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Full-Text Psychology Journal Articles

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

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If you are a psychology student or taking any sort of social science class, then you will need to be able to read and understand the articles found in scientific research journals. Such articles describe different psychology studies on a wide range of subjects. As you are writing papers or conducting your own research, these journals can provide helpful background information and other sources to investigate.

Finding full-text psychology journals online can be challenging. Imagine you think you have found the perfect journal article by its fitting title. You click on it and read the abstract, and now you are certain that you must have this article in your collection of sources, only to find out the full text is hidden behind a paywall. You are shocked to find out you have to pay $29.95 to access the article!

Fortunately, there are a number of psychology, social science, and medical journals that offer  free full-text articles, often labeled "open-access" journals. Full-text journals may be especially useful for people with limited access to academic libraries or online databases and for students living in rural areas or studying via distance education.

This article will review a selection of journals, databases, archives, and search engines that offer access to full-text articles, each with its own benefits and limitations.

Full-Text Psychology Journals

You might consider starting your search with journals that offer full-text, electronic versions of their content. Whether these journals offer the material you need for your research depends on the topic you are researching and the specific guidelines of your assignment.

Recently published articles may not be immediately available. Many journals that offer full-text versions of their content do so after a waiting period that may last anywhere from one month to one year after publication.

• Addictive Behaviors : An open-source platform that offers peer-reviewed journal articles on addictive behaviors. Full-text articles are in both HTML and PDF format.
• American Journal of Drug and Alcohol Abuse : Focuses on a wide range of topics related to alcohol, substance abuse, and behavioral addictions, and includes topics related to public policy, epidemiology, neurobiology, and treatment aspects of substance abuse.
• Archives of Internal Medicine : Offers online full-text articles to registered users (registration is free), but you have to wait 12 months after publication to view articles for free. This journal is published by the American Medical Association (JAMA) and covers clinically relevant research on diverse medical topics.
• Journal of Psychopathology and Clinical Science (formerly called Journal of Abnormal Psychology ): Dating back to 1906, this journal has articles on a variety of topics related to  abnormal psychology ; and is published by the  American Psychological Association . Some of the articles are open-access, free-to-read, or provide a manuscript to view. Others require a subscription or you can pay a fee for individual articles.
• Journal of Applied Behavior Analysis : Hosted by Wiley Online Library, some articles require payment or a subscription to view current research and discussions on applied behavior analysis. However, some articles are marked as open-access or free-to-read.
• Journal of Experimental Psychology: Applied : Offers a selection of full-text journal articles on topics in experimental psychology. Some of the articles are open-access, free-to-read, or provide a manuscript to view. Others require a subscription or you can pay a fee for individual articles.
• Journal of General Psychology : Hosted by Taylor & Francis Online, this journal offers full-text articles on a variety of topics in psychology. Some articles are open-access and can be a great reference for psychology students.
• Learning and Memory : Focuses on the neurobiology of learning and memory and offers free access to full-text articles one year after publication . Some articles are available immediately if the author of the article pays a surcharge, known as "gold" open-access.
• Research on Child and Adolescent Psychopathology (formerly called Journal of Abnormal Child Psychology ): Hosted on the SpringerLink platform, this journal features full-text articles focused on psychotherapy , prevention, assessment, and treatment of childhood conditions such as developmental disorders, depression, and anxiety. There is a subset of open-access articles in this journal that can be viewed for free.
• The British Journal of Psychiatry : Focuses on clinical aspects of mental health . Full-text articles are available from January 2000 to the present, and all articles are available free of charge one year after publication . Under the search bar, there is a box to check "search within full-text."
• The Journal of Neuroscience : Offers free full-text journal articles in their archive starting in 1981 up to the present, and are made available six months after publication.

These journals represent just some of the resources that are available online. If you are still looking for additional research, pay a visit to your university library. In many cases, your school's library may have access to a number of different research databases where you can find free full-text journal articles for your research.

Finding Free Full-Text Articles

In addition to looking at specific journals that provide access to full-text articles free of charge, it can be helpful to know how to find them in a more general sense. You can do a broader search for articles using the following archives, databases, and search engines:

CogPrints is a repository that holds self-archived articles for greater public access. Articles are categorized by topic, including many in psychology. Find articles on behavioral analysis , clinical psychology , psychobiology, social psychology , and more.

Taylor & Francis Online

Taylor & Francis provides hundreds of open-access journals to search, with full-text articles, including Health Psychology & Behavioral Medicine, Psychology Research and Behavior Management, and Nature and Science of Sleep.

Google Scholar

You can search for any topic using Google Scholar , and it will pull a list of journal articles, books, and other sources for you to consider. The more specific your search terms, the better. If you come across articles that only have abstracts or the first page, don't give up. Some authors may post the full content on their personal websites as HTML links or downloadable PDFs, or you may find the article available in other formats on other academic sites or journal databases. Do a little more digging (or googling).

JAMA Open Network

The JAMA network has 13 journals, of which two are fully open access ( JAMA Network Open and JAMA Health Forum ). However, JAMA allows authors from within any of the other specialty network journals to publish their articles in an open-access format giving the public immediate access to many of their current publications. Otherwise, there is a 6 to 12-month wait to view the full text which becomes available in PubMed Central.

Public Library of Science

PLOS One : The Public Library of Science provides open access to 12 journals that are peer-reviewed covering research in medicine and other scientific disciplines including psychology. PLOS Mental Health is a specific section covering mental health research.

PubMed Central

PubMed Central is a free digital archive of open-access, full-text scholarly articles published in biomedical and life science journals. This database is maintained by the United States National Library of Medicine. You can search for articles by topic, author, and journal-title. Be sure you don't confuse this with PubMed where you will only find abstracts.

Sage Journals

Sage Journals is a collection of open-access full-text journals categorized by topic, having 785 journals categorized as "social sciences and humanities." Registration is free. This includes a variety of journals like American Behavioral Scientist, Clinical Child Psychology and Psychiatry, Evolutionary Psychology, and Journal of Attention Disorders .

Springer Link

SpringerLink offers open access to journal articles and other resources. While not all of the content on the site is available in full-text, or free, many journals provide "gold" open access which allows immediate access to their published articles. To narrow down the search to full-text, open-access journals, you have to unselect the box that says "include preview-only content." You can find journals like Crime Science , Journal of Eating Disorders, and BioPsychoSocial Medicine .

The Cochrane Library

The Cochrane Library offers open-access, full-text versions of systematic reviews of existing research. You can browse by topic, look through special collections, or use the search tool to find articles relevant to your research.

In addition to finding sources in journals that publish full-print versions online, you can also look through databases and sites that may contain full-text psychology journal articles. If you find an abstract for an article that seems like it might be a good source, a simple online search can often turn up a full version of the article.

A Word From Verywell

Knowing where to locate journal articles can be helpful, but having the skills to search for them on your own can be invaluable. Each site is a little different and takes some getting used to. If you are still struggling to locate sources online, consider visiting your school's library for more information, tips, and resources. You might also consider signing up for workshops or courses offered by your school that help teach students how to search for academic resources.

JAMA Network. For authors .

Wiley Online Library. Issue information .

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Singh A, Singh M, Singh AK, Singh D, Singh P, Sharma A. Free full text articles": Where to search for them?   Int J Trichology . 2011;3(2):75-79. doi:10.4103/0974-7753.90803

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Contributions of Attachment Theory and Research: A Framework for Future Research, Translation, and Policy

Jude cassidy.

University of Maryland

Jason D. Jones

Phillip r. shaver.

University of California, Davis

Attachment theory has been generating creative and impactful research for almost half a century. In this article we focus on the documented antecedents and consequences of individual differences in infant attachment patterns, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications. We pay particular attention to the concept of cognitive “working models” and to neural and physiological mechanisms through which early attachment experiences contribute to later functioning. We consider adult caregiving behavior that predicts infant attachment patterns, and the still-mysterious “transmission gap” between parental AAI classifications and infant Strange Situation classifications. We also review connections between attachment and (a) child psychopathology, (b) neurobiology, (c) health and immune function, (d) empathy, compassion, and altruism, (e) school readiness, and (f) culture. We conclude with clinical-translational and public policy applications of attachment research that could reduce the occurrence and maintenance of insecure attachment during infancy and beyond. Our goal is to inspire researchers to continue advancing the field by finding new ways to tackle long-standing questions and by generating and testing novel hypotheses.

One gets a glimpse of the germ of attachment theory in John Bowlby's 1944 article, “Forty-Four Juvenile Thieves: Their Character and Home-Life,” published in the International Journal of Psychoanalysis . Using a combination of case studies and statistical methods (novel at the time for psychoanalysts) to examine the precursors of delinquency, Bowlby arrived at his initial empirical insight: The precursors of emotional disorders and delinquency could be found in early attachment-related experiences, specifically separations from, or inconsistent or harsh treatment by, mothers (and often fathers or other men who were involved with the mothers). Over the subsequent decades, as readers of this journal know, he built a complex and highly generative theory of attachment.

Unlike other psychoanalytic writers of his generation, Bowlby formed a working relationship with a very talented empirically oriented researcher, Mary Ainsworth. Her careful observations, first in Uganda ( Ainsworth, 1967 ) and later in Baltimore, led to a detailed specification of aspects of maternal behavior that preceded individual differences in infant attachment. Her creation of the Strange Situation ( Ainsworth, Blehar, Waters, & Wall, 1978 ) provided a gold standard for identifying and classifying individual differences in infant attachment security (and insecurity) and ushered in decades of research examining the precursors and outcomes of individual differences in infant attachment. (A PsycInfo literature search using the keyword “attachment” yields more than 15,000 titles).

By the beginning of the 21 st century, the National Research Council and the Institute of Medicine's Committee on Integrating the Science of Early Childhood Development based its policy and practice conclusions and recommendations on four themes, one of which was that “early environments matter and nurturing relationships are essential ( Shonkoff & Phillips, 2000 , p. 4) … Children grow and thrive in the context of close and dependable relationships that provide love and nurturance, security, responsive interaction, and encouragement for exploration. Without at least one such relationship, development is disrupted, and the consequences can be severe and long-lasting” (p. 7). This clear and strong statement could be made in large part because of the research inspired by Bowlby's theory and Ainsworth's creative research methods.

Years after Ainsworth's Strange Situation was proposed, Mary Main and colleagues (e.g., George, Kaplan, & Main, 1984 ; Main, Kaplan, & Cassidy, 1985 ) provided a way to study the intergenerational transmission of attachment patterns. They and other researchers found that a parent's “state of mind with respect to attachment” predicted his or her infant's pattern of attachment. Moreover, since the 1980's there has been an explosion of research examining attachment processes beyond the parent-child dyad (e.g., in adult romantic relationships), which has supported Bowlby's (1979) belief that attachment is a process that characterizes humans “from the cradle to the grave” (p. 129). In the present article, space limitations lead us to focus principally on attachment processes early in life and consider the adult attachment literature largely in relation to parental predictors of infant attachment.

A Simple Model of Infant-Mother Attachment

During the 70 years since Bowlby's initial consideration of the developmental precursors of adolescent delinquency and psychopathology, researchers have provided a complex picture of the parental and experiential precursors of infant attachment, the links between early attachment-related experiences and later child functioning, the mechanisms involved in explaining these links, and moderators of these linking mechanisms. Much has been learned at each of several analytic levels, including behavior, cognition, emotion, physiology, and genetics. Figure 1 summarizes this literature in a simple model. We have selected several of the components in Figure 1 for further discussion. For each component, following a brief background and review of the current state of knowledge, we offer suggestions for future research, based largely on identification of gaps in theory or methodological innovations that make new lines of discovery possible. We begin by considering one of the central concepts of attachment theory, the internal working model, followed by a consideration of physiological mechanisms that also help to explain the influence of early attachments. Next, we consider the caregiving behavior that predicts infant attachment and the perplexing issue of the transmission gap between parental Adult Attachment Interview (AAI) classifications and infant Strange Situation classifications. We then examine connections between attachment and (a) child psychopathology, (b) neurobiology, (c) health and immune function, (d) empathy, compassion, and altruism, (e) school readiness, and (f) culture. Finally, we discuss the translational application of attachment research to reducing the risk of developing or maintaining insecure attachments and the policy implications of attachment research.

Note . A complete depiction of attachment processes would require several pages. For instance, here we note the parent's own attachment representations as a contributor to parental attachment-related behavior. There are many other important contributors to parental behavior, including culture, SES, parental age, parental personality, child temperament, and presence or absence of a partner, to name a few. Each of the constructs and arrows in Figure 1 could be surrounded by numerous others.

Internal Working Models

One of the key concepts in attachment theory is the “attachment behavioral system,” which refers to an organized system of behaviors that has a predictable outcome (i.e., proximity) and serves an identifiable biological function (i.e., protection). According to Bowlby (1969/1982 ), such a system is organized by experience-based “internal working models” (IWMs) of self and environment, including especially the caregiving environment.

It is by postulating the existence of these cognitive components and their utilization by the attachment system that the theory is enabled to provide explanations of how a child's experiences with attachment figures come to influence in particular ways the pattern of attachment he develops. (pp. 373-374)

Much of the research on these models is based on the notion that, beginning in the first year of life, mentally healthy individuals develop a “secure base script” that provides a causal-temporal prototype of the ways in which attachment-related events typically unfold (e.g., “When I am hurt, I go to my mother and receive comfort”). According to Bretherton (1991 ; Bretherton & Munholland, 2008 ), secure base scripts are the “building blocks” of IWMs. Theoretically, secure children's and adults' scripts should allow them to create attachment-related “stories” in which one person successfully uses another as a secure base from which to explore and as a safe haven in times of need or distress. Insecure individuals should exhibit gaps in, or distortion or even absence of, such a script. H. Waters and colleagues ( H. Waters & Rodrigues-Doolabh, 2001 ; H. Waters & Waters, 2006 ) tested this hypothesis by having children complete story stems that began with a character's attachment behavioral system presumably being activated (e.g., a child rock-climbing with parents hurts his knee). Secure attachment at 2 years of age was positively correlated with the creation of stories involving knowledge of and access to the secure base script at ages 3 and 4. (A similar methodology has been used in studies of young adults; see Mikulincer, Shaver, Sapir-Lavid, & Avihou-Kanza, 2009 .)

New Directions in the Examination of IWM Formation during Infancy

Despite Bowlby's hypothesis that infants develop IWMs during the first year of life (see also Main et al., 1985 ), almost no empirical work has focused on attachment representations during infancy (instead, most research on IWMs has involved children, adolescents, and adults). We believe, as do others ( Johnson et al., 2010 ; Sherman & Cassidy, 2013 ; Thompson, 2008 ), that IWMs can be studied in infancy. Such work is made possible by recent efforts to bridge social-emotional and cognitive developmental research (e.g., Calkins & Bell, 2010 ; Olson & Dweck, 2008 ), along with methodological advances and accumulating research on an array of previously unexplored infant mental capacities.

Attachment researchers have assumed that infants recall the emotional nature of their attachment-related social experiences with specific individuals (e.g., experiences of comfort with vs. rejection by mother), and that they use these memories to create IWMs that guide their attachment behavior in subsequent interactions with these individuals. This claim has been supported with correlational research findings; for example observations indicating that infants' daily interactions with attachment figures are linked to their IWMs reflected in behavior in the Strange Situation ( Ainsworth et al., 1978 ). These findings can now be supplemented with results from experimental studies.

There is a compelling body of experimental work showing that infants extract complex social-emotional information from the social interactions they observe. For example, they notice helpful and hindering behaviors of one “person” (usually represented by a puppet or a geometric figure) toward another, they personally prefer individuals who have helped others, they form expectations about how two characters should behave toward each other in subsequent interactions, and they behave positively or negatively toward individuals based on what they have observed (e.g., Hamlin & Wynn, 2011 ; Hamlin, Wynn, Bloom, & Mahajan, 2011 ). This work could and should be extended to include attachment relationships, revealing in detail how infants form “models” of particular adults and then modify their emotional reactions and social behaviors toward those adults accordingly ( Johnson et al., 2010 ). At present, there is no experimental research showing that infants form expectations about the later social behavior of another person toward them based on the infants' own past interactions with that person – a capacity that is assumed to underlie infants' development of working models of their caregivers.

As explained in detail in another paper ( Sherman & Cassidy, 2013 ), we urge infancy researchers to consider the specific cognitive and emotional capacities required to form IWMs and then to examine these capacities experimentally. Methods used by researchers who study infant cognition, but rarely used by attachment researchers (e.g., eye-tracking, habituation paradigms), will prove useful. For example, habituation paradigms could allow attachment researchers to study infant IWMs of likely mother and infant responses to infant distress (see Johnson et al., 2010 ). Another research area relevant to attachment researchers' conception of IWMs concerns infants' understanding of statistical probabilities. When considering individual differences in how mothering contributes to attachment quality, Bowlby (1969/1982) adopted Winnicott's (1953) conception of “good enough” mothering; that is, mothering which assures a child that probabilistically, and often enough, the mother will prove responsive to the child's signals. Implicit in such a perspective is the assumption that an infant can make probabilistic inferences. Only recently has there been a surge in interest in the methods available to evaluate this assumption of attachment theory (e.g., Krogh, Vlach, & Johnson, 2013 ; Pelucchi, Hay, & Saffran, 2009 ; Romberg & Saffran, 2013 ; Xu & Kushnir, 2013 ).

One useful conceptual perspective, called rational constructivism, is based on the idea that infants use probabilistic reasoning when integrating existing knowledge with new data to test hypotheses about the world. Xu and Kushnir (2013) reviewed evidence that by 18 months of age, infants use probabilistic reasoning to evaluate alternative hypotheses ( Gerken, 2006 ; Gweon, Tenenbaum, & Schulz, 2010 ), revise hypotheses in light of new data ( Gerken, 2010 ), make predictions ( Denison & Xu, 2010 ), and guide their actions ( Denison & Xu, 2010 ). Moreover, infants are capable of integrating prior knowledge and multiple contextual factors into their statistical computations ( Denison & Xu, 2010 ; Teglas, Girotto, Gonzales, & Bonatti, 2007 ; Xu & Denison, 2009 ). Xu and Kushnir (2013) have further proposed that these capacities appear to be domain-general, being evident in a variety of areas: language, physical reasoning, psychological reasoning, object understanding, and understanding of individual preferences. Notably absent from this list is the domain of social relationships, including attachment relationships.

Several questions about probabilistic inferences can be raised: Do infants make such inferences about the likely behavior of particular attachment figures, and could this ability account for qualitatively different attachments to different individuals (e.g., mother as distinct from father)? Do infants use probabilistic reasoning when drawing inferences related to the outcomes of their own attachment behaviors? (This is related to if-then contingencies: “If I cry, what is the probability that χ will occur?”) How complex can this infant reasoning become, and across what developmental trajectory? “If I do χ, the likelihood of outcome y is 80%, but if I do w , the likelihood of y is only 30%.” Do infants consider context? “If I do χ, the likelihood of y is 90% in context q , but only 20% in context r .” How do infants calculate variability in these probabilities across attachment figures?

In sum, it seems likely that infants use statistical inference to understand their social worlds. This ability would seem to be evolutionarily adaptive in relation to attachment figures, because infants could incorporate probabilistic inferences into their IWMs and use them to guide their attachment behavior. Important advances in our understanding of attachment behavior might occur with respect to how and when this incorporation happens, and also with respect to the role of statistical inference in infants' openness to change in response to changing environmental input (e.g., in response to interventions designed to change parental behavior).

Child-Parent Attachment, Response to Threat, and Physiological Mechanisms of Influence

Bowlby's emphasis on cognitive IWMs as the mechanism through which early experiences influence later functioning is understandable given the emerging cognitive emphasis in psychology when he was writing. But scientists are becoming increasingly aware that the effects of attachment-related experiences are carried in the body and brain in ways not easily reducible to cognition. As a way to touch briefly on the physiological processes involved in attachment, we focus here on a central issue in attachment theory: infants' responses to threat as these are shaped by attachment relationships. One of the core propositions of attachment theory is that proximity to an attachment figure reduces fear in the presence of a possible or actual threat. As explained in the previous section, Bowlby thought the mechanism that explained this link is children's experience-based cognitive representation of the availability of an attachment figure. Specifically, it is because securely attached infants are more likely than insecurely attached infants to have mental representations of caregiver availability and responsiveness that they are able to interpret a threat as manageable and respond to it with less fear and anxiety. Yet in species that do not possess human representational capacities, the link between attachment and response to threat clearly exists, suggesting that in humans there is likely to be more to attachment orientations than cognitive IWMs. (For the initial and more extensive discussion of ideas presented in this section, see Cassidy, Ehrlich, and Sherman [2013] .)

Another Level of “Representation” or Internal Structure: Physiology

Since the time of Bowlby's original writings, one important advance that has extended our understanding of the link between attachment and response to threat has roots in Myron Hofer's laboratory in the 1970s. Hofer, a developmental psychobiologist, noticed defensive vocal protest responses to maternal separation in infant rat pups and asked what non-representational process could account for them. He and his colleagues conducted a series of tightly controlled experiments to identify what physiological subsystems, which he called hidden regulators, are disrupted when mothers are removed from their pups (for reviews, see Hofer, 2006 ; Polan & Hofer, 2008 ). The pups exhibit changes in multiple physiological and behavioral systems, such as those controlling heart rate, body temperature, food intake, and exploration. Hofer concluded that mother-infant interactions have embedded within them a number of vital physiological regulatory functions that are disrupted by separation from mother and do not require cognitive mediators. These regulators can be disentangled by experimentally manipulating parts of a “mother”: the food she provides, her warmth, her licking and grooming, etc. Later, Meaney and colleagues (e.g., Liu et al., 1997 ; reviewed in Meaney, 2001 ) found that rat pups that received high levels of maternal licking and grooming and arched-back nursing positions had milder responses to threat and increased exploratory behavior – effects that lasted into adulthood (and in fact, into subsequent generations as a function of maternal affection in each successive generation). This research group further found that individual differences in maternal behavior were mediated by differences in offsprings' gene expression ( Weaver et al., 2004 ), a finding that has opened up a new research domain for researchers studying both animals and humans ( Sharp, Pickles, Meaney, Marshall, Tibu, & Hill, 2012 ; Suomi, 2011 ).

