Maternal-fetal relationship quality was higher for women at weeks than Keywords: Antenatal attachment, Caregiving, Mental health, Pregnancy, Relationships Individual differences in the way mothers conceptualize their . Because we were interested in a global conceptualization of MFR, and. The empirical evidence supporting the role of the attachment relationship in appropriate social-emotional and cognitive tasks in childhood and adulthood ( see e.g., .. This suggests that the specific type and range of caregiving behavior will . conditional patterns that allow the child to maintain proximity to the mother. research concerning the continuity of attachment from infancy to adulthood Bowlby's attachment theory posits that experience with primary caregivers beliefs (“working models”) about the self, the world, and relationships (Bowlby, /). research related to the specific processes underlying continuity and change.
In the current study I examined an additional factor, adult attachment patterns, to determine whether attachment-based emotional bonds between daughters and their older mothers were associated with a the amount and nature of care that daughters provide and b caregiving burden experienced by daughters. Basic Concepts in Attachment Theory Originating with the work of John Bowlbyattachment theory describes a socioemotional behavioral system that guides how individuals manage their need for emotional security.
This system is first evident early in life as children interact with their primary caregiver. When they are physically or psychologically threatened, children turn to their caregiver for comfort, and ideally their caregiver responds with immediate, positive, and consistent support.
In reality, of course, caregivers do not always respond in ways that children expect. On the basis of their accumulated experiences with caregivers, children develop mental representations, or internal working models Bowlbythat reflect their beliefs about the responsiveness of caregivers and the environment more generally.
Seminal work by Mary Ainsworth Ainsworth, Blehar, Waters, and Wall identified behavioral manifestations of internal working models in the form of attachment styles, secure versus insecure attachment being the most broad differentiation. Children with a secure attachment were likely to seek and savor contact with their caregiver, to use that person as a secure base for exploration. Meanwhile, children with an insecure attachment were likely to avoid their caregiver or demonstrate anxiety in contact with him or her.
A broad array of research has suggested that a child's initial attachment bond has an impact well beyond their first critical relationship and influences not only subsequent relationships but also a wide range of social and emotional outcomes later in life Feeney and Noller ; Rothbard and Shaver Despite a burgeoning empirical literature on attachment dynamics, significant conceptual issues remain.
For example, it is unclear whether attachment patterns represent an aspect of individuals i. Likewise, there is debate about whether attachments are categorical phenomena or are best thought of as graded entities Feeney, Noller, and Hanrahan Diversity of theory is also apparent in the variety of attachment taxonomies that exist, although a parsimonious nomenclature for attachment patterns is beginning to emerge see Feeney et al.
Another issue is whether a construct originally validated with research on children is relevant to individuals at other ages. Although Bowlby first focused on the attachment dynamic between infants and their caregivers, he asserted that "attachment behaviour is held to characterize human beings from the cradle to the grave" Bowlbyp.
And indeed, research on attachment in childhood has been complemented by expanding attention to attachment in adults. Attachment in Adulthood Attachment patterns are hypothesized to persist across the life span through the reinforcing properties of internal working models Bowlby ; Main, Kaplan, and Cassidy The first attachment relationship provides a template, a self-perpetuating schema that influences subsequent relationships. Mental representations from early attachment bonds thereby influence how individuals seek, anticipate, and interpret future interpersonal interactions West and Sheldon-Keller Reflecting its roots, attachment theory also has emerged as a framework for understanding the relationship between adult children and their parents.
Some theorists have suggested that adult children relinquish their parents as attachment figures Weisswhereas others have amassed secondary evidence that attachments to parents are sustained Krause and Haverkamp In a study of adult children whose parents were institutionalized, Crispi, Schiaffino, and Berman found that children's attachment style predicted aspects of their well-being.
Specifically, a secure attachment style was associated with less caregiving difficulty and less psychiatric symptomatology.
Another study of children whose parents were in nursing homes found that children's attachment was related to parent mood Pruchno, Peters, Kleban, and Burant Attachments were less intense when parents were depressed and no longer able to provide the emotional support that children expected from the relationship. It may be that attachment dynamics, forged in childhood, continue to influence child—parent relationships later in the life span. But even if attachment patterns in adult children are discontinuous from their earliest manifestation, contemporary attachment patterns may still be relevant to the way in which adult children interact with their parents via children's capacity for self-reflectiveness, empathy, and their own needs for security Crose Cicirelli has suggested that adult children provide care to their parents to forestall the dissolution of their attachment relationship.
