A glance at the magazine Adoption Today for June 2014 is enough to raise many questions
about this publication’s purposes and accuracy. From page 48 to page 73, we
have nothing but advertisements for therapists who purport to handle issues of
“attachment and trauma”.
And what names are here! It’s like a history of
potentially harmful treatments. I see a number who use checklists to diagnose
“attachment disorders”. I see at least one who advocates holding therapies for
babies. I see one who is under investigation in her home state after a suicide attempt
by a 12-year-old whose parents followed her instructions. I see at least one
whose advice was associated with the death of a young child. And I see a lot
who think attachment occurs telepathically before birth.
In the midst of these listings is nestled a cameo
photo of Ronald Federici (no oil painting as shown here) having a chat with
Heather Forbes. The text notes that these two are “top experts”, although they
have never published in a peer-reviewed journal; however, they say they are
top, and I suppose they should know, shouldn’t they? (Presumably money changed hands to achieve
this conspicuous position for the picture.) In any case, the “as told to” text
contains an interesting remark, quite relevant to the matters I want to discuss
in this post: “Trauma goes much deeper than attachment. We must work with our
children from a developmental spectrum and not focus solely on attachment,
otherwise we miss a huge window for healing.”
I am not at all sure what working “from a
developmental spectrum” might mean. The reference is possibly to the importance
of developmentally appropriate practice, so rarely considered in Attachment
Therapy or its various cousins. If that is what’s meant here, that would be a
step in the right direction, as most of the therapists in the Adoption Today listings have long
persisted in the view that they can “regress” a child to any developmental
period and then move him back to his original stage, so consideration of his
actual developmental status is not necessary.
But what about the rest of the statement? Here’s how
I translate it: “Trauma is the flavor of the month! It’s all about
trauma-informed stuff nowadays. Attachment issues are old-fashioned and too
many people are getting to know that what we’ve been saying about attachment is
wrong. Our business plans had better include moving to the trauma thing, or
we’re sunk. But attachment is still a good buzzword, so what to do? How about
we say ‘attachment and trauma’ for a while, just like we used to say
‘attachment and bonding’? That should work, because the public will start
finding ‘trauma” just as familiar as ‘attachment’. Then we can pull in the
families that obviously don’t have attachment problems (like the ones where the
kid was in the NICU) and we can tell them the problem is trauma-- or even more likely, they’ll come and tell us
that there must be trauma.”
Am I saying that trauma is not a problem? No, of
course not. A trauma is by definition an event that causes long-term adverse
outcomes of physical or psychological development and functioning. An event
that looks horrible to bystanders may not act as a trauma and may cause no
adverse outcomes. Another event that seems innocent to bystanders may be
experienced by the victim in such a way that it acts as a trauma and causes adverse
outcomes over the long term. For example, in Susan Clancy’s work on adults who had been sexually abused as
children, some of the experiences did not act as traumas, even though we might
have expected them to, but for some people their later thinking about the
childhood events was somewhat traumatic in light of their learned expectations
and beliefs. Traumatic events are often
re-assessed as the individual’s development progresses, and they may be
remembered vaguely, vividly, or anywhere in between, but it does not seem
likely that they are “repressed” or show up later as “recovered memories.”
There are both good and bad messages about trauma in
circulation today. The accurate messages remind adults that a child’s
resistance to certain actions or reluctance to come close to certain people may
be caused by earlier trauma and are not evidence of defiance or opposition.
When adults understand this, they can learn to manage the child’s experiences
more appropriately and will be less tempted to threaten or punish a traumatized
child into compliance. The right messages about trauma are helpful in this way.
Inaccurate messages, on the other hand, suggest that
if children show unwanted moods or behaviors, they must have experienced trauma,
even if no other evidence supports this idea. These messages encourage adults
to forget the roles played by the situation and by non-traumatic learning in bringing
about problem behavior. Bad trauma messages also tend to “horribilize” the
child’s position by stating that his entire body is a repository of unconscious
memories of trauma, and that the memories can only be released by non-cognitive
methods. These messages also imply that trauma is monolithic-- that every bad experience, at every point in
the child’s development, causes equal difficulty. As a result, adults who
receive inaccurate messages about trauma are persuaded to ignore some useful
approaches to helping the child, and to accept treatments that may be
ineffective and even potentially harmful.
What’s the connection between attachment and trauma?
