Discussion @ Early Childhood Attachment Issues & Enmeshment

[Therapist4Chnge]

I've always been interested in the balance between "healthy attachment" during the first years of life and unhealthy attachment which can lead to enmeshment issues later in life (hello object relations ). Children aren't really my pop, but I run into a lot of issues surrounding enmeshment later in life, and I thought it'd be a good opportunity to talk a bit about the research and current practices in regard to early childhood development and/or how to build healthy attachment.

So.....anyone work in this area, have an interest in early childhood attachment, or have something they want to talk about in relation to this stuff?

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[RayneeDeigh]

I have no expertise whatsoever in early childhood attachment stuff, but I did find something interesting in my honours thesis. People with insecure attachment styles actually prefer partners who also have insecure attachment styles. Misery loves company.

Sorry, that probably had nothing to do with anything whatsoever.

 

[Therapist4Chnge]

It involves attachment style...so that is fair game!

 

[WannaBeDrMe]

Hey RD, I remember that too... I've always said you have to have a well-balanced amount of crazy in a relationship for it to work! (not being mean to anyone, crazy as in the crazy we all have... gotta match it up and balance it, ha)

I know a little about enmeshment from my work with individuals with borderline personality disorder. So, the only attachment related issues I have experienced are related to early trauma.

However, I have zero experience (other than tangential) with early interventions. So, don't really have a lot to offer as related to current research.

I know there are some child trauma people here... aren't there? I thought I'd seen that before...

 

[myelin]

I worked on a research team coding behaviors for an assessment tool called the Parent Child Interaction Assessment. Here is the abstract from an introductory paper:

The Parent-Child Interaction Assessment (PCIA) is a procedure developed to yield data about parental attunement as well as other aspects of parent, child, and dyadic functioning. The procedure involves videotaping parents and children ages 4-10 yrs as they go on an imaginary trip to the zoo together. They begin with a short free-play interaction and then "play out" several scenarios with toy people, animals, and blocks. After cleaning up the toys, the parent and child each are shown the videotape of their interaction. The parent and the child are interviewed about what he or she and the other person are doing, thinking, feeling, and wanting. This article describes the development and contemporary psychoanalytic theoretical basis of the PCIA. A coding system under development and potential research and clinical applications are discussed. Case examples of 2 dyads, 1 a mother in her late 20s with a 6.1-yr-old daughter and the other a mother in her early 30s with a 4.9-yr-old son, are provided to illustrate the PCIA. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

From: Introduction to the Parent-Child Interaction Assessment by Holigrocki and Kaminski. It is a rather unique assessment tool for those interested in assessing parent/child interactions and how they respond to each other in given situations.

 

[Terapueta24]

I am currently applying to graduate schools and have always been very interested in early childhood attachment and how it influences mental health functioning. Unfortunately I have no research to add to this discussion, just anecdotes from my past experiences. I worked for three years in a children's psychiatric center with children 3-6 and the majority had attachment disorders due to their abuse histories. I was always dismayed by the lack of research in the field about how to treat these disorders...many of the books out there are the worst form of pseudoscience and border on being unethical with the suggestions they make. It was always disheartening when an adoptive parent would find a book that said that their child would never get better or that they needed to take control from their child to "cure them" (including taking away the right to speak).

Since this line of discussion opened up does anybody know of quality, research based labs that are working on treatment for young children with attachment disorders? I am under the impression that it is very difficult to treat and therefore study but from my work I do believe that relationship-based therapy and intensive work with parent and child can make a difference... and that treating insecure attachment at a young age is crucial to prevention of future mental health issues. It is so important that we get empirically based treatment for these disorders to give hope to foster and adoptive parents. I would love to study this in grad school but am yet to find the right program.

 

[mountaindrew]

I am currently applying to graduate schools and have always been very interested in early childhood attachment and how it influences mental health functioning. Unfortunately I have no research to add to this discussion, just anecdotes from my past experiences. I worked for three years in a children's psychiatric center with children 3-6 and the majority had attachment disorders due to their abuse histories. I was always dismayed by the lack of research in the field about how to treat these disorders...many of the books out there are the worst form of pseudoscience and border on being unethical with the suggestions they make. It was always disheartening when an adoptive parent would find a book that said that their child would never get better or that they needed to take control from their child to "cure them" (including taking away the right to speak).

Since this line of discussion opened up does anybody know of quality, research based labs that are working on treatment for young children with attachment disorders? I am under the impression that it is very difficult to treat and therefore study but from my work I do believe that relationship-based therapy and intensive work with parent and child can make a difference... and that treating insecure attachment at a young age is crucial to prevention of future mental health issues. It is so important that we get empirically based treatment for these disorders to give hope to foster and adoptive parents. I would love to study this in grad school but am yet to find the right program.

