Part Five describes and reviews the main findings about the effectiveness (where evaluated) of a number of interventions which are either based on attachment theory or which include the term 'attachment'. Part Four described the dichotomy between an academic and evidence-based approach to attachment disorders and a wide, loose approach to attachment disorders. A similar dichotomy is found when considering the current state and evidence base for interventions aimed at enhancing attachment security and ameliorating less than optimal attachment behaviour and organisation.
As described in Chapter 4, caregiving and caregiver sensitivity are the principal determinants of the child's attachment security. There have therefore been many reported studies of attachment theory-based interventions, mostly with parents of young children, the aim of these interventions being the enhancement of the quality of the caregiver's interaction with the child. The reviews here include meta-analyses, and some individual studies which illustrate the nature of the interventions.
Some of these studies are termed preventive, while others are reactive. Even the preventive ones mostly fall into the class of secondary prevention (Browne, Davies and Stratton 1988), which aims at vulnerable or high-risk groups, but before harm has occurred. In attachment terms, this would mean that the child is likely to form a disorganised attachment unless there is a change and improvement in the caregiver sensitivity. These are either parent–child dyads who are living in stressful social circumstances or where the parents possess risk factors for insensitive caregiving (e.g. drug or alcohol abuse, very troubled and abusive childhood histories or past unresolved trauma or loss).
Reactive interventions, also termed tertiary prevention (Browne et al. 1988), are those which aim at minimising or reversing harm which is already established. In attachment terms, the aim would be to change disorganised into