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Expert’s Corner: Mary Cullen


Clare Jerrom speaks to Independent Social Worker, Mary Cullen about the importance of attachment theory in social work practice.

Attachment theory can be under-rated in social work practice, an expert in parenting, emotional and cognitive functioning in children and adults has warned.

Independent Social Worker Mary Cullen says that while attachment theory is one of many strands she draws on when carrying out parenting assessments, the theory can generally be under-rated in the profession.

‘Attachment theory needs delving into’

Mary’s career has largely been within the children and families sphere and she now works as an ISW providing well-evidenced assessments of risk, parenting and attachment. She was fortunate enough to have worked as a social worker and case manager at Family Care, Marcus House, between 2006 and 2012 where she was responsible for undertaking parenting assessments, providing reports in Family Court Proceedings, attending court as an expert witness in matter relating to attachment, parenting, risk assessment, family relationships and contact in relation to children.

“The organisation was very interested in attachment theory and invested heavily in training on the issue. The team reflected together and worked together as a whole to put strategies in place and it’s where the majority of my knowledge on attachment theory stems from,” she explained.

Mary also delivers one-day lectures on attachment theory to social work students and her experience of using the theory in her work, however, she says she doesn’t think it is routinely “delivered as much as it should be” for social work students. “There needs to be a lot more done on it.  It needs to be delved into rather than just given the blanket approach,” she says.

‘Victoria Climbie and Baby Peter exhibited avoidant-dismissive, compulsive attachment very clearly’

Attachment theory was first derived from psychanalyst John Bowlby who drew together a large base of theoretical work. Mary Ainsworth developed the thinking further and Pat Crittenden, a student of Ainsworth and a theorist in developmental psychopathology, developed the Dynamic-Maturational Model of attachment and adaptation (DMM) which is the model that Mary uses in her parenting assessments.

Mary describes attachment theory as “looking at how an individual organises their behaviour and thinking in order to stay safe”. Initially Bowlby referred to four types of attachment:

  1. Avoidant-dismissive
  2. Secure
  3. Anxious-ambivalent
  4. Disorganised

DMM discards the disorganised attachment, claiming that some people may have a combination of the other three.

Mary explains: “Children who use dismissive/avoidant and compulsive strategies (in at risk cases) inhibit their feelings when under threat. They do what other people want, blame themselves, exonerate powerful adults, feels shame, sometimes explode with anger and have no explanation for explosive behaviour. In the two high profile child deaths Victoria Climbie and Baby Peter Connolly, both children exhibited compulsive strategies.  They suffered horrific physical abuse but had big smiles on their faces to hide what was happening. They inhibited their own feelings and developed a strategy of smiling to appease their abusers (to reduce the possibility of dangerous consequences), however these strategies did not keep them safe. Professionals seeing the children wouldn’t know anything was wrong.”

Attachment strategy refers to the mental and behavioural strategies used by children and adults in order to stay safe and elicit support, when faced with anxious or threatening situations.  Put another way, an attachment strategy is what we do and how we think when we feel unsafe or uncomfortable. Such strategies and defences, whilst developed in infancy and childhood to elicit nurture and protection from parents and carers, continue to shape relationships into adulthood, as well as be informed by them. Interviews such as the Adult Attachment Interview track how information is distorted by the brain in order to assist an individual in dealing with any perceived dangers to themselves or their children.  Over time, human beings learn to exaggerate the importance of feelings and thinking that has helped them stay safe, and omit, or minimise what has been irrelevant or misleading to them.  In this way our ways of thinking and feeling about our close relationships are influenced by the dangers and fears we have experienced.  Sometimes, however what may have helped us stay safe in one situation can mislead and cause problems when we face a situation that is very different, or these strategies might have unintended consequences on other people.

Type A inhibit their emotions, Type C exaggerates them             

Type B, the secure attachment, is where the individual is balanced and can use integrated affect and cognition, Mary adds.

“The anxious-avoidant children in Type C are the children who keep attachment behaviour turned on beyond the point safety is available.  They exaggerate three feelings; fear, anger and a desire for comfort.  The Type C coercive strategy do things that will maximise and keep adult attention.  Type C use little cognition and intense affect.  Also called coercive, preoccupied, and in at risk cases, obsessive.”

“Type A inhibit their emotions, Type C exaggerate them,” adds Mary.

Naturally when Mary is carrying out parenting assessments, she looks at both the attachment strategy of the child and also of the parent and looks into their childhood histories to see why they act the way they do and therefore if there are risks to the child. She outlines how a parent who is Type A and avoidant will minimise and dismiss problems in order to reduce conflict and difficulty.

Type C parents perceive themselves as victims blaming others and consider themselves as innocent.  They will often offer elaborate false reasoning to mislead themselves and others, adds Mary. They find it almost impossible to see another person’s perspective.

Some parents become controlling

Mary uses attachment theory all the time in her parenting assessments. She turns to the ‘Meaning of the Child’ Interview,  an interview asking parents to talk about their child, their experience of parenting, and of being parented, to examine parental reflective capacity, as well as how the parent is connected to the child: what the child means to his or her parent.

Difficulties in parenting often occur when a child takes on a meaning to the parent (perhaps one more related to the parents’ own experiences), which varies from the child’s individual characteristics and development, and yet comes to dominate the parent-child relationship.  The interview allows this “script” for the parent-child relationship to be seen and understood, so the risk can be more accurately assessed, and interventions offered when appropriate.

