Have you ever found yourself wondering or worrying, “Will sleep training harm our attachment?”

Or have you seen people warning you on Instagram about sleep training and the negative effect it will have on your baby’s attachment?

Or have you heard people buzzing about “attachment parenting” and the importance of co-sleeping and baby wearing and extended breastfeeding?

Well, today we are kicking off a little series on sleep training hesitations. And to do that, I’m bringing in an expert.

I’m interviewing Dr. Shanna Sarita Alvarez, licensed psychologist of Helping Families Thrive, who will be sharing with us what the research really says about secure attachment and sleep training. She is sharing:

• What attachment actually is (and what it isn’t)
• How attachment is formed
• What the research actually says about sleep training and attachment

And so much more!

Introduce Yourself and Tell Us About Helping Families Thrive

I’m Shanna Sarita Alvarez and I am a psychologist with Helping Families Thrive. I specialize in supporting families of children who have what I call “fast and big feelings”.

Some of those feelings might be feelings that are, “I feel it and then I spew them all over the place outward at the world,” and some of those kiddos might be more like, “I feel really intensely and then I push all the feelings inward.”

So I not only support those children and teach them skills and tools, but I also support the systems that surround them, including the parents, other caregivers, and the school systems.

At Helping Families Thrive, though we are based in Washington, we provide clinical services across the country in all PSYPACT states, which is a variety of states throughout the U.S. that have agreed to recognize psychology licenses across different states. This has been so helpful to reach kids in more rural areas who might not otherwise be able to access clinical services. We are also able to serve families in British Columbia, Canada!

I got my first master’s degree in speech and language pathology, and I first worked at Seattle Children’s Hospital. I quickly found that I was really drawn toward children with high levels of aggression; I was passionate about them. I’m drawn to the kids where it’d be easy to make assumptions and you have to stop yourself, which is kind of how I approach science, too.

Over the years, I became kind of obsessed with zooming out above the child and looking at the whole system surrounding them – the parents, the school, and the community – because we had a lot of kids that would cycle in and out of inpatient psychiatric care. And what you would see is that everything was so siloed; the child would work with the therapist in a room, and then the parents may or may not get services. And then the school didn’t know what the therapist was doing, etc.

And we really have to help create families that are going to make it through, sometimes chronic long-term challenges their kids might have by zooming out. And so we really became passionate about system-based care.

And because of that, I went back for a master’s and a PhD in psychology. And when I finished my doctoral work, I initially worked as a research scientist, because I really do love research. I love evidence and questioning things. I learned that science really doesn’t speak in extremes, but reinforces healthy doubt and humility and uncertainty and always having more questions.

And when I ultimately decided to refocus on clinical work, I really took that with me. So Helping Families Thrive is really about evidence and balance – bringing the evidence into real life and then adapting it to real-life families, which can be hard to do.

I am a parent of all stripes. I’ve done foster care and kinship care and foster adoption, and also have tummy kids. And trying to navigate resources for kids that don’t fit in a box or for kids that people don’t really want to think about is kind of ugly. We would get bounced around and other families I knew would get bounced around and referred from one place to another to another. So, in founding Helping Families Thrive, we just wanted to be a home for families.

What is Attachment?

I actually want to start by describing what attachment science and secure attachment are not, because I think a lot of parents are coming into this conversation with a lot of information about what attachment and attachment science are.

And some of it might be scientifically founded, and some of it might be opinion or philosophy.

What Attachment is Not

To start, while attachment science and attachment parenting sound similar, they’re actually not at all the same thing.

Attachment science is the rigorously studied and more importantly, evolving field of research built on Bowlby and Ainsworth’s work. We’ll talk about them as the founders of the field of attachment as we go on. And attachment parenting is a philosophy founded by Dr. Sears, who we will also talk about.

So attachment parenting is a philosophy that is a beautiful fit for some parents, but not all parents. And it’s not a rigorously studied approach or intervention. There are actually no peer-reviewed studies of attachment parenting and its outcomes, which doesn’t mean it’s a right or wrong choice; it just means that it’s a choice. It’s a philosophy. It is not to be confused with attachment science, and it is not the only pathway to healthy attachment.

So let’s continue with what attachment science is not, but clarify what attachment parenting is.

