Transcript PowerPoint Presentation - Helping Families Cope With Crises

Keeping Attachment Intact
Following Trauma
Douglas Goldsmith, Ph.D.
Executive Director
The Children’s Center
18th Annual Conference on Child Abuse & Family Violence
October 2005
Special Thanks
Dr. David Oppenheim
University of Haifa
Dr. Janine Wanlass
Westminster College
For their contributions and support on
conceptualizing issues around attachment
and permanency
Overview
What is a “secure base” and why is it
important?
What happens when children are separated
from their caregiver?
What should we do to foster a secure
attachment after trauma and loss?
Development of Attachment
Biological process
Recognition of the caregiver
Utilization of the caregiver as
a “haven of safety” and a
“secure base” in order to
explore the environment
Attachment Behaviors
Approach the caregiver
Crying
Seeking contact
Maintaining the contact
The number of attachment behaviors will
vary with the degree of the perceived threat
in the environment
Weinfield et al (1999)
Secure vs Insecure
Attachment
The classifications “Secure” vs “Insecure”
“Reflect the infant’s apparent perception of
the availability of the caregiver if a need for
comfort or protection should arise, and the
organization of the infant’s responses to the
caregiver in light of those perceptions of
availability.”
Weinfield et al (1999)
Impact of Attachment
Whether a child or adult is in a state of
security, anxiety, or distress is determined in
large part by the accessibility and
responsiveness of the principle attachment
figure.
Bowlby (1973)
Secure Attachment
The caregiver is
perceived as a reliable
source of protection
and comfort
Secure Attachment
When I am close to my loved one I feel good,
when I am far away I am anxious, sad or lonely
Attachment is mediated by looking, hearing, and
holding
When I’m held I feel warm, safe, and comforted
Results in a relaxed state so that one can, again,
begin to explore
•Holmes (1993)
Secure Attachment
Attachment is a reciprocal
relationship
The parent offers
caregiving behavior that
matches the attachment
behavior of the child
The child, using social
referencing, checks in
with the mother “looking
for cues that sanction
exploration or
withdrawal”
Holmes (1993)
Anxious Attachment
Maintain constant low levels of anxiety
about the caregiver’s availability
Unable to explore the environment without
worry
Fail to achieve confidence in themselves
and mastery of their enviroment
Weinfield et al (1999)
Response to Separation
Increased fear
Increased anger
Hostile behaviors increase and may persist
Sadness, withdrawal, disengagement
Hatred and resentment may be accompanied
by desire to harm parents
Children’s Response to
Trauma
Loss of sense of basic trust
Loss of security
Destabilized “Secure Base”
Compromised emotional
development
Impact of Parental
Depression
Children:
Show more depressed affect
 Show more behavior problems
 Maladaptive interactions with parents

Field (1987, 1995)
Impact of Parental Anxiety
Unable to hear their children’s distress
Withdraw to protect themselves emotionally
Difficulty tolerating children’s anxiety and
aggression
Osofsky & Fenichel, (1994, 1996, 2000)
PTSD
Post Traumatic Stress Disorder
Persistent re-experiencing of trauma
Avoidance of stimuli associated with trauma
Increased arousal
Impairments in social, emotional, and
occupational functioning
PTSD à deux
“ The parents own traumatic response to the
trauma endured by the child creates a
complex system that may maintain or
contribute to dysfunction in both parent and
child”
Appleyard & Osofsky (2003)
Relational PTSD
Parents may be traumatized even if not present at
the trauma:
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Withdrawn/Unresponsive/Unavailable
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Overprotective/Constricting
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Emotionally and functionally unavailable
May have suffered trauma in the past
Preoccupied about the trauma re-occuring
Reenacting/Endangering/Frightening

Repeatedly ask about the event
Scheeringa & Zeanah (2001)
Infants and Toddlers
Following violence in their home or community:
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Increased irritability
Immature behavior
Sleep disturbances
Emotional distress & crying
Fears of being alone
Physical complaints
Loss of skills – regression in toileting and language
Increased separation distress
Appleyard & Osofsky (2003)
Young Children
Re-experiencing of the traumatic event
Avoidance
Numbing of responsiveness
Increased arousal
Fear going to sleep to avoid nightmares
Restricted range of emotion in play
Serious, disorganized, somber
Appleyard & Osofsky (2003)
Access to early memories
22 children 8-10 year olds
Shown photos of preschool classmates
Unable to consciously identify the pictures
But pictures of children with whom they
were familiar elicited reliable skin
conductance responses
Early memories may remain even after
conscious recall disappears Vaughn & Bost (1999)
Memory of the trauma
First weeks of life

