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LIFESPAN LEARNING INSTITUTEUCLA CAMPUSMARCH 9, 2008

INTEGRATING ATTACHMENT,AFFECT REGULATION AND NEUROBIOLOGY:

IMPLICATIONS FOR RESEARCH AND TREATMENT

ALLAN N. SCHOREallanschore.com

UCLA DAVID GEFFEN SCHOOL OF MEDICINE

• In 1969 John Bowlby published hisgroundbreaking volume Attachment,in which he detailed a comprehensivemodel of early development.

• “The merits of a scientific theory areto be judged in terms of the range ofthe phenomena it embraces, theinternal consistency of its structure,the precision of its predictions it canmake and the practicability of testingthem.”

• 30 years after Bowlby’s seminalvolume Thompson looked back andoverviewed the progress ofattachment theory by the end of thelast century:

• Attachment theory now described as“the dominant approach tounderstanding early socioemotionaland personality development duringthe past quarter-century of research”(Thompson, Child Development,2000).

• At this same point Mary Main (1999) lookedforward, and concluded:

• “We are currently at one of the most excitingjunctures in the history of the field. We are now,or will soon be, in a position to begin mappingthe relations between individual differences inearly attachment experiences and changes inneurochemistry and brain organization.

• In addition, investigation of physiological‘regulators’ associated with infant caregiverinteractions could have far-reachingimplications for both clinical assessment andintervention.”

• This lecture: an update of our progress in that effort,which is now moving rapidly.

• Current energization of attachment theory expressedin updating and deepening of its underlyingtheoretical concepts, its increased clinical relevance,and its expansion outside of developmentalpsychology into direct communication with otherdisciplines (neuroscience, psychiatry, traumatology,psychoanalysis, behavioral biology).

• Dialogue of attachment theory with other disciplines isin turn expanding and transforming the theory.

• From its very beginnings, attachment theory hasbeen grounded in an interdisciplinaryperspective.

• Bowlby’s major influences - Darwin and Freud.Attempt to model critical early events that occurat interface of the outer and inner worlds.

• Ainsworth (1969): “In effect what Bowlby hasattempted is to update psychoanalytic theory inthe light of recent advances in biology.”

• Schore’s (2000) introduction to reissue ofAttachment: “In essence, a central goal ofBowlby’s first book is to demonstrate that amutually enriching dialogue can be organizedbetween the biological and psychological realms.”

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• Current biological realm = neurobiology.• Attachment theory now serving as catalyst for

integration of models that integrate biologicalstructure with psychological function.

• Schore (1991-2008): attachment communicationscritical to development of structural right brainsystems involved in processing of emotion,modulation of stress, self-regulation, and thefunctional origins of bodily-based implicit self.

• Watt (2003): “Attachment experiences form theground out of which we emerge, and certainly thegroundwork for much of cortical development andprefrontal system development.”

• In 3 volumes I have presented interdisciplinary datawhich indicates that neurobiology of attachmentunderscores the central role of affect and affectregulation in early development.

• Bowlby (1969): mother-infant relationship“accompanied by the strongest of feelings andemotions.”

• Attachment theory is an engine to current paradigmshift from cognition to bodily-based affect

• Ryan (Motivation & Emotion, 2007): “After threedecades of the dominance of cognitive approaches,motivational and emotional processes have roaredback into the limelight.”

• Attachment theory as generator of models ofpsychopathogenesis

• Bowlby (1969): “In the fields of ethology andpsychopathology attachment theory can be used toframe specific hypotheses which relate differentfamily experiences to different forms of psychiatricdisorder and also, possibly, to the neurophysiologicalchanges that accompany them.”

• Schore, Siegel, Cozolino and others focus onenduring effects of nonoptimal attachmentexperiences on experience-dependent maturation ofbrain regulatory mechanisms, and genesis of apredisposition to various psychopathologies.

• Lecture: recent advances in theneurobiology of attachment has increasedrelevance of theory to clinical models.Attachment function + structure.

• Development: role of early developing rightbrain in attachment communications andlifelong impact on implicit (nonconscious)functions.

• Psychopathogenesis: relational trauma,type D attachment, and impairment ofmaturation of right brain regulatorymechanisms.

• Attachment neurobiology and development• Bowlby (1969): mother-infant attachment

communications occur within a context of “facialexpression, posture, tone of voice, physiologicalchanges, tempo of movement, and incipient action.”

