Treating Depression In Insecurely Attached Adolescents
Kassie Markovich
Ball State University













Abstract
The intention of this paper is to examine secure and insecure attachment styles in child-parent relationships and how they facilitate in the mental development of adolescents. This paper will address the correlation between negative schemas and depressive symptoms. Furthering the understanding and importance of recognizing the period of adolescent development as unique and addressing effective treatment methods for this stage of development is the hope of this essay.











Discussion
According to the founder of attachment theory, Bowlby (1982) said that an infant will develop a type of relationship with its primary caregiver based on the attention and protection it receives. This relationship is referred to as attachment. For a child to develop a secure attachment with its caregiver the latter would show responsiveness and sensitivity to the child’s needs. For example, when the child cries and the caregiver responds attentively the former is learning he will be cared for. As the relationship develops the child will interpret the interactions as a reflection on his personal value. In other words, the child will internalize the message that he is wanted. (Baldwin, Fehr, Keedian, Seidel, & Thomson, 1993)
If the situation was reversed the child would develop an insecure attachment. This type of bonding is a result of negative or lack of experiences with the caregiver. Insecure attachment styles can be classified into three types. A fearful-avoidant child would have a negative view of himself and a negative view of others. He is generally distrustful of others because of harmful interactions with the caregiver. An anxious-ambivalent child would have a negative view of himself and a positive view of others. His caregiver would have had an inconsistent parenting style of positive and negative interactions. As a result the child would view others as having the potential to be helpful and harmful. Lastly, a dismissive-avoidant child would have a positive view of himself and a negative view of others. As a reaction to negative treatment with the primary caregiver this child would have a high opinion of himself and a low opinion of others. Not clarified earlier, a securely attached child would have a positive view of himself and others. This child would have had caring and attentive parents growing up. As a result he would be able to see his own worth and the good in others. (Bartholomew & Horowitz, 1991) These examples of attachment styles show that early interactions between child and caregiver play a significant role in how children learn to view themselves and the world they live.
According to a study done by Liu (2006) the gender of the parent can play a role in how the child interacts with his environment. For a girl, having a secure attachment with both her father and mother helps prevent the development of depressive symptoms in adolescence. This finding suggests that girls use both their mother and father as a security when dealing with relationship stress. Boys, on the other hand, are found to only use the secure attachment with their mother when confronted with psychosocial stress. This might be because there is a negative stigma regarding men expressing helpless emotions, such as sadness. As a male they may not feel welcome to come to their father with this type of problem. (Leadbeater et al., 1995) However, research has shown that a secure bond with both parents can cause children to become less aware of negative interpersonal relations because of their learned positive view of self and others. This finding would correlate with Bowlby’s attachment theory. The studies reflected show that parental involvement from both mother and father are important factors in the developing mental health of their child.
The relationship a child develops with his parents will influence his adolescent development. Beck (1976) introduced the theory of cognitive vulnerability that states that an insecurely attached child will learn negative schema. That negative worldview will make him susceptible to dysfunctional attitudes. Dysfunctional attitudes can leave the child vulnerable to low self-esteem. (Kuiper & Olinger, 1986) Low self-esteem is often associated with depressive symptoms. (Hankin, 2005) Having a negative view of self in adolescence works as a double-edged sword because the child will not only deal with low self-esteem but also have difficulty building a positive support group of peers that could help combat depressive symptoms. Blatt (1974) found that adolescent women often became depressed because of negative self-image and fear of abandonment. Lack of confidence in self and maintaining a relationship would prevent the teenager from actively developing friendships. In a research study by Gillihan, MacGeorge, & Samter (2005) social support was shown to provide emotional support and help members within the group manage stress in a healthy way. In another study by Pauley and Hess (2009) depression and treatment by alcohol consumption were related. When the participants in the study received emotional support for their depression they no longer relied on alcohol because their preferred treatment was positive socialization. The benefits of social support show to be very helpful in combating excessive stress and depressive symptoms. Sadly those who are inhibited in developing these relationships because of learned negative schema are cutting themselves off from healthy and effective treatment.
Thus far we have seen the effects early childhood relationships have on developing mental wellbeing. Research has shown the benefits of positive involvement of both opposite gendered parents. These parent child relationships play a significant role in teaching the child how to value himself and others. If the parent-child interactions are negative the adolescent could become cognitively vulnerable to dysfunctional attitudes. These attitudes are often associated with low self-esteem and depressive symptoms. Low self-esteem will inadvertently work against gaining the needed support to treat depression.
The negative schema learned from the primary caregivers can have a significant impact on the adolescent’s mental wellbeing. That is why when I become a counselor I want to utilize family therapy in treating adolescent depression. This type of therapy views the problems of the child as a sign of other problems within the family unit. (Duffy, Kirsh, & Atwater, 2008) The cause affect relationship between parent-child interaction displays the negative outlook of some children to be family related. Having the parents understand where the problems originate in the home is important in correcting the negative behavior and working on developing a supportive environment for the child. Also having the child understand the outside influence that helped define his world view will help him to recognize them for what they are and move past them by replacing negative schema for positive schema. Having both mother and father in session with the child will help identify individual parent-child relationship patterns instead of using one parent to represent both parents or attributing all influence to one parent. As research has shown, mothers and fathers play different roles within child interaction. Understanding a complex view of influences in the home in order to create a positive environment would be benefited with both parents in session.
When family therapy isn’t possible I would use person-centered therapy and existential therapy in treating adolescent depression. Person centered approach offers unconditional acceptance and understanding to the client. (Duffy, Kirsh, & Atwater, 2008) When treating a client with depressive symptoms who lack emotional support from friends, creating a welcoming environment would allow that person to gradually develop trust in another person. Making sure the client is never judged and feels understood will allow me to build a relationship of emotional support that the adolescent could rely on. The trust developed would open the door for conversation. It would also require the client to alter their worldview because he would not only have found someone to trust, but someone who found value in him. This could possibly facilitate a session developing positive schema towards relationships with others and self.
Once the trust based relationship was given time to grow I would use existential therapy. This form of treatment promotes the personal growth through free choice. (Duffy, Kirsh, & Atwater, 2008) I think this is important in working with adolescents who have negative relationships with their parents because during that time period the child is limited in what he can do to change the situation. Because of cultural and financial reasons the client is dependant on the negative relationship for survival. This is a simplistic view and does not address emotional attachment but is still a relevant factor to adolescent depression treatment. Using existential therapy, the client would be taught to feel empowered in his free choice. Focusing on his mental freedom could help him develop a positive worldview regardless of what is being taught or implied at home. Helping the client develop long term goals and breaking them down into short term goals would help him think futuristically and still feel satisfied with the gradual progress of a positive future.
Conclusion
As a counselor, ideally I would want to help the parents and child develop a supportive relationship. This would help the child gain a positive view of himself and others without losing a relationship with his parents. Unfortunately, sometimes removing the client from a harmful situation is the best choice, especially if the caregivers refuse to engage in positive change. My ultimate goal is to help adolescents overcome depressive symptoms and from the research I’ve gathered, helping the client develop a positive self-view and healthy support group seems most effective. Restoring an insecurely attached client to a secure attachment would allow the client to experience life with positive regard and hope for a happy future.