Early Attachment-Related Experiences and Human Infant Biological Response to Stress

In humans, a fully developed stress response system, the HPA axis, is present at birth ( Adam, Klimes-Dougan, & Gunnar, 2007 ). A growing body of research indicates that differences in the quality of early care contribute to variations in the initial calibration and continued regulation of this system. This regulation in turn plays an important role in shaping behavioral responses to threat ( Jessop & Turner-Cobb, 2008 ).

Researchers have examined connections between caregiving experiences and infant stress physiology by comparing infants' cortisol levels before and after a stressful task (e.g., the Strange Situation). For example, Nachmias, Gunnar, Mangelsdorf, Parritz, and Buss (1996) found that inhibited toddlers who were insecurely attached to their caregivers exhibited elevated cortisol levels following exposure to novel stimuli. There is also experimental evidence that mothers' touch buffers infants' cortisol stress response (in this case, during the still-face laboratory procedure in which mothers are asked to cease interacting emotionally with their infants; Feldman, Singer, & Zagoory, 2010 ). Children living in violent families endure particularly stressful caregiving environments, which are extremely dysregulating for them ( Taylor, Repetti, & Seeman, 1997 ). A number of studies have documented the disrupted stress response of maltreated children (e.g., De Bellis et al., 1999 ; Hart, Gunnar, & Cicchetti, 1995 ). Even living in a family in which the violence does not involve them directly has negative consequences for children, and studies suggest that the quality of caregiving in these harsh environments plays an important role in modifying the stress response (e.g., Hibel, Granger, Blair, Cox, & The FLP Investigators, 2011 ).

Attachment as a Regulator of Infant Stress Reactivity: Further Questions

Just as infants are thought to have evolved a capacity to use experience-based information about the availability of a protective caregiver to calibrate their attachment behavioral system ( Main, 1990 ), and given the close intertwining of the attachment and fear systems, it is likely that infants also evolved a capacity to use information about the availability of an attachment figure to calibrate their threat response system at both the behavioral and physiological levels ( Cassidy, 2009 ). And this capacity is probably not solely “cognitive,” which raises important questions for research: How are representational and physiological processes linked and how do they influence each other and affect child functioning? Does the nature of their interaction vary across particular aspects of child functioning and across developmental periods? How can we understand these interactions in relation to both normative development and individual differences?

In humans, representations and physiological (e.g., stress) reactions are thought to affect each other in ways unlikely to occur in other species. Sapolsky (2004) noted that, in humans, representational processes – the anticipation of threat when none currently exists – can launch a stress response. Relatedly, Bowlby (1973) , focusing on the link between attachment and fear, specified representational “forecasts of availability or unavailability” of an attachment figure as “a major variable that determines whether a person is or is not alarmed by any potentially alarming situation” (p. 204). Thus, the representations that others will be unavailable or rejecting when needed – that is, representations that characterize insecure attachment – could contribute to chronic activation of physiological stress response systems, as could the associated representations of others as having hostile intentions ( Dykas & Cassidy, 2011 ). Conversely, in times of both anticipated and actual threat, the capacity to represent a responsive attachment figure can diminish physiological responses associated with threatening or painful experiences (see Eisenberger et al., 2011 ; Coan, Schaefer, & Davidson, 2006 ). Moreover, consideration of linkages between representational and non-representational processes must include the possibility that causality flows in both directions: Physiological stress responses can presumably prompt a person to engage in higher-level cognitive processes to understand, justify, or eliminate the stressor.

When and how do young children use attachment-related representations as regulators of stress? Neither normative trajectories nor individual differences in the use of representations to influence stress reactivity have been examined extensively. Evidence that stress dysregulation can lead to the conscious engagement of representational processes comes from children as young as 4 who are able to describe strategies for alleviating distress (e.g., changing thoughts, reappraising the situation, mental distraction; Sayfan & Lagattuta, 2009 ). Less studied but of great interest are possible “automatic emotion regulation” processes ( Mauss, Bunge, & Gross, 2007 ) that do not involve conscious or deliberate self-regulation. Recent studies of adults show that there are such processes, that there are individual differences in them that might relate to attachment orientations, that they are associated with particular brain regions that are not the same as those associated with conscious, deliberate emotion regulation, and that they can be influenced experimentally with priming procedures.

Many researchable questions remain: Given the extent to which many forms of psychopathology reflect problems of self-regulation in the face of stress (e.g., Kring & Sloan, 2010 ), can “hidden regulators” stemming from infant-mother interactions tell us about the precursors of psychopathology? What about hidden regulators embedded within a relationship with a therapist (who, according to Bowlby [1988] , serves as an attachment figure in the context of long-term psychotherapy)? When change occurs following long-term therapy, does this change emerge through cognitive representations, changes at the physiological level, or both? See Cassidy et al., (2013) for additional suggestions for future research.

Maternal Caregiving and Infant Attachment: Intergenerational Transmission of Attachment and the “Transmission Gap”

In 1985, Main and colleagues published the first evidence of the intergenerational transmission of attachment: a link between a mother's attachment representations (coded from responses to the AAI; George et al., 1984 ) and her infant's attachment to her ( Figure 1 , Path c). Based on findings from Ainsworth's initial study of the precursors of individual differences in infant attachment ( Ainsworth et al., 1978 ), researchers expected this link to be explained by maternal sensitivity: That is, they believed that a mother's state of mind with respect to attachment guides her sensitive behavior toward her infant ( Figure 1 , Path a), which in turn influences infant attachment quality ( Figure 1 , Path b). However, at the end of a decade of research, van IJzendoorn (1995) published a meta-analysis indicating that the strong and well-replicated link between maternal and infant attachment was not fully mediated by maternal sensitivity (see also Madigan et al., 2006 ). van IJzendoorn labeled what he had found as the “ transmission gap .” Moreover, meta-analytic findings revealed that the link between maternal sensitivity and infant attachment, although nearly universally present across scores of studies, was typically considerably weaker than that reported in Ainsworth's original study ( De Wolff & van IJzendoorn, 1997 ).

The transmission gap has been one of the most perplexing issues facing attachment researchers during the past 15-20 years. Immediate attempts to understand it focused largely on measurement of maternal behavior. Many studies have been aimed at understanding why the strength of the association between maternal sensitivity and infant attachment, while not negligible, is lower than the particularly strong effect found in Ainsworth's original study, and lower than attachment researchers expected. These studies have provided important insights, but no consensus has emerged about how to understand maternal behavior as a predictor of infant attachment. Continued efforts in this area are essential, and they will inform both researchers' understanding of the workings of the attachment behavioral system and clinicians' attempts to reduce the risk of infant insecure attachments.

Further consideration of Bowlby's concept of the secure base may help researchers better understand maternal contributors to infant attachment. First, we should note that any consideration of caregiving influences necessitates consideration of differential child susceptibility to rearing influence. According to the differential susceptibility hypothesis ( Belsky, 2005 ; see also Boyce & Ellis, 2005 , on the theory of biological sensitivity to context, and Ellis, Boyce, Belsky, Bakermans-Kranenberg, & van IJzendoorn, 2011 , for an integration of the differential susceptibility hypothesis and the theory of biological sensitivity to context), children vary genetically in the extent to which they are influenced by environmental factors, and for some children the influence of caregiving behavior on attachment may be minimal. Moreover, we underscore that the thinking presented in the present paper relates to the initial development of infant attachment during the first year of life; contributors to security are likely to differ at different developmental periods.

A focus on secure base provision

For Bowlby (1988) , the secure base concept was the heart of attachment theory: “No concept within the attachment framework is more central to developmental psychiatry than that of the secure base” (pp. 163–164). When parents provide a secure base, their children's confidence in the parents' availability and sensitive responsiveness when needed allows the children to explore the environment freely. The secure base phenomenon contains two intertwined components: a secure base from which a child can explore and a haven of safety to which the child can return in times of distress. In fact, as noted earlier, the central cognitive components of secure attachment are thought to reside in a secure base script (i.e., a script according to which, following a distressing event, the child seeks and receives care from an available attachment figure, experiences comfort, and returns to exploration).

If the goal of research is to understand what components of a parent's behavior allow a child to use the parent as a secure base, researchers should focus as precisely as possible on the parent's secure base provision rather than on his or her parental behavior more broadly. Through experience-based understanding of parental intentions and behavior, an infant gathers information to answer a central secure base question: What is my attachment figure likely to do when activation of my attachment system leads me to seek contact? If experiences lead the infant to believe that the parent will be responsive (most of the time) to behaviors related to activation of his/her attachment system, then the infant will use the parent as a secure base, and behavioral manifestations of the secure base script will appear (i.e., the secure base script will be evident in the Strange Situation attachment assessment, and the infant will be classified as secure). In 2000, E. Waters and Cummings, when proposing an agenda for the field in the millennium of the 2000s, urged that the secure-base concept be kept “at center stage in attachment theory and research” (p. 164). We share this opinion, and believe that additional consideration of the secure base notion will provide a useful framework within which to consider parental behavior as a predictor of infant attachment.

Bowlby (1988) emphasized that an infant's sense of having a secure base resides in the infant's confidence that parental sensitive responsiveness will be provided when needed (e.g., specifying “especially should he [the infant] become tired or frightened” [p. 132]). As such, it may be useful for attachment researchers to frame their question as: Which contexts provide the infant with information about the parent's likely behavior when needed – not in all contexts, but specifically in response to activation of the infant's attachment system ? Bowlby (1969/1982) described the relevant contexts as “fall[ing] into two classes: those which indicate the presence of potential danger or stress (internal or external), and those concerning the whereabouts and accessibility of the attachment figure” (p. 373).

Especially during the early years of life, both of these circumstances are likely to be associated with infant distress. This association has led some writers to wonder whether maternal response to infant distress is particularly predictive of infant attachment quality (e.g., Thompson, 1997 ), and there is compelling evidence that this is the case (e.g., Del Carmen, Pedersen, Huffman, & Bryan, 1993 ; Leerkes, 2011 ; Leerkes, Parade, & Gudmundson, 2011 ; McElwain & Booth-LaForce, 2006 ). When infants experience comfort from parental sensitive responses to their distress, they develop mental representations that contribute to security (“When I am distressed, I seek care, and I am comforted”). These representations are then thought to guide secure attachment behavior, and the physiological regulation that comes from regaining calmness in contact with the parent is thought to calibrate the child's stress reactivity systems and feed back into further secure mental representations (e.g., Cassidy et al., 2013 ; Suomi, 2008 ). The greater predictive power of the maternal response to distress, compared to maternal response to non-distress, may emerge from the considerable intertwining of infant distress and the infant's attachment system during the first year of life.

Future studies attempting to predict infant attachment might benefit from a framework that considers two components of parental behavior: (a) parental behavior related specifically to the secure base function of the infant's attachment system as Bowlby described it (see above), and (b) parental response to infant distress. Table 1 presents a 2 (attachment-related or not) × 2 (infant distressed or not) matrix that gives rise to a number of research questions. One key question is the following: Is parental behavior in response to an infant's attachment behavioral system most predictive of infant attachment, regardless of whether or not the infant is distressed (i.e., parental behavior in both cells 1 and 2)? Another set of questions relates to distress: Is parental response to any form of infant distress the most central predictor of infant attachment (i.e., parental behavior in both cells 1 and 3)? Does the termination of the physiological and emotional dysregulation of distress – no matter what the cause – that occurs through parental care solidify a tendency to use the parent as a secure base? Or do the cognitive models that derive from experiences of distress in different contexts (e.g., distress during play versus distress when seeking comfort) contribute differentially to secure base use? Most previous research has not drawn distinctions concerning the context of infant distress; future work that considers this distinction is needed.

Note . The following examples describe 5- to 12-month old infants participating in studies with their mothers in Cassidy's lab. Cell 1 . The context is attachment-related, and the infant is distressed: After having been left alone in an unfamiliar laboratory playroom, a crying 12-month-old crossed the room to her returning mother and reached to be picked up. Cell 2 . The context is attachment-related, and the infant is not distressed: An 8-month-old infant had been playing contentedly for 20 minutes near her mother at home. The mother had been sitting on the floor holding a toddler whose hair she was braiding. When the mother finished and the toddler moved away, the infant crawled to the mother, clambered up on her lap, and snuggled in for a hug; after exchanging tender pats with her mother, the infant returned to play on the floor. The lack of accessibility to the mother may have led to the infant's seeking contact in a manner that did not involve other activities (e.g., play or feeding). Cell 3 . The context is not attachment-related, and the infant is distressed: A 12-month-old infant became distressed when a toy was removed. Cell 4 . The context is not attachment-related, and the infant is not distressed: An infant, with her mother nearby, played happily with toys.

Additional questions raised by Table 1 include: Is it the combination of maternal behavior when the infant's attachment system is central, along with any behavioral response to infant distress, that best predicts infant attachment (i.e., maternal behavior in cells 1, 2, and 3)? Finally, is it the case (as some have suggested; e.g., Pedersen & Moran, 1999) that maternal behavior in all four cells is predictive of infant attachment? Attempts to increase understanding of the precursors of infant attachment will require the development of detailed coding systems.

Finally, it will be crucial for future research conducted within a secure base framework to identify the specific maternal behaviors in response to activation of the infant's attachment system that predict infant security (for one approach, see Cassidy et al., 2005 , and Woodhouse & Cassidy, 2009 , who note that providing physical contact until the infant is fully calmed may be a more powerful predictor of later security than the general sensitivity of the parent's response). Basic research examining the extent to which infant distress occurs in relation to the attachment behavioral system will provide an important foundation for further work.

Additional mediational pathways: Genetics, cognitions, and emotions

Following the discovery of the transmission gap, several studies examined the possibility of a genetic mediating mechanism. However, neither behavior-genetic nor molecular-genetic research so far indicates a genetic component to individual differences in secure vs. insecure attachment, although mixed findings have emerged concerning a genetic vulnerability for infant disorganized attachment ( Bakermans-Kranenburg & van IJzendoorn, 2004 , 2007 ; Bokhorst et al. 2003 ; Fearon et al., 2006 ; Roisman & Fraley, 2008 ). (For evidence that variability in infants' serotonin-transporter-linked polymorphic region 5-HTTLPR predicts not whether infants are secure or insecure, but their subtype of security or subtype of insecurity, see Raby et al., 2012 ). Future research should examine other genes and gene X environment interactions (see Suomi, 2011 , for examples from primate research).

Despite a conceptual model of intergenerational transmission in which maternal behavior is central, examination of additional linking mechanisms purported to underlie maternal behavior, such as maternal cognitions and emotions, will continue to be important. Perhaps such factors may be more reliably measured than maternal behavior, and if they are, mediating relations may emerge to shed light on mechanisms of transmission (e.g., Bernier & Dozier, 2003 ). Moreover, from a clinical standpoint, factors thought to underlie maternal behavior may be more amenable targets of intervention than her behavior itself. For example, continued examination of maternal cognition through the study of constructs such as reflective functioning and maternal insightfulness may shed light on the link between mother and child attachment ( Oppenheim & Koren-Karie, 2009 ; Slade, Sadler, & Mayes, 2005 ). These constructs refer to the extent to which a mother can see the world from her infant's point of view while also considering her own mental state. There is evidence that these and other components of maternal cognition (e.g., perceptions of the baby, attributions about infant behavior and emotions, maternal mindmindedness) are linked to maternal and/or child attachment, and additional research is needed to clarify the extent to which these components mediate the link between the two (e.g., Leerkes & Siepak, 2006 ; Zeanah, Benoit, Hirshberg, Barton, & Regan, 1994 ).

Another aspect of maternal functioning that should prove fruitful for researchers examining the transmission gap is maternal emotion regulation. As Cassidy (2006) has proposed, much maternal insensitivity can be recast as a failure of maternal emotion regulation. That is, when mothers themselves become dysregulated in the face of child behavior or child emotions that they find distressing (particularly child distress), their maternal behavior is more likely to be driven by their own dysregulation rather than the needs of the child (see also Slade, in press ). Evidence that maternal emotion-regulation capacities contribute to problematic parenting and insecure attachment has been reported ( Leerkes et al., 2011 ; Lorber & O'Leary, 2005 ), as have data indicating that maternal state of mind with respect to attachment (i.e., maternal secure base script knowledge) is uniquely related to maternal physiological regulation in response to infant cries (but not in response to infant laughter; Groh & Roisman, 2009 ). Unfortunately, although there is a sound conceptual and empirical basis for maternal emotion regulation as a mediator of the link between maternal and child attachment, there has been no empirical examination of this possibility.

In sum, the direction of future work depends on researchers' goals. If the goal is to understand the maternal behavior that mediates the link between maternal state of mind and child attachment, then the focus, obviously, must be on maternal behavior. If, however, the goal is to understand what factors may guide maternal behavior, and as such may themselves be successful targets of intervention, then examination of factors such as maternal cognitions and emotions should prove useful as well.

Caregiving as a Function of Adult Attachment Style

Although most researchers using self-report measures of adult attachment have not focused on links with parenting, there is a substantial and growing body of literature (more than 50 published studies) that addresses this link (see Jones, Cassidy, & Shaver, 2013 , for a review). Whereas researchers using the AAI have focused mainly on links between adults' AAI classifications and their observed parenting behaviors , attachment style researchers have focused mainly on links between adult attachment style and self-reported parenting cognitions and emotions (reviewed by Mikulincer & Shaver, 2007 ). But the few studies in which self-report attachment measures were used to predict parenting behavior have found support for predicted associations (e.g., Edelstein et al., 2004 ; Mills-Koonce et al., 2011 ; Rholes, Simpson, & Blakely, 1995 , Study 1; Selcuk et al., 2010 ). This is especially the case for maternal self-reported attachment-related avoidance (note that each of these studies was conducted with mothers only [Edelstein et al. included 4 fathers], so caution is warranted in generalizing these findings to fathers).

It would be useful to have more studies of adult attachment styles and observed parenting behavior. It would also be important to conduct longitudinal and intergenerational research using self-report measures. Prospective research is needed examining the extent to which adult attachment styles predict both parenting behaviors and infant attachment (see Mayseless, Sharabany, & Sagi, 1997 , and Volling, Notaro, & Larsen, 1998 , for mixed evidence concerning parents' adult attachment style as a predictor of infant attachment). Of related interest to researchers examining attachment styles and parenting will be longitudinal research examining the developmental precursors of adult attachment as measured with self-report measures (see Fraley, Roisman, Booth-LaForce, Tresch Owen, & Holland, 2013 , and Zayas, Mischel, Shoda, & Aber, 2011 , for evidence that self-reported attachment style in adolescence and early adulthood is predictable from participants' mothers' behavior during the participants' infancy and early childhood).

In general, we need more merging of social and developmental research traditions. It would be useful to include both the AAI and self-report attachment style measures in studies of parenting behaviors and cognitions. It would also be useful to know how the two kinds of measures relate similarly and differently to parenting variables. Scharf and Mayseless (2011) included both kinds of measures and found that both of them prospectively predicted parenting cognitions (e.g., perceived ability to take care of children), and in some cases, the self-report measure yielded significant predictions when the AAI did not (e.g., desire to have children). From the viewpoint of making predictions for practical or applied purposes, it is beneficial that both interview and self-report measures predict important outcomes but sometimes do so in non-redundant ways, thus increasing the amount of explained variance.

Mothers and Fathers

It is unclear whether it is best to think of a single kind of parental caregiving system in humans or of separate maternal and paternal caregiving systems. Harlow proposed separate maternal and paternal systems in primates (e.g., Harlow, Harlow, & Hansen, 1963 ). Within a modern evolutionary perspective, the existence of separate maternal and paternal caregiving systems is readily understood. Because mothers and fathers may differ substantially in the extent to which the survival of any one child enhances their overall fitness, their parenting behavior may differ. In addition, the inclusion of fathers in future attachment research is crucial. We contend that the field's continued focus on mothers is more likely to reflect the difficulty of recruiting fathers as research participants than a lack of interest in fathers. Bowlby, after all, was careful to use the term “attachment figure” rather than “mother,” because of his belief that although biological mothers typically serve as principal attachment figures, other figures such as fathers, adoptive mothers, grandparents, and child-care providers can also serve as attachment figures. Presumably, it is the nature of the interaction rather than the category of the individual that is important to the child. Also, addition of fathers will permit examination of attachment within a family systems perspective ( Byng-Hall, 1999 ; Johnson, 2008 ). Future research should examine (a) whether the precursors of infant-father attachment are similar to or different from the precursors of infant-mother attachment; (b) whether the Strange Situation best captures the quality of infant-father attachments (some have suggested that it does not; Grossmann Grossman, Kindler, & Zimmermann, 2008 ); (c) the influence of infants' relationships with fathers and father figures on their subsequent security and mental health; (d) possible differences in the working models children have of mothers and fathers; and (e) possible influences of parents' relationship with each other on the child's sense of having, or not having, a secure base ( Bretherton, 2010 ; Davies & Cummings, 1994 ).

Attachment and Psychopathology

As mentioned at the outset of this article, Bowlby was a clinician interested in the influence of early experiences with caregivers on children's later mental health and delinquency ( Bowlby, 1944 , 1951 ). Yet following a line of thinking that later came to characterize the developmental psychopathology approach (e.g., Cicchetti, 1984 ), Bowlby developed attachment theory as a framework for investigating and understanding both normal and abnormal development ( Sroufe, Carlson, Levy, & Egeland, 1999 ). Given space limitations and the focus of this journal, we will concentrate on relations between attachment and child psychopathology ( Figure 1 , Path d; see Cassidy & Shaver, 2008 , and Sroufe, Egeland, Carlson, & Collins, 2005a , for reviews of attachment and psychosocial functioning more broadly). The vast majority of existing studies have, however, not focused on clinically diagnosed psychopathology, but have been concerned with relations between attachment and continuous measures of internalizing and externalizing symptoms (e.g., assessed with the Child Behavior Checklist [CBCL]; Achenbach, 1991 ).

