Supporting the Family
“What is attachment”?
To attach is instinctive. Attachment behaviors are necessary for an infant’s survival because they promote care taking from parents. Attachment develops as a result of the cycle that occurs when an infant expresses a need and someone in the environment satisfies that need. When needs are repeatedly not met the infant cannot develop trust. Instead, a negative blueprint of the world is developed that can have serious consequences on the child’s social, emotional, and physical development.
A child's ability to attach may be disrupted by loss of birth parents, multiple foster home placements, inadequate care, abuse or neglect by caregivers with mental illness or drug abuse, and even unhealthy in-utero environments.
Symptoms of Insecure attachments vary from child to child and are associated with:
- History of abandonment, neglect, abuse, and/or multiple placements
- Indiscriminately seeks affection and/or comfort from strangers (i.e., pseudo-attachments)
- Anti-social behaviors (e.g., lying, stealing, manipulating, destructiveness, cruelty, fire-setting, aggression)
- Lack of authenticity, spontaneity, flexibility, and empathy
- Lack of physical affection and closeness and/or inappropriate clinginess
- Poor eye contact
- Problems with learning, attending, self-regulating, self-monitoring
- Abnormal eating and elimination patterns (e.g., wetting, soiling, hoarding food)
What the family / parents experience
Parents who have not been educated about attachment impairment are typically blind-sided by behaviors displayed and spend a lot of energy trying to figure out how to parent the child better. The problem is that typical parenting techniques do not work with traumatized children with attachment deficits. As the families parenting these children try to understand the symptoms mentioned above, they often begin to doubt themselves and their ability to parent.
Parents may begin to isolate themselves and the family in an attempt to keep from being judged. If they have shared their concerns with a close friend or family member about the problems they are having, they may not be receive the support they need or be believed because the behaviors are not always witnessed outside the family. If you do witness out of control behavior, it is only the tip of the iceberg compared to what these parents are experiencing
Inappropriate behaviors are typically directed more in the direction of one parent than the other, most often the mother. The attachment impaired child will 'triangulate' between parents, behaving one way towards one parent, another way to the other parent and the parents then find themselves at odds with each other. The child will tell any number of false stories; the parents become tense with each other and the family becomes less stable. The child is smart enough to make sure none of the behaviors thrown at mom occur in front of dad.
This instability is what the child feels comfortable with, it is what they 'know' from previous life experiences and they are now 'in control'. Even parents familiar with attachment disorders find themselves overwhelmed with the constant vigil required to maintain parental control and keep the family on an even keel.
What Attachment and Trauma Focused Therapy accomplishes
At the Attachment Institute of New England Treatment takes place in our outpatient setting following an assessment, during which the family demonstrates a satisfactory level of commitment to the child.
- Attachment and Trauma Focused Therapy is an integrative treatment that utilizes elements of multiple therapies including cognitive-behavioral, object relations, psychodynamic, family therapies and biofeedback.
- Families learn to develop emotional attunement to address the child’s affective dysregulation.
- In most cases two therapists are assigned to each family.
- Primary caretakers are expected to attend each session. The child is frequently held on the parents’ lap to promote physical intimacy which is integral to the formation of a secure attachment.
- Eye Movement Desensitization and Reprocessing (EMDR), a specialized form of treatment for trauma, may also be used.
- In addition to holding and EMDR, some parents have found treatment modalities such as neurofeedback, and medication to be useful; these treatments are not provided at the Attachment Institute of New England.
Supporting the Family, How you can help
When parents share their struggle with you, recognize that this sharing is a big step and one that needs to be treated gently and with respect. The parents are making themselves vulnerable, trusting that you will hear them, believe them, not judge, but support them. Most likely they will not share all details due to shame or fear that they will not be believed. These families are traumatized, fragile and working very hard to stay afloat; they are scared, weary, worried, and may feel desperate.
