Attachment

Developing and repairing the bond between parent

and child

Attachment: where does it begin?

Attachment is always a two way street

Before birth in the womb

After birth: attachment chemicals (oxitocin) in the brain of child and mother

Taking care of the baby- responding to his basic needs

Pattern of care in early years set an expectation of relationships within the individual for life

What is attachment?

Special enduring emotional relationship (bond) with a special person

Involves familiarity, comfort, soothing and pleasure

Threat of losing that specific person is distressing

Security and safety within the context of the relationship

Emotional glue between people

Phases of attachment

Birth to six weeks: neutralSix weeks to six months: developing attachment with primary care giverSix months to 15 months: discriminate between carers, preferred attachment16 months and three years: established-start to experiment and expanding to othersThree years and onwards: repeating attachment patterns in all relationships

Discuss

What age were the children placed in your care, removed from their birth parents? ORAt what age was your child separated from you?In what phase of attachment were they?What implications do you think this had in the children? [10 min]

Attachment patterns

Secure: safe well balanced emotional connection between parent and child

Parent is attuned and responsive to the child's needs

Child respond to the carer with affection respect and accepts guidance from adult

Trust is established

Attachment patterns continued

Insecure attachment:

Avoidant: parent not giving attention to the child- child gives up-avoid making contact.

Ambivalent: parent sometimes gives attention sometimes not. Child becomes hyper demanding to ensure parents attention

Attachment patterns continued

Disorganised: could be avoidant or ambivalent but with element of fear or abuse-child disconnects

Indiscriminate: multiple placements multiple carers- child will attach to anyone- superficial attachments

Case study

Peter was removed at 18 monthsChronic neglect- hospitalised for infected nappy rash for third timeDid not talk sit crawled or walked and did not eat solidsHospitalised for 8 weeks where he caught up most of milestonesWas in three places of safety before entering long term foster careAt age 15 he does not interact with peers and has been reprimanded for setting the dog on fire and watching while the dog burned

Discuss

Does he have a secure / insecure attachment?What possible attachment pattern does he have?Can you recognise any possible attachment patterns of your child/foster child?How does this make you feel? [10 min]

Internal working model

From birth to 3 years a child form an opinion about themselves and the world based on the interactions with their primary care givers-engrained in implicit memory If the child has been abused / neglected they would view the world as a hostile environment without any warm place for himselfIf that inner working model goes unchallenged they would use this as their point of departure in all their interactions

How do you change this inner working model?

Healing takes place through positive repetitive ,specific, predictable, experiences in a cognitively stimulating and attachment rich environment

What is the effect of insecure attachment of children

Problems accepting adult controlChild: “I must take charge of things or no one will”- internal messageRefuses to co-operate not accepting leadership of parentParents: Threatens parents belief that they have the right to parent the childFeels frustrated or like failure+Response: safety, understanding, structure, completing tasks –lead by doing not saying story telling.

DISCUSS

What is your child’s inner message about accepting adult control?

How have you been affected by his/ her refusal to accept your leadership?

What is the effect of insecure attachment of children

Engagement and relationship problems

Child: “I must stay away to avoid getting hurt” internal messageNo eye/ physical contact, superficial relationships, unpredictable, not thereParent: difficult to claim child as own or develop mutual feeling of belongingFeels rejected by child+Response check up list, wonderment, eye contact, repetition story telling

DISCUSS

What is your child’s doing to avoid engaging with you?

How have you been affected by this?

What is the effect of insecure attachment of children

Problems in accepting care.Child: “ I can take care of myself-don’t need anyone” internal messageDon’t ask for help. Don't allow assistance with care- wear dirty clothes wont let you wash hair.Parents: feel rejected and frustratedNot easy or pleasurable to sooth comfort these childrenCaretaking becomes devoid of emotion foster family vs. board & lodging+ Response: soothing, singing, rocking, lotioning feeding, tucking in at night. Repetition story telling

DISCUSS

How is your child avoiding your attempts to care for him/ her?

How have you been affected by this?

What is the effect of insecure attachment of children

Problems with competence and self- worth

Child: “ I deserved the bad treatment- its my fault” ” I'm worth nothing” internal message.

Cognitive and developmental delays

Poor school performance, child feels like a failure

Parent: Too high expectations, disappointment with child's performance

Extra expenses of occupational therapy or remedial classes

Enrol child for activities they are not ready for

+ Response: more nurturing and warmth than challenge

Lower expectations so that the child can achieve success

DISCUSS

What is your child’s inner message about their self –worth?

have you been expecting too much or have you been disappointed by their lack of performance?

What is the effect of insecure attachment of children

Problems with regulation and expressing of emotionsChild: “emotions are bad and scary” internal messageCant control emotions- “loose it” and has low frustration threshold. Emotional age is much younger than actual age.Hurt others tantrums, no remorse, or cut off from their feelingsParent: sometimes panic in fear or become out of control themselves.Parents own emotions become a barrier between them and the child.+ Response: acknowledge and validate their emotionsDon’t react but parent from safety- provide emotional safety for child to feel and express their emotions.

DISCUSS

Can your child express his/her emotions?

How have you been affected by their emotional state?

Intervention dimensions

Structure: routine, guidance, consistencyEngagement: catching them off guard, new interesting experiences.Nurture: physical and emotional care, involvement Challenge: challenging old ways, stretching, moving out of the comfort zone

References

Jenberg, A.M. & Booth, P.B. 2005. Theraplay: Helping parents and children build better attachments through attachment based play.2nd ed. San Francisco: Josey Boss PublishersMay, J.C. 2005. Family Attachment Narrative Therapy: healing the experience of early childhood maltreatment. Journal of Marital and Family Therapy, 81-99, Jul.Peluso, J. P. Peluso, P. R. Kern, R. M. & White, J. F. 2004. A comparison of Attachment Theory and Individual Psychology: A review of literature. Journal of Counselling and Development, Vol. 82:139+Single, T. 2005. Long term foster care for abused and neglected children: how foster parents can help healing the trauma. Unpublished training manual for John Hunter Children's Hospital.