Bowlby's Theory of Attachment and Psychopathology

Bowlby used Waddington's (1957) developmental pathways model to explain how early attachment relates to later developmental outcomes, including psychopathology. According to this model, developmental outcomes are a product of the interaction of early childhood experiences and current context (at any later age). Early attachment is not expected to be perfectly predictive of later outcomes. Moreover, attachment insecurity per se is not psychopathology nor does it guarantee pathological outcomes. Instead, insecurity in infancy and early childhood is thought to be a risk factor for later psychopathology if subsequent development occurs in the context of other risk factors (e.g., poverty, parental psychopathology, abuse). Security is a protective factor that may buffer against emotional problems when later risks are present (see Sroufe et al., 1999 , for a review).

Attachment and Internalizing/Externalizing Behavior Problems: State of the Field

Over the past few decades, there have been many studies of early attachment and child mental health. The findings are complicated and difficult to summarize, as explained by Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, and Roisman (2010 , p. 437): “With the sheer volume, range, and diversity of studies…it has become virtually impossible to provide a clear narrative account of the status of the evidence concerning this critical issue in developmental science” (italics added). Studies contributing to this body of work have used diverse samples and different methods and measures, and have yielded inconsistent and, at times, contradictory results. Fortunately, two recent meta-analyses ( Fearon et al., 2010 ; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012 ) provide quantitative estimates of the degree of association between child attachment and internalizing/externalizing symptoms.

The meta-analyses revealed that insecurity (avoidant, ambivalent, and disorganized combined) was related to higher rates of internalizing and externalizing symptoms (though the link appears to be stronger for externalizing symptoms). When the subtypes of insecurity were examined individually, avoidance and disorganization were each significantly related to higher rates of externalizing problems, but only avoidance was significantly related to internalizing problems. Ambivalence was not significantly related to internalizing or externalizing. Contrary to expectations, neither meta-analysis yielded much support for an interaction of child attachment and contextual risk in predicting behavior problems. For example, neither meta-analysis found support for the predicted child attachment by SES interaction. However, given that high versus low SES is a rather imprecise measure of the numerous psychosocial risk factors that could contribute (individually and additively) to behavior problems, along with evidence from large sample studies supporting an attachment by risk interaction (e.g., Fearon & Belsky, 2011 ), these results should be interpreted cautiously. In sum, the answer to the question “Is early attachment status related to later mental health difficulties?” is a resounding yes, but the precise nature of the connections remains unclear.

Attachment and Psychopathology: Gaps in the Research and Future Directions

More research is needed on mechanisms, or mediators, that help to explain how insecurity, or a particular form of insecure attachment, leads in some cases to psychopathology. These mechanisms should be considered at different levels of analysis: neurological, hormonal, cognitive, behavioral, and social-interactional. Mediators may include difficulties in emotion regulation and deficits in social skills, for example. Given the documented links between early attachment and emotion regulation and physiological stress responses ( Cassidy, 1994 ; Spangler & Grossmann, 1993 ), as well as the role of emotion dysregulation and HPA axis irregularities in psychopathology ( Gunnar & Vazquez, 2006 ; Kring & Sloan, 2010 ), emotion regulation seems to be a promising target for mechanism research. More research is also needed on potential moderators and risk factors, such as age, gender, personality, traumas and losses, SES, exposure to family and neighborhood violence. Researchers should consider the cumulative effects of multiple risk factors as well as interactions among risk factors ( Belsky & Fearon, 2002 ; Fearon & Belsky, 2011 ; Kazdin & Kagan, 1994 ).

Given that most research on the mental health sequelae of early attachment has focused on internalizing and externalizing symptoms in non-clinical samples, future research should focus more on clinically significant problems and consider specific clinical disorders. The CBCL is not a measure of psychopathology, although it does indicate risk for eventual psychopathology ( Koot & Verhulst, 1992 ; Verhulst, Koot, & Van der Ende, 1994 ). Future research should address why the link between attachment and problematic behaviors is stronger for externalizing than for internalizing problems, and whether this difference holds for diagnosable pathology (e.g., conduct disorder or major depression). This may be partially a measurement issue. The CBCL is often completed, with reference to a child, by a parent, a teacher, or both. It may be easier to see and remember externalizing behaviors than it is to notice whether a child is experiencing anxiety, sadness, or internal conflicts. Another important diagnostic issue is comorbidity. It is very common for clinicians to assign a person to multiple diagnostic categories. Perhaps attachment theory and related measures could help to identify common processes underlying comorbid conditions and suggest where their roots lie ( Mineka, Watson, & Clark, 1998 ). One likely possibility is emotion regulation and dysregulation influenced by early experiences with parents.

Moreover, additional research is needed on the precise nature of the early childhood predictive factors and issues of causation. Is the issue really attachment status at age 1, for example, or is it continual insecure attachment across years of development? Also, we need to know whether attachment status per se is the issue or whether, for example, poor parenting predicts both attachment classification and psychopathology. Answering these questions will require studies using repeated assessments of attachment, parenting, context, and psychopathology. Further, there is increasing recognition of the importance of genetics and gene-by-environment interactions in understanding the development of psychopathology (e.g., Moffitt, 2005 ). Given preliminary evidence for genetic influences on disorganized attachment ( Lakatos et al., 2000 ) as well as evidence for a gene-by-early-maternal-sensitivity interaction in predicting mental health outcomes ( Bakermans-Kranenburg & van IJzendoorn, 2006 ), this area of inquiry is a very promising avenue for further research. There is also growing evidence concerning environmental effects on gene expression (i.e., epigenetics; Meaney, 2010 ). Especially interesting is the possibility that secure attachment may protect a child from the expression of risky genotypes (see Kochanska, Philibert, & Barry, 2009 , for preliminary evidence).

The Neuroscience of Attachment

Recent methodological advances (e.g., fMRI) have enabled researchers to investigate the neural correlates of attachment in humans. Initial theoretical formulations and empirical findings from the nascent subfield of “attachment neuroscience” ( Coan, 2008 ) have begun to provide answers to important questions about the neurobiology of attachment. Recent advances in this area include: (a) identifying key brain structures, neural circuits, neurotransmitter systems, and neuropeptides involved in attachment system functioning (see Coan, 2008 , 2010 , and Vrtička & Vuilleumier, 2012 , for reviews); (b) providing preliminary evidence that individual differences in attachment can be seen at the neural level in the form of differential brain responses to social and emotional stimuli ( Vrtička & Vuilleumier, 2012 ); (c) demonstrating the ability of attachment figures to regulate their spouses' neural threat response (i.e., hidden regulators; Coan et al., 2006 ); and (d) advancing our understanding of the neurobiology of parenting (see Parsons, Young, Murray, Stein, & Kringelbach, 2010 , for a review).

These early findings suggest important directions for attachment research. First, the vast majority of research on the neurobiology of attachment has been conducted with adults (yet see Dawson et al., 2001 ; White et al., 2012 ). However, researchers have the tools to examine the neural bases of attachment in younger participants. It is feasible to have children as young as 4 or 5 years old perform tasks in a functional magnetic resonance imaging scanner ( Byars et al., 2002 ; Yerys et al., 2009 ), and less invasive measures such as EEG are commonly used with infants and even newborns. Additional investigations with younger participants could move the field of attachment neuroscience forward in important ways. For example, researchers could find ethically acceptable ways to extend the work of Coan and colleagues (2006) to parents and children: Just as holding the hand of a spouse attenuates the neural threat response in members of adult couples, holding the hand of a caregiver may have a similar effect on children. Researchers should also extend the sparse literature on how individual differences in attachment in children relate to differential neural responses to social and emotional stimuli.

Second, there is a need for longitudinal investigations that address several important unanswered questions: (a) What does child-parent attachment formation look like at the neural level in terms of the circuits involved and changes in neurobiology over time? (b) What is the role of developmental timing (i.e., sensitive and critical periods in brain development) in the formation of neural circuits associated with attachment? (c) Is the neural circuitry associated with attachment the same for children, adolescents, and adults? Some researchers have suggested that the neural circuitry associated with attachment may be different at different ages ( Coan, 2008 ).

Third, future research should examine the ability of experience to change neural activity in brain regions related to attachment, and should explore potential clinical implications of these findings. For example, Johnson et al. (2013) compared the ability of spousal hand-holding to buffer neural responses to threat before and after couples underwent Emotion-Focused Therapy (EFT). They found that EFT increased the ability of hand-holding to attenuate threat responses; similar examination of both parent and child neural activity in response to attachment-related interventions would be informative.

Fourth, it is important for future research to identify which, if any, brain regions are specific to attachment and which are shared with other related social constructs such as caregiving or affiliation more broadly. There is initial evidence that caregiving and attachment involve both unique and overlapping brain regions ( Bartels & Zeki, 2004 ).

Finally, given the inherent interpersonal nature of attachment, future research should attempt to study attachment-related neural processes in situations that approximate as closely as possible “real” social interactions ( Vrtička & Vuilleumier, 2012 ). To date, all studies of the neuroscience of attachment have focused on the neural activity of only one partner in a relationship. By capitalizing on further methodological advances in neuroimaging (e.g., hyperscanning; Montague et al., 2002 ) researchers may be able to examine simultaneously the neural activity of a parent and child while they are interacting.

Attachment, Inflammation, and Health

Evidence is accumulating that attachment insecurity in adulthood is concurrently associated with negative health behaviors (e.g., poor diet, tobacco use; Ahrens, Ciechanowski, & Katon, 2012 ; Huntsinger & Luecken, 2004 ; Scharfe & Eldredge, 2001 ) and problematic health conditions (e.g., chronic pain, hypertension, stroke, heart attack; McWilliams & Bailey, 2010 ). Despite these intriguing cross-sectional findings in adult samples, much less is known about how early attachment relates to long-term health outcomes. One longitudinal study ( Puig, Englund, Collins, & Simpson, 2012 ) reported that individuals classified as insecurely attached to mother at 18 months were more likely to report physical illnesses 30 years later. Two other studies found that early insecure attachment was associated with higher rates of obesity at age 4.5 ( Anderson & Whitaker, 2011 ) and 15 ( Anderson, Gooze, Lemeshow, & Whitaker, 2012 ). Additional longitudinal investigations of the links between early attachment and health outcomes are needed to replicate these findings in different samples using a wider variety of health measures (e.g., medical records, biomarkers, onset and course of specific health problems).

Another goal for future research is to advance our understanding of the processes or mechanisms by which early attachment is related to later health outcomes. Recent proposals that early psychosocial experiences become “biologically embedded” at the molecular level and influence later immune system functioning (e.g., inflammation) provide a promising model with which to pursue this kind of research (see Miller, Chen, & Parker, 2011 , for a review of the conceptual model and its empirical support). In brief, the model proposes that early adverse experiences result in immune system cells with a “proinflammatory phenotype” and neuroendocrine dysregulation leading to chronic inflammation. Inflammation, in turn, is involved in a variety of aging-related illnesses including cardiovascular disease, autoimmune diseases, and certain types of cancer ( Chung et al., 2009 ).

As mentioned earlier, there is mounting evidence that early experiences with caregivers (including their influence on attachment) contribute to the calibration and ongoing regulation of the HPA axis (e.g., cortisol reactivity, diurnal cortisol rhythms), a system that is central to the body's stress response ( Adam et al., 2007 ; Gunnar & Quevedo, 2007 ; Luijk et al., 2010 ; Spangler & Grossmann, 1993 ). The HPA axis also plays an integral role in inflammatory responses and immune system functioning. In addition, there is evidence that early maternal warmth (retrospectively reported) can buffer the deleterious effects of early adversity on pro-inflammatory signaling in adulthood ( Chen, Miller, Kobor, & Cole, 2011 ; see also Pietromonaco, DeBuse, & Powers, 2013 , for a review of the links between adult attachment and HPA axis functioning). Finally, studies show that attachment in adulthood is concurrently related to biomarkers of immunity: attachment-related avoidance is related to heightened levels of the proinflammatory cytokine interleukin-6 (IL-6) in response to an interpersonal stressor ( Gouin et al., 2009 ) and to lower levels of natural killer cell (NK) cytotoxicity (NK cells are involved in immune defense; Picardi et al., 2007 ); attachment-related anxiety is related to elevated cortisol production and lower numbers of T cells ( Jaremka et al., 2013 ).

These initial findings provide an empirical basis for researchers to pursue further the connections between attachment and health. Future research should prospectively examine the relation between early attachment security and biomarkers of inflammation in adulthood. Further, researchers should attempt to elucidate the relations among attachment, HPA axis functioning, inflammation, and the immune system to better understand the biological processes underlying the link between early experience and later health outcomes.

Attachment and Empathy, Compassion, and Altruism

Shortly after the development of the Strange Situation, which allowed researchers to validly assess infants' attachment orientations, there was strong interest in the potential links between attachment security and prosocial motives and behaviors (e.g., empathy, compassion). From a theoretical standpoint, there are reasons to expect that secure children – whose own needs have been responded to in a sensitive and responsive way – will develop the capacity to respond to the needs of others empathically. Several early investigations confirmed the association between child attachment security and empathic responding ( Kestenbaum, Farber, & Sroufe, 1989 ; Sroufe, 1983 ; Teti & Ablard, 1989 ). Over the past 24 years, however, the link between child attachment status and prosocial processes (e.g., empathy, helping, altruism) has received surprisingly little research attention (though see Panfile & Laible, 2012 ; Radke-Yarrow, Zahn-Waxler, Richardson, Susman, & Martinez, 1994 ; van der Mark, van IJzendoorn, & Bakermans-Kranenburg, 2002 ). In contrast, social/personality psychologists have generated substantial and compelling empirical support for a connection between adult attachment and prosocial motives and behaviors.

Mikulincer, Shaver, and colleagues ( Mikulincer & Shaver, 2001 ; Mikulincer, Shaver, Gillath, & Nitzberg, 2005 ; Mikulincer, Shaver, Sahdra, & Bar-On, in press ) have demonstrated that both dispositional and experimentally augmented attachment security (accomplished through various forms of “security priming”) are associated with several prosocial constructs, including reduced outgroup prejudice, increased compassion for a suffering stranger and willingness to suffer in her place, and the ability and willingness of one partner in a couple to listen sensitively and respond helpfully to the other partner's description of a personal problem. In addition, surveys completed in three different countries (United States, Israel, the Netherlands) revealed that more secure adults (measured by self-reports) were more likely to volunteer in their communities (e.g., by donating blood or helping the elderly). Avoidant respondents were much less likely to volunteer, and although anxious respondents volunteered, their reasons for doing so (e.g., to receive thanks, to feel included) were less generous than those of their more secure peers ( Gillath et al., 2005 ).

Further study of how early attachment relates to various forms of prosocial behavior is needed. Developmental attachment researchers would benefit from using the experimental techniques that Mikulincer, Shaver, and colleagues used. Are young children who were classified as secure in the Strange Situation (especially in comparison to children classified as avoidant) more willing to help a suffering individual or more willing to interact with a child from a different ethnic group? Can experimental security “boosts” increase tolerance, empathy, compassion, and altruism in children? There is already robust experimental evidence that infants as young as 14 to 18 months readily engage in altruistic behavior (e.g., retrieving an out-of-reach object for a stranger; see Warneken & Tomasello, 2009 , for a review). To the best of our knowledge, however, no study has examined whether variations in infant attachment predict individual differences in this kind of instrumental helping behavior (although the potential for attachment-related differences has been proposed by Dweck; see Tomasello, Dweck, Silk, Skyrms, & Spelke, 2009 ). Warneken and Tomasello (2009) have proposed that these early helping behaviors reflect a biological predisposition for altruism in infants that begins to be influenced by social and cultural experiences only “a year or two after [the infants] have started behaving altruistically” (p. 400). However, given the innumerable social experiences that infants encounter in the first year of life and the pioneering work by Johnson and colleagues ( Johnson, Dweck, & Chen, 2007 ; Johnson et al., 2010 ) showing that 12- to 16-month-old infants with different attachment patterns have different expectations about others' helpfulness, it may be possible to observe attachment-related individual differences in early helping behaviors earlier than Warneken and Tomasello suggest.

Attachment and School Readiness

In recent years researchers, educators, and policy makers have been increasingly interested in understanding factors that predict children's school readiness and in developing and testing programs that may better prepare children (particularly at-risk children) for school entry. In his 2013 State of the Union Address at the beginning of his second term, President Obama proposed implementing universal, high-quality preschool for all American children with the idea that these early preparatory experiences will enhance school readiness and future academic performance. The focus of much of the initial research on school readiness has been on children's basic cognitive skills such as early literacy and numeracy abilities (e.g., Duncan et al., 2007 ). More recently, researchers have recognized the importance of other competencies such as emotion regulation and social skills (e.g., High and the Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health, 2008 ). Further, High et al. listed “strong nurturing relationships” as one of the universal needs of children that must be met to promote school readiness and positive educational outcomes (p. e1009).

The conclusions reached by High et al. suggest that child attachment security is an important factor to consider when studying school readiness and developing programs designed to improve school readiness (for initial empirical evidence, see Belsky & Fearon, 2002 , and Stacks & Oshio, 2009 ). Decades of research have provided substantial evidence that early attachment security is associated with better emotion regulation capacities and greater social competence (e.g., Cassidy, 1994 ; Sroufe et al., 2005a ; Thompson, 2008 ). In addition, research has demonstrated that secure attachment is associated with better academic performance ( Granot & Mayseless, 2001 ) as well as enhanced cognitive skills and executive functions ( Bernier, Carlson, Deschênes, & Matte-Gagné, 2012 ; Jacobsen, Edelstein, & Hofmann, 1994 ). Thus, as research on school readiness continues to advance, greater consideration of the direct and indirect influences of early attachment security on school readiness is warranted. For example, researchers should test mediational models in which attachment security predicts greater emotion regulation or social competence, which in turn predicts greater school readiness. In addition, both parenting and school readiness interventions could consider whether increasing parental secure base provision fosters a child's school readiness. Moreover, consideration of the extent to which preschool teachers perform secure base and safe haven functions for their young students, and whether these components of the student-teacher relationship relate to young children's classroom functioning will be important (see Commodari, 2013 ).

Attachment and Culture

Bowlby (1969/1982 ) viewed the attachment behavioral system as a product of human evolutionary history, making it cross-culturally universal. Ainsworth's (1967 ; Ainsworth et al., 1978 ) early studies in Uganda and the US provided empirical support for similar attachment processes in very different cultures. Although some researchers have disputed the cross-cultural validity of core tenets of attachment theory (e.g., Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000 ), decades of research strongly suggest that the basic phenomenon and the major kinds of individual differences are universal (see van IJzendoorn & Sagi-Schwartz, 2008 , for a review). Three hypotheses rooted in attachment theory have been examined and supported in cross-cultural research: that secure attachment is the most prevalent pattern in all cultures and is viewed as the most desirable pattern; that maternal sensitivity influences infant attachment patterns; and that secure infant attachment predicts later social and cognitive competence.

Yet much more research is needed. As psychological knowledge, research, and applications become increasingly global, it will become more feasible to map the detailed effects of cross-cultural and contextual differences in parenting, co-parenting, community care, environmental harshness and instability, and conflicts and war on attachment patterns and attachment-related mental health problems. It will be increasingly important to define “culture” and “context” more specifically. Within any large and diverse society, and in every large urban area (in a world increasingly urbanized), there are many cultures and subcultures. Moreover, within any modern society there are large differences in ethnicity, religion, diet, education, income, economic security, and threats to health and the availability of medical care. It is therefore important not to think of differences only between nation states but also within different groups and contexts within each nation.

Translating Attachment Research to Clinical Practice Interventions with Infants and Young Children at Risk for Insecure Attachment

Just as the study of individual differences in attachment began with the study of infants, so the systematic study of how to create attachment-related change focused initially on attempts to alter the developmental trajectory of infants who are at risk of developing or maintaining insecure attachments. Given the substantial and converging longitudinal research underscoring the risks associated with insecure attachment (e.g., poorer mental and physical health and lower social competence), the need to intervene to reduce the risk of insecure attachment is clear. In the past 20 years, researchers and clinicians have developed numerous therapeutic programs to prevent or reduce insecure attachment ( Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2003 ; Egeland, Weinfield, Bosquet, & Cheng, 2000 ; see Berlin, Zeanah, & Lieberman, 2008 , for a review). Despite the fact that a handful of attachment interventions have shown initial success (e.g., Bernard et al., 2012 ; Cassidy et al., 2011 ; Cicchetti, Rogosch, & Toth, 2006 ; Hoffman, Marvin, Cooper, & Powell, 2006 ; Klein Velderman, Bakermans-Kranenburg, Juffer, & van IJzendoorn, 2006 ; Lieberman, Weston, & Pawl, 1991 ; Lyons-Ruth & Easterbrooks, 2006 ; Sadler et al., 2013 ; Toth, Rogosch, Manly, & Cicchetti, 2006 ; van den Boom, 1994 , 1995 ), we have as yet a collection of individual initiatives with little replication. More research is needed to identify the critical targets of attachment interventions and to understand the process of change.

Targets of early intervention

What should an intervention target? Until recently, this question was framed largely as: Should interventions target parental behavior, parental representations, or both? Greater specificity is required. When an intervention targets parental behavior, what specific components of behavior should be targeted? We discussed potential aspects of parental behavior earlier. When an intervention targets parental representations, what specific components should be targeted? Should interventions target representations of the parent her- or himself, of the infant, of the relationship; of the baby as an entity with a mind (e.g., mentalizing approaches; Slade et al., 2005 ); or maternal attributions about the infant's behavior ( Bugental et al., 2002 )?

Several studies (described earlier) suggest additional intervention targets. For example, the evidence that maternal emotion regulation capacities influence parenting ( Dix, 1991 ; Leerkes, Crockenberg, & Burrous, 2004 ; Lorber & Slep, 2005 ; Smith & O'Leary, 1995 ) suggests that targeting maternal emotion regulation capacities might be useful in bringing about change (e.g., the Circle of Security intervention; Hoffman et al., 2006 ). Another target of intervention is suggested by research with non-human primates and other mammals that demonstrates the soothing and regulatory functions that physical contact with an attachment figure can provide ( Hofer, 1994 , 2006 ; Meaney, 2001 ; Suomi, 2008 ; see Feldman, Singer, & Zagoory, 2010 , for such evidence in humans; see also Field, 2011 ). Interventions focused on infant-mother contact may prove useful (see Anisfeld, Casper, Nozyce, & Cunningham, 1990 , for a randomized trial in which mothers assigned to carry their infants in soft baby carriers were more likely to have infants who were securely attached at age 1). Of course, consideration of intervention targets necessarily requires considering moderators of intervention effectiveness. Targeting certain components may be more effective for some mothers than others.

