Grief attachment theory and Horowitz and Bartholomew

¶ … Theory -- Horotwitz & Bartholomew

Attachment Theory and Grief

Understanding attachment theory as applied in the study of grief and bereavement in adults require a thorough reading of one of the theory's pioneers, John Bowlby. Traditional and modern theories and discussions on attachment theory and its relationship to bereavement are rooted on Bowlby's explication of the nature and dynamics of attachment among humans. Inevitably, because attachment theory explains the development of human attachments and the significance of the relationship not only among infants and mothers, but also among siblings, parents and their children (among many other relationships), it also provides an adequate description of what happens when this attachment is severed with the loss of a loved one or significant individual in a person's life.

In this paper, an intensive review of the history of attachment theory will be discussed, focusing mainly on John Bowlby and Mary Ainsworth (as another theorist that Bowlby had partnered with to develop what is now considered the traditional theory of attachment). Bowlby and Ainsworth's attachment theory will be studied and contextualized against modern attachment theories, which will be described later as deeply rooted in basic principles with the pioneer authors' theory of attachment. To increase the relevance of the theory to the study of grief and bereavement, an application and analyses of attachment theory and the concept of continuing bonds will be conducted to develop a more meaningful implication as to how attachment theory can help develop therapeutic interventions to make grieving or bereavement a healthy process for the individual.

II. History of Attachment Theory

Attachment theory, as mentioned earlier, traces its roots to John Bowlby, and then eventually, as he partnered with Mary Ainsworth, both had developed what would be the classic definition and description of attachment theory. A second phase in the theory's history, however, is the future direction that the theory took as it is applied to different contexts. Most important, however, is the application of attachment theory to the study of grief and bereavement, which gave way to the development of the Continuing Bonds theory of bereavement. The concept of "continuing bonds" demonstrate the development and improvement of attachment theory to not only explain attachment per se, but also to provide an adequate understanding of the bereavement process and how this knowledge will best help alleviate the potential detrimental effects grieving could develop within the individual.

The texts that follow provide a thorough discussion of the classic and modern theories of attachment, starting from Bowlby and Ainsworth and attachment theorists who have taken on their work in the 21st century.

a. John Bowlby

John Bowlby was a British psychologist known to have pioneered and developed the theory of attachment as it is known today. Influenced by the leading schools of thought of his time -- the 20th century -- Bowlby anchored the development of his theory based on the psychopathology of humans. In the midst of a society predominantly influenced by Freud's method of psychoanalysis and its role in interpreting dreams and fantasies, Bowlby took the path of explaining how attachment and its development between or among humans can be best explained as a psychopathological need. For him, attachment in humans "is motivated by survival and procreation," in the same manner that humans engage in parenting, mating, and feeding (Bretherton, 1992:19).

One of the significant demonstrations of human attachment is the infant-mother attachment, wherein the concept of the "attachment figure" (represented by the mother to the baby) was developed. Bowlby argued that every individual needs an "attachment figure" to whom s/he could turn to when they feel insecure or threatened. The attachment figure's "evolutionary function is protection of the infant from danger" (20). Further emphasizing his point that his theory departs from Freud's theoretical influence in mother-and-child relationships, he identified the mother, as the primary attachment figure for most infants, is both the child's "ego and superego" (7).

However, Bowlby also clarified that inasmuch as humans need to have an attachment figure in their lives that would positively influence their need to survive and/or be protected, there is also the opposite end of attachment: rejection. Inevitably, according to him, "expressions of rejection are appraised as disagreeable or painful by both (the child and mother/attachment figure)" (20). In fact, rejection or lack of attachment in an individual can develop a deep imprint wherein the individual's "mental state" will be affected by the kind of "intimate personal relationship" s/he had, which could be either "warm and harmonious" or "tense, angry, anxious… nonexistent" (Bowlby, 1988:54). Individuals who have had insecure relationships with their attachment figures develop "separation anxiety," a phenomenon triggered when there are "repeated threats of abandonment or rejection by parents," or in Bowlby's case, attachment figures (Bretherton, 1992:11).

