Affective Developmental Psychotherapy and other attachment therapies are forms of treatment effective with trauma-attachment disordered children. Attachment theory was pioneered by John Bowlby, who first applied this idea to the infant-caregiver bond. He was inspired by Konrad Lorenz's studies of imprinting in baby geese. He believed that the human baby, like the young of most animal species, is equipped with a set of built-in behaviours that helps keep the parent nearby, increasing the chances that the infant will be protected from danger. Bowlby was careful to point out that feeding is not the basis of attachment.
Dyadic Developmental Psychotherapy is primarily an experiential-based treatment, designed to facilitate experiences of safety and security so that a secure attachment may grow. It is an approach and a set of principals that have proven to be effective in helping trauma-attachment disordered children heal; that is, develop healthy, trusting, and secure relationships with caregivers. As with any specialised treatment, it must be provided by a competent, well-trained, licensed professional. It is generally a family-focused treatment. It is an attachment-based therapy based on five central principals. These principals are based on the causes and courses of disorders of attachment.
At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first two years to three years of life. These experiences disrupt the normal attachment process so that the child's capacity to form a secure attachment with a caregiver is distorted or absent. The child lacks trust, safety, and security. The child develops a negative working model of the world in which:
- Adults are experienced as inconsistent or hurtful.
- The world is viewed as chaotic.
- The child experiences no effective influence on the world.
- The child attempts to rely only on him/her self.
- The child feels an overwhelming sense of shame, the child feels defective, bad, unlovable, and evil.
The therapy is experiential. Since the roots of disorders of attachment occur pre-verbally, therapy must create experiences that are healing. Experiences, not words, are the "active ingredient" in the healing process. Traumatised children who are unable to trust do not respond to traditional forms of treatment such as play therapy, residential treatment, or talk therapies, since these therapies require and work through a relationship between the therapist and client.
Effective therapy uses experiences to help a child experience safety, security, acceptance, empathy, and emotional attunement. A number of techniques and methods are used including psychodrama, playful and nurturing activities, and other exercises. One key element is maintaining emotional attunement with the child through PACE; being Playful, Accepting, Curious, and Empathic.
The therapy must be family-focused. Therapy opens up a child so that what the parents have to offer can get in and heal the child. It is the parents' capacity to create a safe and nurturing home that provides a healing environment. Being able to have empathy for the child, accept the child, love the child, be curious about the child, and be playful are all part of the "attitude" that heals. Parents are actively involved in treatment. They are either in the session with the child on the parent's lap or watching the therapy through a one-way mirror or by closed circuit TV. This is essential. It ensures that the parents are actively and fully involved in treatment.
Trauma must be directly addressed. Therapy helps healing by providing the safety and security so that the child can re-experience the painful and shameful emotions that surround the child's trauma. Revisiting the trauma is essential if the child is to begin to revise the child's personal narrative and world-view. It is by revisiting the trauma and sharing the anger and shame with an accepting, empathetic person that the child can integrate the trauma into a coherent self.
A comprehensive milieu of safety and security must be created. Traumatised children are often hyper-vigilant, insecure, and deeply distrusting. A consistent environment that is safe and secure is essential to creating the experiences necessary for the child to heal. This milieu must be present at home and in therapy. Good communication and coordination among home, school, and therapy is another important element of effective treatment.
Therapy is consensual and not coercive. Physical restraint is not treatment. A child may be restrained if the child is about to hurt him/her self, destroy property, or hurt the therapist. Holding is one of the experiential methods used, but it is not a restrictive, invasive, or constricting holding. The holding used is better described a cradling much as one would cradle an infant or toddler. Cradling helps promote a safe, secure, and comforting milieu. Parents review and sign a detailed informed consent document, as do teenagers. In the first session all children identify something that the child wants different about the child's life; that is the basis for a consensual relationship.
Dyadic Developmental Psychotherapists must be well trained, licensed, and have significant experience in treating trauma-attachment disordered children. In selecting a therapist you should look for the following:
- Significant training from a recognised training program.
- An office set-up so that sessions are videotaped and parents can watch sessions from another room if not actually in the room.
- Ongoing training. Ask when was the last training event the therapist attended and how long was the event.
- An initial assessment to develop a differential diagnosis and treatment plan.
In summary, therapy for traumatised children who have disordered attachments must be experiential, consensual, and provide an environment of security, acceptance, safety, empathy, and playfulness. Only an experienced and trained therapist can provide Dyadic Developmental Psychotherapy.
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