As parents age and weaken, their impermanence becomes more apparent to children. Anxious about the threatened loss of their attachment figure, children may provide support to bolster their parent and preserve the important attachment object. Cicirelli study of caregiving daughters revealed that attachment had a direct and positive relationship with the care that daughters were providing to their mothers: Stronger attachment bonds were associated with greater amounts of care, independent of mothers' level of functional dependency.
Stronger attachment bonds also were associated with lower caregiver burden.
One limitation of Cicirelli work is that it employed a global index of attachment rather than an assessment of specific attachment styles or dimensions. Yet just as attachment styles are associated with different behavior patterns and outcomes in other realms e. Securely attached adult children, whose parents have been responsive and supportive, may be highly motivated to care for their parents to protect the valued attachment figure.
They may continue to experience felt security Sroufe and Waters in the attachment relationships with their parents, and they may desire to preserve that secure base as long as possible. In contrast, insecurely attached children, whose parents have been unresponsive and unsupportive, may be less eager to care for their parents because the psychological rewards for sustaining that relationship are unreliable. Their anxiety, distrust, or unease may translate into a lack of contact compared with that of peers with more secure attachments.
Thus, one question I pursued in the current study was whether specific attachment patterns are related to the amount of care children provide to older parents. Another question was whether attachment patterns also are associated with the nature of parent care provided. Securely attached children may be comfortable providing a range of both emotional and practical care. Their stable, internal working models enable them to get close to their parents and offer a balance of pragmatic support as well as emotional availability.
Also, because of their security and emotional flexibility they are likely to perceive caregiving as less burdensome. In contrast, insecurely attached children may be less willing to provide emotional support because of the psychological risks, although they may still provide practical assistance because of its relative emotional safety.
Moreover, any care that insecurely attached children do provide is likely to be stressful because of underlying uneasiness in the dyad.
In summary, my purpose in this study was to examine the relationship between attachment dimensions and the nature of care that adult daughters were providing to their older mothers. In this initial study I chose to focus on this one type of family dyad given its commonality in caregiving, but future research will need to include the full range of family relationships. I explored whether attachment dimensions contribute to the explanation of instrumental and emotional caregiving above and beyond the influence of demographic and contextual factors that may be related to parent care.
The following hypotheses were tested: Securely and insecurely attached daughters provide comparable amounts of instrumental care to their older mothers. Securely attached daughters provide more emotional care to their mothers than insecurely attached daughters. Securely attached daughters experience lower caregiver burden than insecurely attached daughters. Methods Participants and Procedure Eighty adult daughters completed one semistructured interview.
Inclusion criteria for the study were that daughters provided at least 5 hr of care each week to their mother and had been doing so for at least 2 months. In addition, mothers were required to be aged 60 and older and living alone or with their daughters. The sample size reflected a desired power of. Interviews were conducted by an advanced clinical psychology graduate student, lasted approximately 1—2 hr, and took place without the mother being present.
Referrals were made to social services agencies e. Statistical comparisons between ethnic groups, however, revealed no significant differences on study variables. Two thirds of the daughters were working, with most in sales, technical, or administrative support positions. Fifty-one percent of the daughters were residing with their mother.
Daughters had been providing care for an average of 4. Measures Care provided to mother.
Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships
The assessment of caregiving focused on two content areas, instrumental and emotional care. An inventory of 31 instrumental activities and 22 emotional activities was presented to daughters.
Examples of instrumental activities included preparing meals, performing housework, assisting with grooming, and obtaining medical equipment and supplies. Examples of emotional activities included providing gifts, hugging and kissing, voicing one's love, and offering comfort and sympathy. Daughters rated how often they had engaged in each activity with their mother in the past month on a 5-point scale: I summed ratings to provide two caregiving scores for each daughter: I used two instruments to assess adult attachment.
Items reflect the theoretical underpinnings of attachment behavior, such as distress upon separation, joy upon reunion, and felt security provided by the relationship.
Daughters rate items on a 7-point Likert-type scale ranging from 1 "not at all true, disagree completely" to 7 "definitely true, agree completely". Items are summed to yield a total score that can range from 16 towith higher scores indicating a stronger attachment to mother according to Cicirelli.
