A Preliminary Investigation of the Effectiveness of Attachment Therapy for Adopted Children with Reactive Attachment Disorder

The purpose of this preliminary investigation was to examine the effectiveness of attachment therapy for adopted children diagnosed with Reactive Attachment Disorder (RAD). Although attachment therapy is widely utilized in the practice community, outcomes of such therapy have not been well documented. In this study a pretest–posttest one-group design was used with a sample of 24 adopted children who received attachment therapy from trained, licensed therapists. Therapy was funded by the Georgia Office of Adoptions under a contract with a non-profit adoptive parent advocacy group which provided training of therapists and direct services to families. RAD was measured with the Randolph Attachment Disorder Questionnaire (RADQ), Third Edition; functional impairment was measured with the Child and Adolescent Functional Assessment Scale (CAFAS). Statistically significant decreases in scores on the RADQ and CAFAS from pretests to posttests indicate improvement for the children who received therapy. In spite of methodological limitations, the current study adds to the limited knowledge about effective treatment for RAD.     

Attachment,Conflict Resolution,and Sexual Satisfaction in Adoptive Couples

Abstract

Attachment theory affirms that one’s partner is vital to fostering support and security. It is important for adoptive couples to be mindful of this support because it is at the forefront of healthy family functioning. With a sample of adoptive couples (n?=?166), this study examines the influence of attachment style on conflict resolution and sexual satisfaction. Significant findings indicate that an avoidant attachment style is directly associated with lower conflict resolution and sexual satisfaction. Better conflict resolution significantly predicts greater sexual satisfaction. These findings demonstrate the importance of establishing a more secure romantic attachment in clinical work with adoptive couples.     

Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment

The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.     

Au Revoir: An Attachment and Loss Perspective on Termination

Traditional views of psychotherapy hold that termination allows both for a consolidation of therapeutic work and an opportunity to work through issues of separation and loss. Such a view suggests not only that those issues will resolve in treatment, but also that endings are inevitable, permanent, and that the feelings invoked can and should be mastered and worked through. Recent research on termination, attachment, loss and grieving suggests a different conception. Consideration of that research can better ground therapists in more nuanced techniques for ending treatment in both child and adult psychotherapy.

Disrupting Power and Privilege in Couples Therapy

Power disparities underlie many of the issues that couples bring for therapy. People in relationships are not equal; often one partner is systematically conferred unearned advantage and dominance. This article synthesizes results from three qualitative research studies to propose a social justice approach for clinical practice with couples. Interventions are suggested to keep issues of power and privilege a central focus while addressing the ordinary issues partners present for therapy.

Attachment Perspective on Marital Dissolution and Relational Family Therapy

Divorce or dissolution of a long-term intimate relationship is an event on the continuum of an individual’s experience of attachment injury that is reawakened and played out again in this process. An attachment injury means the experience of rejection and betrayal of trust at a critical time of distress when one is in need of support. By means of the case study method, the article presents a case of a female client dealing with divorce. The history of traumatic relations through a lens of attachment theory is presented, along with divorce as the reawakening of an attachment injury and its processing in a relational family therapy model.     

Laugh and the World Laughs with You: An Attachment Perspective on the Meaning of Laughter in Psychotherapy

From infancy laughter is a right-brain-to-right-brain attachment behavior mutually aroused and regulated within the caregiver–infant partnership. Laughter continues to be attachment behavior throughout life with potential for enhancing attachment bonds or for defending against them. Laughter in psychotherapy has primarily been viewed as a discharge phenomena with typical interpretations focused on the humor that elicits the laughter rather than the meaning of the behavior itself. Viewing laughter as attachment behavior in psychotherapy provides the clinician with valuable insight about its meaning and management within the therapeutic relationship.

Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy

Children with histories of maltreatment are at significant risk of developing severe psychiatric problems. Treatment of such children is difficult and there are no empirical studies evaluating the effectiveness of outpatient treatment for children with trauma-attachment disorders. The present study examines the effectiveness of Dyadic Developmental Therapy, a treatment based on attachment theory, provided by one therapist in an outpatient setting. The 64 subjects all had trauma-attachment disorders, met the DSM-IV criteria for Reactive Attachment Disorder, and had histories of serious maltreatment. The 34 children in the treatment group were treated in weekly outpatient therapy at The Center For Family Development with Dyadic Developmental Psychotherapy. The 30 children in the control group were evaluated but did not received Dyadic Developmental Psychotherapy and received treatment from other providers at other clinics. Eligible subjects were children between the ages of five and seventeen years whose case had been closed in 2000 or 2001. All children had significant past histories of abuse, neglect, or orphanage care. Findings for children in the treatment group, as measured by the Achenback and Randolph Attachment Disorder Questionnaire, were significant decreases (p<.01) in symptoms of attachment disorder, withdrawn behaviors, anxiety and depression, social problems, thought problems, attention problems, rule-breaking behaviors, and aggressive behaviors. The findings for children in the control group showed no changes in the variables measured. Dyadic Developmental Psychotherapy appears to be an effective treatment for children with trauma-attachment disorders.The author would like to gratefully acknowledge Ms. Geraldine Gallucci, a master’s level social work intern, who was placed with The Center For Family Development. Ms. Gallucci ensured that the follow-up questionnaires were mailed to the families and returned to the agency.Arthur Becker-Weidmann is affiliated with Center for Family Development, Williamsville, USA.     

Homecoming as Safe Haven or the New Front: Attachment and Detachment in Military Couples

Traumatized military couples represent a new population for the application of attachment theory constructs. An innovative clinical social work practice model, grounded in a synthesis of social and psychological theories, aims to assist these couple and families who are navigating very difficult transitions. Since social support is known to be a central protective factor in mediating the long-term adverse effects of combat trauma, this therapeutic focus addresses two compelling problem areas: the disruption of secure attachments and affect dysregulation. The effects of deployment stressors on soldiers, their intimate partners, and their families are discussed in depth. Clinical illustrations highlight the utility of a phase-oriented culturally responsive couple therapy practice approach that has clear clinical implications for military couples.

A Review and Reformulation of Adoptive Relationships from an Attachment Perspective

ABSTRACT

From an attachment perspective, the formation and maintenance of adoptive relationships involve many atypical events and circumstances for both adoptive parents and adopted persons. The present analysis reviews the existing theoretical and empirical literature on several of these issues and examines the utility of conceptualizing them from an attachment perspective, focusing in particular on Bartholomew's (1990) categorical model of attachment styles. Inferences regarding the impact of attachment status (both for those who adopt and for those who have been adopted) on interpersonal and family functioning are formulated and critical areas in need of further research are outlined.     

Sustained Empathic Focus and its Application in the Treatment of Couples

Although all psychoanalytically informed approaches to couples therapy recognize the importance of underlying dynamics, there are important differences in the focus of the treatment. This paper suggests a focus that is based on a self-psychological/intersubjective viewpoint. Two concepts that exemplify this model, a sustained empathic focus and an appreciation of the experience of vulnerability, are discussed and applied to a couples session. What is emphasized in this material is a process of focusing on underlying vulnerability, affect and subjective experience.

Couples Therapy for Intimate Partner Violence: A Systematic Review and Meta‐Analysis

Intimate partner violence is a serious public health problem accompanied by substantial morbidity and mortality. Despite its documented impact on health, there is no widely recognized treatment of choice. Some studies indicate that couples suffering from situational violence may benefit from couples therapy, but professionals are cautious to risk the possibility of violent retaliation between partners. After a comprehensive literature search of 1,733 citations, this systematic review and meta‐analysis compiles the results of six studies to investigate the effectiveness of couples therapy as a treatment for violence. Preliminary data suggest that couples therapy is a viable treatment in select situations.     

Foster Caregiver Motivation and Infant Attachment: How do Reasons for Fostering Affect Relationships?

