Practitioner Review: Clinical applications of attachment theory and research for infants and young children

Abstract

Study of attachment in the 1970s and 1980s focused on operationalizing and validating many of the tenets of attachment theory articulated in Bowlby’s landmark trilogy, Attachment and Loss (Bowlby, 1982, 1973, 1980), robustly underscoring the central role of child to parent attachment in the child’s development and mental health. Attachment theory and its implications have long interested clinicians, though determining how best to translate complex theoretical constructs and research methods into the clinical arena has been challenging. Nevertheless, well-defined landmarks in early childhood attachment are clinically useful, and the emergence of interventions drawn from systematic research is promising. The purpose of this paper is to summarize salient issues from attachment theory and research and discuss how these issues inform clinical work with infants and young children. We recognize that there is a range of clinical settings in which child–parent attachment will be important. Likewise, among practitioners serving young children and their families, there is a broad range of familiarity with and expertise in attachment principles and attachment-based treatment. We assert that all clinical services for young children and their families will be enhanced by providers’ understanding of attachment theory and research. We further assert that in some clinical contexts understanding child–parent attachment is essential. We begin by reviewing developmental research on attachment to describe how attachments develop, how individual differences in selective attachments manifest, and the characteristics of clinical disorders of attachment. Next, we turn to assessment of attachment in clinical settings. Then, we describe selected specialized clinical contexts in which assessing attachments are uniquely important. Finally, we describe four interventions for young children and their families, all of which are closely derived from attachment theory, supported by rigorous evaluations, and designed to support directly the developing child–parent relationship.