Ambivalent Attachment — MRCPsych Paper B MCQ

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ModeratePsychotherapyAmbivalent AttachmentMRCPsych Paper B

An 18-month-old child is observed during a standardised separation–reunion procedure. Before separation, she remains close to her mother and explores little. She becomes intensely distressed when her mother leaves. On reunion, she immediately reaches to be picked up but then angrily pushes her mother away and continues crying despite contact. She shows no freezing, dazed behaviour or apprehension towards her mother. Which attachment classification best fits this presentation?

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Correct answer: B — Ambivalent/resistant (Type C)

The correct answer is B, ambivalent/resistant attachment. Type C children typically show limited exploration, pronounced separation distress and high-intensity proximity-seeking on reunion, but remain difficult to soothe and may angrily resist the contact they seek. This represents an organised strategy that maximises attachment signals and is associated, at a group level, with inconsistent caregiver responsiveness. Secure children are comforted and return to exploration, while avoidant children minimise overt distress and contact-seeking. Disorganised attachment is the most plausible distractor, but it involves a breakdown of a coherent strategy, with behaviours such as freezing, disorientation, apprehension or markedly anomalous approach. The vignette explicitly excludes these features. “Insecure-dismissing” was removed because it is adult attachment-interview terminology rather than a childhood Strange Situation classification.

Reference: British Psychological Society. Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists working with People who have Intellectual Disabilities, section 2.1, June 2017. https://www.rcpsych.ac.uk/docs/default-source/members/faculties/intellectual-disability/bps-attachment-guidelines.pdf?sfvrsn=a83ef76b_2