This study reports the results of the effects of types of caregiver motivation to foster parent on the security of attachment of infants in care. Using the Motivations for Foster Parenting Inventory and the Ainsworth Strange Situation Procedure, the differences in motivation of kin and non-kin caregivers and the effects of motivation on security of attachment of 46 infants is reported. Result found that motivations to foster, such as the desire to increase family size, and social concern for the community, were significant predictors for secure attachment; while reasons for fostering such as spiritual expression, adoption, and replacement of a grown child, were predictors of insecure attachment. Research and practice implications are discussed. Susan A. Cole is an Assistant Professor, School of Social Work, University of Illinois-Urbana-Champaign.     

Representations of Attachment to Father in the Narratives of Preschool Girls in Post-Divorce Families: Implications for Family Relationships and Social Development

This study used the Attachment Story Completion Task-Revised (ASCT-R) (Bretherton, Ridgeway, & Cassidy, 1990), a representational measure of attachment security, to examine characteristics of preschool-aged girls' narratives associated with portrayals of attachment to the father. The children's (n = 27) parents had been divorced or legally separated for at least 2 years, and they lived in the primary custody of their mothers. We had previously discovered that girls' responses to the ASCT-R differed from those of boys in unexpected ways. Whereas boys' representations of child-father attachment varied positively with teacher ratings of social behavior in child-care settings, the opposite was the case for girls. Girls who portrayed children's attachment to the father more frequently were rated lower in social competence, contrary to expectations. A more detailed analysis of responses to the ASCT-R suggests that girls' representational attachment behavior toward the father was associated with narrative representations of both parents as unavailable, family instability, and concerns for the father's well-being.     

Woman Abuse and Conjoint Therapy: Therapists' Experiences of Engagement

ABSTRACT

Treatment approaches with couples in which woman abuse is a factor have been the subject of much attention and concern in the therapeutic community. We used focus groups to examine therapists' experiences of what they see as impeding or facilitating their ability to engage therapeutically with heterosexual couples when a man has used violence. Results were coded along four categories: contextual issues, the person of the therapist, client characteristics, and strategies for enhancing engagement. Results point to the difficulties therapist participants experienced engaging with males who have been violent with their partner. Strategies which therapists used to enhance engagement are illuminated. We discuss differences between the experiences of male and female therapists, and implications for clinical work and future research.     

Intimate partner violence: An application of attachment theory

ABSTRACT

Attachment theory has gained increased prominence over the past several decades in the fields of psychiatry, psychology, and social work. Attachment theory, however, has not been systematically applied to intimate partner violence (IPV), a phenomenon that disproportionately affects women in poverty. This article provides an overview of IPV as a social problem, reviews existing literature related to the application of attachment theory to IPV, discusses the theory’s strengths and limitations in understanding and resolving IPV, and considers areas for future knowledge development.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

A Case Study of a Maltreated Thirteen-Year-Old Boy: Using Attachment Theory to Inform Treatment in a Residential Program

This paper presents therapeutic interventions from an attachment perspective with a thirteen-year-old boy with a history of maltreatment, living in a residential treatment facility. Attachment theory holds that accumulated memories of experiences with caregivers become organized into representational structures called internal working models. The guiding principles of the therapy begin with the critical role played by the individual therapist as an attachment figure. The central purposes of the therapy are conceived as promoting the restructuring of the internal working models of others to reflect expectations of trustworthiness and reliability, and models of the self as worthy to receive care. The approach described is contrasted with common approaches to residential treatment that rely on environmental behavioral contingencies, modeled on social learning theory.     

Confronting Anxiety in Couple and Family Therapy Supervision: A Developmental Supervisory Model Based on Attachment Theory

Referencing relevant supervisory literature and attachment theory, this article presents a developmental couple and family therapy supervisory model that emphasises the efficacy of the supervisory relationship. Issues concerning anxiety, cognition and learning theory are addressed and phases in the supervisory process are identified and described. Cognitive, emotional and social development are linked to attachment theory and discussed in the supervisory context.