The desire to intervene to reduce the risk of insecure attachment rests on the assumption that doing so in turn reduces the risk of poor child functioning, including a reduction in behavior problems and psychopathology. Remarkably, although there are a number of studies, described above, that show a link between insecure attachment and behavior problems and psychopathology, much less research has focused on whether intervening to reduce the risk of insecure attachment actually leads to a reduction in later problems (yet see Dozier et al., 2006 ; Moss et al., 2011 ; Klein Velderman et al., 2006 ; van den Boom, 1995 ; Van Zeijl et al., 2006 ). Future intervention research should test the change model according to which improving parenting reduces the risk of insecure attachment, which in turn reduces child behavior problems and psychopathology. Given that behavior problems associated with early insecure attachment may not emerge until later in development, and the evidence that the link between insecure attachment and behavior problems grows stronger over time ( Fearon & Belsky, 2011 ), longitudinal studies with long-term outcome assessments will be an important component of future intervention research.

Intervention development and issues of implementation

No attachment intervention has yet achieved widespread implementation. When following the typical efficacy-to-effectiveness clinical model, researchers initially design an intervention with a highly specified protocol, and only once it has proven to be efficacious in a tightly controlled setting do they begin to consider the adaptations needed for effectiveness in real-world settings. With attachment-based infant interventions, the problem has been that initial interventions are typically very expensive, and real-world social agencies attempting to meet the needs of at-risk infants cannot afford them. This is an unfortunate situation, especially because, over the past decade, there has been a call for researchers to attend to issues of implementation during the early stages of intervention planning. For instance, an argument that “the focus on feasibility in the prevention research cycle should not be restricted to the effectiveness stage” has been put forward by Ialongo and colleagues (2006) .

Several components of early attachment-based interventions make implementation at a broad public health level impractical. Many such interventions involve videotaping individual parent-infant interactions and providing individualized parental feedback (e.g., Dozier et al., 2006 ; Klein Velderman et al., 2006 ). This requires considerable resources: extensive training and supervision of staff; expertise and time to create individual diagnostic and treatment plans; and time, space, equipment, skills, and parental assent for individual videotaping. From an attachment perspective, the problem is how to provide an individualized approach that does not require expensive highly skilled staff. This problem has not been easy to solve (e.g., Berlin, Ziv, Amaya-Jackson, & Greenberg, 2005 ). Continued attempts to develop interventions that are widely and affordably implementable are important.

We urgently need evaluations of comprehensive theory- and research-based intervention protocols that can be widely implemented among families whose infants and children are at elevated risk for developing or maintaining insecure attachments . Addressing this need is in keeping with the NIMH (2008) strategic plan's objective of moving interventions to “common practice” more quickly and of examining interventions in “the care setting in which they are delivered” (p. 35). Continued testing of attachment-based interventions should occur further down the efficacy-to-effectiveness stream – with affordable protocols that can be provided through existing service delivery mechanisms. Expensive interventions are not implementable on a broad scale within the current American health care and educational structures.

Intervention development and testing are enormously expensive, yet replication of existing interventions is crucial. We propose that the dedication of resources to development of new interventions occur only when theory, clinical perspectives, or research indicate that existing interventions lack an important component that could reasonably contribute to change.

Interventions during Adolescence

Adolescence is a period of increased risk-taking behavior and mental health disorders ( Centers for Disease Control and Prevention [CDC], 2012 ; Roberts, Attkisson, & Rosenblatt, 1998 ), and attempts to reduce these problematic symptoms and behaviors are important. The dramatic biological and cognitive changes that occur during adolescence have led some researchers to consider this period as a second sensitive period (e.g., Andersen & Teicher, 2008 ; Guttmannova et al., 2011 ), and as such, adolescents may be particularly open to environmental interventions that can lead to improved functioning.

Interventions designed to help adolescents are typically targeted at the reduction of specific problems (e.g., depression or delinquency), and there are many effective interventions for helping troubled adolescents (e.g., Dishion & Kavanagh, 2003 ; Stein, Zitner, & Jensen, 2006 ). Yet given evidence that the link between attachment security and healthy functioning continues to exist in adolescence ( Dykas, Ziv, & Cassidy, 2008 ; Kobak & Sceery, 1988 ; see Allen, 2008 , for a review), increasing adolescent attachment security may also be an effective means of reducing adolescent problems. In other words, does an intervention focused on the adolescent-parent attachment relationship increase the likelihood of reduced problematic adolescent behavior? There has been remarkably little research on this important question. Moreover, the associations among intervention, attachment, and psychopathology may be more complex in adolescence than they are in infancy and early childhood. Another important way to examine the connections among these factors is to design studies to determine whether reducing adolescent psychopathology contributes to secure adolescent attachment.

In an intervention designed to enhance adolescent-parent attachment security – with the idea being that increased security will reduce the prevalence of adolescent problems – questions about intervention approaches arise. For instance, should an intervention include the parent, the adolescent, or both? Bretherton (1992) described Bowlby as the first family therapist because of his proposition that change in a child's attachment to a parent is possible only when there is change within the interaction between the child and the parent (see also Byng-Hall, 1999 ). There has been almost no examination of this proposition in adolescence. One randomized controlled trial ( Diamond et al., 2010 ) showed that Attachment-Based Family Therapy (ABFT) was more efficacious than Enhanced Usual Care in reducing adolescents' depressive symptoms and suicidal ideation.

Policy Implications

Throughout this article we have suggested topics for future research. At least as important are the needs for application of the findings already obtained and increased collaborations among researchers, policy makers, educators, and child service workers. Here we list a few important areas for such efforts.

Attachment research has clearly established the importance of early experiences with parents for child development. Yet far too many parents enter parenthood with insufficient knowledge about child development and the importance of the early parent-child relationship, and without the knowledge and skills needed to parent in a sensitive, responsive manner. Unfortunately, there is almost no future-parent education at any grade level in public schools. In American schools, there seems to be a greater focus on education about sex than about successful parenting. (And most sex education classes do not deal with other aspects of couple relationships, even though there is a considerable body of attachment-related research relevant to establishing and maintaining healthy couple relationships – a foundation for healthy parent-child relationships.) Even at the college level, there are few courses aimed at preparing young adults for healthy marriages and parenting. Researchers and educators should work together to develop future-parent curricula that could be implemented as part of high school and university education. There are several empirically supported parent training programs based on attachment research (described earlier; see Berlin et al., 2008 , for a review), but these have yet to be made a part of general education.

In the context of dramatic social and economic changes, many parents are struggling to strike a balance between work and family responsibilities and to find quality care for their children while the parents are at work or school. There is a need for more flexible work arrangements that recognize child care as a prime societal concern. This includes re-examination of parental leave policies that require parents to return to work too soon after childbirth, either because of company policy or because of financial necessity. In addition, greater attention to the training and screening of childcare workers and prospective foster parents is warranted. In a review of attachment theory and its implications for society, Sweeney (2007) suggested, among several policy implications, “legislative initiatives reflecting higher standards for credentialing and licensing childcare workers, requiring education in child development and attachment theory, and at least a two-year associate's degree course as well as salary increases and increased stature for childcare positions” (p. 342). The massive NICHD childcare study showed that high quality daycare is compatible with secure attachment of young children to their parents, and also that when home conditions make secure attachment unlikely, high quality daycare can increase children's chances of achieving attachment-related security ( NICHD Early Child Care Research Network, 1997 ).

Policies directed at helping families in which one or both parents serve in the military could also be informed by attachment theory and research. Military service often entails frequent moves within the United States and separation of at least one parent from the family during periods of service overseas. In thousands of cases, the separation ends with a soldier's death, and his or her family is left to cope with the tragedy. Attention to helping spouses and children cope effectively with attachment-related stresses that have the potential to damage their lives for years to come has increased in recent years (e.g., Maholmes, 2012 ; see also Riggs & Riggs, 2011 , for consideration of military families within an attachment theory framework), but there continues to be a need for research-informed interventions that consider the particular challenges faced by military families (for discussion, see Miller, Miller, & Bjorklund, 2010 ; Paris et al., 2010 ).

We end with a brief mention of policy implications related to parental incarceration. Elsewhere ( Cassidy, Poehlmann, & Shaver, 2010 ) we have provided reviews and studies related to this issue. Often, incarcerated parents are unable to see their children, and pressures are placed on the rest of extended families, and in many cases on the foster care system. For each adult placed in prison, there are likely to be, on average, more than one or two people outside of prison who suffer from the incarceration. Policy makers could consider the separations and losses that accompany parental incarceration within an attachment framework. Research is needed to assess the value of greater contact between incarcerated individuals and their children, and of parenting interventions that can take place as part of rehabilitation.

Brief Conclusions

Our goal in this article has been to provide a current “state of the art” description of what is known in many important areas of attachment research, discuss gaps in current knowledge, and suggest important avenues for future research and for creating and evaluating practical interventions. Although we have, by design, focused on issues within attachment research specifically, an important enterprise for the future is to consider how attachment is differentiated from, and integrated with, other features of development. As our colleague Alan Sroufe responded when asked his views on the future of attachment research (personal communication, 2012; see also Sroufe, Egeland, Carlson, & Collins, 2005b ), “There is a lot more to personal development than attachment, and there is a lot more even to parenting than attachment. The task is to describe how all of this fits and works together.” That task arises with respect to every phase of development – infancy, childhood, adolescence, and adulthood. And the range of issues and factors to be considered is somewhat different at every stage or phase of development.

Certain large goals of any worthy society – the mental and physical health of its members, the optimal development of each individual's interests and capacities, and a safe environment free of violence and hatred – are likely to be achieved only to the extent that infants and children receive the benefits of what Bowlby and Ainsworth called a safe haven and a secure base, which as far as we can see imaginatively into the future are likely to depend on responsive attachment figures. Partly through the efforts of Bowlby, Ainsworth, and their intellectual offspring, it has been possible to improve hospital procedures, reduce child abuse, contribute to better parenting, increase understanding of the development of psychopathology, and to provide a much better understanding of our social nature as mammals, primates, and human beings. With the goal of a mentally and physically healthy human race in mind, we can simultaneously be proud of the accomplishments of attachment researchers and look forward to participating in addressing the many intellectual, clinical, and educational challenges remaining.

Acknowledgments

Author Note: The writing of this article was supported by awards to Jude Cassidy from NIDA (R21 DA025550), to Jason Jones from NIDA (F31 DA033848), and to Phillip Shaver from the Fetzer Institute. The authors are grateful to Susan S. Woodhouse for engaging in extensive conversations about maternal response to distress, and to Kenneth N. Levy for helpful suggestions about links between attachment and psychopathology.

Invited contribution to the 25 th anniversary edition of Development and Psychopathology .

Contributor Information

Jude Cassidy, University of Maryland.

Jason D. Jones, University of Maryland.

Phillip R. Shaver, University of California, Davis.

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• van IJzendoorn MH. Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin. 1995; 117 :387–403. [ PubMed ] [ Google Scholar ]
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• Van Zeijl J, Mesman J, van IJzendoorn MH, Bakermans-Kranenburg MJ, Juffer F, Stolk MN, Alink LA. Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing behavior problems: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2006; 74 :994–1005. [ PubMed ] [ Google Scholar ]
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• Waters HS, Waters E. The attachment working models concept: Among other things, we build script-like representations of secure base experiences. Attachment & Human Development. 2006; 8 :185–197. [ PubMed ] [ Google Scholar ]
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Psychology Journals and research: Original, Theoretical or Meta-analysis

• Original, Theoretical or Meta-analysis

What is original research?

Original research is considered a primary source.

An article is considered original research if...

• it is the report of a study written by the researchers who actually did the study.
• the researchers describe their hypothesis or research question and the purpose of the study.
• the researchers detail their research methods.
• the results of the research are reported.
• the researchers interpret their results and discuss possible implications.

What is Theoretical Research?

Theoretical research is explanatory, and leads to the advancement of “knowledge for knowledge’s sake. This type of research attempts to gather knowledge about a phenomenon or idea whose conclusions may not have any immediate real-world application. It is sometimes referred to as "basic research."

How can I tell if the Article is Original Research?

There is no one way to easily tell if an article is a research article like there is for peer-reviewed articles in the Ulrich's database. The only way to be sure is to read the article to verify that it is written by the researchers and that they have explained all of their findings, in addition to listing their methodologies, results, and any conclusions based on the evidence collected. 

All that being said, there are a few key indicators that will help you to quickly decide whether or not your article is based on original research. 

• Literature Review or Background
• Conclusions
• Read through the abstract (summary) before you attempt to find the full-text PDF. The abstract of the article usually contains those subdivision headings where each of the key sections are summarized individually. 
• Use the checkbox with CINAHL's advanced search to only see articles that have been tagged as research articles.   

Examples of Theoretical Research

Examples of Theoretical research in psychology might include:

• An investigation looking at whether stress levels influence how often students engage in academic cheating
• A study looking at how caffeine consumption impacts the brain
• A study assessing whether men or women are more likely to be diagnosed with depression
• A study looking at how attachment styles among children of divorced parents compare to those raised by married parents

Notice in all of these examples, the goal of the research is merely to increase the amount of knowledge on a topic, not to come up with a practical solution to a problem.

What is Meta-Analysis?

Meta Analysis refers to a research strategy where instead of conducting new research with participants, the researchers examine the results of several previous studies. This is done with the purpose of gaining greater confidence in the results because of the larger pool of participants, as long as steps are taken to avoid errors that may have existed in the original studies.

Why study the studies?

Opposing theories and disparate findings populate the field of psychology; scientists must interpret the results of any single study in the context of its limitations. A researcher might study the studies by assimilating data across studies identified through a literature review. Meta-analysis has many strengths. First, meta-analysis provides an organized approach for handling a large number of studies. Second, the process is systematic and documented in great detail, which allows readers to evaluate the researchers’ decisions and conclusions. Third, meta-analysis allows researchers to examine an effect within a collection of studies in a more sophisticated manner than a qualitative summary.  

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Student Notebook

Exploring the pages of psychology’s past: archival research in the history of psychology.

• History of Psychology

“If you would understand anything, understand its beginning and its development.” -Aristotle

Everyone has heard the cliches about why we should study history. History helps us avoid the mistakes of the past. It gives us a better understanding of the present. It makes us more critical of contemporary work. These clichés are indeed true. However, there is another good reason for studying the history of psychology: good old-fashioned curiosity and enjoyment.

There is nothing quite like finding out where that particular personality test came from, how a particular specialty was established, or how your own psychology department came to be. The history of psychology is full of odd, interesting, and unexpected facts. Did you know that one of the first large corporations to fund psychological research was Coca-Cola? Or that William James practiced spiritualism and attended séances? Or that Darwin almost didn’t make it on to the Beagle voyage because of the shape of his nose? The history of psychology is full of these fascinating facts; you just have to take the time to look for them.

Researching and writing the history of psychology takes many forms. For many historians, however, archival research is one of the greatest perks of the job. Journals and biographies can be used to trace the history of an idea or influential figure, but there is a different “feel” about archival documents. There is a sense of raw, unrestricted data. Clearly, archival documents pose their own difficulties. They are fragmentary, censored, and like all historical data, they require reconstruction. But these documents help us to see a different side of institutions, individuals, and schools of thought. In this article, we outline the ins and outs of archival research to help interested psychologists get started. We also hope to show that while researching the history of psychology can be challenging, it is also very intriguing and, with careful planning and preparation, can be done quite easily.

Finding an Archive Archives hold a variety of material; whatever your topic, there is a good chance that somewhere an archive contains documents relevant to your research. Holdings include personal papers, governmental documents, newspaper clippings, oral history recordings, and more. The material comes in many forms, including textual sources, photographs, microfilm, and audio/video recordings. To find a relevant archive, start with an online search engine (see resources section). Universities, colleges, and governmental bodies maintain their own archives or can direct you to where pertinent materials are held.

Preparing for the Archives Gather as much preliminary information as you can prior to visiting the archives. Know the significant people, places, and dates connected to your topic because this information will often appear in the archival documents. Creating a timeline of important events will help you keep track.

Next, search for an online finding aid. A finding aid is essentially a guide to the collection. Some are more detailed than others, but most will give you an idea about the scope of the collection, what time period it covers, and information regarding access restrictions. Many will give you an itemized account of the specific contents. It is important to note where the material is located; if it is stored off-site, you will need to request the material in advance. It is always a good idea to contact the archives before your visit. Inform them of what collections you are interested in, when you intend to visit, and ask if this will be a convenient time.

At the Archives Every archive will have a registration process, which typically involves signing up for a reader card. Personal belongings are not permitted in the reading room and policies regarding the use of laptops and digital cameras vary. Pencils and paper may or may not be provided. Lockers are not always available, so leave your valuables at home.

Photocopying and microfilm printing are typically done by the archivist and may not be available the same day. Note, however, that both of these services are costly so choose carefully. Before you leave an archive, familiarize yourself with their publication policies to avoid any later issues with publishing materials belonging to the collection.

After the Archives Be sure to acknowledge the archives in any presentation of your research. As for referencing, APA is still developing a standard method, but generally the rule is to provide as much information as possible (box number, file number, archive, etc.).

And that’s it! The steps may make the process seem quite involved, but with preparation, it is really no more difficult than a trip to the library. Remember, the history of psychology is not for historians alone. Delving into the history of your current research topic may supplement your literature review and provide you with insight into your topic that would not have been gained from other empirical styles. It may also prove to be a valuable research project in its own right. Regardless you will find that delving into historical research is just plain interesting and fun!

Archival Resources Archive Grid Global repository of archival collections. http://www.archivegrid.org/web/index.jsp

Archives of the History of American Psychology Collection pertaining to the history of American psychology. Includes papers of over 740 prominent American psychologists. http://www3.uakron.edu/ahap/

General Resources History and Theory of Psychology Student Network Information on the History/Theory community http://www.student.yorku.ca/~jbazar/htn/index.html

History and Philosophy of Psychology Web Resources Collection of history of psychology resources http://www.psych.yorku.ca/orgs/resource/

Classics in the History of Psychology Primary texts in the history of psychology http://psychclassics.yorku.ca/

APS regularly opens certain online articles for discussion on our website. Effective February 2021, you must be a logged-in APS member to post comments. By posting a comment, you agree to our Community Guidelines and the display of your profile information, including your name and affiliation. Any opinions, findings, conclusions, or recommendations present in article comments are those of the writers and do not necessarily reflect the views of APS or the article’s author. For more information, please see our Community Guidelines .

Please login with your APS account to comment.

About the Authors

Cathy Faye and Jennifer Bazar are doctoral students in the History and Theory of Psychology program at York University, Toronto, Canada. Both authors can often be found in dusty old basements and reading rooms, but they do emerge periodically to check their e-mail. You can contact them at [email protected] and [email protected] .

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National Museum of Psychology on the Way

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Experimental (Empirical) Research Articles

• Library vs. Google
• Background Reading
• Keyword Searching
• Evaluating Sources
• Citing Sources
• Need more help?

How Can I Find Experimental (Empirical) Articles?

Many of the recommended databases in this research guide contain scholarly experimental articles (also known as empirical articles or research studies or primary research). Search in databases like: 

• APA PsycInfo ​
• ScienceDirect

Because those databases are rich in scholarly experimental articles, any well-structured search that you enter will retrieve experimental/empirical articles. These searches, for example, will retrieve many experimental/empirical articles:

• caffeine AND "reaction time"
• aging AND ("cognitive function" OR "cognitive ability")
• "child development" AND play

Experimental (Empirical) Articles: How Will I Know One When I See One?

Scholarly experimental articles  to conduct and publish an experiment, an author or team of authors designs an experiment, gathers data, then analyzes the data and discusses the results of the experiment. a published experiment or research study will therefore  look  very different from other types of articles (newspaper stories, magazine articles, essays, etc.) found in our library databases..

In fact, newspapers, magazines, and websites written by journalists report on psychology research all the time, summarizing published experiments in non-technical language for the general public. Although that kind of article can be interesting to read (and can even lead you to look up the original experiment published by the researchers themselves),  to write a research paper about a psychology topic, you should, generally, use experimental articles written by researchers. The following guidelines will help you recognize an experimental article, written by the researchers themselves and published in a scholarly journal.

Structure of a Experimental Article Typically, an experimental article has the following sections:

• The author summarizes her article
• The author discusses the general background of her research topic; often, she will present a literature review, that is, summarize what other experts have written on this particular research topic
• The author describes the experiment she designed and conducted
• The author presents the data she gathered during her experiment
• The author offers ideas about the importance and implications of her research findings, and speculates on future directions that similar research might take
• The author gives a References list of sources she used in her paper

Look for articles structured in that way--they will be experimental/empirical articles. ​

Also, experimental/empirical articles are written in very formal, technical language (even the titles of the articles sound complicated!) and will usually contain numerical data presented in tables. 

As noted above, when you search in a database like APA PsycInfo, it's really easy to find experimental/empirical articles, once you know what you're looking for. Just in case, though, here is a shortcut that might help:

First, do your keyword search, for example:

In the results screen, on the left-hand side, scroll down until you see "Methodology." You can use that menu to refine your search by limiting the articles to empirical studies only:

You can learn learn more about advanced search techniques in APA PsycInfo here . 

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PSYCH 3002 - Research Methods in Psychology

• APA PsycInfo
• Google Scholar
• Find Cited Articles
• Find "Cited by" Articles
• Browsing Best Journals
• Psychology Journals
• Is it Peer Reviewed?
• Interlibrary Loan

The power of APA PsycInfo Subject Searching

To focus your searches using APA PsycInfo try the following commands:

Also consider using the NOT command which eliminates all results with the word that follows it.

e.g.,   the search        "social media"  AND Meta NOT "meta-analysis"

... returns results that contain both the phrase " social media " and Meta , but not the phrase " meta-analysis "  The " N " command (proximity) only returns results where search terms appear within a specified number of words from each other:

e.g.,  the search:         "social media"  N4  algorithm ... returns results where the phrase social media is within four words of the word algorithm .

