Dynamic-Maturational Model of Attachment and Adaptation

Attachment is a system which involves a person's need to be protected from danger, and comforted especially after exposure to danger and a relationship with an attachment figure who can provide protection from danger and comfort. As a model centered on survival, it also involves a person's need to increase reproductive opportunities and protection of progeny.[1][10]

Particularly when the attachment system involves a caregiver and child, the relational interactions related to attachment needs shapes neural development and emotional and biological regulation processes in children, which has lifelong impacts.[2][11]

An attachment figure may be a parent, other close caregiver, or romantic partner, and has the qualities of an affectively charged relationship, providing assistance in regulating emotions, and protecting the person from being forced to handle something outside their developmental ability (Zone of Proximal Development (ZPD)).[2]

Teachers, helping professionals and other people may function as an auxiliary attachment figure[2] or transitional attachment figure to help get through a difficult experience.[2][11]

Danger can be objective (deep water, cliff edges, snakes) or subjective and relevant to only particular attachment patterns. For people who tend to use self-protective A-strategies, danger can include aggressive or dismissive parental responses, not doing the right thing, doing the wrong thing, expressing feelings especially if negative, and relying on others to meet needs. For people who tend to use self-protective C-strategies, danger can include lack of parental response, not expressing and satisfying feelings especially if negative, following someone else's rules which don't satisfy feelings, compromising, relying on the self to meet needs.[1][12]

Crittenden and colleagues have advanced attachment knowledge in numerous ways. Crittenden and Landini describe many of these in their 2011 book Assessing adult attachment: A dynamic-maturational approach to discourse analysis.

Focus on danger. The DMM focus on danger, rather than safety, orients an understanding of the attachment system in a way that is practical and useful for understanding response to threat and conflict .

Development of lifespan attachment assessments. Crittenden and colleagues developed a comprehensive lifespan set of attachment assessments (described below), and enhanced existing measures. Since theory leads scientific inquiry, and scientific findings add to theory, DMM assessments contributed to better theory.

Maturational. DMM-attachment recognizes that humans are able to utilize more and more sophisticated self-protective attachment strategies as they age. Hence, attachment patterns can become increasingly complex with age. Infants begin with instinctive strategies such as smiling and reaching, and through behavioral learning develop an increasing array of ways to gain protection from danger from their caregivers. Thought and communication patterns are eventually added to a person's available strategies.

Strategies. Strategies are the ways people get their needs met. Self-protective strategies are not diagnoses or mental health disorders. The strategies may be quite functional in certain types of relationships, and dysfunctional in other relationships if not adjusted. Selecting a specific response in a specific situation is not necessarily dictated by a strategy preference, it is situation and context driven, which Crittenden describes as a dispositional representation (DR). Crittenden expanded and more finely defined attachment strategies (or patterns), as noted below.

Adaptive and strategic function of behavior. Attachment behaviors and communication styles are developed through adaptation to danger and function to promote survival in a given relationship.

Every DMM-attachment pattern involves both adaptive and maladaptive behaviors. A person using B3 "balanced" strategies may fail to predict danger or access a self-protective strategy and end up being harmed. A person using A-strategies may focus on cooperating and avoiding conflict to the exclusion of protecting their children or financial interests. A person using C-strategies may focus on satisfying their own feelings to the exclusion of cooperation and conflict resolution.

Individual behaviors can be seen in all attachment strategies, but serve different functions. For example, bright smiling can serve several self-protective purposes. In A-strategies it can function to hide pain and take attention away from in-the-moment negative experiences. In C-strategies it can function to disarm prior or following aggression.

Dimensional. Strategies are described as dimensional rather than categorical. As demonstrated on the DMM Circumplex, they range from exposing people to more and more risk (moving down the outside of the Circumplex), and more or more intensity (moving from the center of the Circumplex to the outer rim). The DMM eschews the terms secure and insecure, although it is used in various DMM literature.

The DMM has and continues to incorporate all relevant disciplines. It incorporates all the disciplines Bowlby utilized, including psychoanalytic, ethology, general systems theory, evolutionary biology, cognitive information processing, and cognitive neurosciences. It incorporates all the disciplines Ainsworth utilized, including naturalistic observation, and empirical grounding of attachment theory. DMM additions include genetics, epigenetics, neurobiology, sociology, developmental psychology, Piaget's cognitive development, Eriksonian development, behavioral learning theory, social learning theory, theory of mind, cognitive psychology, Vygotsky's Zone of Proximal Development, Vygotsky and Bronfenbrenner's social ecology, transactional theory, family systems theory, polyvagal theory, mindfulness theory, and Functional Somatic Symptom theory.[11][13][1]

The DMM is supported by the International Association for the Study of Attachment (IASA). The Family Relations Institute (FRI) is the primary organization teaching DMM theory and assessments. The Attachment Studies programme at University of Roehampton, U.K., includes the DMM and some of its assessments.

