What Works & What Doesn’t
Let’s start with what DOESN’T WORK…and why:
Traditional Psychotherapies — i.e. talk therapies, don’t work with children with an Attachment Disorder or those with early childhood, (especially pre-verbal) trauma. Two reasons. First,traumatized children are not helped by talk therapy because of their inability to access (talk about) their actual trauma memories and the specific events and triggers. Neuroscience is showing over and over that trauma is housed in our “mid brains” – the limbic system. This is not the part of the brain that has language and logical thought. Even in adults, who developmentally have language, who are traumatized and get PTSD, using talk therapies is of little value because it’s very difficult to move the trauma “memories” from the mid brain to the cortex/language centers to process. Imagine how much more challenging this is when the trauma occurred prior to the development of language. Second, traditional therapies all depend on developing a relationship of trust between the child and therapist and/or child and parent. A child with an Attachment Disorder, or attachment impairments, is by definition a child who finds it difficult to trust others — it’s a relationship disorder. The therapies that help our children must be experiential. Therapies that involve the parents and work toward building the trust between parent and child are the kinds of therapies that work. Therapies that don’t involve the parent are WRONG for, and usually damaging to, a child with an Attachment Disorder. Therapies to help our children must be EXPERIENTIAL and not talk-based.
Doing Nothing — waiting for them to outgrow it. Well meaning experts, family and friends will often tell newly adoptive parents to not worry so much about a child’s odd behaviors. While there is definitely an adjustment period, if you feel like there are issues with your child, you are probably right. Attachment issues will not usually get better without intervention. Children who withdraw and exhibit troubling behaviors will only worsen if left untreated. Bonding and attachment depends on connecting with the child, and the longer you wait the harder the connection will be to make. As research emerges showing how attachment affects brain development, it points with even more clarity the importance of QUICK and EARLY Intervention!
Behavioral Therapies that use small rewards (or sometimes punishments) as motivators. Traumatized children and those with Attachment Disorders do not respond in typical ways to rewards and punishments, although rewards and punishments can definitely become triggers for our children. One reason is that the behaviors you’re trying to extinguish are really “can’ts” not “won’ts”. The child’s trauma background makes them dysregulated and the behaviors (could be fight, flight, freeze or tend & befriend) are due to the triggered dysregulation. Sometimes our children are described as “manipulative” or “attention-seeking”. In reality, their brains are hijacked by the trauma and stress chemicals and flooded with the “memories” and they’re emotional systems are overwhelmed (and their logical, higher brain is not about to control this). For some children with an Attachment Disorder, the reward/punishment approach becomes almost a “game”. With their mid-brain stuck in survival mode, most traumatized children attach little value to the rewards as motivators. Instead, some will use the system the adults have set up to maintain a sense of control over the situation. Children from highly deprived backgrounds see little intrinsic value in possessions and focusing on material rewards or the loss thereof does little to foster attachment and trust. In other words, using rewards and punishments is often futile and counterproductive. Many, many, many parents, teachers and therapists try traditional behavior modification programs on children with attachment and trauma problems, to no avail. In some cases, emphasizing rewards and punishments can increase the child’s anxiety and trauma responses, making these approaches actually harmful.
So what DOES WORK with traumatized children and those with Attachment Disorders:
1. Focus on Parent-Child Relationship. Attachment Disorders are relationship disorders. The goal of therapy with these children should be to develop a healthier attachment to their primary caregiver (i.e. parents). This means that parents should be actively involved in the therapy sessions and not just sitting in the waiting room. The therapist often acts as a coach and/or parent trainer, guiding the parents to learn the specialized parenting needed to make their responses to the child more “therapeutic”. Successful attachment & trauma therapists recognize the critical role the parent must play as the catalyst for healing and encourages and supports the parent(s) learning these skills.
2. Experiential Learning. Because our children’s traumas can not be accessed by talking, therapies must include experiences and activities that allow the child to access the traumas in a safe environment with the experienced therapist there to help process them. Movement, music, art, play are all tools attachment/trauma therapists use to help our children experientially. These tools often help our children with any sensory dysfunction as well, which can often happen when children have developmental trauma.
3. Focus on Teaching Regulation. At the core of a traumatized child is dysregulation. The behaviors that manifest are from the child’s dysregulation – from being triggered by past traumas and their skewed world view/self view. Therapists who understand this also understand how important it is to actively teach the child to recognize their own dysregulation and give them tools to help them reach a regulated state. Yoga, mindfulness, mediation, physical activity, movement and many more tools can be given to children as they are developmentally ready to learn to self-regulate.
4. Therapist “Fit”. Research on all psychotherapy has shown that success is more a determination of the client’s relationship with the therapist than what treatment modalities are used. For children with a “relationship disorder” building a relationship is especially tricky. First off, the focus needs to be on the primary relationship — the parent/child relationship — because it is through building a healthier primary attachment that resiliency is gained. Yet, it is important that when seeking an attachment/trauma therapist, you find someone who understands the importance of relationship-building, a therapist who is empathetic, curious and playful and understands attunement. Children will often not “like” their therapist because the therapist makes them work on hard stuff (processing their early trauma) and holds them accountable for their actions. So parents find that it’s often better to use their own judgement as to the “fit” of the therapist. If the therapist is a person with whom the parent can build trust and work as a collaborative team — a person who coaches and supports the parent and whole family — this is a good indicator of a good therapist “fit”.