Wednesday, June 18, 2014
Trauma, Attachment, and "Adoption Today"
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.