Attachment Theory in Adult Mental Health: a Case Analysis of Laura’s Life and Relationships

Attachment Theory Diamond D. Grundy University of Texas at Arlington Introduction This paper explores the case study of Laura, a 47-year-old woman, who has a diagnosis of major depressive disorder and generalized social phobia. Laura reported chronic feelings of dissatisfaction with her life which has caused her to experience intervals of major depression. She stated that during her childhood her parents fought often. Laura’s father was emotionally unavailable. She also recalled experiencing physical punishment by her parents including being hit with a board that would leave her “black and blue for weeks.” Laura also recalled her mother making her feel as if she was “bad” or “sneaky.” In an attempt to gain her mother’s approval, she would overcompensate in her actions by being “extra good.”

This caregiving relationship between Laura and her parents is identified as the parent-child relationship. Laura was referred for treatment of depression by her family doctor. During intake, she recalled experiencing anxiety in social settings, which she believes has affected her work. Laura’s history includes periods of depression, parental physical abuse, and emotional negligence. Additionally, she had decided that she never wanted to get married or have children. However, Laura has recently experienced sadness due to finding out that she is currently in menopause. She is unable to express personal and emotional feelings in her relationships. Laura indicated increased job stress over the past 4-5 years since the passing of her father. During this time, she has “let many friendships slip away.” She also became the caretaker for her mother but reported resentful feelings due to the responsibility.

Laura also indicated that several of her family members may have had mental health conditions. In this paper, I will utilize information from attachment theory to create a treatment plan for Laura. Attachment Theory Attachment theory implies that many mental health conditions may stem from inadequacies in parent-child relationships. When a child’s need for emotional security, comfort, and protection is not met, the child may develop unhealthy attachment styles. Parent-child relationships in which the parent is abusive, unreliable, insensitive, or unpredictable could prevent the child from developing a secure and positive self-esteem. This also means that the child may develop insecure attachment of their self and others, displaying reduced resilience, difficulty coping with stressful experiences, and have an inclination to psychological disruptions. In order for children to develop appropriate secure attachment, they must have closeness in their relationship with their parents. Secure attachment between a parent and child is characterized by the parent being consistent and available to the child. In a healthy parent-child relationship, the child learns to trust their parent and turns to them for safety and consolation. With age, children require less closeness in their parental relationships. However, they will continue to find security and comfort in the relationship when facing hardships or difficulties. As the child grows, they will display confidence in their exploration of the world.

The child will also perceive him or herself as lovable and will develop positive expectations of others. In an avoidant attachment parent-child relationship, the parent displays unavailability or indifference towards the child. The parent may also display independence in relation to the child by becoming hostile or denying the child’s needs or feelings. In turn, the child may mimic these behaviors, taking an independent stance in their relationships, believing that he or she needs to care for themselves. Additionally, the child will likely be compliant and display a positive affect in an attempt to appease the caregiver and maintain the relationship. According to attachment theory, children who have avoidant attachment parent-child relationships tend to develop dismissive behaviors. Dismissive behaviors include suppressing feelings and emotions, needing to be independent and self-sufficient, focusing on activities while avoiding feelings of closeness with others, and distancing themselves from people who they feel may reject them.

The child may also develop attachment anxiety, leading them to expect separation, desertion, or inadequate love in relationships. In adulthood, this person may devalue close relationships. Both Laura’s mother and father displayed avoidant attachment. In relation to her parents Laura depicts her parents as cold, difficult, physically abusive, and emotionally unavailable. Because Laura’s parents exhibited avoidant attachment in their parenting, Laura displays dismissive behaviors with her peers. She distances herself from coworkers and friends, has difficulty with assertion, and has anxiety in social settings. Laura assumes that others will reject her, view her as boring, or become upset. Although Laura reports having friends and being in a long-term relationship, she noticeably keeps her distance.

She expressed discomfort concerning sharing her private thoughts and feelings with her partner or friends. She also made the decision to never get married or have children. It is likely that these behaviors are an attempt to dismiss and/or avoid emotional dependence on others. Laura has learned not to depend on others for emotional support due to emotional negligence during her childhood. Insecure attachment leaves children and adults vulnerable to mental health conditions such as depression, anxiety, and social phobia. When combined with genetic, cultural, and environmental factors, insecure attachment can have challenging effects on the child. If unresolved, these effects could pose a threat to the child’s mental health, even into adult. Laura appears distant and detached in her relationships, similar to the actions of her father. Studies show that people tend to give and receive support in a manner that coincides with their models of self and others (Morse, Shaffer, Williamson. It is likely that Laura is also experiencing depression stemming from being the sole caregiver for her mother as well as unresolved feelings from her father’s death. Providing caregiving services for family members has been shown to increase the risk for depression in caregivers.

A negative valuation of self is synonymous to attachment anxiety . A negative valuation of others is synonymous to attachment avoidance. In order to create a more meaningful relationship with herself and others, Laura will require therapeutic services that allow her to assess her relationships with herself and others. In doing so, Laura is likely to improve her mental state. Attachment style has a direct correlation to an individual’s ability to regulate emotions, coping skills, and reflective functioning. Adult Attachment Interview (AAI) has been identified as the most valid and dependable method of intervention for attachment insecurity. AAI uses self-report questionnaires to assess client relational functioning. The questionnaire allows the client to consciously and unconsciously assess their relationships. More specifically, AAI requires clients to reflect on past childhood relationships with parents, peers, parents, or romantic partners as well as current relationships. AAI in combination with psychotherapy will create an avenue for Laura to explore and improve her attachment style. Psychotherapy has been widely utilized as a treatment intervention in attachment theory. Psychotherapy combines storytelling, listening, listening, and understanding.

This method would allow Laura the opportunity to express her feelings and emotions in a therapeutic environment. Psychotherapy would also allow her to create a secure attachment with the therapist, which would promote her reflective functioning and understand of self. Therapists working with clients who display attachment insecurity should strive to establish themselves as a secure base in which clients can explore their trauma and cultivate an improved sense of themselves and others. Clients who display avoidant/dismissive attachment styles are likely to minimize their feelings and emotions. Clinicians will need develop a treatment plan that will motivate the client to accept and express their feelings towards painful experiences. If the therapist is not careful in maintaining reliability and consistency or termination of services, the client would be at risk for increased mental health conditions or psychological breakdowns. Additionally, psychotherapy is limited due professional boundaries.

Conclusion Attachment theory is advantageous in assessing Laura’s case due to its proven contributions to clients with unhealthy attachment styles. However, attachment theory fails to explore the effects of environmental factors such as racism, social class, and poverty. Overall, the benefits of an attachment-informed treatment plan would be extremely beneficial in assisting Laura with developing secured attachment. This would improve her mental state allowing her to accept and express issues as they arise. If Laura is able to obtain a better valuation of herself and others, her feelings of attachment anxiety and avoidant/dismissive behaviors will subside. She will likely experience decreased periods of depression. Laura’s treatment plan should include continual AAI assessment combined with psychotherapy. By providing a safe place for Laura to accept and express her emotions, she will learn to explore these feelings in her relationships. Creating a better sense of self and others will promote secured attachment in Laura’s relationships with her romantic partner and friends.

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