The Impact of Attachment as an Actor of Resilience: In the Light of the Comparative Analysis of Two Clinical Cases: A Chilean Experience

Presentation of the Background of the Cases

The young people in question are known as Daniel and Andrés, both were 16 years old when they entered the program, they were detected together after a mapping1 in the sector of Providencia district of Santiago de Chile, they had been hiding for days from another group of young people who were looking for them to take revenge. Daniel, was born product of the stable relationship of his parents, however both consumed drugs and were involved in micro-trafficking issues, so the young boy entered for the first time at the age of six months to the protective system of the State of Chile specifically in Casa Nacional del Niño (residence for infants and preschool children), after the family court determined that the then baby was being seriously violated in their rights, From that moment on Daniel began a long path of institutionalization in different residences, the last one being at the age of 15, after that the young man decided to leave and that is where the street circuit begins, from the time he entered the different spaces the contact with his mother was more and more diminished, being the young man the one who visits her from time to time, but of those encounters always the experience was negative, either by rejection of the mother, arguments, among other things.

On the other hand, Andres was born as a result of a relationship of which no further information is known, he never knew his father, nor was he recognized by him, his mother never took care of him, being given to his godmother when he was only days old, when the young boy was four years old, she died of cancer, At this age he began his journey through the institutional system, not having a responsible adult who could take care of him, during this period the mother was diagnosed with paranoid schizophrenia, in addition to an accumulation disorder that disqualified her from taking care of the child, this is how the young man passed through two residences throughout his childhood, abandoning the last one at the age of 16 and with this the beginning of the street transit.

Clinical Conceptual Development

It is considered relevant to take the Attachment Theory when talking about children and young people in street situations, due to many factors, but one of them is that it has its origins in the study with institutionalized children, a situation that is observed in most of the children living in the street.

First, it is necessary to mention that according to Marrone, Bowlby would define attachment theory as: “a way of conceptualizing the tendency of human beings to create strong affective bonds with particular people and an attempt to explain the wide variety of forms of emotional pain and personality disorders, such as anxiety, anger, depression and emotional withdrawal, which are produced as a consequence of unwanted separation and affective loss” [1]. Another important term to refer to is “street children” which is used in a generalized manner to refer to high-risk children in urban areas, but without considering the differences among them. Not all children and adolescents are abandoned, and not all live on the street. UNICEF distinguishes between two groups of children according to the situation of their families: “Children “on” the street are the largest group. They work on the streets but maintain close relationships with their families. The majority (approximately 75%) maintain their family ties, and although they spend a lot of time away from them, they feel they have a home. The children “from” the street (approximately 25%) are homeless and have broken family ties due to instability or disintegration in their families of belonging. In some cases, they have been abandoned by their families and in other cases they themselves have decided to leave. They eat, sleep, work, make friends, play in the street and have no alternative but to fight for their lives alone” [2]. The two young people presented belong to the second group, “where there seems to be a basic failure in attachment, without having achieved a secure attachment base” [3].

Regarding the types of attachment and its impact on people’s personality, Ainsworth & Bell [4] identified attachment styles based on the quality of the mother-child relationship. From this, they designed an experimental situation, “the Stranger Situation”, to examine the balance between attachment and exploration behaviors under high stress conditions. The aim was to assess how children used adults as a source of security, from which they could explore their environment; also how they reacted to the presence of strangers, especially at times of separation and reunion with the mother or caregiver.

In the test results, Ainsworth found clear individual differences in the behavior of the children in this situation. These differences allowed him to describe four behavioral patterns that were representative of the different attachment styles established:

• Secure attachment
• Avoidant attachment
• Ambivalent-anxious attachment
• Disorganized attachment - disoriented attachment Regarding secure attachment they visualized that, the child believes that his needs will be perceived and satisfied by his attachment figures [5], therefore, he builds a secure base that allows him to explore his environment with confidence. He knows that his caregivers will be attentive to him. As for avoidant attachment, they observe that the child believes that his caregivers will not be able to offer him protection and emotional support, the child avoids searching for the attachment figure and his emotional closeness. In ambivalent-anxious attachment, they visualize that the child feels insecure about the emotional availability of his caregivers and their capacity to satisfy his needs, in this sense, he fears separation and loss, and as a strategy he actively seeks physical closeness. Finally, in disorganized attachment they observe that the child may be indifferent, aggressive and/or fearful towards his caregivers, who in turn are negligent in the physical and emotional care of the child.

From this conceptual theoretical development, Fonagy (2001) refers that the attachment style of a child at one year of life is a significant predictor of its future development (a secure attachment is the best guarantee of mental health; protective function, psychic resilience) [5], as well as there is a significant correlation between the representation that parents have of their own attachment bonds and the nature of the attachment they develop with their children, thus attachment is specific to the relationship, not to the person.

Thus, the integration of neuroscience and attachment theory is reflected in the current view that brain maturation is experience-dependent and that there are critical experiences that facilitate brain growth in the first two years of life, which are triggered in the transactional affective relationship co- constructed by the infant and the primary caregiving figure [6].

The relationship between attachment and mental health or pathology has been studied for a long time. It is clear that early attachment relationships are decisive for the acquisition of the infant’s capacities for attentional control, affective regulation, mentalization, and sense of autonomy [7].

These studies confirm that 50-80% of patients with borderline personality disorder meet the criteria for the anxious or disorganized style [7]. In fact, it is disorganized attachment that is most related to emotional regulation problems. Adults with anxious attachment are more prone to personality disorders: histrionic, borderline, avoidant and dependency, and are also more sensitive to rejection and anxiety [7]. The most critical element in the development of secure attachment is good quality bonding relationships; in turn, emotional secure attachment more than intellectual stimulation, is crucial for the development of a healthy personality [7].

