Elsevier

Developmental Review

Volume 34, Issue 2, June 2014, Pages 114-167
Developmental Review

Emotional availability (EA): Theoretical background, empirical research using the EA Scales, and clinical applications

https://doi.org/10.1016/j.dr.2014.01.002Get rights and content

Highlights

  • The concept and background of emotional availability is reviewed.

  • Empirical research on emotional availability is reviewed.

  • Clinical applications are summarized.

Abstract

Emotional availability (EA), as a construct, refers to the capacity of a dyad to share an emotionally healthy relationship. The Emotional Availability (EA) Scales assess this construct using a multi-dimensional framework, with scales measuring the affect and behavior of both the child and adult partner (caregiver). The four caregiver components are sensitivity, structuring, non-intrusiveness, and non-hostility. The two child components are the child’s responsiveness to the caregiver and the child’s involvement of the caregiver. We first describe this relationship construct, look at psychometric properties in basic and prevention/intervention efforts, then review the extant empirical literature in order to examine the scope of studies assessing EA by using the EA Scales. We also explore its use in clinical practice. Throughout, we critically evaluate the knowledge base in this area as well as identify areas for further growth.

Introduction

The intent of this paper is to outline the theoretical background and use of the Emotional Availability (EA) Scales, a tool that can be used to “take the temperature” of relationships between children and their caregivers. There is a large body of empirical research using the EA Scales, a relationship-based assessment that can be used to examine caregiver–child relationships across a broad spectrum of adult–child relationships (e.g., parent–child, child care provider/teacher–child), developmental ages (e.g., infancy, preschool, middle childhood, and adolescence), and contexts (e.g., naturalistic, semi-structured and structured play, teaching, feeding, bathing, separation–reunion). Our goal in this paper is to (a) provide an overview of the theoretical background of the EA Scales; (b) examine the psychometric evidence in basic science, prevention/intervention studies, and cross-cultural applications; (c) summarize the large body of empirical research using these scales; (d) understand the clinical practice that employs the EA Scales; and (e) critically evaluate this work and interpret the findings emanating from it.

Section snippets

Theoretical background

Mahler, Pine, and Bergman (1975) first used the term “emotional availability” to describe a mother’s supportive attitude and presence in the context of infant/toddler explorations away from her. They noted that healthy mother–child relationships allow for exploration and autonomy, at the same time recognizing the importance of physical contact and emotional “refueling.” Other writings (e.g., Sorce & Emde, 1981) emphasized the importance of emotional availability including not merely physical

Descriptions of and procedures for using the Emotional Availability (EA) Scales

Emotional availability is a dyadic or relationship construct: although the caregiver dimensions are distinguished from the child dimensions, the emotional availability (EA) of both partners is viewed from within the context of this particular relationship. This means that the score for one of them can only be meaningfully assessed when the other’s complementary qualities (as they relate to one another) are taken into account. Thus, the system is a relationship evaluation system, rather than a

Reliability1

The operationalization of emotional availability in the EA Scales has demonstrated acceptable psychometric properties, including validity and reliability. For example, one study (reporting on two occasions of in-home observations one week apart, that is test–retest reliability) of 52 middle-income mothers and their 5 month-old infants, used average absolute agreement intra-class correlations (ICCs) in a two-way random effects model. ICCs yielded reliabilities that ranged between .79 for

Basic research using the EA Scales

In addition to the growing use of the EA Scales to evaluate prevention and intervention science studies, as noted above, there is a much larger body of basic research utilizing the system. Researchers in North America, South America, Europe, Australia, and many non-Western countries have studied the correlates, predictors, as well as sequelae of both parental and child EA. We will review this research within the context of several organizing principles. The first organizational framework is

Evidence-based practice or psychotherapy

We were able to locate only three published studies that examined the EA Scales in clinical settings, potentially because clinicians may not publish their observations. One such investigation used EA to evaluate Parent Child Attunement Therapy (Dombrowski, Timmer, Blacker, & Urquiza, 2005), an intervention for parents of toddlers, adapted from Parent Child Interaction Therapy (PCIT). In this single-case study (Dombrowski et al., 2005), clear improvements in maternal EA (in particular,

Methodological considerations

In the following section we will offer reflections on the use of the EA Scales. Several special journal issues on the topic (see Biringen and Easterbrooks, 2008, Biringen and Easterbrooks, 2012, Easterbrooks and Biringen, 2000, Easterbrooks and Biringen, 2005, Easterbrooks and Biringen, 2009) have explored methodological issues, as well as application across different samples and ages. There presently, then, is a “critical mass” of knowledge upon which to reflect (more than 100 peer-reviewed

Aspects of the system

The newest (4th) edition of the coding manual includes the Emotional Attachment & Emotional Availability (EA2) Clinical Screener, which also provides not only the means to summarize the EA Scales, but also a means to provide an “attachment” score. The screener ranges between 1 and 100, and an adult–child relationship is assigned into one of four zones – “problematic zone” (1–40), “detachment” (41–60), “complicated emotional availability” (61–80), and “dyadic emotionally availability” (81–100),

Conclusion

In this paper we addressed both theoretical and methodological aspects of the EA Scales, critically reviewing some 112 published empirical articles. Here, we want to applaud the 26 additional conceptual pieces (e.g., Aviezer, 2008, Barone and Biringen, 2007, Beeghly, 2012, Biringen, 2000, Biringen, 2005, Biringen and Easterbrooks, 2000, Biringen and Easterbrooks, 2008, Biringen and Easterbrooks, 2012, Biringen and Robinson, 1991, Biringen et al., 2005, Biringen et al., 2005, Biringen et al.,

Acknowledgments

We thank Robert N. Emde for his critical reading of this manuscript, his support of and contributions to the work on emotional availability over the past 25 years, and his important suggestion to recast attachment as a relationship construct. We also thank the participants of the Affect, Stress, and Prevention (ASAP) Seminar at the University of Colorado at Denver Anschutz Medical Campus for regularly meeting and critically discussing frontiers. Further, we thank all of the children, caregivers,

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