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?
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when caregiver is rejecting and unresponsive Moms/parents – often depressed, drugs/alcohol problems Passive and withdrawn behavior – doesn’t express distress Avoids closeness to others Avoids feelings Seldom seeks comfort Passive-aggressive Don’t expect much/minimize expectations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 ATTITUDE Daniel 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.
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