Healing the Attachment System

 

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My observations in India – just as my much longer experience in El Salvador – have led me to question the idea that the way to heal attachment disorders is either by the establishment of a potentially secure attachment relationship through adoption or foster parenting, or through intensive and lengthy psychotherapy. That is not to say that I saw uniformly effective healing in either place, but just that I observed alternative healing methods that seemed to me to have promise. 

In each children’s home, for example, there are multiple caregivers, at least one central parental figure, and (when all is going well) a secure environment. The secure environment is not only associated with the person of the caregiver but is also related to adequate food and shelter and freedom from threat. At Love and Hope, Rachel is the central parental figure, and the children also have important relationships with the tias and tios (female and male caregivers), the cook (as witnessed in the “papusa maker” video), and a social worker and psychologist on staff; the high caregiver-child ratio is one of the strengths of the home. At Deenabandhu, there are two central parental figures – Prajna and Prof. Jayadev – and the important continuity of one (the same) skilled and caring teacher throughout the early years of school. In addition to these strengths in each home there are the important relationships between and among the children – age mates and older-younger pairs. Perhaps the power of the peer relationships is enhanced by aspects of the culture; in El Salvador it is not uncommon to see a young boy carrying a baby on his hip. At any rate, the richness of the interpersonal environment offers many opportunities for finding security in a trusting relationship, contingent social interactions, and the subjective experience of caring and personal recognition. 

 

 It is important to recognize the apparently contradictory results of the Romanian orphanage studies that point to the dangers of early institutionalization and the need for a primary caregiving relationship such as through adoption or foster care (Zeanah et al, 2011, Fox et al, 2010). When viewing the films of the children in these orphanages, the caregivers appear to be surprisingly pleasant and sometimes engaging in friendly, even helpful, interactions with the children. The main problem, I guess, is the lack of contingency of caregiver responses, especially in infancy. That is, the children are fed without reference to their cues or initiatives, aggression in the free play situation is not responded to helpfully, and the caregivers do not play with the children. I guess I would suggest that the big difference I observed between what I saw in the films of the Romanian orphanages and what I saw at Love and Hope and Deenabandhu is greater personal involvement of the caregivers and the children so that relationships were encouraged, the children were known for who they were as little individuals, and there was a lot of interaction between caregivers and children – in play and in academic learning. This is related to the idea of “magic moments“, or “lost momentos magicos” of earlier posts. 

I am reminded of Bruce Perry’s observations that traumatized children initially do better when allowed to seek out particular caregivers to fill specific personal needs – such as one caregiver to roughhouse with, another to provide food, another for comfort at times of emotional distress, another to help with homework. I am also reminded of Peter Fonagy’s therapeutic model of mentalization. That model avoids directly engaging the attachment system without simultaneously working on building reflective capacity that can guard against what one might call the “regressive pull” to intense destructive relationship patterns that were established in early childhood. Fonagy’s model was originally designed to treat adults with Borderline Personality Disorder, many of whom have experienced early trauma. However, it seems to me to be equally relevant to children – at least those with the cognitive capacity for mentalization – who cannot trust adult caregivers and cannot comfort or care for themselves. None of this means that developing a trusting and loving caregiving relationship with a single person is not healing. It is just to say that – at least now in my thinking – I am leaning towards the idea that there are multiple ways of healing the attachment system of children who have experienced trauma and severe neglect.

 

I hope my readers can make comments on this posting.

 

Bos K, Zeanah C, Fox N, Drury S, McLaughlin K, & Nelson C, Psychiatric outcomes in young children with a history of institutionalization, Harvard Review of Psychiatry, January/February, 2011, pp. 15-24; Fox S, Levitt P, & Nelson C, How the timing and quality of early experiences influences the development of brain architecture, Child Development, January/February, 2010, Vol. 81, Number 1, pp. 28-40).

 

Photograph by Ginger Gregory

 

 

 

Read this blog in Spanish.

 

 

 

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