Understanding Attachment and Attachment Disorders: Theory, Evidence, and Practice

By Vivien Prior; Danya Glaser | Go to book overview

18 Interventions with No
Evidence Base

Direct intervention with the child

There are no reports of systematically evaluated, direct interventions with the child, which are based on attachment theory. Based on the theory and understanding of attachment disorders, children with attachment disorders and insecure/disorganised attachments show difficulties in their social interactions which have often become extended beyond the relationship with their primary caregivers. These children's internal working models will have come to skew their views and expectations of others and determine the children's consequent maladaptive social responses. On theoretical grounds there is, therefore, a place for direct therapeutic work with the child in which these internal working models can be explored. This would not, however, address attachment formation or attachment relationships.

Hughes (2004) presents 'An attachment-based treatment of maltreated children and young people' (p.263). He describes the therapist's attunement to the child, which is followed by the therapist 'co-regulating' the child's affective states, 'co-constructing' meanings for the child's experiences and, together with the child, constructing a narrative of the child's experiences. Hughes considers favourably having the child's primary caregiver actively present in the therapy, providing that if this caregiver was the maltreating parent, they have taken responsibility for the maltreatment. As Trowell (2004) comments, Hughes is clearly a very experienced and sensitive clinician. However, the therapy remains unevaluated and is not sufficiently systematised to be applied in an intervention trial. Moreover, while Hughes refers to and describes aspects of attachment theory, there is little application of the theory during the therapy, which reads like good therapeutic work with children who have been abused and neglected.

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