1. ©2008 National Association of Social Workers. All Rights Reserved. 1 HIV/AID’S and Orphaned and Vulnerable Children: Consideration from an Attachment Perspective Tracey Cardello, LCSW Psychotherapist Hicksville, NY, USA Johannesburg, South Africa Wednesday, October 15, 2008

2. ©2008 National Association of Social Workers. All Rights Reserved. 2 Overview of Attachment Theory Observed 1 st by John Bowlby late 1930’s “Strange Situation” observations 1 st conducted by Mary Ainsworth Mary Main bridges the gap from children to adult with the “Adult Attachment Interview” Peter Fonagy studies PTSD and Intergenerational transmission of attachment with Holocaust survivors Mark Tomlinson studies attachment in South Africa.

3. ©2008 National Association of Social Workers. All Rights Reserved. 3 Attachment Theory Humanistic way of understanding development which fits nicely “over” other treatment methods Sensitive to the role of the environment in child development Tested and replicated in a variety of populations and settings Predicts infant vulnerability and aims toward prevention

4. ©2008 National Association of Social Workers. All Rights Reserved. 4

5. ©2008 National Association of Social Workers. All Rights Reserved. 5 What is the Function of Secure Attachment? 1. Biological 2. Developmental 3. Repair / Restore

6. ©2008 National Association of Social Workers. All Rights Reserved. 6 Biological In the face of danger or stress the system is activated to alert (enlist) the mother of the need for protection or comfort

7. ©2008 National Association of Social Workers. All Rights Reserved. 7 Developmental Function In the absence of any threat, secure attachment provides a “safe base” from which a child may: explore, play and learn.

8. ©2008 National Association of Social Workers. All Rights Reserved. 8 Resilience from Trauma Attachment security helps to mitigate trauma and restore a sense of safety and equilibrium cause by a rupture in an important relationship.

9. ©2008 National Association of Social Workers. All Rights Reserved. 9 4 Types of Infant Attachment Secure Insecure Avoidant Insecure Ambivalent Disorganized / Disoriented

10. ©2008 National Association of Social Workers. All Rights Reserved. 10 Secure

11. ©2008 National Association of Social Workers. All Rights Reserved. 11 Avoidant

12. ©2008 National Association of Social Workers. All Rights Reserved. 12 Ambivalent

13. ©2008 National Association of Social Workers. All Rights Reserved. 13 Disorganized

14. ©2008 National Association of Social Workers. All Rights Reserved. 14

15. ©2008 National Association of Social Workers. All Rights Reserved. 15 Attachment Trauma is Handed Down Attachment security helps to mitigate trauma and restore a sense of safety and equilibrium.

16. ©2008 National Association of Social Workers. All Rights Reserved. 16 Behaviors Which Contribute to Disorganization in Infants Physical or Sexual Abuse Bizarre Punishment Parental death or suicide Parental illness or Disease Caretaker Depression Witnessing violence Parental fear or panic Hostile or Intrusive Behavior

17. ©2008 National Association of Social Workers. All Rights Reserved. 17 Children w/ Disorganized Attachment are at Higher Risk For developing depression, borderline and dissociative disorders Aggressive, reactive or violent behavior Poor or rigid peer relationships Lack of empathy Alienation Criminality

18. ©2008 National Association of Social Workers. All Rights Reserved. 18 “At Risk” Children Disorganized Attachment HIV/AIDS, Orphan Status Poverty, Deprivation

19. ©2008 National Association of Social Workers. All Rights Reserved. 19 Treatment Considerations with “At Risk” populations. Attachment intervention can begin in the maternity ward Attend to ‘vulnerable mothers” to help them help their children. Use tried and true social work principals of non-judgment and empathic listening. Be emotionally attuned and focus on experience, process, and affect. Challenge negative internal working models and assist in the creation of deeper meaning and new understanding. Model curiosity, healthy attachment, acceptance of emotions, reduction of shame and re- integration of trauma affect.

20. ©2008 National Association of Social Workers. All Rights Reserved. 20 ( Consistency + Repetition + Patience ) + Secure Attachment = Empathy and Compassion