It’s certainly true that there can be one. When children between about 8 months
and three years of age are abruptly separated from familiar caregivers for many
months, and when they do not receive sympathetic support from a small number of
new caregivers, they respond with serious distress and grief. They sleep poorly,
are reluctant to eat, and do not play or seem interested in engaging with other
people. Their physical health may suffer and language and cognitive development
is slowed. Not only do they seem to experience distress over the loss, but they
miss out on a variety of experiences like speech interactions that contribute
to normal development. If they have the opportunity to form new attachments to
good caregivers, the children recover from this experience (although they may
assess it as traumatic when they learn about it in later life). If they do not have
that opportunity, they will show problems of development-- but it’s hard to say whether this is because of
trauma or because the situation involves a cascade of other unusual experiences
unsupportive of good development.
Children who are under perhaps 6 months of age, or
over three years, at the time of separation from familiar caregivers do not
respond with the intense distress we see during the period described above. The
older they are, the better their cognitive and language abilities enable them
to withstand the potential effects of their experiences. If they are young
enough, and if they now are in the care of sensitive and responsive adults,
little or no distress will occur, and no trauma is experienced. (This
statement, of course, is at odds with the beliefs of a number of the therapists
listed by Adoption Today, who are
convinced that attachment occurs prenatally and that all adopted children have
experienced traumatic separation, no matter when the adoption occurred.)
What take-home messages do we have here? One is that
whether a specific event is experienced as traumatic depends on a number of
factors, among which a primary one is developmental age. Attachment-related
events, especially, can be traumatic during a particular age range, and if supportive
caregivers are absent-- but they are
less traumatic when a child receives sensitive, responsive adult care, and
still less traumatic when the child is younger or older than the most
vulnerable age period. A second is that worrisome child moods or behaviors are
not in themselves evidence of earlier trauma, and that assuming this connection
robs caregivers of tools to use in helping the child. Third, there are a number
of much mistaken assumptions about the nature of therapy for either trauma or
attachment-related problems.
Good therapy for children with mood or behavior
problems works in the same ways whether the difficulties are caused by trauma,
attachment history, genetic factors, social learning, or situational variables.
Each of these factors needs to be considered as it affects the individual
child. Among the social learning and situational variables, the influences of
adult caregivers are especially powerful, and that means that understanding and
managing adult behavior must be given high priorities.
How do parents find therapists who will do this?
They need to look for practitioners whose licensure and training show them to
have the needed skills, acquired in respected academic programs. Such people
are not to be found by looking in the listings of Adoption Today or Psychology
Today, nor do they call themselves Registered Attachment Therapists or
overemphasize the importance of trauma, and I doubt that many are members of
the American Psychotherapy Association. The website of a state psychological
association can be helpful for concerned parents, and licensure verification
can be done through state websites. But these methods are not enough, if
parents have the wrong expectations about how treatment works, and if they
reject the possibility that they are part of a problematic situation. Parents
who genuinely want to help children need to understand that they themselves may
need to change in order to achieve the outcomes they want.
As if to confirm your observations, Tina Trasker is at it again:
ReplyDeletehttp://m.nymetroparents.com/article/tina-traster-answers-questions-about-her-adopted-childs-reactive-attachment-disorder
A couple of quotes: "The traumatic break of the maternal bond, or the primal wounds, as some call it, affects the child's capacity to trust a caregiver."
" Adoptive or foster parents need to be educated and have their antennae up, and not dismiss these behaviors as something a child will grow out of."
The woman is doing her best to misinform everyone else, isn't she?! She's like the Jenny McCarthy of the adoption world.
DeleteI'm going to try to do another post about the trauma issues, today or tomorrow.
It's all the same as an orphanage, as far as I can see.
ReplyDeleteAren't vacations "the devil" when you have ANY children? Aren't all children gobsmacked by large groups of unfamiliar people, and thrown off balance by new places and changes of routine-- unless adults spend much of their time buffering these effects?
ReplyDeleteI notice that in one of the other "parts" he recounts conversations with one child about what her mother may have done 9 years ago. How much of her continuing distress and vigilance is iatrogenic--- brought about by the parents' assumptions about what must have happened?
Just askin'.
I needed a vacation from vacation after taking my 3 securely attached, biological kids to Disney world.
ReplyDeleteWouldn't we all! Thank goodness the "other grandmother" of two of my grandchildren likes to do this job.
Delete