Object Relations/Attachment Theory and Adolescents: A Review of The Current Literature

Treatment effectiveness Case Study

Walsh (2010) illustrates how different types of early attachments can have an effect on adolescents who present with delinquent type behaviors. 

The case study, involving a fifteen year old girl who was reported by her mother as constantly being in trouble, illustrates object relation intervention. Upon further exploration of the client’s conduct it was discovered that she was caught stealing and was facing legal charges for arson. The mother also expressed she was concerned about her inappropriate sexual behaviors and possible human trafficking.  She often exhibited aggressive behavior and appeared to her family as unhappy and ungrateful. With her peers she had good social skills but often got involved in negative activities.  She did not appear to apply herself in school and seemed to have no motivation to study or excel in her classes.  She was described as being the youngest child, with an age gap of seven years and the only girl in the family.  Her mother was overprotective and obsessed with her due to previously losing a child during pregnancy.  Due to the age gap she did not have a good relationship with her siblings. This attachment style made her wary of getting close to people because she was afraid of being smothered.  As a result of this attachment style, when people were friendly but did not come close she saw them as good, but once they became close she saw them as bad.  In this case her behavior was not caused by a lack of attention, but by too much attention by the primary caregiver preventing the teenager from gaining the appropriate transition to independence.  She therefore equates closeness with smothering.  As a result she presented with anger issues and oppositional behavior.  What this case study demonstrates is how attachment styles are developed and influence future relationships. What the social worker did which proved to be effective, was to use object relations theory, which helped the client to break her behaviors and understand that getting close to someone in a relationship did not mean she had to lose her own identity (Walsh 2010).

Intervention

Object relation theory intervention focuses on the reflection of sustainment, development and influence of relationships over a client’s lifetime.  Clinicians have to remain empathetic as the client’s mood changes due to bringing up past issues. The first step for the clinician is finding the pattern of relationships that may have a positive or negative affect on the client.  The clinician then makes interpretations of the impact of these relationships and the client’s feelings about them, and identifies areas of maladaptive coping. The final step in intervention is helping the client cope with the negative relationships and to resolve the interpersonal conflicts (Walsh, 2010).

Effectiveness of Theories on Adolescents

Despite limited research validation, object relations theory has proved effective in a number of populations, for example children in foster care, survivors of child abuse, juvenile delinquency and other emotional issues for adolescents (Walsh, 2010).  Evidence also suggests that object relations therapy can provide huge benefits. In a nondirective leadership style they were able to ask questions that encouraged developmental reflection (Walsh, 2010).

Evidence has shown a strong connection between the level of psychological functioning and level of secure attachment (Brown & Wright, 2001). According to Colonnessi et al. (2011), there is a strong correlation between insecure attachments and the level of anxiety, and the level of anxiety is heightened through adolescence.  The result from their study indicated that an ambivalent attachment style due to the uncertainty of the proximity of the caregiver in early childhood can increase the level of anxiety, which is thought to be linked to internalizing problems and the lack of self-confidence (Brown & Wright, 2001).

Interpersonal relationships with both same and opposite sexes are important in adolescence and failure to make these connections has been suggested to lead to problems with adjusting with and coping with further challenges (Christopher, Nangel & Hansel, 1993).  

As adolescents age, the complexity of these relationships expands and their peer group grows. Adolescents need to form their own identity during the developmental stages.  If this is not successfully completed it might lead to an identity crisis.  If an adolescent has an identity crisis they may have a tendency to be aggressive and have a volatile personality (Christopher, Nangel & Hansel, 1993).

Patrick and Rich (2004) considered that utilizing object relations while providing learning skills to adolescents with anger management issues, helped connect them with their internal world.  These adolescents had difficulties with object constancy and the representations of good and bad are not integrated.  They have found role playing exercises rapidly brought about transference issues. 

Establishing autonomy in adolescents is the central task, and can be conceptualized by severing emotional ties with the parents, while making new connections with their peers.  If the parent provides adequate parenting style, the adolescent can make these necessary transitions (Church, 1994).  It was found that adolescents react to authoritarian figures negatively, preferring a more egalitarian approach (Church, 1994), yet still responded to the direct approach when seeking advice.  Attachment in adolescence begins to change as the adolescent ventures out to gain independence, yet emotionally is still looking for support from the caregiver. This transition can be difficult, which is why adolescents are at a greater risk for participating in delinquency, suicide attempts, suicide, risky behaviors, and eating disorders during this period (Brown & Wright, 2001).  There are links between maladaptive coping and specific attachment styles.  Studies have suggested that maternal attachment insecurity has led to depression during adolescence (Brown & Wright, 2001).  Those with unresolved attachment were more likely to report high levels of suicide attempts (Brown & Wright, 2001).  Adolescents that reported unattached and overly controlling caregivers had a higher prevalence of eating disorders (Brown & Wright).  Cases of adolescent delinquency and conduct disorders often experienced a higher level of abandonment or abandonment threats. Adolescents are at a higher risk of maladaptive coping when they had avoidant and unresolved attachment (Brown & Wright, 2001).  Hoglend et al. (2011) conducted a study which found that object relations has an important role in transference work when adolescents are more unstable in relationships, such as fear of rejection, avoidance and devaluing themselves.