   ===   ===   ===   ===   ===   ===   ===   

A powerful technique to use in APA PsycInfo is " subject " searching.  If you perform a keyword search on "disabilities" and "reading".  This search returns over 8,000 results - many not particularly focused on either "disabilities" or "reading".

However, if you look at the " Subjects " listing under search results that look promising you will find specific subject terms that are linked with that article e.g., Learning Disabilities, Reading, Reading Achievement, Reading Comprehension, Reading Development, Reading Disabilities, Reading Skills, Reading Speed, etc.

Each "Subject" heading such as Reading Disabilities indicates that an article is particularly focused on that concept - making subject searching much more powerful than keyword search (or Google Scholar searching).

So start with a keyword search in APA PsycInfo ... then identify some potentially useful subject terms ... and then repeat the PsycInfo search limiting to the subject heading by changing the dropdown menu to SU Subjects  

Other Options

You might also try limiting your search terms to either AB Abstract or TI Title ... especially if there are no obvious or effective subject headings to choose from.

Before you search - you may wish to limit your search to “Scholarly (Peer Reviewed) Journals.”   

To limit to “Scholarly (Peer Reviewed) Journals” be sure to check the box labeled “Scholarly (Peer Reviewed) Journals” farther down the search screen:

Finding Empirical or Experimental Research using APA PsycInfo

You can use APA PsycInfo to search specifically for empirical research - articles that report an actual experiment or study.  To find research articles t ype in your search and then - using the " Methodology " option at the bottom of the search page - limit your search to  the option " EMPIRICAL STUDY "

Limiting to More Specific Types of Empirical Research.

You can also use the Finding Empirical or Experimental Research using APA PsycInfo search option to focus on more specific types of research such as a  Qualitative Study or  Quantitative Study.

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Psych 01 - General Psychology: Types of Journal Articles

• Research Process
• Magazines/Journals
• Types of Journal Articles
• Article Databases
• Web Resources
• Citation Overview
• APA Citation 7th Ed.
• Scholarly Journal Articles Handout

Scientific Literature

You will find two types of research articles in peer-reviewed science journals: primary and secondary.

Primary research  articles describe original research written by the researcher(s) of the study. A research article explains the topic, purpose of the study, the demographics of the groups studied, how the study was conducted (methodology) and data collected, the results of the study and why the research is valuable.  These include experiments, observations, case studies, and surveys. The following are examples of peer reviewed/refereed research articles:

• Original Research Case Study Example
• Original Research Survey Example
• Original Research Double-Blind, Placebo-Controlled Trial Example

Review Arizona State University's Ask A Biologist  website to learn more about how to identify an original research article by its components.

Secondary research  provides a summary and/or analysis of original scientific research. The most common type of secondary research articles are review articles (literature, systematic review, meta-analysis). These types of articles summarize a number of research studies in a particular area and provide analysis on the research as a whole. 

• Review Article Example

Image from Tacoma Community College

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Psychology: Original Research & Research Methods

• Getting Started
• Using the Catalog & Library
• Articles & Databases
• Developmental Psychology & Child Development
• Social Psychology
• Statistics, Data, and Demographics
• Original Research & Research Methods
• Evaluating Your Resources
• Keeping Track of & Citing Sources
• Ornstein-Sloan, Family Caregiving Across the Lifecycle
• Ornstein-Sloan

Conducting Primary Research

Primary research refers to your original research, specifically the information that you collect and analyze from the field. This includes conducting interviews, designing surveys, and observations. Use this page and check out the Purdue link below to learn more.  

• Purdue: Conducting Primary Research

Resources for Writing It Up

Books to consider, doing qualitative research, measures for clinical practice and research, methods that matter, principles of research in behavioral science, qualitative research in psychology, qualitative strategies for ethnocultural research, research design, research methods, associations to learn more.

• American Psychological Association (APA) Databases Methodology Field Value

• Qualitative Research Guide from USC Libraries
• Qualitative and Mixed Methods Research Post from monthly e-newsletter of the APA Science Directorate.

You can search the catalog for books and articles on specific types of research or on mixed methods. Try searching by these subject headings to find more: 

• Mixed methods research.
• Qualitative research.
• Quantitative research.
• Research - evaluation. 
• Research - methodology.
• Research design.

Primary Research Resources

• Questionnaires & Surveys
• Statistics & Data

Interviews are a great way to gather qualitative information from subjects. Check out the links below to learn more about conducting interviews and get tools to help you build yours.

• A Guide to Interview Guides from Michigan State University Learn more about how you can direct an interview toward the topics and issues you want to learn about.
• Interviewing - Purdue OWL Learn more about different types of interviews.

Questionnaires and surveys can help you collect information from specific population groups in a much more structured manner than an interview.

A questionnaire is a set of questions with a choice of answers used for a survey. A survey can be used to gather information about a specific topic or issue.

There are many different ways that you can conduct a survey; check out the sources listed below to learn more.

• Things to Consider When Conducting Surveys - From Purdue OWL

Statistics, data, and demographics are considered primary sources. They are primary because they are the raw materials from which scholars in the field will draw their own analysis and conclusion. Looking for data-sets to work with? Looking for ways to access Statistics, Data, and Demographics? Try one of these resources:

• Data & Statistics on the Gender and LGBTQ Guide
• Data & Statistics on the Immigrant and Refugee Studies Guide
• Data & Statistics on the Latin American and Latino/a Studies
• Health Statistics & Demographics on the Health Sciences Guide
• Polls, Statistics, Data on the Political Science Guide

The Common Rule & Institutional Review Board (IRB)

Sarah Lawrence IRB

"The purpose of the Sarah Lawrence IRB is to support the practice of ethically sound scientific research with human participants by faculty, staff, and students of Sarah Lawrence College." Simply put, the IRB is in place to make sure the Sarah Lawrence community follows the regulations outlined in the Common Rule.

• MySLC IRB Information Must be logged in to view.

What is this?

When working with human subjects it is necessary to follow the Common Rule (Federal Policy for the Protection of Human Subjects). The requirements and the regulations of the Common Rule are set forth in Title 45 Public Welfare, Department of Health and Human Services, National Institutes of Health, Office for Protection from Research Risks, Part 46 Protection of Human Subjects . The federal government created these regulations to protect human research subjects. The Common Rule is heavily influenced by the Belmont Report and was preceded by the Nuremberg Code and Declaration of Helsinki .

Why does it matter?

After discovering the Nazi experimentation that took place during World War II it was decided that regulations were needed to dictate appropriate behavior on human subjects. That is when the Nuremberg Code was written. In the United States more stringent regulations and the founding of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research were preceded by the Tuskegee Study . 

These horrible injustices, along with others, are the reason that the Common Rule is so important when conducting research on human subjects.

• Federal Policy for the Protection of Human Subjects ('Common Rule')

Ethics & Responsible Conduct of Research (RCR)

• Ethical Principles of Psychologists and Code of Conduct
• Responsible Conduct
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• Howard Community College Library
• Library Resources & Services
• Subject Guides
• Psychology Subject Guide
• Primary Original Research Articles

Psychology Subject Guide: Primary Original Research Articles

• Quick Start
• Background Info
• Books & Media

What is a Primary Original Research Article?

Parts of a primary original research article, searching databases for primary original research articles.

• Cite & Write
• Basic Rules
• In-Text and Parenthetical Citations
• Background Sources
• Media - Images & Artwork
• Media - Video & Music

Are you looking for a primary original research journal article ?

If so, then you need to search for a peer-reviewed or scholarly journal article that:

• reports a research study written by the actual researchers who did the study.
• follows a structured reporting style.

Primary research articles can be identified by a commonly used format or structure. Primary research articles will often contain:

• Title and Author Information - provides the main idea of the article and authors are listed, along with their credentials
• Abstract - provides a summary of the research article. This is useful for quickly determining if the article is relevant to your research.
• Introduction or Literature Review - states the purpose of the research, may provide a summary of other research related to the topic, and may state a hypothesis or research question.
• Methods or Methodology - describes how the research was conducted, with details about who participated in the study, the procedure, what was measured, and how it was measured. Note: A methods section indicates that a study is original research and that the article is a primary source.
• Results - research findings are presented with results displayed using tables, charts, or figures along with a written explanation. Note: A results section  usually indicates that a study is original research and that the article is a primary source.
• Discussion or Conclusion - explains how the results answered the research question and may suggest future areas for research.
• References, Bibliography or Works Cited - lists the publications that the authors cited in the article.
• Parts of a Primary Research Article

Primary original research studies are available in many of the Library's databases, but you may want to consider searching databases in your subject area .

Most databases do not allow you to limit your search to primary original research only - you will need to search for peer-reviewed or scholarly articles on your topic and then look through the search results to find articles that describe primary original research.

Search Tips: Adding Keywords to Your Search

Adding certain keywords to your search may improve your chances of finding primary original research articles:

• results and method*
• pet therapy and results and method*
• teens and marijuana and experiment
• children and television and study
• domestic violence and empirical
• research and developmental college students

Search Tips: CTRL+F or Command+F

Control + F (PC) or Command + F (Mac), is a keyboard shortcut for the Find command.

If you're in a web browser and need to find where a word appears on a web page:

• press Control+F (PC) or Command+F (Mac) to bring up a search box;
• type in the word method & the web page will show where that term first appears on the web page - you may need to use the search box's next arrow to see additional uses of the word method on the web page.
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• Systematic Review
• Open access
• Published: 30 May 2024

The effectiveness of interventions for offending behaviours in adults with autism spectrum disorders (ASD): a systematic PRISMA review

• Jody Salter 1 , 2 &
• Sarah Blainey 1 , 3  

BMC Psychology volume  12 , Article number:  316 ( 2024 ) Cite this article

134 Accesses

1 Altmetric

Metrics details

Previous research has suggested that the core features of autism spectrum disorders (ASD) may contribute to offending behaviours and increased vulnerability within the Criminal Justice System. To date, there is a paucity of evidence assessing the effectiveness of interventions for offending behaviour in adults with ASD but without co-occurring intellectual disability (ID) across a broad range of forensic settings. The lack of robust evidence is concerning, as limited effectiveness may contribute to an increased likelihood of prolonged incarceration, particularly in the most restrictive settings. A PRISMA systematic review was conducted with a narrative synthesis to: (a) evaluate the evidence of the effectiveness of interventions aimed at reducing recidivism, (b) assess whether the core features of ASD impact the effectiveness of these interventions, and (c) identify additional factors that may affect the effectiveness of interventions within this population. Seven studies involving ten male participants were identified. The findings suggest that interventions for offending behaviours in adults with ASD without intellectual disability (ID) are largely inadequate, and that core ASD features need to be considered. Additionally, a complex interplay of risk factors potentially impacting intervention effectiveness was suggested. Limitations include heterogeneity across intervention types, measures of effectiveness, and what constitutes effectiveness. Despite the limited number of studies and data quality, the review aligns with a growing body of literature highlighting vulnerability and a need for evidence-based interventions for people with ASD. The review also discusses the broader implications of ineffective interventions.

Peer Review reports

Introduction

Autism spectrum disorders (ASD) represent a group of complex and highly heterogeneous neurodevelopmental disorders. A diagnosis of ASD is based on the presence of two core features: impairments in social communication and interaction (SCI), and restrictive and repetitive behaviours (RRBs) [ 1 ].

Phenotypic manifestations of the core features often present with varying degrees of social disengagement, difficulties in establishing and sustaining relationships, social naivety, lack of eye contact, and difficulties in interpreting facial expressions [ 2 ]. RRBs manifest as intense and highly restrictive special interests, a strong inclination for environmental consistency [ 3 ], cognitive rigidity, and hyper-or hypo sensory responses to the environment [ 4 ].

Additional factors modulate and influence these core features, including the extent of sensory and motor impairments, language and cognitive abilities, adaptive functioning, gender and the presence of co-occurring psychiatric disorders [ 5 , 6 , 7 ]. The increasing recognition of ASD has resulted in significantly higher diagnosis rates across all age groups [ 8 ], which are currently estimated to be 1 in 57 in England [ 9 ]. Consequently, this increase in diagnoses has led to a greater representation of individuals with ASD within the criminal justice system (CJS).

ASD in the criminal justice system

An increasing body of research has highlighted the significant vulnerability experienced by individuals with ASD while navigating the CJS. This vulnerability becomes evident throughout multiple stages of the criminal justice process, ranging from initial encounters with police [ 10 ] through to police interviews [ 11 ], to court room proceedings [ 12 ] and prison services [ 13 ]. This heightened vulnerability is exacerbated by the reported general lack of understanding of ASD within the CJS, among both professionals and the general public [ 13 , 14 , 15 , 16 ].

Individuals with ASD and co-occurring intellectual disability (ID) are often identified and diverted from the criminal justice system (CJS). This is due to a recognition of their reduced culpability, a result of impairments in both intellectual and adaptive functioning [ 15 ]. In contrast, individuals with ASD but without co-occurring ID, the population on which this review focuses, exhibit significant deficits in adaptive functioning despite their intellectual capabilities. This difference is often referred to as the IQ functioning gap and is unique to individuals with ASD [ 17 ]. Despite impairments in adaptive functioning, this population is considered intellectually capable. Therefore, they are generally perceived as culpable and sufficiently competent to navigate the complexities of the CJS and receive a fair trial. This contrast raises further questions concerning culpability ranging from criminal responsibility to the appropriateness of sentencing.

Following conviction, when an offence has met the custody threshold, offenders with ASD are typically diverted to the community or prison. Alternatively, if detained under the Mental Health Act 1983 (the legislative framework governing mental healthcare and treatment in England and Wales), they may be detained in a secure hospital environment (classified as low, medium, or high security).

Estimating the prevalence of ASD within the UK prison population is difficult because of a lack of routine assessment; nonetheless, ASD is estimated to range between 1% and 4.4% [ 5 ]. Research has shown a disproportionately high prevalence of ASD in secure hospital settings (6.5%), exceeding the estimate for the general population [ 18 ].

Qualitative studies examining the experiences of prisoners with ASD without co-occurring ID have highlighted their increased vulnerability to bullying, exploitation, and social anxiety in prison [ 13 ]. In addition, research aimed at evaluating the prevalence of the broader autistic phenotype among a prison population, as well as comparing their mental health characteristics to those without, revealed a significant risk of self-harm and suicide in individuals presenting with autistic traits. Within this cohort, of the 240 prisoners assessed, 46 displayed significant autistic traits, with 12 meeting the diagnostic criteria for ASD. Notably, only two of these individuals had been previously recognised by the prison as having ASD. This finding highlights the under recognition of ASD and emphasises the heightened vulnerability of this population to a range of mental health risks within the prison environment [ 5 ].

Although it may be logical to assume that a secure hospital setting may better meet the treatment needs of people with ASD than a prison setting, current evidence suggests otherwise. Concerns have been raised, including the high likelihood of long-term seclusion in people with ASD compared to those without ASD [ 19 ] and significantly longer than average stays within secure hospital settings [ 20 ].

Despite several initiatives aimed at improving the recognition of ASD within the prison population [ 21 ], a recent UK government report on ‘neurodiversity’ [ 22 ], a term encompassing various conditions that fall into the broader category of neurodevelopmental disorders (NDDs) including ASD, highlighted three notable areas of concern. These included a greater likelihood of neurodivergent individuals being held on remand, inappropriately pleading guilty, and judges often failing to recognise a defendant’s neurodivergence as a mitigating factor when sentencing. These findings demonstrate that much work is needed to address the challenges faced by individuals with ASD and neurodivergent conditions in the CJS.

ASD and risk of offending

While there is insufficient evidence to suggest that individuals with ASD are at greater risk of engaging in offending behaviours [ 23 ], it has been suggested that the core features of ASD may contribute to the risk of offending behaviours [ 24 , 25 ]. Risk factors for offending behaviour in the general population are associated with the cumulative influence of various factors, including alcohol and drug abuse, low socioeconomic status, mental disorders, adversity, child abuse, and traumatic brain injury [ 26 , 27 , 28 ]. Less is known about the risk factors for offending behaviour within the ASD population, with the exception of co-occurring psychiatric disorders, such as personality disorders and psychosis [ 5 ].

Research suggests that individuals diagnosed with ASD early in life face barriers to services throughout their lifespan, resulting in unmet education, health, and therapeutic needs [ 29 , 30 ]. Research suggests that certain demographic groups, such as women [ 31 , 32 ], individuals from ethnic minorities, and those from lower socioeconomic backgrounds [ 9 , 33 ], are far more likely to be underdiagnosed. This in turn increases the risk of unmet needs [ 34 , 35 ]. These factors may contribute as variables that collectively increase the overall cumulative risk of engaging in offending behaviours.

Forensic interventions

Interventions for offending behaviour often use cognitive-behavioural techniques to reduce recidivism, with an emphasis on perspective-taking, self-and relationship management, and problem solving. In the United Kingdom, the Ministry of Justice requires a sufficient evidence base for the accreditation of forensic interventions. This accreditation aims to promote high-quality programs in prisons and community settings to reduce recidivism [ 36 ].

Cognitive behavioural therapy (CBT) is widely recognised as one of the most effective interventions for offending behaviours [ 37 ]. There is evidence that CBT reduces recidivism by 20–30% in the general offending population [ 38 , 39 ]. However, there is little evidence to support the effectiveness of such interventions for offending behaviour in forensic secure settings, often yielding inconsistent findings [ 40 ].

Beyond forensic settings, evidence suggests that adapted CBT is effective for individuals with ASD [ 41 , 42 ]. These adjustments are necessary due to the core features of ASD and challenges in areas such as perspective taking and cognitive rigidity, both of which are conducive to successful therapeutic outcomes in this population [ 43 ]. Additionally, evidence supports the use of social skills training [ 44 ] and group-based social skills interventions in adults with ASD [ 41 ] However, there is no consensus regarding the specific adaptations most beneficial for individuals with ASD.

Furthermore, the lack of appropriate outcome measures has been reported to be a barrier to determining the effectiveness of interventions within secure forensic hospital settings [ 45 , 46 , 47 ]. Despite the evidence for CBT use within the general offender population and for individuals with ASD outside forensic settings, there are reports that the implementation of these interventions is not effective for individuals detained within secure hospital settings [ 19 , 48 , 49 ].

The increasing recognition of the vulnerability of individuals with ASD within the CJS highlights the urgent need for a systematic evaluation of the effectiveness of interventions for offending behaviours in adults with ASD. While previous research has examined interventions for individuals with ASD and co-occurring ID [ 49 ], a significant research gap remains regarding the effectiveness of forensic interventions for individuals with ASD but without co-occurring ID [ 14 ].

This systematic review aims to address this gap by conducting a comprehensive evaluation of intervention effectiveness in an ASD population without co-occurring ID.

Research aims

This systematic review is guided by the following research objectives:

To systematically review and evaluate the effectiveness of interventions for offending behaviours in adults with ASD without co-occurring ID, as reported in the literature;

To ascertain whether the core features of ASD impact the effectiveness of the identified interventions; and.

To identify additional risk factors that may impact the effectiveness of interventions in this population.

Inclusion criteria

Each potentially eligible study was screened based on the inclusion and exclusion criteria described in the PICO framework below [ 50 ].

Population.

Participants included adults aged 18 years and older diagnosed with ASD, as defined by the authors in the literature. Studies involving participants with co-occurring ASD and ID and those that did not differentiate between these two populations were excluded.

Intervention & Outcomes.

Our review aimed to identify studies that objectively and/or subjectively measured the effectiveness of therapeutic or pharmacological interventions for reducing recidivism in individuals with ASD exhibiting offending behaviours. These included interventions delivered in all categories, namely, prisons, probation supervision, and secure hospitals.

Study Design and Comparison.

All primary research studies were included, regardless of publication date or country of origin. Studies that were peer-reviewed (e.g., grey literature and conference abstracts), systematic reviews, and those not published in English were excluded. An inclusion-exclusion criterion related to the type of comparison conducted in individual studies was not imposed.

Search strategy

The search was conducted on the 27th of March 2021 across five databases, covering a broad timeframe and utilising international terminology. The databases included:

Embase (1974 to 2021).

Ovid MEDLINE(R) and Epub ahead of print, In-process, In data-review and other Non-Indexed Citations.

Ovid MEDLINE(R) Daily.

Global Health (1973 to March 2021).

APA PsychInfo (1806 to February 2021).

Furthermore, a web-based search using Google Scholar was conducted with the same search terms. The first 15 pages of results were manually reviewed; however, no additional studies meeting the inclusion criteria were found. Additionally, the reference lists and citations of relevant reviews were manually checked, but this did not yield any further eligible studies.

Data selection and extraction

The data selection and extraction processes consisted of two stages:

During Stage 1, potential eligible studies were screened based on their titles and abstracts against the predefined inclusion and exclusion criteria. Owing to the limited number of results, the screening process was performed manually and repeated one week later to increase accuracy.

Stage 2 involved a comprehensive review of the full texts of the selected studies to confirm their alignment with the inclusion criteria. Relevant data were extracted and organised into spreadsheets using Microsoft Excel.

PRISMA flow diagram of searches of databases and registers only

Consistent with the primary aim of this systematic review, the first outcome measure is the effectiveness of the identified forensic interventions, measured by a reduction in recidivism. While reducing recidivism is the principal goal of forensic interventions, it is often viewed as a proxy measure that may not fully capture the complexity of offending behaviours, particularly in cases of crossover crime [ 46 , 51 ]. To address this limitation, additional relevant measures contributing to reduced recidivism were collected to allow for a preliminary assessment of intervention effectiveness. These additional measures included variables such as a reduction in security levels within institutional settings (i.e., medium to low security) or significant positive changes compared to baseline measurements recorded before and after the intervention.

