Therapeutic Parenting A handbook for parents of children who have disorders of attachment Dedicated to Linda Eisele June, 2008 ©2008 ATTACh (Association for the Treatment and Training in the Attachment of Children). All rights reserved. Please do not copy without written permission from ATTACh. Please forward any questions or comments regarding this manual to [email protected]. Contents Chapter 1—Introduction ......................................................................... 1 Chapter 2—The Attachment Puzzle: How Our Histories Fit Together .... 5 Parent attachment issues—an important piece of the puzzle .....................................6 Forming secure attachments .......................................................................................8 How insecure attachments form ..................................................................................9 Old roadmaps in a new relationship ..........................................................................12 Disorders of attachment ............................................................................................14 Understanding adult attachment patterns .................................................................15 Secure-autonomous attachment style .......................................................................17 Insecure attachment styles .......................................................................................18 Putting it all in perspective ........................................................................................20 iii Contents Chapter 3—Therapeutic Parenting ...................................................... 23 A brief history of attachment therapy ........................................................................ 23 Regulation and dysregulation ................................................................................... 24 Attunement and empathy ......................................................................................... 27 Coercion ................................................................................................................... 30 Physical containment ................................................................................................ 30 Minimizing trauma during temporary separations ..................................................... 32 Q & A ........................................................................................................................ 33 Chapter 4—Parent Practice from A to Z .............................................. 43 Chapter 5—Adjusting Expectations ...................................................... 61 Taking care of yourself .............................................................................................. 61 Every day life is no longer “every day life” ................................................................ 64 When dreams collide with reality .............................................................................. 65 Redefining success .................................................................................................. 66 Grieving unfulfilled dreams ....................................................................................... 69 The journey is the destination ................................................................................... 74 Chapter 6—Loss: The Hidden Trauma ................................................. 77 Loss and adoption .................................................................................................... 77 Other types of loss .................................................................................................... 80 The dream child ........................................................................................................ 81 Chapter 7—Stories from the Front Lines .............................................. 85 A mom’s story ........................................................................................................... 85 A child’s story ............................................................................................................ 88 iv Contents Chapter 8—When Children and Parents Need More ........................... 93 Short-term respite care .............................................................................................94 Long-term respite care ..............................................................................................95 Psychiatric hospitalization .........................................................................................95 Residential treatment centers ...................................................................................96 Adoption disruptions and dissolutions .......................................................................96 Appendix A—Choosing an Attachment Therapist .............................. 109 Professional qualifications .......................................................................................109 Training questions ................................................................................................... 110 Therapeutic process questions ............................................................................... 110 Financial considerations .......................................................................................... 112 Appendix B—Fact Sheet for Educators.............................................. 113 What’s a teacher to do? .......................................................................................... 115 Classroom strategies .............................................................................................. 116 Goals for children with disorders of attachment, at school and in the home ........... 117 Tool for managing extreme behaviors ..................................................................... 118 Alternative classroom placements .......................................................................... 119 Appendix C—Resources .................................................................... 121 Bibliography ............................................................................................................121 Websites .................................................................................................................124 Appendix D—ATTACh Accepted Definitions...................................... 129 v Contents vi CHAPTER 1 Introduction This manual is designed to help parents of children who have disorders of attachment learn to parent their children effectively. By “effectively” we mean in a manner that: • helps children to heal from the trauma or maltreatment they experienced early in life from relationships with primary caregivers • helps children form secure attachments with their current primary caregiver, provid- ing the foundation of trust that is necessary for successful relationships in all aspects of their lives • helps the children learn the skills they need to be successful in life This manual assumes that the child has been diagnosed by a qualified attachment therapist as having a disorder of attachment, and that organic barriers to attachment have been ruled out through a complete medical exam (including hearing, vision, sensory integration testing and assessment for other developmental problems). If this is not the case, see attach.org for a referral to a local therapist who specializes in diagnosing and treating disorders of attachment. This manual also assumes that you have a basic understanding of disorders of attachment, their underlying causes, and their symptoms (see attach.org for more 1 information). It is not intended to replace the guidance of a qualified attachment ther- apist, but rather to supplement therapy by painting a clear picture of the current pro- fessional thinking about treating disorders of attachment and how to apply those philosophies to real-life parenting challenges. Because of their unresolved relationship trauma, children often react to current, nur- turing caregivers with the same defensive behaviors they needed to survive their early trauma. This is a difficult concept to keep in mind, when, for example, you take your child to the latest movie that he is anxious to see, buy tickets, popcorn and sodas and get settled into your seat in time to watch the previews, but five minutes into the movie he starts screaming that he wants to go home! How embarrassing! And infuriating! Is he being a difficult child who just changed his mind and expects to get his way? Is he just trying to punish you for making him go to bed early last night? Or is it that he is so distrustful of adults, due to his early abuse, that it is truly terrifying for him to sit next to anyone for more than 15 minutes? How you diagnose the behav- ior, and respond to it, will determine whether or not you help your child, and your rela- tionship, to move forward. Parenting a child who has a disorder of attachment is the hardest job you will ever have. Period. It requires you to give and give, without receiving much in return (at least in the beginning). It requires rethinking your parenting instincts, experience with other children, and advice on child rearing. It means making conscious, therapeutic parenting decisions, hour after hour, day after day, week after week. It requires con- stant focus on the deeper meaning of your child's behavior, so that you respond to the causes, needs, and motivations of your child. It is exhausting. It is isolating, as