An exploration of attachment-based formulations and interventions

  • Chloe Crompton

Student thesis: Doctor of Clinical Psychology


This thesis explored attachment-based formulations and interventions. It is comprised of three papers: 1) a systematic literature review, 2) an empirical study and 3) a critical appraisal of the research process. The systematic review (Paper 1) investigated which manualised attachment-based interventions were effective for improving the caregiver-infant relationship from conception to two years. The review involved two stages: Stage 1 identified manualised attachment-based interventions and Stage 2 reviewed the evidence-base for each included intervention. Twenty-five interventions were included, eligible evidence was identified for 16 interventions and 36 studies were synthesised. Findings demonstrated that there was some empirical evidence to support that the 16 manualised attachment-based interventions improved caregiver-infant relational outcomes. Stronger evidence was determined for three interventions. However more high-quality research evidence was needed before firm conclusions could be made. In light of the review findings, recommendations were made to improve future research quality and build on intervention efficacy. The empirical study (Paper 2) is a qualitative study that aimed to explore biological parents experiences when they were informed by a clinical or related service that their child was considered to have attachment-related difficulties. Sixteen semi-structured interviews were conducted and transcripts were analysed using a grounded theory approach. Findings revealed four superordinate themes from the data including 1) failing as a parent, 2) the process of making sense, 3) a call to action and 4) attachment awareness and interrelated difficulties. Shame was found to be the core concept that was central and interrelated with each of these themes. These findings were combined to develop a grounded theory of the parental journey from shame into awareness. Findings were discussed in relation to existing literature and clinical recommendations made on how healthcare professionals could support parents’ emotional reactions and facilitate their attachment-related understanding and engagement with help and support. The critical appraisal (Paper 3) provides a reflection of the research process. The rationale and justifications for decisions and choices made, challenges faced, skills gained and how this process will contribute towards future professional practice are discussed.
Date of Award31 Dec 2021
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorAnja Wittkowski (Supervisor) & Ming Wan (Supervisor)

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