Thanatology 2200 Lecture Notes - Lecture 2: Utrecht University, Attachment Theory, The Jewish Home
Continuing bonds in adaptation to bereavement: Toward theoretical integration
Margaret Stroebe
a,
⁎, Henk Schut
a
, Kathrin Boerner
b
a
Department of Clinical & Health Psychology, Utrecht University, Box 80140, 3508 TC Utrecht, The Netherlands
b
Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine/Research Institute on Aging, Jewish Home Lifecare, 120 West 106th Street, New York,
NY 10025, USA
abstractarticle info
Article history:
Received 19 April 2009
Received in revised form 17 November 2009
Accepted 25 November 2009
Keywords:
Bereavement
Grief
Attachment
Continuing bonds
Theory
There is lack of clarity in the scientific literature concerning the adaptive functions of continuing versus
relinquishing bonds to deceased persons. It remains unclear what type of bonds or underlying processes
are related to (mal)adaptive bereavement outcomes. Furthermore, empirical research has rarely been
theoretically-driven. Thus, the purpose of this article is to outline a theoretical model for predicting the (mal)
adaptiveness of continuing-relinquishing bonds. Attachment theory provides a generic framework for under-
standing patterns of individual differences in the impact of continuing bonds. Within this framework, using
bereavement-specific models compatible with attachment theory, (1) ways of coping with the bond to the
deceased can be linked to outcome (using the Dual Process Model, Stroebe & Schut, 1999), and (2) related
cognitions about the deceased person proposed (drawing on Mental Representations Theory, Boerner &
Heckhausen, 2003). This integrative model can be used to systematically examine the relationship between
continuing bonds and bereavement adaptation.
© 2009 Elsevier Ltd. All rights reserved.
Contents
1. Individual differences in the nature of bonds: the attachment theory perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
1.1. Attachmentstyles/dimensions.................................................. 260
1.2. Internalworkingmodels..................................................... 262
1.3. Affect regulation: hyperactivation and deactivation of the attachment system . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
2. Differences in grief reactions according to attachment style. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
3. Attachmentstylesandcontinuingbonds ................................................ 263
3.1. Secureattachment ....................................................... 263
3.2. Insecure–dismissing/avoidant .................................................. 263
3.3. Insecure–preoccupied...................................................... 263
3.4. Insecure–fearful......................................................... 263
4. Ways of coping with bereavement: the Dual Process Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
5. Cognitive processes in bereavement: Mental Representations Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
6. The Integrative Model: identifying (un)healthy bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
7. Conclusions.............................................................. 266
References................................................................. 267
In their influential volume Continuing Bonds,Klass, Silverman, and
Nickman (1996) challenged the long-standing belief deriving from
the psychoanalytic tradition (Freud, 1917/1957) that ties to a deceased
person need to be relinquished, in order for adaptation to bereavement
to take place. This caused something of a pendulum swing, whereby the
focus in the scientific literature came to be placed more on the benefits
of continuing a connection with a deceased person. Recently, however,
there has been increased understanding that there is no “either/or”rule
to be applied: it is neither generally adaptive for bereaved people to
continue their bonds with deceased loved ones, nor to relinquish them
(e.g., Field, 2008; Field, Gao, & Paderna, 2005; Stroebe & Schut, 2005).
In line with such reasoning, Field et al. (2005) stressed the role of indi-
vidual differences in effective versus ineffective use of continuing bonds
Clinical Psychology Review 30 (2010) 259–268
⁎Corresponding author. Tel.: +31 30 2533456; fax: +31 30 2534718.
E-mail addresses: [email protected] (M. Stroebe), [email protected] (H. Schut),
[email protected] (K. Boerner).
0272-7358/$ –see front matter © 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cpr.2009.11.007
Contents lists available at ScienceDirect
Clinical Psychology Review
in coping with bereavement (taking “continuing bonds”to mean the
presence of an ongoing inner relationship with the deceased person
1
).
Along similar lines, Stroebe and Schut (2005) argued that researchers
need to work toward understanding for whom continuing or relinquish-
ing bonds promote adjustment. For some, it would seem necessary to
work toward loosening a bond, for this is retained too closely. For others,
precisely the opposite seems to be the case: some persons need to
continue or enhance their connection in order to relocate the deceased
person in their ongoing lives. Furthermore, Stroebe and Schut (2005)
drew attention to the need to examine the process —the underlying
dynamics —through which continuing versus relinquishing bonds may
be reached, and how these processes are related to adaptation: how
do bereaved people go about relocating their loved one —cognitively,
behaviorally and affectively —over the course of their bereavement?
Accordingly, analysis is needed of both individual differences and
underlying processes in continuing/relinquishing bonds.