In addition to the concepts of attachment figure and separation anxiety, another feature of the attachment theory is its description of emotion regulation in the individual. The process of emotion regulation in attachment theory occurs when the individual is subjected to the loss or separation from his/her attachment figure. The consequent behavior determines the level of regulation the individual would healthily (or unhealthily) develop over time. An individual who has had a secure relationship with his/her attachment figure will be able to deal with the loss of the attachment figure in a healthy manner, as opposed to an individual with an insecure relationship with his/her attachment figure (Waters, Crowell & Elliott, 2002:8). This, in fact, would eventually lead to a study of grief and bereavement in the context of attachment theory. Emotion regulation is a key component of the theory of attachment that it ultimately determines specific points of action from which clinical psychologists could use and develop for the individual a healthy intervention during the grieving/bereavement process. (Discussion on grief and bereavement will be thoroughly dealt with in the following chapter.)

Attachment figure, separation anxiety, and emotion regulation would later develop the core of not only the attachment theory, but the theory as contextualized in grief/bereavement. Understanding of the nature, dynamics, and even history of attachment theory are best found in Bowlby's beginnings as an ethological theorist and development psychologist specifically interested and specializing in the science of human attachments and relationships, from the psychopathological perspective.

b. Mary Ainsworth

Bowlby's work had been regarded significantly by other theorists and psychologists from all over the world, but it is Mary Ainsworth, a Canadian psychologist, who was able to contribute significantly to the growth of the theory as Bowlby was still developing it. Where Bowlby laid the first "bricks" of the theories foundations, Ainsworth made use of these foundation bricks to add more and enhance the evidence supporting the theory. Ainsworth's training and expertise is in clinical psychology, although working with Bowlby had developed natural behavior observation skills and techniques. Thus, using the natural observation method, she was able to conduct a study on Ugandan infant-and-mother relationships, which became the basis of three (3) attachment patterns that are now acknowledged as significant proof that indeed, Bowlby's argument about secure and insecure relationships with attachment figures determine the kind of behavior that an individual will manifest eventually as s/he grows older.

The three (3) attachment patterns observed from the Ugandan families are: (1) securely attached infants, who were observed to have "cried little and seemed content to explore in the presence of the mother; (2) insecurely attached infants, "who cried frequently, even when held by their mothers"; and (3) not-yet attached infants, "who manifested no differential behavior to the mother" (Bretherton, 1992:15). These attachment types have been useful in attachment and even general psychology studies in determining the kind of relationships established and nurtured not only between mother and child, but also among siblings, between parents and children, and husband and wife.

Another contribution of Ainsworth in the field of attachment theory is her further elaboration of Bowlby's concept of the attachment figure. This also foreshadows the use of this information in the study of attachment theory and grieving, which would explain why bonds are not immediately severed after the loss or separation of a loved one, significant other, or attachment figure (Ainsworth, 1984:799, 801):

…an affectional bond, and hence attachment figures are never wholly interchangeable with or replaceable by another, even though there be another to whom one is also attached… in older children and adults that closeness can to some extent be sustained over time and distance, nevertheless there is at least intermittent desire to reestablish proximity and interaction to pleasure…in reunion… but since not all attachments are secure this shall be modified to imply seeking [sic] to find comfort and security in the other.

In the development of attachment theory, Ainsworth helped 'test and expand' Bowlby's ideas and ensure that these have indeed, real-life basis and not based on ethological 'musings' alone. Ainsworth's contribution of the three attachment types and elaboration on the role of attachment figures and their significance in the event of a loss or separation laid the foundation for her work on "maternal sensitivity," which are based on infant-mother relationships, but are also applicable in describing the nature and dynamics of attachment relationships as they occur between or among individuals (Bretherton, 1992:1).

c. Other theorists (Modern Attachment Theories)

Upon the establishment and strengthening of Bowlby and Ainsworth's Attachment Theory, other theorists have developed new studies which either tested the theory or sought to apply it in different contexts or scenarios. Inevitably, most scenarios and contexts that new theorists and psychology researchers took is the path to explaining grief and bereavement. Others, however, have centered on specific aspects of the theory and sought to expound and/or test it, as Ainsworth did when Bowlby was still in the process of strengthening his attachment theory.

