by Georgina Psomiadis, Clinical Psychologist
You are surely familiar with the concept of separation anxiety, particularly in children. The tears and clinginess that could be experienced when a child first separates from their parents. Of course, it’s very appropriate for young children to experience some mild anxiety when they first start school or spend their first night away, though with some practice, are soon able to regulate themselves during times of separation because they know their caregiver will come back for them. Then there are children who are not able to regulate themselves and continue to show signs of distress for an extended period of time.
In the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5, 2013), Separation Anxiety Disorder is categorised by showing developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached for at least 4 weeks in children and adolescents (if not better explained by another condition such as refusal to leave home because of excessive resistance to change in autism spectrum disorder, amongst other conditions). In this most recent edition of the DSM-5, adults have now been included in this diagnosis, though the length of excessive fear lasts for more than 6 months.
One of the major theories that inform separation anxiety is Attachment Theory, first founded by John Bowlby then extended by Mary Ainsworth. The basic perspective of Attachment Theory is that the kind of bonds we have in our early life shapes the kind of relationships we form as adults. The developing child builds up a set of models of the self and others, based on repeated patterns of interactive experience. These internal working models are thought to form relatively fixed representational models which the child uses to predict and relate to the world.
A securely attached child will store an internal working model of a responsive, loving, reliable caregiver, and of a self that is worthy of love and attention and will bring these assumptions to bear on all other relationships. On the other hand, an insecurely attached child may view the world as a dangerous place in which other people are to be treated with caution, and see themselves as ineffective and unworthy of love.
Within the first 6 months of life, parental responsiveness is a fundamental factor impacting the quality of attachment. This is where mirroring responses are crucial. The onset of a smiling response at 4 weeks marks the beginning of the cycles of interaction between the caregivers and their baby. The baby’s smile evokes a mirroring smile in their parent; the more they smile back the more the baby responds, and so on. These are called ‘mirroring’ responses because it is thought that what the baby sees when their caregivers copy their expressions, is in fact, themselves… i.e., they are developing their sense of self. The physical holding, protection, nurturing and caring that is also felt by the infant further creates the sense of inner security.
Between 6 months and 3 years old, the goal for the child is to keep close enough to their caregiver, to use them as a secure base for exploration (i.e., separation) when the environmental threat is at a minimum, and to exhibit separation protest or signalling danger when the need arises. The over-anxious parent may inhibit the child’s exploratory behaviour, making them feel stifled or smothered; conversely, the parent that may not have the capacity to be attuned to the child’s needs may inhibit exploration by failing to provide a secure base, leading to feelings of anxiety or abandonment.
Attachment relationships continue to evolve throughout the lifespan. The child-parent relationship forms the primary attachment figures until adolescence, which is when peer relationships become the primary attachment figures, then romantic relationships in adulthood.
If a child has developed an early insecure attachment and an internal working model/core belief that others can’t be trusted and they are unlovable, there is a tendency for later peer and romantic relationships to reinforce and strengthen this internal working model. For example, a teenager with this internal working model may act either by avoiding developing close relationships, being ‘clingy’ or controlling of others, which would elicit undesired responses from others that will reinforce their initial core belief.
How can therapy reduce or eliminate excessive separation anxiety?
A key element in psychological therapy, whether that is for children, adolescents or adults is for the therapist to become a ‘safe base’ that the patient can feel secure to ‘explore’, whether that is the exploration of the physical environment for young children (play) or their internal world (adolescents and adults). Many of the elements that foster a secure early attachment as outlined in Attachment Theory are typically utilised in therapy (i.e., mirroring, being highly attuned/sensitive to the patient’s needs, support, validation, unconditional positive regard) so the patient can first start to develop a secure sense of themselves, which only after this is achieved can extend to feeling secure with significant others. Of course, as parents tend to enact their own attachment style onto their children, parenting support and explicit teaching of responses that foster a secure attachment, especially for young children is also an essential component of therapy.