Attachment Disorders: Do You Really Need a Specialist?
Before I started my own practice, I worked with a lot of children in crisis. For the most part, I was a rockstar with troubled kids and families. But there were always those few cases, usually kids who had suffered profound, ongoing relational trauma and neglect, where all my training seemed to fall short. These were parents and children who, looking back, probably had some real dysfunction in their attachments.
I did the usual stuff with these kids. I did the Trauma-Focused Cognitive Behavioral Therapy. I taught all the coping skills. We made homemade stress balls and glitter bottles. I worked within the "language of the child" by playing with toys, making art projects, and reading picture books on therapeutic themes. Together with parents and teachers, we created firm boundaries and structure for the child at home, school, and daycare. We set up meaningful, personalized reward systems. We were painstakingly consistent and unbelievably warm. With the majority of the kids I helped, these interventions were creating lasting positive change. But with a few kids, none of it worked. I had been vaguely introduced to "attachment problems" in grad school, but I thought that what I learned didn't apply to my clients. It certainly couldn't apply to me.
I thought "I have a world-class education." I thought, "I could attach to a rock! No attachment problem is any match for me!" In short, I lacked humility. And I lacked specialized training.
If you are a child therapist like me, you need to know that some of the tricks in your bag are truly meaningless when it comes to treating problems with attachment. The reason for this is quite simple: most models of treatment require the child to have enough of an ability to trust another person, in order to trust you. Children with a history of profound trauma and neglect often do not feel safe trusting others on even a very, very basic level.
Many models of child therapy require the ability to use symbolism, to act out internal struggles via play, or to think and speak abstractly. Children with histories of profound trauma and neglect often do not have a strong ability to do any of those things in the presence of another person. It’s also important to remember that if the trauma occurred in infancy or toddler years, traditional talk therapy would be unlikely to access the memories.
Then there are the behavioral approaches, in which you are coaching parents to use time-outs, sticker charts and the like. Those also rarely work in the long term, since behavioral approaches require the child to have some level of desire to please the adult, some level of self-confidence and self-esteem. Children who are terrified of relationships are often working subconsciously to drive their caregivers away and prove to everyone that they truly deserved the abuse they received. Subconsciously they feel “bad” and act congruently with that belief. So setting up a sticker chart is almost like providing a roadmap for how to confirm all of their worst fears about themselves and relationships.
No. "Treatment as usual" isn’t going to work.
The case that finally pushed me to go get the training I needed? I worked with a child several times a week, for many months without much improvement. I adored this child and knew in my heart that what I was doing wasn't working. Coincidentally, the Theraplay® Institute was offering a 4-day Level 1 training in Raleigh, so I drove across the state, dipped into my savings, and took the days off work. When I got back from the training, I was ready to try something drastically different.
Instead of talking about her choices or creating new consequence and reward charts, we engaged on an emotional, right-brained level, without talking. I delighted in her. I sang to her, I rocked her, I counted her perfect little fingers and toes, I put bandaids on her hurts, I laughed with her. She cried with me.
Within 5 sessions, I was seeing major breakthroughs! Suddenly this child who had been pure charm, telling me only what I wanted to hear, was showing me her deepest fears. Emotionally we were truly connecting. Whereas before, she was too afraid to show me her “bad” behaviors, now that trust was building, she began testing out the safety of our attachment: lying to me, stealing from me, yelling at me, biting me, scratching me, calling me horrible names, hitting and kicking me. Finally I could see what Mom experienced with her little girl. Finally I could see how much pain this child was experiencing. Finally I could help!
The enormity of the changes I saw over the next 4 months were astonishing. Listening improved, behavior improved, relationships improved. This little one went from only playing by herself, digging in the dirt at recess, to playing collaboratively with other children, even making friends. She went from hugging strangers and sexualizing her peers, to showing up with clear, healthy touch boundaries and preferential attachment to just a couple of special caregivers.
It was a wonderful process, but looking back, this family shouldn't have had to wait so long to see improvements. During those months I struggled (not to mention the years and years of treatment before I was involved!), this family’s problems were only being compounded and reinforced. The parents' sense of hopelessness, shame, and alienation was being rubbed in, like salt to a wound. The child's feeling of being in constant peril, defective, worthless, unlovable somehow. . . her behaviors that devolved and worsened, becoming more severe as time went on. . . her parents’ lack of understanding how to help. . .
My lack of training- and my pride- contributed to that process. Looking back, that's what I regret the most.
The flip-side of this regret? Deep gratitude to this family for delivering me to my passion. Deep humility in the face of complex trauma and attachment wounding. And a deep desire to educate others about Theraplay! This stuff works!
Danielle Maxon is a Licensed Clinical Social Worker in the State of North Carolina. She has over a decade of clinical experience working with children and families.
In August of 2015 she created her private practice, Under Wing Therapeutic Services, PLLC, which offers attachment-based therapy for parents and children. Danielle specializes in working with gifted, twice-exceptional, and neurodivergent families.