Parent and Child Therapy (PACT) In Action: An Attachment‐Based Intervention for a Six‐Year‐Old With a Dual Diagnosis

This case study explores Parent and Child Therapy (PACT), an attachment‐based intervention for mothers and children experiencing intractable relationship distress originally developed by Heather Chambers (a Child Psychotherapist and Family Therapist working in New Zealand). We describe the use of PACT with a mother—child dyad presenting a history of severe abuse and neglect. The child had been diagnosed with Conduct Disorder and co‐morbid Attention Deficit Hyperactivity Disorder. We consider the themes arising in the therapy, the emotional process experienced by the mother and child, the initial outcome and 10‐month follow up. The case study indicates that PACT can be learned and used by practitioners outside of the team that conceptualised and developed it. The case highlights the links between externalising difficulties and attachment disorganisation and points to PACT as a promising treatment for the chronic sequelae of early interpersonal childhood trauma. The need for research and possible directions of this research are discussed.     

Attachment‐Based Family Therapy With a 13‐Year‐Old Girl Presenting With High Risk for Suicide

This article describes the application of Attachment‐Based Family Therapy (ABFT) to the treatment of a 13‐year‐old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family‐based treatment of suicidal youth.     

Attachment and the Repetition of Trauma: A Case Study of Attachment‐Based Crisis Intervention

This article explores the difficult case of a 16‐year‐old who was causing a great deal of anxiety by presenting with dramatic behaviour, such as leaping off buildings, swallowing needles and poisons, and jumping in front of cars. The case study explores a six‐month period of crisis intervention, which focused on the unique kind of attachment relationship that existed between the teenager and his mother. The mother had experienced recurrent traumatisation prior to his birth, and it was found that the aftereffects of this traumatisation must have influenced the teenager's early attachment experiences and subsequent development. The attachment‐based therapy treated the crises as primarily ‘relational crises’. The therapy involved investigating and sharing formulations about their attachment history, cultivating an insight into the relational or dynamic determinants of the teenager's crises. Broader suggestions are made concerning the application of attachment theory to different approaches in family therapy, as well as to our understanding of phenomena such as transgenerational traumatisation.     

Parent Perspectives on Intensive Intervention for Child Maltreatment

Multi-level intervention, based on an ecological perspective, has been promoted at the preferred model of providing parenting support to high-risk families. However, parent views regarding such interventions have not been determined. Focus groups consisting of 24 parents who had recently completed an intensive parenting program yielded results supporting multi-level interventions but highlighting processes rather than content within such programs as well as the reciprocal effect of particular level interventions. Processes identified at intervention levels included Affirming Parent Self-Worth, Non-Directive Instruction, Promoting Social Connections, and Empowering Communication. Increased understanding of and attending to processes in intensive intervention with high-risk families is indicated.     

Income,Relationship Quality,and Parenting: Associations With Child Development in Two‐Parent Families

Prior research suggests considerable heterogeneity in the advantages of living in a 2‐parent family. Specifically, children living with married biological parents exhibit more favorable outcomes than children living with cohabiting biological parents and with married and cohabiting stepparents. To explain these differences, researchers have focused almost exclusively on differences in the levels of factors such as income, parental relationship quality, and parenting quality across family types. In this study the authors examined whether differences in the benefits associated with these factors might also account for some of the variation in children's cognition and social‐emotional development. Focusing on children at the time they enter kindergarten, they found only weak evidence of differences in benefits across family types. Instead, they found that children living in stepfather families experienced above‐average levels of parental relationship quality and parenting quality, which in turn played a protective role vis‐à‐vis their cognitive and social‐emotional development.     

The Hungry‐for‐Attention Metaphor: Integrating Narrative and Behavioural Therapy for Families With Attention Seeking Children

Many families come to treatment with concerns about attention‐seeking children. This paper examines the dominant socio‐cultural and biological influences on individual parent and child narratives about attention‐seeking behaviour and explores the misalignment between the two. A case study illustrates the reconstruction of the dominant problem‐saturated story through the hungry‐for‐attention metaphor. Finally, the author proposes an integrative approach to combining narrative practices with behavioural interventions for families and professional caregivers.     

The Impact of Parent,Child, and Therapist Mental Representations on Attachment-Based Intervention with Prepubertal Children

Although attachment-based interventions with mothers and infants are beginning to flourish, guidelines for developing attachment-based intervention with prepubertal children are lacking. This article remedies this lack by discussing the potential intervention points of entry with prepubertal children based on attachment theory. In contrast to attachment-based early intervention, in which parental characteristics are targeted, attachment-based intervention with prepubertal children must include the child as well as the parents. Therapists attempting such an intervention must take into account the quality of the child’s mental representation as well as their own quality of mental representation to provide an effective clinical experience.     

