Catherine Young, MFT

          

The Art and Science of

Being Whole

Marriage and Family Therapist, license # MFC36431

Certified Hypnotherapist

 

Attachment Theory and Therapy

                  

A child’s healthy attachment to his/her caregiver is instrumental in helping the child to develop a positive sense of self, the ability to regulate emotion, a strong moral compass, resiliency in the face of challenges, and to exhibit prosocial behavior and empathy towards others.


When the child’s attachment has been severely disrupted and has not been treated, the child will likely face issues of low self esteem, difficulty regulating emotions, lack of empathy towards others, and display anti-social or even bizarre behaviors.  Though these children may be bright, they will often struggle to cope with the challenges of life.  Their ability to establish healthy relationships will be severely impaired.  Those trying to parent these children often feel like failures as nothing seems to work.  Many adoptive and foster family placements fail due to unaddressed attachment issues.


Many things can disrupt a child’s attachment, including both caregiver factors and child factors. 


Caregiver factors include:

Multiple, sequential caregivers - a child can benefit from multiple caregivers if these are co-occuring and consistent over time, as in an extended family.  If multiple caregivers are sequential, however, such as a child moving form foster home to foster home, great damage can be done as each caregiver attachment is broken, one after the other.  Foster and adopted children are at risk for attachment issues, particularly if they have moved around a lot.


Impairment in the caregiver’s ability to respond appropriately to the child - This may include anything from depression, illness, substance abuse, mental illness, prolonged separation or a parent with their own  attachment issues impairing their ability respond to their child.  Abuse and neglect will damage a child’s ability to attach appropriately.  Severe neglect can be even more damaging than abuse to a child’s attachment.  The child who is not responded to at all can be more damaged in their attachment than the child who is responded to harshly.


Child factors include:

Anything that may impair a child’s ability to respond to their caregiver including illness, chronic pain, disability, or extended separation from their caregiver.


The young child with significantly disrupted attachment will often respond in one of two ways with others: 


Inhibited attachment:  These children will act as if adults don’t exist in their world.  They have come to believe that adults have nothing to offer them.  They do not come to adults for solace or safety or assistance.  They do not look to adults for positive interactions of any kind.  They have no positive expectations of adults.  In their world, they have come to rely only on themselves.


Indiscriminant attachment:  These children will go to anyone, any time.  They do not differentiate between the familiar and the stranger.  They do not develop specific attachments to anyone. Although they can be charming, their relationships are superficial.  They have learned to look everywhere and anywhere to try to get their physical and emotional needs met.  They will often jump into the lap of a stranger or take the hand of someone they have never met.  They are vulnerable to being victimized due to their neediness and lack of discrimination.


Sometimes children with attachment issues will look to peers to meet their primary attachment needs.  This is a strategy that is bound to fail as their peers are unable to provide them the nurturing, stability and maturity that they need.


Whether the child initially exhibits inhibited or uninhibited attachment patterns, their ability to form strong, positive, reciprocal relationships is severely impaired.  Those trying to engage in relationship with them will often feel manipulated, because these children have not learned what it is to truly relate to another human being.  And, sadly, while these children may feel empty inside, they do not really know what they are missing.  The children with the greatest disturbance in attachment are said to have Reactive Attachment Disorder.  These children do not tend to be responsive to behavioral interventions alone or other child therapies.  They often will get worse rather than better over time without attachment based interventions.  For these children, attachment therapy is critical.


Of course many children have attachment issues without fully meeting criteria for Reactive Attachment Disorder.  All children with significant attachment issues can benefit from attachment therapy. 

Attachment Theory (see below for Attachment Therapy)


Attachment theory postulates that the attachment, or connection, that a child forms with his/her primary caregiver during the first three years of life has a dramatic and profound effect on that child’s development.  Emotional, behavioral, moral, and relational aspects of the child’s life are greatly impacted by their first relationships. 


Attachment is not something the child does, or the parent does.  Rather, it is the connection that is developed through the reciprocal interaction between parent and child.  When the child cries, the parent responds.  When the parent makes silly noises, the child smiles.  Through these kinds of positive interactions the child forms a sense of self worth, a sense of efficacy in the world, and a template for all future relationships.

