Here again the
evidence
suggests that, in ensuring the
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, Stovall-McClough, C.
, Clarkin, J.
, & Levy, K.
(2003) Patient-therapist attachment in the treatment of Borderline Personality Disorder.
Bul- letin of the Menninger Clinic 76, 227-259.
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K. , & Zimmerman, P. (1999) A Wider view of attachment and exploration: sta- bility and change during the years of immaturity. In Handbook of Attachment (Eds J. Cassidy & P.
Shaver). London: Guilford.
Grossman, K. , Grossman, K. , & Kindler, H. (2005)
Early care and the roots of attachment and part- nership representation in the Bielefeld and Re- gensburg longitudinal studies. In Attachment from infancy to adulthood: the major longitudin- al studies. New York: Guilford.
Hesse, E. (1999) The Adult Attachment Interview: His- torical and Current Developments. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). Lon- don: Guilford.
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? ? ? Holmes, J. (1993) John Bowlby and Attachment The- ory. London: Routlege.
Holmes, J. (2004) Disorganised attachment and Borderline Personality Disorder: a clinical per- spective. Attachment and Human Development 6, 181-190.
1
CARING FOR CHILDREN
During the early months of 1980 I was giving lectures in the United States. Amongst invita- tions reaching me was one from the psychiatric staff of the Michael Reese Hospital in Chicago to address a conference on parenting.
AN INDISPENSABLE SOCIAL ROLE
At some time of their lives, I believe, most human beings desire to have children and desire also that their children should grow up to be healthy, happy, and self-reliant. For those who succeed the rewards are great; but for those who have children but fail to rear them to be healthy, happy, and self-reliant the penalties in anxiety, frustration, friction, and perhaps shame or guilt, may be severe. Engaging in parenthood therefore is playing for high stakes. Furthermore, because successful parenting is a principal key to the mental health of the next generation, we need to know all we can both about its nature and about
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? ? ? the manifold social and psychological conditions that influence its development for better or worse. The theme is a huge one and all I can do in this contribution is to sketch the approach that I myself adopt in thinking about these issues. That approach is an ethological one.
Before I go into detail, however, I want to make a few more general remarks. To be a successful parent means a lot of very hard work. Looking after a baby or toddler is a twenty-four-hour-a- day job seven days a week, and often a very wor- rying one at that. And even if the load lightens a little as children get older, if they are to flourish they still require a lot of time and attention. For many people today these are unpalatable truths. Giving time and attention to children means sac- rificing other interests and other activities. Yet I believe the evidence for what I am saying is un- impeachable. Study after study, including those pioneered in Chicago by Grinker (1962) and con- tinued by Offer (1969), attest that healthy, happy, and self-reliant adolescents and young adults are the products of stable homes in which both par- ents give a great deal of time and attention to the children.
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? ? ? I want also to emphasize that, despite voices to the contrary, looking after babies and young chil- dren is no job for a single person. If the job is to be well done and the child's principal caregiver is not to be too exhausted, the caregiver herself (or himself) needs a great deal of assistance. From whom that help comes will vary: very often it is the other parent; in many societies, including more often than is realized our own, it comes from a grandmother. Others to be drawn in to help are adolescent girls and young women. In most societies throughout the world these facts have been, and still are, taken for granted and the society organized accordingly. Paradoxically it has taken the world's richest societies to ignore these basic facts. Man and woman power devoted to the production of material goods counts a plus in all our economic indices. Man and woman power devoted to the production of happy, healthy, and selfreliant children in their own homes does not count at all. We have created a topsy-turvy world.
But I do not want to enter into complex politic- al and economic arguments. My reason for rais- ing these points is to remind you that the society we live in is not only, in evolutionary terms, a
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? ? ? product of yesterday but in many ways a very pe- culiar one. There is in consequence a great danger that we shall adopt mistaken norms. For, just as a society in which there is a chronic insuf- ficiency of food may take a deplorably inadequate level of nutrition as its norm, so may a society in which parents of young children are left on their own with a chronic insufficiency of help take this state of affairs as its norm.
AN ETHOLOGICAL APPROACH
I said earlier that my approach to an understand- ing of parenting as a human activity is an etholo- gical one. Let me explain.
In re-examining the nature of the child's tie to his1 mother, traditionally referred to as depend- ency, it has been found useful to regard it as the resultant of a distinctive and in part prepro- grammed set of behaviour patterns which in the ordinary expectable environment develop during the early months of life and have the effect of keeping the child in more or less close proximity to his mother-figure (Bowlby, 1969). By the end of the first year the behaviour is becoming organ- ized cybernetically, which means, among other things, that the behaviour becomes active
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? ? ? whenever certain conditions obtain and ceases when certain other conditions obtain. For ex- ample, a child's attachment behaviour is activ- ated especially by pain, fatigue, and anything frightening, and also by the mother being or ap- pearing to be inaccessible. The conditions that terminate the behaviour vary according to the in- tensity of its arousal. At low intensity they may be simply sight or sound of the mother, especially effective being a signal from her acknowledging his presence. At higher intensity termination may require his touching or clinging to her. At highest intensity, when he is distressed and anxious, nothing but a prolonged cuddle will do. The bio- logical function of this behaviour is postulated to be protection, especially protection from predators.
In the example just given the individuals con- cerned are a child and his mother. It is evident, however, that attachment behaviour is in no way confined to children. Although usually less read- ily aroused, we see it also in adolescents and adults of both sexes whenever they are anxious or under stress. No one should be surprised there- fore when a woman expecting a baby or a mother caring for young children has a strong desire to
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? ? ? be cared for and supported herself. The activation of attachment behaviour in these circumstances is probably universal and must be considered the norm. 2
A feature of attachment behaviour of the greatest importance clinically, and present irre- spective of the age of the individual concerned, is the intensity of the emotion that accompanies it, the kind of emotion aroused depending on how the relationship between the individual attached and the attachment figure is faring. If it goes well, there is joy and a sense of security. If it is threatened, there is jealousy, anxiety, and anger. If broken, there is grief and depression. Finally there is strong evidence that how attachment be- haviour comes to be organized within an indi- vidual turns in high degree on the kinds of exper- ience he has in his family of origin, or, if he is un- lucky, out of it.
This type of theory I believe to have many ad- vantages over the theories hitherto current in our field. For not only does it bring theory into close relationship with observed data but it provides a theoretical framework for the field compatible with the framework adopted throughout modern biology and neurophysiology.
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? ? ? Parenting, I believe, can usefully be ap- proached from the same ethologically inspired viewpoint. This entails observing and describing the set of behaviour patterns characteristic of parenting, the conditions that activate and ter- minate each, how the patterns change as a child grows older, the varying ways that parenting be- haviour becomes organized in different individu- als, and the myriad of experiences that influence how it develops in any one person.
Implicit in this approach is the assumption that parenting behaviour, like attachment beha- viour, is in some degree preprogrammed and therefore ready to develop along certain lines when conditions elicit it. This means that, in the ordinary course of events, the parent of a baby experiences a strong urge to behave in certain typical sorts of way, for example, to cradle the in- fant, to soothe him when he cries, to keep him warm, protected, and fed. Such a viewpoint, of course, does not imply that the appropriate beha- viour patterns manifest themselves complete in every detail from the first. Clearly that is not so, neither in man nor in any other mammalian spe- cies. All the detail is learned, some of it during in- teraction with babies and children, much of it
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? ? ? through observation of how other parents be- have, starting during the parent-to-be's own childhood and the way his parents treated him and his siblings.
This modern view of behavioural development contrasts sharply with both of the older paradigms, one of which, invoking instinct, over- emphasized the preprogrammed component and the other of which, reacting against instinct, over- emphasized the learned component. Parenting behaviour in humans is certainly not the product of some unvarying parenting instinct, but nor is it reasonable to regard it as the product simply of learning. Parenting behaviour, as I see it, has strong biological roots, which accounts for the very strong emotions associated with it; but the detailed form that the behaviour takes in each of us turns on our experiences--experiences during childhood especially, experiences during adoles- cence, experiences before and during marriage, and experiences with each individual child.
