This book was initially conceived as an evidence-based document on attachment, along similar lines to other publications by FOCUS which have considered the evidence base for interventions in a number of different disorders. However, it became apparent early in the endeavour that a somewhat different format would be required. In discussing the clinical application of the concept of attachment, three aspects needed to be considered in detail: (1) attachment theory; (2) the assessment of attachment patterns; and (3) disturbances related to attachment. An evidence-based approach has been applied to considering these three aspects.
Attachment theory was introduced and described in detail by John Bowlby in his many papers and books. Bowlby regarded attachment as a biological instinct, evolved to ensure the survival of the vulnerable young. Bowlby's trilogy (1969/1982, 1973, 1980) considered the formation of attachment, separation and loss. Subsequent attention has become focused on the process of attachment of children to their caregivers, with much less emphasis on separation and loss. It is clear that separation and loss are painful and distressing and, if unresolved, may leave lasting emotional sequelae. Prior security of attachment is, however, protective of the effects of later stresses. Insecure attachment is best regarded as a vulnerability factor or a marker of risk to the child's functioning and wider social adaptation. How attachment behaviour becomes organised is largely determined by the caregiving environment. This places the onus of 'responsibility' for the formation of secure attachments on the young child's caregivers.
What is remarkable is the extent to which Bowlby's writing and predictions, which were based on extensive observations, have been proved correct. The theory has stood the test of empirical scrutiny and is referred to