Child and Adolescent Mental Health Volume 11, No. 3, 2006, pp. 128–134 doi: 10.1111/j.1475-3588.2006.00393.x Developmental Attachment Psychotherapy with Fostered and Adopted Children David Howe School of Social Work and Psychosocial Sciences, Elizabeth Fry Building, University of East Anglia, Norwich, NR4 7TJ, UK. E-mail: [email protected] Developmental attachment theory and research is now beginning to inform practice, particularly in the field of foster care and adoption. A brief outline of attachment theory and the four main patterns of attachment is followed by a review of attachment-based support services and psychotherapies with fostered and adopted children, including infants, preschoolers, school age children, and caregivers. Particular attention is given to the behaviour, defensive strategies and developmental needs of fostered and adopted children with pre-placement histories of abuse and neglect. Keywords: attachment; psychotherapy; foster children; adopted children Introduction explaining that ‘young minds form in the context of close relationships’. Thus, as carers help children make The goal of the attachment system is protection at times sense of their own and other people’s behaviour by of danger. Attachment is one of a number of proximity recognising that lying behind actions and behaviour are seeking behavioural control systems, which also in- minds, mental states and intentions, a whole train of clude affiliation, sexuality and caregiving. Attachment psychosocial benefits accrue, including emotional behaviours are triggered whenever the highly vulner- attunement, reflective function, social cognition, emo- able human infant experiences anxiety, fear, confusion, tional intelligence and interpersonal competence. It is or feelings of abandonment. Distress signals, such as these developmental and relational insights that crying, either bring the sensitive carer to the child, or if underpin and inform most attachment-based therapies. the child has locomotion, get the child to the carer. In Children whose carers are responsive and available this sense, the primary caregiver, destined to become at times of need and who are sensitive and emotionally the child’s selective attachment figure, acts as a secure attuned are likely to be classified as securely attached. base, a haven of safety. With maturation, these children develop mental repre- As the young child seeks proximity with her attach- sentations (internal working models) of themselves as ment figure, she is likely to be in an emotionally dys- loved and worthy of that love, and a complementary regulated state. Thus, as well as acting as a secure model of others as available and loving, understanding base, sensitive caregivers also help their child regulate and interested, particularly at times of need. Children and manage arousal and distress. There is a strong view who experience secure attachments therefore are likely that attachment is primarily a regulator of emotional to enjoy healthy psychosocial development, improved experience, including physiological arousal (Schore, social cognition, and raised levels of resilience based on 2001a). Within the affective exchanges between parents high self esteem, self-efficacy and coping capacity. and infants, children begin to build up an under- However, in the case of insecure children, the avail- standing of how their own and other people’s minds ability, sensitivity and responsivity of carers at times work at the emotional, intentional and behavioural of need is not so straightforward (Howe et al., 1999). level, and how these mental states affect social inter- Avoidant and ambivalent children defensively have to action and relationships. organise their attachment behaviour to increase the The more open, reflective, undefended, curious, fas- availability of their carer at times of need and distress. cinated, emotionally attuned and communicative the These adaptive strategies involve downplaying or carer is about her child’s mental state, the more the excluding some types of psychological information from child feels understood. The more understood the child conscious processing. This affects the individual’s feels, the more understanding she has of her own and ability to cope in a fully rounded and reflective way with other people’s psychological make-up. Therefore, carers the normal range of stresses met in social relationships. who see and acknowledge the child’s mind at work help Avoidant (defended) children (whose carers become their child develop mindful qualities. Following Fonagy anxious and rejecting whenever others place emotional and colleagues (2002), the parent’s capacity to observe demands on them) cope and adapt by excluding the child’s mind seems to facilitate the child’s general attachment-based feelings and behaviours from understanding of minds, and hence her self-organisa- conscious processing. Displays of need, weakness, tion through the medium of a secure attachment. dependency, and vulnerability in the self or others, Indeed, Schore (2001a) puts it even more forcefully make them anxious and avoidant. In order to Ó 2006 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA Developmental Attachment with Fostered and Adopted Children 129 be acceptable and increase the other’s availability, they to increase the carer’s availability, hence the classifi- become emotionally self-contained but astute observers cation of disorganised attachment (Main & Solomon, of other people’s feelings and behaviour. More extreme 1990). avoidant strategies are used by children who suffer Developmentally, abused and neglected children rejection, abuse and psychological maltreatment. For with disorganised attachments suffer more complex example, physically and emotionally abused children and profound impairments as they experience the typically do not seek comfort or safety when upset, ill, worst elements of both avoidant and ambivalent vulnerable, or frightened. They have learned that care caregiving environments. In effect, they experience and protection are not unconditionally available, and unpredictable danger and abandonment over which, that being in a state of need only seems to make matters as infants, they have little control and can develop worse and might even make the carer more dangerous. no attachment strategy. Emotional arousal and the Trust in the availability, care and interest of others is attachment system remain acutely and chronically largely absent. This means that any relationship in activated. Much mental time and energy is spent on which there are attachment-related issues will trigger issues of safety, security and monitoring, leaving less feelings of anxiety, distress and aggression. Children time for exploration and pleasurable interaction with who experience extreme tension, stress and rejection in their caregiver. Being the cause of their children’s the parent-child relationship can even suffer growth distress, and being caught up in their own anxiety failure and poor physiological health. For children and dysregulation, these parents fail to perceive and classified as avoidant, the therapeutic aim is to help emotionally attune with their children’s distressed children access, admit, acknowledge, explore and re- mental states at the very time the children most need flect on their own feelings, especially those involving to feel safe, recognised, understood, contained and need and vulnerability. regulated. Children therefore fail to develop coherent Ambivalent (resistant, dependent) children (whose models and mental representations of their own or carers are inconsistent and poor at recognising other other people’s psychological make-up, and so find it people’s needs and attachment signals) cope and adapt difficult to regulate their own arousal or deal reflect- by maximising their distress and attachment behaviour ively with their own needs. It is this group of children to increase their chances of getting noticed. Their who are most at risk of developing behavioural prob- greatest anxiety is being ignored, abandoned and left lems (including aggression), psychopathology, and alone with needs unmet and arousal unregulated. They being placed in foster or adoptive care (Howe, 2005). live in an unpredictable world, in which there seems no With maturation, disorganised children do manage to guarantee that others will be there or respond at times develop fragile and more coherent representations of of need and distress. They have little confidence in their themselves as less helpless or at the mercy of others. own abilities to bring about change and get the things With carers who are unavailable and frightening, chil- they need. This results in a passive and fatalistic atti- dren begin to take control of their own safety and needs. tude to events; an anxious preoccupation with other This results in various controlling strategies, including people’s inconsistent emotional availability; and an compulsive compliance, compulsive caregiving, com- angry, demanding, dissatisfied, needy, pleading, and pulsive self-reliance, and coercion as the child out- provocative approach to relationships. There is little manoeuvres the parent and controls their availability monitoring of one’s own behaviour or emotional condi- by switching between threatening/aggressive and dis- tion. More pronounced versions of this attachment arming/helpless behaviours (Crittenden, 1995, 1997). strategy are met in some types of