Transcript Attachment Focused Family Therapy: Best Practices

Understanding Trauma Effects
On Children Session I and II
Lois A. Pessolano Ehrmann PhD, LPC, NCC
ATTACh Registered Clinician; Certified Attachment Focused Family Therapist
EMDR Certified Clinician and Approved Consultant & Certified IFS Therapist
ATTACh Board of Director
Founder and Executive Director of the Individual and Family CHOICES Program
State College, PA
Most Important Credential: Mom of a previously attachment challenged and traumatized child
Northeast Adoption Summit
WELCOME!!!!
Who are you?
Clinicians?
Parents?
Educators?
Advocates?
Double Duty?
Learning Objectives
As a result of finishing this training participants
will be able to:
1. Describe theoretical foundations and core
concepts related to childhood traumatic stress.
2. Discuss the impact of simple and complex
trauma on the developing brain.
3. Describe the impact of traumatic stress on a
child’s daily functioning.
The Tentative Schedule
Before the Break: Part I
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What is Trauma ?
Simple versus complex?
Hey what is your ACE number?
Child traumatic stress: Core Concepts and theoretical foundations
After the Break: Part II
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Trauma and the Brain: A sad and terrible mix
Trauma and daily functioning: Really NO Fun
Treatments that show promise!
What is Trauma?
Definitions- Trauma
Traumatic event- one in which a person
experiences, witnesses or is confronted with
threatened death, or serious injury, or threat to
the physical integrity of oneself or others.
Person’s response- intense fear, helplessness or
horror
Private versus Personal
From DSM-IV , Fourth Edition; American Psychiatric Association
The Expansion of the Definition
Experiences of threatened death
Witnesses of threatened death
Serious injury
Threat to the physical integrity of oneself or
others
ACE Study (Felitti et. Al., 1998)
Two Categories of Trauma
One-Episode Trauma (Type I post-traumatic stress disorder PTSD)
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Retain detailed memories
Intrusive recollections
Nightmares
Startle and vigilance
Why me?
Repeated Trauma (Type II post-traumatic stress disorder PTSD)
– All of the above plus
– repeated trauma occurs in children who have been abused often and for a long time.
common in children who have been reared in violent neighborhoods or war zones
– witness violence in the home or in their communities
– sickening anticipation and dread of another episode. After being repeatedly confusing
combination of feelings, at times angry and sad, at others fearful
– appear detached and seem to have no feelings (emotional numbness)
Let’s Make it even MORE Complex!
What is Complex Trauma?
• Also called developmental trauma
• Involves multiple traumatic experiences
• Defining factor is chronic early maltreatment
within a caregiving relationship
Complex Trauma:
Where Trauma and Attachment
Collide
Trauma is perpetrated by the child’s caregiver so
Maltreatment itself
+
Loss of caregiver as safe base
+
Overwhelming distress with which the child must
cope and navigate developmental challenges
mostly alone
Maltreatment by Primary Caregiver
• Results in amplified damage that is pervasive
• Erosion and damage of the child’s normal
developmental pathways
• Places individual at risk for chronic and
recurrent anxiety
• Breaks down fundamental psychobiological
development in the body, healthy identity,
coherent personality secure attachment
• Disturbed relationships
Complex Trauma Impairs 7 Domains
Attachment
Biology
Emotional regulation
Behavioral regulation
Defenses
Cognition
Self concept
And Let Us NOT Forget SIT…..
Children and Trauma Often Misdiagnosed
Child’s Age
Internalizing Behaviors
Externalizing Behaviors
Five years and
younger
Fear of separation from mother or primary caretaker;
excessive clinging; crying, whimpering, trembling;
frightened facial expression; immobility;
Regressive behaviors such as thumb sucking, bedwetting
and fear of the dark
Screaming; aimless motion
6-11 years old
Extreme withdrawal; emotional numbing or flat affect;
somatic complaints; symptoms of depression and anxiety;
guilt; inability to pay attention; other regressive behaviors
including sleep problems and nightmares
Irritability; outbursts of anger
and fighting; school refusal
12-17 years old
Emotional numbing; avoidance of stimuli; flashbacks and
nightmares; confusion; depression; withdrawal and
isolation; somatic complaints; sleep disturbances;
withdrawal and isolation; somatic complaints; sleep
disturbances, academic or vocational decline; suicidal
thoughts; guilt; revenge fantasies
Interpersonal conflicts;
aggressive responses; school
refusal or avoidance; substance
abuse; antisocial behavior
From: Responding to Childhood
Trauma: The Promise and
Practice of Trauma Informed
Care
Gordon R. Hodas MD (2006)
The Misdiagnosis of Trauma in
Children
ADHD/ADD
Bipolar Disorder
Schizophrenia
Generalized anxiety disorder
Depression
Elective Mutism
Intermittent explosive disorder
ODD
RAD
Enuresis/encopresis
Eating Disorders
Stereotypic movement disorder
Still Expanding the Definition…
ACE Study (Felitti et. Al., 1998)
http://www.cdc.gov/ace/outcomes.htm
What is Your ACE Score???
