Opioid Use Disorder,Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.     

Adoptive Mothers’ Perceptions of Reactive Attachment Disorder Therapy and its Impact on Family Functioning

The purpose of this qualitative study was to explore adoptive mothers’ perceptions of attachment therapy and its impact on family functioning. Sixteen mothers were interviewed 3 years after therapy. Analysis of the data revealed two sets of parental perceptions: first, attachment therapy was consistently supportive, emotionally painful, and physically safe; second, therapy preserved family structure, mothers remained committed to their children, and parenting was continuously stressful. This study highlights the need for further research on the treatment of children with attachment disorders and is not intended as a treatise on the efficacy of attachment therapy as a treatment modality.     

Adopting children with attachment problems.

This article describes children with significant attachment problems and summarizes the actions needed to increase the probability that such children can be successfully adopted. Healthy and disordered attachment patterns are detailed, as well as the principles and strategies that are important in parenting such children and the parenting characteristics that should be sought in selecting families for children with attachment disorder. Psychological treatment and other postadoption services necessary to support the adoption and the child's ability to successfully form a secure attachment with the adoptive parents are also highlighted.     

The Relevance of Attachment Research for Adult Narratives Told in Psychotherapy

This paper discusses categories of attachment organization in infants, with an emphasis on the avoidant and disorganized/disoriented category. An example of how the avoidant infant attachment organization shows continuity throughout the lifespan is discussed. Finally, a case example of a man seen to have a dismissing/unresolved pattern of attachment organization is presented. In the ensuing discussion, the authors suggest that knowledge of infant attachment research can help therapists identify patterns that manifest in adult psychotherapy.     

Children adopted from China: Attachment security two years later

Background

This study continues the examination of the process of attachment formation of mothers and their adopted Chinese daughters two years postadoption.

Method

30 children adopted from China (mean age = 13.6 months at adoption) were assessed and followed two years following adoption. They were compared to 31 nonadopted Canadian girls of similar age and family background. In earlier reported longitudinal studies of the adopted children, maternal reports of attachment security were employed. In the current study the Strange Situation Procedure was used.

Results

Adopted children show signs of having a secure attachment with their mothers two years following adoption. There was some evidence that disorganized attachment characterized these children more so than for children in the comparison group.

Conclusions

The moderate degree of emotional deprivation experienced by Chinese adoptees does not hinder their ability to form a new attachment with adoptive mothers. Attachment appears open to change, even after a time when children should have already formed an attachment relationship and the change is maintained.     

Writing a Book Review for JFSW

ABSTRACT

For children in foster care, continued contact with biological parents may have significant implications. This article seeks to synthesize literature examining attachment theory and visitation between children in foster care and their parents. The results of the research synthesis indicate that although the exploration of attachment theory began over 40 years ago, the questions regarding the implications of foster care visitation and attachment continuation surprisingly remain unanswered.     

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.     

Mind‐Mindedness as a Multidimensional Construct: Appropriate and Nonattuned Mind‐Related Comments Independently Predict Infant–Mother Attachment in a Socially Diverse Sample

In a socially diverse sample of 206 infant–mother pairs, we investigated predictors of infants’ attachment security at 15 months, with a particular emphasis on mothers’ tendency to comment appropriately or in a non‐attuned manner on their 8‐month‐olds’ internal states (so‐called mind‐mindedness). Multinomial logistic regression analyses showed that higher scores for appropriate mind‐related comments and lower scores for non‐attuned mind‐related comments distinguished secure‐group mothers from their counterparts in the insecure‐avoidant, insecure‐resistant, and insecure‐disorganized groups. Higher scores for appropriate mind‐related comments and lower scores for non‐attuned mind‐related comments also independently predicted dichotomous organized/disorganized attachment. General maternal sensitivity predicted neither attachment security nor organization, although sensitivity was found to relate to dichotomous secure/insecure attachment specifically in the context of low socioeconomic status. The findings highlight how appropriate and non‐attuned mind‐related comments make independent contributions to attachment and suggest that mind‐mindedness is best characterized as a multidimensional construct.     

Place attachment among children in a street situation in Pelotas,Brazil

This article explores the processes which affect street children and youths’ relationships with the place called the ‘streets’. The street as a place to live is violent and hostile. However, street dwellers aspire to see the street environment positively. In fact, being able to establish a positive relationship with the street, to become attached to it, is crucial for coping within it. In this research, longitudinal qualitative data concentrating on processes were produced time-geographically with 19 street children and youths in the Brazilian town of Pelotas. The analyses of this research reveal that attachment changes over time instead of remaining static. Examples from the streets demonstrate how the human–environment relationship is shaped by constantly changing encounters of physical, social and mental (f)actors. This article stresses the importance of individual life experiences and goals for the attachment processes and for what positively affects the attachment.     

Disorganized Attachment: A Compass for Navigating the Confusing Behavior of the “Difficult-to-Treat” Patient

The concept of disorganized attachment gives a framework with which to understand patients who present a confusing pattern of relatedness. The therapist may experience feeling connected with the patient only to see a sudden retreat, expressed by silence, argumentativeness, or missed sessions. After presenting a theoretical summary of disorganized attachment, I give two clinical examples. The first illustrates the theoretical material that is presented and gives the reader an idea of what a disorganized attachment pattern looks like in the clinical setting, while the second briefly shows how use of this framework increased my comfort level.     

