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Transcript of Attachment Disorders
1. Safe Haven
2. Secure Base
3. Proximal Maintenance
4. Separation Distress Secure Attachment Attachment Disorders
Attachment in children deals with the theory of attachment between children and their caregivers. John Bowlby formed his theory of attachment after many years of observing institutionalized children. He wrote many papers drawing from ethology, cybernetics, developmental psychology and cognition. Bowlby published his full theory in a trilogy of papers entitled Attachment and Loss.
Characteristics of Attachment:
1. Safe Haven
2. Secure Base
3. Proximal Maintenance- is when the child remains close to the caregiver to ensure they are safe. The child typically will not stray very far from their caregiver with whom they feel and see as safe.
4. Separation Distress- when the child is away from the caregiver, they typically become distressed and upset. The child is out of their comfort zone as they are unsure if they are safe. Mary Ainsworth and the Strange Situation
Ainsworth moved her work to the laboratory in order to assess the effect of maternal absence on infant exploratory behaviours. Her paradigm, called the Strange Situation, is a thirty-minute procedure that consists of a series of separations and reunions among a caregiver, a child, and a stranger. Safe Haven- means that when a child is afraid they can rely on their mother for comfort. For instance, if a child is scared by a loud noise, they can then turn to their mother who assures them that everything is fine and they are okay. Separation Distress- when the child is away from the caregiver, they typically become distressed and upset. The child is out of their comfort zone as they are unsure if they are safe. Secure Base- means that the child has a caregiver who provides a dependable support system from which they can explore the world around them. A child who has a healthy relationship with their caregiver is free to discover their surroundings. This is possible because they are reassured in knowing if they fall, they have this person to rely upon. Proximal Maintenance- is when the child remains close to the caregiver to ensure they are safe. The child typically will not stray very far from their caregiver with whom they feel and see as safe. Characteristics of Attachment:
According to some psychological researchers, a child becomes securely attached when the mother is available and able to meet the needs of the child in a responsive and appropriate manner. Attachment Styles Securely attached children are best able to explore when they have the knowledge of a secure base to return to in times of need. When assistance is given, this bolsters the sense of security and educates the child in how to cope with the same problem in the future. Anxious-Ambivalent Insecure Attachment A child with an anxious-ambivalent attachment style is anxious of exploration and of strangers, even when the mother is present. When the mother departs, the child is extremely distressed. The child will be ambivalent when she returns - seeking to remain close to the mother but resentful, and also resistant when the mother initiates attention. Anxious-Avoidant Insecure Attachment A child with an anxious-avoidant attachment style will avoid or ignore the mother - showing little emotion when the mother departs or returns. The child will not explore very much regardless of who is there. Strangers will not be treated much differently from the mother. There is not much emotional range displayed regardless of who is in the room or if it is empty. D i s o r g a n z e d i A t t a c h m e n t Disorganized attachment is actually the lack of a coherent style or pattern for coping. While ambivalent and avoidant styles are not totally effective, they are strategies for dealing with the world. Children with disorganized attachment experienced their caregivers as either frightened or frightening. Human interactions are experienced as erratic, thus children cannot form a coherent interactive template. Coping Stratagies Avoidantly attached children appear to know that signalling their desire for closeness will most likely be met with rejection, they learn, as early as the first year of life, to inhibit such attachment behaviours as protesting a separation, following, calling, crying, and clinging. Children who display disorganized behaviours have no appropriate or adequate behaviour pattern at their disposal in such stressful situations as separation and reunion. These children tend to behave in a controlling fashion during reunions with a parent displaying either a controlling-punitive or a controlling- caregiving response to the returning parent. Attachment Disorders Attachment disorder refers to the failure to form normal attachments with caregivers during childhood. The Diagnosis and Typology of Attachment Disorders In children with an attachment disorder, one may observe very deviant patterns that are exhibited with a variety of attachment figures. Attachment problems can be resolved at older ages through appropriate therapeutic interventions. No Signs of Attachment Behaviour Children in this category are remarkable in that they demonstrate absolutely no attachment behaviour toward anyone. This behaviour is seen in children who have experienced numerous relational breaks and shifts during infancy or were brought up in institutions or multiple foster homes. Undifferentiated Attachement Behaviour Children in this category are friendly toward everyone and do not differentiate between strangers and people they have known for a long time. This is also known as social promiscuity. A variation of this disorder has been called the counterphobic. These children tend to endanger and injure themselves, and are frequently involved in accidents that on examination they appear to have courted by their own flagrant risk-taking behaviour. Both of these variants of attachment disorder may be found in children in institutional or foster care whose attachment figures have changed frequently. They are also found in neglected children. Exaggerated Attachment Behaviour This form of attachment disorder is characterized by excessive clinging. These children can be calmed and steadied only in close proximity to an attachment figure. This disorder may be observed in children whose mothers suffer from an extreme fear of loss. They need their children to serve as a secure emotional base for them, so they can stabilize themselves intrapsychically. Inhibited Attachment Behaviour Children with inhibited attachment behaviour react to separation with little or no resistance. In interactions with attachment figures they