Protecting the Child’s AttachmentFollowing Removal From

Parental Care

Douglas Goldsmith, Ph.D.

Executive Director

The Children’s Center

The Christmas Box House Annual Conference

2005

Special Thanks

Dr. David Oppenheim University of Haifa Dr. Janine Wanlass Westminster College

For their contributions and support on conceptualizing issues around attachment and permanency

Overview Attachment Theory Internal Working Models Reflective Functioning Insightfulness Application to Permanency The Attachment Toolbox

Attachment

Emotional bond with another person Behaviors promote proximity with one

perceived as older, stronger, and wiser Motivational system to seek proximity Enhances feelings of security Motivates baby to take action when

frightened

Attachment Theory

When I am close to my loved one I feel good, when I am far away I am anxious, sad or lonely

Attachment is mediated by looking, hearing, and holding

When I’m held I feel warm, safe, and comforted

Results in a relaxed state so that one can, again, begin to explore Holmes (1993)

Attachment in Action

Behaviors shown by careseeker and caregiver

Aware of and seek each other out if careseeker is in danger due to physical separation, illness, or fright

Secure Attachment

The caregiver is perceived as a reliable source of protection and comfort

Cooper, Hoffman, Marvin &Powell , 2000

Attachment Classifications

The strange situation– Secure 65%– Avoidant 20%– Ambivalent 10%– Disorganized 5-10% (80% maltreated)

Secure (B)

Uses mother as secure base Signs of missing mother Actively greets with smile or gesture Signals or seeks contact if upset Once comforted resumes exploration

Solomon & George (1999) p.291

Secure Attachment

“Attachment is mediated by looking, hearing and holding: the sight of my loved one lifts my soul, the sound of her approach awakes pleasant anticipation. To be held and to feel her skin against mine makes me feel warm, safe and comforted.”

Holmes (1993)

Avoidant (A)

Explores readily Little visible distress when left alone Upon reunion, looks away or actively

avoids May stiffen or lean away if picked up

Solomon & George (1999) p. 291

Ambivalent (C)

Distressed, fretful, passive Fails to explore Unsettled, distressed by separation Alternates bids for contact with signs of

angry rejection Fails to find comfort from the parent

Solomon & George (1999) p.291

Insecure Attachment

Intense love and dependency Fear of rejection Irritability Vigilance Punish their attachment figure for any

sign of abandonment

Insecure Attachment

The insecurely attached person is saying:“Cling as hard as you can to people –they are likely to abandon you: hangon to them and hurt them if they showsigns of going away, then they may be less likely to do so.”

Holmes (1993)

Disorganized (D)

Behavior lacks an observable goal Look fearful Behavior is bizarre May try to leave after the reunion or

freeze

Attachment Behavioral System

Attachment figure:Near, responsive,

attunedFelt security, love,

self-confidence

Playful, smiling,Exploratory, sociable

Holmes (1993)

Attachment

Attachment is a reciprocal relationship The parent offers caregiving behavior

that matches the attachment behavior of the child

The child, using social referencing, checks in with the mother “looking for cues that sanction exploration or withdrawal”

Holmes (1993)

Parenting

Overanxious Parent – inhibits child’s exploratory behavior– Child feels stifled or smothered

Neglectful Parent – inhibits exploration by failing to provide secure base– Child feels anxious or abandoned

Holmes (1993)

Attachment ProblemsBowlby

A severely hurt child fails to seek comfort

Signals that ordinarily activate attachment behavior fail to do so

System controlling attachment, and the feelings and desires associated, is rendered incapable of being aroused

Attachment From the Child’sPoint of View

How do children view their parents? How do children learn to think about

themselves as separate from their parents?