Kinship Care for Children of a Parent With a Mental Illness

Little is known about “hidden” kinship caregivers of children of a parent with a mental illness (COPMI). An exploratory study surveyed 56 COPMI caregiver members of a kinship center administered by a school of social work in a large public university. The COPMI sample was a subset of a larger kinship caregiver study. Nearly one in four caregivers was providing COPMI kinship care. The COPMI caregivers reported numerous child behavioral crises and decreased caregiver physical and emotional health since they began providing care. Practice, policy, and research require development to increase support for COPMI caregivers and their families.     

Brief Emotion Focused Family Therapy: An Intervention for Parents of Children and Adolescents with Mental Health Issues

This study evaluated the 2‐day intensive modality of Emotion Focused Family Therapy (EFFT). The intervention attempts to prepare parents to take a primary role in their child's recovery from a range of mental health issues. One hundred and twenty‐four parents completed the intervention and provided data a week prior to intervention, post‐intervention and at 4‐month follow‐up. Results include significantly reduced parent blocks and increased parental self‐efficacy in relation to involvement in their child's recovery, as well as significant improvement in child symptomatology. The findings confirm positive results from an earlier pilot study involving eating disorders and demonstrate the potential for EFFT as an intervention for a range of clinical problems in children and youth.     

From Scared to Repaired: Using an Attachment‐Based Perspective to Understand Situational Couple Violence

Situational couple violence (SCV) is a common problem in couples presenting for therapy. SCV, as seen through the lens of attachment, can be viewed as a result of an insecure attachment system within the couple. Although several authors have discussed individual attachment styles as predictors of both the receipt and perpetration of violence, in this article we seek to portray the attachment system as a relational and changing construct. As such, we argue for conjoint treatment for SCV as a way to restructure a more secure attachment system within the couple. Cautions for the appropriateness of couples counseling with ongoing violence are included. Finally, we discuss the use of an attachment‐based safety plan and time‐out strategy to use with couples experiencing SCV.     

Family‐Focused Child Therapy in Marital Separation

When marriages and long‐term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family‐focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system.     

Maternal Cohabitation and Child Well‐Being Among Kindergarten Children

Using data collected from 10,511 kindergarten children and their parents from the Early Childhood Longitudinal Study—Kindergarten Cohort, this study examines child well‐being across cohabiting 2‐biological‐parent families; cohabiting stepfamilies; married stepfamilies; and married 2‐biological‐parent families. Findings indicate no differences in child well‐being for children living in cohabiting stepfamilies and cohabiting 2‐biological‐parent families. Multivariate models controlling for child characteristics, economic resources, maternal depressive symptoms, stability, and parenting practices show no significant differences across family types in child well‐being indicators, with the exception of reading skills. Important factors in explaining the link between cohabitation and child well‐being include economic resources, maternal depressive symptoms, and parenting practices.     

Indebted Relationships: Child Support Arrears and Nonresident Fathers' Involvement With Children

Low‐income, nonresident fathers owe a disproportionate amount of child support arrears, creating potential challenges for these fathers and their family relationships. This article uses mediation analysis to provide new evidence about how and why child support debt is related to paternal involvement using information from 1,017 nonresident fathers in the Fragile Families Study. Results show that child support arrears are associated with nonresident fathers having significantly less contact with children, being less engaged with them in daily activities, and providing less frequent in‐kind support 9 years after the birth. This negative association between child support debt and father involvement is most strongly and consistently mediated by the quality of the relationship between the biological parents. Although child support policies are designed to facilitate fathers' economic and emotional support, these results suggest that the accruement of child support debt may serve as an important barrier to father involvement.     

The Family Context of Assent: Comparison of Child and Parent Perspectives on Familial Decision‐Making

Assent guidelines currently fail to include an assessment of a child's decision‐making ability, experience and interest. This paper summarises a two‐stage study, conducted in the United Kingdom, exploring perspectives on children's decision‐making power and ability within their family, as an indicator for overall decision‐making readiness. Children desired to make some decisions but knew their parents held ultimate authority. Parents believed their children could make some decisions and actively trained them through involvement in daily decisions. Researchers should strive to include children in enrolment decisions to some degree, based on a consideration of their expectations for involvement informed by their daily family context.     

How to Deal With Moral Tales: Constructions and Strategies of Single‐Parent Families

This study explored how normative understandings based on the nuclear family ideology are linked to constructions of single‐parent families and sheds light on the strategies single parents and their children adopt in dealing with negative accounts. Guided by social constructionist and configurational approaches, the in‐depth analysis is based on an Austrian qualitative study, comprising interviews with 50 ten‐year‐old children and their 71 parents, living in nuclear, reconstituted, and single‐parent families. The results showed that single‐parent families are constructed predominantly in terms of deficits and disadvantages, with the nuclear family serving as an ideological code along the dimensions of normalcy, complementarity, and stability. To deal with negative accounts, single parents and their children use three basic types of strategy: (a) imitation, (b) compensation, and (c) delimitation.