Why Attachment Matters Across the Lifespan. A summary of the Scottish Attachment in Action Annual Conference, 18th December 2019
Reflecting its vision of promoting attachment relationships throughout life, Scottish Attachment in Action’s 11th Annual Conference held in the Queen Elizabeth University Hospital, Why Attachment Matters Across the Lifespan, brought together an impressive range of speakers who provided a stimulating, reflective and often touching account of this important but perhaps rather overlooked area.
Edwina Grant, SAIA’s chair introduced and welcomed each speaker to what is a new venue for SAIA events.
Sir Professor Harry Burns, Professor of Global Public Health, University of Strathclyde started off the day by giving a characteristically thought provoking and humorous overview of the importance of consistent parenting. Always thoughtful and engaging and with his renowned firm grounding in science (“unless you have evidence all you have is opinion”), Sir Harry is never afraid to make a powerful social comment.
He reminded us that the evidence is clear that the most successful societies are those with strong social bonds, connection and cohesion and gave a comprehensive overview of the evidence which supports this, as well as an insight into the motivation to improving the health of Scotland stemming from his early experience as a surgeon in Glasgow.
Citing a range of data and scientific studies as well as the inspirational rectorial address by Jimmy Reid in the early 1970’s on alienation, described by the New York Times as the “the greatest speech since President Lincoln’s Gettysburg Address, Professor Burns provided a compelling and motivating call to the promotion of wellness through meaningful asset based support for and empowerment of families and reminded us that solutions emerge when we ask ‘what matters to you?’
The themes and insights of Sir Professor Harry Burns’ keynote address were echoed throughout this fascinating and inspiring day, with all speakers making links directly and indirectly with Sir Harry’s commentary.
[view Sir Professor Harry Burns presentation]
Scottish Attachment in Action’s patron Professor Helen Minnis, Child and Adolescent Psychiatry (Mental Health and Wellbeing), University of Glasgow gave us the benefit of her extensive professional and research experience on the topic of Getting a good early start: supporting attachment relationships in young children and stressed parents.
Once again, we were treated to a comprehensive and accessible overview of a complex area. The Harvard Centre for the Developing Child was highlighted at the outset of Helen’s talk as a helpful source of information particularly for its use of metaphor such as ‘serve and return’ which will be a familiar term for many who work with infants.
We were reminded by Helen that if we look across human populations, we recognise that we are adapted to cope with stress, that not all stress is ‘bad’ and that in fact stress responses are helpful in many situations where we are required to perform. The key to understanding human development lies in the understanding of what makes us resilient and adaptive. If we take an evolutionary perspective the quality of the ‘relationships within the pack’ play a vital role and help us to manage throughout life. Adults are programmed to respond to infants’ attachment behaviours but as we are aware there are sometimes barriers which affect this instinctive parental response and that in those circumstances, we need to address the neurodevelopmental issues of parents.
Helen went on to describe the divergent developmental paths related to the interactions of temperament and parenting and reminded us that the range of ‘good enough’ parenting can be very wide and varied indeed. Working together to urgently support stressed parents is key, as are relationship focused interventions to support attachment relationships to remove barriers so that instinctive parenting can emerge. The importance of good formulation and helping the person to understand was emphasised. That deeper understanding, so eloquently described, is potentially very helpful in promoting that good formulation.
[View Professor Helen Minnis presentation]
Following the break and opportunity for networking, Dr Andrea Williams, Consultant Psychiatrist and Medical Psychotherapist, NHS Greater Glasgow and Clyde gave a very interesting presentation on the topic of Attachment Theory and personality disorder: how theory helps in the chaos.
The focus of Andrea’s presentation was the work of the Personality and Homelessness Team which works across traditional boundaries to support a more coherent and attachment informed response to those with a diagnosis of personality disorder who find themselves homeless. The themes emerging from this work had resonance for many working to support particular ‘hard to serve’ groups and provided a compelling insight into the importance (and challenge) of taking a relational approach to the way we offer our services.