Internal consistency reliability of the AAS has been reported as.
In the current sample, the coefficient alpha was. Drawing on Bowlby conception of internal working models, Bartholomew has suggested there are two dimensions, or models, at work in an individual's attachment style. The other model represents the degree to which other people are expected to be available when needed and the disposition to seek or avoid close relationships.
The self model embodies the degree to which individuals possess an internalized sense of self-worth and experience anxiety in relationships. The other and self models interact to yield four attachment styles: Secure, Preoccupied, Fearful, and Dismissive. To complete the RQ, participants rate the extent to which descriptions of the four styles correspond to the relationship they have with a particular individual.
In this study the text was modified so that descriptions pertained to mothers. Ratings are made on a 7-point Likert-type scale, ranging from 1 "not at all like me" to 7 "very much like me"; see AppendixNote 1. Scharfe and Bartholomew reported moderate stability of self-reported attachment patterns. In the current study internal consistency reliability among the four attachment style ratings was. Mother's level of functional dependency.
Each daughter was asked to rate her mother's abilities on physical and instrumental ADLs using a 3-point scale: Total ADL score was the sum of the 14 items, with higher scores representing greater functional independence. Internal consistency reliability for the scale was. The seven-item scale used by Cicirelli to measure caregiver burden was used in this study. Daughters rate the extent to which caring for mother interferes with their social life, relationship with partner, physical health, and mental health.
Ratings are made on a 5-point Likert-type scale ranging from 1 "not at all" to 5 "very much". Ratings are summed, and higher scores indicate greater burden. Cicirelli reported an internal consistency for the scale of.
Daughters also were asked how many months they had been providing the level of care they were currently providing. Duration of caregiving was included because some studies have documented a relationship between length of caregiving and negative caregiver outcomes Hannappel, Calsyn, and Allen Demographic and family structure.
Additional information that was collected included daughter's age, ethnicity, marital status, number of years of education, current or most recent occupation, number of children currently living with daughter, mother's age, and whether mother was currently living with daughter.
Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships
BUT, family ties and the knowledge that the secure base is still available in times of difficulty remain very important. The formation and development of attachment relationships continue through the lifespan, so that adult children's relationships with their parents will change and, for example, as adults we both care for and receive care from our partners.
Two important concepts of attachment theory that are relevant for the secure base model will be briefly summarised here: An internal working model is a set of expectations and beliefs about the self, others and the relationship between the self and others. Thus, the internal working model of an individual will contain particular expectations and beliefs about: If, for example, the baby finds that his feelings of hunger and his accompanying crying behaviour results in a prompt response from a loving adult who makes him feel better, he will learn that certain of his behaviours are linked with the positive behaviours of his caregiver.
A more generalised expectation of adults as people who are likely to be there to help and protect also develops over time. At the other end of the spectrum, a response that is unavailable or cold will lead to an internal working model of the attachment figure as rejecting, the self as unworthy of care and others as not to be relied on for help and support. Bowlby observed that these models are established in the first few years of life and as children get older models retain some flexibility but become increasingly resistant to change.
Children's behaviours become organised around their expectations of themselves and others and, as they grow older, these expectations tend to influence the way in which others relate to them. In this way, positive and negative cycles of reinforcement are set up. I will be a good friend' and so elicits a positive response. Positive internal working models can cope with a degree of rejection. Negative internal working models tend to see hostility even in neutral behaviour.
Thus to change children's negative expectations of self and others requires caregivers who can sustain availability and sensitive responding in the face of apparent hostility and lack of trust. Mind mindedness Bowlby's view of what was necessary for sensitive care relied on the caregiver thinking about the thoughts and feelings of the child, and over time enabling the child to think about the thoughts and feelings of the caregiver and other adults and children. Modern attachment researchers have built on the foundations of Bowlby's thinking.
This process begins in infancy with the sensitive caregiver viewing even the tiny baby as having thoughts and feelings. The caregiver speculates about these thoughts and feelings and reflects them back to the baby Are you hungry? Were you feeling lonely?
In doing so, the baby begins to understand and make sense of his inner experiences and feelings and gradually to manage and express them appropriately.
Through this sort of interaction and verbalisation of thoughts and feelings the child learns to distinguish between different feelings in self and others, to express feelings in ways that are effective and socially acceptable, and to empathise with others.