Family Centered
Practice,
June 8,
2007
Regional
Child Abuse
Prevention
Councils 2011
The ACE Score
In your family of origin have you experienced
any of the following? If so give yourself 1 point
for each one.
•Recurrent physical abuse
•Recurrent emotional abuse
•Contact sexual abuse
•An alcohol and/or drug abuser in the household
•An incarcerated household member
•Someone who is chronically depressed, mentally ill,
institutionalized, or suicidal
•Mother is treated violently
•One or no parents
•Emotional or physical neglect
The Important Implications of
The ACE Study
http://www.azpbs.org/strongkids/
Adverse Childhood Experiences
vs. Smoking as an Adult
20
18
16
14
12
10
8
6
4
2
0
0
1
2
3
4-5
6 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
Adverse Childhood Experiences
vs. Adult Alcoholism
18
16
% Alcoholic
14
12
10
8
6
4
2
0
0
1
2
3
>=4
ACE Score
Regional Child Abuse Prevention Councils 2011
ACE Score vs.
Intravenous Drug Use
% Have Injected Drugs
3.5
3
2.5
2
1.5
1
0.5
0
0
1
2
3
4 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
Adverse Childhood Experiences vs.
Likelihood of > 50 Sexual Partners
Adjusted Odds Ratio
4
3
2
1
0
0
1
2
3
4 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
% have Unintended PG, or AB
ACE Score vs. Unintended
Pregnancy or Elective Abortion
80
Unintended Pregnancy
70
Elective Abortion
60
50
40
30
20
10
0
0
1
2
3
4 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
% With a Lifetime History of
Depression
Childhood Experiences
Underlie Chronic Depression
80
70
60
50
40
30
20
10
0
Women
Men
0
1
2
3
>=4
ACE Score
Regional Child Abuse Prevention Councils 2011
Childhood Experiences
Underlie Later Suicide
25
% Attempting Suicide
20
15
10
5
0
0
1
2
3
>=4
ACE Score
Regional Child Abuse Prevention Councils 2011
% with Job Problems
ACE Score vs.
Serious Job Problems
18
16
14
12
10
8
6
4
2
0
0
1
2
3
4 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
Again Expanding the Definition of
Trauma
Untreated Trauma linked to negative outcomes (Mueser et. al., 2002)
Trauma survivors are at risk (Felitti et. al., 1998)
Between 51% and 98% of public mental health clients diagnosed with
severe mental illness have trauma histories. (Mueser et. al., 1998)
Trauma linked to social, emotional, economic costs and cognitive
impairments, disease, disability, serious social problems and
premature death (Center for Substance Abuse Treatment, 2000).
In children trauma may be incorrectly diagnosed (Shonkoff, 2000;
Cook, Blaustein, & van der Kolk, 2003).
Common Observations by Adults of Children
who have Experienced Maltreatment
(Hodas, 2006) page 26
“A casual adult observer, unfamiliar with maltreatment and its
potential effects, might obtain a highly skewed impression of a child
so affected.”
Many of the following characteristics apply to both males and
females, but tend to be more extreme in males:
Guarded, defensive, and angry behavior; Difficult to redirect, and
dismisses support.
High degree of reactivity.
Behaviors may be extremely inappropriate and offensive.
Slow recovery and holds onto grievances
Common Observations by Adults of Children
who have Experienced Maltreatment
(Hodas, 2006) page 26 Continued
Blames others or minimizing the event
Oppositional and disruptive “on purpose”.
Overly sexualized behaviors and a lack of
interpersonal and physical boundaries.
Social withdrawal and lack of response to adult efforts
at engagement.
Common Cognitions & Beliefs of Children (and
Adults) Who have Experienced Trauma – Page 27
“The world is threatening and bewildering.”
“The World is punitive, judgmental, humiliating and
blaming.”
“Control is external, not internal and therefore I don’t have
control over my life.”
“People are unpredictable. Very few are to be trusted.”