• Brown & Jaffe (Neuropsychologia, 1975): “The righthemisphere can be considered dominant in infancy,for the type of visual and acoustic communicationwhich is relevant for the prelinguistic child.”

• Chiron et al. (Brain, 1997): “The right brainhemisphere is dominant in human infants.”

• Schore (Develop. and Psychopathology,1996):• “The infant’s early maturing right hemisphere,

which is dominant for the child’s processing ofvisual emotional information, the infant’srecognition of the mother’s face, and theperception of arousal-inducing maternal facialexpressions, is psychobiologically attuned tothe output of the mother’s right hemisphere,which is involved in the expression andprocessing of emotional information and innonverbal communication.”

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• Schore (Pediatrics in Review, 2005):during emotionally-charged mutual gazeepisodes of RH visual-facial, auditory-prosodic, and gestural affectivecommunications the sensitive,psychobiologically attuned caregiver’sbehavior is contingent, easily predictable,and manipulatable by the infant.

• RH visual-facial attachment communications• Myowa-Yamakoshi et al. (Cognition, 2003):• “For survival, it may be crucial for infants to

perceive gaze early, as it may help to attract theattention of caretakers and increase theopportunities for receiving care…Gazeperception…may depend upon prolongedexposure to faces and may develop during thefirst few months of life.”

• Le Grand et al. (Nature Neuroscience, 2003):“Expert face processing requires visual input tothe right hemisphere during infancy.”

• RH visual-facial attachment communications• Grossmann et al. (Social Cognitive and Affective

Neuroscience, 2007): 4-month-old infantspresented with images of a female face gazingdirectly ahead show enhanced gamma electricalactivity over right prefrontal areas.

• “The brain mechanisms underlying eye gazeperception show a high degree of specializationearly in ontogeny, recruiting very similar areas inthe right hemisphere as in adults.”

• RH auditory-prosodic attachmentcommunications

• Bogolepova & Malofeeva (Neurosci. Behav.Physiol., 2001): “The right hemisphere of theneonate is actively involved in the perceptionof speech melody and the intonations of thevoices of mother and surrounding people. Thepre-speech stage of child development ischaracterized by interactions of the descriptiveand emotional components due mainly tomechanisms operating within the hemisphereson the principle of non-verbal communication.”

• RH tactile-gestural attachment communications• Nagy (Infant Child Develop., 2006): study human

neonates in their first 3-96 hours of life, and find a“lateralized system for neonatal imitation.”

• “The early advantage of the right hemisphere (Chironet al.,1997; Schore, 2000; Trevarthen, 2001) in thefirst few months of life may affect the lateralizedappearance of the first imitative gestures.”

• Sieratzki & Woll (Behav. Brain Sci., 2005) on touchand RH: “The emotional impact of touch, the mostbasic and reciprocal mode of interaction is also moredirect and immediate if an infant is held to the left sideof the body.”

• Fundamental role of nonconscious attachmentdynamics is interactive regulation:

• Schore (1994): in order to regulate infant’s rightbrain state crescendos and decrescendos ofmother's affective state in resonance with similarcrescendos and decrescendos of the infant’sinternal states of positive and negative arousal.

• Pipp & Harmon (Child Development, 1987):“It may be that throughout the lifespan we arebiologically connected to those with whom wehave close relationships…Homeostatic regulationbetween members of a dyad is a stable aspect ofall intimate relationships throughout the lifespan.”

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• Bradshaw & Schore (Ethology, 2007): acrossvertebrates, evolutionary mechanism of attachment,represents regulation of biological synchronicitybetween and within organisms.

• Ovtscharoff & Braun (Neuroscience, 2001):“The dyadic interaction between the newborn and themother...serves as a regulator of the developingindividual’s internal homeostasis. The regulatoryfunction of the newborn-mother interaction may be anessential promoter to ensure the normal developmentand maintenance of synaptic connections during theestablishment of functional brain circuits.”

• Fonagy & Target (Attachment & Hum. Devel., 2005):“If the attachment relationship is indeed a majororganizer of brain development, as many haveaccepted and suggested (e.g., Schore, 1997, 2003),then the determinants of attachment relationships areimportant far beyond the provision of a fundamentalsense of safety or security (Bowlby, 1988).”