appear inhibited and demonstrate excessive compliance. These children have learned, often as a result of extensive physical abuse or the use or threat of physical violence, to express their desire for attachment cautiously and reticently. Aggressive Attachment Behaviour Children exhibiting this attachment disorder organize their attachment relationships around physical and/or verbal aggression. Attachment Behaviour with Role Reversal This type of attachment disorder is characterized by role reversal between attachment figure and the child. The child takes responsibility for the adult and in turn, limits their own exploration of their surroundings, or willingly forgoing it as soon as the attachment figure signals a need for help and support. Psychosomatic Symptoms Attachment disturbances can also express themselves in psychosomatic symptoms. When the attachment figure displays a pronounced avoidant or distancing attitude toward the child, physical growth may slow down or even come to a halt, in spite of adequate physical care. Reactive Attachment Disorder (DSM Diagnosis) Reactive attachment disorder is typically seen in children who have been abused, bounced around in foster care, lived in orphanages, or taken away from their primary caregiver after establishing a bond. Links between attachment style and psychopathologies: There is evidence that a secure attachment relationship functions as a protective factor for children. agoraphobia,
and conduct disorders. Insecure-Avoidant Attachment:
is predisposed for the development of psychosomatic symptoms and diseases. Disorganized attachment can lead to:
borderline personality disorder
vulnerability to various psychiatric illnesses. Risk Factors Important life events during the first year of life are capable of transforming a secure quality of attachment into an insecure one. Examples include:
such as divorce,
or the death of a parent Infants with parents suffering from either depression or schizophrenia demonstrate a greater than expected incidence of insecure attachment. However, this may not become evident until the ages of 2 or 3. A variation of this disorder has been called the counterphobic. These children tend to endanger and injure themselves, and are frequently involved in accidents that on examination they appear to have courted by their own flagrant risk-taking behaviour. Children with inhibited attachment behaviour react to separation with little or no resistance. In interactions with attachment figures they appear inhibited and demonstrate excessive compliance. Attachment Measures Strange Situation Attachment Story Completion Test The Attachment Q-sort Attachment in adolescents and adults is commonly measured using the Adult Attachment Interview and self-report questionnaires. General Considerations for Child and Adolescent Psychotherapy
The Child Thereapist must:
function as a reliable emotional and physical base.
facilitates play that promotes both direct interaction and observations of symbolic play.
fosters emotional expression related to attachment issues.
promote an enviroment, through new security-providing attachment experiences, an environment in which the child can free himself from earlier destructive and insecure attachments.
dissolve the therapeutic bond carefully so that it will serve as a model for handling separations. (Physical separation is not the same as loss of the “secure base”; should the child or parents need help at a later date, they can still rely on the therapist.) Special Considerations Changes in attachment figures during the first years of life, as well as inconsistent and ambivalent caregiving on the part of the attachment figure must be considered. Therapists must deal with the attachment needs against which patients are defending and carefully interpret them, while at the same time paying heed to the need for distance conditioned by the patient’s disorder. In general, patients expect that their need for attachment will not be satisfied in therapy either, and that sooner or later they will experience the disappointment of their desire for attachment. The secure base offered by therapy makes possible an affective “new beginning”, or a “corrective emotional experience”. It is a fundamental prerequisite for the processing of old maladaptive attachment patterns. Studies seem to be in favour that a secure “state of mind” with respect to attachment can be achieved later, possibly as a result of new corrective attachment experiences in the course of psychotherapy. Therapies Dyadic Developmental Psychotherapy The therapist attunes to the child’s "subjective experiences" and reflects this back to the child by means of eye contact, facial expressions, gestures and movements, voice tone, timing and touch, "co-regulates" emotional affect and "co-constructs" an alternative autobiographical narrative with the child. Theraplay Theraplay® is a short-term, therapist-directed play therapy for children and their parents. It is designed to enhance attachment, raise self-esteem, improve trust in others and create joyful engagement. CULTURAL CONSIDERATIONS In African, Chinese, Israeli, Japanese, Western European, and American cultures alike, most children, about two-thirds, are securely attached to their caregivers. Consider that in Japan a higher proportion of children are classified as ambivalent and a lower proportion of children are classified as avoidant than in Western European and American cultures. Rothbaum and his colleagues argued that caregiver sensitivity in Japan is a function of parents' efforts to maintain high levels of emotional closeness with their children, but that in the United States it is a function of parents' efforts to balance emotional closeness with children's assumed need to become self-sufficient. Attachment Across the Lifespan There is some evidence that attachment status is a stable phenomenon. Patterns of attachment in infancy are also predictive of the quality of relationships with people other than parents. Events that may redirect secure infants toward patterns of insecurity in adolescence and adulthood include maltreatment, the loss of a parent, parental divorce, or a serious illness for the parent or child. Common Signs
* An aversion to touch and physical affection.
* Control issues.
* Anger problems.
* Difficulty showing genuine care and affection.
* An underdeveloped conscience. Reactive Attachment Disorder, sometimes called "RAD", is a psychiatric diagnosis. The essential feature of Reactive Attachment Disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 and is associated with grossly pathological care. Insecure-ambivalent attachment:
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