CUA I. COURSE PURPOSE THE CATHOLIC UNIVERSITY OF AMERICA National Catholic School of Social Service Washington, DC 20064 202-319-5458 Fax 202-319-5093 SSS 653 Attachment Theory and Neurobiology: Implications for Social Work Practice and Policy Summer 2013 (3 credit) This course outline is the property of NCSSS and the instructor and may be distributed with written permission This advanced elective provides an overview of the research and conceptual framework of attachment theory as it pertains to new directions in clinical practice and to social work policy. It describes the evolution of attachment theory from the original works of Bowlby and Ainsworth to the expansion of contemporary theory based on neurobiological research. The course emphasizes the importance of attachment and right brain affect regulatory functioning as basic to healthy development across the lifespan. Findings from a wealth of clinical and longitudinal research studies document the importance of attachment security in the prevention of relational and behavioral disorders in individuals, couples, families, and groups. Attention is placed on appreciating the role of secure parenting and the development of attachment relationships within the context of diverse cultures. Special emphasis is given to the implications of attachment research for policy formulation, analysis, and implementation, particularly to child welfare policy and the prevention and sequelae of child maltreatment. This course introduces students to attachment-based treatment models for child and adult disorders and examines the evidence for an attachment-based social work practice. Prerequisite: SSS 571-572. II. EDUCATIONAL OBJECTIVES Upon the completion of this course, students will be able to: 1. Demonstrate understanding of the historical roots of attachment theory as an evolutionary, universal, continuous, and motivational system.
2 2. Articulate the linkage between the infant s emotional experience, caregiver-child reciprocity, brain development, and ongoing affective regulation. 3. Demonstrate knowledge of the longitudinal studies documenting the influence of attachment on the neurobiological, behavioral, cognitive, relational, and physiological development of individuals across the lifespan. 4. Critically evaluate the cultural differences of attachment patterns validated through empirical cross-cultural research. 5. Analyze the impact of poverty, abuse and neglect, separation and loss, foster care, and adoption on child development. 6. Evaluate the ethical dilemmas inherent in child welfare placement decisions due to disruption of attachment relationships between children and caregivers. 7. Demonstrate understanding of the role of adult attachment in caregiving, friendship, and adult romantic relationships. 8. Articulate the relationship between attachment and the development of relational and behavioral disorders and psychopathology among children and adults. 9. Develop understanding of attachment-based models of clinical intervention for children, adults, couples, and families, including adoptive and foster parents. 10. Critically analyze the widespread policy implications of attachment and neurobiological research and the need for early intervention and prevention. 11. Identify and formulate recommendations for policy and social work practice based on knowledge and evaluation of research on attachment and neurobiology. III. COURSE REQUIREMENTS A. Required Texts Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice. New York: Norton and Co. Bennett, S., & Nelson, J. (Eds.). (2010). Adult attachment in clinical social work: Practice, research, and policy. New York: Springer. Cassidy, J., & Shaver, P. (Eds.). (2008). Handbook of attachment: Theory, research and clinical applications (2 nd ed.). New York: Guilford B. Recommended Texts (for recommended readings Bowlby, J. (1988). A secure base. NY: Basic Books. Wallin, D. (2007). Attachment in psychotherapy. NY: Guilford
3 C. Other Strongly Recommended Resources Books: Berlin, L., Ziv, Y., Amaya-Jackson, L., & Greenberg, M. (Eds.). (2005). Enhancing early attachments: Theory, research, intervention, and policy. New York: Guilford Grossman, K. E., Grossman, K., & Waters, E. (2005). Attachment from infancy to adulthood: The major longitudinal studies. New York: Guilford Mikulincer, M., & Shaver, P. (2007). Attachment in adulthood: Structure, dynamics, and change. NY: Guilford. Journals: Attachment and Human Behavior Infant Mental Health Journal Clinical Social Work Journal, Special Edition on Attachment Websites: http://www.education.umn.edu/icd/parent-child/default.html http://www.psychology.sunysb.edu/attachment/ http://www.zerotothree.org/vol20-2.html http://www.psych.uiuc.edu/~rcfraley/lab.htm D. Course Assignments There are three graded assignments for this course (two objective quizzes and a 10-page paper), plus a grade for class participation. See the last page of this syllabus for details. E. Grading Policy and Weights of Assignments Grades will be based on the CUA Grading Policy as described in the Graduate Announcements. Full credit will not be given for assignments that are submitted late. The following provides weights for the various course assignments: Quiz 1 30% Quiz 2 30% Presentation 30% Attendance and Participation 10% Grading System Letter Grade Numeric Range A 95 100 A- 90 94 B+ 87 89 B 83 86 B- 80 82 C 70 79 F 0 69 F. Preparation, Attendance & Participation Students are required to attend classes and are expected to participate meaningfully in class discussion/exercises and online forums as required. The class participation grade will be determined by the instructor s perception of the student s preparation for and