“When challenged, I must defend myself- my honor and my
self-respect. Above all else I must defend my honor-at any
price.”
“If I admit a mistake, things will be worse than if I don’t.”
Overview of Attachment Theory
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Common Language
Attachment
“the deep and enduring connection established
between a child and caregiver in the first several
years of life. This connection profoundly influences
every component of the human condition- mind,
body, emotions, relationships and values.”
From: Attachment Trauma and Healing: Understanding and Treating
Attachment Disorder in Children and Their Families
by Terry Levy and Michael Orlans
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Founders of Attachment Theory
First Wave
John Bowlby
Mary Ainsworth
Second Wave
Mary Main
Sroufe
Trevarthen
Tronick
Others
34
Recent Influences in Attachment Theory and
Therapy Kicked it up a Notch or Two
Trauma researchers and clinicians
Schore
Perry
Van der Kolk
Neurobiological Focus
Siegel
Emotion Focused Therapy out of Canada
Leslie Greenberg & Susan Johnson
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Bonding
Focuses on caregiver rather then the child.
child attaches to a parent but a caregiver bonds to the
infant.
Related to choices a caregiver makes in order to bring
the caregiver/ child relationship into attunement.
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Conscience
Development of an internally modulated sense
of caring about what happens to others, the
world and the self.
This sense of caring helps the individual to
decipher right from wrong.
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Internal Working Model
The template or blue print that a person
develops internally about him or her self, other
people, and the world in general.
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Why is Attachment so Important to the
Development of a Healthy Individual ?
1. Basic Trust and Relationship Reciprocity
2. A Secure Base
3. Formation of an Identity
4. Self Regulation Ability
5. Pro-social Moral Framework
6. Positive Internal Working Model
7. Defense against Stress and Trauma
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The Context in Which Attachment and
Bonding Occurs
• Touch
• Smile and Positive
Affect
• Eye Contact
• Need Fulfillment
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The Healthy Attachment/ Bonding Cycle
Attachment occurs between the infant and caregiver within the context of the baby’s
needs. When they are met most of the time, trust in relationships and attachment occurs.
4th TRUST- Baby
develops trust from
having needs met
1st-NEED-
The Baby is
hungry/wet/scared
and needs touch,
food, comfort etc.
3rd-GRATIFICATION
Baby’s needs are met
through being fed held
comforted
2nd-AROUSALBaby is angry,
crying or upset
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What Happens when the Healthy Attachment
Bonding Cycle is Broken
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Intersubjectivity
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Refers to those moments when the parent and child
are in synch with each other.
Both child and parent or caregiver are affectively
(emotionally) and cognitively (thoughts) present to
each other.
Vitality of their affective states are matched and
their cognitive focus is on the same event or object.
Affect is being co-regulated and within the dyad
parent and child are co-creating meaning.
Attachment Focused Family Therapy by Dan Hughes
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The Brain….What is
Happening in there?
What is Happening in the Brain
The Harlow Monkey Studies
Neglect as far worse then abuse
Van der Kolk and Perry: Trauma is stored/ stuck
in the right hemisphere
Amygdala issues
The reason for the stuckness is
underdevelopment/ Trauma and
Learning Disabilities
Overstimulated Stress Response
Cortex Damage
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On Line 3-D Images of the Brain
http://www.g2conline.org/2022
The Harlow Monkey Studies
Experiments in the 1960s with Rhesus Monkeys
Cloth mothers or wire mothers with food
Role of the mother as a secure base
The babies had behavior problems
Clinging desperately/trauma bonded
Freeze flight fight
Motherless monkeys
Love at Goon Park: Harry Harlow and the Science
of Affection (2002) by Deborah Blum
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Effects of Abuse and Neglect on the Brain
Neglect has been found to be far more a factor for
attachment disorder then abuse.
Bessel Van Der Kolk and Bruce Perry did Pet Scans
on the brains of various children and adults. The
following findings were documented:
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The Brains of Two
Three Year old Children
Regional Child Abuse Prevention Councils 2011
Trauma Storage in Integration
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Amygdala Issues
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Trauma and Learning Disabilities
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Is it Neurological Immaturity &/or
Neurological Impairment
• attachment disorders who have neurological
immaturity
• neurologically impaired children who look
attachment disordered but….are they really???
• neurologically impaired children that do also
have a legitimate attachment disorder too!!
• Neurologically impaired children
– have primary process thinking and cognitive
distortions.
