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1
Considering Attachment inthe Context of Adoption
and Foster Care

• Douglas Goldsmith, Ph.D.
• Executive Director
• The Childrens Center

2
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

3
Overview

• Attachment Theory
• Internal Working Models
• Reflective Functioning
• Insightfulness
• Application to Permanency
• The Attachment Toolbox

4
Understanding Attachment
5
Attachment

• Emotional bond with another person
• Behaviors promote proximity with one perceived as
  older, stronger, and wiser
• Motivational system to seek proximity
• Enhances feelings of security
• Motivates baby to take action when frightened

6
Attachment Theory

• 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 Im held I feel warm, safe, and comforted
• Results in a relaxed state so that one can,
  again, begin to explore
  
  Holmes (1993)

7
Attachment in Action

• Behaviors shown by careseeker and caregiver
• Aware of and seek each other out if careseeker is
  in danger due to physical separation, illness, or
  fright

8
Secure Attachment

• The caregiver is perceived as a reliable source
  of protection and comfort

9
Cooper, Hoffman, Marvin Powell , 2000
10
Attachment Classifications

• The strange situation
• Secure 65
• Avoidant 20
• Ambivalent 10
• Disorganized 5-10 (80 maltreated)

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Secure (B)

• Uses mother as secure base
• Signs of missing mother
• Actively greets with smile or gesture
• Signals or seeks contact if upset
• Once comforted resumes exploration
• Solomon George (1999) p.291

12
Secure Attachment

• Attachment is mediated by looking, hearing and
  holding the sight of my loved one lifts my
  soul, the sound of her approach awakes pleasant
  anticipation. To be held and to feel her skin
  against mine makes me feel warm, safe and
  comforted.
• 
  Holmes (1993)

13
Avoidant (A)

• Explores readily
• Little visible distress when left alone
• Upon reunion, looks away or actively avoids
• May stiffen or lean away if picked up
• Solomon George (1999) p. 291

14
Ambivalent (C)

• Distressed, fretful, passive
• Fails to explore
• Unsettled, distressed by separation
• Alternates bids for contact with signs of angry
  rejection
• Fails to find comfort from the parent
• Solomon George (1999) p.291

15
Insecure Attachment

• Intense love and dependency
• Fear of rejection
• Irritability
• Vigilance
• Punish their attachment figure for any sign of
  abandonment

16
Insecure Attachment

• The insecurely attached person is saying
• Cling as hard as you can to people
• they are likely to abandon you hang
• on to them and hurt them if they show
• signs of going away, then they may be
• less likely to do so.
• Holmes (1993)

17
Disorganized (D)

• Behavior lacks an observable goal
• Look fearful
• Behavior is bizarre
• May try to leave after the reunion or freeze

18
Attachment Behavioral System
Felt security, love, self-confidence
Attachment figure Near, responsive, attuned
Playful, smiling, Exploratory, sociable
Holmes (1993)
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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)

20
Parenting

• Overanxious Parent inhibits childs exploratory
  behavior
• Child feels stifled or smothered
• Neglectful Parent inhibits exploration by
  failing to provide secure base
• Child feels anxious or abandoned
• Holmes (1993)

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Attachment ProblemsBowlby

• A severely hurt child fails to seek comfort
• Signals that ordinarily activate attachment
  behavior fail to do so
• System controlling attachment, and the feelings
  and desires associated, is rendered incapable of
  being aroused

22
Attachment From the Childs Point of View

• How do children view their parents?
• How do children learn to think about themselves
  as separate from their parents?

23
Internal Working Model

• Based on the childs real-life experience of day
  to day interactions with his parents
• Reflects the images the parents have of the child
• Images communicated by how each parent treats the
  child and what each parent says to the child

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Impact of the Internal Working Model

• The model governs how children feel toward each
  parent and about themselves, how they expect to
  be treated and how they plan their own behavior
  toward their parent

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Securely Attached Child

• Internal Working Model
• Responsive, loving, reliable caregiver
• Self is worthy of love and attention
• 
  Holmes (1993)

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Insecurely Attached Child

• The world is dangerous
• Treat others with great caution
• Self is ineffective and unworthy of love
• These assumptions are stable and enduring and
  terribly difficult to modify
• 
  Holmes (1993)
• Video Rosies Kids

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Development of Relationships

• For a relationship between any two individuals
  to proceed harmoniously each must be aware of the
  others point-of-view, his goals, feelings, and
  intentions, and each must so adjust his own
  behavior that some alignment of goals is
  negotiated.

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Development of Relationships

• This requires that each should have reasonably
  accurate models of self and other which are
  regularly updated by free communication between
  them. It is here that the mothers of securely
  attached children excel, and those of the
  insecure are markedly deficient.
• Bowlby (1988) p. 131

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Parenting

• How do parents foster secure attachment?
• What should we look for when we observe parents?