Thus I regard it as useful to look upon parent- ing behaviour as one example of a limited class of biologically rooted types of behaviour of which attachment behaviour is another example, sexual behaviour another, and exploratory behaviour
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? ? ? and eating behaviour yet others. Each of these types of behaviour contributes in its own specific way to the survival either of the individual or his offspring. It is indeed because each one serves so vital a function that each of these types of beha- viour is in some degree preprogrammed. To leave their development solely to the caprices of indi- vidual learning would be the height of biological folly.
You will notice that in sketching this frame- work I am making a point of keeping each of these types of behaviour conceptually distinct from the others. This contrasts, of course, with traditional libido theory which has treated them as the varying expressions of a single drive. The reasons for keeping them distinct are several. One is that each of the types of behaviour men- tioned serves its own distinctive biological func- tion--protection, reproduction, nutrition, know- ledge of the environment. Another is that many of the detailed patterns of behaviour within each general type are distinctive also: clinging to a par- ent is different from soothing and comforting a child; sucking or chewing food is different from engaging in sexual intercourse. Furthermore, factors which influence the development of one of
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? ? ? these types of behaviour are not necessarily the same as those that influence the development of another. By keeping them distinct we are able to study not only the ways in which they differ but also the ways in which they overlap and interact with each other--as it has long been evident they do.
INITIATION OF MOTHER-INFANT INTERACTION
During the past decade or so there has been a dramatic advance in our understanding of the early phases of mother-infant interaction, thanks to the imaginative research of workers on both sides of the Atlantic. The studies of Klaus and Kennell are now well known. Of special interest here are their observations of how mothers be- have towards their newborns when given free- dom to do what they like after delivery. Klaus, Trause, and Kennell (1975) describe how a moth- er, immediately after her infant is born, picks him up and begins to stroke his face with her finger tips. At this the baby quietens. Soon she moves on to touching his head and body with the palm of her hand and, within five or six minutes, she is likely to put him to her breast. The baby responds with prolonged licking of the nipple.
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? ? ? 'Immediately after the delivery', they noted, 'the mothers appeared to be in a state of ecstasy', and, interestingly enough, the observers became elated too. From the moment of birth attention becomes riveted on the baby. Something about him tends to draw not only the mother and father but all those present to the new arrival. Given the chance, a mother is likely during the next few days to spend many hours just looking at her new possession, cuddling him, and getting to know him. Usually there comes a moment when she feels the baby is her very own. For some it comes early; perhaps when she first holds him or when he first looks into her eyes. For a large minority of primaparae who are delivered in hospital, however, it may be delayed for up to a week, of- ten until they are home again (Robson and Ku- mar, 1980).
Phenomena of the greatest importance to which recent research has drawn attention are the potential of the healthy neonate to enter into an elemental form of social interaction and the potential of the ordinary sensitive mother to par- ticipate successfully in it. 3
When a mother and her infant of two or three weeks are facing one another, phases of lively
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? ? ? social interaction occur, alternating with phases of disengagement. Each phase of interaction be- gins with initiation and mutual greeting, builds up to an animated interchange comprising facial expressions and vocalizations, during which the infant orients towards his mother with excited movements of arms and legs; then his activities gradually subside and end with the baby looking away for a spell before the next phase of interac- tion begins. Throughout these cycles the baby is likely to be as spontaneously active as his mother. Where their roles differ is in the timing of their responses. Whereas an infant's initiation and withdrawal from interaction tend to follow his own autonomous rhythm, a sensitive mother reg- ulates her behaviour so that it meshes with his. In addition she modifies the form her behaviour takes to suit him: her voice is gentle but higher pitched than usual, her movements slowed, and each next action adjusted in form and timing ac- cording to how her baby is performing. Thus she lets him call the tune and, by a skilful interweav- ing of her own responses with his, creates a dialogue.
The speed and efficiency with which these dia- logues develop and the mutual enjoyment they
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? ? ? give point clearly to each participant being pread- apted to engage in them. On the one hand is the mother's intuitive readiness to allow her inter- ventions to be paced by her infant. On the other is the readiness with which the infant's rhythms shift gradually to take account of the timing of his mother's interventions. In a happily developing partnership each is adapting to the other.
Very similar alternating sequences have been recorded in other quite different exchanges between mother and child. For example, Kaye (1977), observing the behaviour of mother and in- fant during feeding, has found that mothers tend to interact with their infants in precise synchrony with the infant's pattern of sucking and pausing. During bursts of sucking a mother is generally quiet and inactive; during pauses she strokes and talks to her baby. Another example of a mother taking her cue from her infant, in this case an in- fant within the age range 5 to 12 months, is re- ported by Collis and Schaffer (1975). A mother and her infant are introduced to a scene in which there are a number of large brightly coloured toys which quickly seize their visual attention. Obser- vation of their behaviour then shows two things. First, both partners as a rule are looking at the
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? ? ? same object at the same time. Secondly, examina- tion of the timing shows almost invariably that it is the baby who leads and the mother who fol- lows. The baby's spontaneous interest in the toys is evidently closely monitored by his mother who almost automatically then looks in the same dir- ection. A focus of mutual interest having been es- tablished, mother is likely to elaborate on it, com- menting on the toy, naming it, manipulating it. 'A sharing experience is then brought about, instig- ated by the infant's spontaneous attention to the environment but established by the mother al- lowing herself to be paced by the baby'.
Yet another example, also reported by Schaffer (Schaffer, Collis, and Parsons, 1977), concerns vocal interchange between mother and child at a preverbal level. In a comparison of two groups of children, aged 12 and 24 months, it was found that the ability of the pair to take turns and to avoid overlapping was not only strikingly efficient but as characteristic of the younger as of the older infants. Thus, long before the appearance of words, the pattern of turn-taking so characteristic of human conversation is already present.
Here again the evidence suggests that, in ensuring the
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? ? ? smooth transitions from one 'speaker' to the oth- er, mother is playing the major part.
My reason for giving these examples at some length is that I believe they illustrate some basic principles both about parenting and about the nature of the creature who is parented. What emerges from these studies is that the ordinary sensitive mother is quickly attuned to her infant's natural rhythms and, by attending to the details of his behaviour, discovers what suits him and behaves accordingly. By so doing she not only makes him contented but also enlists his co-oper- ation. For, although initially his capacity to adapt is limited, it is not absent altogether and, if al- lowed to grow in its own time, is soon yielding re- wards. Ainsworth and her colleagues have noted that infants whose mothers have responded sens- itively to their signals during the first year of life not only cry less during the second half of that year than do the babies of less responsive moth- ers but are more willing to fall in with their par- ent's wishes (Ainsworth et al. , 1978). Human in- fants, we can safely conclude, like infants of other species, are preprogrammed to develop in a so- cially cooperative way; whether they do so or not turns in high degree on how they are treated.
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? ? ? This is a view of human nature, you will notice, radically different from the one that has long been current in western societies and that has permeated so much of the clinical theory and practice we have inherited. It points, of course, to a radically different conception of the role of parent.
ROLES OF MOTHERS AND FATHERS: SIMILARITIES AND DIFFERENCES
In the examples given so far, the parent con- cerned has been the mother. This is almost inev- itable because for research purposes it is relat- ively easy to recruit samples of infants who are being cared for mainly by their mother, whereas infants being cared for mainly by their father are comparatively scarce. Let me therefore describe briefly one of several recent studies which, to- gether, go some way to correct the balance.
Several hundred infants have now been studied by means of the strange situation procedure de- vised by Ainsworth (Ainsworth et al. , 1978) which gives an opportunity to observe how the infant responds, first in his parent's presence, next when he is left alone, and later when his parent returns. As a result of these observations infants
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? ? ? can be classified as presenting a pattern either of secure attachment to mother or of one of two main forms of insecure attachment to her. Since these patterns have been shown to have consider- able stability during the earliest years of life and to predict how a nursery-school child in the age range 41/2 to 6 years will approach a new person and tackle a new task (Arend, Gove, and Sroufe, 1979), the value of the procedure as a method of assessing an infant's social and emotional devel- opment needs no emphasis.