Interventions with troubled adolescents can be challenging, as this is a period of rapid growth in all aspects of developmental stages. Maturation of the body often happens in advance of the responsibilities of an adult. The consequences often cause strain in interpersonal relationships within the family dynamic (Kalinyak & Jones, 1999).  Recognition is given to the structure of the nuclear family and the unspoken rules that influence behaviors.  These behaviors are often preconceived expectations with a lasting influence (Kalinyak & Jones, 1999).

Klometk et al. (2007) studied the self-object with suicidal adolescents comparing and contrasting three groups. The group identified as suicidal had significant problems differentiating negative issues of the self from that of their parents, providing evidence of the effectiveness of object relations in understanding this group in relation to symbiosis.  Mandin (2007) focused their study on the object relations regarding projection and splitting to try to make sense of an infant’s inner world.  In the first three months it is thought the baby manages their anxiety by separating feelings into good and bad by projecting difficult anxieties on the external objects.  In the second stage the infant starts to recognize the whole objects, so that they can tolerate co-existing emotions.  This is further explained by Brodie (2007) who considers that delinquent teens often see things in black and white terms, and promotes intervention in helping them recognize the whole-object perspective, and that positive and negative can simultaneously exist in object relations.

As cited in Sousa et al. (2011), Armsden and Greenberg (1987) considered that adolescents that have a more secure attachment in the early developmental stages with their primary caregiver go on to develop high self-esteem, well-being and satisfaction with life in general.   Additionally, they are successful in forming stable relationships with others.

Effectiveness in cultural aspects

Studies have found several cultural differences in effectiveness, this may be due to the lack of research on attachment in other countries and the difference of how attachment in perceived (Colonnessi et al, 2011). ­ Culture defines how children are raised and the age appropriate expectations, so it is not surprising the theory has difficulty being universally applied as it is based on a perception of an American Caucasian family.  There are some things that are common between cultures, such as explanation of deaths or accidents, nature, development of language, and a family unit.  Those who grow up surrounded by these norms consider it natural (Applegate,1990).  Transitional objects or non-living attachments may be to unconventional objects or in some cases objects from a person’s home country.  Children in other countries may have little need to acquire a transitional object in instances where they have multiple satisfying relationships with caregivers.  In some cultures the idea of psychotherapy is invasive and embarrassing (Applegate, 1990).  The commonly used term “melting pot” that is said to minimize the difference of cultures neglects to see the value of individualism and lets clinicians become desensitized to the impact cultures have on the individual (Applegate, 1990).

References

Applegate, J.S. (1990). Theory, culture, and behavior: Object relations in context. Child and Adolescent Social Work, 7(2), 85-99.  Retrieved from Ebscohost.

Brodie, B.R. (2007). Adolescence and delinquency: An object relations theory approach. MD: Lanham

Brown, L.S., & Wright, J. (2001). Attachment theory in adolescence and its relevance to developmental psychopathology.  Clinical Psychology and Pyshcotherapy, 8, 15-32.  Retrieved from ebscohost. 

Christopher, J.S., Nangle, D.W., & Hansen, D.J. (1993). Social-skills interventions with adolescents: Current issues and procedures. Behavior Modificaiton, 17, 314-338. doi: 10.1177/0145445593173005

Church, E. (1994). The role of autonomy in adolescent psychotherapy.  Psychotherapy, 31(1),101-108.  Retrieved from Ebschost.

Colonnesi, C., Draijer, E.M., Stams, G.J.J.M., Van der Bruggen, C. O., & Bogels, S.M. (2011). The relation between insecure attachment and child anxiety: A meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 40(4), 630-645.  doi: 10.1080/15374416.2011.581623

Hoglend, P., Hersoug, A.G., Bogwald, K.P., Amlo, S., Marble, A., Sorbye, O., Rossberg, J.I., Ulberg, R., Gabbard, G.O., & Christoph, P.C. ( 2011). Effects of transference work in the context of therapeutic alliance and quality of object relations. Journal of Consulting and Clinical Psychology, 5, 697-706. doi: 10.1037/a0024863

Klomek, A.B., Zalsman, G., Apter, A., Meged, S., Har-Even, D., Diller, R., & Orbach, I. (2007). Self-object differentiation in suicidal adolescents. Comphrensive Psychiatry, 48, 8-13. doi: 10.1016/j.comppsych.2006.06.001

Mandin, P. (2007). The contribution of systems and object-relation theories to an understanding of the therapeutic relationship in social work practice. Journal of Social Work Practice, 21(2), 149-162.  doi: 10.1080/026505530701371861

Patrick, J. & Rich, C. (2004). Anger management taught to adolescents with an experiential object relations approach. Child and Adolescent Social Work Journal, 21(1), 85-100.  Retrieved from ebscohost.
Sousa, C., Herrenkohl, T.I., Moylan, C.A., Tajima, E.A., Klika, J.B., Herrenkohl, R.C., & Russo M.J. (2010). Longitudinal study on the effects of child abuse and children’s exposure to domestic violence, parent-child attachment, and antisocial behavior in adolescence.  Journal of Interpersonal Violence, 26, 111-136. doi: 10.1177/0886260510362883

Walsh, T. (2010). Theories for direct social work practice (2^nd ed.). CA. Belmont: Brooks /Cole.