We Are Now Published In German by Beltz

A different book jacket and title that translates roughly into “The Car Is Parked At The Bridge. I Am Sorry. A Father’s Search For Answers To His Daughter’s Suicide.”

With over 80 million people, Germany is the largest country in Europe.

9783407864161

My Enlightening Interview With An Attachment Expert

Apologies go out to my readers for my lack of postings these last couple of weeks.

IMG_0481My wife and I have been swamped moving back into our home – a 1917 cottage on a hillside above Fairfax, California – that has been under renovation for the past six months. On top of that, I just got a new job after being out of the market since Casey’s suicide. Yes they still hire geezers like me out there, amazing as that seems. So the last few weeks have been like fighting off a water cannon.

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dr_marvinThis week I want to share more of my research into different schools of thought over attachment theories and therapies that I learned in an interview with Dr. Robert Marvin. Dr. Marvin is the Director of the Mary D. Ainsworth Child-Parent Attachment Clinic at the University of Virginia Medical Center. He began his career as a research associate with Mary Ainsworth – an early founder with John Bowlby of attachment theory – at Johns Hopkins. For the next four decades, his work focused on attachment research, developing assessment tools for families of foster and adopted children, and intervention with families experiencing varying forms of disrupted relationships and separation.

He talked at length about two groups of professionals who’d worked with children suffering attachment-related difficulties. One group emerged in the 1980’s, comprised primarily of clinicians, who took a behavioral approach to the mysterious disorders observed in children from foster care and orphanages. They developed a group of therapies, most commonly called holding therapies (where the therapist and/or parents literally hold the child in an embrace), but also known as rage reduction, rebirthing and attachment-parenting therapies. Their goal was to regress the child to an earlier age and then bring her back a whole person. Marvin believed that the mistake the clinicians made was to focus on the child’s undesirable behavior as something she did deliberately. Consequently, it had to be to controlled. But their work turned out to be coercive and controversial. These physical forms of therapy sometimes resulted in serious damage to children, including eight deaths, and landed some practitioners in prison.

The second group was comprised of researchers, academics, medical school clinicians and adoption agency staffers whose work was grounded in the Bowlby-Ainsworth theory of attachment. Since the 1950’s, they’ve compiled a huge body of peer-reviewed research, which has been used in the assessment and treatment of children and families with a variety of challenges from disrupted homes.

Marvin’s work rejects the notion that the child’s undesirable behavior (such as rages and tantrums) is deliberately aimed at tormenting those around her. Rather, it’s based on the premise that the child lacked an early parenting partner who could’ve helped her co-regulate her distress. Left without any soothing skills, she’d blow up when upset.

He observed over the years that children neglected in Eastern European orphanages hadn’t had the thousands of interactions that parents and babies have every day, so their brains didn’t develop in the same way as “normal” babies’ brains. He believes that orphanage practices that discourage attachment with caregivers – for fear that the child will suffer when faced with letting go – are more harmful than not allowing the child to attach at all.

“We now know that if the child is adopted within the first year, the adverse effects of institutionalization are not too difficult to treat.” He explained. “But for a child like Casey, adopted at fourteen months, there’s already been a fair amount of psychological and brain development damage that leads to very unusual behavior.”

“This information still hasn’t fully made its way into the mainstream.” He said. “Only in the last few years have we come to realize what’s happened to these kids and how to intervene.”

He went onto tell me that some adoptive parents seemed to know intuitively or trip over the right way to parent these children. Many didn’t, but it wasn’t their fault. He heard from many parents, feeling unloved and exhausted from their efforts to “fix” their child, who felt they had no choice but to hand the child over to a professional. But Marvin claimed that it’s the parents whom the child loves, even though she may not act like it, and it’s the parents who need to lead the child back to a normal developmental pathway.

I came away from this interview with a pretty negative impression of holding therapies, but I talked to other professionals who were not so dismissive of the practice. I’ll look at this further in an upcoming post.

What Is Attachment Disorder?

Casey Photos 1991-96_0032           Casey Photos 1991-96_0046

From that first night in Warsaw, we saw things in Casey that took us aback – the uncontrollable tantrums, primal-type screaming, near imperviousness to discipline and lack of coping skills, among other things that evolved as she grew older. But we saw them as nothing more than parenting and behavioral challenges because the vast majority of the time Casey was so absolutely delightful. These were mere distractions that could be dealt with by “proper” (i.e. strict) parenting and discipline.

How wrong we were and how little we knew!

Erika and I hadn’t even heard of the phrase “attachment disorder” until Casey’s third and last therapist brought it up in a debrief session to discuss her refusal to continue therapy. My initial reaction was dismissive – another convenient disorder, just like ADD, ADHD or OCD. Everybody has a disorder! But after getting so close to a proper – if possibly accidental – diagnosis, she veered off in a direction that she was convinced was at the root of Casey’s problems – pot. Indeed, Casey was a teenager who smoked pot just like I did, but that wasn’t the root cause of her problem. Without seeming blasé about teen drug use, I’ve never heard of pot smoking resulting in suicide. That’s straight out of the 1930’s movie Reefer Madness.

Attachment disorder was never again discussed, and the following year Casey was dead. When I revisited that phrase years later while writing my book, I was shocked. It explained everything.

So What Is Attachment Disorder (a/k/a reactive attachment disorder)?

hommedia.ashxThe disorder was an outgrowth of the work, beginning in the 1950’s, by British psychoanalyst, John Bowlby, considered by many the father of attachment theory. He was joined in his work by psychologist Mary Ainsworth. They believed that mental health and behavioral problems could be attributed to early childhood, suggesting that children come into the world biologically pre-programmed to form attachments with others, their form of survival. The main points of their theory are summarized below.

1. Though a child may have multiple attachments, she has an innate need for a primary bond to one main attachment figure, usually the mother. Any breakdown of this maternal attachment could lead to serious negative consequences. The child behaves in ways that elicit contact or proximity to the caregiver. When she experiences heightened arousal, she signals her caregiver (by crying, smiling, locomotion, etc.). Instinctively, caregivers, by creating a reciprocal pattern of interaction, instill in the child a sense of safety in her environment.

Mary-Ainsworth

2. A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life. Bowlby claimed that mothering is almost useless if delayed until after two and a half to three years and, for most children, if delayed till after 12 months.

3. If the attachment figure is broken or disrupted during the critical two-year period the child can suffer irreversible long-term consequences, including delinquency, reduced intelligence, increased aggression, depression, affection-less psychopathy.

4. The child’s attachment relationship with their primary caregiver – the prototype for future relationships – leads to the development of an internal working model with three main features: (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

Mother and Child watching each other

Mother and Child watching each other (Photo credit: Wikipedia)

Attachment disorders arise – simply put – when this primary attachment is broken or was never properly formed in those crucial first years of infancy. Wikipedia defines it broadly as a disorder of mood, behavior and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood, resulting in problematic social expectations and behaviors. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers after about 6 months of age but before about three years of age, frequent change of caregivers or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts.

We’ll discuss how attachment disorders can manifest in children in subsequent posts.