The second aim of this review was to examine whether the core features of ASD present barriers to the rehabilitation process. To achieve this objective, data concerning the interactions between impairments in social communication and interaction (SCI) and restrictive and repetitive behaviours (RRBs) in relation to interventions within individual studies, as described by clinicians were collected and analysed.

Thirdly, this review aimed to identify additional risk factors described within findings that may influence the effectiveness of the interventions. The aim of the analysis is to provide a more comprehensive understanding of collective risk factors and their interactions with intervention effectiveness assessed through narrative synthesis. In addition, the data collected included the study design, author, and country of origin. When reported, participant demographics, such as age, gender, offence, ethnicity, and socioeconomic status, were reported. The intervention data included the type of intervention used, setting, duration, and frequency, only when available.

Study risk of bias assessment

The Mixed Methods Appraisal Tool (MMAT) [ 52 ] is a comprehensive tool for critically evaluating various research methods. The methodological quality of each study and the potential risk of bias were assessed using the MMAT. The results of this assessment are presented in tabular form (Table  2 , ‘MMAT Quality Appraisal’, appendix).

Synthesis method

A narrative synthesis [ 53 ] was used for this review as a meta-analysis was not appropriate because of the significant heterogeneity between studies. The synthesis process began with a preliminary analysis, in which the data were extracted and presented in tabular form to provide a summary of the findings and to identify potential patterns within the data. A guided conceptual framework was constructed based on the narrative synthesis of the primary data. This framework aimed to assess both the similarities and differences between the included studies while exploring emerging thematic elements.

Study selection

The initial database search returned 2,551 results after removing duplicates, as shown in Fig.  1 of the PRISMA flow diagram, which depicts the flow of information at each stage of the systematic review search. Subsequent screening included an initial assessment of the titles and a subsequent assessment of the abstracts, which led to the exclusion of an additional 2,530 articles. To ensure accuracy, abstract screening was repeated one week later. Subsequent full-text eligibility screening excluded 14 additional studies. The reasons for exclusion included the following: (a) participants under 18 years of age ( n  = 4), (b) lacked differentiation between the ID and ASD populations ( n  = 4), (c) were differentiated but not described in the context of the results ( n  = 2), (d) measurement of interventions for self-harm and suicide among offenders with ASD rather than for offending behaviour ( n  = 1), and (e) removal of commentary papers ( n  = 3). Consequently, the final number of included studies from the initial database search was seven ( n  = 7).

Study characteristics

Among the seven studies identified, three were case reports ( n  = 3), two were qualitative studies ( n  = 2), and two were quantitative case series ( n  = 2). These studies jointly assessed the effectiveness of the various interventions. The total sample size of all the studies was limited to 10; all the participants were men, and demographic information was limited. It is worth noting that despite the use of international terminology in the search criteria, all seven articles described studies conducted exclusively in southern England, United Kingdom (UK). In these studies, all participants, apart from one were held in secure hospital units under the provisions of the Mental Health Act 1983. The most prevalent types of offending behaviours observed were sexual offences ( n  = 4), followed by manslaughter ( n  = 3), and arson ( n  = 3).

Table  1 ‘Summary of Findings’ provides a summary of each study included in the systematic review. The summary includes author information, available participant demographics, offence type, setting, detainment status (i.e., under the mental health act), intervention approach, study findings, intervention effectiveness, measurement used to assess effectiveness, and whether there was evidence to suggest that the core features of ASD impacted the effectiveness of forensic intervention(s). These are separated by impairments in social communication and interaction (SCI) and restrictive and repetitive behaviours (RRBs).

Risk of bias in studies

The methodological quality of the studies was assessed using the MMAT [ 52 ] (Table  2 , ‘MMAT Quality Appraisal’, appendix). Each of the three case reports received a 3-star rating, indicating a moderate risk of bias and meeting 75% of the qualitative MMAT criteria [ 54 , 55 , 56 ].

The two quantitative case series were found to be at a higher risk of bias due to difficulties in distinguishing the treatment groups, recruitment difficulties, lack of a control group, and incomplete outcome data for the ASD group without co-occurring ID. They received a 2-star rating, meeting 50% of the MMAT quantitative criteria [ 58 ].

The second quantitative study [ 57 ], raised concerns about the validity and reliability of outcome measures, which were originally designed for the ID population but applied to the ASD group without co-occurring ID. This study also received a 2-star rating and met 50% of the MMAT’s quantitative criteria.

The remaining qualitative studies received a 3-star rating, meeting 75% of the MMAT criteria. The first evaluated intervention effectiveness from the perspective of the clinicians who delivered the therapeutic program [ 59 ]. The second assessed offenders’ views via self-report, which carry a potential risk of response bias [ 60 ].

Selection bias was observed in studies that combined ID and ASD populations. Overall, it was difficult to establish a causal relationship between the interventions and outcomes.

Notably, not all the studies reviewed explicitly documented obtaining informed consent from participants. The discrepancy in informed consent between studies, particularly in restrictive forensic settings, presents challenges extending beyond ethical considerations. Such discrepancies may compromise the validity of intervention comparisons, introduce biases in participant selection, and undermine the reliability of data.

Interventions

The interventions examined across the reviewed studies were diverse, as presented in Table  3 , titled ‘Summary of Interventions’.

Three studies incorporated both pharmacological and psychological interventions. Specifically, antipsychotics were used to address co-occurring psychosis, contributing to instances of offending behaviour [ 55 ]. Antipsychotics were also used to manage stress-induced psychosis [ 56 ]. In the context of directly treating offending behaviours, two distinct medications were applied in cases of sexual offending, each with different mechanisms of action [ 54 ] (Table  3 ).

Four studies relied exclusively on psychological interventions [ 57 , 58 , 59 , 60 ]. Among these, two studies implemented adapted forms of CBT. Specific details regarding the non-standardised adaptations used in CBT were not provided by the study author, except that individual delivery was necessary due to difficulties encountered within group settings [ 54 , 56 ].

The third study that incorporated CBT included elements similar to those of the Adapted Sex Offender Treatment Program (A-SOTP) [ 58 ]. The effectiveness of the A-SOTP was described in two studies [ 59 , 60 ]. Furthermore, the Equipping Youth to Help One Another (EQUIP) was adapted and piloted for use with individuals with ID and developmental disabilities (DD) who had committed sexual offences [ 57 ]. Supplementary interventions included speech and language therapy to facilitate communication [ 55 ], occupational therapy to address impairments in executive functioning [ 55 , 56 ] and art therapy [ 54 ].

Table  3 visually depicts a summary of the diverse interventions extracted, reviewed, and categorised according to intervention type: pharmacological, psychological, and supplementary intervention approaches. In addition, the table includes the type of offence, studies using intervention, underlying mechanism of action or theory, evidence base supporting intervention, and measurements used to assess effectiveness.

Measurements

Numerous approaches were adopted to measure effectiveness across the studies. Two studies measured effectiveness by reduced recidivism and the need to repeat the intervention. Other studies utilised a range of standardised measurements to evaluate psychological interventions. For example, one study [ 54 ] employed the Behavioural Status Index (BSI) every six months as a measurement tool. In contrast, another [ 56 ] employed the State Trait Anger Expression Inventory (STAXII II) and the Millon Multiaxial Personality Inventory (MMPI), combined with standardised risk assessment, one-year postintervention.

Regarding pharmacological interventions, one case report used a combination of subjective and objective measurements. These included self-reports and the systematic monitoring of inappropriate glancing behaviours over time by staff members [ 54 ]. In another instance, the reduction in verbalised delusions served as a measure of the effectiveness of antipsychotic medication [ 55 , 56 ].

The effectiveness of interventions such as the A-SOTP was assessed differently across the two studies. In one study, effectiveness was evaluated through clinician views [ 59 ], while in the other, effectiveness was determined by the participants’ subjective experiences with the intervention [ 60 ].

In the case of CBT, which shares similarities with A-SOTP, standardised measures were applied both pre- and post-intervention. These measures consisted of sexual attitudes consistent with sexual offending (QACSO), sexual offenders’ self-appraisal scale (SOSAS), the sexual attitudes and knowledge scale (SAKS), and the victim empathy scale-adapted (VES-A) [ 58 ].

The EQIP study, which also focused on sexual offending [ 57 ], assessed effectiveness by examining improvements in baseline scores on standardised tests related to moral reasoning, cognitive distortions, problem-solving abilities, and anger. In addition, a move to a lower security level was considered an indicator of overall effectiveness. Furthermore, in a case study that included speech and language therapy, the clinician’s subjective view of improved communication within the secure unit served as a measure of the intervention’s effectiveness [ 55 ].

Among the seven studies reviewed, only one pertaining to an arson offence considered the intervention(s) effective. In this case, a pharmacological intervention was used to treat co-occurring alcohol-induced psychosis, and the unspecified antipsychotic proved successful in reducing delusions. Furthermore, speech and language therapy aimed at improving communication skills was also deemed to be effective [ 55 ].

However, the remaining six studies, which included a total of nine participants, concluded that the interventions were largely ineffective. One case report addressing sexual offending behaviours used pharmacological interventions. The first involved cyproterone acetate, a testosterone inhibitor, however, the outcome could not be conclusively determined owing to adherence and dosage issues [ 54 ]. In the second, the selective serotonin reuptake inhibitor (SSRI) fluoxetine was deemed ineffective, as inappropriate behaviours did not significantly decrease [ 54 ]. It is worth noting that the evidence for both of these drugs has since been described as insufficient to guide clinical practice, with cyproterone acetate considered inadequate [ 61 ], and the evidence for fluoxetine has not been fully determined [ 62 ].

Among the two studies that utilised the A-SOTP and a similar form of CBT for sexual offending, one participant repeated the intervention program six times and subsequently re-offended and a further two participants repeated the yearlong intervention program and reoffended [ 58 ]. These findings are consistent with the results of the study that assessed clinician views [ 59 ]. Even in the case of CBT, as used in two studies, the intervention was deemed ineffective despite adaptations made to accommodate individuals with ASD [ 54 , 56 ].

ASD core features and impact upon intervention effectiveness

The application of a narrative synthesis facilitated the identification and extraction of recurring patterns within the data. These patterns were evident across all the studies, highlighting the considerable challenges posed by impairments in social communication and interaction (SCI) and the presence of restrictive and repetitive behaviours (RRBs) on the effectiveness of interventions, as depicted in Fig.  2 .

Impact of The Core Features of ASD upon Intervention Effectiveness. Note. This describes the core features of ASD, both ‘impairments to SCI’ and ‘presence of RRBs’, and their impact upon intervention effectiveness as extracted from studies

Additional factors impacting intervention effectiveness

In addition to the core features of ASD, this review sought to identify additional risk factors that may influence the effectiveness of the intervention(s). Potential risk factors highlighted by the authors of each study were collected, and through narrative synthesis, several recurring themes emerged from the data. Co-occurring personality disorders and psychosis [ 55 , 56 ], were identified as potential factors impacting intervention effectiveness, as described within the literature. Additionally, events such as childhood adversity, sexual abuse, trauma, and having a dysfunctional family life were described as potential contributors [ 58 ]. Late diagnosis of ASD was theorised to lead to maladaptive coping skills deriving from unmet needs, which were described in three of the studies [ 54 , 55 , 56 ].

An overarching theme identified across the majority of the seven studies was the insufficiency of service provision, staff expertise, and the evidence base.

The present systematic review identified seven studies with ten participants who underwent forensic interventions aimed at reducing offending behaviours in adults with ASD, particularly those without co-occurring ID. The principal aim of this review was to evaluate the effectiveness of these interventions. The secondary aim was to examine whether the core features of ASD have an impact on the effectiveness of these forensic interventions and to identify other variables that may impact the overall effectiveness of interventions.

Regarding the first aim, the evidence suggests that the interventions reviewed were inadequate. However, these findings should be treated with caution not only because of the small sample size but also because of limitations in the generalisability of the findings. Despite an extensive literature search, all the studies were conducted in southern England, UK, and included only male participants. In addition, all participants, with the exception of one individual living in the community, were detained within secure hospital settings under the provisions of the Mental Health Act (1983). This highlights the lack of data from prison and the probation service, which limits the scope of the review. Furthermore, this review highlights a critical lack of research within this domain. Even when the literature was identified, it was often of inadequate quality owing to various design limitations. The significant heterogeneity between studies, each utilising distinct intervention methods and tools for measuring intervention effectiveness, illustrates a notable lack of standardisation in both clinical and research methodologies within this field. This lack of consistency aligns with broader research on mental health in individuals with ASD [ 45 , 46 ]. Nonetheless, the forensic domain faces additional challenges, such as the lack of randomised control trials, which means that the effectiveness of interventions is difficult to fully determine. These challenges are exacerbated by unavoidable confounding variables, the risk of bias, and the ethical implications of a no-treatment group [ 66 ], all of which contribute to the lack of evidence.

The secondary aim was to examine the potential impact of the core features of ASD on the effectiveness of interventions designed to reduce recidivism. The data patterns identified through narrative synthesis consistently emerged across all studies, highlighting the significant challenges posed by impairments in social communication and interaction (SCI) and the presence of restrictive and repetitive behaviours (RRBs). These challenges highlight the general inappropriateness of forensic interventions within this population.

The third and final aim was to identify factors, beyond the core features of ASD, that may influence the effectiveness of interventions. Throughout the studies, a recurring theme emerged, highlighting significant systemic factors impacting intervention effectiveness. These include issues such as a shortage of government funding leading to inadequate service provision, the question of whether ASD and ID services should be combined, and the substantial unmet needs throughout the lifespan of individuals with ASD, all of which affect the success of forensic interventions. While the core features of ASD are significant, they may not be the primary cause of intervention failure. Rather, they seem to be contributing factors within a broader and more complex array of variables that collectively impact the overall effectiveness of these forensic interventions.

Implications

The inadequate provision of forensic services carries significant implications, especially when prolonged detainment becomes necessary due to the shortcomings of forensic interventions. Such deficiencies may subject individuals with ASD to non-evidence-based interventions, often repeatedly [ 56 , 58 ]. This then increases the likelihood of these individuals being labelled as ‘unrehabilitated,’ potentially leading to extended periods of detainment. Consequently, this creates a counterproductive cycle that not only exacerbates the economic burden but also raises serious concerns about human rights and the potential legal consequences of prolonged confinement.

These issues underscore fundamental questions about the fairness and adequacy of the legal system. Therefore, addressing these knowledge gaps and the lack of evidence-based approaches are crucial to ensuring a more equitable criminal justice system for individuals with ASD.

Future research

This review identifies several key areas for future research in this field. Developing evidence-based interventions tailored to the unique needs of individuals with ASD is crucial. Establishing a consensus on the measurements used for assessing the effectiveness of these interventions, as well as a clear definition of what constitutes effectiveness, would significantly enhance research quality.

Moreover, due to the bias towards studies conducted in southern England, the consistency of interventions for treating offending behaviours in adults with ASD in England remains unclear, especially considering the persistent regional health disparities between the North and South of England [ 67 , 68 ].

Data availability

No datasets were generated or analysed during the current study.

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Salter, J., Blainey, S. The effectiveness of interventions for offending behaviours in adults with autism spectrum disorders (ASD): a systematic PRISMA review. BMC Psychol 12 , 316 (2024). https://doi.org/10.1186/s40359-024-01770-1

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Social media use and sleep duration connected to brain activity in teens

Study finds bidirectional relationship between social media engagement, sleep duration and neural reward responses in adolescents.

A new study to be presented at the SLEEP 2024 annual meeting found a distinct relationship between sleep duration, social media usage, and brain activation across brain regions that are key for executive control and reward processing.

Results show a correlation between shorter sleep duration and greater social media usage in teens. The analysis points to involvement of areas within the frontolimbic brain regions, such as the inferior and middle frontal gyri, in these relationships. The inferior frontal gyrus, key in inhibitory control, may play a crucial role in how adolescents regulate their engagement with rewarding stimuli such as social media. The middle frontal gyrus, involved in executive functions and critical in assessing and responding to rewards, is essential in managing decisions related to the balancing of immediate rewards from social media with other priorities like sleep. These results suggest a nuanced interaction between specific brain regions during adolescence and their influence on behavior and sleep in the context of digital media usage.

"As these young brains undergo significant changes, our findings suggest that poor sleep and high social media engagement could potentially alter neural reward sensitivity," said Orsolya Kiss, who has a doctorate in cognitive psychology and is a research scientist at SRI International in Menlo Park, California. "This intricate interplay shows that both digital engagement and sleep quality significantly influence brain activity, with clear implications for adolescent brain development."

This study involved data from 6,516 adolescents, ages 10-14 years, from the Adolescent Brain Cognitive Development Study. Sleep duration was assessed from the Munich Chronotype questionnaire, and recreational social media use through the Youth Screen Time Survey. Brain activities were analyzed from functional MRI scans during the monetary incentive delay task, targeting regions associated with reward processing. The study used three different sets of models and switched predictors and outcomes each time. Results were adjusted for age, COVID-19 pandemic timing, and socio-demographic characteristics.

Kiss noted that these results provide new insights into how two significant aspects of modern adolescent life -- social media usage and sleep duration -- interact and impact brain development.

"Understanding the specific brain regions involved in these interactions helps us identify potential risks and benefits associated with digital engagement and sleep habits," Kiss said. "This knowledge is especially important as it could guide the development of more precise, evidence-based interventions aimed at promoting healthier habits."

The American Academy of Sleep Medicine recommends that teenagers 13 to 18 years of age should sleep 8 to 10 hours on a regular basis. The AASM also encourages adolescents to disconnect from all electronic devices at least 30 minutes to an hour before bedtime.

This study was supported by grants from the National Institutes of Health. The research abstract was published recently in an online supplement of the journal Sleep and will be presented Sunday, June 2, and Wednesday, June 5, during SLEEP 2024 in Houston. SLEEP is the annual meeting of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

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• Orsolya Kiss, Linhao Zhang, Eva Müller-Oehring, Brittany Bland-Boyd, Anya Harkness, Erin Kerr, Ingrid Durley, Nicole Arra, Leticia Camacho, Lucas Tager, Ruby Fan, Evelyn Perez-Amparan, Marie Gombert, Jason Nagata, Fiona Baker. 0148 Interconnected Dynamics of Sleep Duration, Social Media Engagement, and Neural Reward Responses in Adolescents . SLEEP , 2024; 47 (Supplement_1): A64 DOI: 10.1093/sleep/zsae067.0148

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Strange & offbeat.

I want to keep my child safe from abuse − but research tells me I’m doing it wrong

Founder and Executive Director, Center for Violence Prevention Research; Affiliate Faculty with the Crimes Against Children Research Center, University of New Hampshire

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Melissa Bright receives funding from the Centers for Disease Control and Prevention and the World Childhood Foundation (via work with Stop it Now!).

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Child sexual abuse is uncomfortable to think about, much less talk about. The idea of an adult engaging in sexual behaviors with a child feels sickening. It’s easiest to believe that it rarely happens, and when it does, that it’s only to children whose parents aren’t protecting them.

This belief stayed with me during my early days as a parent. I kept an eye out for creepy men at the playground and was skeptical of men who worked with young children, such as teachers and coaches. When my kids were old enough, I taught them what a “good touch” was, like a hug from a family member, and what a “bad touch” was, like someone touching their private parts.

But after nearly a quarter-century of conducting research – 15 years on family violence, another eight on child abuse prevention, including sexual abuse – I realized that many people, including me, were using antiquated strategies to protect our children .

As the founder of the Center for Violence Prevention Research , I work with organizations that educate their communities and provide direct services to survivors of child sexual abuse. From them, I have learned much about the everyday actions all of us can take to help keep our children safe. Some of it may surprise you.

Wrong assumptions

First, my view of what constitutes child sexual abuse was too narrow. Certainly, all sexual activities between adults and children are a form of abuse.

But child sexual abuse also includes nonconsensual sexual contact between two children. It includes noncontact offenses such as sexual harassment, exhibitionism and using children to produce imagery of sexual abuse. Technology-based child sexual abuse is rising quickly with the rapid evolution of internet-based games, social media, and content generated by artificial intelligence. Reports to the National Center for Missing & Exploited Children of online enticements increased 300% from 2021 to 2023 .

My assumption that child sexual abuse didn’t happen in my community was wrong too. The latest data shows that at least 1 in 10 children, but likely closer to 1 in 5, experience sexual abuse . Statistically, that’s at least two children in my son’s kindergarten class.

Child sexual abuse happens across all ethnoracial groups, socioeconomic statuses and all gender identities. Reports of female victims outnumber males , but male victimization is likely underreported because of stigma and cultural norms about masculinity .

I’ve learned that identifying the “creepy man” at the playground is not an effective strategy. At least 90% of child sexual abusers know their victims or the victims’ family prior to offending. Usually, the abuser is a trusted member of the community; sometimes, it’s a family member .

In other words, rather than search for a predator in the park, parents need to look at the circle of people they invite into their home.

To be clear, abuse by strangers does happen, and teaching our kids to be wary of strangers is necessary. But it’s the exception, not the norm , for child sexual abuse offenses.

Most of the time, it’s not even adults causing the harm. The latest data shows more than 70% of self-reported child sexual abuse is committed by other juveniles . Nearly 1 in 10 young people say they caused some type of sexual harm to another child . Their average age at the time of causing harm is between 14 and 16.

Now for a bit of good news: The belief that people who sexually abuse children are innately evil is an oversimplification. In reality, only about 13% of adults and approximately 5% of adolescents who sexually harm children commit another sexual offense after five years . The recidivism rate is even lower for those who receive therapeutic help .

By contrast, approximately 44% of adults who commit a felony of any kind will commit another offense within a year of prison release .

What parents can do

The latest research says uncomfortable conversations are necessary to keep kids safe. Here are some recommended strategies:

Avoid confusing language. “Good touches” and “bad touches” are no longer appropriate descriptors of abuse . Harmful touches can feel physically good, rather than painful or “bad.” Abusers can also manipulate children to believe their touches are acts of love.

The research shows that it’s better to talk to children about touches that are “OK” or “not OK,” based on who does the touching and where they touch. This dissipates the confusion of something being bad but feeling good.

