Child/Teen Attachment Therapy
Corrective Attachment Parenting
Many children with attachment disorders are adopted by well-meaning parents who are
ill-prepared to handle their severe emotional and behavioral problems. These children
are unable to give and receive love and affection, constantly defy parental rules and
authority, are physically and emotionally abusive to caregivers and siblings, and
create ongoing stress and turmoil in the family. As a result of insufficient
preplacement services (education, training, support, matching) and postplacement
services (individual and family therapy, parent education, support) family members and
marriages suffer.
Many parents of attachment disordered children have been "through the mill" of mental health and social service programs. They are commonly blamed for their child's problems, denied access to social service records, and thoroughly frustrated in their attempts to get help. They are angry with their child, feel guilty and inadequate, and are often on the verge of relinquishment. The therapeutic challenge is to enhance parents' motivation, positive emotion, faith and hope, and encourage a more effective framework for conceptualizing their parenting role and understanding their child.
Specialized parenting skills are required in order to be successful. Listed below are specific parenting concepts, skills, goals and methods that are learned during treatment:
- Parents' background: Parents' or caregivers' attachment histories play a
significant role in their current lives. They must be aware of how prior
family-of-origin issues influence their parenting attitudes and practices,
marital relationships, and current psychosocial functioning.
- Attachment begins with the parents: Parents and caregivers are responsible
for creating a framework of love, sensitivity, empathy, caring, security and
protection. They must model effective communication, coping and problem-solving
skills, and management of emotions for their children.
- New ideas and skills: Parenting concepts and techniques that are effective
with many children fail miserably with attachment disordered children. Parents
must be willing and able to learn totally new concepts and techniques of
parenting that are effective with attachment disordered children.
- Parenting for attachment: Effective parenting with attachment disordered
children must provide the same key ingredients as secure parent-infant
attachment. Parents provide a balance of structure and nurturance, which
changes based on the developmental needs and capabilities of the child.
- The "Four R's": Parents are taught that children are expected to be responsible,
respectful, resourceful and reciprocal. Children are held accountable for their
choices and actions, and for responsibilities as a family member (e.g. chores).
- Support: Parents must have sufficient support from both inside and outside of
the family. A united front is crucial in the parental team, as is support from
extended family.
- Hope: After years of unresolved conflict and failed attempts to remedy the
problem, most parents come to us hopeless, demoralized and burned out. The
parenting framework must instill and enhance a sense of hopefulness, enabling
parents to experience success.
- Specific parenting goals and skills:
- Creating a healing environment
- Providing clear and consistent structure
- Caring for self and partner
- Communicating effectively
- Providing choices and consequences
- Increasing family participation
- Parenting creatively
- Competency-based parenting
- Basic objectives of effective parenting (goals for children):
- Develop the capacity to form secure attachments and reciprocal relationships; the ability to give and receive love and affection.
- Develop the internal resources necessary to make healthy choices, solve problems, and manage adversity effectively.
- Cultivate a positive and realistic sense of self and self-in-relation to the world.
- Learn to identify, manage and express emotions in a constructive manner.
- Learn prosocial values and morality, as well as the self-discipline and self-control necessary to function successfully in society.
- Develop the capacity for joy, playfulness and a positive meaning in life.
Creating Secure Attachments
More and more children are products of high-risk families -- poverty, maltreatment,
substance abuse, violence -- and up to 80% of these children develop severely
compromised attachment. The foster care system is flooded with these wounded children.
In 2002, 534,000 children were in foster care, almost double the numbers in the early
1980's. These children have many problems and are extremely challenging: 75% have a
family history of mental illness or substance abuse; over 80% have serious emotional
and behavioral problems; 50% have cognitive and learning disabilities.
Despite these challenges, it is your job as a foster parent to create a therapeutic environment. By being a healthy role model, and offering a predictable, safe, and nurturing family experience, you can help children achieve positive changes and heal emotional wounds. Below are the ingredients for creating a healing family environment.
Creating a Healing Environment
We all know that foster children need lots of love, nurturance, security, and consistency. However, there are certain characteristics of children in foster care, both young and older, that makes it difficult to give them what they need. First, they commonly behave in alienating ways toward caregivers: will not show their needs for nurturance or reassurance; will turn away or push away, as if to say, "I don't need you." You must realize they are afraid to connect. Don't focus on their rejecting behavior; deep down they need love and support. Second, they developed a viewpoint or belief that caregivers will be hurtful, and they will expect the same cruel and insensitive treatment from you. You must show them something different and better, and eventually they will learn to trust. Third, many of these children are biologically and biochemically imbalanced, due to prior abuse, neglect, prenatal exposure to drugs and alcohol, and multiple moves. They are unable to cope with stress, lack self-control, and are difficult to soothe. You must provide a consistent, predictable, and structured environment to help them feel safe. Lots of hugs and love helps, but you must be patient and respectful of your child's timing. Last, it is important to remember that your child is bossy and controlling because he learned that control means survival. So, when your child is being manipulative or defiant, it is really about fear: afraid to trust, connect, and be emotionally vulnerable.