4 contributions to class discussion/activities. Different students will make different kinds of contributions. Some will have an easy time with spontaneous interactions while others will be more comfortable making planned statements about key ideas from the readings or other sources. Both types of contributions are valued. G. Course and Instructor Evaluation NCSSS requires electronic evaluation of this course and the instructor. At the end of the semester, the evaluation form may be accessed at http://evaluations.cua.edu/evaluations using your CUA username and password. Additional, informal written or verbal feedback to the instructor during the semester is encouraged and attempts will be made to respond to requests. IV. CLASS EXPECTATIONS Please refer to NCSSS Announcements, or appropriate Program Handbook for Academic Requirements (http://ncsss.cua.edu/courses/index.cfm), including scholastic and behavioral requirements. NCSSS is committed to creating an open and inclusive learning environment where all members - including students, faculty, administrators, and staff strive to listen to and learn from one another. We recognize that in a multicultural society, it is inevitable that issues or tensions relative to diversity and different life experiences will arise. It is how we handle these events that matters. Therefore, when such issues occur inside or outside of the classroom - we agree to engage in respectful and productive discussion with one another until learning is enhanced and understanding is deepened by all involved. A. Scholastic Expectations All written work should reflect the original thinking of the writer, cite references where material is quoted or adapted from existing sources, adhere to APA, v.6 format, and should be carefully proof read by the student before submission to the instructor for grading. B. Behavioral Requirements: Students are expected to maintain accepted standards of professional conduct and personal integrity in the classroom. Students should: Attend all classes and contribute constructively to the classroom culture Recognize and avoid behavior that jeopardizes the learning/teaching environment of other students or the instructor Demonstrate competence in planning academic activities and in following through on those plans Reasonably respond to and respect others reactions to one s comments or actions in the classroom Use an appropriate level of class time and instructor s time and attention in and out of class Behave in a manner that is consistent with the ethical principles of the social work profession.
5 C. Academic Honesty Joining the community of scholars at CUA entails accepting the standards, living by those standards, and upholding them. Please refer to University Policy (http://graduatestudies.cua.edu/currentstudents/academintgrt.cfm) and appropriate Program Handbooks. D. Confidentiality Each student is expected to adhere to the Confidentiality Agreement that is signed at the beginning of every semester. This agreement covers practice materials in classes, supervisory sessions, case conferences, seminars, and other educational settings within the NCSSS BSW or MSW programs are for professional learning purposes only and are subject to strict professional standards of confidentiality. These same standards of confidentiality also extend to various forms of written communication and peer consultation. Adherence to these standards means all students refrain from communicating beyond the classroom setting about practice material that is presented in class. I will also refrain from using social media outlets (blogs, twitter, Facebook, etc.) or email to discuss practice settings, program responsibilities and projects with individuals who are not in teaching or supervision roles directly related to the situation. E. Accommodations Students with physical, learning, psychological or other disabilities wishing to request accommodations must identify with the Disability Support Services (DSS) and submit documentation of a disability. If you have documented such a disability to DSS that requires accommodations or an academic adjustment, you much present that documentation to your instructors and arrange a meeting with as soon as possible to discuss these accommodations. F. Use of Electronic Devices No laptops or other electronic devices are permitted in the classroom, unless you have a specific documented learning disability. Please turn off all cell phones or other devices that would disrupt the learning environment of the classroom and put them away and removed from the classroom environment.