• Howard & Reggia (Brain and Cognition, 2007):“Earlier maturation of the right hemisphere issupported by both anatomical and imaging evidence.”

• Helmeke et al. (Cerebral Cortex, 2001):“The functional maturation of limbic circuits issignificantly influenced by early socio-emotionalexperience”

• RH deeply connected into limbic system, CNScircuits that rapidly process and regulateemotional information. Intense limbic maturationfirst 2 years.

• Dapretto et al. (Nature Neurosci., 2006):“Typically developing children can rely upon aright hemisphere-mirroring neural mechanism -interfacing with the limbic system via the insula -whereby the meaning of imitated (or observed)emotion is directly felt and hence understood.”

• Basch (1976): “the language of mother and infantconsist of signals produced by the autonomic,involuntary nervous system in both parties.”

• Psychobiological attachment communicationsallow for experience-dependent maturation ofCNS-ANS that regulates bodily-based states.

• RH deeply connected into energy-expendingsympathetic and energy-conservingparasympathetic components of ANS thatgenerate the somatic aspects of emotions.

• Porges (Biological Psychology, in press):“Consistent with the views that the righthemisphere appears to play a greater role inaffect, especially the adaptive expression ofnegative affect, the right hemisphere also appearsto have a greater role in regulation of cardiacfunction presumably via shifts in vagal regulation.”

• Schore (1994): for the rest of the life span RHstores a vocabulary for nonverbal social-emotionalsignals such as facial expressions, prosody, andgestures = Bowlby’s attachment system andbrain’s autonomic regulation of cardiac function.

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• Gunnar & Donzella (Psychoneuroendocrinol., 2002):infant’s relationship with mother shapes postnataldevelopment of HPA axis, thereby programmingstress resistance in developing individual.

• Allman et al. (Trends in Cognitive Sciences, 2005):“The strong and consistent predominance for the righthemisphere emerges postnatally.”

• Sullivan & Dufresne (Brain Research, 2006):optimal stress regulation is dependent upon changesin cortical development, “namely, the righthemispheric specialization in regulating stress - andemotion-related processes.”

• Trevarthen (1996): “The right hemisphere ismore advanced than the left in surface featuresfrom about the 25th (gestational) week and thisadvance persists until the left hemisphereshows a postnatal growth spurt starting in thesecond year.” [critical period of attachment]

• Early developing right (and not left) brainencodes, in implicit-procedural memory, internalworking model of attachement, strategies ofaffect regulation that nonconsciously guideindividual through interpersonal contexts.

• Main (Handbook of Attachment, 1999) postulatesthat the attachment system, or parts of it, arecontinually active.

• Schore (2003): Unconscious right brain implicitself described as “a cohesive, active mentalstructure that continuously appraises life’sexperiences and responds according to itsscheme of interpretation.”

• Bargh & Morsella (Perspectives in PsychologicalScience, 2008):“It is concluded that in bothphylogeny and ontogeny, actions of anunconscious mind precede the arrival of aconscious mind - that action precedes reflection.”

• Bowlby, a psychoanalyst, highlighted thecentral role of the unconscious in everyday lifein his assertion that internal working modelsare unconscious.

• Larsen et al. (J. Psychosomatic Res., 2003):“In most people, the verbal, conscious andserial information processing takes place inthe left hemisphere, while the unconscious,nonverbal and emotional informationprocessing mainly takes place in the righthemisphere.”

• Attachment and RH emotional functions

• Niedenthal (J. Pers. Soc. Psych, 2002):attachment orientation influences emotionregulation and expression, as well as “howindividuals process incoming information that isemotionally significant.”

• This processing of emotional informationencoded in internal working models is donerapidly and nonconsciously by the right and notleft brain.

• Implicit appraisal of nonverbal visual-facial,auditory-prosodic, and tactile-gesturalsocioemotional cues.

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• Main (Handbook of Attachment, 1999)referring to the AAI: “that these measurescan be considered to yield‘representational products’ but they arenot the same as the ‘internalrepresentations’ themselves, which are ofcourse inaccessible to direct inspection.”

• Perhaps inaccessible to overt behavioral andverbal cognitive inspection, but interdisciplinaryand clinical attachment data suggest that theAAI be used in conjunction with neurobiologicaland psychobiological measures of affectprocessing, nonverbal communication, andregulation / dysregulation.

• Especially measures of structure-functionrelationships of the emotional right brain whileindividuals of different attachment orientationsare under various interpersonal stressors.