Attachment parenting is a parenting philosophy, and the term was popularized by Dr. William Sears, a pediatrician, and Martha Sears, who was a nurse. And it really became popular in the late 80s and 90s. And I’ll just add a little note here for context that this was right around the time when women (mothers) were increasingly entering the workforce.

And through this series of book releases, William and Martha Sears were becoming more popular and known. And in one of their books about attachment, it said, “We believe that attachment parenting immunizes children against many of the social and emotional diseases that plague our society.”

This is a really powerful claim that is, again, neither right nor wrong. To be fair, they said, “We believe,” but it’s a very big claim. Especially in the science world!

So this attachment parenting philosophy proposes methods aimed to promote attachment of parent and infant, not only through lots of warmth and empathy and responsiveness, but also with a huge emphasis on bodily closeness and touch.

In attachment science research, we really focus a lot on the caregiver. But the foundation of attachment parenting really emphasizes the role of the mother, specifically this need for mothers to compensate through attachment-building activities, for each hour worked outside the home away from the baby.

This comes from a beautiful place of wanting young children to have healthy outcomes, but they proposed the following seven behaviors (or seven B’s) to do so:

• Birth bonding
• Breastfeeding
• Baby wearing
• Bedding close to the baby
• Belief in the language value of your baby’s cry
• Beware of baby trainers
• Balance

So these seven behaviors really are aimed at not just reducing crying or helping soothe a crying child, but actually even a step beyond that, to prevent crying in the first place. They recommended moms do these things as much as possible so that you can be so responsive that the need for comfort doesn’t actually occur as much during the day.

But again, this is not an intervention; there aren’t any studies on it. It doesn’t mean that it’s good or bad, but a lot of the claims here are unfounded. Those seven behaviors have not been studied as an intervention to see if they lead to healthy or unhealthy attachment, meaning this is a preference! This is a philosophy.

And it’s a lot of pressure on parents (but moms, specifically), to make or break their child’s entire future!

That’s not to minimize the role of mothers or the role of any caregiver or parent, because on the one hand, it’s kind of cool to know we do have such a powerful, beautiful role in our children’s lives. And on the other hand, if we come to that final B of “balance” – hang on a second, here!

So that’s what attachment science is not. It’s a preference of philosophy. It’s something interesting that makes us have questions.

What Attachment Is

And then we come to attachment science and secure attachment. So I want to first reduce some fear that it’s nuanced what healthy attachment is.

We have a full workshop that really breaks down the literature in a parent-friendly way on what attachment is, the mixed research on attachment, and how that relates to sleep and potential sleep interventions. (Use the code GRACEHFT for a 20% discount!)

But the take home here is that healthy attachment, stable attachment, is the ability for a child to use the attachment figure (the main attachment figure in their life) as what is termed a “secure base.”

What I mean by that is the “secure base” is a resource that you feel safe enough for two things:

1. To go for comfort
2. Secure enough to wander away from (this piece gets missed a lot!)

So you can explore and experience distress because you know the secure base is still there. That doesn’t mean right on your or next to you all the time, but still there, at a distance and available for you to come and go to get what you need in order to assist your soothing.

So it’s important to clarify that secure attachment is not about proximity. Secure attachment comes from the field of attachment science.

The workshop will go into more depth, but Bowlby and Ainsworth are essentially the founders of attachment science, and interestingly, Bowlby was separated from his family during wartime. He was sent to a boarding school as a young child, and that kind of sparked his initial interest in relationships between parents and children when there’s distance.

And then we have Ainsworth, whose work was really sparked when she was working in Uganda and making observations of babies using their mothers as this “secure base” during times of distress. She’d watch them go back and forth between exploration and experiencing distress and going back to check in when they needed to.

So when Ainsworth came back from Uganda, she came back to the U.S. to a very different culture and was like, how do I learn more about this? And that’s where this famous experiment, now known as “the strange situation,” came from. If you’re not familiar with it, grab a tissue and you can see some videos demonstrating the strange situation. And it’s really powerful…

Imagine a room, like a university lab, and you first see the caregiver and the baby come in and play together. And they’re kind of observed on the other side of the mirror to look at temperament. Temperament is like early personality: are they reserved and not exploring right away? Are they exploring and checking things out? Are they reactive?

