Dustin H. Reed MHS, CRC, PLPC
Doctoral Student
Our Lady of Holy Cross College
Department of Counseling and Behavioral Sciences
New Orleans, Louisiana









Presentation Goals
Definition of Treatment
Overview of Attachment Styles
Professional/People with Disabilities Relationships
PWD and Family Relations
PWDs and Caregivers
PWD and Relationships
PWD and Healthcare Treatment
Disability, Attachment, and Pain
1.) Connect Attachment Theory with its role in
conceptualization of relationships of people with
disabilities with their caretakers, friends, and families.
2.) Connect Attachment Theory with its role in
treatment pertaining to people with disabilities.
3.) Explore how Attachment Theory relates to attitudes
and perceptions of people concerning people with
disabilities.

Kate is a 31 year old Caucasian, bi-sexual female.
She has multiple learning disabilities. Kate also
has trouble remembering to do things at times (lock
the house door when she leaves, close her car door
or house door, put away food, bring her house key
when she leaves the house). Kate talks with her
parents of wanting to have a child with someone.
When asked, Kate says that she is thinking about
having a man get her pregnant and then raise the
child with a woman (believing that the man would
just be the sperm donor and nothing more to the
child)

thinking about interrationships—the
relationships that bind…. What would your
initial impression of Kate be as a counseling
professional if she were your client? How
would you approach her situation to help
Kate help herself and in the process form a
secure bond with Kate instead of making
Kate feel fearful, insecure, or avoidant of
receiving help with her current situation?

Tim is a 16 year old African American male.
He has Type 1 diabetes. He was diagnosed
when he was 10. His parents are very
supportive and he has a very secure
relationship with them. However, Tim acts
out and has trouble in his classes. When he
isspeaking to the school counselor about his
behavior, Tim tells the counselor, “I’m
different from the other kids, they make fun
of me because I have diabetes.”

If you were Tim’s counselor, how
would you approach his situation?
Thinking about interrationships, the
relationships that bind…. What are
some approaches you could use to
help Tim be more secure about
forming relationships with his
peers?

Research suggests that psychiatric
caregivers and the psychiatric
institutions may be viewed as attachment
figures for people with psychiatric
disabilities
(Adshead, 1998)

Through utilization of attachment theory
when listening to patients’ stories, psychiatric
caregivers may provide a basis for helping to
ameliorate patients’ anxieties and allow for a
safe haven that patients with a psychiatric
disability may utilize to help with the
management of their disability.
(Adshead, 1998)


Parents who have intellectual disability
If taught and treated with respect by professionals
- allows for better adapting to parenthood

Negative perception leads to reciprocal negative
perception

Secure base of support from professionals lost or strained
(Joreskog & Starke, 2013; McConnell, Llewellyn, & Bye, 1997)

Negative preconceived conceptualization:
 affects how professionals treat PWD
 relates to attachment style between
professional and PWD
(Joreskog & Starke, 2013)

Some people with Intellectual Disabilities are
perceived to lack empathy

Thus relates to and could affect:
child/parent bonding
(Joreskog & Starke, 2013)


There are organizations that provide support
for PWD.
(i.e., Disability Issues Office, Families
Helping Families).
(American Psychological Association, 2015;
Families Helping Families, 2015)
 Attachment
styles of professional
caregivers are associated with and
affect:
 effective response to cues
 quality of life
Direct Service Caregivers should
 Assess their relationships with PWDs
 Try to determine better ways to
interact
(Schuengel, Kef, Damen, & Worm, 2010)
Internal views of self are related to attachment and
relationships with others (Johnson & Whiffen, 2006, p.
240).
Some people with disabilities

more than people without disabilities
experience negative self-image, depressive
symptoms, and suicidal ideations.
(e.g., children and adolescence with spinabifida)
(Appleton et al, 1997)

The children’s perception of the
support parents gave significantly
related to:
 depressed mood
 global self worth
(Appleton et al, 1997)

Findings suggest interventions aim to:
 Promote child/parent communication
 Help children with disabilities to feel
competent despite their disability

Help the child address negative selfschema of body image.
(Appleton et al, 1997)

People with different types of
disabilities (i.e., depression,
schizophrenia, alcoholism)
 Were perceived negatively by
individuals according to a study done in
the U.K.
(Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000)
 Research
shows evidence linking
genes (i.e., dopamine, scrutonin,
oxytocin) to social behavior and
disability (i,e., generalized anxiety
disorder).
(Gillath, Shaver, Baek, & Chun, 2008)

Children with learning disabilities reported less
secure attachments in close relationships and more
anxiety and avoidance
Versus

Children who have normal development who
reported more secure attachment in close
relationships
(Al-Yagon & Mikulincer, 2004)
 There
have been cases of parents
with disabilities having their
rights of being parents taken
away from them (i.e., Native
American community).
(National Council on Disability, 2015)

