Essay Grade

Bringing practice into theory:
Reflective practice and attachment
theory
Maree Foley, Mary Nash and Robyn Munford
Maree Foley is a PhD candidate in the Department of Management and International Business at
the University of Auckland Business School, a NZ Registered Psychotherapist and full member of
NZACAP.
Mary Nash is a Life Member of ANZASW and lectures at Massey University.
Robyn Munford is co-leader of a FRST-funded research project on young people’s pathways to resilience and works in the School of Health and Social Services, Massey University.
Abstract
The relationship between social work practice and attachment theory has been longstanding across decades. While much attention has been paid to the use of attachment theory
within specific social work practice settings, less attention has been focused on the use of
attachment theory to guide the social worker in their practice based reflections. This article
explores the potential relevance of attachment theory for use within a reflective practice setting. This exploration is based on key findings from a recent study conducted in Aotearoa
New Zealand. A proposed beginning framework of attachment theory informed reflective
practice is offered for practitioners to explore in their reflective practice.
Introduction
Exploration of the relationship between theory and practice has been a longstanding endeavour within many disciplines including social work (Longhofer & Floersch, 2004; D’Cruz,
Gillingham, & Melendez, 2007, p.74). This paper explores the use of attachment theory to
inform reflective practice and, in turn, to potentially inform social work practice. This exploration is based on a recent Aotearoa New Zealand Masters research study that explored the
relationship between theory and practice, from the vantage point of the social worker (Foley,
2007). This paper begins by providing a brief overview of this study, including a review of
current attachment theory literature for social work practitioner use. Next, a summary of
the study’s findings is reported.
The remainder of this paper attends to the authors’ reflections on how the raw findings
might usefully inform reflective practice. It is postulated that knowledge of attachment
theory can be useful for the practitioner to increase understanding of both shared and unique
protective and adaptive behaviours within a practice setting where their capacity to think,
reflect and make meaningful connections may become compromised. Based on these postuISSUES 1 AND 2, 2009
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lations, an exploration of bringing key dynamics of social work practice with children and
families into attachment theory is explored. This exploration is followed by the beginning
formulations of an attachment theory informed reflective social work practice.
Overview of the study
This study began with a review of the literature on attachment theory and social work practice, where it was clear that interest in attachment theory as a relevant social work practice
theory has been sustained over a number of decades (Bowlby 1969, 1973 and 1980; Ainsworth
& Bowlby, 1991; Cassidy and Shaver, 1999). As such a plethora of relevant literature for this
study was found (Fahlberg, 1991; Howe, 2005; Howe, Brandon, Hinings & Schofield, 1999;
Nash, Munford, & O’Donoghue, 2005; Atwool, 2006). Surprisingly, studies that investigated
social work practitioners’ knowledge of attachment theory to inform their practice, found
that attachment theory knowledge was not as prominent as expected (Hesse, 1982; Grigsby,
1994; Hendemark, 2004). In addition, recommendations from these social work practice
specific studies each implied a view that advocating for increased attachment theory oriented education would equate with the capacity to use this theory in practice. As such there
seemed to be an underlying assumption within the recommendations of these studies that
theoretical knowledge equates with use, and use amidst the real time and moments of the
social work-client relationship.
Given the above paradoxical findings above, Foley (2007) conducted a study that
sought to gather Aotearoa New Zealand data regarding the practice status of attachment
theory and research developments as experienced by social workers within their social
work practice with children and their families. While keeping in mind socio-culturalcontextual issues, the primary focus of this study was the microsphere of practice. This
study endeavoured to understand the journey of a theory, attachment theory, through
the vehicle of the social worker in their practice descriptions of using attachment theory
to inform their practice.
In this qualitative phenomenological study (Van Manen, 1990), eight social workers who
self-identified as being interested in and knowledgeable about attachment theory were interviewed and were invited to reflect on their experiences of putting attachment theory into
social work practice with children and families. One of the interview questions included:
‘What aspects of attachment theory have made the most sense to you as a social worker?’