One such study was conducted by Schore and Schore (2008), which explored the emotion regulation aspect of the theory. In their study, the authors realized the potential of attachment theory in developing a "therapeutic intervention" from which coping on the loss of the attachment figure would be a healthier process for the individual. The authors shifted from the issue of attachment to (emotion) regulation, determining that using principles from attachment theory, the therapeutic intervention to effective and healthier coping "can repair damage and create new structure that is more able to cope with the demands of life" (18). Schore and Schore have taken on the challenge that Bowlby presented after discussing attachment theory thoroughly: how knowledge about the theory could improve issues of attachment that children, particularly adolescent children, have to deal and cope with.

Another group of researchers sought to develop an integrative model of attachment, which centered on the "system activation dynamics" of individuals (Mikulnicer et. al., 2003:90). Anchoring on Bowlby and Ainsworth's study on secure and insecure attachments/relationships, the authors identified two kinds of activation systems that are triggered when there is a loss or separation from a loved one and/or attachment figure. The first activation system is called "deactivating," wherein the individual chooses to "distance people from their own emotions," and hence seeks isolation. This coping mechanism results to 'aversion of painful experience, but forgoes the effect of positive affect' that comes from acknowledging the loss or separation from a loved one or significant other. Conversely, "hyperactivating" occurs when the individual engages in different emotional states with different people, which could only delay the acknowledgment and despair that comes with the loss or separation. In the end, the individual would only feel an "exacerbation of the negative affect," which could further the feeling of despair within the individual. Ideally, however, based on the integrative model developed, healthy and secure individuals would be able to transition from co-regulation (with the loved one, significant other, or attachment figure) to self-regulation (94). As with Bowlby, the ultimate end to studying attachment theory is to enable individuals to cope with insecure attachments or loss/separation from the attachment figure, go through the process of transitioning from co-regulation to self-regulation in the healthiest way possible.

Deeper into Bowlby's concepts of attachment, separation anxiety, and attachment figures are the work of theorists Kim Bartholomew and Leonard Horowitz, researchers and theorists who worked together to determine, test, and establish the "two-dimensional four-category model of adult attachment" (Bartholomew and Shaver, 1998:31). In this model, both researchers theorized that adult attachment is anchored on two important models, which are based on one's conception of his/her self and of other people. Ultimately, an adult with healthy attachment would have a positive conception of his/her self and other people. Bartholomew and Horowitz (1991) explained, "the valence of both self models and models of others are separate, important dimensions of an adult orientation to close relationships and that the two dimensions can vary independently" (240). While the models are related to each other in creating the kind of adult attachment one has, the models operate independently from each other, but are critical factors considered together when looking at the 'attachment health' of an adult.

The two dimensions are determined as the model of self and the model of others. The model of self is "associated with the degree of anxiety and dependency on other's approval in close relationships," while the model of others is the "tendency to seek out or avoid closeness in relationships" (Bartholomew and Shaver, 1998:31). The conception created in the model of self weights greatly on one's perceived importance of having someone in his/her life to turn to for approval. The model of others, meanwhile, operates when the individual is deciding whether or not to become attached with another individual and to further the level or "closeness" of relationship to the point of making that person as his/her attachment figure.

The level of dependency and closeness that one establishes with an attachment figure could lead to different "schemes," which make up Bartholomew and Horowitz' "4-category classification scheme" of adult attachment: (1) secure, (2) dismissing, (3) fearful, and (4) preoccupied. Each category describes a specific kind of relationship between the adult and his/her attachment figure, determined in terms of the two dimensions (models of the self and of others), and the level of dependency and closeness established between them (i.e., adult and the attachment figure) (Bartholomew and Shaver, 1998:31-2):

Secure- internalized sense of self-worth and are comfortable with intimacy in close relationships;

Preoccupied- anxiously seek to gain acceptance and validation from others, seeming to persist in the belief that they could attain safety, or security, if they could only get others to respond properly toward them;

Fearful- highly dependent on others' acceptance and affirmation; however, because of their negative expectations, they avoid intimacy to avert the pain of loss or rejection; and Dismissing- avoid closeness because of negative expectations; however, they maintain a sense of self-worth by defensively denying the value of close relationships.