Hitherto almost all the studies using this pro- cedure have observed infants with their mothers. Main and Weston (1981), however, extended the work by observing some 60 infants, first with one parent and, six months later, with the other. One finding was that, when looked at as a group, the patterns of attachment that were shown to fath- ers resembled closely the patterns that were shown to mothers, with roughly the same per- centage distribution of patterns. But a second finding was even more interesting. When the pat- terns shown by each child individually were ex- amined, no correlation was found between the pattern shown with one parent and the pattern shown with the other. Thus one child may have a
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? ? ? secure relationship with the mother but not with the father, a second may have it with the father but not with the mother, a third may have it with both parents, and a fourth may have it with neither. In their approach to new people and new tasks the children represented a graded series. Children with a secure relationship to both par- ents were most confident and most competent; children who had a secure relationship to neither were least so; and those with a secure relation- ship to one parent but not to the other came in between.
Since there is evidence that the pattern of at- tachment a child undamaged at birth develops with his mother is the product of how his mother has treated him (Ainsworth et al. , 1978), it is more than likely that, in a similar way, the pat- tern he develops with his father is the product of how his father has treated him.
This study, together with others, suggests that, by providing an attachment figure for his child, a father may be filling a role closely resembling that filled by a mother; though in most, perhaps all, cultures fathers fill that role much less fre- quently than do mothers, at least when the chil- dren are still young. In most families with young
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? ? ? children the father's role is a different one. He is more likely to engage in physically active and novel play than the mother and, especially for boys, to become his child's preferred play com- panion. 4
PROVISION OF A SECURE BASE
This brings me to a central feature of my concept of parenting--the provision by both parents of a secure base from which a child or an adolescent can make sorties into the outside world and to which he can return knowing for sure that he will be welcomed when he gets there, nourished phys- ically and emotionally, comforted if distressed, reassured if frightened. In essence this role is one of being available, ready to respond when called upon to encourage and perhaps assist, but to in- tervene actively only when clearly necessary. In these respects it is a role similar to that of the of- ficer commanding a military base from which an expeditionary force sets out and to which it can retreat, should it meet with a setback. Much of the time the role of the base is a waiting one but it is none the less vital for that. For it is only when the officer commanding the expeditionary force is
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? ? ? confident his base is secure that he dare press forward and take risks.
In the case of children and adolescents we see them, as they get older, venturing steadily further from base and for increasing spans of time. The more confident they are that their base is secure and, moreover, ready if called upon to respond, the more they take it for granted. Yet should one or other parent become ill or die, the immense significance of the base to the emotional equilib- rium of the child or adolescent or young adult is at once apparent. In the lectures to follow evid- ence is presented from studies of adolescents and young adults, as well as of school children of dif- ferent ages from nursery school up, that those who are most stable emotionally and making the most of their opportunities are those who have parents who, whilst always encouraging their children's autonomy, are none the less available and responsive when called upon. Unfortunately, of course, the reverse is also true.
No parent is going to provide a secure base for his growing child unless he has an intuitive un- derstanding of and respect for his child's attach- ment behaviour and treats it as the intrinsic and valuable part of human nature I believe it to be.
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? ? ? This is where the traditional term 'dependence' has had so baleful an influence. Dependency al- ways carries with it an adverse valuation and tends to be regarded as a characteristic only of the early years and one which ought soon to be grown out of. As a result in clinical circles it has often happened that, whenever attachment beha- viour is manifested during later years, it has not only been regarded as regrettable but has even been dubbed regressive. I believe that to be an appalling misjudgement.
In discussing parenting I have focused on the parents' role of providing a child with a secure base because, although well recognized intuit- ively, it has hitherto, I believe, been inadequately conceptualized. But there are, of course, many other roles a parent has to play. One concerns the part a parent plays in influencing his child's be- haviour in one direction or another and the range of techniques he uses to do so. Although some of these techniques are necessarily restrictive, and certain others have a disciplinary intent, many of them are of an encouraging sort, for example, calling a child's attention to a toy or some other feature of the environment, or giving him tips on how to solve a problem he cannot quite manage
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? ? ? on his own. Plainly the repertoire of techniques used varies enormously from parent to par- ent--from largely helpful and encouraging to largely restrictive and punitive. An interesting start in exploring the range of techniques used by the parents of toddlers in Scotland has been made by Schaffer and Crook (1979).
PERI- AND POST-NATAL CONDITIONS THAT HELP OR HINDER
So far in this lecture my aim has been to describe some of the ways in which the parents of children who thrive socially and emotionally are observed to behave towards them. Fortunately, much of this behaviour comes naturally to many mothers and fathers who find the resulting interchanges with their children enjoyable and rewarding. Yet it is evident that, even when social and economic conditions are favourable, these mutually satisfy- ing relationships do not develop in every family. Let us consider therefore what we know of the psychological conditions that foster their doing so and those that impede them.
At several points I have referred to the ordin- ary sensitive mother who is attuned to her child's actions and signals, who responds to them more
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? ? ? or less appropriately, and who is then able to monitor the effects her behaviour has on her child and to modify it accordingly. The same de- scription, no doubt, would apply to the ordinary sensitive father. Now it is clear that, in order for a parent to behave in these ways, adequate time and a relaxed atmosphere are necessary. This is where a parent, especially the mother who usu- ally bears the brunt of parenting during the early months or years, needs all the help she can get--not in looking after her baby, which is her job, but in all the household chores.
A friend of mine, a social anthropologist, ob- served that in the South Sea island in which she was working it was the custom for a mother, both during and after the baby was born, to be atten- ded by a couple of female relatives who cared for her throughout the first month, leaving her free to care for her baby. So impressed was my friend by these humane arrangements that, when her own baby was born on the island, she accepted suggestions that she be cared for in the VIP way, and she had no cause to regret it. In addition to practical help, a congenial female companion is likely to provide the new mother with emotional support or, in my terminology, to provide for her
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? ? ? the kind of secure base we all need in conditions of stress and without which it is difficult to relax. In almost all societies an arrangement of this sort is the rule. Indeed in all but one of 150 cultures studied by anthropologists a family member or friend, usually a woman, remains with a mother throughout labour and delivery (Raphael, 1966, quoted by Sosa et al. , 1980).
Turning to our own society, preliminary find- ings that, if confirmed, are of the greatest interest and practical importance have recently been re- ported by the Klaus and Kennell team from a study conducted in a hospital maternity unit in Guatemala (Sosa et al. , 1980). One group of wo- men went through labour and delivery according to the routine practice of the unit which meant in effect that the woman was left alone for most of the time. The other group received constant friendly support from an untrained lay woman from the time of admission until delivery, one woman during the day and another at night. In the supported group labour was less than half as long as in the other, 8. 7 hours against 19. 3. 5 Moreover, the mother was awake for a greater part of the first hour of the infant's life during
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? ? ? which she was much more likely to be seen strok- ing her baby, smiling, and talking to him.
Effects of a similar kind on the way a mother treats her baby as a result of her having addition- al contact with him soon after his birth are now well known. Amongst differences observed by Klaus and Kennell, when the babies were one month old, was that a mother given extra contact was more likely to comfort her baby during stressful clinic visits and, during feeding, was more likely to fondle the baby and engage him in eye-to-eye contact. Differences of a comparable kind were observed when the babies were 12 months old and again at 2 years. In these studies the increased contact amounted to no more than an extra hour within the first three hours after birth, with a further five of contact each after- noon during the next three days (Kennell et al. , 1974; Ringler et al. , 1975). 6
Findings of another study of the part these kinds of peri- and post-natal experiences play in either assisting a mother to develop a loving and sensitive relationship to her baby or impeding it are reported by Peterson and Mehl (1978). In a longitudinal study of 46 women and their hus- bands, interviewed and observed during
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? ? ? pregnancy, labour, and on four occasions during the infants' first six months, the most significant variable predicting differences in maternal bond- ing was the length of time a mother had been sep- arated from her baby during the hours and days after his birth. Other variables that played a sig- nificant but lesser part were the birth experience and the attitudes and expectations expressed by the mother during her pregnancy.