That is, most of the social workers in this study began their reflections not with accounts of
attachment theory knowledge, but with their own responses to the theory.
Following these interviews, an analysis process (Colaizzi,1978; van Manen, 1990) ensued, guided by a key question: ‘Are there identifiable patterns, implicit and or explicit,
being used by the interviewed social workers in their processing of attachment theory
as a social work practice theory, to inform child and family oriented social work?’ The
initial analysis focused on ascertaining from the descriptions an anticipated pattern of
‘putting theory into practice’. However, the descriptions of these social workers in this
study did not fit this pattern. Instead a different pattern was identified: That is, when
the participants’ responses were analysed, the self of the practitioner along with practice
knowledge preceded any theoretical comment, reflecting a process more akin to ‘Bringing
practice into theory’(Foley, 2007).
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As the coded analysis continued, a general pattern emerged where it appeared that each
social worker was bringing their experience of attachment theory along with their understandings to their practice. In turn, bringing social work practice into attachment theory
became understood to represent a process where neither practice nor theory was privileged.
Instead, privileged was the social worker. It was this finding that largely informed a key
recommendation of this study:
Attachment theory as a relational theory requires a broadening of the potential scope of relevance within attachment theory informed social work practice theory to be inclusive of the
social worker, the client and the social worker-client relationship (Foley, 2007, p. 138).
In addition, the attachment theory foundations prominent in this study were considered a useful theoretical framework to support re-positioning of the social worker to
the centre of the theory – practice dance. As such, this paper returns to the relevant
literature of this study but with a different purpose in mind: to view attachment theory
as being potentially useful to inform the social worker about themselves and their
relationships; and for this exploration to be supported and developed in a reflective
practice structure.
Re-viewing attachment theory for practitioner use
While there are many comprehensive reviews of attachment theory across disciplines
(Cassidy & Shaver, 1999) within social work, attachment theory is commonly identified as most relevant to specific fields of practice such as the care and protection needs
of infants and young children (Howe, 2005; Schofield & Beek, 2006). While attachment
theory is often associated with infants and young children, current studies have sought to
examine the activation of the attachment system in adulthood at times of stress/distress
(Mikulincer, Birnbaum, Woddies & Nachmias, 2000; Mikulincer, Gillath & Shaver, 2002).
That is, to explore whether adults continue to seek out a significant other (someone in a
caregiving role) at times of high stress, with the goal of that other providing relief and
support that in turn facilitates exploration of possible problem-solving routes. It has been
repeatedly found that under stress all adult participants ‘underwent preconscious activation of the attachment system’ (Mikulincer & Shaver, 2003, p. 89). These findings highlight
that the attachment system is relevant throughout the life span and optimally viewed in
relationship to and with two other interdependent systems: the caregiver system and the
exploratory system.
Central to these stress/distress-based understandings within attachment theory is the
construct of ‘the secure base’ (Bowlby, 1988; Schofield & Beek, 2005). In attachment theory,
an experience of ‘felt security’(Sroufe & Waters, 1977, p. 1186) increases the capacity to experience stress without being overwhelmed. In turn ‘felt security’encouraged exploration
at difficult times, it kept problem solving mobile, creative and relational. Bowlby proposed
that when ‘felt security’at times of stress was compromised then one way to create security
was to become self protective through using processes of the mind referred to as ‘defensive
exclusion’ and/or ‘selective exclusion’ (Bowlby, 1980, p. 52). As a consequence of these
mind processes, aspects of experience could be excluded from awareness and therefore not
as readily available to remember, share and/or prompt help seeking to resolve the stress
which was being experienced.
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Central to the development of attachment theory has been the development of the hypothesis that repeated experiences of the attachment-caregiving and exploratory system
become internalised as implicit mental maps of how relationships when under stress best
function. These maps, referred to as ‘internal working models’, are open to adaptation and
change yet often remain unchanged in structure across generations (Cassidy & Shaver, 1999).