6 Class Schedule Class PART I: Topics and Readings ATTACHMENT THEORY AND NEUROBIOLOGICAL RESEARCH: OVERVIEW OF BASIC CONCEPTS 1 Introduction to course; Historical context of attachment theory Bowlby and the Secure Base of attachment Significance of neurobiology for understanding affect regulation and attachment Historical context of attachment theory and Bowlby s earliest influences Exploration of Bowlby s secure base concept Relationship of the child s attachment system to the exploratory system The universality and continuity of attachment Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. xi-13). New York: Norton and Co. Bennett, S., & Nelson, J. (2010). Introduction. In S. Bennett & J. Nelson, J. (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 1-14). New York: Springer. Sable, P. (2010). The origins of an attachment approach to social work practice with adults. In S. Bennett & J. Nelson, J. (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 17-29). New York: Springer. Bowlby, J. (1988). A secure base (pp. 1-38). NY: Basic Books. Wallin, D. (2007). Attachment in psychotherapy (pp. 1-8). NY: Guilford 2 Mary Ainsworth and the Strange Situation (SS) Internal Working Models (IWM) of attachment Bowlby s theories regarding the child s adjustment to separation and loss Ainsworth s empirical contribution, developed from studies of mothers and babies in Uganda and Baltimore Home visitation and the SS observational measure Exploration of IWM of attachment: secure, insecure avoidant, and insecure resistant attachment Mental representations of attachment
7 Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 40-81). New York: Norton and Co. Cassidy, J. (2008). The nature of the child s ties. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 3-22). New York: Guilford Kobak, R., & Madsen, S. (2008). Disruptions in attachment bonds: Implications for theory, research, and clinical intervention. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 23-47). New York: Guilford Bretherton, I., & Munholland, K. (2008). Internal working models in attachment relationships: Elaborating a central construct in attachment theory. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 102-127). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 9-24). NY: Guilford 3 Mary Main and the Adult Attachment Interview (AAI) The theory and concepts underpinning Main s AAI States of mind with respect to attachment Meta-analysis and validity of AAI as predictive of child attachment The impact of unresolved trauma and loss on adult attachment security Solomon s and Main s conceptualization of disorganized attachment Bennett, S., & Nelson, J. (2010). Contemporary theory and research on adult attachment: Where is the field today? In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 31-55). New York: Springer. Hesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 552-598). New York: Guilford Shaver, P., & Fraley, C. (2008). Attachment, loss, and grief: Bowlby s views and current controversies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 48-77). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 25-42). NY: Guilford
8 4 Fonagy and the concept of mentalization Adult Attachment Styles as viewed through social psychology Cultural context and attachment Fonagy s view of reflective functioning and mentalization in adults Self-report research on adult attachment styles The correlation between SS and AAI in cross-cultural studies Cross-cultural studies of IWM in European and non-western cultures Crowell, J., Fraley, C., & Shaver, P. (2008). Measurement of individual differences in adolescent and adult attachment. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 599-634). New York: Guilford Fonagy, P., Gergely, G., & Target, M. (2008). Psychoanalytic constructs and attachment theory and research. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 783-810). New York: Guilford van IJzendoorn, M., & Sagi-Schwartz, A. (2008). Cross-cultural patterns of attachment: Universal and contextual dimensions. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 880-905 ). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 43-58). NY: Guilford 5 The neurobiology of attachment and affect regulation Understanding the brain s organization and function The neurobiology of short and long-term memory Early affect regulation as part of attachment and relational experiences Psychobiology of affective attunement and brain development The neurobiology of the development of the self Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 15-57). New York: Norton and Co. Schore, J., & Schore, A. (2010). Clinical social work and regulation theory: Implications of neurobiological models of attachment. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 57-75). New York: Springer.