In general, theoretical formulations should enhance understand-
ing of the complex relationships between continuing/relinquishing
bonds and adjustment to bereavement indicated above, enabling
more precise predictions about who has beneficial versus detrimental
effects from continuing a bond (Field, 2008; Field et al., 2005) and
Stroebe, Schut, and Stroebe (2005) adopted an attachment theoretical
framework (Bowlby, 1969, 1973, 1980; see also Cassidy & Shaver,
1999; Mikulincer & Shaver, 2003, 2008) to explain patterns of in-
dividual differences in bereavement reactions. Because bereavement
has fundamentally to do with human relationships —not the forming
or maintaining, but with the ending of a relationship —it stands to
reason that a relationship theory such as attachment theory should
be a useful heuristic framework for understanding continuing bonds.
Field (2008; see also Field et al., 2005) defined the relationship to the
deceased in terms of attachment theory's postulation of separation
anxiety and phases of adjustment during bereavement, highlight-
ing the way that continuing bonds may be defined and identifying
patterns of continuing bonds according to attachment styles. Along
similar lines, Shaver and Tancredy (2001), Mikulincer and Shaver
(2008), and Stroebe et al. (2005) related attachment styles to com-
plications in the grieving process. Other theoretical perspectives
have focussed on identifying processes in continuing bonds. These
perspectives cover a variety of different constructs and potential
mechanisms.
Despite availability of the theoretical perspectives mentioned
above, empirical research on the relationship between continuing–
relinquishing bonds and adjustment has not typically been theory-
driven (a rare exception is the empirical study by Field et al., 2005).
Furthermore, empirical studies to date have failed to reveal a clear
picture about this relationship: sometimes continuing bonds have
indeed been found to be associated with better adaptation, sometimes
they have not (cf. Boelen, Schut, Stroebe, & Zijerveld, 2006; Field, Gal-
Oz, & Bonanno, 2003; Schut, Stroebe, Boelen, & Zijerveld, 2006). Thus,
it seems useful to assess available theoretical approaches, with the aim
to develop a predictive model for clarifying the relationship between
bonds and bereavement outcomes. A central question in this article is:
how can the manifestations and patterns of benefits versus detrimen-
tal consequences of either holding on to or relinquishing ties to a
deceased person be understood on a theoretical level? To address this
question, we first outline attachment theory's approach to individual
differences, with special reference to the impact of continuing–
relinquishing bonds in bereavement. We turn to bereavement-specific
models to provide analysis of ways of coping and cognitive processes
within this generic theory of attachment, proposing an integrative
framework, summarized in Table 1, for predicting and empirically
examining the relationship between continuing–relinquishing bonds
and adjustment to bereavement.
1. Individual differences in the nature of bonds: the attachment
theory perspective
As indicated above, attachment theory —with its focus on the
nature of relationships between close persons —provides an excellent
generic framework for examining the value of continuing versus
relinquishing bonds. Thus, we describe this theory in some detail next,
in order to draw the links between attachment styles and particular
types of continuing–relinquishing bonds.
Early attachment theory described the formation and long-term
impact of infants' relationships with their primary caregivers (e.g.,
Bowlby, 1953; for more detailed reviews of the relationship between
attachment patterns and adjustment to bereavement, see Field, 2008;
Field et al., 2005; Mikulincer & Shaver, 2008; Shaver & Tancredy, 2001;
Stroebe et al., 2005).
2
A basic theme of the theory is that persons
who have experienced (lack of) dependability and consequent (in)
security in their early childhood relationships will subsequently re-
main influenced by this in forming, maintaining and —importantly
here —relinquishing relationships.
1.1. Attachment styles/dimensions
Based on empirical research, attachment theorists developed the
well-known classification system of different types of relationships in
terms of secure versus insecure attachment styles (e.g., Ainsworth,
Blehar, Waters, & Wall, 1978; Main & Solomon, 1986, 1990).In brief:
Secure attachment in adulthood is characterized by ease in being close
to others, feeling comfortable depending on others and, in turn, in
having others depend on them. Not surprisingly, secure attachment is
associated with more satisfaction and higher levels of psychological
well-being than insecure attachment (e.g., Collins & Read, 1990;
Feeney, 1999). Insecure attachments have been classified as dismiss-
ing, preoccupied or disorganized.
3
Adults with a dismissing style are uncomfortable with closeness to
others, find it difficult to trust others, to depend on or be dependent
on them. Those with a preoccupied style see others as reluctant to get
as close to them as they would like and worry about others' love
for them or scaring them away with their need for closeness. Finally,
relationships that are characterized as disorganized want closeness
with others but feel uncomfortable with it and fear rejection. Like
those with a dismissing style, they too find it difficult to trust others,
but, unlike those with a more dismissing style, they would actually
like closer relationships.
