1. Considering Attachment in the Context of Adoption and Foster Care
Douglas Goldsmith, Ph.D.
Executive Director
The Children’s 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 I’m 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 %
Avoidant %
Ambivalent %
Disorganized % (80% maltreated)

11. 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)

19. 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 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)

21. 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

22. 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?

23. 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

24. 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

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

26. 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

27. 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.

28. 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

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

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

31. 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

32. 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)

33. 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)

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

35. 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

36. 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
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

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

41. 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.”

42. 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?

43. 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

44. 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)

45. 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)

46. 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)

47. 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)

50. 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

51. 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

52. 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

53. 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

54. 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)

55. 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)

56. 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)

57. 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)

58. 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)

59. 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)

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

61. 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

63. The Case of Sara Allegations of neglect arise
Sara is removed from the home at the age of 10 months

64. The Case of Sara Shelter home for four days
Second foster home for one week
Third foster home for eight
weeks
Adoptive home

65. 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

66. 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

67. 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

68. 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

69. 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

70. 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”

71. 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

72. 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

73. 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

74. 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

75. 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

76. 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

77. 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?

78. 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)

79. 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

80. 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

81. 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

82. Attachment Toolbox Developmentally appropriate expectations
Managing parental stress
Providing respite care

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

84. 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

85. 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)