Parents often report to us that traditional psychotherapeutic approaches have not been effective with their severely attachment-disordered children because of their lack of trust and inability to form a working alliance basic to success in therapy.
Lack of secure attachment in the early years results in a need to control, a fear of closeness and a lack of reciprocity. The therapeutic challenge is to take charge in a firm, yet caring, way and gradually form a working relationship with the child. The same characteristics that make it difficult to help those with antisocial personality (no empathy or remorse, angry, defiant, dishonest and self-centered) are present in these children. The therapeutic challenge is to instill the basics: trust, empathy, cooperation and conscience – qualities essential for successful living in a family and community.
Family-systems principles provide the foundation for Corrective Attachment Therapy. It is necessary to understand the child within the context in which he or she functions—the family. The family-systems approach focuses on assessing and changing relationship patterns. Family relationships are reciprocal and circular with the behavior of each family member serving as both a trigger and response for one another. These ongoing patterns of interactions maintain the family system and often the behaviors and symptoms of family members. In our book, Healing Parents, we refer to the modification of family dynamics as, “change the dance, change the child” (Orlans & Levy 2006).
Children with attachment disorder enter a family with a variety of prior psychosocial patterns and symptoms
Children with attachment disorder enter a family with a variety of prior psychosocial patterns and symptoms. For example, when a child with a history of maltreatment, several out-of-home placements and anxious and/or disorganized attachment is adopted into a family, the focus becomes not only the child’s history of problems, but also the constellation of family-related issues: parents’ attachment histories, marital relationship issues, sibling issues, parenting attitudes and skills, relationship patterns and dynamics and external social systems.
The Traumatized Family
Families who enter treatment are commonly demoralized, angry, and “burned out.” The parents were often intellectually and emotionally unprepared when they adopted the child with attachment disorder. After several years of having the child in their home, high levels of stress and ongoing negative patterns of relating have produced a climate of hopelessness and despair. Previous treatment failures are common, including a variety of ineffective therapeutic interventions and parenting approaches.
Parents have often been blamed by mental health and social service professionals who lack an understanding of attachment disorder. Professionals may assume the child’s acting out is entirely a result of ineffective parenting without identifying the child’s prior attachment difficulties. Symptoms of post-traumatic stress disorder are routinely observed in the parents, the siblings and the child with attachment disorder.
Symptoms of post-traumatic stress disorder are routinely observed in the parents, the siblings and the child with attachment disorder.
Some parents who adopt special-needs children are psychologically capable of meeting the challenge. Others, however, have histories of dysfunctional family relationships and current individual and marital difficulties. In these cases, treatment must focus, in part, on the parents’ issues to avoid scapegoating the child. The therapist must walk a tightrope to maintain a delicate balance. On the one hand, provide empathy and support to parents who are feeling disgruntled, hopeless and blamed. On the other hand, confront the parents’ own issues to effect necessary change.
Secondary Traumatic Stress
Many parents, and sometimes siblings, have secondary traumatic stress (STS). STS, also called compassion fatigue and vicarious traumatization, refers to the cumulative effects of living with and dealing with a survivor of traumatic life events. STS is also seen in nurses, first responders, trauma therapists and military personnel. The symptoms of STS include anxiety, depression, fatigue, physical illness, emotional numbing, social withdrawal, loss of motivation and feelings of hopelessness and despair (Figley 1996, 2002; Osofsky 2011). The risk factors for STS include: measuring one’s self-worth by how much one helps, having unrealistic expectations of self and others, being self-critical and a perfectionist, fear of being judged by others, being unable to receive emotional support, overextending oneself, and having a history of trauma in one’s own background.
Studies have shown that support and social connectedness reduces the emotional strain and increases positive coping abilities of caregivers and parents of children with severe emotional and behavioral problems
Parents participating with their children in our treatment program often have STS symptoms. These symptoms are a result of dealing with challenging children and, in many instances, due to their own histories of interpersonal trauma. Discussing their Life Scripts with understanding and supportive therapists helps them to become aware of issues from their past that are triggering strong emotional reactions. Support is crucial. Studies have shown that support and social connectedness reduces the emotional strain and increases positive coping abilities of caregivers and parents of children with severe emotional and behavioral problems (Munsell et al. 2012). We provide substantial support to parents and encourage them to develop and maintain helpful support systems at home (e.g., family, friends, religious and community connections).
Power and Control
Families whom we treat are characterized by both a control-oriented child and parents who lack the information and skills necessary to effectively deal with their child, resulting in chronic power struggles.
Positive changes for the child and parents become the focus. The therapist creates a climate of healthy limits, boundaries, and structure for the child by providing rules, contract, and clear expectations. The dynamics of power and control shift, as the child’s control strategies become ineffectual with a firm and confident therapist. Over time, the child learns to feel safe with external limits. This is crucial modeling for the parents, who become more hopeful by observing strategies that are effective with their child and increasingly motivated to learn new parenting attitudes and skills. During the course of treatment, the therapist spends considerable time educating the parents about attachment disorder and rehearsing effective parenting approaches.
Children with attachment disorder are experts at “working one against the other.” For example, a child may form a coalition with one parent against the other, or with a counselor against the parents. This is one of the child’s strategies of manipulation and control. The structure of treatment prevents this triangulation. The treatment team and parents create a strong and unified collaborative alliance, while the parents are also helped to develop and maintain a unified parental team. An emphasis is placed on the parents’ learning communication and problem-solving skills so that they can be “on the same page.” It is also important that treatment team, parents, and external systems (e.g., social services) are united and working towards common goals.
One mother writes:
It is impossible for me to put into words the effect this child has had on our marriage. She intentionally causes arguments between my husband and me. The bad thing is we know she is doing it, and we try not to let it happen, but sometimes she has done it before we even realize what is going on. It sounds hard to believe this conflict is brought about by a 4 year-old child, but it is. After she has gotten my husband to do whatever it is she wants him to do, she gives me the most superior look. It just blows my mind.