It takes a village: a call for engaging attachment with adjunct disciplines to clarify “in-house” clinical conundrums

ABSTRACT

Researchers have long discussed the rich clinical applications of attachment theory. Specifically, clinicians have been compelled by the idea that insecure attachment, broadly speaking, may bring about stressful (real or perceived) interpersonal experiences that increases risk for internalizing symptoms. However, recent meta-analyses examining the links between attachment representations and internalizing symptoms have challenged this assumption, highlighting the importance of considering insecure attachment subtypes in understanding one’s vulnerability for internalizing symptoms. Here we expand on this special issue’s target papers and propose that, despite an increase in citation impact of clinically relevant attachment research, there are still core theoretical and methodological questions left unanswered. We highlight three clinical conundrums: (1) hyperactivating, but not deactivating, attachment is linked to increased internalizing symptoms in adolescence and adulthood; (2) the magnitude of the associations between insecure attachment subtypes and internalizing symptoms varies depending on the developmental period; and (3) self-reported, but not narrative-based, deactivating attachment is associated with increased internalizing symptoms. We call for engagement with adjunct academic disciplines to elucidate these issues. These clinical conundrums have important ethical implications regarding how we understand insecure attachment and necessitate close theoretical and empirical attention before attachment findings can truly inform clinical practice.

KEYWORDS:

• Clinical
• deactivating
• hyperactivating
• insecure attachment
• internalizing symptoms

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Of note, given the limited space, in this commentary we do not elaborate on attachment disorganization; for an in-depth discussion on this attachment pattern, see Haltigan et al. (2021).