– don’t move to preoperational thinking
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Overstimulated Stress Response
Systems
Excess Cortisol
Results in abnormal brain development
Impairs the immune system and sets up circuitry for
psychosomatic disorders
Kills neurons in the Limbic System of the Brain
Reduces post-natal growth and produces functional
impairments of the process of directing emotions into
adaptive channels
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Cortex Damage
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Underlying Neurobiological Processes
related to Trauma Exposure
• Acute Trauma shocks a person’s neurological
system and creates a fear response
• Complex physiological systems and multiple
brain structures are affected via chemical
activations and feedback loops
• Active Response: Fight or Flight
• Passive Response: Surrender or Freeze
Response
Underlying Neurobiological Processes related
to Trauma Exposure-Continued
HPA Axis
Brain stem; amygdala (limbic system);
hippocampus; prefrontal cortex; vermis of the
cerebellum, corpus collosum and cerebral
cortex
Cortisol
Traumatic Stress and Daily
Functioning of a Child
Infancy
Still Face
http://www.youtube.com/watch?v=apzXGEbZht0
Toddlerhood
Possible effects of maltreatment overlap through
the developmental stages and can be seen well
into adulthood such as:
• Chronic malnutrition: growth retardation, brain
damage, possibly mental retardation
• Head injury and shaking: skull fracture, mental
retardation, cerebral palsy, paralysis, coma,
death, blindness, deafness
• Internal organ injuries
• Chronic illness from medical neglect
Preschool
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Speech delays: May not use language to communicate
Insecure or disorganized attachment: overly clingy, lack of
discrimination of significant people, can’t use parent as source of
comfort
Passive, withdrawn, apathetic, unresponsive to others
Frozen watchfulness, fearful, anxious, depressed
Feel they are “bad”
Poor muscle tone, motor coordination
Poor pronunciation, incomplete sentences
Cognitive delays; inability to concentrate
Cannot play cooperatively; lack curiosity, absent imaginative and
fantasy play
Social immaturity: unable to share or negotiate with peers;
overly bossy, aggressive, competitive
Underweight from malnourishment; small stature
Excessively fearful, anxious, night terrors
Reminders of traumatic experiences may trigger severe anxiety,
aggression, preoccupation
Early Childhood (Ages 5-7)
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Lack of impulse control, little ability to delay gratification
Exaggerated response (trantrums, aggression) to even mild stressors
Poor self-esteem, confidence: absence of initiative
Blame self for abuse or placement
Physical injuries, sickly, untreated illnesses
Enuresis, encopresis, self-stimulating behavior-rocking, head-banging
Poor social/academic adjustment in school: preoccupied, easily
frustrated, emotional outbursts, difficulty concentrating, can be overly
reliant on teachers; academic challenges are threatening, cause anxiety.
Extremes of emotions, emotional numbing
Act out frustration, anger anxiety with hitting, biting, fighting, lying,
stealing, breaking objects, verbal outbursts, swearing
Extreme reactions to perceived danger (fight, flight or freeze)
May be mistrustful of adults, or overly solicitous, manipulative
May speak in unrealistically glowing terms about his parents
Difficulties in peer relationships, feel inadequate around peers, overcontrolling
Unable to initiate, participate in, or complete activities, gives up quickly
Role reversal to please parents, and take care of parent and/or younger
siblings.
Elementary/Middle Childhood (Ages 8-10)
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Brief and usually limited denial and emotional numbness.
Try to stop thinking of the traumatic experience
In repeated trauma a type of self-hypnosis (dissociation) that enables them to
deaden, at least in their minds, the pain
Emotional distancing as a frequent coping mechanism
Rage as anger festers, occasionally exploding as tantrums and violent behavior
Rage turned within, engaging in self-mutilating and self-endangering behavior,
or by making physically damaging suicidal gestures
Anger outward through aggressive or delinquent behavior
Identification with the aggressor by turning the rage toward other children,
victimizing and humiliating them
Children may also experience aggression as dangerous so behavior may
become extremely passive resulting in victimization.
Holding tenaciously to the specific memory of the trauma may be an effort to
master the experience
Developing a belief in omens – attaching meanings to unrelated occurrences
Unresolved mourning, and continuing grief interferes with the ability to move
on with life.
