Recent studies show that a number of stress-related psychiatric conditions including post-traumatic stress disorder (PTSD), chronic pain disorder and chronic fatigue syndrome are associated with low blood cortisol, which can be inherited by children from traumatised parents[1].

Latest research also shows that psychological trauma such as childhood abuse might impact the long-term physical health of not only the immediate victim, but also their offspring, by etching itself onto the victim’s DNA[2] – having a visible impact on Attachment patterns.

Moreover, we now have evidence that:

• Maternal PTSD increases the probability of developing an insecure mother-infant attachment relationship and
• An insecure mother-infant attachment relationship increases the risk of the child developing PTSD following trauma exposure in later life[3]

Understanding attachment across the lifespan and generations in tandem is paramount for psychotherapists due to the intricate interplay and transmission of attachment patterns. The interconnectedness of attachment dynamics across generations unveils a tapestry woven with complexities, where early experiences profoundly shape an individual’s attachment style, influencing relational patterns throughout life. Learning this interconnectedness provides therapists with a comprehensive understanding of the origin and continuity of attachment-related issues, facilitating more nuanced interventions. Clinical challenges arise in deciphering the intricate links between a client’s past attachment experiences, their present relational dynamics, and the transmission of attachment patterns to future generations. Therapists can struggle with navigating how a client’s early attachment experiences might manifest in their current relationships or parenting styles, often presenting as maladaptive behaviours or unresolved relational patterns. Additionally, addressing intergenerational transmission demands therapists to consider cultural influences, migration, and family dynamics, amplifying the complexity of therapeutic interventions.

At this intellectually stimulating seminar based on cutting-edge research, Dr Gwen Adshead and Dr Chrissy Jayarajah come together to explore the dynamics of Attachment, not just across a lifespan but also across generations. Dr Adshead will first present research data that supports and challenges how attachment styles might be transmitted from adult to child. She will also discuss the role of:

• Maternal Mentalising and reflective function (RF) and
• The role of fathers in influencing childhood attachments

Dr Chrissy Jayarajah will then offer a series of clinical vignettes from her practice as a perinatal psychiatrist to illustrate how attachment can be transmitted across generations. She will also discuss the role of cultural influences, and the impact of migration on attachment.

Vignette one: Ruth is a 40-year-old nurse with six-month-old twins and a daughter aged five. She has a known diagnosis of OCD and anxiety disorder. She describes as having a perfect childhood. However, she notes that she had a better relationship with her father than her mother, whom she described as ‘very critical’. Her medical records note that she was diagnosed with anorexia nervosa aged 14 yrs old. When you ask her about this, she states that it was a misdiagnosis, and she is just a very ‘health-conscious individual’. In her pregnancy, Ruth had become increasingly preoccupied with her health and wellbeing, taking several natural remedies and supplements and exercising for 2 hours a day. She is currently mixing breast and bottle feeding, but you are concerned as she has mentioned that she needs to “reduce the ounces of milk” for her twins as its “too many calories”. She mentions that she has put her five-year-old daughter on a diet, as she has enrolled her for national ballet competition, which is very competitive.

Vignette two: Maryam is a 24-year-old asylum seeker and is fleeing the civil conflict. She and her husband moved to the UK three years ago when they got married, and she gave birth to her first child earlier this year. She presents to her doctor asking for specialist help, as she has been having difficulty sleeping and recurrent nightmares. She also describes feeling scared in her own home – particularly at night when she is alone as her husband is working late at the restaurant. When she takes a shower, she describes feeling “ghosts” are surrounding her and can see snakes at the end of her bed. She can also hear male voices at night, which she describes are the voices of the soldiers in her village back home which causes her to feel very fearful. She has no past mental health history. On further exploration you recognise that she is quite isolated with no family support, and her experience of mothering is very different to what she grew up with (in a large extended family with her mother grandmother and aunties in her family home).

Following on from these discussions, Dr Jayarajah will discuss the theory of attachment applied in detail to different kinds of family relationships across the lifespan. Using an understanding of theory from epigenetics, connectomics neuroscience and family therapy, she will explore how attachment needs might change with age and stage of development; and the attachment needs of young adults and older adults of both sexes.

Both speakers will draw on their respective clinical experiences (including perinatal work and family courts) to specifically discuss:

• Attachment from the cradle to the grave; understanding that attachment is fluid and can change across the lifespan
• Examples of “parenting challenges” through the different phases (new-born, toddler, school age, teenage and adult)
• Attaching and the attached – thinking about parenting whilst being parented; caring for elderly and/or vulnerable parents
• Systemic family therapy principles used in clinical practice (including family scripts)
• Attachment in special circumstances (IVF / donor egg insemination / adoption)
• Video based therapies (VIPP/VIG) the new therapeutic modality to support with improving attachment related difficulties in clinical practice

Overall, the webinar explores the domains of attachment theory as they apply to parenting; across the generations and from infancy to adulthood. The speakers will present research and clinical vignettes to explore how the attachment system is a living dynamic one, with both physical and psychological aspects.

There will be time for discussion and comment at the end of both evenings.

Learning Objectives:

• Analyze the research data that supports and challenges how attachment styles might be transmitted from adult to child
• Discuss the role of fathers in influencing childhood attachments
• Attachment from the cradle to the grave; explain how attachment is fluid and can change across the lifespan
• List examples of “parenting challenges” through the different phases (new-born, toddler, school age, teenage and adult)
• List systemic family therapy principles used in clinical practice (including family scripts)
• Discuss attachment in special circumstances (IVF / donor egg insemination / adoption)

[1] Rachel Yehuda

[2] Harvard Study

[3] Yehuda, Halligan, Bierer, 2001

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