Thus, it can be referred that all early formative psychopathology is an attachment disorder and manifests itself in failures of self-regulation (under- or over-regulation) especially in biologically more primitive affects: shame, anger, arousal, euphoria, disgust, and panic-terror. Hence the relevance of early interventions (critical period of attachment and brain development).

Based on the above, the first concept of Attachment Figure will be used in the first instance, understood as: “the person who is trusted, the one who provides a secure base from which to operate” [8, 9], in this sense any caregiver can be considered, beyond the parents, it is the attachment figure capable of providing that secure base from which the child can venture to explore. Thus, taking up the cases of the youngsters previously exposed, it is observed that Daniel, since he was taken out of his mother’s arms, does not manage to have an attachment figure because he was never with a fixed caregiver, but with different people who took care of him; on the other hand, Andrés, although his mother was not his attachment figure, managed to generate attachment with his godmother until he was four years old, after that, he spent from four to twelve years old in a single place where he managed to make bonds.

A second concept to be developed is that of Secure Base, which is central to Attachment Theory, referring to the child- adult bond. Bowlby (1989) [9], referring to the child-adult bond, states that “providing children and adolescents with a secure base is key for them to be able to venture into the outside world and feel confident in this process, to be more emotionally stable, among other things”. This concept will not only be present during the early childhood of people, but throughout their lives, thus the author will refer that people at any age will develop better if they see that they have someone they trust, where to lean on in a problematic moment, with whom to share in the happy moments of their lives. At this point we can glimpse the intervention processes that the young people in the program carried out; on the one hand, Andrés was able to go back to school, make new bonds of trust, get out of his street situation and thus carry out a successful therapeutic process, while Daniel made some progress, but so far he has not been able to leave the street; And part of the answer to this is that Andres managed to trust the people who worked with him and create new meaningful bonds for him, while Daniel always distrusted the process he was carrying out and at the first failure he could not tolerate frustration, he went backwards and even worsened the progress achieved so far.

Thirdly, the term Transference will be used, which is defined as: “the direct manifestation, in interpersonal situations, of the individual’s internal operative models. That is to say, the way in which a patient perceives his analyst is partially influenced by his internal operative models” [1]. In this sense it is important to highlight how the two youngsters influence in terms of transference this referred to “the caregiving relationship he establishes with the patient, is being assimilated to some pre-existing (and perhaps unconscious) model that the patient has of how any caregiver can be expected to relate to him” [1], this is particularly visible in Daniel, who according to work patterns triggered a lot of rage and anger, referring that this is how the mother spoke to him, or recalling episodes of other programs he had been in. With Andres this again made a difference, as he was much kinder, an empathic young man who was very pleasant at first contact. It is important to consider this idea after three years of this process, because perhaps having made this point visible at the time would have made a big difference in the therapeutic relationship and therefore in Daniel’s intervention process.

Another idea is Mentalization, which “consists of the capacity to imagine and understand mental states in oneself and in others; it is the ability to give a convincing interpretation to one’s own and others’ behavior, based on the underlying mental states” [10]. This mental state was a little more difficult to visualize in both young people, since it was not possible to observe the capacity of the young people to understand these mental states, nor what was their perception of themselves, since it was complex to see if they reflexively understood their own experience and that of others.

Finally, Affective Regulation consists of “the process of elaborating mental states according to a sense of agency. It occurs at different levels; from homeostatic regulation, of which we are not aware, to self-regulation through relationships with others, in which awareness becomes essential” (Fonagy, P. 2002. p.435), i.e., from homeostatic regulation, of which we are not aware, to self-regulation through relationships with others, in which awareness becomes essential” [11], this is fundamental in the theory of attachment, since it would directly affect the organization of the personality, which in the case of Andrés is visualized in that he shows positive affections, trust in others, while in Daniel the opposite is seen; a distrustful young man, who does not show fear or sadness, in extreme situations in the life of any person, such as, for example, the death of a loved one.

Conclusions

In this section it is necessary to mention the current situation of these young men, Andres is twenty-five years old and Daniel is twenty-four years old. After reaching the age of majority, Andres had the clear purpose of continuing his studies in higher education and was in his first year as a technician in architectural drawing, when he was diagnosed with testicular cancer, Andres had to leave his studies and work and entered a residence for young people in a program of the Ministry of Social Development, having overcome his illness, he returned to study, this time Social Work of which he has already graduated, together with two friends he rents an apartment in the center of Santiago, has a girlfriend and says he is happy with the achievements of his life. On the other hand, Daniel, after reaching the age of majority, committed a crime, which had him deprived of liberty for two years, now in freedom the young man is unable to overcome the street situation, he has a long term relationship with another young woman in the same situation and although they try to progress for periods, they return to the same place in downtown Santiago, he sells candy and intends to resume his secondary education studies.

Through the development of the concepts it is possible to visualize how attachment has influenced the lives of these young people, in spite of having a very similar life history, Andrés in his early childhood had the opportunity to develop bases that allowed him to develop important attachment styles that provided him with basic tools in his life, contrary to Daniel who lacked these affections and relationships, in this way it is possible to observe that attachment figures strengthen resilience, concept understood as the “resistance to suffering, as the capacity to resist psychological “bruising of wounds”, after having experienced a trauma, as in the impulse of psychic repair that is born from that resistance” [12], as it happened in the case of Andrés, thus demonstrating that the nature of the care provided by the parents to the child in his infancy is of fundamental significance in the future of mental health [13, 14].