• Fallacy that all language is in the left hemisphere• Right hemisphere is dominant not only for prosody

but processing of emotional words, detection of one’sfirst name, social discourse, metaphor and theorganization of information at the pragmatic-communicative level as well as in the generation andmodification of mental models that fit a text.

• Schutz (Neuropsychology Review, 2005) refers to the“right brain’s powerful integrative processing.”

• RH cortical-subortical integration responsible for LHcoherent narrative?

• Cohen & Shaver (Cognition and Emotion, 2004):study of attachment and hemispheric lateralization

• Refer to “the relative absence of certain positivebehaviors and qualities in avoidant individual’s closerelationship…Avoidant individuals report experiencingfewer positive emotions and rate everyday socialinteractions as boring and unengaging.”

• “While nonavoidant individuals automatically activatemental representations of their attachment figures intimes of threat, avoidant individuals, even on apreconscious level, steer clear of this kind ofrepresentations…”

• Report “a right hemisphere advantage forprocessing negative emotion andattachment-related words.”

• “In the brain, this effect may originate frompoorly represented positive informationnetworks in the right hemisphere.”

• Adult avoidant attachment associated with“emotional negativity and withdrawalmotivation have been connected inpsychophysiological studies with the rightfrontal lobe of the brain.”

• Gillath et al. (NeuroImage, 2005):fMRI study of attachment styles and braincircuits of emotion regulation

• “Level of attachment anxiety correlatedwith emotion-related areas of the brain(anterior temporal lobe) and inverselycorrelated with activation in a regionassociated with emotion regulation(orbitofrontal cortex).”

• Highly anxious individuals showdeactivation in orbitofrontal cortex.

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• Zhang et al., Brain responses to facial expressionsby adults with different attachment-orientations.NeuroReport, 2008:

• “Attachment theory is a useful conceptualframework for understanding individual differencesin emotional processing and regulation.”

• Use subliminal (unconscious) and supraliminal(conscious) presentations of emotional faces.

• Conclude, “anxious individuals devote most, andavoidant individuals devote least, attentionalresources to face stimuli than secure persons, andthese individual differences are the results ofautomatic processes.”

• Show frontal activity differed according toattachment orientation.

• “Compared with the secure participants, theavoidant and anxious participants…performedless elaborative encoding of the structuralinformation of faces, and they are susceptibleto the arousal of emotional content.”

• No difference in attachment orientation isassociated with other areas involved in thehigh level semantic processing of facialexpression.

• Kampe, Frith, & Frith (J. Neuroscience, 2003):“The cognitive process underlying our ability toattribute intentions to self and other has been termed“Theory of Mind” or “mentalizing.”

• “Far from being a complex process of consciousinferences, mentalizing is thought to be an automaticcognitive process and may not require a deliberatedecision to attend.”

• “Mentalizing ability has been pinpointed as a crucialfactor in everyday human communication andprovides the mechanism needed to recognize theintention to communication.”

• Activates right paracingulate (medial) cortex.

• Attachment neurobiology and psychopathogenesis• Glaser et al. (J. Psychosomatic Research, 2006):• “Childhood trauma may have long-lasting and

enduring effects on adult psychological functioning,as exposed individuals continually react more stronglyto small stressors occurring in the natural flow ofeveryday life.”

• “Emotional stress reactivity is most pronounced forsubjects who experienced trauma early in life…Theeffects of trauma are more detrimental when traumaoccurs at a younger age.”

• Major contribution of Main: groundbreaking discoveryof “Type D,” insecure-disorganized / disorientedattachment pattern

• Main & Solomon (1986): “Because the attached infantinevitably seeks the parent when alarmed, anyparental behavior that directly alarms an infant shouldplace the infant in an irresolvable paradox in which itcan neither approach, shift its attention, or flee.”

• These infants are unable to generate a coherentbehavioral (active) coping strategy to deal with thisemotional challenge of a reunion with mother.

• Strange Situation: One infant “became for amoment excessively still, staring into spaceas though completely out of contact withself, environment and patent.”

• Another showed “a dazed facial appearance…accompanied by a stilling of all bodymovement, and sometimes a freezing oflimbs which had been in motion.”

• Another “fell face-down on the floor in adepressed posture to separation, stilling allbody movements.”