At the Attachment Institute of New England, the child is learning how to become Responsible, Real, and Respectful (the 3 R’s), while dealing with traumatic issues that have affected their ability to attach. Using the same language the parents use with the child helps reinforce what the child is learning and supports and validates the parents.
There is a list of “One Liners”, verbal responses parents will use to acknowledge and interact with the child without engaging in a power struggle. This list of one-liners is located under the Resources tab on the home page. Ask the parents if they would like you to use these same responses and show an alliance with the parents by using the same language. These one-liners are always to be said in a loving tone without sarcasm. A network of consistent responses from other adults close to the family is very supportive.
Additional articles are listed in the Resources tab regarding shame, educational issues and information that will broaden your knowledge of attachment impairments. Reading these articles and discussing them with the parents shows support; the fact that you have taken the time to read, learn, and understand the issues speaks powerfully of your support and love.
Concerning holidays, birthdays, and gift giving; it is always best to run gift ideas past the parents first. Keeping it simple is what the parents try to do and a single thoughtful gift is generally more appropriate for these children. Holidays and celebrations are often stressful triggers for the child, and if the parents ask you delay gift giving, respecting their wishes is supportive.
The parents need consistency from other adults who interact with the child. The best way to offer uniformity is to follow the parents’ lead when interacting with the child. You cannot parent this child and any chance you have to redirect the child’s affectionate approaches back to the parents is the most healing thing you can do for the child. Unless directed by the parents, do not allow the child to hold your hand, climb into your lap or lay down with you. As an extended family member this can be a tough thing to do, but it is the most loving and curative gift you can give the child.
The child is in therapy to learn how to be real, respectful, responsible, and fun to be around. It will take time and patience. There are repeated setbacks as the child moves forward. The value of your consistent responses to the child, following the parents’ cues and support of the parents cannot be underestimated. Loving support of the parents, respecting their wishes, listening to their trials without judgment, and just being there for them is re-energizing to this stressed family. You are an asset and blessing to this family. As someone who has been confided in and trusted, you are as much a part of the healing process as anyone.
What else can I do?
Depending on your own situation, it is a great gift to parents to have someone offer to take the child for an afternoon, an evening, or perhaps even overnight. Using the parents rules and giving the parents time to relax and regroup is immeasurably rejuvenating; it tells the parents you support them, and the child gets the message that the parents are important and deserve some fun.
Make a scholarship donation in the family’s name. The Attachment Institute of New England supports a scholarship fund to assist families who are struggling financially to provide therapy for their traumatized child. Donations are tax deductible and can be made using the Donate button on the home page. Donations may also be mailed to the Attachment Institute of New England, 21 Cedar Street, Worcester, MA, 06109.
What NOT to do
Attachment and Trauma Focused Therapy and home parenting techniques are exhausting and time consuming. If the parents appear harried, turn down social invitations, or cut visits short, they are trying to take care of themselves by not overextending themselves. Therapeutic parenting is demanding, often leaving the parents with little remaining energy for social interactions with the rest of the world. Do not take offense to shortened visits or declined invitations.
Do not judge the parents or their parenting tactics. Customary parenting will not work with attachment-impaired children. While the parents may seem to be harsh with the child, they are really trying to help the traumatized child heal. It is likely that what you perceive to be harsh parenting interactions are following inappropriate behaviors you have not observed. These children need to know their parents are strong and the ones in control; the child feels safer when parents are in control.
If the family is visiting your home, do not accept poor manners or speech from the child. The child must always use please and thank you when appropriate.
Do not contradict the parents in front of the child. For example, if the parents state abruptly that they must leave, trust that they are following cues they are picking up from the child. If the child becomes dysregulated before they leave, do not offer the child rewards or treats in order to get good behavior or to make the family stay. Instead, assist the parents with their departure; make sure the child hears you telling the parents you enjoyed seeing them and that they are welcome back. Rather than saying a simple goodbye to the child, say something like, “Gee, I hope next time you are stronger so you can stay longer!” Say this in a loving, sincere tone, with loving eyes.