INFLUENCE OF PARENTS' CHILDHOOD EXPERIENCES
There is, of course, much clinical evidence that a mother's feeling for and behaviour towards her baby are deeply influenced also by her previous personal experiences, especially those she has had and may still be having with her own par- ents; and, though the evidence of this in regard to a father's attitudes is less plentiful, what there is points clearly to the same conclusion. On this matter evidence from systematic studies of young children is impressive: it shows that the influence that parents have on the pattern of caring that their children develop starts very early. For example, Zahn-Waxler, Radke-Yarrow, and King (1979) have found not only that aiding and
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? ? ? comforting others in distress is a pattern of beha- viour that commonly develops as early as a child's second year of life, but that the form it takes is much influenced by how a mother treats her child. Children whose mothers respond sens- itively to their signals and provide comforting bodily contact are those who respond most read- ily and appropriately to the distress of others. 7 Not infrequently, moreover, what a child does in such circumstances is a clear replica of what he has seen and/or experienced his mother do. The follow-up of a group of children showing these early differences would be of the greatest interest.
Another line of evidence regarding the influ- ence of childhood experience on how a woman mothers her child comes from studies under- taken in London. For example, a study by From- mer and O'Shea (1973) shows that women who, during their pregnancy, give a history of having been separated from one or both parents before the age of 11 years are particularly likely to have marital and psychological difficulties after their baby's birth and also to have trouble with their infant's feeding and sleeping. Another study, also in London, by Wolkind, Hall, and Pawlby (1977) is extending this finding by showing that women
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? ? ? with this type of childhood history interact signi- ficantly less with their 5-month-old first-born in- fants than do women who have had more settled childhoods. These observations, which were car- ried out by an ethologist, extended over a period long enough to record 50 minutes of the baby's waking life, exclusive of any time taken to feed him; this usually necessitated the observer stay- ing for the whole morning. Not only did the mothers from a disrupted family of origin spend on average twice as long as the other mothers out of sight of their babies, but, even when one of them was with her baby, she was likely to spend less time holding him, less time looking at him and less time talking to him. Moreover, when asked the question, 'It takes a bit of time to begin to see a baby as a person--do you feel this yet? ', mothers from a disrupted family were much less likely to say they did (Hall, Pawlby, and Wolkind, 1979). The point I wish to emphasize is that the study provides firm evidence that women whose childhood has been disturbed tend to engage in less interaction with their infants than do moth- ers with happier childhoods--at a period in their baby's life when the amount of interaction that
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? ? ? ensues is determined almost entirely by the mother.
Some of the clearest evidence regarding the enormous part played by childhood experience in determining in later years how a parent treats a child comes from studies of parents known to have abused their children physically (Parke and Collmer, 1979). A common picture includes a childhood in which parental care was at best er- ratic and at worst absent altogether, in which cri- ticism and blame were frequent and bitter, and in which parents or step-parents had behaved viol- ently towards each other and sometimes though not always towards the children. A feature that emerges from a study by DeLozier of mothers known to have abused a child physically (a study described in detail in Lecture 5) is the high pro- portion who have lived in constant dread of being deserted by one or both parents and therefore of being sent away to a foster home or institution, and who have also been threatened frequently with violent beatings or worse. Not surprisingly these girls have grown up to be perpetually anxious lest husband or boyfriend desert, to re- gard physical violence as part of the natural
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? ? ? order, and to expect little or nothing in the way of love or support from any quarter.
Not every woman with childhood experiences of these sorts batters her child, however; nor in- deed does a woman who physically abuses one of her children necessarily abuse the others. What accounts for these differences? Evidence suggests that individuals who, thanks to earlier experi- ences, are markedly prone to develop unfavour- able parental attitudes are more than usually sensitive to what happens to them in the time during and after the birth of their babies. It seems that for these women adverse experiences during this time can prove the last straw.
In a study done at Oxford, for example, Lynch (1975) compared the histories of 25 children who had been physically abused with those of their siblings who had escaped. Children who had been abused were significantly more likely than their siblings to have been the product of an abnormal pregnancy, labour, or delivery, to have been sep- arated from their mother for 48 hours or more soon after birth, and to have experienced separa- tions of other kinds during their first six months of life. During the first year of these children's lives, moreover, the abused children were much
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? ? ? more likely to have been ill than were the non-ab- used siblings; and the mothers also were more likely to have been ill during the abused child's first year than during the siblings' first year. Since in this study the personalities and child- hood histories of the parents were the same for the abused siblings as for the non-abused, the fate of each seems to have turned in large part on the mother's experiences with the child during the peri- and early post-natal periods. The find- ings of a study by Cater and Easton (1980) point to the same conclusion. 8
Of the many other disturbed patterns of par- enting that can be traced, in part at least, to childhood experience, there is one that happens also to be well documented in studies of abusing mothers (e. g. Morris and Gould, 1963; Steele and Pollock, 1968; Green, Gaines, and Sandgrun, 1974; DeLozier, 1982). This is their tendency to expect and demand care and attention from their own children, in other words to invert the rela- tionship. During interview they regularly describe how, as children, they too had been made to feel responsible for looking after their parents instead of the parents caring for them.
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? ? ? Most, perhaps all, parents who expect their children to care for them have experienced very inadequate parenting themselves. Unfortunately, all too often, they then create major psychological problems for their children. Elsewhere (Bowlby, 1973, 1980) I have argued that an inverted parent-child relationship of this kind lies behind a significant proportion of cases of school refusal (school phobia) and agoraphobia, and also prob- ably of depression.
HOW WE CAN BEST HELP
In this contribution I have given principal atten- tion to what we know about successful parenting and to some of the variables that make it easier or more difficult for young men and women to be- come sensitive, caring parents. In consequence I have been able to say only a little about the many and varied patterns of deficient and distorted parenting that we meet with clinically. Another large theme omitted is how we can best help young men and women become the successful parents I believe the great majority wish to be. In conclusion, therefore, let me state what I believe to be the first principles for such work--which are that we seek always to teach by example, not
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? ? ? precept, by discussion, not instruction. The more that we can give young people opportunities to meet with and observe at first hand how sensit- ive, caring parents treat their offspring, the more likely are they to follow suit. To learn directly from such parents about the difficulties they meet with and the rewards they obtain, and to discuss with them both their mistakes and their suc- cesses, are worth, I believe, hundreds of instruc- tional talks. For a programme of this kind, which in some places might be an extension of the mothers' self-help groups now beginning to flour- ish, we would need to enlist the active co-opera- tion of sensitive, caring parents. Fortunately there are still plenty of them in our society and I believe many would be willing and proud to help.
1 Throughout this book the child is referred to as mas- culine in order to avoid clumsy constructions.
2 An increased desire for care, either from husband or mother, has been reported in studies of representative groups of women by Wenner (1966) and Ballou (1978). 3 See especially the work of Stern (1977), Sander (1977), Brazelton, Koslowski, and Main (1974) and Schaffer (1977). For excellent reviews see Schaffer
(1979) and Stern (1985). The state of heightened sens- itivity that develops in a woman during and especially
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? ? ? towards the end of pregnancy, and that enables her 'to adapt delicately and sensitively' to her infant's needs, is a process to which Winnicott (1957) has called attention.
4 Studies of relevance are those of Lamb (1977), Parke (1979), Clarke-Stewart (1978), and Mackey (1979).
5 In a further and larger study, also carried out in Guatemala and by the same research group, all find- ings were replicated. Samples numbered 279 in the routine group and 186 in the supported group. Not only was the duration of labour halved but the incid- ence of perinatal complications halved also (Klaus et al. , 1986).
6 Since more recent studies, e. g. Svejda, Campos, and Emde (1980), have failed to replicate initial findings of the effects of early mother-infant contact, the issue re- mains in doubt. It may be that in this sensitive area de- tails of how this early contact is arranged and by whom would explain discrepancies.
7 The role of close physical contact with mother during human infancy has been studied especially by Ainsworth who finds that children who develop a se- cure attachment to mother are those who, during early infancy, are held longest in a tender and loving way (Ainsworth et al. , 1978).
