Perceptions of clinical psychologists working in low income, high violence communities in Cape Town: Exploring the link between infant-caregiver attachment and the development of internalizing problems in children
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Given that numerous research studies have established the important role that attachment plays in the development of internalizing disorders in children, it is important to ensure that the clinical psychologists working within this population and within this category of disorders are aware of this link. This will help ensure that they intervene adequately and appropriately. Although there is some emerging research on psychologists' perceptions and practices regarding the assessment of internalizing disorders, there is very little available information to date specifically addressing clinical psychologists' perceptions and understandings regarding the influence of attachment on the development of internalizing disorders in children. This study aimed to explore how clinical psychologists operationalize internalizing disorders in children and how they understand the link between infant-caregiver attachment and internalizing disorders in children. Parents/caregivers from low income, high violence communities are a vulnerable group in South Africa, and as a result, it is becoming increasingly important to explore how clinicians understand the development of children growing up in conditions where the nature of parenting is taking place under conditions of pervasive adversity. As such, this study explored the perceptions of clinical psychologists working in low income, high violence communities within Cape Town. This research was conducted using a qualitative research approach that makes use of in-depth individual interviews. Semi-structured interviews were conducted, and then transcribed and analysed using thematic analysis. A sample size of eight participants was recruited using a purposive, snowball sampling technique. All ethical considerations were adhered to and appropriate ethical clearance was obtained from all relevant ethical committees. Object relations theory provided the theoretical framework through which data was interpreted. A specific focus on attachment theory was incorporated. Findings suggest that although clinicians acknowledge and accept the important influencing factor of infant-caregiver attachment on the development of internalizing disorders in children, very few clinical psychologists make use of attachment theory as their primary theoretical or therapeutic orientation. Participants highlighted the importance of an integrative approach to the understanding of childhood pathology and made reference to the fact that the impact of attachment relationships needs to be considered in conjunction with other risk factors that predispose children to the development of internalizing disorders. Given the importance that participants placed on systemic and contextual factors influencing the attachment relationship, future research could investigate the role of a multi-disciplinary approach to the treatment of internalizing disorders in children. Further research also needs to be conducted that examines the efficacy of attachment-based conceptualizations and interventions in diminishing internalizing problems in children, and the way that these are perceived by the clinical psychologists working with these behaviours.