Attachment Therapy

Michael Orlans, Dr. Terry Levy and colleagues have been developing and refining approaches for the treatment of attachment disordered children and families. We have found that effective treatment involves: creating secure attachment patterns; systemic, holistic and integrative interventions; and utilizing a developmental structure (Revisit, Revise, Revitalize).

• Creating secure attachment patterns: The primary therapeutic goal is to facilitate secure attachment in the parent-child relationship. To achieve this goal it is necessary to recreate the elements of secure attachment which were unavailable in the child's early developmental stages. In the context of the Holding Nurturing Process (HNP), children are provided with structure, attunement, empathy, positive affect, support, reciprocity and love. The HNP is a therapeutic relationship and milieu which promotes secure attachment via social releasers, safe containment, corrective touch, access to "old brain" functions which control attachment behavior, and the development of a secure base in which positive developmental changes occur.
  
  
• Systemic: Attachment develops in the context of overlapping relationship systems, including parent-child, marital, family, extended kin and community. For example, the quality of the mother-infant relationship is influenced by behaviors and attitudes of the father. Thus, effective treatment must address the various social systems in the life of the child and family.
  
  
• Holistic and integrative: Treatment focuses on mind, body, behaviors, emotions, relationships and morality. Therapeutic interventions and strategies are varied - experiential, psychoeducational, cognitive, skill-based. The holistic approach is based on the concept that many factors interact to create both health and dysfunction.
  
  
• Revisit, Revise, Revitalize: Treatment is developmental, requiring the successful completion of each stage building upon the next. Attachment trauma is first revisited to address core issues. Next, revisions are facilitated in belief systems, choices, relationship patterns, and coping skills. Lastly, revitalization includes celebrating achievements, cementing positive changes, and enhancing hope for the future.

Parents often report to us that traditional psychotherapeutic approaches have not been effective with their severely attachment disordered children, due to 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, 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.

Two Week Treatment Program

This treatment program is called the "Two Week Intensive", and is designed to work with children diagnosed with Reactive Attachment Disorder of Infancy or Early Childhood (DSM-IV, 313.89). Children commonly have concurrent diagnoses of Oppositional Defiant Disorder, Posttraumatic Stress Disorder, Attention-Deficit/Hyperactivity Disorder, and Depression. All suffer from a grief reaction to significant losses early in life.

Treatment occurs Monday through Friday, three clinical hours per day for two weeks. Families stay at local lodges. The time in therapy is divided between working with the child, the parents, and the entire family unit. A team of therapists are utilized, providing flexibility in treatment format and focus. Follow-up therapists are encouraged to participate during the two week intensive, which provides supervision and facilitates more effective follow-up.

Treatment always involves the child and parents. The parents are either in the therapy room with their child, or observing treatment on a T.V. monitor in another room.

The "Two Week Intensive" focuses on the following areas:

1. Child: address trauma, attachment disorder and negative working model (negative belief system and self-image); learn prosocial coping skills (communication, anger-management, problem-solving), respect, responsibility, resourcefulness and reciprocity.
   
   
2. Parent-Child Relationship: enhance secure attachment, including trust, affection, intimacy, communication and reciprocity; reduce anger and negative patterns of relating.
   
   
3. Family Issues: address negative relationship patterns, including sibling issues; enhance stability, support from inside and outside the family, and a climate of hope, joy and positivity.
   
   
4. Parenting Skills: learn the specific concepts, skills and attitudes that are effective with the attachment disordered child (angry, oppositional, mistrustful, controlling, deceitful).
   
   
5. Parents: address historical and/or current issues that are unresolved and prevent effective functioning; including family-of-origin (prior loss, trauma, attachment difficulties) and marital/relationship problems.