These conversations require clear identification of all body parts, from head and shoulders to penis and vagina. Using accurate anatomical labels teaches children that all body parts can be discussed openly with safe adults. Also, when children use accurate labels to disclose abuse, they are more likely to be understood and believed.

Encourage bodily autonomy. Telling my children that hugs from family members were universally good touches was also wrong . If children think they have to give hugs on demand, it conveys the message they do not have authority over their body.

Instead, I watch when my child is asked for a hug at family gatherings – if he hesitates, I advocate for him. I tell family members that physical touch is not mandatory and explain why – something like: “He prefers a bit more personal space, and we’re working on teaching him that he can decide who touches him and when. He really likes to give high-fives to show affection.” A heads-up: Often, the adults are put off, at least initially.

In my family, we also don’t allow the use of guilt to encourage affection. That includes phrases like: “You’ll make me sad if you don’t give me a hug.”

Promote empowerment. Research on adult sexual offenders found the greatest deterrence to completing the act was a vocal child – one who expressed their desire to stop, or said they would tell others.

Monitor your child’s social media. Multiple studies show that monitoring guards against sexting or viewing of pornography , both of which are risk factors for child sexual abuse. Monitoring can also reveal permissive or dangerous sexual attitudes the child might have.

Talk to the adults in your circle. Ask those watching your child how they plan to keep your child safe when in their care. Admittedly, this can be an awkward conversation. I might say, “Hey, I have a few questions that might sound weird, but I think they’re important for parents to ask. I’m sure my child will be safe with you, but I’m trying to talk about these things regularly, so this is good practice for me.” You may need to educate them on what the research shows.

Ask your child’s school what they’re doing to educate students and staff about child sexual abuse. Many states require schools to provide prevention education; recent research suggests these programs help children protect themselves from sexual abuse .

Talk to your child’s sports or activity organization. Ask what procedures are in place to keep children safe . This includes their screening and hiring practices, how they train and educate staff, and their guidelines for reporting abuse. The Centers for Disease Control and Prevention provides a guide for organizations on keeping children safe .

Rely on updated research. Finally, when searching online for information, look for research that’s relatively recent – dated within the past five years. These studies should be published in peer-reviewed journals .

And then be prepared for a jolt. You may discover the conventional wisdom you’ve clung to all these years may be based on outdated – and even harmful – information.

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The clinical generational interview. an instrument for family assessment.

• Department of Psychology, Catholic University of Sacred Heart, Milan, Italy

Interviews are the privileged tool for carrying out qualitative research and clinical assessments on family relationships. Nevertheless, there are limited examples of interviews in clinical and psychosocial literature that are explicitly aimed at the evaluation of relational-family constructs. This paper presents the essential characteristics of the Clinical Generational Interview (CGI): an original tool for investigating and evaluating family relationships, that aims to combine the complexity of the subject being studied with the systematic and rigorous approach. It was created according to the following criteria: a flexible qualitative approach, the production and relational reading of information, intersubjective measurability and control of the inferential/interpretative process, and clinical use. Although it is organized in a structured and well-defined form and provides a precise system for encoding information, it is not a test, nor an algorithm that can be used in a mechanically diagnostic sense; it is a very versatile psychological tool that can be used in two different areas: the first is related to clinical research on family and couple relationships, the second to relational assessments. The contribution illustrates the path of construction and elaboration of the instrument, considering first of all its theoretical foundations and the constructs derived from them and around which the set of items is organized. The criteria for coding and analyzing the information thus produced and the different possible areas of application are then described. Finally, the theoretical and methodological characteristics of the instrument are also considered in relation to the main interviews in the literature in order to highlight differential particularities.

1 Introduction

Interviews are the privileged tool for carrying out qualitative research and clinical assessments on family relationships. Nevertheless, there are limited examples of interviews in clinical and psychosocial literature that are explicitly aimed at the evaluation of relational-family constructs.

The contribution illustrates the Clinical Generational Interview (CGI): a tool for investigating and evaluating family relationships ( Cigoli and Tamanza, 2009 ). It aims to combine the complexity of the topic studied (family relationships) with the systematicity and rigor of an intersubjective analysis procedure. It was created according to the following criteria: a flexible qualitative approach, the production and relational reading of information, intersubjective measurability and control of the inferential/interpretative process, and clinical use.

Although it is organized in a structured and well-defined form and provides a precise system for encoding information, it is not a test, nor an algorithm that can be used in a mechanically diagnostic sense; it is a very versatile psychological tool that can be used in two different areas: the first is related to clinical research on family and couple relationships; the second to relational-generational assessments.

The CGI is built around the macro-construct of family generativity ( Cigoli and Scabini, 2006 ). This construct was chosen and conceptually defined starting from the clinical and psychosocial literature on family relationships, especially taking the acquisitions developed within the relational-symbolic model into account. Generativity is conceived as a “synthetic measurement” of the complexity of bonds and, more properly, of the quality of the exchange developed between generations. Its reference and source of information is the couple, and its implementation is divided into three dimensions (or axes) concerning the origins of each partner, the formation and development of the couple relationship and the passage and transmission to the next generation (the child(ren)).

Several years of work were required to build the CGI, and several clinical and psychosocial research teams were involved. Qualitatively discriminating items had to be chosen for each analytical dimension. Subsequently, the calculation system was constructed in order to obtain an analytical measurement method (for each dimension/axe) and a summary of the total family generativity considered. Over time, the instrument has been used to investigate different domains of family relationships, both with reference to different stages of the life cycle ( Tamanza et al., 2016 ; Gennari and Tamanza, 2018 ; Tamanza et al., 2019 ) and considering different clinical intervention contexts LIKE…( Molgora et al., 2014 ; Ranieri et al., 2016 ; Gennari et al., 2018 ). The application of the CGI to these different objects and contexts has confirmed the usability of the instrument in its structure and sequence of items and, at the same time, its adaptability about how it is applied. This concerned, in particular, the possibility of administering the CGI in a single time session, but also in multiple sessions, as well as meeting with the couple jointly, but also with individual partners.

Antecedents to the CGI can be connected to theoretical references from the psychodynamic panorama (aspects from relational psychoanalysis, gestaltism and systemic relational therapy) which, as mentioned, were then taken and translated into key concepts and a research methodology falling under the Relational-Symbolic Model ( Cigoli and Scabini, 2006 ). This paper presents the essential characteristics of the tool and the elements that distinguish it from other types of interviews, the logic that entails its use, as well as the criteria for analyzing and interpreting the information produced.

2 Comparison with other family interviews

Clinical research on family relationships has widely used qualitative methodologies, developing some interesting tools for observation and analysis of interactions. Much more limited, however, are the examples of instruments aimed at structured analysis of discursive productions that:

a. are explicitly aimed at the evaluation of relational-family constructs and, even less, attributable to the issue of generativity;

b. are organized in a structured way and provide for a specific system of analysis and information encoding.

In our exploration of the literature, we have identified six interesting tools from a conceptual and methodological point of view which are relevant for dissemination and use. Table 1 presents a summary of the various interviews considered according to the identification of constructs, the setting (or detection unit), the encoding system and the measurement system. As can clearly be observed, this is a rather varied panorama consisting of very different tools, even if they have certain similar aspects.

Table 1 . Comparing family interviews.

As for content, it should be noted that only two tools are created with synthetic constructs: the Current Relationship Interview ( Crowell and Owens, 2004 ) and the Cumberwell Family Interview ( Vaughn and Leff, 1976 ), even if only the former has a construct referring to a precise and consolidated theoretical framework. The other tools refer to a plurality of variables and dimensions which, although they make an overall reading of the themes investigated possible, are not attributable to a unitary construct, in some cases also referring to different theoretical assumptions.

There is also a high degree of variability in the measurement systems adopted in the various interviews, both in terms of the founding method (in some cases the use of quantitative systems and in others qualitative systems), and the different degree of rigor, systematicity and inference. On the contrary however, they are much more similar in terms of the “setting” and encoding unit of the information produced, which is however almost always of an individual type.

The Clinical Generational Interview differs from each of these tools in the specificity of the reference construct and its clearly relational nature, the setting to produce information, the consequent encoding unit which attributes a distinctly peculiar significance to the couple, and lastly the measurement system tethered to the semantic evaluation of the propositional content, which includes a complex articulation of quantitative and qualitative elements.

The Clinical Generational Interview is placed within a precise theoretical-methodological reference that identifies the distinctive and identity-constituting character of the family within generativity. It is a “three-dimensional macro-construct” (origins, couple, passage to the next generation) that identifies the crucial dynamic and evolutionary junction of its constitution in the couple. From a procedural point of view, it follows that the joint meeting with the couple becomes the elective setting to produce information. The interview must also be conducted using specific relational methods that take the following aspects into account:

a. management of the exchange methods to facilitate the dialogue-conversational-imaginal production of both partners in relation to the proposed themes, and respectful of the specificities of the joint setting;

b. different modulation in introducing questions and regulating communication. The first part of the Interview (related to the partners’ origins) is in fact addressed to each partner, always in the presence of the other, while the second and third parts (couple and passage) are jointly addressed to the couple. In fact, it is as if the first part is an interview “in couple” (the other partner is present and may speak) and the second an interview “of couple”;

c. the interviewer must behave in a way which solicits openness from the parental couples and their active involvement in the task they have been proposed. Dialogue is exchanged both with the interviewer and between the partners themselves, and discursive production should be encouraged and facilitated, allowing it to develop according to the progress of the couple’s exchange itself, rather than according to a rigid and mechanical sequence of questions and answers.

In other words, the Interview should be conducted with the couple using the typical style and sensitivity of clinical work.

3 The path of construction and validation of the instrument

The path of construction of the CGI was developed in three distinct and logically consequential stages (see Figure 1 ): the conceptual design of the instrument; the selection of the discriminant items and the construction of the coding system; the empirical validation of the instrument based on a normative sample.

Figure 1 . The path of construction and validation of the instrument.

The first phase of the work was carried out according to an up-down logic, that is, from a theoretical-conceptual vision assumed a priori . It consisted of two moments: the identification of the synthetic construct (generativity) and its tripartite articulation (i.e., the three analytic dimensions) and the identification of a set of verbal and imaginative stimuli. They were initially constructed by the research team during some “ideative production” sessions and then selected based on their comprehensibility and relevance through the contribution of some “focus groups” conducted with clinical psychologists and family psychotherapists. In this way, a “preliminary version” of the interview was obtained, which, in the second time, was administered to a sample of thirthy parents’ couples 1 for the purpose of verifying its usability, i.e., to assess the discriminating value of each stimulus and thus obtain an effective and manageable version of the instrument.

This second phase of work involved four steps: the construction of the coding system for each stimulus, the identification of the computational rules for measuring each axis/size, the selection of the discriminating stimuli for each axis/size, and the definition of the final version of the interview. In this second phase, the path followed a bottom-up logic, like the process of “ item analysis ” typically used in the construction of metric scales 2 , with the relevant difference that in this case it involved the development of a system of analysis and measurement of dialogic-discursive material coded in categorical terms, including also the interrelation of three different analytical measures and the construction of a single summary assessment.

This second version of the interview, significantly smaller than the preliminary version 3 , was then administered, in the third phase of the course, to a second sample 4 and the results thus obtained were the subject of two further analyses carried out quite independently: a clinical evaluation and a linguistic-textual analysis . 5 This was done to be able to carry out a comparative evaluation of the results produced through the three different modes of analysis and thus to be able to obtain further elements of validation (or possible disconfirmation) of the adequacy and reliability of the CGI.

4 Thematic contents

In its entirety, the CGI consists of 23 openings for dialogue and two series of graphic-pictorial stimuli (paintings by authors), divided into three sections: the relationship for each partner with his/her origins (8), the couple relationship (9) the generational passage (6).

All the stimuli (dialogue-pictorial) were created by the research team during creative production sessions and subsequently chosen based on their comprehensibility and relevance, thanks also to the contribution of some “focus groups” conducted with clinical psychologists and family psychotherapists. The creation of stimuli was based on the following criteria:

a. congruence with the conceptual construct (generativity) and its articulation in the three distinct dimensions/axes;

b. production of representational elements and actions related to the affective and ethical dimensions of the family bonds ( Cigoli and Scabini, 2006 ) concerning the three dimensions/axes.

These different stimuli were conceived in terms of integration, in the sense that the imaginative stimuli were introduced with the aim of promoting the partners’ reflection and verbalisation of their own family experience and couple dialogue, and not as independent indicators of the variables considered. This is why they are considered together with the discursive productions that accompany them in the subsequent encoding system. As will be better illustrated in the following paragraph, these stimuli were also the subject of preliminary work aimed at selecting the most suitable images for eliciting certain emotions, by grouping them into homogeneous categories.

First, we shall present the stimuli related to the first section (see Table 2 ).

Table 2 . Relationship with the family of origin.

The first Interview section is related to origins. This dimension regards each member of the couple specifically and in a differentiated manner. The relative items are therefore addressed and referred to each partner and are encoded separately for each of them. However, it is conducted in the presence of both partners, who are also invited to comment on the choices and responses of the other at the end of their discussion.

After the presentation of the objectives, the interview begins with a moment for “warming-up.” This helps facilitate the couple’s involvement in the proposed task and helps them mentally place themselves in their own generational history. It then proceeds in alternation, asking one partner the questions first, and then the other partner.

The first Interview questions investigate the content and quality of the representations related to the origins. That is, they are aimed at exploring how the partners mentalize their family and cultural origins and the representations and affections that characterize them. The opening question/stimulus reveals various aspects:

1.1 Firstly the capacity/willingness of the couple to “go back in time.” The act of “letting go,” also by closing the eyes, conveys whether or not you trust in the clinical context, as well as the partners’ available mental resources. The producers of images and scenarios are therefore the partners themselves, and their focus is not on the confusion or the “void” of an image, but what actually results.

There are similarities here between the Interview and Gestalt’s techniques.

Last but not least, “showing the other” is a way to immediately put the relationship on the playing field. In doing so, one partner can interpret the other’s representations of his or her “origins,” gathering similarities as well as profound differences. Both a disqualification of others’ experiences and a lack of cognitive-sentimental focus correspond to deficits in the relational matrix.

The researcher-clinician also forms his or her own representation. Thus, in turn, he or she can intervene both to clarify and to further certain aspects. After this part of the interview, the attention is directed to family rituals (presence/absence and quality).

1.2 “Origins” and “rituals” are in fact connected to each other. The poor mentalization of contents and affects also includes the absence of significant rituals (ruinous typology); mentalization with open and suspended problems and widespread negativity also includes uncertain and confused rituals (critical typology); mentalization which is rich in contents and affections is associated with an active and heartfelt ritual (productive typology). Gregory Bateson (1972) discussed “heart algorithms” in this regard, meaning that family life practices, and in particular rituals, reveal meaning with regard to relational exchange. For our part, we attribute a sacred dimension to the origins ( Cigoli, 2006 ), and a lack of sacredness has negative effects on family bonds.

Questions 2/5 seek to further, in specific terms, the re-evocation of the “environment of origin” previously carried out. There are two semantic areas solicited: the profound dimension of rules (the “golden rules”) of family life and the memory of relational events with the most significant figures, and the relative range of feelings inherent in the maternal-paternal-fraternal relationship.

At this point the first task concentrating on images is proposed, asking the couple to choose their “landscape of origin.” Thanks to their specific polysemic nature, the introduction of pictorial stimuli aims to activate imaginative thinking in the subjects (poiesis), and also aims to enrich dialogue. In fact, the entire interview is held in the presence of the partner, who is reciprocally invited to comment on the other’s choice.

The images were chosen based on the identification of three categories highlighted by research work on landscapes in painting ( Cigoli, 1999 ; Büttner, 2006 ). The categories of the images are: ideal landscapes, real landscapes and ambiguous landscapes (see Figure 2 ). The ideal landscapes include paintings where the artist’s intention is to communicate mental states of “paradise,” a “golden age,” an “ideal well-being.” The real landscapes include paintings where the artist’s intention is to communicate the “lived life,” “good and bad weather,” a “conflictual state” (heat and cold, light and shadow, the virginity of nature and the occupation of man, etc.). The ambiguous landscapes include paintings where the artist’s intention is of an uncertain nature, disturbing and alienating.

Figure 2 . Landscape painting. Reproduced from Cigoli and Tamanza (2009 , p. 117-120).

It is important to note that the categories of chosen images, both as regards the landscapes of origin and the couple scenarios, have nothing to do with the normal/abnormal, healthy/ill, correct/incorrect polarities and the like. Indeed, the images are to be considered visual stimuli that encourage a choice and not indicative in themselves of unique and discriminating meanings. What matters is how the partners react to and consider the image from a cognitive (perception, focus of attention, communication), affective (referring to the world of emotions-feelings) and ethical (referring to the value, or less, of the bond) point of view. Lastly, what matters is how the partners talk to each other. In this regard, the criteria related to communication (according to attention, socio-emotional and prognostic variables) that have been highlighted by systemic research for many years are valid.

The following questions (7/8) put the partners in “third-party position,” meaning they become observers involved in the relationships of others, whether they are those of a parenting couple of origin or those between parents and families of origin (in the sense of clan membership, ethnicity, lineage).

Striving for “having learned” (questions 7/8) serves to introduce, in a latent way, the identification issues affecting the generations. In the same way the problem-theme of the relationship between families of origin is introduced through the couple.

The following Table 3 presents the stimuli related to the second section: the couple relationship.

Table 3 . The couple relationship.

The second section of the interview concerns the couple relationship. The related questions are addressed and refer to the couple as a whole, and the partners themselves will decide how to respond and react to the questions asked. The encoding of the information produced is based on the response of the couple as such.

The interactive-communicative dynamic is not analytically encoded (microanalysis), but constitutes useful information about the adequacy of the interviewing process. In this regard, the researcher is advised to take note, on a separate sheet, of the recurring methods of exchange, as is traditional in interactive research (and clinical setting) on family relationships. It is also one of the fundamental elements the interviewer uses to modulate and manage the relationship with the couple. As mentioned, it is important for the couple to engage in the proposed dialogue according to its own methods, also ensuring that each partner expresses his or her position in relation to the proposed themes.

The first question (“How did you meet”) refers to Watzlawick’s (1966) famous Family Interview. It is however formulated as an opening based on dialogue, immediately followed by mentally urging the partners to grasp the difference between interaction and bond (question 2). Interactions are innumerable, but only few become a bond characterized by needs and desires that interlock and require a response. The crucial theme of the promise can also be introduced. Following Hanna Arendt (1958) , we hold that this bond cannot hold true through life, living and its trials without any promises having been made. The Relational-Symbolic Model considers “secret interweaving” and the “promise” as the crucial dimensions of a couple bond ( Cigoli and Scabini, 2006 ).

The following questions (3/5) imply a strong reference to the interpersonal plane (the relationship with the other) and projective and interjective identification processes. They are aimed at focusing the couple’s dialogue on the foundations of the bond, which in this case concern the previously mentioned “secret understanding,” i.e., the latent and often unconscious dimension of the bond itself. As can easily be understood, it is important to invite the partners to explore sensitive and very delicate topics and contents, and the interviewer must maintain a trusting and collaborative atmosphere, avoiding making the members of the couple feel excessively exposed or threatened in relation to any intimate and vulnerable aspects. In any case, the “climate” the interviewer senses is one of the indicators to be taken into account.

Question 6 instead focuses on the relationship-bond as such. It assumes that there is no bond without conflict (the soul of the relationship) and difficulties which must be faced, and calls on the couple’s commitment to cope with it. The “commitment” variable is very developed in the psychosocial research related to bonds and can be considered an analogue of the promise (to have an obligation, to pledge) that can be assumed, fragile, disqualified and attacked. “Promising,” however, is knowing how to “go beyond” the same perspective, while commitment concerns the resonance of the word given in the present. In any case, it is a “good accompaniment.”

Then a second task is proposed which is focused on images, this time with a new choice of pictures that concern “couple’s scenes.” The methods and aims of the proposal are substantially the same as those already illustrated in relation to the first series of images (the “landscapes of origin”): they favour the partners’ identification with the relationship by soliciting psychological characteristics. In short, the subject the images depict is not as important as the effect they have on an affective-ethical level.

In this case the three types, with four pictures for each of them, are the following: ecstasy, dialogue, division (see Figure 3 ). Ecstasy refers to paintings in which the artist’s intention is to communicate the presence of an ecstatic, fusional, paradisiacal, idyllic relationship: the couple transcends the everyday and “escapes” the present. Dialogue refers to paintings in which the artist’s intention is to compare the male and the female, to consider the similarities and differences and any shared aspects: the couple is at the forefront and takes each other by the hand. Division refers to paintings in which the artist’s intention is to highlight the presence of a fracture, isolation, discord: the couple is in a painful, broken, anguished, desperate state. After choosing the image, the partners are explicitly invited to comment on the choice made by the other, in order to enrich the couple’s dialogue and thus bring out the characteristics of the bond.

Figure 3 . Couple’s painting. Reproduced from Cigoli and Tamanza (2009 , p. 117-120).

As the literature on family relationships has clearly highlighted, it is impossible to divide the couple relationship from that of both partners’ families of origin, in the sense that it is an integral part of the same bond. For this reason, the theme of the “other” (the other lineage) and the modalities of reception or rejection are introduced at this point in the interview. The partners’ experiences and above all the couple’s dialogue (the commentary) help us add another piece to the “puzzle” of the couple bond and its qualities, considering the relationship between the couple and their respective families of origin. In various cultures, whether patriarchal or matriarchal, cognatic or bilinear, the relationship between lineages and classes of belonging, as well as socio-economic status, involves and even anticipates the couple bond.

The “family of origin” should be understood as a place of interaction/clash, of domination and marginalization, of communion and rejection or isolation. In other words, the generative basis (and its drama) does not remotely end with the parent–child relationship, but opens up to the causes in a vertical sense and to the exchange between memberships and clans, also involving souls and the dead ( Cigoli, 2006 ).

The last question (9) of this part of the Interview features an imaginative opening onto the future. It is obvious that the future being discussed, as well as the past, is in the present of the relationship, as taught by St. Augustine. This is how we have another source available for qualifying the “reality” of the couple bond. Furthermore, opening with the future helps us introduce and prepare the third part of the Interview relating to parenting (see Table 4 ).