Infants can recognize stimulus cues associated
with trauma and show distress reactions
Three to four months

Recognition of trauma and distress can persist
for weeks to months
Six to twelve months

Internal representation of the trauma as seen
through play
Gaensbauer (2002)
The Case of Sara
Placed for adoption upon discharge
from the hospital
5 months of age legal adoption is not
completed
Sara enjoys a loving relationship with
her parents
The parent child relationship is marked
by reliable, emotionally attuned, and
responsive care
The Case of Sara
Allegations of neglect arise
Sara is removed from the home at the
age of 10 months
The Case of Sara
Shelter home for four days
Second foster home for one week
Third foster home for eight
weeks
Adoptive home
The Case of Sara
Upon arrival to the adoptive home Sara
stares blankly, refuses social
interaction, and is oblivious to pain
after undergoing a medical procedure
Believing that Sara is available for
adoption her name is changed
The Case of Sara
At the age of 15 months Sara is
responding well to her new
environment
First adoptive family hasn’t seen her
for 6 months and want her returned to
their care
The Case of Sara
Should she return?
Who are the “psychological” parents?
Does she remember her first adoptive
parents?
She’s so young that she won’t remember
anything and can be returned without
distress
Sara is a “resilient” child
The Case of Sara
The internal working model – viewing the
world through Sara’s eyes
Assessing “risk”
Could reunion reactivate feelings of loss?
Utilization of second adoptive parents as a
secure base
Impact of no contact
Factors Favoring
Sara’s Return
Sara is a “resilient” child and can weather
more moves.
Sara needs to return to be able to resolve her
grief
As she gets older, Sara will long to be with
her first adoptive family
Sara should not have been removed in the first
place
Factors Against
Sara’s Return
Length of time away from her first family
without any contact
Her name change has impacted her Internal
Working Model
She now views her new family as her only
family and calls her new parents “mama”
and “dada”
Factors Against
Sara’s Return
Sara clearly shows signs of a secure
attachment to her new parents
A return could, in fact, be viewed by Sara as
traumatizing and as being “ripped away”
from her family
Trauma could create a Reactive Attachment
Disorder
Factors Against the
Return of Sara
Comparing the future stability of the two
families
First family is struggling with high levels of
stress and their relationship has been negatively
impacted and, largely ignored
 Second family has, and will likely, withstand
stressors

Implications for
Caseworkers
Request relationship-based assessments
Understand children’s needs vs. parental
capacity for caregiving
Develop specific recommendations about
what behaviors the parent needs to develop
to successfully parent this particular child
Use of Supervised Visits
Used routinely but should be used for
extreme cases where abuse/neglect even
under supervision is of high risk
Need to find ways to allow for more contact
with parents in a more natural setting

Use of foster parents as peer parents
Therapeutic visits vs. supervised visits
Supervised Visits
Be mindful of the limits to interpretation of
the behaviors between the parent and child
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Playfulness does not equal attachment
Stress following the visit is natural and
should not necessarily be interpreted to
mean that visits are experienced negatively
by the child
Observation of Parent-Child
Relationship
Observe proximity seeking behaviors – watch eye
contact and social relatedness
Observe parental sensitivity and insightfulness to
child’s cues
Who does child seek out when frustrated or
frightened
Use doll play to assess attachment hierarchy
Assessment
Assess parental response to the trauma
Assess pre and post family functioning
Assess impact on attachment system
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Can child continue to utilize parent as a secure
base?
Availability of family support system
Intervention
Increase protection for highly anxious
children
Temporarily change sleeping arrangements
 Actively demonstrate safety
 Allow child to maintain closer proximity when
possible
 Decrease toileting demands on very young
children
 Increase use of transitional objects
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Intervention
Increase structure to manage acting out
behaviors
Remind children that rules haven’t changed
 Continue with consequences
 Increase communication and help child
understand their response to trauma
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Intervention
Limit access to television and radio
broadcasts
Increase reassurance
Maintain routines
Encourage parents to take care of their own
mental health needs
Intervention
Attempt, within limits of safety issues, to
maintain close contact between the children
and their primary caregiver