Attachment Therapy


So, how do we heal damaged attachment?  How can we work most effectively with these most challenging of children? 

There have been a number of therapies that have attempted to specifically address attachment issues in children.  Through my study of attachment therapy techniques and work with children with severe attachment issues, I have developed a model that is both playful and respectful.  My working model is an amalgam of approaches, but I have found that one of the key pieces to reaching these children is incorporating attachment based play into the individual and family therapy components. 


Attachment based play is play that serves to engage, nurture, encourage trust and provide structure and safety.  Play has been described as the language of childhood.  What better way to reach children?  One component of attachment based play is that the adults are in charge of the session.  In this way children learn that they can trust the adults to be in charge, and not only is it safe, it is fun too!


FAMILY THERAPY


Family therapy consists of two parts:  Parent sessions and Parent/Child sessions.


PARENT SESSIONS


The parent sessions are an important part of the therapy.  This is an opportunity to address parenting issues through the lens of attachment theory.  Parents receive support, education and an opportunity to discuss concerns.  The number, length and nature of parent sessions are designed around parent needs.


PARENT/CHILD SESSIONS


Parent/Child sessions are the heart of attachment therapy.  Through attachment play and therapy we begin the reparative, healing work for the child. 


The following is an example of a ‘typical’ parent/child therapy session:


Parent(s) and child come in and sit on the couch together.  We start out with some games.  These games are designed to engage the child, provide nurturing and structure, encourage self regulation, and build trust and a sense of safety.  They may include:


Follow the leader games (the adults in the room always start as the leaders, but the child always gets a turn to lead as well) . These games allow the child to learn to follow an adult’s lead in an enjoyable and positive way, and gives the child the chance to be followed or mirrored by caring adults.


Touch games that are positive, non intrusive and non threatening such as clapping games, passing a ‘touch’ around the circle, thumb wrestling, or practicing a ‘gentle touch’ between parent and child.  Positive touch is key to these children’s healing and development.


Singing games that are adaptations of familiar songs (row row row your boat, or twinkle twinkle or Rock a bye baby) that express caring and nurturing for the child. 


Eye contact games (i.e. peek-a-boo for young children, seeing how long parent and child can look at each other without breaking eye contact for older children).


Children are at times assisted in participating, or encouraged to participate, but are never forced to engage.  Being playful often draws them in, and on occasions when they choose not to engage, parent and therapist continue the play until the child is ready to re-engage.  In most cases the child will go through a phase of resistance to the therapy as they are resisting giving up control, or feeling more vulnerable than they like, but this is usually short lived.


After the play we usually talk about whatever is appropriate - this may include current behavior, addressing/understanding past history, goals for the week, successes, challenges, etc.


After we talk we have a snack.  I typically use small crackers which the adult(s) feed to the child as we, or the child, answer questions such as “What is one time that you had fun with your child this week?”  Questions are always positive, success oriented.  Thus the session is ended on a positive note.


These parent/child sessions are often short, 30 - 50 minutes depending on issues, focus and age of the child.  They may occur more than one time a week.  There are many subtleties to the therapy that can not be adequately described here.  Though the techniques may sound simple, the effects are often profound.



INDIVIDUAL THERAPY


Individual therapy can be used to supplement the family therapy components as needed.  For instance, sometimes it is prudent for the therapist to work with the child first before starting the parent/child sessions if the child tends to exhibit extreme oppositional behaviors with their parent(s). 

The individual sessions also offer the child another way to process or address their issues.  Individual sessions often include structured attachment based play therapy, followed by a more traditional non-directive play therapy.  Traditional non-directive play therapy alone is often not effective with children with serious attachment difficulties.  I have found, however, that combined with attachment based play therapy, it can be quite effective.


Individual therapy for attachment issues is also indicated in situations where the child does not have an appropriate adult to work with them in the therapy.  This, of course, is not ideal as all children need a loving adult to care for and commit to them.  Nevertheless, good work can be accomplished.



Your Child:


If you are wondering if attachment therapy is right or indicated for your child, feel free to call me to discuss your situation or schedule an appointment.  I conduct a thorough assessment of every child coming in for therapy.