Foster parents often feel particularly challenged by teenagers. There are two practical methods to enhance attachment that we find very helpful with teens: the autonomy circle and ACT (Attachment Communication Training).
The Autonomy Circle: Parents often argue with children about how much structure or freedom to provide. The amount of freedom you give your teenager should be based on his or her abilities or competencies in four areas: knowledge, skills, self-control, and judgement. When your child shows how she is responsible and competent in these areas -- has the information and skills, exercises self-discipline, and makes good decisions -- you can "loosen the reins." Teenagers like this idea because they have the power to get more freedom by their own actions; they have some say in the matter. Parents like this because it is not arbitrary -- children either earn the freedom or not -- and there is nothing to argue about.
Attachment Communication Training (ACT): Teenagers are renowned for not communicating directly. ACT is a way to learn effective communication skills, including honest sharing and empathic listening. There are basic ground rules: no blaming, criticizing, defensiveness, or stonewalling; take turns, no interrupting; agree to disagree, each person can have their own viewpoint; no running away. There are four steps. (1) Share: One person speaks while the other listens; tell about your own feelings and thoughts; be honest and brief; be aware of your tone of voice and body language. (2) Listen: To really listen, you must have empathy (think how the other person feels), be non-judgemental (don't judge, try to understand), be aware of yourself (is your body language telling the sharer that you are safe or threatening?). (3) Re-state: Tell the sharer what you heard. "I hear you saying..."; This prevents misinterpretation -- message sent, message received. (4) Feedback: The sharer tells the listener how he or she did; "Thank you, you heard me" or "No, I didn't say what you heard; let me try again." Make sure there are plenty of opportunities for each person to share and listen. With practice, ACT leads to safe and constructive confiding. You and your teenager will be practicing effective communication skills which are a part of healthy attachment.
Terry M. Levy, Ph.D. and Michael Orlans, M.A. are co-directors of the Evergreen Psychotherapy Center, Evergreen, Colorado, and the authors of Attachment, Trauma and Healing (Child Welfare League of America, 1998).
Despite these challenges, it is your job as a foster parent to create a therapeutic environment. By being a healthy role model, and offering a predictable, safe, and nurturing family experience, you can help children achieve positive changes and heal emotional wounds. Below are the ingredients for creating a healing family environment.
Creating a Healing Environment
- Cannot "fix" a Child
Parents cannot "fix" a child, but can create a healthy environment with opportunities for positive change, healthy growth and development, and secure attachment. You can encourage, guide, and be a role model for your child, but you cannot control him.
- Look in the Mirror
Your own background -- how you were raised and the type of attachments you formed -- play a major role in how you parent your children. Your child will trigger unresolved issues and sensitivities left over from childhood. By knowing yourself well -- looking in the mirror -- you are more likely to be proactive rather than reactive; able to respond constructively to your child's attempts at blaming, distancing, and controlling you, rather than reacting in a destructive "knee-jerk" manner.
- Labels Affect Actions
The way you interpret, explain, and label a child's behavior will determine how you intervene to help or change that child. For instance, children labeled as biochemically imbalanced (e.g. bipolar disorder) are given medicine to change their behavior. When you understand your child's behavior as symptoms of compromised attachment, your goal is to find a way to connect with, not control, your child.
- Family and Community Systems
A system is a set of connected parts that work together to form a whole. In families, all members affect one another in ongoing, circular patterns -- the dance of family dynamics. Everyone works together to keep the dance going, either in a healthy or dysfunctional way. Attachment develops within the larger emotional network of the family system, including birth, foster, and adoptive family relationships, the roles of other siblings, the marital and co-parenting relationships, and extended kin (e.g. grandparents). Social and community systems also affect the child, parents, and development of attachment. This is illustrated by the family-school connection. It is crucial for parents and school personnel, such as teachers and counselors, to be a cooperative team for the benefit of the child.