I know of a couple of labs which work on attachement. There are some researchers which you should look up like Belsky and Sroufe, because I don't know where they work. Then, there's an attachment lab at Western Ontario with Pederson and Moran, which developped the Maternal Behavior Q-Set, a tool assessing maternal sensitivity. My own advisor is Tarabulsy, which has a lab and studies where he intervenes with adolescent/at-risk mothers but we are in Quebec, so French is everywhere.

 

[mountaindrew]

About the enmeshment :
Attachment doesn't mean that a kid is enmeshed. A securely attached child is supposed to have a sense that the parent is there in case of need and that the parent is able to detect, interpret and adequately and promptly respond to the child's signals.

Some insecure child have a parent which avoids emotional issues and never responds to emotional cues (the child then has a tendency to stay close to the parent but ask him only for practical things, this is the insecure-avoidant attachment and also the one that we think in the West which is a symbol of independence). There's a strong belief that avoidant kids are doing good because they don't cry when the parents leaves the room, they seem in control and in fact it's exactly the problem. No one should expect a 1-1.5 year-old to be so much in control of himself at that age. It's a big problem because some people who work with kids and who are not familiar with this theory think that infants/toddlers who are insecure-avoidant are doing great while it is actually a risk factor for socio-emotional problems.

Some parents will respond to the child's request infrequently and the child learns that he has to grossly exaggerate cues to get a response (this is the insecure-resistant kid).

There is no genetic (temperamental) characteristics that say that the kid will be secure or insecure. The temperament will tell HOW the security or insecurity is manifested though (if the child cries a lot or if he is comforted easily). There's also a strong genetic component to a child's dependency, which is something else.

 

[psychmama]

I'm also very interested in attachment, both in children and as it relates to later adult functioning. Last summer I read a very interesting book on the topic that I'd recommend:

Wallin, D. (2007). Attachment in Psychotherapy. New York (Guilford).

It gives a good overview of attachment research, then discusses how to make use of these principles in psychotherapy.

 

[idgie]

I do a lot of work with children who have attachment disorders. Relationship-based psychotherapy approaches and intensive family treatment are what works best with these kids/families. Psychodynamic, cognitive-behavioral, and systems work all seem to be more effective than any of the control-based "therapies" out there. Add EMDR, expressive (art/sand tray work), and somatic-based interventions, which all increase the likelihood of these kids getting better. There are some children who are so far gone that treatment, even intensive treatment, does not seem to work.

All of the kids I work with have abuse/neglect in their backgrounds, which has caused the defect in their ability to build secure relationships with others. These kids don't trust anyone, for good reason, and the time spent building rapport with these kids can seem like an eternity. Safety is a key issue and they will test the clinician and the parents (foster or adoptive) incessantly to see if they are trustworthy adults. If clinicians who are well trained in the treatment of attachment disorders can intervene early, say before age 10, and the child/children are placed in a home environment that is capable of meeting the emotional needs of these kids (whether long term foster or adoptive placement) in a healthy way, these kids do make good progress. The trick is finding parents who are willing to put in the time and energy needed to work with these types of kids.

It can be exhausting for the parents, both emotionally/psychologically and physically. What I have noticed is that parents (foster or adoptive) who are completely burned out will turn to the more unusual, and sometimes dangerous, techniques out there being touted as "appropriate" treatment for AD as a way to exert control over these kids because they feel so out of control themselves. I've never seen it be effective on a long term basis and it also serves to re-traumatize the client. It doesn't make much sense to me to find ways to manipulate and control a child, which often triggers emotional reactions of fear/rejection/shame, as a way to force them to accept rules. And to me it does nothing to build a secure relationship as the dynamics are similiar to the abusive relationship the child had with his/her parents.

I also work with some adults who were abused as children, some of which continue that pattern of interaction into adulthood. Adults with antisocial and borderline (narcissistic as well) personality disorders are adult forms of attachment disorders.

I'm not aware of any labs or research-based activities, aside from some research being done by those following Ainsworthy's work, though I wish I did.

 

[mountaindrew]

I do a lot of work with children who have attachment disorders. Relationship-based psychotherapy approaches and intensive family treatment are what works best with these kids/families. Psychodynamic, cognitive-behavioral, and systems work all seem to be more effective than any of the control-based "therapies" out there. Add EMDR, expressive (art/sand tray work), and somatic-based interventions, which all increase the likelihood of these kids getting better. There are some children who are so far gone that treatment, even intensive treatment, does not seem to work.

All of the kids I work with have abuse/neglect in their backgrounds, which has caused the defect in their ability to build secure relationships with others. These kids don't trust anyone, for good reason, and the time spent building rapport with these kids can seem like an eternity. Safety is a key issue and they will test the clinician and the parents (foster or adoptive) incessantly to see if they are trustworthy adults. If clinicians who are well trained in the treatment of attachment disorders can intervene early, say before age 10, and the child/children are placed in a home environment that is capable of meeting the emotional needs of these kids (whether long term foster or adoptive placement) in a healthy way, these kids do make good progress. The trick is finding parents who are willing to put in the time and energy needed to work with these types of kids.

