Understandings of attachment theory for clinical practice


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Attachment theory and research is considered to have a great deal of relevance for clinical and social welfare practice. Practitioners are encouraged, through literature, training and policy, to learn, understand, refer to and use their knowledge of attachment theory and research when working to meet the needs of the children and families they encounter. However, there has been very little empirical study of how practitioners have understood attachment concepts and methods in order to do this. The research reported here examines how clinicians and researchers understand attachment theory and research in the context of clinical practice for child mental health. Chapter 1 spotlights the gap in empirical work pertaining to practice-based understandings and behaviour, with respect to attachment theory. It draws on theories and models of professional knowledge to contextualise the forthcoming study; framed as an evaluation of attachment theory’s intelligibility. Chapter 2 reviews a range of source materials surrounding the development and distribution of attachment knowledge. It presents a narrative synthesis of the diverging ways attachment concepts are used within academic, policy and practice literature. Attention is given to issues arising from each discourse when considering implications for clinical practice. This work generated the initial themes that informed the study design and development. Chapter 3 explores what beliefs about attachment applications may exist by assembling a pool of relevant claims observed from the literatures. Q-methodology was used to examine the views of international attachment researchers and clinicians working with children, adolescents and their families in the UK. Additional background and demographic information were collected to explore potential mediating influences that may shape the perspectives of these participants.

Chapter 4 reports in detail on the by-person factor analysis employed to make sense of the data. A substantial degree of commonality was observed, alongside profiles of three perspectives that diverged on a number of key issues. Participants clustered around these viewpoints based on shared professional characteristics. Chapter 5 discusses the findings with particular emphasis on identified areas of consensus and divergence between researchers and clinicians. In addition, it reflects on the contextual influences which shaped the views and concerns expressed by participants. Chapter 6 concludes with a consideration of how knowledge is shared between domains of research and practice, and a coherent and incisive position on the current state of play. It ends with a reflexive narrative about approaching and conducting this work as a practicing clinician and researcher within the field.
The work reported in this dissertation will be of particular value to i) researchers interested in how best to communicate with and learn from practitioners and wider publics; and ii) practitioners interested to think further about the implications of attachment theory and research for their own work.

Duschinsky, Robbie
Freeston, Mark
van IJzendoorn, Marinus
Woolgar, Matt
attachment theory, Q methodology, clinical practice
Awarding Institution
University of Cambridge
Wellcome Trust (103343/Z/13/A)
National Institute for Health Research (NIHR) (via University of Oxford) (unknown)
Wellcome Trust Investigator Award (WT103343MA); NIHR School of Primary Care funding round 15 (392)