Attachment Disorders
Identifying Symptoms, Challenges, and
Treatment of Attachment Disordered Youth
Attachment Disorders
Jennifer Vernon, MS, LPC – Clinical Manager of Child and
Family Services
Michelle Anspaugh, MS, LPC – Child and Family Therapist
Synergy Services, Inc.
How many of you have been to attachment trainings?
How many of you currently do attachment work?
Attachment Styles of Youth
Secure Attachment
Avoidant Attachment
Anxious Attachment
Ambivalent/Disorganized Attachment
Secure Attachment
Seek primary attachment figure when distressed.
Curious and responsive to environment
Self-confident and good self-esteem
Empathetic, humorous, playful
Will try in the face of adversity
Can ask for help when needed/balanced with
developing independence.
In shelters for situation specific (parent lost job) or
conflict w/ parent
Avoidant Attachment
Develops when caregiver is rejecting and unresponsive
Moms/parents – often depressed, drugs/alcohol problems
Passive and withdrawn behavior – doesn’t express distress
Avoids closeness to others
Avoids feelings
Seldom seeks comfort
Passive-aggressive
Don’t expect much/minimize expectations
Have minimal narrative-facts (explicit memory) vs. emotional
memories (implicit memory)
Anxious Attachment
Develops when caregiver is inconsistent responding to child.
Anxiety connected to fear of abandonment
Seeks emotional closeness as “valium” to quiet anxiety.
Can be charming or whiny/complain
Non-stop talking, constantly interrupting, or asking questions
Looks like ADHD
Uses “impression management”/people pleasers
Behavior varies depending on who is present
Rarely openly defiant or passive-aggressive
Fall in love easily – focus on “other”
Ambivalent/Disorganized Attachment
Most severe attachment disorders
Often develop into personality disorders and sociopaths
Root cause is often Betrayal Trauma - occurs when the people or
institutions we depend on for survival violate us in some way
Child/teen responds with extreme self-reliance
Very controlling with others
Push-pull style
Odd behaviors and unpredictable moods
Focus on injustices done to them/consider themselves victims
Openly angry, defy rules, high-risk behaviors, superficially charming, lack
empathy, delinquent acts, self-harm, suicide attempts, cry to get others to
engage, lying, aggression, promiscuity
RAD, ODD, CD, Complex/Developmental Trauma
Experiences That Lead to Attachment Problems
Abuse and neglect
Loss of parent
Unavailability of parent
Premature birth
Medical problems (especially before age 2)
Chronic pain
Poor prenatal care
Challenges of Treatment
Availability of attachment figure
Attachment and trauma hx of attachment figures
Time in tx
Fears of clients:
Trusting us
Allowing others to help
Being let down (again)
Being hurt
Being vulnerable – dangerous
Treatment
PACE
Connection vs. Correction
Create a Coherent Narrative
Connect client’s story to current
behaviors/feelings
Trauma work
Educate caregivers/ staff about Therapeutic
Parenting
PACE ATTITUDEDaniel Hughes – Attachment-Focused Family Therapy
Playfulness
Acceptance
Curiosity
EmpathyTherapist engages youth with this attitude, helping youth engage
relationally in a different way.
Therapist helps the parent/caregiver engage in PACE attitude to
become emotionally connected to youth.
How do we get in?
Connnection vs. Correction:
Feels counter-intuitive
Reflect youth’s feelings/inner thoughts before
giving consequences/lecture
Changing neural feedback loops of interacting
Speaking to
Speaking for
Speaking about
Create A Coherent Narrative
Connect youth’s story to thoughts/feelings
Trauma Work – Trauma effects attachment.
Ask youth to bridge the gap between
distressing event and emotions/thoughts/body
sensations – between explicit and implicit
memory.
EMDR, TFCBT, etc.
Any Questions?
Thank you for attending today
References Attach.org
Clark, Mindi Higgins Kessler. (2009) Diagnostic and Treatment
Features of Reactive Attachment Disorder
Emdria.org
Forbes, Heather T. and Post, Bryan B. (2009) Beyond Consequences,
Logic, and Control: A Love Based Approach to Helping Children With
Severe Behaviors
Freyd, Jennifer J., What is Betrayal Trauma? What is Betrayal Trauma
Theory? http://dynamic.uoregon.edu/~jif/defineBT.html
Hughes (2007). Attachment-Focused Family Therapy
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