It is thought that the greater opportunity for felt security on offer from the caregiver system
at times of high need/stress, the more open, dynamic and creative the exploratory system
can remain for problem solving. In contrast, when ‘felt security’ is compromised in some
way, it is more likely as Bretherton (1985) stated that if ‘material is defensively excluded
from awareness, it cannot be restructured or updated…’(p. 13).
Therefore attachment theory infers that in the presence of ongoing stress within the attachment-caregiver and exploratory systems, a working model exists of how relationships
function when stress develops. In turn, this implicit model includes experiences and expectations of self concerning one’s capacity to seek out and make use of help and support at the
times it is most needed. Included also are experiences and expectations of how others are
likely to respond to requests for help and support. For example, information can become
repeatedly excluded for the purpose of self-protection from unbearable pain. The more information is excluded from attention and processing, the less responsive a person can become
to considering new information that does not fit the current view of their relationships.
In summary, attachment theory advocates that at times of overwhelming stress/pressure,
our capacity to experience stress/pressure and be able to think and act in ways to reduce
the stress/pressure is related to the quality of the relationship that we have, or can in the
present establish, with a secure base. In turn attachment theory asserts that the quality of
relationship made possible with the sought-after secure base is influenced by the internal
working model of relationships and the type of exclusion/inclusion defences activated to
protect against any expected suffering specific to attachment-caregiving experiences. In
addition the experience with the secure base at times of high stress impacts on the capacity
and content possibilities of reflection.
Bringing social work practice into attachment theory
Social work with children and families is often conducted amidst high anxiety, uncertainty
and emotion. Within this emotional context, the social worker is both ethically and professionally responsible to reflect, think and act with coherence. However, Fonagy, Steele and
Steele (1991) assert that ‘day-in, day-out, social workers (and their agencies) practise in
emotionally demanding environments which trigger characteristic coping styles, defensive
strategies and adaptive behaviours’ (p. 205).
In addition, in a social work setting, the nature of social work service provision often
structures the social worker-client relationship with the social worker in the helper/help
provider role and the client in the helpee/help seeking role. Therefore, regardless of the
social work field of practice, when a context of stress/pressure is recognised for the social
worker and or the client, attachment theory can be relevant in understanding the following. First, unique responses of the social worker and the client to distress-stress; second,
the impact of these responses on the capacity of the social worker and the client to reflect
on and then become exploratory towards possible solutions; and third the social worker’s
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practice capacity to enact the social work plan along with the client’s capacity to experience
being helped and supported.
In a social work relationship it is often the social worker who is working with the client
to co-construct a secure base within the client’s family and community. At best a secure
base is where the conditions for ongoing experiences of ‘felt security’are on offer. Within
an attachment theory informed social worker-client relationship, it is the task of the social
worker, in the role of helper to assess and, where possible, structure conditions for the client
that will optimally provide the conditions for the client to experience ‘felt security’.
While in principle it is easy to concur with the global social work goals of providing
help, support and the conditions for felt security for clients, most social workers will have
stories and experiences where help offered to another in need is rejected, not made use of,
fought against. We know from practice that while some clients who meet the criteria for
high needs, who have multiple needs, who concur with the social worker that they need
help are also at times the most challenging to a social worker’s sense of efficacy. Failure, fear
and hopelessness can quickly overshadow the original quest to provide/offer social work
service. In addition, some of these very clients with high needs, can also be the clients who
are the most difficult to listen to and to spend time with. A social worker may feel embarrassed, ashamed, private about their own practice responses to these clients. For example,
a social worker who wishes to provide help and support may repeatedly find themselves
at work acting in ways that are unresponsive, inconsistent, avoiding responding to phone
calls and dismissing or minimising a family’s needs.
Recent social work practice research by Ruch (2005a; 2005b; 2007) advocates that for social
workers to engage in best practice, social workers need organisational support to develop
their reflective capacities. Ruch (2007) proposes one way to support social workers in this
endeavour is to step up the secure base that their respective practice agencies offer to social
workers to support them in their practice. Therefore, by increasing organisational support,
a social worker is more likely to experience felt security within their organisation, in turn,
increasing a social worker’s reflective capacities (Ruch, 2005b, p. 111).
