John Bowlby

• Although IPT has no one theoretical basis, the current conceptualization of Attachment theory helps better understand some of the mechanisms of production of illness as well as some idea of how a psychtherapeutic process can contribute to recovery.



• In the 1960s John Bowlby made observations of interaction between children and caregivers. Inspired by Lorenz's work in observing "imprinting" and Harlow's experiments with primates, Bowlby pioneered the idea that humans, as do all animals, form attachments to care givers and seek proximity as a primary drive. Bowlby later described responses to separation and loss of attachments and offered these as a basis to understand human intrapsychic experience.



• In Attachment Theory the relationship is regarded as the primary focus of psychic functioning. Attachment is regarded as a biological drive that forms a cybernetic system (whereby changes in attachment status eg separation bring about changes at the levels of intrapsychic functioning).



• Bowlby advanced the idea of "inner working models" in so far as patterns of attachment that developed in childhood as a result of early handling in infancy and later childhood tend to persist, but are not fixed. Patterns of attachment are thought to persist within relationships and across relationships in adult life.

Later Contributors to Attachment Theory

• The diagram below depicts the numerous contributors to our current understanding of human attachment.

• Ainsworth studied infant responses to separation in the experimental protocol of the "Strange Situation Procedure"(SSP). Following these observations Ainsworth described infants as having three types of attachment:



1. Secure attachment (Type B)



2. Insecure Ambivalent attachment (Type C)



3. Insecure Avoidant attachment (Type A)

Later a fourth type of attachment, Disorganized (Type D) was added.

• Mary Main's work focussed upon the development of the "Adult Attachment Interview" which attempted to typify adult attachment. Experiments with expectant mothers using the AAI were able to confidently predict the later attachment style of their child on the SSP.



• Hazan and Shaver in 1994 devised their "Individual Differences Research" which adapted infant attachment typology to adult relationships. They found that proximity and responsiveness were key determinants to adult intimate relationships. Using a forced choice questionnaire they attempted to modify Ainsworth's SSP to statements about relationships. They found that infant patterns were able to be seen in adult relationships



1. Type B - Secure - found proximity and responsiveness easy.



2. Type C - Insecure / Ambivalent - tended to fall in love frequently, were more likely to be jealous, revealing and perceive partners as fickle.



3. Type A - Insecure/ Avoidant - Tended to avoid Intimacy, and dissociate sexual from emotional commitment.

Attachment Theory in relation to Depression

• Whilst insecure attachment is not regarded as essentially pathological, those with less secure attachment are more prone to develop depression.



• It is also recognized that disruption of attachment such as traumatic or premature loss, or loss in a vulnerable individual increases the likelihood of developing depression.



• Depression is an illness that occurs in an interpersonal context and although it results from a combination of interpersonal and biological factors, the illness has interpersonal implications that can be seen as arising for attachment issues.

Attachment Theory and Psychotherapy

• In IPT the focus is arguably on the issue of attachment- i.e. interpersonal relationships. It is assumed that resolution of "here-and-now problems" in an interpersonal and hence attachment context should result in symptom relief.



• Whilst alteration of inner working models and hence attachment style is unlikely to occur in 12 - 16 sessions, fundamental personality change is unlikely in short-term treatment such as IPT.



• Jeremy Holmes in Great Britain, has also advanced the idea that the "secure base effect" described by Bowlby (that a caregiver's proximity enables an infant to explore, play and interact) may have implications for a psychotherapeutic relationship.



• In IPT the relationship is considered a "real" relationship and consequently an attachment is assumed to have formed. In this way the IPT therapist, by forming a warm, empathic and collaborative relationship may help the patient by providing a "secure base" to explore their interpersonal circumstances and make changes necessary to achieve symptom relief.