Feelings guilt, shame, self-revulsion, or rage
Late Childhood/Pre-adolescense (Ages 10-11)
• Lag behind peers in all developmental areas
• Cognitively looks like ADHD symptoms such
as lack of concentration and disorganization
• Can especially be seen in emotional and
psychosocial functioning
• View clips of B. showing:
– Regression to where trauma occurred
– Evidence of unhealthy internal working model
Middle School (Ages 11-13)
• A sense of responsibility or guilt for the bad things
that have happened
• Feelings of shame or embarrassment
• Feelings of helplessness
• changes in how they think about the world
• Loss of faith
• Problems in relationships including peers, family, and
teachers
• Obsessive retelling of the single episode trauma
• Sleep disturbances
• Difficulty concentrating or focusing in the classroom
• Conduct problems
Adolescence (Ages 14-21)
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Anxiety, depression, and/or anger
Cognitive distortions
Posttraumatic stress
Dissociation
Identity disturbance
Affect dysregulation
Interpersonal problems
Substance abuse
Self-mutilation
Bingeing and purging (bulimia)
Unsafe or dysfunctional sexual behavior
Somatization
Aggression
Suicidality
Personality disorder
From: Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): A
Guide for the Treatment of Multiply-Traumatized Youth by John Briere,
Ph.D. and Cheryl Lanktree, Ph.D; MCAVIC-USC Child and Adolescent Trauma
Program;National Child Traumatic Stress Network;Final draft, August 2008
Best Practices of
Trauma Informed Treatment
Trauma, Brain and Relationship: Helping
Children Heal, You Make the Difference
http://youtu.be/RYj7YYHmbQs
Prenatal Development
• Providing a safe haven of a “good womb”
experience can be done through monitoring
your stress, using sensation-focused
mindfulness to alleviate the accumulation of
stress, giving you and your baby an
opportunity for deep relaxation and rest.
• Eating a healthy diet, sleeping well and light
exercise daily
• Reading, talking, singing to your baby
Child Birth
Birth as nature intended-good health, emotional
support and a tranquil environment with privacy
from strangers
Infancy
• Healthy infant development is all about attunement or
the careful “tuning in” to the baby’s needs.
• Talk to your infant directly and wait for their
response.
• Babies need quiet, softness, appropriate stimulation,
gentle rocking, cuddling, eye contact, calmness,
soothing voices, and music, tranquility, swaddling, and
firm support (especially for the neck.)
• They also need warmth, skin contact, snuggling,
molding into their caregiver’s body. They need an easy
pace and the environment to be arranged to help
them repair any traumatic experiences.
• Biodynamic cranial sacral therapy
Toddlerhood
• Play therapy-helping children express
their concerns in their native
language=play.
• Providing the opportunity to try
things out and master skills need to
overcome traumatic situations
• EMDR
• Attachment-focused family therapy
Preschool
• PCIT- Parent Child Interaction Therapy
• Dyadic Developmental Psychotherapy (DDP)
and other safe Attachment Focused Therapy
• Prescriptive Play Therapy
• Trauma Narratives
• EMDR
• Begin a basic IFS (Internal Family Systems)
understanding
Early Childhood (Ages 5-7)
• Prescriptive Play Therapy
• PCIT
• Dyadic Developmental Psychotherapy (DDP)
and other Attachment Focused Family Therapy
• Trauma Narratives with more of a focus on Art
therapy
• Sand Trays
• EMDR
• IFS using toys & symbols to physically represent
parts.
Children Ages 8-10
(Middle and Late Childhood)
Play Therapy
Art Therapy
Internal Family
Systems
DDP and
Attachment Focused
Family Therapy
EMDR
Neurofeedback
Cranial Sacral Therapy
Excellent FREE Resource for Trauma
Work with Adolescents
Integrative Treatment of Complex Trauma for
Adolescents (ITCT-A): A Guide for the
Treatment of Multiply-Traumatized Youth
John Briere, Ph.D. and Cheryl Lanktree, Ph.D;
MCAVIC-USC Child and Adolescent Trauma
Program;National Child Traumatic Stress
Network; August 2008
www.JohnBriere.com
Middle School &
Adolescence
(Ages 11-21)
Individual Psychotherapy
DDP & Attachment Focused
Family Therapy
Internal Family Systems
– Video clip of B. and his family reworking a traumatic memory
Trauma-Focused CBT (TF-CBT)
Psychological first aid/crisis management
Mindfulness/Meditation Strategies
Eye movement desensitization and reprocessing (EMDR)
– Video clip of B’s mother in the Resource Development phase of
EMDR Processing
Play therapy
Neurofeedback
Required Qualities of the Therapist in Individual
Psychotherapy with Traumatized Youths
Nonintrusiveness
Visible positive regard
Reliability and stability
Transparency
Demarking the limits of confidentiality
Visible willingness to understand and accept
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Attunement
Empathy
Acceptance;
Understanding
Curiosity about the client’s perspective and internal experience
Active relatedness (including emotional connection)
Patience
From: Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): A
Guide for the Treatment of Multiply-Traumatized Youth by John Briere,
Ph.D. and Cheryl Lanktree, Ph.D; MCAVIC-USC Child and Adolescent Trauma
Program;National Child Traumatic Stress Network;Final draft, August 2008
Preventing Vicarious Trauma in the Helper
• Self-care cannot be over emphasized when
working with trauma. We hear, witness and
feel many of our child clients’ painful and
traumatic memories.