Benefits of mother goose: influence of a community-based program on parent-child attachment relationships in typical families

An estimated 50 to 60% of children from typical families develop secure attachment relationships with their parents (Ainsworth, Blehar, Waters, & Wall, 1978; Van IJzendoorn & Kroonenberg, 1988); however, intervention research has focused primarily on interventions for high-risk clinical samples (Berlin, Zeanah, & Lieberman, 2008). In this project, the influence of a popular community-based parent-child program was assessed in a non-clinical sample of families. Families participating in a 10-week Parent-Child Mother Goose Program (n.d.) and families on the waitlist for the program were asked to complete questionnaires to assess parenting efficacy and satisfaction as well as parents' perception of their own and their child's attachment styles at the beginning of the program, the end of the program, and six months later. Mothers in the program group reported significantly more positive change in their reports of parenting efficacy over time and also reported significantly more change in their children's attachment category. Specifically, children in the program group were significantly more likely to be classified as secure over time (55% at T1 to 81% at T3) as compared to the waitlist participants (45% at T1 to 62% at T2). In this popular 10-week, community-based program, parents learned skills that continued to influence their relationship with their children six months after the conclusion of the program.     

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.     

A Trust-Based Intervention for Complex Developmental Trauma: A Case Study from a Residential Treatment Center

This case study, conducted in a Midwest residential treatment center, reports results from an attachment-based intervention that addressed the needs of a 16-year-old female, Rachel. Rachel had a long and documented history of severe abuse and neglect before her adoption from a Bulgarian orphanage at age 12 and numerous psychiatric hospitalizations in the years subsequent. Upon entering this residential treatment center, Rachel did not respond to traditional residential treatment modalities and was considered one of the most difficult children the facility had ever attempted to help. After the intensive attachment-based intervention for Rachel, her adoptive parents, and facility staff, dramatic increases in pro-social and attachment behaviors were noted, as well as a significant decrease in violent and self-injurious behaviors. The intervention consisted of three phases of differing levels of intensity and was designed to address the attachment system and related sub-systems in order to facilitate the development of healthy attachments.     

The Effectiveness of an Attachment-focused Treatment Model in a Therapeutic Preschool for Abused Children

Child maltreatment is associated with detrimental developmental effects. In view of the fact that child maltreatment typically occurs within the context of a caretaking relationship, attachment theory can give us insight into the nature of difficulties experienced by survivors. Therapeutic preschool has been found effective in addressing developmental problems in abused children. This study examines the effectiveness of an attachment-based therapeutic preschool for maltreated children. Means tests indicate that, at the time of discharge, the children being served had made significant overall developmental gains as well as significant gains in the personal–social and adaptive domains of development.     

A discussion of current attachment research and its clinical applications

This article highlights Stern's recent conceptualization of the infant's development of internal working models of attachment and the relationship between internal working models and the narrative self. Research studies, including Ainsworth's and Main's seminal work on types of infant attachment models, are reviewed. These include secure, avoidant insecure, ambivalent insecure, and disorganized-disoriented types of infant attachment. Later research supports the continuation of these same attachment patterns in the children at age six. A clinical case, a sixteen year old and her infant, is presented to illustrate how the client's working model of attachment plays out in the treatment process.     

Some Clinical Applications of Attachment Theory in Adult Psychotherapy

This paper discusses the usefulness of attachment theory in working with adults in psychotherapy. There are four classifications of attachment status in adults: secure attachment, and three types of insecure attachment: dismissing, preoccupied, and disorganized. These categories do not conform to standard diagnostic entities. I discuss examples of the three insecure attachment categories and the likely transference and countertransference configurations that may occur in each category. These categories provide an additional way for therapists to understand and to respond to the needs of their clients.     

Infants in Foster Care

Abstract

This article highlights the importance of attachment issues for infants placed in foster care. We offer a framework for understanding how early separation and maltreatment may affect infants' ability to securely rely on a foster parent. We argue that disruptions in foster infants' primary attachment relationships, combined with a history of maltreatment, place these infants at risk for developing predominantly insecure or disorganized attachments to foster parents, regardless of foster parent characteristics. We argue that foster infants' successful passage through the foster care system requires a high level of foster parent sensitivity to their unique attachment needs. We also argue that this level of sensitivity is likely to require specialized training for foster parents.     

The Child in the Family of a Drug-Using Father: Attachment Styles and Family Characteristics

SUMMARY

The study examined the impact of family characteristics and parental attachment styles on the children of drug-using (DU) fathers in fifty-six families (n = 168) in Israel. Of the DU fathers, 60.7% were characterized by avoidant attachment style. Among the non-DU mothers, 53.6% were characterized by secure attachment style, 42.9% by avoidant style, and 3.6% by anxious/ambivalent style. Surprisingly, family cohesion and adaptability scores were similar to the Israeli norm, perhaps because the DUs had completed detoxification treatment and participated in rehabilitation programs. Of the children, 61.8% were characterized by secure attachment style, 21.8% by avoidant style, and 16.4% by anxious/ambivalent style. Stepwise regression to predict children's attachment styles revealed that maternal security of attachment and paternal anxious/ambivalent style predict similar attachment styles among the children. The important combined effects of spousal attachment styles on the children are discussed.     

Intergenerational solidarity: An attachment perspective

The concept of intergenerational solidarity between parents and children has been addressed within sociology using an increasing number of dimensions, some overlapping with phenomena studied in attachment theoretical research within psychology. Attachment theory is an important candidate for cross-disciplinary research into intergenerational solidarity, because it identifies causal processes within individuals as well as relationships. Due to its developmental nature the attachment theory is also highly relevant to life-cycle issues surrounding intergenerational solidarity. In this theoretical review, the basic dimensions which attachment theory uses to describe relationships are articulated with reference to pertinent issues under the rubric of intergenerational solidarity. Examples are provided to illustrate how at the cross-section of psychology and sociology these dimensions (direction, quality, and penetration) can be used for answering questions (patterns of exchange, tensions, ambivalence) about relationships between adult children and aging parents.