Attachment style is related to reported symptoms of some
PWD in healthcare
Women with fearful and preoccupied
attachment


Reported higher somatic symptoms
versus secure and dismissive patients

Fearful and dismissive women
had less utilization of healthcare
(Ciechanowski, Walker, Katon, & Russo, 2002)


Why did females with fearful and preoccupied
attachment report higher somatic symptoms versus
secure and dismissive patients?
The authors suggest it is related to self esteem due to
earlier caregiving relationships.
(Ciechanowski, Walker, Katon, & Russo, 2002)

Human rights of people with mental disabilities
are a global concern advocated for by The World
Health Organization (WHO)

The stigma associated with mental disability
breeds prejudice among healthcare professionals
and the public.
(WHO, 2007)

How well people deal with perceived pain
levels, in combination with levels of comfort
about being close to another person….
 moderates the level of perceived
disability.
(Meredith, Strong, & Feeny, 2006)

People who have an insecure
attachment style have vulnerability
to developing disability after
experiencing acute pain.
(Meredith, Ownsworth, & Strong, 2008)
1.) Connect Attachment Theory with its role in
conceptualization of relationships of people with
disabilities with their caretakers, friends, and families.
2.) Connect Attachment Theory with its role in
treatment pertaining to people with disabilities.
3.) Explore how Attachment Theory relates to attitudes
and perceptions of people concerning people with
disabilities.
Questions?







Adshead, G. (1998). Psychiatric staff as attachment figures – Understanding management
problems in psychiatric services in the light of attachment theory. The British Journal
of Psychiatry, 172, 64-69. doi: 10.1192/bjp.172.1.64
Al-Yagon, M. & Mikulincer (2004). Patterns of close relationships and socioemotional and
academic adjustment among school-age children with learning disabilities. Learning
Disabilities Research & Practice, 19(1), 12-19. The Division for Learning Disabilities
of the Council for Exceptional Children.
American Psychological Association (2015). Disability issues office. Retrieved from
http://www.apa.org/pi/disability/
Appleton, P. L., Ellis, N. C., Minchom, P. E., Lawson, V., Boll, V., & Jones, P. (1997).
Depressive Symptoms and self-concept in people with spina bifida. Journal of
Pediatric Psychology, 22(5), 707-722.
Crawford, N. (2003). Parenting with a disability: The last frontier. Monitor on
Psychology, 68. American Psychological Association. Retrieved from
https://www.ncd.gov/publications/2012/Sep272012/Ch6
Ciechanowski, P.S., Sullivan, M., Jensen, M., Romano, J., & Summers, H. (2003). The
relationship of attachment style to depression, catastrophizing and healthcare utilization
in patients with chronic pain. Pain, 104(3), 627-637. doi: 10.1016/S03043959(03)00120-9.
Ciechanowski, P. S., Walker, E. A., Katon W. J. , & Russo J. E. (2002). Attachment theory:
A model for health care utilization and somatization. Psychosomatic Medicine, 64,
660-667. doi: 10.1097/01.PSY.0000021948.90613.76





Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000).
Stigmatisation of people with mental illnesses. BJP, 177, 4-7.
Families Helping Families of Jefferson Parish, (2015). Retrieved from
http://fhfjefferson.org/
Gillath, O., Shaver, P. R., Baek, J. M., & Chun, D. S. (2008). Genetic correlates of adult
attachment. PSPB. doi: 10.1177/0146167208321484
Joreskog, K. & Starke, M. (2013). Professionals’ perceptions of and approach to parents
with intellectual disability: A question of knowledge? International Journal of Social
Sciences, 1(2), 20-30. doi: 10.11114/ijsss.vli2.134
McConnell, D., Llewellyn, G., & Bye, R. (1997). Providing services for parents with
intellectual disability: Parent needs and service constraints. Journal of Intellectual
and
Developmental Disability, 22, 5-17. Retrieved from
http://informahealthcare.com/doi/abs/10.1080/13668259700033251





Meredith, P., Ownsworth, T., & Strong, J. (March, 2008). A
review of the evidence linking adult attachment theory and
chronic pain: Presenting a conceptual model. Clinical Psychological
Review, 28(3), 407-429. Retrieved from
http://www.sciencedirect.com/science/article/pii/S027273580
00
1304
Meredith, P., Strong, J. & Feeny, J. A. (2006). Adult attachment,
anxiety, and pain self efficacy as predictors of pain intensity and
disability. Pain, 123, 146-154.
National Council on Disability (2015). Parental disability and child
welfare in the native american community.
Whiffen, V. E. & Johnson, S. M. (2006). Attachment processes:
In
couple and family therapy, 240. New York: The Guilford Press.
WHO (2007). Mental health legislation & human rights denied citizens:
Including the excluded - Promoting the rights of people with mental
disabilities. World Health Organization.