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Mothers of Secure Infants

• Continuously monitor the infants state
• Accurately interpret the signal for attention
• Act accordingly to meet the infants needs

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Mothers of Anxious Infants

• Monitor the infants state only sporadically
• Inconsistently notice the infants signals
• May interpret the signal inappropriately
• Respond to the signal inappropriately, or tardily

32
Ambivalently Attached Child

• Shows overt aggression toward the inconsistent
  mother
• Dont you dare do that again! but has to cling
  because he knows from experience that she will.
• 
  Holmes (1993)

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Avoidant Child

• Outbursts of unprovoked aggression
• Needs to appease to the mother because the child
  wants so badly to feel close
• Fears shell rebuff him if needs are revealed too
  openly or if anger about abandonment is shown
  too openly
• 
  Holmes (1993)

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John Seventeen Months For Nine Days in a
Nursery James Joyce Robertson
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Phases of Response to Separation

• Protest
• Upset, confused, frightened by loss of mother
• Urgent desire to find mother
• Looks eagerly toward any sight, sound
• Despair
• Increasing hopelessness
• Less active, withdrawn, apathetic
• Decreases demands on environment

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Phases of Separation

• Despair may be misinterpreted by presuming that
  distress has decreased because the child is
  settling in
• Detachment
• Makes the best of the situation by repressing
  longing for mother
• When mother returns he hardly seems to know her
• May appear to not need any mothering at all

37
John The Follow-up

• First Week
• Rejected his parents
• Wont accept comfort or affection
• Wont play
• Shuts self in room
• Cried a great deal
• Cant cope with the slightest frustration
• Aggressive and destructive

38
Follow-Up

• Second Week
• Undemanding
• No tantrums
• Plays alone quietly

39
Follow-Up

• Third Week
• Dramatic change
• Tantrums return
• Refuses food and loses weight
• Sleep is disrupted
• Gulf between parents and John

40
Follow-Up

• One Month
• Relationship with mother improves
• Joyce visits and he regresses
• Refuses food and attention
• Three weeks later, second visit from Joyce
• Extreme disturbance for 5 days
• Includes aggression toward mother

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Follow-Up

• Three years after his stay in the residential
  nursery, when John was four and one half years
  old, he was a handsome, lively boy who gave much
  pleasure to his parents. But there were two
  marked features which troubled them. He was
  fearful of losing his mother and got upset if she
  was not where he thought she would be. And every
  few months he had bouts of provocative aggression
  against her which came out of the blue and lasted
  for several days.

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Attachment The Parents Point of View

• How does the parents past impact attachment?
• How do we get in to the parents head?

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Impact of Empathic Failure

• Whatever she fails to recognize in him he is
  likely to fail to recognize in himself. In this
  way, it is postulated, major parts of a childs
  developing personality can become split off from,
  that is, out of communication with, those parts
  of his personality that his mother recognizes and
  responds to, which in some cases include features
  of personality that she is attributing to him
  wrongly. Bowlby (1988) p.132

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Reflective Function

• The reflective function refers to the
  psychological processes underlying the capacity
  to mentalize. . . mentalizing refers to the
  capacity to perceive and understand oneself and
  others behavior in terms of mental states, i.e.,
  reflection.
• Fonagy, Steele, Steele Target (1997)

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Reflective Function

• Allows the individual to make sense of his or her
  own and others psychological experience, to
  enter into anothers experience, to read
  anothers mind
• Allows the child to make others behavior
  meaningful and predictable, and permits him to
  respond adaptively
• Slade (1999)

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Reflective Function

• The mothers capacity to understand the childs
  mental states create the context for a secure
  attachment relationship
• The mother is able to view the infant as
  intentional
• Reflective functioning provides protection
  against damaging effects of abuse and trauma
• Slade (1999)

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Reflective Function

• The capacity to tell a story that is affectively
  believable
• The capacity to understand emotional processes
• The ability to accurately understand ones own and
  others behavior
• Slade (2002)

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Dyadic Patterns Marvin et al (2002)

• Secure child Autonomous Parent
• Easily approach and interact when distressed
• The reunion calms the child and facilitates
  exploration
• Child can shift between exploration and using the
  parent as a safe harbor with little anxiety
• Close attunement disruptions easily repaired

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Dyadic Patterns Marvin et al (2002)

• Insecure child Dismissing Parent
• Both partners minimize intimate
  attachment-caregiving interactions
• Miscue Im really more interested in playing
• Independence is highly valued
• Overregulated affect, little emotional
  self-knowledge

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Dyadic Patterns Marvin et al (2002)

• Insecure Child
• Ambivalent/Preoccupied Parent
• Both partners minimize independent exploration
• Child is overly dependent on the parent
• Miscue dont explore, there really is something
  to be anxious about
• Under-regulated affect

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Dyadic Patterns Marvin et al (2002)

• Insecure, Disordered Child
• Disorganized/ Insecure Parent
• Parent fears or becomes angry in response to
  childs attachment behavior and abdicates
  caregiving
• Caregiver has unresolved trauma
• Role reversed relationship

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Maternal Attributions

• Fixed beliefs that the mother has about the child
  beliefs that she perceives as objective,
  accurate perceptions of the childs essence.
• Lieberman (2000)

