Considering Attachment in the Context of Adoption and Foster Care Douglas Goldsmith, Ph.D. Executive Director The Children’s Center

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

Understanding Attachment

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

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

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

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

Cooper, Hoffman, Marvin &Powell , 2000

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

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

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)

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

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

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

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)

Disorganized (D) Behavior lacks an observable goal Look fearful Behavior is bizarre May try to leave after the reunion or freeze

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

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)

Parenting Overanxious Parent – inhibits child’s exploratory behavior Child feels stifled or smothered Neglectful Parent – inhibits exploration by failing to provide secure base Child feels anxious or abandoned Holmes (1993)

Attachment Problems Bowlby 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

Attachment From the Child’s Point of View How do children view their parents? How do children learn to think about themselves as separate from their parents?

Internal Working Model Based on the child’s 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

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

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

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 – Rosie’s Kids

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

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

Parenting How do parent’s foster secure attachment? What should we look for when we observe parents?

Mothers of Secure Infants Continuously monitor the infant’s state Accurately interpret the signal for attention Act accordingly to meet the infant’s needs

Mother’s of Anxious Infants Monitor the infant’s state only sporadically Inconsistently notice the infant’s signals May interpret the signal inappropriately Respond to the signal inappropriately, or tardily

Ambivalently Attached Child Shows overt aggression toward the inconsistent mother “Don’t you dare do that again!” but has to cling because he knows from experience that she will. Holmes (1993)

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

John: Seventeen Months. For Nine Days in a. Nursery John: Seventeen Months For Nine Days in a Nursery James & Joyce Robertson

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

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

John – The Follow-up First Week Rejected his parents Won’t accept comfort or affection Won’t play Shuts self in room Cried a great deal Can’t cope with the slightest frustration Aggressive and destructive

Follow-Up Second Week Undemanding No tantrums Plays alone – quietly

Follow-Up Third Week Dramatic change Tantrums return Refuses food and loses weight Sleep is disrupted “Gulf” between parents and John

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

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.”

Attachment: The Parent’s Point of View How does the parent’s past impact attachment? How do we get in to the parent’s head?

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 child’s 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

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)

Reflective Function Allows the individual to make sense of his or her own and others’ psychological experience, to enter into another’s experience, to “read” another’s mind Allows the child to make others’ behavior meaningful and predictable, and permits him to respond adaptively Slade (1999)

Reflective Function The mother’s capacity to understand the child’s 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)

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)

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

Dyadic Patterns Marvin et al (2002) Insecure child – Dismissing Parent Both partners minimize intimate attachment-caregiving interactions Miscue – I’m really more interested in playing “Independence” is highly valued Overregulated affect, little emotional self-knowledge

Dyadic Patterns Marvin et al (2002) Insecure Child – Ambivalent/Preoccupied Parent Both partners minimize independent exploration Child is overly dependent on the parent Miscue – don’t explore, there really is something to be anxious about Under-regulated affect

Dyadic Patterns Marvin et al (2002) Insecure, Disordered Child Disorganized/ Insecure Parent Parent fears or becomes angry in response to child’s attachment behavior and abdicates caregiving Caregiver has unresolved trauma Role reversed relationship

Maternal Attributions Fixed beliefs that the mother has about the child – “beliefs that she perceives as objective, accurate perceptions of the child’s essence.” Lieberman (2000)

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)

Maternal Attributions: Protective 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)

Parental Insightfulness “Parental empathic understanding involves the capacity to see things from the child’s point of view within a balanced, accepting, and coherent frame.” Oppenheim (2000)

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

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)

Disengaged Lack emotional involvement Minimally attempt to understand what’s on their child’s mind Oppenheim (1999) Video

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?

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 Therapeutic visits vs. supervised visits

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

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 – 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?

Assessment of Parent’s 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 didn’t. What gives you the most joy in your relationship? What gives you the most pain? Where do you turn for emotional support? Steele (2003)

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

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 you’ll be available once the child is calm

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

Attachment Toolbox Developmentally appropriate expectations Managing parental stress Providing respite care

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

Educating Parents Parents need to understand children’s histories to be on alert for trauma reminders Be realistic about attachment issues but recognize parent’s ability to hear the concerns Encourage parents to seek treatment

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 life’s greatest privileges is just that – the experience of being held in someone’s mind.” Pawl (1995)