Attachment theory can further develop this proposition. Attachment theory can be useful
to guide the reflection process concerning relationships that are functioning within stressful/overwhelming experiences/situations, and where these relationships reflect a helpeehelper dynamic. As such attachment theory could be used to inform reflective practice, the
place where it is commonly agreed social workers bring themselves and their practice into
view, for theoretical and practical review, often within a supervisory relationship.
Bringing the social work practitioner into attachment theory: Reflective
practice
In addition to the original understandings espoused by Bowlby (1969; 1973; 1980), Ainsworth
and Bowlby (1991) plus the recent work on adult attachment (Mikulincer & Shaver, 2003) three
useful constructs have emerged from attachment theory research that have direct relevance
to reflective social work practice: ‘Coherence’(Main 1991); ‘reflective functioning’(Fonagy
et al., 1991) and ‘mind-mindedness’ (Meins, Fernyhough, Fradley & Turkey, 2001). While
there is not the space to delve into each of these constructs, they each extend an assumpISSUES 1 AND 2, 2009
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tion in attachment theory: That what is held in mind of a relationship functions to guide
what can be observed, acknowledged, and attended to in a way that provides the security
seeker with relief.
As such, based on the theoretical exploration above, for a social worker in a caregiver,
helper role, it is possible to hypothesise from an attachment theory perspective, that what
is available for reflection, and the degree of relational capacity that can be sustained while
reflecting, in turn impacts on the social worker’s capacity to provide ‘sensitive responding’
(Ainsworth, Blehar, Waters & Wall, 1978) to their client. That is to attune, to interpret and
to respond within the client’s time frame. Bowlby’s constructs of selective and defensive
exclusion, referred to above, function to self protect from experiencing affects and thoughts
that are perceived as overwhelming and unbearable. As a consequence this impacts on what
is available to be reflected on. Therefore, attachment theory does not assume that what we
report, and have immediate access to for reflection, is all that there potentially is to reflect
on. It assumes instead, that by increasing our capacity for ‘reflective functioning’(Fonagy
et al., 1991) and ‘mind-mindedness’(Meins et al., 2001) we will come to know much more
of what is there to be known within the helper-helpee relationship.
A working model of attachment theory informed reflective social work practice
While social work has a strong tradition of reflective models of social work practice (for
example see: Redmond, 2004; Ruch, 2005a and 2005b), attachment theory provides a lens in
which to view the reflective process itself and to gain greater understanding and empathy
for what each social worker within each unique social work-client relationship can access
of that relationship for reflection.
What follows is the beginning formulations of an attachment theory informed framework
for reflective practice. Central to this formulation are two key attachment theory constructs:
the attachment-caregiver and exploratory systems and the secure base. These key constructs
in turn can inform the development of guiding questions for use within a reflective practice setting. As such, it is suggested here that the following needs consideration: the social
worker’s internal working model; how the social worker functions in the presence of intense
affect and stress and how they relate to others when in a helper-caregiving role; knowledge
about defensive exclusion strategies used, when they are used and with whom.
For the purposes of an attachment theory model of reflective practice:
Knowledge of self becomes inclusive of knowing how one feels, thinks and acts when stressed
and when needing to be in a help provider role at this time. To develop attachment theory
informed questions that are structured so that at all times the challenge to think and act in a
relational way is present (Foley, 2007, p. 146).
A working example is presented in the diagram below: Secure-base reflective questions.
This diagram has been developed from drawing on the work of Zeanah, Boris, Scott Heller,
Hinshaw-Fuselier, Larrieu, Lewis, Palomino et al. (1997), who during infant-parent assessments keep in mind a key question throughout the process. That is: ‘what it feels like to
be this particular infant in this particular relationship with this particular caregiver at this
particular time’ (p. 186). The study showed it is possible to extend and adapt this key question to assist reflective practice concerning social worker-client relationships.
