In the George Washington (GW) University Hospital auditorium, a video of 1-year-old Harry played across a screen. Harry, sharing a room with his mother, dragged a musical push-along toy before dropping it to bat at a stuffed monkey. As a stranger entered the room and engaged with the babbling Harry, Harry’s mom left. When he noticed her absence, Harry picked his way across the floor, shoving strewn toys out of his path. At his mother’s return, Harry’s distress dissipated, but he continued to grip at her clothes.
“He cleared away those toys as if clearing a landmine or a series of landmines in order to get back to his caregiver for safety,” explained Miriam Steele, Ph.D., professor and director of clinical training at the New School for Social Research.
Harry’s experience during the “Strange Situation,” a test designed to examine child attachment patterns, was just one element Steele presented during her talk, “Clinical Implications of Attachment Theory and Research,” at the 35th Annual Daniel Prager, M.D., Endowment Lecture at GW May 28. Prager, said James Griffith, M.D., the Leon M. Yochelson Professor and chair of the Department of Psychiatry and Behavioral Sciences at GW’s School of Medicine and Health Sciences, “was a beloved teacher for many years” as well as a practicing psychoanalyst. Prager’s friends and colleagues endowed the lecture in order to bring leading psychoanalytic thinkers to GW. Steele, Griffith added, typifies such a thinker.
“She learned how to achieve therapeutic effects with far briefer treatment approaches, not by diagnosing psychiatric illnesses in children, but by learning how to work therapeutically with their attachment relationships with parenting figures,” Griffith said. “Dr. Steele’s work has achieved significance as a bridge between the world of psychoanalytic thinking and clinical practice and contemporary research in child development.”
Steele has traced her research through several studies, including the longitudinal one in which Harry and his mother participated. Harry, Steele explained, exhibited “secure” attachment. “These are children who tend to get upset in the Strange Situation, but most importantly look to the caregiver for protection or to get emotionally refueled and get back to some kind of emotional homeostasis when the parent returns,” she said.
Sixty-five percent of children qualify as secure, she added, while 20 percent are thought to be avoidant — they don’t exhibit distress when separated from a caregiver, though their cortisol levels rise and don’t subside upon reunion — and another 10 percent are considered resistant or ambivalent. “These children tend to fall apart during the Strange Situation,” Steele said. “They try and get their parent to pick them up when the parent returns. As soon as they get picked up, they want to be put down again. Once they’re down, they want to be picked up again.” All three categories — secure, avoidant, and resistant — aren’t necessarily problematic, because in each case, the child has a strategy. It’s the remaining 5 to 10 percent of children who qualify as “insecure” that raises concerns.
“These are the children we’re most concerned about,” said Steele. “They’re children who seem not to have a strategy. They tend to fall apart during the Strange Situation by doing things like freezing or stilling, or when the parent walks into the room, they leave the room, which, from an evolutionary perspective, doesn’t make a lot of sense.”
To ameliorate the negative effects of insecure attachments, Steele turned to the parents. As she explained, secure or insecure attachments are intergenerational; parents, who as children developed secure attachments with their parents, will likely have a secure bond with their own children. For insecure parents, then, a potential solution comes by focusing on the parent, rather than the child. The key, Steele found, is in “reflective functioning.”
“Reflective functioning, briefly defined, is that capacity to put yourself in someone else’s shoes and to think about the thoughts, feelings, and attentions of the other and to speak about them in a coherent way,” Steele said.
When a mother can understand the thoughts, motivations, and feelings of her own mother during her childhood, she’s better equipped as a caregiver. One way in which Steele approached reflective functioning was through an adult attachment interview with 100 mothers and 100 fathers. Interviewees identified five adjectives to describe their mother and father, explained what they would do when angry as a child, and talked about physical abuse and loss. They then answered questions designed to assess reflective functioning, such as “Why do you think your parents behaved the way they did during your childhood?” and “Do you think that your childhood experiences have in any way influenced who you are today?”
The results showed that reflective-functioning capability allowed parents — regardless of whether their backgrounds were secure or deprived — to develop secure bonds with their children. Those who didn’t have that ability were less likely to establish secure attachments.
“From this, we learned something really important about how to break that cycle of abuse, how to break the cycle of that intergenerational pattern of handing down insecurity,” Steele said.
Steele’s studies have also focused on late adoptions and ensuing parent-child bonds as well as Group Attachment Based Intervention, or therapy that targets a high-risk group; parents in this study suffered from past and ongoing trauma, and their children, aged 0 to 3, were also potentially exposed to trauma.
As Steele wrapped up her lecture, she turned back to Harry, the toddler who showed secure attachment in her longitudinal study.
“Development is a magical thing, and we can try and trace some of what he shows as a 1-year-old with how he responds to questions about where he’s at as a 19-year-old,” Steele said.
As an adult, Harry, who is studying biomedical science at Southampton University in England, was completing the separation process from his mother. “At first you’re a bit apprehensive, then you just kind of settle into a routine,” he said of his move away from home. “I’m coping fine. I call my mum up if I do have any problems, if I’ve broken the dryer or something. Apart from that, it’s going really well.”