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• Hesse & Main (Development andPsychopathology, 2006):

• Primary aspects of frightening parentalbehavior expected to directly evokeinfant alarm

• Threatening behavior inexplicable inorigin: “In non-play contexts, stiff-legged ‘stalking’ of infant on all fours ina hunting posture; exposure of caninetooth accompanied by hissing; deepgrowls directed at infant.”

• Direct indices of entrance into a dissociative state:“Parent suddenly completely ‘freezes’ with eyesunmoving, half-lidded, despite nearby movement.”

• Abrams, Rifkin, & Hesse (Development andPsychopathology, 2006) describe dissociativebehavior in a parent of a disorganized infant, who“froze all movements with a fixed gaze for 45s whilethe infant very actively attempted to attract theparent’s attention.”

• Earlier, Hesse and Main observed disorganizationand disorientation of type “D” attachmentphenotypically resembles dissociative states.

• This work parallels my own on the neurobiology oftype D, focusing on the other side of the dyad, theinfant’s body and developing brain

• Schore (Infant Mental Health J., 2001): “The effects ofrelational trauma on right brain development, affectregulation, and infant mental health”

• Krystal (1988): “What can be the psychic state of achild overwhelmed with the primitive affectprecursors…that involve a massive responsemobilizing the entire ANS as well as the precursors ofpain?”

• Infant’s response to trauma is more thanbehavioral or cognitive butpsychobiological responses of the CNSand ANS stress regulating HPA axis. Twoseparate psychobiological survivalresponses: hyperarousal and dissociation.

• Hyperarousal: initial stage of threat, startle-alarm reaction. Sympathetic component ofANS significantly activated, resulting inincreased heart rate, blood pressure, andrespiration.

• Dissociation-hypoarousal: child disengages fromexternal world, freezes, stares off into space, out ofcontact with self, environment, and parent.

• Parasympathetic conservation-withdrawal,immobility, reduced heart rate, involuntaryautonomic disengagement and ultimatelyhypoarousal and metabolic collapse of thepsychobiological bodily-self.

• Barach (Dissociation, 1991): Bowlby’s detachment“is actually a type of dissociation…althoughBowlby uses the term detachment in describinghow children respond to abandonment, he is reallydescribing a dissociative process”

• Bernard & Bandler (J. Comp. Neurol.,1998):active vs. passive coping strategies

• Active emotional coping strategies = fight, flight,• Passive emotional coping strategies (quiescence,

immobility, hyporeactivity) are characterized by“disengagement or withdrawal from the externalenvironment” and parasympathetic bradycardia.

• Observed following traumatic injury or repeateddefeats in social encounters (i.e., inescapablestress or pain).

• Although Type D shows no active coping strategy,utilize passive coping strategy of dissociation

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• Psychological factors "prune" or "sculpt" neuralnetworks in the postnatal brain

• Adamec et al. (Prog Neuro-Psychopharmacol.Biol. Psych., 2003) show “neuroplasticity inright hemispheric limbic circuitry in mediatinglong-lasting changes in negative affectfollowing brief but severe stress.”

• Schore (Austral. New Zeal. J. Psychiatry,2002): early affectively traumatic environmentsinterfere with organization of right hemisphericlimbic circuits

• Schore (in press), Attachment trauma and thedeveloping right brain: Origins of pathologicaldissociation. In Dissociation and theDissociative Disorders: DSM-V and Beyond.

• Dissociation: inability of right brain cortical-subcortical system to recognize and coprocess(integrate) external stimuli (exteroceptiveinformation coming from environment) andinternal stimuli (interoceptive information frombody, the corporeal self).

• Spitzer et al. (J. Neuropsychiatry Clin.Neurosci., 2004): “Dissociation mayinvolve a...lack of integration in the righthemisphere. This corresponds with theidea that the right hemisphere has adistinct role in establishing, maintaining,and processing personally relevantaspects of an individual’s world.”

• The latter is lost in dissociated state.

• A dysregulated dissociating right braindescribed by Hesse and Main (2006):

• Note lateralization of type D dissociation inStrange Situation:

• At reunion, one “toddler approached hermother, slapped her full in the face with herleft hand, and then, with a dazed[dissociated] expression, and still standingin place, used her right hand to pull the lefthand and arm down.”

• Main (1999): notes attachment system is instrumentalto directing attention toward attachment-relevantevents, and to preparation of defensive processing ofemotion-arousing information.

