Wallis, Paul; (1997) Attachment, reflective-self functioning, and interpersonal difficulties in adolescent in-patients. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Developments in the field of attachment theory research in the past ten years have allowed for the detailed study of the impact of early childhood attachment experiences on the development of psychopathology in later life. In particular the Adult Attachment Interview has afforded researchers the opportunity to formally access the inner world of adults and adolescents, allowing for observation of the way in which both individuals may organise information crucial to social development. Psychopathology in adults is now recognised as being, in part, reflective of insecure patterns of discourse when discussing attachment related experiences. Such patterns in adolescence are less well established. The present study addresses this deficit in the literature, employing the Adult Attachment Interview in a cross-sectional study of 41 adolescents resident on a variety of tertiary care in-patient units. The study confirms the hypothesis that insecure attachment-related discourse is associated with high levels of psychopathology in adolescence, particularly when individuals are unable to resolve early experiences of trauma and abuse. The study further suggests that sexual abuse has a particular impact on the adolescents capacity to mentalise, or think about the thoughts of others, and that this in turn may influence the development of externalising disorders. The findings of the study are limited however, by the absence of an appropriate control sample, and relative sample size. Future research may usefully address adolescent attachment by studying the attachment patterns of those people who have experienced abuse but who do not later develop psychopathology. In addition this study highlights the need for outcome studies with adolescents, examining the impact of psychotherapeutic approaches on the organisation of attachment experiences, and in particular the process of mentalising. The implications of the study for clinical practice indicate the appropriateness of providing a 'secure- base' in order that adolescents resident on in-patient units may have the opportunity to explore both their inner and outer worlds. The task of containment is further highlighted as a crucial factor in the therapeutic treatment of young people who may have experienced early childhood experiences that fostered insecurity in social and psychological functioning, particularly if this was accompanied by experiences of abuse and trauma.

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