If you think about the many relationships that you have in your life and their importance to your happiness and well-being, you can start to gain a greater understanding of how much our attachments and attachment types influence our lives. For those who live with attachment disorders.
Attachment-based therapy encompasses some fairly new, and rather controversial, therapies for treating attachment disorders. Attachment disorders are serious conditions that affect children beginning at a young age. If left untreated, attachment disorders can affect individuals and their relationships for a lifetime.
John Bowlby and Mary Ainsworth were some of the early pioneers on attachment-based therapy. "A Review of General Psychology" survey (2002) ranked Bowlby as the 49th most-cited psychologist of the 20th century.
Research has given us some insight as to some dangerous methods of attachment-based therapy. More importantly, researchers continue to make progress in understanding the types of attachment-based therapies that are beginning to show promising results. However, it’s important to note that attachment-based therapy is still quite controversial, lacking substantial research, and can be dangerous depending on the exact approach used. For example, one attachment-based therapy technique called the rebirthing technique has been entirely banned in Colorado after a ten-year-old girl died due to suffocation. At the very least, significantly more research and understanding is needed before truly utilizing this attachment-based therapy methods.
To date, healing for attachment-based disorders focuses on understanding and strengthening the relationship between a child and his or her primary caregivers.
What Are Attachment Disorders?
Attachment disorders are psychiatric illnesses that develop in very young children as characterized by their inability or difficulty in emotionally attaching to others. The illness is nearly always due to infant or toddler severe neglect or abuse.
Children who lacked early primary caregivers such as those who lived in orphanages, residential centers, or those who had multiple foster care placements, especially where care was abusive or neglectful, often develop attachment disorders. Children who've experienced multiple traumatic losses may also develop attachment-based disorders and could potentially benefit from attachment-based therapy, but, again, more research is needed.
According to the American Academy of Child and Adolescent Psychiatry, symptoms of attachment-based disorders may appear within the first year of life and may persist or exacerbate as the child gets older. Symptoms include:
Attachment-based disorders can develop into Reactive Attachment Disorder or Disinhibited Social Engagement Disorder.
Reactive Attachment Disorder (RAD) is a brain disorder that develops when children have had negative experiences with adults during their early years, and their natural inclination is to disassociate with them. Children living with RAD don't naturally seek out a loving adult when they're stressed, upset, or feeling unregulated. This disorder is based on a child having little or no emotions when they interact with other children, their parents, or other adults. Children living with RAD experience intermittent and unusually strong emotions of unhappiness, irritability, depression, and fear without having the ability to comfort themselves. Chronic symptoms of severe emotional irregularity combined with a history of trauma indicate a diagnosis of RAD.
Attachment-based therapy is one of the most common forms of treatment for RAD. However, it may be beneficial to explore alternative therapeutic treatment paths, as attachment-based therapy for RAD can be rather extreme and is controversial. According to one study focusing on attachment-based therapy for RAD, it is believed that RAD is due to suppressed rage and can be treated through: “…prolonged restraint of the child and exposing the child to noxious stimuli (e.g., tickling, poking, tapping, yelling) until the child's attempts to escape the noxious stimuli have ceased. At that point, the child is given to the caregiver for attachment. Healthy attachment is thought to be able to occur at that point as the child's rage has been released throughout the restraining and noxious stimuli portion of treatment.”
A child who is overly friendly with strangers is indicative of Disinhibited Social Engagement Disorder. Such children aren't afraid of meeting people for the first time. They may walk up to them, talk to them, or even hug them. Very young children may be comfortable allowing strange adults to hold them and talk with them, feed them, and play with them.
When these children are put in a situation with strangers, they don't check with their parents or caregivers for assurance and are often willing to go away with someone they don't know at all. This disorder can also be treated by attachment-based therapy, but again, the practices require more research.
In their efforts to heal children from early trauma and attachment disorders, a handful of therapists devised and practiced holding therapy or rebirthing therapies as mentioned above. This was part of early methods of attachment-based therapy.
The premise behind holding therapy was that the way to heal children who weren't able to bond and attach to their parents or primary caregivers was for the caregiver to hold the child tightly so that they'd eventually become comfortable with the sense of touch and hugs.