• Developing a wellness plan
• How do you let go?
• How do you transition from work?
• What to do with those emotionally intense
cases?
References and Websites
In addition to the references and websites already identified in the slides the following informed this presentation:
The National Child Traumatic Stress Network http://www.nctsnet.org/
Bradenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York: W.W. Norton & Company.
Chaffin, M., Silovsky, J., Funderburk, B., Valle, L., Brestan, E., Balachova, T., Jackson, S., Lensgraf, J., &Bonner, B. (2004). Parent-child interaction therapy with physically
abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72(3), 500-510.
De Bellis, M.D. (2005). The psychobiology of neglect. Child Maltreatment, 10(2), 150-172.
De Wolff, M., & van IJzendoorn, M. (1997). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68(4), 571-591.
Dozier, M., Stovall, K.C., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72(5), 1467-1477.
Dunber, A., Motta, R. (1999). Sexually and physically abused foster care children and posttraumatic stress disorder. Journal of Consulting and Clinical
Psychology,67(3), 367-373.
Hodas, Gordon, R. (2006). Responding to childhood trauma: The promise and practice of trauma informed care. Harrisburg, PA: Pennsylvania Office of Mental Health and
Substance Abuse Services.
Jennings, A. (2004). Models for developing trauma-informed behavioral health systems and trauma-specific services. National Association of State Mental Health Program
Directors (NASMHPD). Washington DC: National Technical Assistance Center.
Shapiro, R. (2010). The Trauma treatment handbook: Protocols across the spectrum. New York: W. W. Norton and Company.
Seigal, D. (1999). The developing mind. NY: Guildford Press.
Siegal, D. (2007). The mindful brain: Reflection and attunement in the cultivation of well-being. NY: W.W. Norton & Co.
Sroufe, L., Egeland, B., Carlson, E., Collins, A. (2005). The Development of the Person: The Minnesota study of risk and adaptation from birth to
adulthood. New York: Guilford Press.
Witness Justice (from Internet May 2009) Trauma: The “common denominator”. Frederick, MD.
Attachment Bibliography
Ainsworth, M. (1969). Object relations, dependency, and attachment: A theoretical review of the infant-mother relationship. Child
Development, 40(4), 969-1025.
Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, N.J.: Earlbaum.
Barnett, D., & Vondra, J. (1999). I. Atypical patterns of early attachment: Theory, research and current directions. Monographs of the
Society for Research in Child Development, 64(3), 1-25.
Bird, G., Peterson, R., & Miller, S. (2002). Factors associated with distress among support-seeking adoptive parents. Family Relations,
51(3), 215-220.
Bowlby, J. (1969). Attachment and loss volume 1: Attachment (2nd Edition). New York: Basic Books.
Chaffin, M., Silovsky, J., Funderburk, B., Valle, L., Brestan, E., Balachova, T., Jackson, S., Lensgraf, J., & Bonner, B. (2004). Parent-child
interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and
Clinical Psychology, 72(3), 500-510.
De Bellis, M.D. (2005). The psychobiology of neglect. Child Maltreatment, 10(2), 150-172.
De Wolff, M., & van IJzendoorn, M. (1997). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment.
Child Development, 68(4), 571-591.
Dozier, M., Stovall, K.C., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child
Development, 72(5), 1467-1477.
Dunber, A., Motta, R. (1999). Sexually and physically abused foster care children and posttraumatic stress disorder. Journal of Consulting
and Clinical Psychology,67(3), 367-373.
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Books for Clinicians on Attachment Therapy
The ATTACh books:
• Hope for Healing: A Parent’s Guide to Trauma and
Attachment;
• The Attachment Therapy Companion: Key Practices
for Treating Children and Families
All books written by Dan Hughes
All books written by Art Becker Weidman
All books written by Greg Keck and Regina Kupecky
All books written by Daniel Siegel and Alan Schore
Bonnie Bradenoch’s book: Being a Brain-Wise Therapist
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