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Positive Maternal Attributions

• When a mother sees her child as the cutest,
  most intelligent, most endearing being ever
  created, she is summoning from the depths of
  herself the capacity for ecstasy that allows her
  to put up with the inevitably annoying,
  exasperating, or simply tedious aspects of
  raising a child.
• Lieberman (2000)

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Maternal AttributionsProtective Function

• Child feels adored
• Allow child to cope with self-doubts and feelings
  of despair
• Allow parent to better tolerate self-sacrifices
  that are integral to the parenting process
• Lieberman (2000)

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Parental Insightfulness

• Parental empathic understanding involves the
  capacity to see things from the childs point of
  view within a balanced, accepting, and coherent
  frame.
• Oppenheim (2000)

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Balanced

• Able to see experiences through their childs
  eyes and make attempts to understand the
  underlying motives
• Talk openly about positive and negative aspects
• Oppenheim (1999)

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One-sided

• Preset conception of their child
• Difficulty staying focused on their child and
  their relationship with the child
• Talk about their own feelings/issues
• Oppenheim (1999)

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Disengaged

• Lack emotional involvement
• Minimally attempt to understand whats on their
  childs mind
• Oppenheim (1999)
• Video

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Foster Care and Permanency

• How does foster placement effect development?
• How do we assess relationships between the
  children and their biological as well as foster
  parents?
• How long in foster care is too long? When can
  children still go home?

62
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

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The Case of Sara

• Allegations of neglect arise
• Sara is removed from the home at the age of 10
  months

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The Case of Sara

• Shelter home for four days
• Second foster home for one week
• Third foster home for eight
• weeks
• Adoptive home

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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

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The Case of Sara

• At the age of 15 months Sara is responding well
  to her new environment
• First adoptive family hasnt seen her for 6
  months and want her returned to their care

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The Case of Sara

• Should she return?
• Who are the psychological parents?
• Does she remember her first adoptive parents?
• Shes so young that she wont remember anything
  and can be returned without distress
• Sara is a resilient child

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The Case of Sara

• The internal working model viewing the world
  through Saras eyes
• Assessing risk
• Could reunion reactivate feelings of loss?
• Utilization of second adoptive parents as a
  secure base
• Impact of no contact

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Factors Favoring Saras 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

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Factors Against Saras 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

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Factors Against Saras 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

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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

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Implications for Caseworkers

• Request relationship-based assessments
• Understand childrens needs vs. parental capacity
  for caregiving
• Develop specific recommendations about what
  behaviors the parent needs to develop to
  successfully parent this particular child

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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
• Therapeutic visits vs. supervised visits

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Supervised Visits

• Be mindful of the limits to interpretation of the
  behaviors between the parent and child
• 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

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Observation of Parent-Child Relationship

• Observe proximity seeking behaviors watch eye
  contact and social relatedness
• Observe parental sensitivity and insightfulness
  to childs cues
• Who does child seek out when frustrated or
  frightened
• Use doll play to assess attachment hierarchy

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Assessment Secure Base

• Over the past two weeks can you think of a time
  when your child was
• Hurt?
• Frightened?
• Separated from you?
• What did your child do?
• How did you respond?

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Assessment of Parents Point of View

• Interview questions
• Could you give me a thumbnail sketch of your
  child?
• Tell me about a time in the past two weeks when
  you and your child really clicked.
• Tell me about a time when you didnt.
• What gives you the most joy in your relationship?
• What gives you the most pain?
• Where do you turn for emotional support?
• Steele (2003)

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Attachment Toolbox

• Nurturing Relationships
• The Ideal Grandma
• Anticipating Needs
• Keeping the child in mind
• Reading and responding to cues
• Emotional Regulation
• Proximity to the child
• Reassurance
• Emotional repairs - Time In

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Time In

• Stay close by to help the child calm down
• Avoid processing until the child is calm
• If child becomes aggressive distance yourself
  while reassuring the child that youll be
  available once the child is calm

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Attachment Toolbox

• Managing anxiety
• Sleep Issues
• Appetite Issues
• Encourage checking-in behaviors
• Providing structure and consistency
• Protecting the child from trauma reminders
• Positive communication skills

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Attachment Toolbox

• Developmentally appropriate expectations
• Managing parental stress
• Providing respite care

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Treatment Options

• Obtain comprehensive, relationship-based
  assessments
• Supervised visits vs. Reunification treatment
• Parent-child therapy
• Individual therapy
• Shelter vs. Residential treatment

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Educating Parents

• Parents need to understand childrens histories
  to be on alert for trauma reminders
• Be realistic about attachment issues but
  recognize parents ability to hear the concerns
• Encourage parents to seek treatment

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Secure Base

• When a child is held in mind, the child feels
  it, and knows it. There is a sense of safety, of
  containment, and, most important, existence in
  that other, which has always seemed to me vital.
  . . It seems to me that one of lifes greatest
  privileges is just that the experience of being
  held in someones mind.
  Pawl (1995)