IASA maintains a list of publications describing the DMM. There are over 500 such publications.

At each stage of information processing, information is transformed as it is converted from what it is, to a representation of what it is in the mind. A test result, a smile, and divorce papers, come to mean something in the mind through a neural process. The DMM[1] currently identifies seven ways information can be transformed, each of which represents increased transformation:

Truly, erroneously, distorted, omitted, falsified, denied, delusively

A child's strong negative emotion, continuing with that example, could be seen:

1. Truly, and provide information with which to ease the child's distress
2. Erroneously, over or under-interpreted, such that a parental response might be non-productive, such as giving too much or not enough attention to the distress
3. Distorted, where some portion of the information is emphasized and the other de-emphasized, such as acknowledging the distress but emphasizing that it will go away on its own
4. Omitted, so that some portion of the information is discarded
5. Falsified, where the emotion is changed from distressed to hungry
6. Denied, where the emotion is actively avoided
7. Delusionally, where new and incorrect information is created to replace the true information, such as thinking the child is laughing or is signaling a desire to play

DMM assessments look for memory system function as described by memory researchers such as Endel Tulving and Daniel Schacter. The memory systems assessed by the DMM method are somatic, procedural, semantic, imaged, connotative, episodic, and reflective integration.[1]

The ICI consists of a 3-minute interaction of a caregiver and child (a 2-person, or dyadic, relationship) aged from birth to 15 months.[17] The ICI assesses interaction, not attachment (which does not develop until 9–11 months of age).  The ICI assesses a dyad's interpersonal functioning under non-threatening play conditions and clusters dyads as  sensitive to good enough, at mild risk of parenting difficulties, or at high risk of parenting difficulties, including infant neglect and maltreatment. It was developed by Crittenden with input from Ainsworth and Bowlby.[18][19] The ICI is considered a valid and reliable assessment and has more than 60 published studies.[17][20][21]

The SSP is the classic assessment of attachment developed by Ainsworth. Almost all other assessments of attachment are validated against it. The SSP consists of eight episodes over 21–23 minutes. Unlike the ICI which assesses only dyadic synchrony under the favorable condition of play, the SSP uses threat to elicit the infant’s pattern of attachment. Threat, or relationship danger, comes in several forms such as the stranger coming into the observation room with parent and child (episode 3), the parent leaving the child in the room with the stranger (episode 4), the parent later leaving the child in the room alone (episode 6), and the stranger re-entering the room without the parent (episode 7). The parent returns and the stranger leaves in the eighth and final episode. The infant’s behavior on the parent's return is the primary basis for classification into one of three major strategies, labeled A, B, and C.

The SSP was developed for 11-month-old infants. It has been used for older infants, but, as infants age, their tolerance for separation increases and the behavioral markers defined by Ainsworth fit less well, resulting in higher proportions of infants classified as secure, including maltreated infants.[22] In the DMM, this problem was resolved by limiting the age range to 11–15 months,[23] and developing, with Ainsworth’s assistance, an alternating A/C classification and pre-compulsive and pre-coercive patterns.[24][25] These include A1-2 or C1-2 patterns, and clear evidence for A+ or C+ patterns (which involves more intense use of self-protective strategies). These expansions of the Ainsworth categories have been associated with maltreated infants and infants of depressed mothers.[26]

The PAA is a version of Mary Ainsworth's Strange Situation Procedure (SSP), adapted to 2-5 year-old children. It assesses the child's self-protective strategies used with the adult involved in the assessment.[27] It also uses a video recorded 8-segment process over a structured 21-23 minute adult-child interaction. The PAA is valid and reliable, with more than 30 studies using it.[28]

The SAA involves an audio recorded interview which is transcribed and analyzed with discourse analysis techniques, for children aged 6–13 years. In the assessment, a child is given story cards which represent increasing levels of danger, and they are asked to make up a story that describes what is depicted on the card, and then, if they had any similar experience in their life, asked a series of exploratory questions. It assesses the child's generalized attachment pattern, self-protective strategies, pattern of information processing, and possible unresolved trauma and loss. It was initially developed in 1997 by Crittenden, has been tested in eight research studies, and is considered to provide discriminate validity.[14][29] The SAA was the subject of a special section of Clinical Child Psychology & Psychiatry, Volume 22 Issue 3, July 2017.

The DMM-AAI is considered one of the most comprehensive attachment assessments, and is well validated. It was initially created by Nancy George and Carol Kaplan in, and later developed with Mary Main in 1985.[30] Crittenden and Landini slightly modified it with DMM theory in 2011.[1][31] It assesses self-protective attachment strategies, patterns of information processing, a possible unresolved trauma and loss which distort behavior and information processing, an over-riding condition which causes information distortion such as depression and triangulation in childhood, memory system usage, and reflective function. The assessment involves asking a person a series of structured questions, transcribing the audio recording, and applying a complex set of discourse analysis techniques. The interview takes 60–90 minutes, and it can take hours or days to analyze. Learning to code reliably generally takes several years.