9 Coan, J. (2008). Toward a neuroscience of attachment. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 241-265). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 59-83). NY: Guilford PART II: ATTACHMENT IN INFANCY, CHILDOOD, AND ADOLESCENCE 6 Secure parenting Influences of age, class, and culture on caregiving and parenting Understanding the internal world of the child The role of caregiver-infant mirroring Viewing attachment and exploration as a Circle of Security Behavioral indicators of infant cues for exploration or safe haven Parenting in different cultures and with multiple caregivers Individual differences among infant-caregiver dyads Howes, C., & Spieker, S. (2008). Attachment relationships in the context of multiple caregivers. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 317-332). New York: Guilford Page, T. (2010). Applications of attachment theory to group interventions: A secure base in adulthood. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 173-191). New York: Springer. Weinfield, N., Sroufe, A., Egeland, B., & Carlson, E. (2008). Individual differences in infant-caregiver attachment: Conceptual and empirical aspects of security. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 78-101). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 84-114). NY: Guilford In Class Quiz 7 Abuse, neglect, and trauma leading to childhood disorganization Longitudinal studies regarding attachment in childhood and adolescence The neurobiology of childhood stress and deprivation Attachment influenced by daycare and multiple caregivers The neurobiology of disrupted attachment
10 Assessment of childhood disorganization from trauma, abuse, and neglect Assessment of childhood disorganization from parent disorganization Resilience and attachment of at-risk children Viewing attachment in context across the lifespan: The Minnesota Longitudinal Study Understanding childhood Reactive Attachment Disorder (RAD) in comparison to disorganized attachment The challenges of parenting children with attachment disorders Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 82-140). New York: Norton and Co. Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 666-697). New York: Guilford Deklyen, M., & Greenberg, M. (2008). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 637-665). New York: Guilford Class Presentations 8 Foster care, adoption, and daycare Implications of child welfare policies Treatment of high-risk children, adolescents, and families Permanency planning and its effect on child attachment Challenges in establishing new child-caregiver attachments Coaching at-risk children and caregivers in the child welfare system Organizational challenges in child welfare agencies Ethical dilemmas in child welfare placement decisions The importance of enhancing parental reflective functioning Attachment-based intervention with foster children and their caregivers Attachment-based intervention with adoptive children and their parents Outcome studies and implications of attachment intervention research Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 141-177). New York: Norton and Co. Berlin, L., Zeanah, C., & Lieberman, A. (2008). Prevention and intervention programs for supporting early attachment security. In J. Cassidy & P.
11 Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 745-761). New York: Guilford Dozier, M., & Rutter, M. (2008). Challenges to the development of attachment relationships faced by young children in foster and adoptive care. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 698-717). New York: Guilford Blome, W., Bennett, S., & Page, T. (2010). Organizational challenges to implementing attachment-based practices in public child welfare agencies: An example using the Circle of Security model. Journal of Public Child Welfare, 4(4), 427-429. DOI: 10.1080/15548732.2010.526904 Allen, J. (2008). The attachment system in adolescence. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 419-435). New York: Guilford Kerns, K. (2008). Attachment in middle childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 366-382). New York: Guilford Rutter, M. (2008). Implications of attachment theory and research for child care policies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 958-974). New York: Guilford Class Presentations PART III: ATTACHMENT IN ADULTHOOD 9 Overview of adult attachment in individuals, couples, and families Attachments in later adulthood and in caregiving relationships What is adult attachment and what does it mean to be attached in adulthood? Predictors of stability and change of attachment security in adults A systems approach to viewing attachments in families Psychobiological perspectives on adult attachment and health Loss and bereavement and the nature of detachment in adulthood The caregiving behavioral system: Secure base and safe haven caregiving Attachment and caregiving within late adulthood Bennett, S., Sheridan, M., & Soniat, B. (2010). Attachment and caregiving for elders within African-American families. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 127-145). New York: Springer. Mikulincer, M., & Shaver, P. (2008). Adult attachment and affect regulation. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research
