Understanding and Utilizing Parallel Processes of Social Interaction for Attachment-based Parenting Interventions

In an effort to meet both the parenting and treatment needs of substance-abusing women who are parents, residential drug treatment programs have been struggling to find the best approach. A qualitative-quantitative study of the parenting experience of mothers in residential drug treatment programs housing both mothers and their children found that relational processes characterized how these mothers perceived parenting as well as treatment. The findings presented the interplay and mutuality between a mother’s interactions (natural or facilitated) with the external social world that includes her child and those connected to the treatment facility and the internal formation of her sense of herself, her child, and others, along with the changes in both areas that took place in the facility. These findings lend important support to the use of attachment-based parenting interventions in residential drug treatment programs by drawing on these relational processes.

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.     

Personal Trauma and Risk Behaviors Among Youth Entering Residential Treatment

The focus of this study was to determine the prevalence and types of traumas experienced by adolescents prior to admission to long term mental health residential care and the impact of these traumas on their risk behaviors. The research was conducted at a state-supported residential mental health treatment facility functioning under the authority of the Department of State Health Services. Client level data was extracted from social assessment forms (N = 457) in case records of clients. Results confirmed that exposure to trauma was pervasive among adolescents admitted to the facility. Findings also revealed a link between trauma and risk behaviors among youth entering residential treatment facilities. Increased trauma exposure significantly impacted the risk behaviors of youths entering the residential treatment facility. The results indicate that the total number of traumas experienced was a greater predictor of risk behaviors among these youth than the specific traumas experienced. Internalizing behaviors such as self-harm and suicide attempts also increased with the number of traumas experienced by the adolescent. The study demonstrates the need for further exploration of the complex relationship between personal trauma, mental health, and social development in adolescents.     

“Why Don’t You Just Tell Me How You Feel?”: A Case Study of a Young Mother in an Attachment-Based Group Intervention

This paper describes an attachment-based parenting intervention, the Circle of Security, and presents a case study of one participant’s experience as a member of it. The Circle of Security is a group intervention for parents of young children ages 1–5 that teaches parents to recognize and respond to their children’s alternating needs for attachment and exploration. The intervention content in group sessions relies to a great extent on discussions of videotaped vignettes of each parent–child dyad. Ultimately, the intervention focuses on strengthening parents’ capacities for empathic responsiveness to their children’s needs for them. In the second part of the paper, the case study illustrates one mother’s experience in a Circle of Security group designed for parents involved with the child welfare system as a result of substantiated maltreatment. Observations of this parent indicate that her capacity for empathic understanding was greatly strengthened, which appears to be related to important behavior change.     

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.     

Social Learning Theory–Based Parenting Programs to Treat Attachment Difficulties: A Case Study of an Older Child Placed Late for Adoption

An attachment-sensitive formulation is presented for a 9-year-old adopted girl with a complex presentation of oppositionality, separation anxiety, and attachment problems. Session-by-session observational data of an evidence-based treatment demonstrates the transactional nature of the carer-child interactions that drove an improvement in attachment behaviors, as well as oppositional and anxiety symptoms at home. Most importantly, a placement in imminent danger of breakdown was stabilized, allowing the child more time to negotiate a reliable attachment to her new carer. Thus, the evidence-base can be used to develop personalized treatment packages for complex adoption cases consistent with the relevant practice parameters.     

The Role of Attachment Behaviors in the Link between Relationship Satisfaction and Depression in Clinical Couples: Implications for Clinical Practice

Using dyadic, clinical data from 104 couples in committed relationships, the purpose of this study was to determine whether relationship satisfaction was associated with depression through perceived partner attachment behaviors—accessibility, responsiveness, and engagement—for both men and women. We found that one's satisfaction in the relationship was the lens through which they viewed their partner's attachment behaviors and—women's relationship satisfaction was the lens through which her male partner viewed her attachment behaviors. Finally, women's relationship satisfaction is associated with both individuals' depression through her perceived partner's accessibility, responsiveness, and engagement. The findings from this study are important because they provide clinically relevant and mutable constructs in which clinicians can intervene at an attachment level in distressed marriages with depressed partners.     

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

This study explored factors associated with the psychiatric rehospitalization of children and adolescents. A retrospective archival review was conducted on 403 children and adolescents admitted into an inpatient psychiatric hospital. Results indicated that 16% were readmitted in the same year. Children and adolescents who had a prior history of psychiatric rehospitalization, lived in a residential treatment facility, and had a diagnosis of oppositional/defiant or conduct disorder were more likely to be rehospitalized. Psychosocial factors must be considered in predicting and preventing psychiatric rehospitalization. Clinical social workers should include therapeutic foster care as an option for aftercare placements of youth exhibiting externalizing behaviors and/or with a history of multiple restrictive care placements.     

Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men

We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.     

Peer contagion among youth in Medicaid-funded residential mental health treatment programs

This paper examined juvenile justice encounters among youth with mental health needs who received care in residential treatment settings. The focus is on peer effects, and whether delinquent peers negatively affected youth. Matched data from Florida Medicaid and Juvenile Justice were used to examine the association between peer delinquency in a residential treatment setting and juvenile justice encounters during and after the treatment episode. Fifteen percent of youth had justice encounters during residential out-of-home treatment, while the rate was lower in the six months after (23.0%) treatment than the six months before (33%). Support for peer contagion was found as youth treated in Medicaid-funded residential mental health treatment programs were more likely to have JJ encounters when the other youth in the facility had histories of delinquency.     

Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques

Suicide is the second leading cause of death among youth, and as many as one in five youth report having had at least one serious thought of suicide in the past year. Despite the enormous emotional pain and suffering associated with suicidal thoughts and behaviors, up to 40 % of suicidal youth never receive treatment. Given that social workers are employed in multiple settings where suicidal children and adolescents are encountered (e.g. schools, homeless shelters, emergency departments, outpatient mental health agencies, private practice), they play a critical role in the identification and treatment of suicidal youth. In the past decade, evidence has emerged that attachment-based family therapy, integrated cognitive behavioral therapy, and dialectical behavior therapy can reduce suicidal ideation and/or suicide attempt in youth. The purpose of this article is to review the theoretical assumptions, conceptual frameworks and key intervention techniques for these three interventions so that clinicians can integrate these approaches into their practice with suicidal youth and families. Implications for practice are integrated throughout the review.     

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.     

Fostering secure attachment in low- and middle-income countries: Suggestions for evidence-based interventions

Children struggling with the effects of trauma in low- and middle-income countries (LMIC) face a substantial mental health resource gap that limits their opportunities for positive psychosocial development. Multidisciplinary interventions working to close this gap may benefit from incorporating an empirically supported treatment (EST) into their approach that targets a universal mechanism implicated in resilience, like attachment. ESTs should be selected based on their level of empirical support and cultural adaptability, and then modified on the basis of qualitative evaluations conducted with the local population and stakeholders. This paper will provide an overview of attachment as a mechanism of resilience, a critical analysis of existing attachment-based ESTs, and recommendations for overcoming EST implementation barriers in LMIC.     

Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.     

Generating Hypotheses From Rachel's Strong Profile

To formulate my reaction to the case materials for Rachel, I imagined how I might use the available information to prepare myself to see Rachel for career counseling. Rachel's case presents an excellent illustration of how the Strong profile can be used to generate hypotheses about the career conflict she is experiencing, how career counseling might progress, and potential issues to explore with her in counseling. Furthermore, Rachel's case provides an example of how information from her profile might be integrated with other available case information. I have divided my reaction into two sections: pre-session preparation, and issues to explore with Rachel in counseling.     

Adults in Wilderness Treatment: A Unique Application of Attachment Theory and Research

Research shows how an understanding of adult attachment applies to clinical treatment, such as outpatient therapy, but no literature explores the application of adult attachment to wilderness therapy, a distinct type of residential treatment. This paper explores how an understanding of adult attachment applies to wilderness therapy clients, as the nature of wilderness therapy involves losses, separations, and reunions, all of which evoke attachment needs. Adult wilderness treatment exemplifies an effective method of treatment that provides a secure base and supports healthy attachment relationships.     

FIELD NOTES: A CONCEPTUAL APPLICATION OF ATTACHMENT THEORY AND RESEARCH TO THE SOCIAL WORK STUDENT-FIELD INSTRUCTOR SUPERVISORY RELATIONSHIP

This article conceptualizes an attachment-based model of the student–field instructor relationship, based on empirical research concerning internal working models of attachment, which continue into adulthood and serve as templates for life-long relating. Supportive relationships within a noncritical context are salient for effective supervision; attachment theory provides a framework for developing supportive supervisory relationships and augments existing theories of supervision. Ideal and problematic supervisory relationships are presented followed by recommendations for interventions and future research. The supervisory relationship will be most successful when the field instructor is guided by attachment theory and its conceptualization of a "secure base" (Bowlby, 1988).     

The Pet Connection: An Attachment Perspective

Using the ethological-evolutionary framework of attachment, and including how the theory has been updated and expanded by findings from attachment-based research, neuroscience and animal studies, this paper proposes that a relationship with a family pet, especially a dog or cat, reflects certain dynamics of attachment which may account for the sense of comfort and connection they provide to individuals at all stages of the life cycle. There is now convincing scientific evidence that companion animals have positive effects on psychological and physical well-being, helping shape how people regulate their emotions, deal with stress or trauma, and relate to others. Discussion considers the implications of these benefits for social work, in particular for policy, prevention, and psychotherapy. An illustration of treatment for pet loss, as well as a framework for promoting attachment in pets adopted from rescue shelters, is also presented. It is recommended that both social work professionals and social work students be educated about the human-animal bond and the significance of pets to so many of our clients.     

Short-term and long-term effects of training in emotionally focused couple therapy: professional and personal aspects

This study investigated the immediate and long-term personal and professional effects of a 4-day externship training in emotionally focused couple therapy (EFT). EFT externship training uses lecture, discussion, video vignettes, live demonstrations, and role-plays to convey an attachment-based approach to working with couples. The two samples included clinicians (N = 76) who completed surveys immediately before and after training, and a subset of these clinicians (N = 29) who completed measures an average of 8 months later. Results indicate that following training, participants increased in their EFT knowledge and competence, became more open to their feelings, were more self-compassionate, were less likely to use avoidant attachment behaviors, and improved their own personal relationships.     

Parenting schemas and the process of change

Parents' childrearing behaviors are guided by schemas of the caregiving role, their functioning in that role, what children need in general, and what their own children are like in particular. Sometimes, however, parenting schemas can be maladaptive because they are too rigid or simple, involve inappropriate content, or are dominated by negative affect. In this article, we describe parenting schemas and provide an overview of empirical work documenting the characteristics of maladaptive parenting schemas. We review how intervention practices common to multiple therapeutic approaches (cognitive-behavior therapy, family therapy, parent training, attachment-based interventions, and psychoanalytic parent-infant psychotherapy) attempt to modify schemas to promote more optimal functioning among parents. We highlight how research in cognitive science may explain, in part, treatment effectiveness.