Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Sunday, August 16, 2015

Follow the Child's Lead to Create Attachment

A recent e-mail from Jessica Pegis called my attention to a set of “rules for bonding” as put out by the magazine Adoption Today (www.adoptiontoday.com/bondingarticle2.html). An on line article on this topic, “Jump-starting attachment with babies and toddlers”, by Mary Ostyn, contains a range of misunderstandings about attachment and young children’s needs, as well as some good advice – e.g., that nurturing does not “spoil” a child.

My first concern about Ostyn’s remarks is that they suggest that attachment (not bonding) is something an adult can do TO a child, and that it is accomplished by ritually re-enacting with toddlers the behaviors that are normal parts of caring for infants. The term attachment refers primarily to attitudes and behaviors of young children toward adults, although some authors have tried to bring all later relationships under the attachment umbrella. As far as we presently know, attachment of a child to a caregiver occurs when the caregiver is sensitive and responsive to the messages the child sends about needs and wishes—that is, when the caregiver pays close attention to the child’s communications about both affectionate interactions and autonomy. (This kind of attention and response is just one detail of what is sometimes called “following the child’s lead”).

Ostyn seems to assume that the caregiving behaviors that typically precede an infant’s attachment to a parent are identical with the behaviors that will encourage attachment in a toddler or preschooler. My guess is that she takes this position because she shares with advocates of attachment therapy the belief that a child who has experienced separation has in some way been blocked from and stopped further development, and therefore experiences characteristic of early life must be recapitulated in order to “jump-start” typical development. However, the fact is that no living child stops developing in any way. Development may be distorted by events, but it continues to occur. This means that a toddler who has undergone separation cannot be considered to be stuck at the stage of development where she was at the time of separation. It’s more accurate by far to consider that aspects of development have been derailed and need to be guided back onto a desirable track.

Re-enacting baby care with an older child is thus not a plausible approach to helping kids who have experienced rough histories. What’s more, this kind of re-enactment of events ignores the important role played in attachment by the caregiver’s responsiveness to the child’s signals. Just doing what a caregiver thinks ought to be done may well involve being unresponsive to child communications, especially if a child is hard to “read”.

As Mary Dozier has pointed out, improving the parent’s ability to understand subtle child cues is the way to improve the child’s attachment to that parent; caregivers who proceed to follow “rules” without considering the child’s signals are working against attachment, not toward it. Ostyn suggests actually ignoring child cues to insist upon physical contact. She also ignores the fact of the typical extreme ambivalence of the toddler toward being held and being let go – the behavior that Margaret Mahler called a “rapprochement crisis”, where a normally-developing child wants to be held and then put down, wants help and then has a tantrum when receiving it, etc.  Rather than recognizing age-appropriate behavior, Ostyn is confused by her assumptions about  “stuck” development into thinking that this is an expression of genuine reluctance to develop a relationship. Instead, it’s an opportunity for a caregiver to show responsiveness to the confused and confusing signals the child is giving. The child’s desire for autonomy needs to be honored as much as the child’s desire for attachment—and I am at a loss as to how hours of carrying a big child can accomplish this, especially when the child resists. Once again, following the child’s lead as much as is practical is the way to go; carrying out a ritual re-enactment of some idea of infant care is not.

This leads me to the whole feeding issue. According to Ostyn, “bottlefeeding is great for bonding”—but there’s certainly no evidence that it makes any difference to attachment, any more than breastfeeding does. Does she mean that bottlefeeding makes a caregiver feel good? That would make sense if she’s really talking about bonding, which is the increased positive feeling of the adult for the child. Not so much if she means attachment, the feeling and behavior of the child toward the adult, however. A toddler or preschool child is likely to resist being given a bottle and will probably want to hold it herself and even take the nipple off to drink better, but caregivers who are convinced by Ostyn will not follow this lead as they should. (Some will even interpret these actions as a refusal to attach to them and a personal dislike.)

 As a further comment on feeding, Ostyn advises that only the mother should feed the child, and all treats should come from the mother. Here we have a clear commitment to the Freudian concept of attachment as “cupboard love” created by associating a caregiver with food or other gratification. This outmoded view has long ago been replaced by the idea of attachment as a robust development that occurs in response to pleasurable social interactions and adult sensitivity to child communications. Certainly mealtime offers many opportunities for happy social engagement and responsiveness to the child’s cues, but these are not based on satisfaction of hunger or experience of “treats”. I might point out also that the idea of monotropy, the attachment of the child to a single individual, as initially argued by John Bowlby in an analogy to the imprinting of ducklings, is long gone from professional discussions of attachment. Most children experience attachment to several caregivers, including fathers and grandparents, and benefit from learning that there are a variety of ways of having pleasurable social play.

Ostyn should be given credit for a couple of good suggestions. One is about responsiveness to children’s night-time concerns, and in her comments about this she does encourage sensitivity and responsiveness to child communications. Her comments about playing on the floor every day are also excellent. “Floortime” (as it was dubbed by Stanley Greenspan) offers many opportunities for pleasurable, sensitive, and responsive communication and for following the child’s lead in play.  