Along the same lines, therapists developed "rebirthing" strategies based on concepts that were intended to simulate the process of being reborn. The concept was for the child to essentially go back in time and re-experience the feelings of warmth, care, and closeness that they should have received as infants and toddlers.
Both methods based on holding and rebirthing resulted in several child deaths. These practices were quickly banned by state legislatures and professional organizations such as the American Academy of Child and Adolescent Psychiatry, the American Professional Society on the Abuse of Children, the American Psychiatric Association, and the American Psychology Association. These organizations have all published warnings regarding these types of harmful treatments, which are no longer used in attachment-based therapy treatments.
Evidence Based Attachment Therapy
Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are serious clinical conditions, and their treatments are not yet well-researched.
What we do know is that individuals who are seeking effective treatment for these disorders need to request a comprehensive psychiatric assessment and individualized treatment plan for attachment-based therapy treatment by a qualified mental health professional.
The best attachment-based therapy treatments for children living with attachment-based disorders involves treating their parents and other family members as well because the premise behind the child's healing requires developing and strengthening relationships between the child and their parents and siblings. Parents should expect an ongoing collaboration between the family and the treatment team during attachment-based therapy to increase the likelihood of a successful outcome.
There are currently no evidence-based therapies for attachment-based disorders because researchers haven't yet had the time or funding for repeat studies or longitudinal studies. Based on information from the California Evidence-Based Clearing House for Child Welfare, the best we have at this time is two programs with a Scientific Rating of 3, which means they are categorized as Promising Research Evidence. Those programs are Child-Parent Relationship Therapy and Dyadic Developmental Psychotherapy (DDP). Let's take a closer look at each one of them.
Child-Parent Relationship Therapy (CPRT) is an attachment-based therapy that works best for children aged 3-8 who live with behavioral, social, and attachment disorders. This treatment is play-therapy based and is a systemic intervention that is based on attachment principles, Child-Centered Play Therapy (CCPT), and interpersonal neurobiology.
The central idea behind CPRT is that it's essential for a child's well-being to have a secure relationship with a primary caregiver. This is a two-part attachment-based therapy treatment through which children can learn to count on their parents to meet their basic life needs of love, acceptance, safety, security, food, and shelter. At the same time, parents learn skills that help them respond to their children in ways that establish or enhance feelings of secure attachment with their children. With this form of attachment-based therapy, parents learn how to respond to the child's needs as opposed to reacting to a child's symptoms. The goals of the attachment-based therapy treatment are to:
Therapists may work with children and their parents in a variety of settings including hospitals, clinics, schools, community centers, and the family's home. This form of attachment-based therapy is significantly less controversial than rebirthing or holding attachment-based therapy.
Dyadic Developmental Psychotherapy (DDP)
Dyadic Developmental Psychotherapy is an attachment-based therapy with a target population of families with children or adolescents aged 5-17. Children who live with attachment disorders and trauma who meet the DSM-V criteria for Reactive Attachment Disorder, trauma-related diagnoses, and those who meet the clinical criteria for Complex Trauma, which is also known as Developmental Trauma Disorder, are typically good candidates for DDP based treatment.
DDP is a type of attachment-based therapy that was designed to treat children who experienced neglect, abuse, and multiple home or foster care placements. The concept is that when a child's early experiences of attachment to their primary caregivers are abusive, neglectful, or inconsistent, they don't have the opportunity to experience the reciprocal, dyadic relationship that is necessary for healthy development. The benefit of a foster or adoptive home with healthy parenting styles may help a child to overcome past abusive or neglectful relationships by encouraging them to trust and engage with the new caregiver. The most traumatized children have greater difficulty in bonding with their new parents, and DDP can enhance their ability to accept being parented.
DDP is grounded in a foundation of playfulness, acceptance, curiosity, and empathy. DDP practices never involve coercion, threat, intimidation, or the use of power to force a child into submission and are instead based on healthy practices.
The goals of DDP for children include:
The goals of DDP for parents or primary caregivers are:
Three other programs are developing as attachment-based therapies. They are not rated at this time because not enough studies have been completed to consider them as evidence based. These attachment-based therapy techniques include:
In the quest to heal children from issues related to trauma and attachment, new attachment-based therapy methodologies have been emerging over the last decade. Evidence-based practices are emerging as trust-based, relationship-centered interventions which have not proven to be dangerous or harmful to children.