Dozier, M. , Chase Stowall, K. , & Albus, K. (1999) At- tachment and psychopathology in adulthood. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). London: Guilford.
Fonagy, P. , Gergely, G. , Jurist, E. , & Target, M. (2002)
Affect regulation, mentalization, and the develop-
ment of the self. New York: Other Press. Grossman, K. , Grossman, K. , & Zimmerman, P. (1999) A Wider view of attachment and exploration: sta- bility and change during the years of immaturity. In Handbook of Attachment (Eds J. Cassidy & P.
Shaver). London: Guilford.
Grossman, K. , Grossman, K. , & Kindler, H. (2005)
Early care and the roots of attachment and part- nership representation in the Bielefeld and Re- gensburg longitudinal studies. In Attachment from infancy to adulthood: the major longitudin- al studies. New York: Guilford.
Hesse, E. (1999) The Adult Attachment Interview: His- torical and Current Developments. In Handbook of Attachment (Eds J. Cassidy & P. Shaver). Lon- don: Guilford.
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? ? ? Holmes, J. (1993) John Bowlby and Attachment The- ory. London: Routlege.
Holmes, J. (2004) Disorganised attachment and Borderline Personality Disorder: a clinical per- spective. Attachment and Human Development 6, 181-190.
1
CARING FOR CHILDREN
During the early months of 1980 I was giving lectures in the United States. Amongst invita- tions reaching me was one from the psychiatric staff of the Michael Reese Hospital in Chicago to address a conference on parenting.
AN INDISPENSABLE SOCIAL ROLE
At some time of their lives, I believe, most human beings desire to have children and desire also that their children should grow up to be healthy, happy, and self-reliant. For those who succeed the rewards are great; but for those who have children but fail to rear them to be healthy, happy, and self-reliant the penalties in anxiety, frustration, friction, and perhaps shame or guilt, may be severe. Engaging in parenthood therefore is playing for high stakes. Furthermore, because successful parenting is a principal key to the mental health of the next generation, we need to know all we can both about its nature and about
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? ? ? the manifold social and psychological conditions that influence its development for better or worse. The theme is a huge one and all I can do in this contribution is to sketch the approach that I myself adopt in thinking about these issues. That approach is an ethological one.
Before I go into detail, however, I want to make a few more general remarks. To be a successful parent means a lot of very hard work. Looking after a baby or toddler is a twenty-four-hour-a- day job seven days a week, and often a very wor- rying one at that. And even if the load lightens a little as children get older, if they are to flourish they still require a lot of time and attention. For many people today these are unpalatable truths. Giving time and attention to children means sac- rificing other interests and other activities. Yet I believe the evidence for what I am saying is un- impeachable. Study after study, including those pioneered in Chicago by Grinker (1962) and con- tinued by Offer (1969), attest that healthy, happy, and self-reliant adolescents and young adults are the products of stable homes in which both par- ents give a great deal of time and attention to the children.
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? ? ? I want also to emphasize that, despite voices to the contrary, looking after babies and young chil- dren is no job for a single person. If the job is to be well done and the child's principal caregiver is not to be too exhausted, the caregiver herself (or himself) needs a great deal of assistance. From whom that help comes will vary: very often it is the other parent; in many societies, including more often than is realized our own, it comes from a grandmother. Others to be drawn in to help are adolescent girls and young women. In most societies throughout the world these facts have been, and still are, taken for granted and the society organized accordingly. Paradoxically it has taken the world's richest societies to ignore these basic facts. Man and woman power devoted to the production of material goods counts a plus in all our economic indices. Man and woman power devoted to the production of happy, healthy, and selfreliant children in their own homes does not count at all. We have created a topsy-turvy world.
But I do not want to enter into complex politic- al and economic arguments. My reason for rais- ing these points is to remind you that the society we live in is not only, in evolutionary terms, a
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? ? ? product of yesterday but in many ways a very pe- culiar one. There is in consequence a great danger that we shall adopt mistaken norms. For, just as a society in which there is a chronic insuf- ficiency of food may take a deplorably inadequate level of nutrition as its norm, so may a society in which parents of young children are left on their own with a chronic insufficiency of help take this state of affairs as its norm.
AN ETHOLOGICAL APPROACH
I said earlier that my approach to an understand- ing of parenting as a human activity is an etholo- gical one. Let me explain.
In re-examining the nature of the child's tie to his1 mother, traditionally referred to as depend- ency, it has been found useful to regard it as the resultant of a distinctive and in part prepro- grammed set of behaviour patterns which in the ordinary expectable environment develop during the early months of life and have the effect of keeping the child in more or less close proximity to his mother-figure (Bowlby, 1969). By the end of the first year the behaviour is becoming organ- ized cybernetically, which means, among other things, that the behaviour becomes active
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? ? ? whenever certain conditions obtain and ceases when certain other conditions obtain. For ex- ample, a child's attachment behaviour is activ- ated especially by pain, fatigue, and anything frightening, and also by the mother being or ap- pearing to be inaccessible. The conditions that terminate the behaviour vary according to the in- tensity of its arousal. At low intensity they may be simply sight or sound of the mother, especially effective being a signal from her acknowledging his presence. At higher intensity termination may require his touching or clinging to her. At highest intensity, when he is distressed and anxious, nothing but a prolonged cuddle will do. The bio- logical function of this behaviour is postulated to be protection, especially protection from predators.
In the example just given the individuals con- cerned are a child and his mother. It is evident, however, that attachment behaviour is in no way confined to children. Although usually less read- ily aroused, we see it also in adolescents and adults of both sexes whenever they are anxious or under stress. No one should be surprised there- fore when a woman expecting a baby or a mother caring for young children has a strong desire to
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? ? ? be cared for and supported herself. The activation of attachment behaviour in these circumstances is probably universal and must be considered the norm. 2
A feature of attachment behaviour of the greatest importance clinically, and present irre- spective of the age of the individual concerned, is the intensity of the emotion that accompanies it, the kind of emotion aroused depending on how the relationship between the individual attached and the attachment figure is faring. If it goes well, there is joy and a sense of security. If it is threatened, there is jealousy, anxiety, and anger. If broken, there is grief and depression. Finally there is strong evidence that how attachment be- haviour comes to be organized within an indi- vidual turns in high degree on the kinds of exper- ience he has in his family of origin, or, if he is un- lucky, out of it.
This type of theory I believe to have many ad- vantages over the theories hitherto current in our field. For not only does it bring theory into close relationship with observed data but it provides a theoretical framework for the field compatible with the framework adopted throughout modern biology and neurophysiology.
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? ? ? Parenting, I believe, can usefully be ap- proached from the same ethologically inspired viewpoint. This entails observing and describing the set of behaviour patterns characteristic of parenting, the conditions that activate and ter- minate each, how the patterns change as a child grows older, the varying ways that parenting be- haviour becomes organized in different individu- als, and the myriad of experiences that influence how it develops in any one person.
Implicit in this approach is the assumption that parenting behaviour, like attachment beha- viour, is in some degree preprogrammed and therefore ready to develop along certain lines when conditions elicit it. This means that, in the ordinary course of events, the parent of a baby experiences a strong urge to behave in certain typical sorts of way, for example, to cradle the in- fant, to soothe him when he cries, to keep him warm, protected, and fed. Such a viewpoint, of course, does not imply that the appropriate beha- viour patterns manifest themselves complete in every detail from the first. Clearly that is not so, neither in man nor in any other mammalian spe- cies. All the detail is learned, some of it during in- teraction with babies and children, much of it
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? ? ? through observation of how other parents be- have, starting during the parent-to-be's own childhood and the way his parents treated him and his siblings.
This modern view of behavioural development contrasts sharply with both of the older paradigms, one of which, invoking instinct, over- emphasized the preprogrammed component and the other of which, reacting against instinct, over- emphasized the learned component. Parenting behaviour in humans is certainly not the product of some unvarying parenting instinct, but nor is it reasonable to regard it as the product simply of learning. Parenting behaviour, as I see it, has strong biological roots, which accounts for the very strong emotions associated with it; but the detailed form that the behaviour takes in each of us turns on our experiences--experiences during childhood especially, experiences during adoles- cence, experiences before and during marriage, and experiences with each individual child.