And then after a period, a stranger, so probably a research assistant, is introduced to the room. And after a little period of getting used to the stranger being in the room, the mom (now they’ve done it with moms and dads) says goodbye to the child and leaves. And they observe from behind the mirror how the baby interacts with the stranger.

Importantly, how the baby responds to the separation is actually not the important part when it comes to attachment. Separation is actually more telling of the early personality, or temperament, we were describing, than it is about the attachment to the parent.

Some kids really freak out when the parents leave, some kids just go about their business, some kids of shut down, etc. That has nothing to do with their attachment to the parent.

Then after this period of time, the reunion in the experiment is what’s important. So when the caregiver returns into the room, we’re watching to see if the child can use that parent to return to their baseline, considering their temperament.

So, for that child, do they go back to business as usual, using that parent to soothe and get comfort, to get them back to their own personal baseline, and then get back to the work of exploring and playing?

Based on these observations, they came up with three categories (now there are four) of responses of children and their attachment style.

1. Secure Attachment – the child might be upset when the parent leaves, but they can explore. And they’re pretty readily comforted when the parent returns. Most kids across the world fall into this category, with a variety of cultural differences and parenting styles.
2. Anxious Avoidant – the child might show little reaction to the parent leaving or returning and doesn’t really explore much, regardless of who’s there
3. Anxious Resistant – there might be a little distress when the caregiver leaves and they don’t explore much, but then when the parent returns, they’re hard to comfort/get back to their baseline
4. Disorganized Attachment – these ones are hard to watch. This is where you can see a child just kind of wandering around, not knowing what to do with themselves. It might even be some fear or avoidance of the caregiver, even if the caregiver is trying to comfort.

My personal experience of disorganized attachment is in fostering one of our little boys. He hadn’t been with us for very long and he got hurt in the backyard. I came outside and kneeled down and I outstretched my arms and he ran towards me like a movie, like he was going to hug me. He was crying and he reached out for the hug and then he punched me across the face. The poor baby didn’t know what to expect from an attachment figure.

This is a precise, nuanced science.

Now, of course we all want our kids to have secure attachment. And when I describe these categories, I just want to call out all the parents out there that are now setting up the strange situation in your living room. Please pause – I feel you. Psychologist parents are a dangerous breed because we have too much information and we so easily fall into this trap.

Don’t do what we did, because there’s no nuance in that!

It’s not about how a child responds in just one moment. But this experiment was pivotal and foundational. And while it’s important, there’s been ongoing work that has shown some mixed results and some limitations.

So all of the studies have brought us more nuance. But this is the foundation of attachment science.

So we have attachment parenting, a philosophy and valid choice, but not a formula for secure attachment. And then we have attachment science, which is rigorously studied, nuanced, and evolving.

And it’s hard to market and sell nuance. People don’t have the attention spans for it! And people can profit more from making people scared, so attachment fear-mongering is real. But it’s scientifically false, it’s unethical, and it’s dangerous.

And just because somebody says, “research shows!” So let’s go back to Dr. Sears. Attachment parenting is a valid choice; we just need to make sure it doesn’t overstate its scientific foundations.

In some of their work, we can see the term “research shows” and even see a citation! So it looks really good, but then you go to the study. And the claim that you “need to respond immediately,” and that promptness has something to do with attachment outcomes, is based on the study of rats.

Now that the rat study is very interesting, but somebody that I would really trust as a scientist should leave a rat study with lots of questions about what the nuance of that would look like in humans. Follow-up studies would not make a giant claim that we can therefore conclude that if you do this behavior to humans, it will have the same impact as on rats.

We actually have a free workshop on parenting for the stressed out parents that just want to do everything right – it’s called Stop Over-Complicating Pareting. Our goal is to help parents cut through all the noise by diving into what the research really says about healthy parenting (spoiler alert: it’s not one-size-fits-all). By grounding yourself in the research and coming back to the basics, you will be able to let go of the pressure to be perfect while also learning concrete strategies.

How Attachment is Formed

I am going to do an overview of how attachment is formed, because there’s a lot! But if you’d like to see the research and the studies, snag this workshop, and you’ll hear us dig even deeper (and use the code GRACEHFT for 20% off!).