It can be exhausting for the parents, both emotionally/psychologically and physically. What I have noticed is that parents (foster or adoptive) who are completely burned out will turn to the more unusual, and sometimes dangerous, techniques out there being touted as "appropriate" treatment for AD as a way to exert control over these kids because they feel so out of control themselves. I've never seen it be effective on a long term basis and it also serves to re-traumatize the client. It doesn't make much sense to me to find ways to manipulate and control a child, which often triggers emotional reactions of fear/rejection/shame, as a way to force them to accept rules. And to me it does nothing to build a secure relationship as the dynamics are similiar to the abusive relationship the child had with his/her parents.

I also work with some adults who were abused as children, some of which continue that pattern of interaction into adulthood. Adults with antisocial and borderline (narcissistic as well) personality disorders are adult forms of attachment disorders.

I'm not aware of any labs or research-based activities, aside from some research being done by those following Ainsworthy's work, though I wish I did.

I'm not sure how it works with older children and adults (and I especially have doubts about how EMDR can be thought of as empirically-supported treatment) but I know that in infants and toddlers, short interventions based on changing maternal sensitivity (which is more behavioral than anything else) are much, much more effective than long-term and/or psychodynamic interventions. See this article for a meta-analysis on the subject :

Psychol Bull. 2003 Mar;129(2):195-215.javascript:PopUpMenu2_Set(Menu12696839);
Less is more: meta-analyses of sensitivity and attachment interventions in early childhood.

Bakermans-Kranenburg MJ, van IJzendoorn MH, Juffer F.
Center for Child and Family Studies, Leiden University, The Netherlands.
Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n = 7,636) and/or attachment (n = 1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d = 0.33) and infant attachment insecurity (d = 0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.

 

[Therapist4Chnge]

....I especially have doubts about how EMDR can be thought of as empirically-supported treatment...

Agreed.

) but I know that in infants and toddlers, short interventions based on changing maternal sensitivity (which is more behavioral than anything else) are much, much more effective than long-term and/or psychodynamic interventions. See this article for a meta-analysis on the subject :

I think people often misunderstand how a psychodynamic approach can be used in practice for a child case with attachment issues. I believe conceptualizing through an object-relational approach can help the clinician understand some of the issues at hand, while the treatment approach may incorporate a variety of interventions. For example, some specific behavioral interventions can be effective in these cases, though not without understanding why those interventions are part of the solution. If people look at the general concepts of an O-R approach, and then consider general attachment theory....they actually compliment each other.

 

[idgie]

Yes for infants/toddlers the treatment of choice is geared toward interventions with the mother/primary caregiver. I completely agree with you. They may be short or long term interventions, depending on how the parent responds to the treatment. The age range I'm referring to, though, is generally from age 5-10 years old. These kids have often already been taken out of the biological home due to chronic abuse/neglect and placed with foster parents and/or placed for adoption due to the failure of the biological parent(s) to get their act together. Long term treatment is often needed for these individuals, though the length of treatment is dependent on many variables....the availability of good foster/adoptive parents, the experience of the therapist, the quality of the relationship between client/therapist/family, and the appropriate timing of appropriate interventions. All of these, and may others, often make a difference in treatment outcome.

Psychodynamic therapies tend to get a bad rap, I understand that, but it often works for the kids I see so I'm not going to argue with success T4C, I agree that an object relations perspective along with attachment theory is helpful in organizing the treatment. I do also tend to look at trauma theory and the psychodynamics of trauma, which often helps clear up the clinical picture. It's not that I'm looking for children to "gain insight" into their psyche, but these psychodynamics are often helpful for the foster/adoptive parents so that they come to understand these kids' emotional/behavioral reactions in relation to previous trauma rather than continuing to believe they are the stuff of deliberate oppositionality and/or other "willful" conduct-related problems.

I had the same concerns about EMDR, but after seeing it work first hand with kids I don't have any doubts about its use. I'm not certified to do it. That work is done by someone else, but I have been present when it was used on different clients. You have to be careful about which clients you would use it with, but for many kids it works very, very well. This is not true, however, for everyone. Some kids react very badly to it, making the situation worse.

 

[Therapist4Chnge]

Not to drag this off topic, but my concern with EMDR is that people can't really isolate the EMDR from such factors as the Therapeutic Relationship. I often wonder if the "effect" is based more in supportive therapy and/or distraction, and not actually in the eye movement.

As for kids in the 5-10 range....that is definitely a tough age, particularly considering the challenges of providing continuous care.

 

[PsyDr]

alan schore's work might be interesting to you.

there's three books of his about the biology of this stuff. the titles usually start with :

"affect dysregulation and XXXXXXXXXXXXXXXXXX"

great stuff, but his reference sections are almost half the book(s).


kinda a heady read.

 

[idgie]

Yea, I like Schore's work. Dr. Bruce Perry is another good clinician who has done a ton of research in the areas of trauma, neurobiology, and attachment with children/adolescents.