Internal Working Model

Based on the child’s real-life experience of day to day interactions with his parents

Reflects the images the parents have of the child

Images communicated by how each parent treats the child and what each parent says to the child

Impact of the Internal Working Model

The model governs how children feel toward each parent and about themselves, how they expect to be treated and how they plan their own behavior toward their parent

Securely Attached Child

Internal Working Model– Responsive, loving, reliable caregiver– Self is worthy of love and attention

Holmes (1993)

Insecurely Attached Child

The world is dangerous Treat others with great caution Self is ineffective and unworthy of love These assumptions are stable and

enduring and terribly difficult to modify Holmes (1993)

Video – Rosie’s Kids

Development of Relationships

“For a relationship between any two individuals to proceed harmoniously each must be aware of the other’s point-of-view, his goals, feelings, and intentions, and each must so adjust his own behavior that some alignment of goals is negotiated.

Development of Relationships

This requires that each should have reasonably accurate models of self and other which are regularly updated by free communication between them. It is here that the mothers of securely attached children excel, and those of the insecure are markedly deficient.”

Bowlby (1988) p. 131

Parenting

How do parent’s foster secure attachment?

What should we look for when we observe parents?

Mothers of Secure Infants

Continuously monitor the infant’s state Accurately interpret the signal for

attention Act accordingly to meet the infant’s

needs

Mother’s of Anxious Infants

Monitor the infant’s state only sporadically

Inconsistently notice the infant’s signals May interpret the signal inappropriately Respond to the signal inappropriately,

or tardily

Ambivalently Attached Child

Shows overt aggression toward the inconsistent mother

“Don’t you dare do that again!” but has to cling because he knows from experience that she will.

Holmes (1993)

Avoidant Child

Outbursts of unprovoked aggression Needs to appease to the mother

because the child wants so badly to feel close

Fears she’ll rebuff him if needs are revealed too openly; or if anger about abandonment is shown too openly

Holmes (1993)

John: Seventeen MonthsFor Nine Days in a Nursery

James & Joyce Robertson

Phases of Response to Separation Protest

– Upset, confused, frightened by loss of mother– Urgent desire to find mother– Looks eagerly toward any sight, sound

Despair– Increasing hopelessness– Less active, withdrawn, apathetic– Decreases demands on environment

Phases of Separation

Despair may be misinterpreted by presuming that distress has decreased because the child is settling in

Detachment– Makes the best of the situation by repressing

longing for mother– When mother returns “he hardly seems to know

her”– May appear to not need any mothering at all

John – The Follow-up

First Week– Rejected his parents– Won’t accept comfort or affection– Won’t play– Shuts self in room– Cried a great deal– Can’t cope with the slightest frustration– Aggressive and destructive

Follow-Up

Second Week– Undemanding– No tantrums– Plays alone – quietly

Follow-Up

Third Week– Dramatic change– Tantrums return– Refuses food and loses weight– Sleep is disrupted– “Gulf” between parents and John

Follow-Up

One Month– Relationship with mother improves– Joyce visits and he regresses

• Refuses food and attention

– Three weeks later, second visit from Joyce• Extreme disturbance for 5 days• Includes aggression toward mother

Follow-Up

“Three years after his stay in the residential nursery, when John was four and one half years old, he was a handsome, lively boy who gave much pleasure to his parents. But there were two marked features which troubled them. He was fearful of losing his mother and got upset if she was not where he thought she would be. And every few months he had bouts of provocative aggression against her which came out of the blue and lasted for several days.”

Attachment: The Parent’s Point of View

How does the parent’s past impact attachment?

How do we get in to the parent’s head?

Impact of Empathic Failure

“Whatever she fails to recognize in him he is likely to fail to recognize in himself. In this way, it is postulated, major parts of a child’s developing personality can become split off from, that is, out of communication with, those parts of his personality that his mother recognizes and responds to, which in some cases include features of personality that she is attributing to him wrongly.” Bowlby (1988) p.132

Reflective Function

“The reflective function refers to the psychological processes underlying the capacity to mentalize. . . mentalizing refers to the capacity to perceive and understand oneself and others’ behavior in terms of mental states, i.e., reflection.”