The relevance of ‘doing with rather than to’ in all our services was amply demonstrated throughout Andrea’s presentation, as was the need to constantly learn and be open to shifts in ideas about what actually does help. The role of mentalising, the capacity to understand the mental state of self or others, was highlighted as an area compromised by high levels of stress arousal for both service users and service providers alike.
Mentalising is a key element in social understanding and ability to adapt and is closely related to attachment experiences. An understanding of the activation of the attachment system under stress and the related difficulties of regulation of affect also underpin the approach to support for this often-stigmatised group. A recognition of the struggle for some to engage with supports led the team to reflect on the underlying dynamic of epistemic trust, the willingness to accept new information as trustworthy, relevant and generalisable, and its role in social learning and the capacity for change.
The overwhelming experience of homelessness coupled with personality disorder can so readily lead to a loss of trust and deep suspicion of those offering help and support. Engagement is often messy, and the service needs to allow for a long intake period before any therapeutic support is even possible. The subtlety of developing trust and the necessity for ostensive cuing (early communicative cues closely allied to mentalising ability) was emphasised as key to the work of the team in engaging with service users and is a reflection from which many services could benefit. “If trust develops people can internalise knowledge and helpful things and take them into their world”.
Following lunch and a further opportunity to network, visit the marketplace and bookstall, Jan Beattie, Executive Lead for People Development, Alzheimer Scotland provided a new and stimulating perspective in her presentation From childhood to later life: childhood experiences in dementia.
Continuing the themes of the importance of attachment relationships and the way we deliver our services, Jan began by highlighting the importance of dementia as a global health priority but one in which there is no cure, and unlikely to be one around the corner. Many of us will be touched by dementia one way or another.
An understanding of attachment can be very helpful in reframing some of the behaviour, distress and responses which can be part of the experience of dementia. It helps us to make sense of the drive to seek connections and the need to offer support which maintains connections. Secure attachment in childhood may lay a protective foundation which enables more effective coping and can be a protection against cognitive decline.
However, 33% of people who receive a diagnosis do not go outside afterwards. This is often about a need to protect but clearly has a huge impact on opportunities for social connectedness. So, at a time of cognitive decline when social connection may be most needed, there is a significant risk of this being lost. The issue of lack of engagement and the ability to accept support also has an impact on the capacity to cope.
Person centred planning taking account of what has been important has strong resonance with Sir Harry’s description of the importance of meaning making. Family support is key and family carers the most important resource. Walking alongside people through their experience of dementia and keeping connections until the end of life is what makes a difference.
Jan ended with a telling and moving personal example from her own experience which gave real meaning to the significance of early relationships throughout life.
[Read Jan Beattie’s presentation]
This fascinating conference closed with a presentation by Andy Lowndes, Deputy Chair and ‘The Music Detective’, Playlist for Life who took us through the work of The Music Detective, giving insight into the importance of music in connecting with important experiences in life. We all have the experience of connecting particular music with important events and feelings and Andy demonstrated this by involving the delegates in sharing some of this experience.
As a former mental health nurse and academic, Andy’s interest in this area was piqued by the experience of Sally Magnusson in caring for her mother and the way in which music seemed to enable a connection with herself and with her family in a way that other senses could not reach. While Andy had seen this during his nursing career, he wanted to carry out some research; and so he did. There is a science base and a growing body of research on brain activity and listening to preferred music. Music is neurologically special, and Andy illustrated this through a series of compelling and touching video clips showing the responses of people affected by dementia when listening to music which had meaning for them.
Andy works with families and carers to identify personally meaningful music to generate a soundtrack to the person’s life and generate the Playlist for Life which can help access important memories, feelings and experiences and bring comfort and soothing to those experiencing the losses associated with dementia. He encouraged us all to give developing a personal Playlist for Life some thought!
[Visit Playlist for Life]
This innovative conference embodied Scottish Attachment in Action’s commitment to promoting attachment informed practice at all stages of life and was at the forefront of connecting the importance of relational approaches to service delivery throughout the lifespan. Grounded in science, and threaded through with warmth and humanity, this was a truly inspirational day.
Lead officer for Health and Wellbeing within the Scottish Attainment Challenge in North Lanarkshire
Thank you to Alison for this great summary of the day!