Thus I regard it as useful to look upon parent- ing behaviour as one example of a limited class of biologically rooted types of behaviour of which attachment behaviour is another example, sexual behaviour another, and exploratory behaviour
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? ? ? and eating behaviour yet others. Each of these types of behaviour contributes in its own specific way to the survival either of the individual or his offspring. It is indeed because each one serves so vital a function that each of these types of beha- viour is in some degree preprogrammed. To leave their development solely to the caprices of indi- vidual learning would be the height of biological folly.
You will notice that in sketching this frame- work I am making a point of keeping each of these types of behaviour conceptually distinct from the others. This contrasts, of course, with traditional libido theory which has treated them as the varying expressions of a single drive. The reasons for keeping them distinct are several. One is that each of the types of behaviour men- tioned serves its own distinctive biological func- tion--protection, reproduction, nutrition, know- ledge of the environment. Another is that many of the detailed patterns of behaviour within each general type are distinctive also: clinging to a par- ent is different from soothing and comforting a child; sucking or chewing food is different from engaging in sexual intercourse. Furthermore, factors which influence the development of one of
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? ? ? these types of behaviour are not necessarily the same as those that influence the development of another. By keeping them distinct we are able to study not only the ways in which they differ but also the ways in which they overlap and interact with each other--as it has long been evident they do.
INITIATION OF MOTHER-INFANT INTERACTION
During the past decade or so there has been a dramatic advance in our understanding of the early phases of mother-infant interaction, thanks to the imaginative research of workers on both sides of the Atlantic. The studies of Klaus and Kennell are now well known. Of special interest here are their observations of how mothers be- have towards their newborns when given free- dom to do what they like after delivery. Klaus, Trause, and Kennell (1975) describe how a moth- er, immediately after her infant is born, picks him up and begins to stroke his face with her finger tips. At this the baby quietens. Soon she moves on to touching his head and body with the palm of her hand and, within five or six minutes, she is likely to put him to her breast. The baby responds with prolonged licking of the nipple.
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? ? ? 'Immediately after the delivery', they noted, 'the mothers appeared to be in a state of ecstasy', and, interestingly enough, the observers became elated too. From the moment of birth attention becomes riveted on the baby. Something about him tends to draw not only the mother and father but all those present to the new arrival. Given the chance, a mother is likely during the next few days to spend many hours just looking at her new possession, cuddling him, and getting to know him. Usually there comes a moment when she feels the baby is her very own. For some it comes early; perhaps when she first holds him or when he first looks into her eyes. For a large minority of primaparae who are delivered in hospital, however, it may be delayed for up to a week, of- ten until they are home again (Robson and Ku- mar, 1980).
Phenomena of the greatest importance to which recent research has drawn attention are the potential of the healthy neonate to enter into an elemental form of social interaction and the potential of the ordinary sensitive mother to par- ticipate successfully in it. 3
When a mother and her infant of two or three weeks are facing one another, phases of lively
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? ? ? social interaction occur, alternating with phases of disengagement. Each phase of interaction be- gins with initiation and mutual greeting, builds up to an animated interchange comprising facial expressions and vocalizations, during which the infant orients towards his mother with excited movements of arms and legs; then his activities gradually subside and end with the baby looking away for a spell before the next phase of interac- tion begins. Throughout these cycles the baby is likely to be as spontaneously active as his mother. Where their roles differ is in the timing of their responses. Whereas an infant's initiation and withdrawal from interaction tend to follow his own autonomous rhythm, a sensitive mother reg- ulates her behaviour so that it meshes with his. In addition she modifies the form her behaviour takes to suit him: her voice is gentle but higher pitched than usual, her movements slowed, and each next action adjusted in form and timing ac- cording to how her baby is performing. Thus she lets him call the tune and, by a skilful interweav- ing of her own responses with his, creates a dialogue.
The speed and efficiency with which these dia- logues develop and the mutual enjoyment they
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? ? ? give point clearly to each participant being pread- apted to engage in them. On the one hand is the mother's intuitive readiness to allow her inter- ventions to be paced by her infant. On the other is the readiness with which the infant's rhythms shift gradually to take account of the timing of his mother's interventions. In a happily developing partnership each is adapting to the other.
Very similar alternating sequences have been recorded in other quite different exchanges between mother and child. For example, Kaye (1977), observing the behaviour of mother and in- fant during feeding, has found that mothers tend to interact with their infants in precise synchrony with the infant's pattern of sucking and pausing. During bursts of sucking a mother is generally quiet and inactive; during pauses she strokes and talks to her baby. Another example of a mother taking her cue from her infant, in this case an in- fant within the age range 5 to 12 months, is re- ported by Collis and Schaffer (1975). A mother and her infant are introduced to a scene in which there are a number of large brightly coloured toys which quickly seize their visual attention. Obser- vation of their behaviour then shows two things. First, both partners as a rule are looking at the
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? ? ? same object at the same time. Secondly, examina- tion of the timing shows almost invariably that it is the baby who leads and the mother who fol- lows. The baby's spontaneous interest in the toys is evidently closely monitored by his mother who almost automatically then looks in the same dir- ection. A focus of mutual interest having been es- tablished, mother is likely to elaborate on it, com- menting on the toy, naming it, manipulating it. 'A sharing experience is then brought about, instig- ated by the infant's spontaneous attention to the environment but established by the mother al- lowing herself to be paced by the baby'.
Yet another example, also reported by Schaffer (Schaffer, Collis, and Parsons, 1977), concerns vocal interchange between mother and child at a preverbal level. In a comparison of two groups of children, aged 12 and 24 months, it was found that the ability of the pair to take turns and to avoid overlapping was not only strikingly efficient but as characteristic of the younger as of the older infants. Thus, long before the appearance of words, the pattern of turn-taking so characteristic of human conversation is already present.
Here again the evidence suggests that, in ensuring the
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? ? ? smooth transitions from one 'speaker' to the oth- er, mother is playing the major part.
My reason for giving these examples at some length is that I believe they illustrate some basic principles both about parenting and about the nature of the creature who is parented. What emerges from these studies is that the ordinary sensitive mother is quickly attuned to her infant's natural rhythms and, by attending to the details of his behaviour, discovers what suits him and behaves accordingly. By so doing she not only makes him contented but also enlists his co-oper- ation. For, although initially his capacity to adapt is limited, it is not absent altogether and, if al- lowed to grow in its own time, is soon yielding re- wards. Ainsworth and her colleagues have noted that infants whose mothers have responded sens- itively to their signals during the first year of life not only cry less during the second half of that year than do the babies of less responsive moth- ers but are more willing to fall in with their par- ent's wishes (Ainsworth et al. , 1978). Human in- fants, we can safely conclude, like infants of other species, are preprogrammed to develop in a so- cially cooperative way; whether they do so or not turns in high degree on how they are treated.
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? ? ? This is a view of human nature, you will notice, radically different from the one that has long been current in western societies and that has permeated so much of the clinical theory and practice we have inherited. It points, of course, to a radically different conception of the role of parent.
ROLES OF MOTHERS AND FATHERS: SIMILARITIES AND DIFFERENCES
In the examples given so far, the parent con- cerned has been the mother. This is almost inev- itable because for research purposes it is relat- ively easy to recruit samples of infants who are being cared for mainly by their mother, whereas infants being cared for mainly by their father are comparatively scarce. Let me therefore describe briefly one of several recent studies which, to- gether, go some way to correct the balance.
Several hundred infants have now been studied by means of the strange situation procedure de- vised by Ainsworth (Ainsworth et al. , 1978) which gives an opportunity to observe how the infant responds, first in his parent's presence, next when he is left alone, and later when his parent returns. As a result of these observations infants
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? ? ? can be classified as presenting a pattern either of secure attachment to mother or of one of two main forms of insecure attachment to her. Since these patterns have been shown to have consider- able stability during the earliest years of life and to predict how a nursery-school child in the age range 41/2 to 6 years will approach a new person and tackle a new task (Arend, Gove, and Sroufe, 1979), the value of the procedure as a method of assessing an infant's social and emotional devel- opment needs no emphasis.