References
Baldwin, M. W., Fehr, B., Keedian, E., Seidel, M., & Thomson, D. W. (1993). An exploration of the relational schemata underlying attachment styles: Self-report and lexical decision approaches. Journal of Personality and Social Psychology, 19, 746 – 754.
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226 – 244.
Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York: International University Press.
Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. Psychoanalytic Study of the Child, 29, 107 – 157.
Bowlby, J. (1969/1982). Attachment and loss. Vol. 1: Attachment (2nd ed.). New York: Basic Books.
Duffy, K., Kirsh, S., & Atwater, E. (2008). Psychology for living: Adjustment, growth, and behavior today. (10th ed.). New Jersey: Prentice Hall.
Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.
Hankin, B. L., Kassel, J. D., & Abela, J. R. Z. (2005). Adult attachment dimensions and
specificity of emotional distress symptoms: Prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality Social Psychology Bulletin, 31, 136–151.

Kuiper, N. A., & Olinger, L. J. (1986). Dysfunctional attitudes and a self-worth contingency model of depression. Advances in Cognitive-Behavioral Research and Therapy, 5, 115–142.

Leadbeater, B. J., Blatt, S. J., & Quinlan, D. M. (1995). Gender-linked vulnerabilities to depressive symptoms, stress and problem behaviors in adolescents. Journal of Research on Adolescence, 5, 1-29.

Liu, Y. (2006) Paternal/Maternal Attachment, Peer Support, Social Expectations of Peer Interactions, and Depressive Symptoms. Adolescence, 705-722