Attachment Disorders: Do You Really Need an Expert?
Hindsight: They say it's 20-20. They don't tell you how much it sucks. . .
So, this professional blog is going to turn confessional today. You've been warned!
Before I started my own practice, I worked with a lot of children in crisis. For the most part, I was a rockstar with troubled kids and families. But there were always those few cases, usually kids who had suffered profound, ongoing relational trauma and neglect, where all my training fell short. These were kids who, looking back, probably had some serious dysfunction in their attachments.
I did the usual stuff with these kids. I did the Trauma-Focused Cognitive Behavioral Therapy. I taught all the right "coping skills." We created trauma narratives and homemade stress balls. I worked within the "language of the child" by playing with toys, making art projects, and reading picture books. Together with parents and teachers, we created firm boundaries and structure for the child at home, school, and daycare. We set up meaningful, personalized reward systems. We were painstakingly consistent and unbelievably warm.
And with the majority of the kids I helped, this stuff was working. But with these few kids, none of it worked. I had been introduced to the very vague concept of "attachment problems" in grad school, but I thought that what I learned didn't apply to my clients. It certainly couldn't apply to me.
I thought "I have a world-class education." I thought, "I could attach to a rock! No attachment problem is any match for me!" In short, I lacked humility. And I lacked specialized training.
If you are a child therapist like me, you need to know that some of the tricks in your bag are meaningless when it comes to treating true problems with attachment. The reason for this is quite simple: most models of treatment require the child to have enough of an ability to trust another person, in order to trust you. Children with a history of profound trauma and neglect often do not know how to trust others on even a very, very basic level.
Also, many models of child therapy require the ability to use symbolism, to act out internal struggles via play, or to think abstractly. Children with histories of profound trauma and neglect often do not have a refined ability to do any of those things. Imagine using non-directive play therapy with an infant. Pretty silly right? On a social-emotional level, many of these children are too young for traditional play therapy or talk therapy to be appropriate.
Then there are the behavioral approaches, in which you are coaching parents to use time-outs, sticker charts and the like. Those also rarely work in the long term, since behavioral approaches require the child to have some level of desire to please the adult. Children who are terrified of relationships are often deliberately trying to do anything and everything to drive their caregivers away. So setting up a sticker chart is almost like giving them a roadmap of how to further hurt, disappoint, and reject their parents.
No. "Treatment as usual" rarely works for these kinds of severely traumatized children.
The case that finally got me to go get the training I needed? I worked with a child several times a week, for 7 months without much improvement. I fell in love with this child and knew in my heart that what I was doing wasn't working. Coincidentally, the Theraplay® Institute was offering a 4-day Level 1 training in Raleigh, so I drove across the state, dipped into my savings, and took the days off work. When I got back from the training, I was ready to try something drastically different.
Instead of talking about her choices or creating new consequence and reward charts, we engaged on an emotional, right-brained, nonverbal level. I delighted in her. I sang to her, I rocked her, I counted her perfect little fingers and toes, I put bandaids on her hurts, I laughed with her. She cried with me.
Within 5 sessions, I was seeing major breakthroughs! Suddenly this child who had been pure charm, telling me only what I wanted to hear, was showing me her deepest fears. Emotionally we were truly connecting. Whereas before, she was too afraid to show me her worst behaviors, now that trust was building, she began testing out the safety of our attachment: lying to me, stealing from me, yelling at me, biting me, scratching me, calling me horrible names, hitting and kicking me. Finally I could see what Mom saw and experienced with her little girl. Finally I could help.
And help I did! The enormity of the changes I saw over the next 4 months were astonishing. Listening improved, behavior improved, relationships improved. This little girl went from only playing by herself, digging in the dirt at recess, to playing collaboratively with other children, even making friends. This little girl went from hugging strangers and sexualizing her peers, to showing up with clear, healthy touch boundaries and preferential attachment to just a couple special caregivers.
It was a wonderful feeling at the time, but looking back, this family shouldn't have had to wait 7 months to see improvements. During those 7 months (not to mention the 5+ years of treatment before I got involved!), the problems this family was experiencing were only being compounded and reinforced. The parents' sense of hopelessness, shame, and alienation was being rubbed in, like salt to a wound. Then there was this child's feeling of being in constant danger, defective, unlovable somehow. . . the behaviors that were devolving and worsening and becoming more dangerous as time went on. . .
My lack of training- and my pride- contributed to that process. Looking back, that's what I regret the most.
The flip-side of this regret? Deep gratitude to this family for delivering me to my passion. Deep humility in the face of complex trauma and attachment wounding. And a deep desire to educate others about Theraplay! This stuff works!
Learn more about Theraplay by checking out my blog "How Relational Play Therapy Heals Children." Get your specific questions about Theraplay and attachment issues answered HERE.