Type A parents, she says, struggle to acknowledge their child’s negative affect and will tell her that everything is great in their relationship and “cannot enter into the child’s emotional state”. On the other side, the parents who are Type C struggle to see their children’s vulnerabilities, and their feelings and underlying needs, and so at times may be blaming of the child, making the child over responsible for the problems in their relationship or they may be distancing of the child.  The child can therefore take on a negative meaning in the parent’s mind that can be more related to the parent’s own past experiences than their current relationship with the child.

Mary is quick to highlight that not every parent who has had a bad childhood will be a risk to their child but it is Mary’s job to see how balanced they, in terms of integrating affect and cognition or whether they cannot achieve balance and are “stuck in a preoccupied or helpless state”.

“It comes down to how they are functioning as a parent and whether they have unresolved traumatic experience.  Unresolved traumatic experiences refer to a possible set of terrifying experiences or losses that distort a person’s behaviour in major ways without them being aware of it.  That is, being exposed to extreme or ongoing danger or loss interrupts a child or adult’s strategy of staying safe, because how they are thinking and feeling has more to do with the past traumatic event or loss, than it has to do with their current situation,” she adds.

Furthermore, some parents who are preoccupied become very controlling of their children and the child has to conform to what the parent wants and that can lead to abuse.

Some children will have been so badly treated – like Victoria Climbie and Peter Connolly – that no work with the family would ever have worked particularly when the parents or parental figures are “very troubled people”. As our special report shows, it can also be difficult to engage with affluent parents of children suffering emotional neglect. While these children live in decadent houses, eat nutritional meals and attend private schools, their parents are very often “emotionally unavailable”. Indeed, the parents use their social status to prevent social work intervention by threatening legal action for example and Mary says these children often “fall through the net”.

CARE-Index

Therapy can be used to address familial issues and is best if problems can be identified before the child is two years old and before they are going to school to enable them to form peer relationships. There is also a “small window” of opportunity to work with teenagers when you can introduce incentives to manage challenging behaviour, adds Mary.  It is for this reason that Mary uses the CARE Index which can be a useful tool when working with babies.

The CARE-Index, developed by Crittenden, is an assessment of the developing relationship between a ‘parent’ and child. It uses a videotaped 3-5 minute free play observation in which the adult is asked ‘to play with your child as you would normally’. The CARE-Index can provide information about parents’ sensitivity and responsiveness to children’s signals and children’s strategies for coping with parents’ behaviour. Parental sensitivity is assessed by the extent to which the parent figure does things that please the child, or rather looks to control the child (because the child does not please them), or is unresponsive (and so is failing to connect with the child).  The child’s strategies can include being cooperative, protesting what they don’t like, passive acceptance, and compulsive behaviour, to fit in with parental expectations. The different patterns of insensitive parental care, and the child strategies that result from them, each carry a different sort of threat to the child’s development.

No hard fast rules

For slightly older children aged around seven to twelve years, Mary would use different techniques incorporating Story Stem Assessment, which is an assessment of attachment of children, using story telling assisted by doll play. For example, the first story stem might be a scenario whereby a child is outside playing and starts crying and Mary would ask the child what would happen next in this story, who would provide comfort to that child who is crying. The child would use dolls and play to act out her version of events which can be easier than asking children to speak about their emotions and what is happening in the family home. “Each story elevates in stress,” says Mary, explaining that the next story stem might be a child knocking over a pan of hot water and scalding themselves and she would ask what would happen next in that situation.

For teenagers, Mary turns to ‘The Child Attachment Interview’ which was developed primarily for 13 year olds but is also used with older adolescents and asks children to describe and reflect on their current attachment relationships and experiences. “I ask them to tell their story so far. Who are they closest to? Who protects them? Why is it that person? Have they got many friends? Are they happy with the number of friends they have? Do they like themselves? You can tell a lot from it.  Some feel helpless and play the victim saying nobody likes them, they have no friends as Type C. Others cannot say anything negative and claim that everything is great as a Type A,” she adds.

Mary is quick to point out that having secure attachment is not the answer to everything. “Attachment is not a trajectory it is dyadic. Just because a child did not have a good relationship with their parents, it might be that they had an attachment to a grandparent, an aunt or uncle where the child was comforted and protected, and that’s what we are looking for – good enough. There are no hard and fast rules. People use different strategies when under threat,” said Mary.

Painful places

“What I am looking at is how insecure the attachment is and the risk to the child. The risk would have to be high whereby they could not protect the child and so there’s a risk to their social and emotional development that could then lead to mental health problems and children self-harming,” explains Mary.  In extreme cases it leads to child deaths.

“A parent’s role in life is to make their child feel protected, comforted, loved, valued, special, and a person of worth. If a child does not feel valued or loved there is a danger that their mental, emotional and social development will be hindered and they will almost definitely have low self-esteem,” she added. Furthermore, there are issues relating to brain development in infants due to the release of cortisol which is released during periods of stress.

“If there is an insecure attachment, it doesn’t mean the child will be removed from their parents. It depends on the level of risk and the strategies the parents are using. If there is a high risk, the child would be removed as it could filter down to neglect and a lack of protection,” says Mary.

However, work can be carried out with families to address issues, in particular working with the parents and the child in Systemic Family Therapy.  Mary warns it can take time and needs the parent to be able to reflect and look at the child’s perspective. “Parents have to go to painful places,” warns Mary.

 

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