When you look at the studies on how attachment is formed, the main predictors of attachment fall into three categories:

1. Parent Factors – depression and anxiety, sensitivity and responsiveness (pausing and reading what your child needs in the moment), intrusiveness (over-responding), attachment style (our knee-jerk reaction to our child crying)
2. Environmental Factors – trauma (i.e. regular conflict in the home) vs. a strong social support
3. Child Factors – the temperament the child is born with

The hard part of this list and the reason that sometimes these things don’t “sell” is that it’s not a checklist of seven B’s, or a formula to follow. “Do this and you will immunize your child from life’s stressors.” I’m sorry, but there’s actually nothing you can do to immunize your child from being human. Being human is going to be hard! So we’re just going to get the best information we can, and do our best.

But here’s what’s so cool, as a foster parent, for example. There are some things from that list that I cannot control, so I focus on what I can have influence over! There are other factors that I can really focus on here where I can have influence.

Attachment is a continuum and it can change! That’s why interventions exist. So a child can start with insecure or disorganized attachment and learn to trust a secure base and have it.

Now, when they’re stressed, sometimes they can fall back into this old attachment style. So it’s not black and white!

Does Sleep Training Affect Attachment? What the Research Actually Says…

There is research specifically on whether sleep training affects attachment, though it’s not as robust, and there are limitations to the research that is out there.

In our attachment and sleep workshop (use code GRACEHFT for 20% off!), we go through each study and describe the limitations and what we can take from it and what we can’t take from it. But there’s really minimal high-quality research assessing sleep training and attachment.

What we do know from the research that does exist is that there is no difference that has been found in the studies that have been done in the long-term attachment outcomes between children who go through sleep training and children who do not go through sleep training. So the attachment style just isn’t related.

What has been consistently found to be related to sleep training is improvement in parental depression symptoms. So sleep train or don’t sleep train, there’s no evidence that it’s going to impact your child’s attachment either way. But there is robust research on parents’ well-being and mental health and its impact on attachment.

So sleep training can help improve parental depression, which improves their ability to sensitively respond to their child! So then the likelihood of being able to engage in the behaviors that promote healthy attachment is there. So, if a family doesn’t find the need for sleep training? Great. But if they do and it works for them, the research supports that it is a healthy choice.

Sleep training is a valid choice to make based on the information that exists! If a mom or a dad is less depressed, they are more able to take delight in their baby, which, in a lot of attachment literature, is kind of discussed as the beauty of attachment. It’s that ability to take delight, even in the complexity, even in the tired, to take delight in your baby.

When I was doing my post-doc at UNC, I worked on the maternal mental health unit for inpatients. So we had a lot of postpartum depression moms that were really severe and had to be hospitalized, to the point of experiencing what’s called postpartum psychosis.

And the first line of intervention for those moms was sleep. Not medication, not even therapy, but sleep! These moms were having full-on hallucinations, and these were not moms that have experienced these symptoms before. These moms were hospitalized and the first intervention that a team of doctors came up with was that they needed to sleep.

It completely makes sense!

As a psychologist, did you sleep train your kids?

I’ve done sleep training and not sleep training, depending on the needs of my kids. I had taken some approaches with some of my children, some approaches with other children, based on the idea that responsiveness is really about pausing, gathering the information, and then applying it to what you know about your family.

My youngest, who’s now six, was really colicky. And when we talk about social supports, I had a partner who was incredibly supportive, doing every wake-up with me and being so calm and validating. My mom also came out to help.

But I had two kids with very intense needs and trauma in my home, plus this colicky newborn. And it was the first time in my life that I felt my brain slipping away from me. People would come and try to let me sleep, and I couldn’t sleep. They would take the baby for a walk, and I could not sleep. And so for me, I wasn’t myself.

I was so anxious all the time, and so with her, I did more structured sleep training (this is not an endorsement!) and in that particular situation, I think it saved me. It helped me return to myself.

If I were to have a baby tomorrow and somebody asked if we were going to sleep train, I would say, “I don’t know.” Maybe, if that’s what’s needed, if that fits, absolutely. But I would know that sleep training and not sleep training were totally valid choices, and I would trust myself.

What would you say to a mom anxious about the sleep training decision?

Trust yourself!

Which I think is something that’s lost with all of this information floating around. We have so much information in front of us saying sleep training will ruin my child, it will ruin me, it will ruin my marriage. And we have so much information saying sleep training will save my child and my marriage.

