applica- tion of attachment theory to psychodynamic psychology, an outstanding psychiatric theory base. Treatment that improved attachment functioning was proposed for people with an eating disorder ( Tasca, Ritchie, & Balfour, 2011). Mary Dozier has written several articles about attachment theory for assisting children, especially those in foster and adoptive care, with attachment issues ( Dozier, 2003; Dozier & Rutter, 2008). She and her colleagues established a lab to study infants and children who have experi- enced adaptation problems with caregivers. The theory also was proposed for adult psychiatry ( Ma, 2006).

Sonkin (2005) wrote, “Over the past ten years, a number of individuals have begun to explore how this body of knowledge of attachment theory would apply to clinical practice” (p. 72). Dutton and Sonkin (2003) described the use of attachment theory as a base for the treatment of men who commit assault. Attachment theory has informed the treatment of depression in adults ( Bettman, 2006). Fraley and Shaver (1997, 1999) described its use in managing unwanted thoughts in obsessive–compulsive disorder and with regard to bereavement and detachment in managing grief. Knowledge of attachment theory and its application enables the social work therapist to promote changes in a client’s feeling and thinking with an increased sense of security that leads to a secure attachment style. Application Of Attachment Theory

The Analytic Principle and Attitude: Mobilizing Psychoanalytic Knowledge to Maximize Social Work Students’ Practice Competence

Les Fleischera and Eunjung Leeb

aDepartment of Social Work, Lakehead University Orillia, Orillia, Ontario, Canada; bFactor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada

ABSTRACT Although psychoanalytic approaches have been marginalized in the foundations of contemporary clinical social work practice, there are core themes in various psychoanalytic theories that can be made accessible to maximize students’ practice competence. We elucidate the psychoanalytic principle of unconsciousness as well as the analytic attitude of inquisitive listening and its components. Using vignettes, we demonstrate how we teach this attitude in bachelor’s in social work (BSW) and master’s in social work (MSW) classrooms. This approach can help students begin to think and listen psychoanalytically. It offers them a way to better understand the person beyond the symptoms.

KEYWORDS analytic principle and attitude; psychoanalysis; social work students; practice competence

Social workers strive to develop a comprehensive understanding of the person in their environment, often with respect to the person’s presenting concerns and their underlying formations, and accordingly, to intervene in a way that will facilitate change. To achieve this professional task, social work curricula and training teach various psychological and social theories to guide students’ practice. Integrating various approaches to custom fit a particular client in a specific environment is an episteme of clinical social work practice. Application Of Attachment Theory

To understand the uniqueness of each person, various psychological theories in general and psychoanalytic theory in particular have been widely incorporated into clinical social work practice and education in a manner that is consistent with social work values, ethics, and ideas (Berzoff, Flanagan, & Hertz, 2011; Borden, 2009; Mishna, Van Wert, & Asakura, 2013; Smaller, 2002). More specifically, psy- choanalysis has enriched social work through its understanding of unconscious processes, intrapsychic and interpersonal dynamics, developmental factors, and the therapeutic relationship. At the same time, social work values and core

CONTACT Les Fleischer, PhD lfleisch@lakeheadu.ca Lakehead University Orillia, Faculty of Health and Behavioural Sciences, Department of Social Work, 500 University Avenue, Orillia, ON L3V 0B9, Canada. © 2016 Taylor & Francis Group, LLC

PSYCHOANALYTIC SOCIAL WORK 2016, VOL. 23, NO. 2, 99–118 http://dx.doi.org/10.1080/15228878.2016.1149776

principles have contributed to contemporary psychoanalytic thinking and concepts by situating the person’s characteristics within the context of their complex envi- ronment (Brandell, 2002, 2004, 2013; Goldstein, 2001, 2009; Miehls, 2011; Smaller, 2002). This close, strong tie between social work and psychoanalysis has a long his- tory that continues to the present day (see Goldstein, 2009).