john bowlby

Attachment Disorders and Grief

Posted on by Dominick Flarey

Human beings are social creatures by nature.  They need care and nurturing in their infancy to properly form bonds with caregivers.  These bonds teach security and help bolster individuals and their social development with others they meet.  Future intimate relationships and friendships are dependent upon initial bonds.  Healthy and secure bonds with the primary caregiver translate to healthier social interaction in the future.

John Bowlby, famous psychoanalyst, worked extensively in the area of attachment.  His attachment theory today remains a benchmark for understanding individuals who suffer various attachment disorders stemming from their infancy and early childhood.

Infants need trust and security in forming early bonds. Please also review AIHCP’s Grief Counseling Certification

 

The article, “What Is an Attachment Disorder?” by Amy Morin examines the various types of attachment disorders.  The article discusses the origins of attachment disorders, the types, and how they manifest during childhood and later in life.  Morin states,

“An attachment disorder is a condition that affects mood or behavior and makes it difficult for people to form and maintain relationships with others. These conditions usually begin in early childhood, but attachment issues may also persist into adulthood.  Attachment issues are not an official diagnosis, but people use the term to refer to an insecure attachment style in adults. Adults with insecure attachment styles may express avoidance or ambivalence in relationships or behave in disorganized or inconsistent ways.”

“What Is an Attachment Disorder?”. Amy Morin. November 14th, 2022. VeryWellMind

To read the entire article, please click here

Commentary

Attachment disorders can play havoc with individual’s future relationships and how they form future bonds.  It is so critical to give little children the love and nurture they need.  When a child’s needs are not met, they can lose trust.  Without trust, the child is becomes untrusting and unable to trust other caregivers or form other bonds.  Bowlby noticed this in his observations of little babies that were cared for when they cried or were hungry as opposed to babies that were left to cry by their parents or their needs were not met.  This created unhealthy bonds with the caregiver and proceeded forward.  What should have been a healthy bond that is trusting and secure, the child exhibited lack of trust and various insecurities.

Clinical Attachment Disorders

The Diagnostic and Statistical Manuel of Mental Disorders recognizes two distinct types of attachment disorders.  They both are due to lack of care and needs met at a young age and both exhibit insecurity and lack of trust but they manifest differently.  The first is Disinhibited Social Engagement Disorder in which the child and later the adult exhibit problems forming true and lasting relationships with others but will look to form superficial bonds that are not permanent.  In children, this is displayed with a lack of shyness around strangers or other adults.  In teen years, they may outwardly form relationships but they are unable to find connection with others and true meaning.  This obviously can lead to many superficial issues.

Children can form avoidant or anxious type disorders when healthy bonds are not formed.

 

The second type of attachment disorder is Reactive Attachment Disorder.  The child and later adult are unable to form new bonds with anyone.  They are quiet, untrusting of caregivers, and avoidant of forming new relationships.  Many are unable to form the necessary connection to have any type of meaningful relationships.  They in turn will jump from relationship to relationship without having any true connection or meaning.

Characteristics of Attachment Disorders

Insecure attachment disorders form due to the lack of security that most children receive at an early age.  Without the security and love, the child grows into new relationships with serious trust issues.  Anxious-Insecure Attachment is the labeled term.    The child exhibits with the primary caregiver a very needy and clingy relationship that pushes for and craves attention but due to the lack of emotional support leads to the numerous issues of mistrust and anxiety in adult relationships.  Anxiety apart from a partner develops and a range of issues can erupt within the relationship itself.  These individuals can become very possessive and clingy in a relationship.

The other spectrum involves Avoidant-Insecure.  This behavior as opposed to clingy and anxious behavior looks to avoid.  These types of children avoid future relationships with adults and as adults, themselves, have a difficult time ever forming permanent bonds with another person.  As children they will look for others to meet needs and form superficial bonds.  They will become unhealthy independent of others.  In future relationships, they can elusive or afraid to commit.

There are also a variety of Disorganized-Insecure attachments where rage or emotion overtake individuals or chaotic anxiety.

The Importance of Secure Attachment

Obviously life is about relationships and social bonds.  A secure attachment permits trust. In turn a healthy attachment permits one to be trusting, open, available, sensitive, responding and accepting to others.  Those without form bonds that are clouded in emotional rage, distrust, anxiety and avoidance.

