Primary treatment for attachment disorders does not take place in an office between a therapist and the child. Healing occurs best in a permanent home. Seven principles should guide the basis for any attachment therapy:
Permanence is critical. Foster care is temporary. The therapist’s first job is a social work task, working with the welfare department to do everything possible to achieve permanence. Help the child remain with the birth parents if possible. If the child must be removed, work to shorten the time in limbo. Help evaluate available kin. Promote concurrent planning to minimize multiple moves. Find adoptive parents.
Understand Bonding. Bonding is a significant reciprocal attachment which both parties want and expect to continue, and which is interrupted or terminated at considerable peril to the parties involved. Humans bond, not through therapy, but quite naturally, by sharing over time important events in daily life, such as eating, sleeping, and playing together.
Disrupted bonding may cause the child to reconsider the risk of future attachments and vote to “opt out.” For this reason, permanence should be established before attachment therapy is attempted.
Work with the parents. More than with any other mental disorder, the healing for attachment disorders takes place in the home. Attachment and bonding cannot be forced; it occurs naturally when the stage is set and the time is right. Meaningful and vital relationships do not occur in artificial environments like offices. They develop in that wonderful mix of emotional entanglements within the family.
Structure connecting. As soon as a permanent home is established, either through reunification or adoption, facilitate the avenues of attachment. Bonding occurs naturally and so should the treatment of any attachment disorder. Remind the parents to smile at their child, and touch, and ask questions. Read or make up bedtime stories. Consider getting a pet to love and be loved by. Parents might notice at least two extra positive things about their child each day.
Model emotions and compassion. Reasoning and logic are analytic and general, but emotions are personal. The therapist might encourage parents to let their own feelings show. Feel free to laugh and cry.
Accentuate the positive. Teach parents to brainstorm about times when their child relates personally with others, when he or she joins a club, has a friend over, or plays with a pet. Be especially aware of incidents such as joining with the family in conversation or action.
Then reward these moments by responding with a comment or a touch. “I was happy to see you and Nicole together….” “I am glad you came with us…..” Parents need to pay attention to these breakthroughs.
Expect misbehavior. Misbehavior may be problematic but it is, nevertheless, a step forward, away from being a loner and into the real world of other people. On the road back to normalcy, children may be disrespectful, lie, fight, steal, break things, and do much else to irritate the parent. They may try a parent’s patience to its limit. Avoid long lectures and discipline that isolates. A wise therapist can show parents how to correct these behaviors without squelching the child.
In summary, the therapist might say to the parent: Open your eyes to the obvious. Healing of attachment disorders takes place not in a therapist’s office, but in a permanent home. Parents need to be patient. Pass the tests. And just be there.