Table 4 . The generational change.

The third part of the Interview concerns generational change. While the first two parts of the interview can be used in clinical and research contexts that involve all couple situations, this third part of the CGI explicitly refers to couples with children, i.e., families. Also in this case, the related questions are addressed and refer to the couple as a whole and the parents themselves decide how to respond and react to the proposed questions. The encoding of the information thus produced will result in a parental couple evaluation as such.

The thematic areas that are explored concern the prefigurative capacity (1) of the parent-partners (a method of “taking hold,” or less, on the future) and their ability to compare the examples with the actual family reality (2). “Equal” and “different” introduce the themes of coincidence and surprise that can be experienced positively or negatively. The next two questions (3.1 and 3.2), which due to their connected meaning are encoded together, aim to connect the world of values and life models with generational change and with the recognition that parents are themselves also children. Is there continuity and a transformation of values through the generations, or a break? The theme of lineage (“your parents”) is also proposed again.

Cognitivist-oriented family research appropriately insists on the aspect of parental effectiveness (4): an expectation is one thing, while the result of an action from which specific feelings arise is another, such as satisfaction or serious disappointment. Moreover, it is easy for the parents to involve the social scene, which can be considered as helpful or harmful.

Lastly, the parents’ dialogue regarding their children addresses the presence of both continuity and differentiation (5). A child is such only if he “has inherited,” but is also recognized for his specific traits. This concerns each child, and so it is not a matter of considering them “in equal parts,” but each according to their specificity (his “own”). This is the challenge.

The last question (6) is intended to recapitulate, as it invites people to reflect on aspects of family history that have spread grief and hope in relationships. Its purpose is to evaluate the ability of parents to recognize risky and resourceful elements inherent in the bonds. But here they are specified in terms of hope and trust which, not by chance and together with justice and equality, are recognized as the symbolic foundation of bonds. We will thus have, still considering the inherent fragility in the bonds between people, cases in which trust and hope are brought to safety and sustained and cases in which they collapse in deep distrust and despair. The Model that guides the Interview, taking up some old wisdom, underlines how the family climate is a decisive factor (not directly causal) in the construction of its members’ personalities. The result is that the so-called “quality of the relationship” is not measured in terms of satisfaction, communication, problem-solving, affective expression and so on, but precisely in terms of trust/mistrust, hope/despair, justice/injustice. We could even consider them from two different psychological languages.

5 The encoding and measurement system

The CGI uses a dual encoding system: typological and taxonomic ( Bailey, 1994 ).

In our case, the taxonomic classification is made up of the set of “semantic categories” through which each textual/discursive unit is encoded and is therefore variable and specific for each item/question. This has also been built empirically (bottom-up) from the verbal productions present in the normative sample and is, by its nature, a classification which is open and can be integrated.

On the contrary, the typological classification is based on a three-step scale (productive/critical/ruinous) and is used for the evaluation of every single item/question, as well as for the evaluation of the whole axis (origins/couple/passage) (see Figure 4 ).

Figure 4 . The encoding and measurement system.

So, it possible to analytically encode family bonds for each Interview axis (origins, couple and children) and is composed of three possible forms: productive, critical and ruinous. These forms of family bonds have been conceived and applied on a theoretical basis, starting from the reference model at the tool’s core. More specifically, productive and ruinous are, respectively, the functional and dysfunctional modes of the bond, while critical represents an uncertain bonding mode, that is to say dubious, confused, with contradictory aspects. In short, these are the three qualitatively different modes of bonds, each with its own distinctive properties.

The analytical typological encoding on the three axes is independent, in the sense that each axis of the family bond can be intrinsically traced back to each of the three forms, that is, regardless of the encoding of the other two axes. Thus, specific situations could arise, for example similar encoding on the three axes (for example an always productive bond), or different encoding on all three axes (for example a productive bond in the relationship with the origins, a critical bond in the couple relationship and a ruinous bond in the relationship with the children, even if highly improbable).

Furthermore, each form of the bond has a meaning that is specifically characterized according to the axis to which it refers. Thus, for example, the ruinous form of the bond relating to origins is qualitatively distinct from the ruinous form of the couple bond, although in both cases it is a “problematic bond,” or an indicator of de-generativity.

Lastly, a joint encoding for both partners is immediately applied to the axes relating to the couple relationship and the relationship with the children, while for the origin-related axis there is initially a specific encoding for each partner. Subsequently, on the basis of a specific combinatorial rule (see Cigoli and Tamanza, 2009 ), a unitary measurement is established that envisages both pure and mixed typologies.

Now we will examine beyond the labels by clarifying the meaning of each encoding category.

We will begin with origins. Productive origins are characterized by the partners’ possibility to identify themselves with members of previous generations, starting from the recognition of the resources that come from the same. This recognition involves the prevalence of feelings of trust and hope, as well as justice and fairness towards the generational bond. Although pain, grief, mistakes and shortcomings are not lacking, they are tolerated, forgiven and cleared. On the contrary, ruinous origins refer to a scorned bond in which the partners are unable to overcome the traumas endured and the suffering deriving from them. The indifference and/or abuse the partners feel victimized by lead to a scarcity of feelings which, if expressed, are negative and connoted in terms of distrust, despair and injustice. Lastly, critical origins are characterized by the presence of negative feelings which, however, do not prevent the partners from recognizing positive identifying sources and seeking the possibility of redemption.

Now we will discuss the couple bond. A productive couple bond is characterized by the partners’ ability to invest in the bond, recognizing its value and feeling their belonging to it (the “us” of a couple). A ruinous couple bond is instead characterized by each partner’s will to dominate and manipulate the other, not recognizing his or her specificity. In fact, a ruinous couple bond is an “anti-bond,” in the sense that the partners do not act in favor of the bond, but against it, even if they need it ( Racamier, 1992 ). Among various concepts, the author has developed the concept of relational perversion. It is characterized precisely by the use-abuse of the other to achieve one’s goals. This also applies to the law, not in the sense of “that which binds men to each other,” but as a tool for achieving one’s goals. The commonality of this method is an aspect of daily life. Lastly, a critical couple bond is characterized by the presence of a constant sense of danger for themselves and for the fate of the bond, so that it is perpetually uncertain and unsettled. This does not mean that the partners do not also show aspects of intimacy and room for possible movement.

Finally, we consider the bond with the children. It is productive when an investment in the future is possible which, despite being connected and continuous with the family’s past, recognizes the children’s “proprium,” as well as recognizing the differences in the times. “Transgression” is given value precisely for this reason, in the sense of going beyond what tradition can do in order to innovate it. This can involve rituals, as well as the “rules of life” and the values that guide them.

Thus, we have two forms of transgression: one that violently attacks expectations, values and rituals and one that innovates them. This is so, for example, in the value currently attributed to “intimacy” in the bond compared to that of “respect” that has marked genders and generations. Transgression is particularly visible in its different forms in cases of family migration, where the wisdom of the older generation is frequently replaced by the technological skill and consumerist spirit of the new generation, or supported by the same skill. The parental bond is considered ruinous when a feeling of resentment and “autogenesis” prevails in the partners, which prevents the children from finding their own place within the family-generational history. Lastly, a critical bond is characterized by the presence of feelings of anguish and distrust towards the future, so that parents experience constant uncertainty both in relation to their own abilities and to their children’s destiny.

A transverse reading of the forms of bonds along the three axes suggests that each of them has constant properties beyond the axis itself. Thus, the three forms of ruinous bonds are united by the absence of movement, i.e., a very painful and “untreatable” situation that is constantly repeated. For their part, the productive forms are not as characterized by the absence of pains and limits as for the possibility of boosting the bond with trust and hope. Lastly, the critical forms show marked contradictions both on the ethical and affective sides.

The second encoding system, namely the taxonomic classification, must be referred to for the analytical classification of each axis of the family bond. This classification concerns the individual Interview stimuli, presents specific labelling categories for each of them and is associated with the corresponding “typological measurement.” Each unit of text corresponding to each stimulus of the CGI is thus read simultaneously in a qualitative manner (through the semantic categories of the taxonomy) and quantitatively (through the scale of the typology). This second measurement of the items forms the basis of the synthetic typological measurement of the axis according to an accumulative process and a prevalence criterion encoded in unique terms. At the end of the encoding process, a typological measurement of the three dimensions investigated by the CGI (origins, couple, passage) will be available alongside the semantic analysis which, through a subsequent combinatorial step, will make it possible to obtain a synthetic measurement of family generativity. The empirical work constructing and validating the CGI has made it possible to identify six different forms of generativity: fertile, evolutionary, blocked, chaotic, degenerative and poor. These are qualitatively distinct forms, each with its own peculiar characteristics and distinguished by its own space-temporality that can also be graphically depicted (see Cigoli and Tamanza, 2009 , p.99).

6 Use in clinical assessment

The Clinical Generational Interview is a useful tool not only in research on family relationships, but also and above all in clinical practice, configuring itself as a therapeutic assessment tool. The CGI serves as a “medium” for the creation of the bond between the parental couple and the clinician, which forms a “working group” that is indispensable for good progress in the clinical pathway and its outcome. Couple assessment, in particular, has proved to be one of the elective clinical areas for the use of the CGI, since the proper setting for this tool is the joint meeting with the couple.

Alongside this homologous setting, however, there is also a substantive reason which makes it, so to speak, quite natural to imagine the use of the CGI in couples counselling. This is due to the fact that, beyond the different theoretical-conceptual references, any preliminary understanding of the couple’s functioning must, to some extent, be based on a recognition of the events and meanings that mark the foundation and development of the same couple’s story: topics that are analytically addressed by the CGI. In this regard, the specialised literature offers many conceptualisations of what function the relationship’s psychological organiser takes on; his recognisability and individuation, however, invariably comes from the reconstruction of the historical methods of the meeting and its subsequent development (see Dicks, 1967 ; Pincus and Dare, 1983 ; Ruszczyski, 1993 ; Losso, 2000 ; Zavattini, 2001 ). The importance that the bond with the family environments of origin and the exercise of parenting takes on is widely recognised for understanding the couple’s dynamics ( Andolfi, 1988 ; Canevaro, 1988 ; Framo, 1996 ).

The CGI has recently been used in a systematic way in many clinical interventions with couples who were facing the same critical event, namely separation/divorce and the family’s rearrangement. These couples are those met in work contexts such as in cases requiring a Court-Appointed Counsellor and Clinical Couple’s Counselling: they are two very different and specific intervention pathways in relation to their purposes, the access modes and the institutional context, but fairly homogeneous as regards the subject and issues addressed ( Gennari and Tamanza, 2017 ). In fact, the Court-Appointed Counsellor is arranged by the judicial authority within contentious procedures which usually feature particularly intense conflict, and has an eminently evaluative purpose. Clinical Counselling, on the other hand, starts from the independent request of the parties and has often constituted, in our case, the preliminary analysis and decoding work relating to family mediation, or couple’s psychotherapy.

From a technical point of view, both cases focus on and circumscribe pathways that primarily aim at producing an understanding of the couple’s situation and its disruptive dynamics, as well as identifying the resources that can be activated in order to achieve effective parenting and, where possible and desired, boost the relationship.

In the cases we refer to, the CGI has been used alongside other tools, including tests, but has always held a central importance because it has established the thematic track that guided the exploration of family history and the reconstruction of the couple’s story. It was initially applied in different formats to verify which administration method was best suited to the context and objectives of clinical work. After repeated attempts, we were able to verify the usefulness of introducing two variants in relation to the administrative procedure envisaged for the research activity, while still maintaining the content and formulation of the stimuli unaltered.

The first concerns the subdivision of the administration of the interview into three parts; that is, proposing the dialogic stimuli related to the three axes of the CGI in three different consecutive meetings and with a more implicit interlocutory mode. This is in relation to clinical work’s typical need of having sufficient time to retrace elements of personal and family life history in detail and in depth, which is at times marked by painful feelings or which, however, cannot often be easily recognised and shared, thus provoking resistance. Spreading out the administration time of the interview not only satisfies the requirement to accommodate people’s need to develop their narratives with appropriate times and rhythms, but first of all the need to ensure that the “working relationship” can be established as a sufficiently safe and trusting one, constituting itself as an appropriate container for the ethical-affective processes solicited by involvement in the proposed task.

The second variation concerns a different articulation of the task of choosing and commenting on the couples images. It is placed at the end of the second part of the interview and, above all, envisages that people choose - initially independently and privately - not one, but up to three images, which refer to three different temporal moments: the first refers to the present, the second refers to the past, and more precisely to the initial phase of the couple’s history and the third refers to the near future (five years later), stating that it must express how people “imagine their relationship will be,” and not as they would like it to be. The emphasis on “prediction” rather than “desire” has been much more functional in helping people confront the “factual truth” of their relational situation. A second way to use the images which has been prompted by emerging needs in clinical work with couples is to modulate the task according to the specific “critical periods” of the couple relationship. Rather than directing the choice of images according to a generic temporal succession (past-present-future), it may be useful to request the choice of an image for each significant moment (acme) of the couple relationship.

The subsequent commentary and comparison thus concern a sequence of images, facilitating and enriching reflection on the diachronic elements of the couple relationship. Not only that, the sequence of images facilitates an overall and synthetic reconstruction of the sense it assumes for each person allowing, with a relative immediacy, access to meanings and contents that often cannot be sufficiently expressed and recognised within the narrative reconstructions. As mentioned, thanks to their complex and polymorphic structure (form, content, colour, stroke, use of space, etc.), the images (the paintings) permit access to a world of meanings that articulates deep cognitive and affective contents which are more difficult to censure than the verbal language the couple can clearly control more. They therefore condense and immediately convey a multiplicity of elements that are particularly useful in order to have an overall picture of the relationship, also in reduced times.

When couples are confronting the topic (potential or current) of crisis, working with images in this way not only helps the clinician, but the subjects themselves, to reinterpret the couple’s reality and crisis in less rigid and self-centred terms ( Tamanza et al., 2018 ). The synoptic “contemplation” of the two sequences of images manifestly demonstrates how the reality of the bond cannot be traced back to the juxtaposition of two different points of view, but refers to a complex and dynamic articulation. The comparative method of the partners’ choices in relation to the same period of the relational event makes it possible to access, in a less inferential way, the vision of the same relationship, identifying themes and elements that cross and go beyond the individual personal positions and which immediately allow access to relational rather than intra-psychological indicators. In doing so, the critical junction can be faced which concerns the need to identify methods and tools that make the scientific community’s widely developed theoretical paradigms that assign priorities to the same relationship highly operational and transmittable, understood as the true subject of clinical action compared to the individual positions of the partners (see Cigoli, 2006 ).

The diachronic succession of images then forces questioning the reasons and the meaning of the change (or absence of change) found in the succession itself. It also helps to examine, in more realistic terms, the existing gap between desire and reality and to search for traces and signs of a possibility to transform the relationship. In other words, the possibility of identifying resources, to be understood as tolerability of the process of overcoming the crisis, with the limits, risks and effort connected to it, as a space for movement and re-signification of what is existing in a perspective of openness to the new and to the unknown, as an assumption of responsibility for one’s own needs and desires and the world of bonds.

Lastly, the observation of the interactive and behavioral methods the couple uses to deal with the proposed task is an important source of information, both in relation to the possibility of using the resources offered in a more or less functional way within the specific counselling setting, and in a perspective and prognostic sense in relation to the possibility and usefulness of promoting subsequent intervention projects.

7 Final considerations

The Generational Clinical Interview, as its name explicitly indicates, is a tool for organizing the clinical encounter with the family from a psychodynamic-generational perspective. Its main intent is to constitute an aid for the investigation and evaluation of family relationships, which can combine an inclusive aspect of the complexity of the object of study with the systematicity and rigor of a structured procedure, useful for increasing the ostensibility and intersubjective validation of the knowledge it produces. A research tool that, formalized in strong coherence with the theoretical assumptions from which it derives, is not only proposed as an algorithm for testing preconstituted hypotheses, but first and foremost as a device aimed at promoting and facilitating the construction of dialogic and participatory understanding of the family relationships. The structured sequence of stimuli and the taxonomic and typological system of coding discursive productions represent the conceptual and procedural framework that guides the exploration and analysis of family ties. They also constitute a double constraint: they constrain the clinician/researcher within a dialogic-narrative canvas that is not rigid but coherent and, at the same time, they also constrain the couple in the same canvas, in a continuous guided confrontation with the origins of each of the two, with the historical and affective plot of the relationship, and with the responsibility of transmission to the children.

There are three areas of use of the Generational Clinical Interview: the first is related to research on family and couple relationships, the second is related to assessment situations, and the third is related to clinical intervention.

As much as the three areas have their specificity of “setting” (or configuration) they are also interrelated. The problem, in fact, is not so much to narrow the gap between “academic/scientific” research and field research, but to flip the relationship in favor of the clinical, remembering that without direct implication in the relational field there is no clinic, and this also applies to the researcher. In fact, the essential purpose of research is to produce the necessary information so as to be able to achieve the knowledge he or she seeks, whether it is exploratory in nature, that is, aimed at formulating descriptions and interpretative hypotheses of a given phenomenon, or evaluative in nature, aimed at corroborating or falsifying previously elaborated hypotheses. Through CGI, the researcher is directly involved in the dialogue-conversation with the couple (i.e., he or she is not external to the family relationship as in the case of the use of self-administered tests or questionnaires) and leaves room for the parental couple to reflect on what was experienced through the Interview. Rather, it is the very structure of CGI that, by targeting the world of relationships, creates a meaningful context from a relational perspective.

The second elective area, is that of therapeutically oriented assessment. In the context of clinical and psychosocial services, whose purpose is to structure intervention plans of various kinds and to assess the outcome of them, CGI constitutes a useful tool and procedure for relational diagnosis, that is, for assessing the generative or degenerative character of generational transitions.

Through the Interview it is indeed easy not only to focus on productive, critical, or ruinous areas of exchange, but also to mobilize some family resources from the outset and thus open an emotional and relational space for the construction of tractability.

The third set (configuration) of use of CGI is that of clinical/therapeutic intervention. It can be realized through specific and very differentiated modes of intervention, but, in any case, the Interview highlights all its value in creating a space for sharing and thus activating a “working group” oriented to the transformation of family relationships. Finally, since clinical psychotherapeutic work needs (and deserves) verification, the Interview, or parts of it, can serve this purpose. This leads us to a final methodological consideration: recognizing the specificities that distinguish clinical work and assuming a consequent attitude that intentionally devotes care and attention to them does not mean misrecognizing the value and necessity of using methodologically reliable tools and techniques. The fact that research and clinical intervention respond to different logics and needs does not mean that they are incompatible. Quite the contrary. Even in clinical work, in fact, it remains of essential importance to proceed systematically to the production and analysis of crucial information with respect to the object under examination (in our case precisely the world of family relationships), and for this purpose the use of structured and empirically validated tools can be particularly valuable.

In any case, the most innovative and distinctive character of CGI is the balanced synthesis between the need to proceed in a systematic and controlled manner in the collection and evaluation of crucial information related to the couple’s relationship and the need to foster a gradual and progressive active involvement of people in the clinical process. Added to this is its structurally relational orientation, that is, its ability to induce a “relational perspective,” because it forces one to think of the reality examined as a problem of relational/generational exchange and not of individuals.

Recourse to the imaginary register then produces an unexpected “displacement” with the breaking of the “escalation” mechanisms and a verbal interlocution reduced to an empty and timed script; this opens up an area for potential listening and interrogation for the couple and offers new ideas for re-defining and understanding the relationship.

The generational segmentation of the proposed topics then calls for a reconsideration of the couple’s history and its difficulties in the context of the exchange between generations, highlighting the possibility of a new definition of the parenting function in the face of the possible, or already occurred, separation. In fact, it is not uncommon for couples to move from a feeling of condemnation of themselves and/or the entire family world to pacification with their own history and with the actors who took part (understanding the conjugal relational history phase), questioning and then looking for ways to “save” the good that the relationship has produced.

However, the most relevant element is the fact that the CGI has proved to be a tool that amplifies and makes it less difficult to have a “collaborative” clinical assessment and even an expert assessment. It allows the spouses/partners to understand the meaning of their respective positions within the relational history, to clarify their respective expectations and fears and, thus, to be able to consciously choose one’s present-future. We could also say that the CGI makes it possible to move within a profoundly epistemological ethical perspective that makes sharing, participation in knowledge and responsible decision-making the main construction techniques of the clinical intervention.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

Ethical approval was not required for the studies involving humans in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

GT: Conceptualization, Data curation, Investigation, Methodology, Writing – original draft, Writing – review & editing. MG: Conceptualization, Data curation, Investigation, Methodology, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Supplementary material

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1. ^ The sample consisted of couples who were going through different stages of the life cycle, namely: couples with children aged 3–6 years, couples with adolescent children (14–18 years), couples with disabled children, adoptive parents and separated parents.

2. ^ Following Clark and Watson (1995) , a frequency distribution analysis was conducted on the initial pool of items (in order to exclude those items with high rates of nondeterminability or excessive concentration in a single response mode) and then a confirmatory factor analysis (CFA) ( Stewens, 1996 ) was conducted.

3. ^ In fact, the preliminary version included 35 dialogic-discursive stimuli, while this second version consists of 23 items.

4. ^ This second sample consisted of sixty pairs, thirty of which were nonclinical (and divided into different stages of the life cycle, like the first sample) and thirty marked by specific clinical and social issues.

5. ^ Linguistic-textual analysis was carried out with the help of T-LAB, a software program that, by means of numerous algorithms, allows for a series of in-depth text operations of an exploratory and interpretative nature. ( Lancia, 2004 ).

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Keywords: couple interview, family relations evaluation, intergenerational assessment, clinical interview, qualitative tool

Citation: Tamanza G and Gennari M (2024) The Clinical Generational Interview. An instrument for family assessment. Front. Psychol . 15:1361028. doi: 10.3389/fpsyg.2024.1361028

Received: 24 December 2023; Accepted: 17 April 2024; Published: 31 May 2024.

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*Correspondence: Giancarlo Tamanza, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.