You can’t “jump-start” attachment by making the child go through ritual re-enactments of infancy. But you can gradually encourage a child’s attachment by becoming sensitive to subtle communications and being willing to follow the leads he gives you. If this seems difficult, sometimes it can be helpful to make videos of your interactions with the child and to look at them later to see whether there are cues that you are missing and leads you are not following. Keep in mind, too, that a toddler is developing attachment relationships that include negotiation and compromise, not just dependence, and that autonomy is an essential goal for development. That toddler or preschooler is not literally “stuck” at a baby’s emotional level—he or she needs experiences that resonate with current needs, not to what some adults imagine as past needs.








8 comments:

  1. Yes, yes and more yes!

    I'm horrified that anyone, under any circumstances, would advise adoptive parents that manhandling their new kid WHO TELLS THEM TO STOP or CLEARLY HATES IT is a good idea.

    A kid should have 100% say over who does (or doesn't) get to touch them.

    ReplyDelete
    Replies
    1. The curious thing is that these people have cherry-picked their rationale from such a wide variety of places-- but they seem to have forgotten all about where their control needs to stop, a topic discussed over and over for many years now.

      Delete
  2. Thanks for this blog- such a nice contrast to all too much of the adoption therapies stuff I keep coming across.
    This post made me laugh a bit- having lugged our 4 year old about on my back for hours, once again, then given a bottle of milk with cuddles. Why did I do this? Because both are consistently demanded due to the presence of a younger sibling who asks for and gets them too! Littly also has a range of issues from learning disability to emotional difficulties, just to start- I really didn't anticipate a 4 year old wanting this stuff!

    ReplyDelete
    Replies
    1. Now, you DO have a good reason for doing these things!

      Delete
  3. I found your blog when doing my own reading and making sense of the Primal Wound. I found it spot on. I am looking for reading and resources on this dilemna. I have an 18 year old daughter adopted from China. Diagnosed with various learning challenges she had speech theraphy, tutoring in reading and math and the Standard testing - very low working memory . With great tenacity on her part she made it, successfully from an academic stand point through her Junior Yr. Then meltdown. Two suicide attempts and other big dangerous and self harming therapy. The confusion in the field about supporting adopted kids, particularly when cognitive issues play off or with the development issues is hard to sort through as a consumer. We hired an Educational Consultant who helped us find a residential wilderness like therapy program that has a very wholistic model and excellent credtentials. We have been pleased. The next step, after a 12 week program, is their recommendation for a theraputic boarding school. We are hiring people to help us sort out candidates but would greatly appreciate a "reading list" for this juncture with our daughter and any thoughts on theraputic boarding schools - particularly any "quack" alerts. This Andrew Solomon: How the worst moments in our lives make us who we are

    https://www.ted.com/talks/andrew_solomon_how_the_worst_moments_in_our_lives_make_us_who_we_are?language=en#t-393653
    comes very close to the "right" philosophy but is not intended and does not suggest the tools.

    Gratefully,
    Mom of adopted and struggling teen

    ReplyDelete
    Replies
    1. So sorry for the delay in answering this-- life seems to have gotten in the way of blogging!

      Thinking about therapeutic boarding schools, I am wondering what your goals are. Are you hoping that such a school will get her ready for college, or do you and she have some other vocational goals that could let her live independently? What are her own goals? Would you be interested in a school that would allow her to live at home, or do you feel that some separation from you is needed? Is your concern that she have treatment for her emotional problems primarily, or is there equal focus on the LD? I am assuming that your consultant has approached these issues with you, but of course I don't know your answers.

      My major concern about a therapeutic boarding school is that it must allow you to visit or be in contact with your daughter as you and she choose. I am sure you are aware that some of these institutions, like some wilderness programs, have allowed students to be physically abused, and your best insurance against this is contact when you want it, and within reason, how you want it. The rules should be similar to those in an ordinary boarding school.

      I would suggest that you also need a place that focuses on her specific needs and wishes for change, and that does not make more of an issue of adoption than she does.

      I am bringing some of this up because I am presently involved with a situation in which a girl was placed in a residential treatment program by her mother and badly mistreated in the program, but unable to tell her mother this because all communications were carefully monitored and even visits were supervised by a staff member , though the mother had never been accused of abusing the girl. In another program I am aware of, parents were told that they must not discuss with their children when or how they might come home-- if this was found to have happened, the child would be expelled at once.

      The fact that your daughter is now 18 requires careful thought. Unless she has been declared incompetent and you are her legal guardian, she is able to make decisions and stay in or leave a program as she prefers. She will also be in a position to consent or withhold consent for you to receive information about her progress. I would suggest that you discuss this carefully with her, with school representatives, and possibly with a family lawyer before you make any choices of school.

      This is not exactly a reading list, but perhaps I've given you some points of guidance--

      Delete
    2. Careful with these "therapeutic" boarding schools... I had an absolutely nightmarish experience at an adoption attachment program . Just do your research....please.

      Delete
    3. Yes, I can't overemphasize this point. My suggestion about research was that she should make sure that communication with the child is open. Do you have other specific suggestions, Gwen?

      I am still not sure whether the goal here is "attachment" or whether it's about the cognitive disabilities, but in either case caution should be the watchword.

      Delete