12 and clinical applications (2 nd ed., pp. 503-531). New York: Guilford Nelson, J. (2010). Separation, loss, and grief in adults: An attachment perspective. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 79-95). New York: Springer. Bowlby, J. (1988). A secure base (pp. 119-136). NY: Basic Books Class Presentations 10 Trauma and domestic violence Adult psychopathology as an outgrowth of attachment disorders Enhancement of reflective functioning and mentalization Attachment-related trauma and Posttraumatic Stress Disorder The relationship of attachment to the development of personality disorders The relationship of attachment to depressive, anxiety, and dissociative disorders Criminality and antisocial behavior viewed as attachment disorders Dozier, M., Stovall-McClough, K. C., Albus, K. (2008). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp.718-744). New York: Guilford Fewell, C. (2010). Using a mentalization-based framework to assist hard-to-reach clients in individual treatment. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 113-126). New York: Springer. Bowlby, J. (1988). A secure base (pp. 77-118). NY: Basic Books. Wallin, D. (2007). Attachment in psychotherapy (pp. 211-338). NY: Guilford Class Presentations 11 Relational treatment with individual adults, couples, and families Attachment theory as a bridge between cognitive and psychoanalytic theory and practice Attachment-based dynamic relational treatment with individual adults The therapist as a secure base in clinical treatment Understanding attachment patterns within the transference relationship
13 Using intersubjectivity in treatment Links between family therapy and attachment research Treatment of stress, conflict, and violence in adult close relationships Repair of ruptures in partner attunement Reshaping early childhood and present-day attachment injuries in couples Enhancing the parenting of adolescent mothers Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 177-201). New York: Norton and Co. Miscall Brown, K., & Sorter, D. (2010). Listening closely: The significance of the therapist s voice intensity, rhythm, and tone. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 97-111). New York: Springer. Shapiro, J. (2010). Attachment in the family context: Insights from development and clinical work. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 147-192). New York: Springer. Slade, A. (2008). The implications of attachment theory and research for adult psychotherapy: Research and clinical perspectives. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 762-782). New York: Guilford Bowlby, J. (1988). A secure base (pp. 137-157). NY: Basic Books. Feeney, J. (2010). Adult romantic attachment: Developments in the study of couple relationships. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 456-481). New York: Guilford Johnson, S. (2008). Couple and family therapy: An attachment perspective. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2 nd ed., pp. 811-829). New York: Guilford Wallin, D. (2007). Attachment in psychotherapy (pp. 115-210). NY: Guilford Class Presentations PART IV: FOCUS ON THE FUTURE 12 Conclusion with focus on policy, social work education, and research The need for policy changes Enhanced practice with an eye on prevention Application of theory to organizational and educational domains
14 Applegate, J., & Shapiro, J. (2006). Neurobiology for clinical social work: Theory and practice (pp. 202-218). New York: Norton and Co. Bennett, S., & Deal, K. (2010). Implications of attachment theory for social work education. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 253-265). New York: Springer. Everett, J. (2010). Policy implications of attachment processes in adulthood: Caregiving and family preservation. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 195-216). New York: Springer. Bettmann, J., & Jasperson, R. (2010). Attachment research: Contributions of social workers. In S. Bennett & J. Nelson (Eds.), Adult attachment in clinical social work: Practice, research, and policy (pp. 217-252). New York: Springer. Take-home final exam due (will discuss answers in class) Assignments 1. In-class objective quiz (class 6) 30% 30-minute objective quiz will examine the students knowledge of terms and concepts that underpin the theory of attachment, based on readings and lectures from classes 1-5. 2. Class presentations (due date assigned in class) 30% Instructor will discuss details about class presentations in first class. 3. Take-home final exam (due class 12) 30% The instructor will distribute the exam in class 10, and will require students to apply attachment theory to case examples from clinical practice. 4. Class Participation 10% The class participation grade will be determined by the instructor s perception of the student s preparation for, and contribution to, class discussion, and by evidence that the student has completed the readings. Students must attend all classes and come on time.