Fonagy, Steele, Steele & Target (1997)

Reflective Function

Allows the individual to make sense of his or her own and others’ psychological experience, to enter into another’s experience, to “read” another’s mind

Allows the child to make others’ behavior meaningful and predictable, and permits him to respond adaptively

Slade (1999)

Reflective Function

The mother’s capacity to understand the child’s mental states create the context for a secure attachment relationship

The mother is able to view the infant as intentional

Reflective functioning provides protection against damaging effects of abuse and trauma

Slade (1999)

Reflective Function

The capacity to tell a story that is affectively believable

The capacity to understand emotional processes

The ability to accurately understand ones own and others behavior

Slade (2002)

Dyadic Patterns Marvin et al (2002)

Secure child – Autonomous Parent– Easily approach and interact when distressed– The reunion calms the child and facilitates

exploration– Child can shift between exploration and using the

parent as a safe harbor with little anxiety– Close attunement – disruptions easily repaired

Dyadic Patterns Marvin et al (2002)

Insecure child – Dismissing Parent– Both partners minimize intimate

attachment-caregiving interactions– Miscue – I’m really more interested in

playing– “Independence” is highly valued– Overregulated affect, little emotional self-

knowledge

Dyadic Patterns Marvin et al (2002)

Insecure Child –

Ambivalent/Preoccupied Parent– Both partners minimize independent

exploration– Child is overly dependent on the parent– Miscue – don’t explore, there really is

something to be anxious about– Under-regulated affect

Dyadic Patterns Marvin et al (2002)

Insecure, Disordered Child

Disorganized/ Insecure Parent– Parent fears or becomes angry in response

to child’s attachment behavior and abdicates caregiving

– Caregiver has unresolved trauma– Role reversed relationship

Maternal Attributions

Fixed beliefs that the mother has about the child – “beliefs that she perceives as objective, accurate perceptions of the child’s essence.”

Lieberman (2000)

Positive Maternal Attributions

“When a mother sees her child as the cutest, most intelligent, most endearing being ever created, she is summoning from the depths of herself the capacity for ecstasy that allows her to put up with the inevitably annoying, exasperating, or simply tedious aspects of raising a child.”

Lieberman (2000)

Maternal Attributions:Protective Function

Child feels adored Allow child to cope with self-doubts and

feelings of despair Allow parent to better tolerate self-

sacrifices that are integral to the parenting process

Lieberman (2000)

Parental Insightfulness

“Parental empathic understanding involves the capacity to see things from the child’s point of view within a balanced, accepting, and coherent frame.”

Oppenheim (2000)

Balanced

Able to see experiences through their child’s eyes and make attempts to understand the underlying motives

Talk openly about positive and negative aspects

Oppenheim (1999)

One-sided

Preset conception of their child Difficulty staying focused on their child

and their relationship with the child Talk about their own feelings/issues

Oppenheim (1999)

Disengaged

Lack emotional involvement Minimally attempt to understand what’s

on their child’s mind

Oppenheim (1999)Video

Foster Care and Permanency

How does foster placement effect development?

How do we assess relationships between the children and their biological as well as foster parents?

How long in foster care is too long? When can children still go home?

The Case of Sara

Placed for adoption upon discharge from the hospital

5 months of age legal adoption is not completed

Sara enjoys a loving relationship with her parents

The parent child relationship is marked by reliable, emotionally attuned, and responsive care

The Case of Sara

Allegations of neglect ariseSara is removed from the home at

the age of 10 months

The Case of Sara

Shelter home for four days

Second foster home for one week

Third foster home for eight weeks

Adoptive home

The Case of Sara

Upon arrival to the adoptive home Sara stares blankly, refuses social interaction, and is oblivious to pain after undergoing a medical procedure

Believing that Sara is available for adoption her name is changed

The Case of Sara

At the age of 15 months Sara is responding well to her new environment

First adoptive family hasn’t seen her for 6 months and want her returned to their care

The Case of Sara

Should she return? Who are the “psychological” parents? Does she remember her first adoptive

parents? She’s so young that she won’t remember

anything and can be returned without distress

Sara is a “resilient” child

The Case of Sara

The internal working model – viewing the world through Sara’s eyes

Assessing “risk” Could reunion reactivate feelings of loss? Utilization of second adoptive parents as a

secure base Impact of no contact

Factors Favoring Sara’s Return

Sara is a “resilient” child and can weather more moves.