So we have to take all that information in and then come back to ourselves and trust that we’re going to sense what’s right. And if we do it and it’s not working, we can change course. We need to trust that we will know what we need to do next.

When I’m working clinically with families, especially with more anxious-leaning families, I approach something new by saying, “Let’s do an experiment. We’ve talked a lot about what your values are. We are not going to do anything that’s against your values. So we’ve determined that these choices are within your value system. All right?

This decision that you’re struggling with so much is not a forever decision. Right? So what if we tried it for two weeks, one week, whatever, and see what happens? What would happen? You have full autonomy. You can stop at any point.”

Sometimes we live in this world of “all or nothing,” and like you’re going to make it or break it at all times with every moment of parenting and it kind of creates this paralysis. But I think most parents actually have a lot of wisdom in them that, when combined with solid information, can be a really powerful thing.

And I can tell you something interesting is that one hallmark of secure adult attachment in adulthood is the ability to sit with mixed feelings and uncertainty. This drive to either fix or avoid can be rooted in your attachment style.

When you have a more secure attachment, you can sit in this distance from certainty. If we think about certainty being a secure base in our mind, we can float, we can explore and still feel safe knowing that we have ourselves to come back to, that we can experience distress:

“I don’t know what’s going to happen. I don’t know if this is the right choice,” and kind of float away from that certainty because we are a secure base and we know we can come back to ourselves.

And so knowing that there’s no certainty, that the best we can do is try to get high quality information amongst all the noise and then sit with it. And then combine it with what you know about yourself, your family, and then have some trust move forward, even when you’re not certain. So that ability to sit in some confidence that you can handle the uncertainty is kind of modeling that secure attachment.

Is there anything else that you would like to share?

In all of this, we’re not saying anything goes. But we are saying there are some pillars to go to when it comes to parenting and trying to raise healthy humans, and trying our best to be a healthy family. There is research; it’s not anything goes.

But it’s kind of like if you imagine reaching the top of a mountain, which is secure attachment or a “healthy family.” There are many paths up that mountain. It doesn’t mean anything goes, as there are some paths that are going to lead off a cliff. But there are many trails!

So we’re led to believe that it’s this style of parenting vs. another style of parenting, but what if we just look at them as different paths, for the most part? My path is not going to look just like your path. We might have more resting spots. There might be different things in my backpack as I head up this terrain than there will be in yours. But we’re heading north, and we’re generally following the map the best we can.

——————————————————————————————————————–

If you’re feeling torn between improving sleep and protecting your bond with your baby, you don’t have to figure it out alone. At Via Graces, we help families create sleep plans that support both independent sleep and secure attachment—without second-guessing every step.

About Shanna Sarita Alvarez

Dr. Shanna Sarita Alvarez is the founder of Helping Families Thrive, a licensed psychologist and mother of three. She received her Ph.D. in Psychology at the University of Washington and completed an APA-accredited internship in Clinical Psychology at the UNC School of Medicine in Chapel Hill. Dr. Alvarez completed her Post-Doctoral Fellowship in Clinical Psychology at the University of Washington’s Center for Human Development and Disability.

Dr. Shanna Sarita Alvarez has worked in a wide array of clinical, educational, and research settings across the U.S and internationally. Her clinical and research focus has included Autism Spectrum Disorders, parental well-being, challenging behaviors, and Acceptance Commitment Therapy. Her greatest passions are evidence-based, systems-focused interventions. By addressing the familial and educational systems that surround each child, she truly embraces the complexity of individual growth and change.

Dr. Alvarez is part of the team at the Seattle Clinic. She is based in White Rock, BC, and is establishing the Canadian branch of Helping Families Thrive.

When not working with families and combating misinformation, Dr. Alvarez spends time with her three children and her dog, enjoys walks at the beach, and dancing.

She is a passionate parent of all stripes (foster, adoptive, biological, kinship) and knows the power and challenges of using science-based strategies in everyday parenting. Dr. Alvarez is also a long-time fitness instructor who loves dance, family mud-races, and all things hip-hop and reggaeton. Dr. Alvarez believes in creating warm, authentic connections through which she can bring evidence-based practices into her clients’ daily lives. Dr. Alvarez provides telehealth services in Washington State and all PSYPACT-participating states of the USA. Telehealth services are offered in accordance with licensing and PSYPACT regulations.

Telehealth services are also available in British Columbia, Canada.