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For example, the diagram below portrays a reflective circle posing a number of questions,
with the social worker taking in turn the position of the key relationships, and reflecting on
what it is like to be in this position in relationship with self and others. These formulated
questions are not intended to be exhaustive nor necessarily representative of all key relationships. They are but as working examples in which to begin to anchor the social worker
in considering the interplay of multiple attachment-caregiver-exploratory systems within
a single social work interaction.
Figure one. Secure-base reflective questions (Foley, 2007, p. 147).
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In addition it is suggested that following reflection on social worker-client experiences, that
an attachment theory-informed framework of reflective practice include reflections on how
to ensure as best as possible an experience of ‘felt security’for both the social worker and the
family as a precursor to any social work intervention. As such the following questions were
formulated within the study as a guide to provide further relational support to the social
worker and the family as an integral aspect of any other social work. The following practice
based attachment theory informed questions are represented below in Table one.
Table one. Practice based attachment theory informed questions (Foley, 2007, p.148).
1. Based on what I have understood about the internal working model of help seeking-provision of
this client/client family, what do I need to offer this client/client family to provide the conditions
for them to have an experience of ‘felt security’? What support might they need to optimally feel
safe in receiving help and support?
2. What does the client/family need to offer to their own family, so as to provide the conditions for
their own family to have an experience of ‘felt security’? What support and/or systems would
optimally provide the conditions for the family to experience efficacy and family belonging/membership.
3. Based on what I know of my own internal working model of help seeking-provision, what do
I need to be offered and receive from my team/colleagues for me to have an experience of ‘felt
security’, so I can help this client/client family?
4, What other key relationships and social resources might I consider as being useful to have on offer
for this client family so as to provide further conditions for ‘felt security’?
Conclusion
In conclusion, while attachment theory and social work have shared a longstanding relationship, the potential for social workers to use attachment theory for their own personal and
professional development has been explored here. Highlighting the attachment-caregiver
and exploratory system in relationship to the secure base and relating this to the social
worker-client relationship, extends the potential use of attachment theory to any social work
interaction functioning in a context of stress and/or distress. The above suggestions of how
one might include these theoretical underpinnings into a reflective practice setting are the
reflective fruit of research-based conversations with the social work participants who were
generous enough to share their practice into theory approaches at work.
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Theory Into Practice: Four Social Work Case Studies
In this course, you select one of the following four case studies and use it throughout
the entire course. By doing this, you will have the opportunity to see how different
theories guide your view of a client and that client’s presenting problem. Each time you
return to the same case, you use a different theory, and your perspective of the problem
changes—which then changes how you ask assessment questions and how you
intervene.
These case studies are based on the video- and web-based case studies you encounter
in the MSW program.
Table of Contents
Tiffani Bradley ………………………………………………………………………………………………….. 2
Paula Cortez ……………………………………………………………………………………………………. 9
Jake Levey …………………………………………………………………………………………………….. 10
Helen Petrakis ………………………………………………………………………………………………… 13
1
Tiffani Bradley
Identifying Data: Tiffani Bradley is a 16-year-old Caucasian female. She was raised in
a Christian family in Philadelphia, PA. She is of German descent. Tiffani’s family
consists of her father, Robert, 38 years old; her mother, Shondra, 33 years old, and
her sister, Diana, 13 years old. Tiffani currently resides in a group home, Teens First,
a brand new, court-mandated teen counseling program for adolescent victims of
sexual exploitation and human trafficking. Tiffani has been provided room and board
in the residential treatment facility for the past 3 months. Tiffani describes herself as
heterosexual.
Presenting Problem: Tiffani has a history of running away. She has been arrested on
three occasions for prostitution in the last 2 years. Tiffani has recently been court
ordered to reside in a group home with counseling. She has a continued desire to be
reunited with her pimp, Donald. After 3 months at Teens First, Tiffani said that she
had a strong desire to see her sister and her mother. She had not seen either of
them in over 2 years and missed them very much. Tiffani is confused about the path
to foll