Hitherto almost all the studies using this pro- cedure have observed infants with their mothers. Main and Weston (1981), however, extended the work by observing some 60 infants, first with one parent and, six months later, with the other. One finding was that, when looked at as a group, the patterns of attachment that were shown to fath- ers resembled closely the patterns that were shown to mothers, with roughly the same per- centage distribution of patterns. But a second finding was even more interesting. When the pat- terns shown by each child individually were ex- amined, no correlation was found between the pattern shown with one parent and the pattern shown with the other. Thus one child may have a
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? ? ? secure relationship with the mother but not with the father, a second may have it with the father but not with the mother, a third may have it with both parents, and a fourth may have it with neither. In their approach to new people and new tasks the children represented a graded series. Children with a secure relationship to both par- ents were most confident and most competent; children who had a secure relationship to neither were least so; and those with a secure relation- ship to one parent but not to the other came in between.
Since there is evidence that the pattern of at- tachment a child undamaged at birth develops with his mother is the product of how his mother has treated him (Ainsworth et al. , 1978), it is more than likely that, in a similar way, the pat- tern he develops with his father is the product of how his father has treated him.
This study, together with others, suggests that, by providing an attachment figure for his child, a father may be filling a role closely resembling that filled by a mother; though in most, perhaps all, cultures fathers fill that role much less fre- quently than do mothers, at least when the chil- dren are still young. In most families with young
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? ? ? children the father's role is a different one. He is more likely to engage in physically active and novel play than the mother and, especially for boys, to become his child's preferred play com- panion. 4
PROVISION OF A SECURE BASE
This brings me to a central feature of my concept of parenting--the provision by both parents of a secure base from which a child or an adolescent can make sorties into the outside world and to which he can return knowing for sure that he will be welcomed when he gets there, nourished phys- ically and emotionally, comforted if distressed, reassured if frightened. In essence this role is one of being available, ready to respond when called upon to encourage and perhaps assist, but to in- tervene actively only when clearly necessary. In these respects it is a role similar to that of the of- ficer commanding a military base from which an expeditionary force sets out and to which it can retreat, should it meet with a setback. Much of the time the role of the base is a waiting one but it is none the less vital for that. For it is only when the officer commanding the expeditionary force is
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? ? ? confident his base is secure that he dare press forward and take risks.
In the case of children and adolescents we see them, as they get older, venturing steadily further from base and for increasing spans of time. The more confident they are that their base is secure and, moreover, ready if called upon to respond, the more they take it for granted. Yet should one or other parent become ill or die, the immense significance of the base to the emotional equilib- rium of the child or adolescent or young adult is at once apparent. In the lectures to follow evid- ence is presented from studies of adolescents and young adults, as well as of school children of dif- ferent ages from nursery school up, that those who are most stable emotionally and making the most of their opportunities are those who have parents who, whilst always encouraging their children's autonomy, are none the less available and responsive when called upon. Unfortunately, of course, the reverse is also true.
No parent is going to provide a secure base for his growing child unless he has an intuitive un- derstanding of and respect for his child's attach- ment behaviour and treats it as the intrinsic and valuable part of human nature I believe it to be.
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? ? ? This is where the traditional term 'dependence' has had so baleful an influence. Dependency al- ways carries with it an adverse valuation and tends to be regarded as a characteristic only of the early years and one which ought soon to be grown out of. As a result in clinical circles it has often happened that, whenever attachment beha- viour is manifested during later years, it has not only been regarded as regrettable but has even been dubbed regressive. I believe that to be an appalling misjudgement.
In discussing parenting I have focused on the parents' role of providing a child with a secure base because, although well recognized intuit- ively, it has hitherto, I believe, been inadequately conceptualized. But there are, of course, many other roles a parent has to play. One concerns the part a parent plays in influencing his child's be- haviour in one direction or another and the range of techniques he uses to do so. Although some of these techniques are necessarily restrictive, and certain others have a disciplinary intent, many of them are of an encouraging sort, for example, calling a child's attention to a toy or some other feature of the environment, or giving him tips on how to solve a problem he cannot quite manage
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? ? ? on his own. Plainly the repertoire of techniques used varies enormously from parent to par- ent--from largely helpful and encouraging to largely restrictive and punitive. An interesting start in exploring the range of techniques used by the parents of toddlers in Scotland has been made by Schaffer and Crook (1979).
PERI- AND POST-NATAL CONDITIONS THAT HELP OR HINDER
So far in this lecture my aim has been to describe some of the ways in which the parents of children who thrive socially and emotionally are observed to behave towards them. Fortunately, much of this behaviour comes naturally to many mothers and fathers who find the resulting interchanges with their children enjoyable and rewarding. Yet it is evident that, even when social and economic conditions are favourable, these mutually satisfy- ing relationships do not develop in every family. Let us consider therefore what we know of the psychological conditions that foster their doing so and those that impede them.
At several points I have referred to the ordin- ary sensitive mother who is attuned to her child's actions and signals, who responds to them more
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? ? ? or less appropriately, and who is then able to monitor the effects her behaviour has on her child and to modify it accordingly. The same de- scription, no doubt, would apply to the ordinary sensitive father. Now it is clear that, in order for a parent to behave in these ways, adequate time and a relaxed atmosphere are necessary. This is where a parent, especially the mother who usu- ally bears the brunt of parenting during the early months or years, needs all the help she can get--not in looking after her baby, which is her job, but in all the household chores.
A friend of mine, a social anthropologist, ob- served that in the South Sea island in which she was working it was the custom for a mother, both during and after the baby was born, to be atten- ded by a couple of female relatives who cared for her throughout the first month, leaving her free to care for her baby. So impressed was my friend by these humane arrangements that, when her own baby was born on the island, she accepted suggestions that she be cared for in the VIP way, and she had no cause to regret it. In addition to practical help, a congenial female companion is likely to provide the new mother with emotional support or, in my terminology, to provide for her
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? ? ? the kind of secure base we all need in conditions of stress and without which it is difficult to relax. In almost all societies an arrangement of this sort is the rule. Indeed in all but one of 150 cultures studied by anthropologists a family member or friend, usually a woman, remains with a mother throughout labour and delivery (Raphael, 1966, quoted by Sosa et al. , 1980).
Turning to our own society, preliminary find- ings that, if confirmed, are of the greatest interest and practical importance have recently been re- ported by the Klaus and Kennell team from a study conducted in a hospital maternity unit in Guatemala (Sosa et al. , 1980). One group of wo- men went through labour and delivery according to the routine practice of the unit which meant in effect that the woman was left alone for most of the time. The other group received constant friendly support from an untrained lay woman from the time of admission until delivery, one woman during the day and another at night. In the supported group labour was less than half as long as in the other, 8. 7 hours against 19. 3. 5 Moreover, the mother was awake for a greater part of the first hour of the infant's life during
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? ? ? which she was much more likely to be seen strok- ing her baby, smiling, and talking to him.
Effects of a similar kind on the way a mother treats her baby as a result of her having addition- al contact with him soon after his birth are now well known. Amongst differences observed by Klaus and Kennell, when the babies were one month old, was that a mother given extra contact was more likely to comfort her baby during stressful clinic visits and, during feeding, was more likely to fondle the baby and engage him in eye-to-eye contact. Differences of a comparable kind were observed when the babies were 12 months old and again at 2 years. In these studies the increased contact amounted to no more than an extra hour within the first three hours after birth, with a further five of contact each after- noon during the next three days (Kennell et al. , 1974; Ringler et al. , 1975). 6
Findings of another study of the part these kinds of peri- and post-natal experiences play in either assisting a mother to develop a loving and sensitive relationship to her baby or impeding it are reported by Peterson and Mehl (1978). In a longitudinal study of 46 women and their hus- bands, interviewed and observed during
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? ? ? pregnancy, labour, and on four occasions during the infants' first six months, the most significant variable predicting differences in maternal bond- ing was the length of time a mother had been sep- arated from her baby during the hours and days after his birth. Other variables that played a sig- nificant but lesser part were the birth experience and the attitudes and expectations expressed by the mother during her pregnancy.