More recently —and importantly for understanding the nature of
continuing bonds —attachment theorists have come to use contin-
uous variables of attachment-related anxiety and avoidance (i.e.
dimensions to do specifically with relationships) instead of the 4
styles, with which they are compatible (see Brennan, Clark, & Shaver,
1998). Individual differences in attachment style can be measured on
these two orthogonal dimensions: A person's position on the anxious
1
For the sake of clarity, we mostly use the term continuing bonds in this manuscript,
but on the understanding that the “opposite side of the coin, namely, relinquishing
bonds (discontinuing the ongoing relationship with the deceased) is also implicated in
predictions.
2
Certain points about attachment theory are frequently misunderstood. It is
fundamentally a trait-type theory, assuming continuity across the life cycle. In fact,
quite some stability has been demonstrated not only across the life span and for
different types of relationships such as mother–child and romantic partners (cf.
Cassidy & Shaver, 1999) but even in terms of cross-generation transmission (e.g.,
Rosenstein & Horowitz, 1996). Nevertheless, there may be change, for example, the
security of attachment (described further on) may be shattered by traumatic
separation(s). Second, the borders between the three or four types of attachment
are not clearly defined, are flexible and may indeed change not only over time but also
between relationships. Persons may also have attachment organization patterns that
are more- or less- prototypical of a particular style.
3
Various labels have been used for the insecure attachment styles. Here we follow
those frequently used in the adult attachment and bereavement literatures.
260 M. Stroebe et al. / Clinical Psychology Review 30 (2010) 259–268
Table 1
Integrative Model of Continuing Bonds and Bereavement Adaptation.
Attachment theory Dual Process Model Mental Representation Theory Continuing/relinquishing bonds
A. Style & self/other
representations
B. Hyper-/deactivation C. Orientation D. Grief reactions E. Positive & negative
appraisal processes
F. Control disposition G. Processes H. Adaptiveness
Secure: Self + Other + Lo hyper-/lo deactivation LO & RO oscillation Normal grief Pos. & neg. oscillation
LO & RO
–Balance between primary and
secondary control striving
–Transforms mental tie to
deceased
CB adaptive: retained but relocated
–Substitution
–Connection & disengagement
Insecure–preoccupied:
Self –Other +
Hi hyper-/lo deactivation LO Chronic grief Pos. & mostly neg. LO –Rigid retention of blocked goal –Little transformation CB maladaptive: need to loosen
–Little or no substitution
(but idealization, sanctification)
–More connection than
disengagement
Insecure–dismissing:
Self + Other -
Lo hyper-/hi deactivation RO Absent, inhibited
grief
Pos. & neg. RO –Excessive secondary control
disposition
–Little transformation CB relinquished, maladaptive: denial
of bond, need to confront & continue–Devaluation of deceased
–Lo substitution
–More disengagement than
connection
Insecure–fearful:
Self –Other -
Hi hyper-/hi deactivation LO & RO disturbed
oscillation
Complications in
grief assimilating/
associated with PTSS
Pos. & mostly neg.
disturbed oscillation
LO & RO
–Confused control striving
(uncoordinated/imbalanced/
inconsistent)
–Confusion re. mental tie/
blocked goal-
CB confusion, maladaptive: need
to confront, continue, find coherence
& then relocate–Substitution difficult
–Disturbed process of
connection & disengagement
Self/other −= negative representation of self/other.
Self/other + = positive representation of self/other.
LO = Loss orientation.
RO = Restoration orientation.
CB = Continued bond.
PTSD = Posttraumatic Stress Disorder.
261M. Stroebe et al. / Clinical Psychology Review 30 (2010) 259–268
Document Summary
Continuing bonds in adaptation to bereavement: toward theoretical integration. Margaret stroebe a, , henk schut a, kathrin boerner b a department of clinical & health psychology, utrecht university, box 80140, 3508 tc utrecht, the netherlands. Brookdale department of geriatrics and palliative medicine, mount sinai school of medicine/research institute on aging, jewish home lifecare, 120 west 106th street, new york, Ny 10025, usa a r t i c l e i n f o a b s t r a c t. There is lack of clarity in the scienti c literature concerning the adaptive functions of continuing versus relinquishing bonds to deceased persons. It remains unclear what type of bonds or underlying processes are related to (mal)adaptive bereavement outcomes. Thus, the purpose of this article is to outline a theoretical model for predicting the (mal) adaptiveness of continuing-relinquishing bonds. Attachment theory provides a generic framework for under- standing patterns of individual differences in the impact of continuing bonds.