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Facing the Fear of Vulnerability Treatment of a Child with Reactive

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Facing the Fear of Vulnerability Treatment of a Child with Reactive Facing the Fear of Vulnerability Treatment of a Child with Reactive Attachment Disorder By Faye Snyder, M.A. A Clinical Case Study Dissertation Submitted in Partial Satisfaction of the Requirements for the Degree of Doctor of Psychology in Clinical Psychology. RYOKAN COLLEGE OF PSYCHOLOGY, LOS ANGELES, CALIFORNIA December 31, 2004 ACKNOWLEDGEMENTS I have such deep gratitude to the child about whom this paper is written, because he decided to honor me with his trust. I am also grateful that his new mommy was remarkably strong, selfless and committed to meet the arduous challenge before her. I would like to acknowledge his father for offering essential and unwavering support necessary to do the work and for his ongoing faith even when the child was backsliding and the process seemed hopeless. I wish to thank Dr. Madeline Taylor, my advisor, for her guidance and lessons in clarity through this phase of my program. That she appreciated the importance of prevention and the significance of attachment in assessment and treatment was spiritually priceless. I wish to thank the administration of Ryokan for hiring so many wonderful teachers. I would also like to thank the Val Verde Scholarship Fund for investing in me this late in my life. I would like to thank my husband, Ron, for accepting and believing in me and for all the housework he assumed to support me in achieving this goal. I am also grateful to my son, Scott, who enjoyed a secure attachment and yet cares for those who didn’t. He has always been curious about my work, including this paper. Finally, I would like to thank my deceased mother, who now lives within, and who offered me just enough attachment to become strong, and not enough, that I am left compelled to speak for babies. i TABLE OF CONTENTS INTRODUCTION .....................................................................................................................1 CHAPTER 1: A BRIEF HISTORY OF TRAUMA THEORY .................................................6 CHAPTER 2: ATTACHMENT THEORY.............................................................................. 12 A Brief History of Attachment Theory ................................................................................12 Interaction and the Formation of Self ..................................................................................19 CHAPTER 3: REACTIVE ATTACHMENT DISORDER..................................................... 32 CHAPTER 4: JAY’S EARLY HISTORY ...............................................................................37 No time to Bond................................................................................................................... 37 No One to See ......................................................................................................................40 CHAPTER 5: MISDIAGNOSIS, ASSESSMENT AND DIAGNOSIS .................................44 Misdiagnosis, a Common Serious Error ..............................................................................44 Genetics and Differential Diagnoses ...................................................................................46 Assessment ..........................................................................................................................53 Diagnosis .............................................................................................................................57 CHAPTER 6: TREATMENT OF RAD.................................................................................. 60 Discipline Techniques.......................................................................................................... 60 Rebonding Techniques and Rage Reduction .......................................................................64 CHAPTER 7: TRAUMA........................................................................................................ 74 The Lasting Effects of Trauma ............................................................................................74 Somatic Memory .................................................................................................................76 ii Differing Approaches to Trauma .........................................................................................83 Reichian Therapy................................................................................................................. 92 Vulnerability and Surrender................................................................................................. 97 CHAPTER 8: GROUNDWORK FOR TREATMENT........................................................ 102 Meeting the Family ...........................................................................................................102 Choosing the Primary Caregiver and Support System ......................................................104 CHAPTER 9: JAY DETERIORATES ..................................................................................107 Getting Started ...................................................................................................................107 Treating Jay with Predictable Failure ................................................................................110 CHAPTER 10: THE NEW BEGINNING OF THERAPY................................................... 115 But Jay Gets Worse ............................................................................................................115 Just a Little Progress.......................................................................................................... 119 CHAPTER 11: FACING RESISTANCE AND CREATING TRUST.................................. 123 Regressing for Fear of Intimacy and Vulnerability ...........................................................123 Attempting Intimacy.......................................................................................................... 124 Couchwork! Not Again! ...................................................................................................128 CHAPTER 12: FACING VULNERABILITY WITH COURAGE...................................... 132 Jay Recovers a Memory ....................................................................................................132 CHAPTER 13: THE RISE AND FALL OF THE FALSE MEMORY DEBATE .................135 War of the Researchers ......................................................................................................149 CHAPTER 14: TERMINATING WITHOUT ABANDONMENT ......................................159 Our Last Session ................................................................................................................160 iii Final Diagnosis ..................................................................................................................165 CHAPTER 15: CONCLUSIONS .........................................................................................169 Symptoms and Treatment ..................................................................................................169 The Experiential and Preventable Cause ...........................................................................169 REFERENCES ......................................................................................................................176 Appendix A: “Lonely Heart” ...........................................................................................189 Appendix B: “Sad” ...........................................................................................................190 iv INTRODUCTION The purpose of this case study dissertation is to explore the causes, symptoms and treatment of a child with Reactive Attachment Disorder. This is about a 10-year-old boy named Jay, who did not have the opportunity to bond and securely attach to his parents during the critical wiring period of the first three years of life. Not only will this paper explore the effects and symptoms this deprivation had on Jay, but it will also study the actual impact such experiences have in the brain and on the formation of personality. Included in this look into cause and effect, I will explore the beliefs through which Jay was perceived and thus treated. Finally, because it is not possible to fully understand and treat attachment trauma without also exploring trauma, in general, this papers begins with a short historical review of Trauma Theory followed by a brief history of Attachment Theory. This paper will explore Jay’s young life, showing how a lack of attachment contributed to his problems as a boy. During treatment, I learned that Jay had four other therapists in his life before the age of four, including his parents’ therapists. Under their watch, Jay missed his opportunity to form a secure attachment. My journey through the attachment and trauma research led me to discover a phenomenon: A perspective exists, supported by therapists and researchers, which commits to protecting parents at the expense of their children during the therapeutic process. Resulting from this perspective or orientation are popular theoretical and treatment approaches which seem to avoid exploring relevant childhood experiences or feelings. Where I had once naively expected that all of my field—because it was psychology—was seeking with me to see more clearly the needs of young children, I discovered I was wrong. 1 I found that one approach to assessment, by virtue of the medical model, preferred genetic explanations to asking probing questions of parents about the child’s quality
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