INFLUENCE OF PARENTS' CHILDHOOD EXPERIENCES
There is, of course, much clinical evidence that a mother's feeling for and behaviour towards her baby are deeply influenced also by her previous personal experiences, especially those she has had and may still be having with her own par- ents; and, though the evidence of this in regard to a father's attitudes is less plentiful, what there is points clearly to the same conclusion. On this matter evidence from systematic studies of young children is impressive: it shows that the influence that parents have on the pattern of caring that their children develop starts very early. For example, Zahn-Waxler, Radke-Yarrow, and King (1979) have found not only that aiding and
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? ? ? comforting others in distress is a pattern of beha- viour that commonly develops as early as a child's second year of life, but that the form it takes is much influenced by how a mother treats her child. Children whose mothers respond sens- itively to their signals and provide comforting bodily contact are those who respond most read- ily and appropriately to the distress of others. 7 Not infrequently, moreover, what a child does in such circumstances is a clear replica of what he has seen and/or experienced his mother do. The follow-up of a group of children showing these early differences would be of the greatest interest.
Another line of evidence regarding the influ- ence of childhood experience on how a woman mothers her child comes from studies under- taken in London. For example, a study by From- mer and O'Shea (1973) shows that women who, during their pregnancy, give a history of having been separated from one or both parents before the age of 11 years are particularly likely to have marital and psychological difficulties after their baby's birth and also to have trouble with their infant's feeding and sleeping. Another study, also in London, by Wolkind, Hall, and Pawlby (1977) is extending this finding by showing that women
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? ? ? with this type of childhood history interact signi- ficantly less with their 5-month-old first-born in- fants than do women who have had more settled childhoods. These observations, which were car- ried out by an ethologist, extended over a period long enough to record 50 minutes of the baby's waking life, exclusive of any time taken to feed him; this usually necessitated the observer stay- ing for the whole morning. Not only did the mothers from a disrupted family of origin spend on average twice as long as the other mothers out of sight of their babies, but, even when one of them was with her baby, she was likely to spend less time holding him, less time looking at him and less time talking to him. Moreover, when asked the question, 'It takes a bit of time to begin to see a baby as a person--do you feel this yet? ', mothers from a disrupted family were much less likely to say they did (Hall, Pawlby, and Wolkind, 1979). The point I wish to emphasize is that the study provides firm evidence that women whose childhood has been disturbed tend to engage in less interaction with their infants than do moth- ers with happier childhoods--at a period in their baby's life when the amount of interaction that
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? ? ? ensues is determined almost entirely by the mother.
Some of the clearest evidence regarding the enormous part played by childhood experience in determining in later years how a parent treats a child comes from studies of parents known to have abused their children physically (Parke and Collmer, 1979). A common picture includes a childhood in which parental care was at best er- ratic and at worst absent altogether, in which cri- ticism and blame were frequent and bitter, and in which parents or step-parents had behaved viol- ently towards each other and sometimes though not always towards the children. A feature that emerges from a study by DeLozier of mothers known to have abused a child physically (a study described in detail in Lecture 5) is the high pro- portion who have lived in constant dread of being deserted by one or both parents and therefore of being sent away to a foster home or institution, and who have also been threatened frequently with violent beatings or worse. Not surprisingly these girls have grown up to be perpetually anxious lest husband or boyfriend desert, to re- gard physical violence as part of the natural
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? ? ? order, and to expect little or nothing in the way of love or support from any quarter.
Not every woman with childhood experiences of these sorts batters her child, however; nor in- deed does a woman who physically abuses one of her children necessarily abuse the others. What accounts for these differences? Evidence suggests that individuals who, thanks to earlier experi- ences, are markedly prone to develop unfavour- able parental attitudes are more than usually sensitive to what happens to them in the time during and after the birth of their babies. It seems that for these women adverse experiences during this time can prove the last straw.
In a study done at Oxford, for example, Lynch (1975) compared the histories of 25 children who had been physically abused with those of their siblings who had escaped. Children who had been abused were significantly more likely than their siblings to have been the product of an abnormal pregnancy, labour, or delivery, to have been sep- arated from their mother for 48 hours or more soon after birth, and to have experienced separa- tions of other kinds during their first six months of life. During the first year of these children's lives, moreover, the abused children were much
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? ? ? more likely to have been ill than were the non-ab- used siblings; and the mothers also were more likely to have been ill during the abused child's first year than during the siblings' first year. Since in this study the personalities and child- hood histories of the parents were the same for the abused siblings as for the non-abused, the fate of each seems to have turned in large part on the mother's experiences with the child during the peri- and early post-natal periods. The find- ings of a study by Cater and Easton (1980) point to the same conclusion. 8
Of the many other disturbed patterns of par- enting that can be traced, in part at least, to childhood experience, there is one that happens also to be well documented in studies of abusing mothers (e. g. Morris and Gould, 1963; Steele and Pollock, 1968; Green, Gaines, and Sandgrun, 1974; DeLozier, 1982). This is their tendency to expect and demand care and attention from their own children, in other words to invert the rela- tionship. During interview they regularly describe how, as children, they too had been made to feel responsible for looking after their parents instead of the parents caring for them.
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? ? ? Most, perhaps all, parents who expect their children to care for them have experienced very inadequate parenting themselves. Unfortunately, all too often, they then create major psychological problems for their children. Elsewhere (Bowlby, 1973, 1980) I have argued that an inverted parent-child relationship of this kind lies behind a significant proportion of cases of school refusal (school phobia) and agoraphobia, and also prob- ably of depression.
HOW WE CAN BEST HELP
In this contribution I have given principal atten- tion to what we know about successful parenting and to some of the variables that make it easier or more difficult for young men and women to be- come sensitive, caring parents. In consequence I have been able to say only a little about the many and varied patterns of deficient and distorted parenting that we meet with clinically. Another large theme omitted is how we can best help young men and women become the successful parents I believe the great majority wish to be. In conclusion, therefore, let me state what I believe to be the first principles for such work--which are that we seek always to teach by example, not
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? ? ? precept, by discussion, not instruction. The more that we can give young people opportunities to meet with and observe at first hand how sensit- ive, caring parents treat their offspring, the more likely are they to follow suit. To learn directly from such parents about the difficulties they meet with and the rewards they obtain, and to discuss with them both their mistakes and their suc- cesses, are worth, I believe, hundreds of instruc- tional talks. For a programme of this kind, which in some places might be an extension of the mothers' self-help groups now beginning to flour- ish, we would need to enlist the active co-opera- tion of sensitive, caring parents. Fortunately there are still plenty of them in our society and I believe many would be willing and proud to help.
1 Throughout this book the child is referred to as mas- culine in order to avoid clumsy constructions.
2 An increased desire for care, either from husband or mother, has been reported in studies of representative groups of women by Wenner (1966) and Ballou (1978). 3 See especially the work of Stern (1977), Sander (1977), Brazelton, Koslowski, and Main (1974) and Schaffer (1977). For excellent reviews see Schaffer
(1979) and Stern (1985). The state of heightened sens- itivity that develops in a woman during and especially
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? ? ? towards the end of pregnancy, and that enables her 'to adapt delicately and sensitively' to her infant's needs, is a process to which Winnicott (1957) has called attention.
4 Studies of relevance are those of Lamb (1977), Parke (1979), Clarke-Stewart (1978), and Mackey (1979).
5 In a further and larger study, also carried out in Guatemala and by the same research group, all find- ings were replicated. Samples numbered 279 in the routine group and 186 in the supported group. Not only was the duration of labour halved but the incid- ence of perinatal complications halved also (Klaus et al. , 1986).
6 Since more recent studies, e. g. Svejda, Campos, and Emde (1980), have failed to replicate initial findings of the effects of early mother-infant contact, the issue re- mains in doubt. It may be that in this sensitive area de- tails of how this early contact is arranged and by whom would explain discrepancies.
7 The role of close physical contact with mother during human infancy has been studied especially by Ainsworth who finds that children who develop a se- cure attachment to mother are those who, during early infancy, are held longest in a tender and loving way (Ainsworth et al. , 1978).