Frequently asked questions
Q: Why can’t the child be happy and grateful to be in a loving home?
A: It is hard to understand why a child remains unhappy and unruly in a loving home. On some level they are relieved, but family life scares these children; the closeness, the idea of trusting, all of them are threats to how the child has learned to survive. What they learned prior to placement was that good things didn’t last. The traumatic events these children endured lead to a re-wiring of the brain which result in larger ‘fight or flight’ behaviors . Perhaps it is easiest to understand the affect of multiple placements on a child by comparing to adult relationships. An analogy adults might appreciate is the experience of divorce. If a marriage fails, it is often hard to believe that you will marry again. If you do marry again, and the 2nd marriage fails, how likely are you to try a 3rd or 4th or 5th time? It is no less traumatic for children who have been distressed by inconsistent care giving, multiple foster homes and a myriad of caregivers. After multiple attempts to bond and lose, they stop trying and start protecting themselves. A child whose caregivers abused drugs or alcohol often received inconsistent care. One day there was love, food, eye contact, then it was gone…for how many days were needs unmet? Maybe the care giving came back…for how many days? Then it was gone, then back…then the child was moved to a strange place by social workers…you get the picture; why should they trust these care givers will be any different? Even wanted and loved biological children can suffer trauma leading to attachment deficits. A child born with severe heart defects may require multiple medical (painful) interventions, with possible isolation in incubators, tubes, wires, beeps, alarms, and more pain. Pain management in neonates and infants is tricky, and while it is far better understood than it was 20 years ago, it is difficult to know their level of pain. If the pain and stress is ongoing in a newborn or infant, lasting psychological effects are possible.
Q: What role does genetics play?
A: There is no doubt that the genes passed along from birth parents play a role in a child’s character.
Some forms of mental illness are inherited and may add to the difficulty of parenting the attachment
impaired child. We are all familiar with the term ‘nature versus nurture’, it is likely that somewhere
in between lies the truth.
Q. Why weren't the parents warned of these attachment problems?
A. The full history of a child's experiences prior to placement may not be available and the likelihood of attachment disorders may not be known at the time of placement. Symptoms of attachment deficits may not be easily detected in infants, and behaviors may not manifest themselves for a while in older children. While a child may fly under the radar in a foster home or residential setting, becoming part of a permanent family is a new threat and can bring out behaviors not previously observed. Additionally, not all placement agencies provide adequate pre-placement training or post-placement follow-up and support. Even if pre-adoptive parents are educated about attachment disorders, they may think it is something that their love and parenting style will be able to overcome. Being educated about attachment impairment and understanding the reasons for it is not same as living with it.
Q. How can I support this family, when it has become too painful for me to see how sad the parents
have become? How can I support this family when I have too much anger towards the child?
A. Watching people you love go through difficult times can be heart breaking. If you feel unable or unwilling to help because you harbor anger towards the child, frustration mounts with the situation and everything in general regarding this family. This is not something to be ashamed of, it is a natural response to a frustrating and confounding situation. Sadly, many of these families do lose the support of people they have counted on for years; but there may be ways you can continue to stay in their lives at a level that is comfortable for you. Perhaps asking them to meet for a quick cup of coffee without kids, or meet you for a brief walk, or a quick chat on the phone, will allow you to stay in touch. If they ask why you are staying away, it is best to be honest. Let them know it hurts you too much to see what they are going through, or that you are frustrated with their situation, but that you want to stay in their lives in some capacity. Being honest, open, and loving, provides an opportunity for everyone to figure out how to maintain the relationship.
Ultimately, how you choose to support a family parenting traumatized children with behavioral issues is entirely up to you. However, if you have trouble believing these concepts are legitimate and cannot abide by the parents wishes, it is kinder to step back so as to not contribute to the family’s stress.