Given these categories of adult attachment, Bartholomew and Horowitz attempted to create general model or "representation" of adult attachment. The theorists are somewhat similar to Ainsworth's role in helping Bowlby develop the traditional or classic adult attachment theory. While Ainsworth conducted research studies to strengthen Bowlby's theory and ethology, Bartholomew and Horowitz are modern theorists whose aim is to develop a more developed, evidence-based, and updated general theory and model of adult attachment. Hence, they based their 2-dimension, 4-category model of adult attachment on Bowlby's ethology and supported the model's basic assumptions through quantitative research studies proving that indeed, there are different kinds of adult attachment.

III. Grief, Attachment Style, and Attachment Theory

In the previous chapter, the concept of secure attachment, separation anxiety, and emotion regulation after a loss or separation from a loved one, significant other or attachment figure are discussed in the context of Bowlby and Ainsworth's attachment theory. In this chapter, attachment theory will be expanded to include another concept that specifically deals with the issue of grieving and bereavement: Continuing Bonds. The theory of continuing bonds is an extension of attachment per se, as it posits that in the event that a person loses or gets separated from a loved one or attachment figure, the kind of relationship s/he had with the attachment figure determines the behavior that s/he would adopt and be manifested as the 'continuing bond' between these people.

Continuing bonds for Bowlby (although he did not used the term per se) starts with the "pain of grief," a concept that is only determined at the beginning of the bereavement process. Bowlby specifically identifies grief and mourning into four phases: numbness, yearning and protest, disorganization and despair, and lastly, reorganization (Packman et. al., 2006:821). As an individual goes through these phases, the individual will also experience a "persistence of the relationship" that s/he previously had with the lost/separated attachment figure. This is, in Bowlby's terms, the 'continuing bonds' that continues to bind the individual to the other person, either in a positive/healthy or negative/unhealthy way (Bonanno and Kalman, 1999:764).

Klass, Silverman and Nickman, proponents of the Continuing Bonds theory, helped evolve Bowlby's concept of "persistent relationship." For them, continuing bonds function in the individual as a "reorganization" sub-process that they must be able to acknowledge and cope with. Ultimately, the authors consider continuing bonds as a facilitative component wherein people will be able to find "solace, comfort and support" in these bonds, 'easing the transition from the past to the future' (765).

Interestingly, grief and bereavement studies applying the continuing bonds theory have shown the same psychopathological perspective that Bowlby had adopted in establishing the attachment theory. In these studies, continuing bonds was indeed a facilitative component, a functional process that individuals must utilize to survive the ordeal they are going through. Without the continuing bonds -- that is, the idea that the memory of the individual lives on in spirit -- people would not have anything to hold on to in their lives after a loss or separation of a loved one/attachment figure, and therefore coping would not be as manageable as it would have been with the continuing bonds (Davies, 2004:509-510).

Similarly, Bartholomew and Horowitz' study of the different categories of adult attachment provide support evidence on the different kinds of responses an individual could have when establishing and/or re-establishing social relationships with another individual or other people in general. Continuing bonds as a coping mechanism for individuals could alternatively be replaced by developing (new) behavior that will validate the healthy or unhealthy development and perception of the individual towards attachment. As specified in the previous chapter, an individual could either feel secure, dismissive, fearful, or preoccupied about establishing/re-establishing new relationships with people depending on the kind of relationship s/he had experienced in the past. Thus, in the study of grief and bereavement, a person could cope by establishing new relationships to substitute for the loss of the previous one or an attached figure. However, the behavior that will be manifested will be highly dependent on one's conception of his/her self after the experience of loss or separation from a loved one or attachment figure. An individual who felt secure and is grieving healthily over the loss of an attachment figure would be able to feel secure and similarly, establish a secure relationship with another individual or with people as a form of coping mechanism (Bartholomew and Shaver: 1998: 31).