• Schore (1994): “The right brain system ischaracterized by particular cognitive, attentional, andarousal capacities that make it uniquely suited torespond to environmental events in an adaptivefashion.”

• Raz (Anatomical Record, 2004): In a state of “vigilantattention” right parietal and right frontal areas areactivated

• Schore (1994, 2003): RH dominant attention, alsodetecting threat, avoidance, human stress response,and processing negative affects such as pain and fear.

• Maier et al. (Attach. & Human Dev., 2005):“The fear system is aimed at monitoring theenvironment so as to quickly identify threat, and thusprotect the individual against predators…The fearsystem is connected to the attachment system.”

• Lyons-Ruth & Spielman (2004): “An emphasis onfearful arousal and the relational modulation of thatarousal lies at the heart of attachment theory.”

• Price, (J. Comp. Neurol., 2005): the emotion of fear“is not necessarily conscious.”

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• Schutz (Neuropsychology Review, 2005):• “The right hemisphere operates a distributed

network for rapid responding to danger and otherurgent problems. It preferentially processesenvironmental challenge, stress and pain andmanages self-protective responses such asavoidance and escape…Emotionality is thus theright brain’s ‘red phone,’ compelling the mind tohandle urgent matters without delay.”

• Type D infants, children and adults have deficits inthese adaptive right brain functions. During stress,even mild stress, the red phone’s line is dead.

• Attachment neurobiology and psychopathogenesis• Disorganized-disoriented attachment as well as

pathological dissociation are found abused /neglected infants and children and adultsdiagnosed as Borderline Personality Disorder.

• Current attachment literature: “Borderlinepersonality was linked to experience of traumaand lack of resolution” (Fonagy et al.,1996).

• This attachment pattern predicts later chronicdisturbances in affect regulation, stressmanagement, hostile-aggressive behavior, anddissociative defenses (BPD symptoms).

• Meares, Melkonian, Schore, Gordon, & Williiams(University of Sydney, Brain Dynamics Centre):“Defining the neurocircuitry of borderlinepersonality disorder: Testing a maturationalmodel by means of single trial ERP analysis”

• Event-related potential (ERP) study of BPD, adisorder of affect regulation, shows impairment ofRH limbic-prefrontal connections

• “The etiology of a disturbed maturation ofneurocircuitry include disturbances of attachment(Schore, 1994, 2005) and also the effect oftraumatic impairments which disrupt maturationalprocesses.”

• “This finding is consistent with the conceptthat disturbances of BPD reflect animpairment and dysregulation of the rightbrain (Schore, 1994).”

• The right brain abnormalities of inhibitorycircuitry indicate a disturbance underlyingof complaints of pain and other bodilydistress made by the typical borderlinepatient.

• Lanius-Schore-Pederson-Moran study, LondonHealth Sciences Center, University of WesternOntario, Canada.

• Neural correlates of mother-infant attachmentrelationships in mothers with borderlinepersonality disorders and healthy controls

• fMRI study of neurobiology of attachment + AAI +home videos + Strange Situation

• Study normal vs. borderline mother’s viewing ofvideos and implicit perception of their infant’sattachment cues; patterns of limbic activation,ANS activity, and affect regulation strategiesassociated with secure and insecure patterns.

• Attachment neurobiology and models of the changeprocess in psychotherapy

• Schore & Schore, Modern attachment theory: thecentral role of affect regulation in development andtreatment. (Clinical Social Work Journal, 2008):

• “We suggest that in line with Bowlby’s fundamentalgoal of the integration of psychological and biologicalmodels of human development, the current clinicaland experimental focus on how affective bodily-basedprocesses are nonconsciously interactivelyregulated… has shifted attachment theory to aregulation theory.”

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• Attachment theory now transforming from abehavioral theory to a cognitive theory to apsychoneurobiological theory of development.Research and clinical models should reflect this.

• At this point in time, no theoretical model ofhuman development can be exclusivelypsychological. Rather, must be consonant withand integrate what we now know aboutneurobiological operations of the brain/mind/body.

• Time is right for integration within child and adultbranches of attachment researchers, as well asbetween researchers and clinicians.

• Last sentence of Bowlby’s Attachment,(1969): “The truth is that the least-studied phase of human developmentremains the phase during which a childis acquiring all that makes him mostdistinctively human. Here is still acontinent to conquer.”