Assessing adult attachment: A dynamic-maturational approach to discourse analysis (2011) is the coding manual for the DMM-AAI, and is publicly available.

The following assessments have not been validated and are not considered by IASA to be acceptable for use forensically.

Toddler Care-Index (TCI)

The TCI video records a 5-minute interaction of a caregiver and child aged from 15 to 72 months. It assesses the general attachment characteristics of a specific dyad, such as mother and child or father and chid. The TCI is considered a useful assessment, but has not been validated by research. It was developed by Crittenden.[32]

Transition to Adulthood Attachment Interview (TAAI)

The TAAI is a modified version of the AAI for adolescents aged about 14–25 years old. It was modified from the AAI by Crittenden in 2005 and 2020.[33][34]

Meaning of the Child interview (MotC)

The MotC is an interview of a parent which is transcribed and assessed with discourse analysis techniques. It is similar to the AAI, but differs in important ways. The MotC assesses a parent's general pattern of attachment, sensitivity and level of responsiveness to their child, the degree and forms of control a parent may utilize, and self-reflective function (mentalization). It was developed by Benjamin Grey and Steve Farnfield in 2017, and uses DMM theory and methods.[35]

Child Attachment and Play Assessment (CAPA)

The CAPA assesses the attachment and exploration systems of children aged 7–11. It uses an interview process similar to the SAA. It was developed by Steven Farnfield, and uses DMM theory and methods.[36]

The DMM and it's methods are useful for discourse and argument analysis, client counseling, forensic purposes, and conflict management. At its heart, attachment theory involves the conflict of contradictory information, and information processing involves a conflict between the emphasis and de-emphasis of information.[9]

Because information processing involves the defensive exclusion and inclusion of information, it can affect how people make decisions and communicate. The DMM-AAI discourse analysis method is specifically designed to “understand the meanings behind unclear communication * * * distorted communication and dysfunctional behavior.”[1] (Crittenden and Landini, p. 1, 2011.)

Attachment assessments can be used in court cases[37] and forensically if done by a trained and reliable coder.[38][39] The IASA Family Court Protocol is designed to promote attachment information in a way that is as comprehensive and reliable as attachment assessments can allow, and which also supplements other information about individuals, family members, and family systems. FRI's Family Functional Formula is comprehensive and valuable, if expensive, method to assess a family system.

Kozlowska[11] argues that functional somatic symptoms are impacted by disrupted or chronically challenged attachment relationships. The DMM assessment method, especially for children, specifically identifies and assesses nonverbal communications and somatic expressions. Two large studies, which Kozlowska relied on, found a strong association between low quality attachment relationships and functional somatic symptoms later in life.[40][41] Kozlowska's own research showed children with functional neurological disorders (FND) almost universally had higher attachment strategies (A3-4, A5-6, C3-4, and C5-6).[42][43]

The DMM is not a therapy model, rather it provides a framework to better understand clients, improve communication, and can assist with selecting appropriate therapy models.[44] It can help therapists:

• Assess or formulate the client's self-protective attachment strategies;
• Focus the therapeutic alliance around the concept of being a transitional attachment figure;
• Identify dangers from the past and in the present;
• Determine how the client functions interpersonally (including with the therapist);
• Identify a client's patterns of information processing and information bias;
• Help clients build a coherent narrative of their experiences.[45][46][47]

For therapists using a family systems approach, it can help identify self-protective strategies between the parents, between each child and parent, and between children, to provide more insight into the functioning of the family system.[48] It can help therapists avoid blame and reframe negative emotions to honesty and more appropriate contexts. It can help a therapist move a client's strong negative emotions such as anger and a desire for revenge to softer and more manageable emotions such as sadness and vulnerability.[49] The DMM provides insight into various mental health issues,[50] such as borderline personality disorder,[51] avoidant personality disorder,[52] eating disorders,[53][54][55][56] conversion disorders,[57][58][59][60][11] and depression.[61][62][63][64]

The DMM theory and assessment methods are useful for conducting attachment assessments. Because there are DMM assessments to cover the lifespan,[16] they can be used to assess a family system.[48] The DMM approach appears to provide more precise results with populations of people whose childhood involved adverse childhood experiences or parents who consistently used cold, inconsistent, harsh or controlling parenting techniques or engaged in parental conflict or failed to protect or comfort their children.[14] It appears that between the DMM and Berkeley assessment methods, the DMM method can better delineate between secure and insecure attachment classifications, and also the quantity of A, C, and mixed AC patterns.[31] This is likely because the DMM is focused on a person’s response to danger and fear, and describes the attachment system’s primary purpose as being to organize self-protective responses.[31][6]