- Love and Limits
Balancing love and limits is important for all children, but especially crucial when creating a healing environment for very challenging children. Nurturing and loving care fosters the learning of trust, empathy, and a positive mindset. Providing limits and structure, including rules, clear expectations, and consequences, helps children feel safe, secure, and learn from their mistakes. A sense of order and predictability is particularly important for children who come from chaotic and frightening backgrounds.
- Opportunity vs. Crisis
In order to create a healing environment, you must be aware of your mindset. Do you view stressful and challenging situations as crises to be dreaded or as opportunities for teaching, learning, and growth? Your child's problems are opportunities for you to teach coping skills and strengthen the parent-child relationship. The opportunity for learning and growth is not only available for your child, but for you as well. Parents often tell us that their most challenging children are their "gurus" -- providing the richest opportunities for personal and marital growth.
- Proactive vs. Reactive
To create and maintain a healing environment you must be proactive: you set the emotional tone, create the emotional climate, take the initiative, and maintain the rules. When you are reactive, you are allowing your child to set the emotional tone, placing her in a position of control. Being proactive involves remaining calm, not taking your child's behavior personally, and dealing with issues and problems as soon as they occur -- on the front-end -- not waiting until the situation escalates out of control.
- Positive Role Model
Your job is to show by example how to effectively communicate, solve problems, set boundaries, cope with stress, manage emotions and conflict, and care about others. It will be easier to be a positive role model when you know yourself and your triggers, possess effective parenting skills, and have adequate support. By presenting your child with a positive role model you can and will make a difference.
We all know that foster children need lots of love, nurturance, security, and consistency. However, there are certain characteristics of children in foster care, both young and older, that makes it difficult to give them what they need. First, they commonly behave in alienating ways toward caregivers: will not show their needs for nurturance or reassurance; will turn away or push away, as if to say, "I don't need you." You must realize they are afraid to connect. Don't focus on their rejecting behavior; deep down they need love and support. Second, they developed a viewpoint or belief that caregivers will be hurtful, and they will expect the same cruel and insensitive treatment from you. You must show them something different and better, and eventually they will learn to trust. Third, many of these children are biologically and biochemically imbalanced, due to prior abuse, neglect, prenatal exposure to drugs and alcohol, and multiple moves. They are unable to cope with stress, lack self-control, and are difficult to soothe. You must provide a consistent, predictable, and structured environment to help them feel safe. Lots of hugs and love helps, but you must be patient and respectful of your child's timing. Last, it is important to remember that your child is bossy and controlling because he learned that control means survival. So, when your child is being manipulative or defiant, it is really about fear: afraid to trust, connect, and be emotionally vulnerable.
Foster parents often feel particularly challenged by teenagers. There are two practical methods to enhance attachment that we find very helpful with teens: the autonomy circle and ACT (Attachment Communication Training).
The Autonomy Circle: Parents often argue with children about how much structure or freedom to provide. The amount of freedom you give your teenager should be based on his or her abilities or competencies in four areas: knowledge, skills, self-control, and judgement. When your child shows how she is responsible and competent in these areas -- has the information and skills, exercises self-discipline, and makes good decisions -- you can "loosen the reins." Teenagers like this idea because they have the power to get more freedom by their own actions; they have some say in the matter. Parents like this because it is not arbitrary -- children either earn the freedom or not -- and there is nothing to argue about.
Attachment Communication Training (ACT): Teenagers are renowned for not communicating directly. ACT is a way to learn effective communication skills, including honest sharing and empathic listening. There are basic ground rules: no blaming, criticizing, defensiveness, or stonewalling; take turns, no interrupting; agree to disagree, each person can have their own viewpoint; no running away. There are four steps. (1) Share: One person speaks while the other listens; tell about your own feelings and thoughts; be honest and brief; be aware of your tone of voice and body language. (2) Listen: To really listen, you must have empathy (think how the other person feels), be non-judgemental (don't judge, try to understand), be aware of yourself (is your body language telling the sharer that you are safe or threatening?). (3) Re-state: Tell the sharer what you heard. "I hear you saying..."; This prevents misinterpretation -- message sent, message received. (4) Feedback: The sharer tells the listener how he or she did; "Thank you, you heard me" or "No, I didn't say what you heard; let me try again." Make sure there are plenty of opportunities for each person to share and listen. With practice, ACT leads to safe and constructive confiding. You and your teenager will be practicing effective communication skills which are a part of healthy attachment.
Terry M. Levy, Ph.D. and Michael Orlans, M.A. are co-directors of the Evergreen Psychotherapy Center, Evergreen, Colorado, and the authors of Attachment, Trauma and Healing (Child Welfare League of America, 1998).