Unhealthy bonds carry into adulthood and Anxious-Insecure or Avoidant-Insecure disorders can manifest in men and women

 

In grief and loss, attachment is key.  The greater the attachment, the greater the loss and adjustment.  Individuals who have healthy relationships grieve the loss but with less complications due to emotional barriers that prevented the relationship from being more healthy.  If a parent passes, an adult who has a attachment disorder may have conflicting emotions regarding the loss and not process the loss the same way as a person with a healthy relationship and bond.  The sting of grief is still great within a normal bond and could still due to other implications become complicated, but unhealthy attachments can bring other emotional baggage.  Grief Counselors who are not licensed need to recognize possible attachment disorders and refer individuals to licensed counselors who can better help them with the complications of the loss.

Helping Children with Attachment Disorders

Beyond therapy from a licensed counselor, children can benefit from consistency, schedule and establishing boundaries.  It is important to discuss emotions and how one feels.  The goal is to help the child feel some sort of security with guaranteed promises and actions to meet the needs that were not met before.

Conclusion

Forming secure bonds with a young infant and toddler is key to helping the child develop future healthy relationships

 

Individuals who due to lack of care in infancy and young childhood will experience avoidant behaviors or anxious behaviors in future relationships.  They will have difficulty forming healthy bonds with others.  Grieving the loss of others can also become more complicated when attachment disorders are present.

Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in grief counseling.

Additional Resources

“4 Types of Attachment Disorders”. March 23, 2017. The Holy Mess. Access here

“Types of Attachment Styles and What They Mean”. Rhona Lewis. September 25th, 2022. Healthline. Access here

“What Is Reactive Attachment Disorder?”. Amy Morin. October 11th, 2021. VeryWellMind. Access here

“Attachment” Psychology Today Staff. Psychology Today.  Access here

Cultural Diversity in Care Giving

Posted on by Dominick Flarey

Caregivers Need to be Culturally Sensitive to Their Patient’s Needs

As the world has become smaller, interaction with other creeds, cultures and races has become more prevalent in all aspects of life.  Caregiving is no exception as doctors, nurses, pastoral counselors and other caregivers find themselves in direct contact with different cultures who demand and deserve certain care.
Within the area of grief, it is essential, according to John Bowlby, that we understand cross-cultural ideals, especially in grief to better provide the vital care patients need.  Rituals, mourning, and family interaction varies from culture to culture and  health care providers need to respect these particular cultures in their  treatment.  By becoming educated with the basics of religious and cultural ideals a care provider can be better equipped to treat his/her patient.  Yet, before generalizations enter into one’s mind, the caregiver must also realize that there are deviations from the norm and not to expect certain reactions from a particular group merely because of their background.
Unfortunately, they did not teach this in medical school and sadly, it may not have even been considered important but only an after thought.  However, as trained caregivers who aspire to a certain level of professionalism, it is important to be educated in regards to the world and potential patients.

The “House” Syndrome

The lack of bedside manner by many caregivers has given rise to pastoral caregivers to become a crossroad between patient and provider, but the “cultural malpractice” by primary providers still remains a concern.  Doctors and many health care providers seem to care only about the healing of the body or the cure of the disease instead of the treating the entire person.  This “House” syndrome, from the celebrated television drama, is only too many times the norm.  The doctor is more concerned with the puzzle and relates very little to the humanity or cultural diversity of the individual they are treating.
Primary caregivers need to understand the spirituality and the culture of each patient.  This is why it is so important for primary providers to do spiritual assessments of patients.  This can be done by a simple conversation with the patient or with the family.  In this assessment, you can become familiar with how the person views life and what religious affiliations he/she has.  Also in doing this, a doctor can treat the whole of the person.  A patient who is beyond saving, sometimes wants someone to pray with them.  Although doctors need to keep a certain distance to maintain objectivity, there are certain times when praying with a patient may be acceptable, especially if requested or both share the same faith.   Spiritual assessments not only help the doctor become more sensitive to the cultural element of the patient but also enables the doctor to be more than a guy in a “white coat” but also a fellow human being who cares.
If you are interested in Pastoral Care Giving, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys)
Mark Moran, MA, GC-C, SCC-C