Frequently Asked Questions (FAQs):
What Are The Four Attachment Styles?
The main four attachment styles of attachment theory are: secure attachment, dismissive-avoidant attachment, anxious-preoccupied attachment, and fearful-avoidant attachment. Those who exhibit a secure adult attachment have a clinical securely attached style. Those with one of the other three types have what are known as insecure attachments. Those who are dismissive-avoidant may be aloof in relationships, and this can be caused by family relationships or early childhood. Additionally, those with an anxious-preoccupied attachment may indicate overthinking or consistently worrying about something in their relationship. Those who have a fearful-avoidant attachment are often reluctant to enter relationships and can appear aloof in family relationships as well.
What Is The Best Therapy For Attachment Disorders?
For children with an attachment disorder, as outlined by attachment theory, play therapy can be effective. This is where a child attends therapy with a caregiver and there is a focus on core elements of the relationships such as bonding and ensuring a child feels safe. For adults, individual sessions-based family therapy or group sessions can be beneficial. All these forms of therapy can help someone with an attachment disorder develop a secure base and adult attachment or childhood attachment that is healthy.
What Is The Attachment Cycle?
The attachment cycle outlined by attachment theory links the patterns of adult relationships to the early attachment relationships we have as children. Whether it is family relationships or relationships with friends, meaningful relationships as children can have a deep impact on a person’s autonomy and competency in the future. Attachment ruptures or insecure attachments that are developed as children can carry into adulthood and make establishing relationships difficult. An emotion-based family therapy ABFT training program can help those with an insecure attachment become securely attached.
What Are The Signs Of Attachment Disorder In Adults?
Some of the main signs of attachment disorder in adults are: difficulty reading emotions, resistance to affection, lack of showing emotion, low trust levels, difficulty maintaining relationships, emotional issues, and impulsivity. There are mental health therapy options available to those with attachment disorders, and family members or individuals living with this type of issue should seek out personal or emotional based family therapy ABFT for a possible solution. Therapy training can help a person establish a secure attachment style in a parent-child relationship, couple relationship, or friendly relationship.
What Does Insecure Attachment Look Like?
The main signs of insecure attachment can be depressed adolescents or the development of mental health challenges. Anxiety and frequent outbursts are also common, as are general erratic behaviors. This typically stems from a difficulty with or inability to see and understand the world or accurately process relationships around them. An insecure child relationship may exhibit more of these signs whereas an insecure adult relationship may have signs such as low trust levels, emotional issues, and a general lack of ability to maintain relationships. Find individuals or emotion-based family therapy ABFT to help improve mental health and a person’s attachment style. You may also consider attending an ABFT training program that can help a person develop key skills that can be used to establish and maintain healthier relationships.
What Are The Symptoms Of Attachment Disorder?
For children, the symptoms of attachment disorder are often: bullying or hurting others, failure to smile, intense bursts of anger, lack of eye contact, lack of fear of strangers, lack of affection, clinginess, and more. These symptoms often manifest in adults as a general inability to maintain a relationship or as serious emotional outbursts. They can also cause severe depression and anxiety, but there is therapy for depressed individuals that can help. Consider attending emotional based family therapy ABFT or personal therapy to learn more about attachment disorder and solve any problems this may be causing. During emotional based family therapy, there are a number of required fields and forms you will likely be asked to fill out that will give a therapist an indication as to the specific type of attachment disorder that may be present.
How Do You Fix Attachment Issues?
One of the best ways to overcome attachment issues is to get to know your attachment pattern by studying attachment theory. Going further, seeing an emotional-based family therapy practitioner or general therapist can help you start to recognize the common signs and symptoms of attachment issues, and can thus help you understand yourself better. This understanding through therapy can help a person apply lessons to their relationships and maintain meaningful connections. Emotion-based family therapy isn’t the only option, as there are many support groups available to those who exhibit the signs of attachment issues. At the end of the day, receiving help through family therapy, individual therapy, couples’ therapy, or another type is often the best way to effectively and healthily resolve attachment issues.