Why Attachment Therapy?

A reader, JM, left the following comment:

I’m curious, if you don’t mind answering, why you chose to do Attachment Therapy with Hope as opposed to other therapies? Also, what do you think about the controversy and criticism of Attachment Therapy?

As we have recently made yet another four hour trip to see the attachment therapist, I thought this would be a good time to start to answer this question. I can only start to answer because Hope’s treatment is a work in progress.

When we Hope first joined our family, it was obvious that she had been severely neglected. Abuse, both sexual and physical, was red flagged by Hope’s behavior the first couple of weeks home. From the moment we took Hope, it was apparent that her rage was focused on the mother. That would be me. Hope has been seeing two trauma therapists since she came home. Last spring, the physical violence against me reached dangerous levels. A friend of mine, who had adopted a child from a Russian orphanage, had used the attachment therapist we are using with good results.

The therapist was Dan Hughes based, and also treated trauma. We did an eight day intensive in July and it was difficult. Difficult for us, difficult for Hope. The therapist told us how seriously disturbed Hope was. She said Hope maybe unable to live in a family, but there was still a spark there to work with.

Hope is not my first child with attachment issues. My first child was adopted at 10 weeks. He cried for the first three months he was home. My oldest daughter, who has FASD, was adopted at 6 months. When my daughter came home, she smiled at everyone. She never cried. She would take right away to anyone she came in contact with. Everybody, including me, thought it was a blessing that she adjusted so well. This was 27 years ago and nobody in the adoption world was talking about attachment issues. She wasn’t diagnosed with RAD until she was 17. She still struggles.

I was looking for a healthier outcome for Hope. I realize attachment therapy comes with a lot of controversy. The “holding” therapy is the source of much of that controversy. Children have died from it. Some of those deaths occurred because parents didn’t feel “in charge” and therefore did not educate themselves on the therapy their child was receiving. By not taking charge themselves, they became subservient to the therapist and allowed physical abuse. The Dad and I are always in the room with Hope and we always know exactly what is going to happen. The only time there is any “holding” involved is during trauma work. During trauma work Hope is rolled up in a blanket on a mattress before it begins.

I feel that since Hope is so young the best outcome for her is for us to become her psychological parents. I still think it is possible for The Dad. I am not sure it is possible for me. I do not know if Hope will ever let anyone be her mother again. This leads me right to where I am. Does Hope have to accept me as her mother in order to grow up healthy in our family?

I have no answer to that question. I can’t find anything in the literature. Most of the literature is written with the assumption attachment is necessary and then goes on to how to get the child attached. I am sure that secure attachment would be the best outcome. Nobody looks at  how to help a child who is not capable of attachment. There were some case studies of unattached child who grew up to be sociopaths, but no examination of unattached children who grew up without becoming sociopaths. I was looking for a study of the differences between the two groups.

I am sure this doesn’t fully answer the question, but I don’t really have an answer. We are a work in progress. Hope is a work in progress. Day by day, we look for new paths, partial answers.

An Attachment Intensive.

There were a couple of questions after my last post and I would like to try and answer them.

The first question was what is an intensive? This is an obvious question that should have been part of my last post. Sometimes I forget that not everybody who reads my stuff lives and breathes adoption, attachment, and RAD.

When speaking about Attachment Therapy, an intensive is a method of delivering that therapy. Therapy happens, with the child and parents, on consecutive days. After each days session, the parents are given specific exercises to practice with the child for the rest of the day. Therapy continues the next day. An initial intensive usually runs about 10 days.

The advantages of an intensive is that the parents and child are immersed in the therapy and unlike weekly or biweekly attachment therapy, sessions where not everything “takes” can be corrected the next day. Also, since one day’s session is directly followed by the next day’s session, the material is fresh for everyone, including the child.

All though every Attachment Therapist varies slightly in method, the goals are similar. They promote the connection between the parent(s) and child, help set up a healthy relationship where the child depends on the parent for what they need, addresses the trauma issues the child has, and gives the parents the tools they need to continue working on the child’s attachment. 

In our initial appointment, the Attachment Therapist worked on eye contact, compliance, and trust between us and Hope. Eye contact is very important. Children with RAD avoid all eye contact unless they are using it to get something. The Attachment Therapist required eye contact every time Hope spoke. 

The Dad and I spent 15 minutes discussing what would happen during our intensive and listening to the Attachment Therapist’s assessment on where Hope stood. We were doing better than we thought, but have a long way to go.

Attachment From My View Point

Hope and I survived the weekend. The psychiatrist Monday cancelled, but we got in touch by email and decided that all the clonidine was doing was making Hope tired, so we stopped the morning and afternoon doses.

I was a little surprised at the responses to my two last posts. I hadn’t realized or  even considered how many people feel entitled to judge my lives’ work.

Monday, after meeting with the waiver worker, we drove down to Philadelphia and had the pleasure of spending the evening with friends. On Tuesday, we spent most of the day with the Attachment Therapist. The Dad and I took the first two hours and then my friend brought Hope to join us.

It was a long and tiring afternoon. These are the things I took with me when we left.

  • Hope experienced a lot of trauma, most of it when she was pre-verbal.

  • She is on the severe end of the Reactive Attachment Disorder spectrum.

  • There are small chinks in her armor that the Attachment Therapist thinks she can work with.

  • Hope had much more difficulty maintaining eye contact with the Dad. She really struggled.

  • Hope found it easier to maintain eye contact with me.

  • The Attachment Therapist was pleased with what we have done so far.

  • She thinks she will need 6 or 7 days for Hope’s intensive instead of the usual 10.

 Now we have to match schedules.

Hope held it together  for most of the session. Of course, once Hope was in the car to go home, she fell apart and raged. We weren’t surprised.

Attachment is so fundamental, I hope we can schedule Hope’s intensive quickly. The Attachment Therapist believes that after Hope does the work of the intensive, all the other services she receives will  be much more effective.