Sara needs to return to be able to resolve her grief

As she gets older, Sara will long to be with her first adoptive family

Sara should not have been removed in the first place

Factors Against Sara’s Return

Length of time away from her first family without any contact

Her name change has impacted her Internal Working Model

She now views her new family as her only family and calls her new parents “mama” and “dada”

Factors Against Sara’s Return

Sara clearly shows signs of a secure attachment to her new parents

A return could, in fact, be viewed by Sara as traumatizing and as being “ripped away” from her family

Trauma could create a Reactive Attachment Disorder

Factors Against the Return of Sara

Comparing the future stability of the two families– First family is struggling with high levels of

stress and their relationship has been negatively impacted and, largely ignored

– Second family has, and will likely, withstand stressors

Implications for Caseworkers

Request relationship-based assessments

Understand children’s needs vs. parental capacity for caregiving

Develop specific recommendations about what behaviors the parent needs to develop to successfully parent this particular child

Use of Supervised Visits

Used routinely but should be used for extreme cases where abuse/neglect even under supervision is of high risk

Need to find ways to allow for more contact with parents in a more natural setting

Therapeutic visits vs. supervised visits

Supervised Visits

Be mindful of the limits to interpretation of the behaviors between the parent and child– Playfulness does not equal attachment

Stress following the visit is natural and should not necessarily be interpreted to mean that visits are experienced negatively by the child

Observation of Parent-Child Relationship

Observe proximity seeking behaviors – watch eye contact and social relatedness

Observe parental sensitivity and insightfulness to child’s cues

Who does child seek out when frustrated or frightened

Use doll play to assess attachment hierarchy

Assessment – Secure Base

Over the past two weeks can you think of a time when your child was:– Hurt?– Frightened?– Separated from you?

What did your child do? How did you respond?

Assessment of Parent’s Point of View Interview questions:

– Could you give me a thumbnail sketch of your child?

– Tell me about a time in the past two weeks when you and your child really clicked.

– Tell me about a time when you didn’t.– What gives you the most joy in your relationship?– What gives you the most pain?– Where do you turn for emotional support?

Steele (2003)

Attachment Toolbox

Nurturing Relationships– The “Ideal Grandma”

• Anticipating Needs• Keeping the child in “mind”

Reading and responding to cues Emotional Regulation

– Proximity to the child– Reassurance– Emotional repairs - Time In

Time In

Stay close by to help the child calm down

Avoid processing until the child is calm

If child becomes aggressive distance yourself while reassuring the child that you’ll be available once the child is calm

Attachment Toolbox

Managing anxiety– Sleep Issues– Appetite Issues

Encourage checking-in behaviors Providing structure and consistency Protecting the child from trauma

reminders Positive communication skills

Attachment Toolbox

Developmentally appropriate expectations

Managing parental stress– Providing respite care

Treatment Options

Obtain comprehensive, relationship-based assessments

Supervised visits vs. Reunification treatment

Parent-child therapy Individual therapy Shelter vs. Residential treatment

Educating Parents

Parents need to understand children’s histories to be on alert for trauma reminders

Be realistic about attachment issues but recognize parent’s ability to hear the concerns

Encourage parents to seek treatment

Secure Base

“When a child is held in mind, the child feels it, and knows it. There is a sense of safety, of containment, and, most important, existence in that other, which has always seemed to me vital. . . It seems to me that one of life’s greatest privileges is just that – the experience of being held in someone’s mind.”

Pawl (1995)