Treatment strategies and outcomes for 'attachment disordered' children : perspectives of therapists, parents/carers and children

Central in Bowlby's thinking about attachment theory was the infant's biological proclivity to form attachments to initiate, maintain, and terminate interaction with the caregiver and use this person as a 'secure base' for explorations and self enhancement. Persistent abuse and neglect of infants and young children by their carers can lead to complex developmental and emotional difficulties. These are often symptomatic of the traumatic effects of the maltreatment on children as well as implicit in their failure to develop a consistent pattern of attachment with their caregivers. Currently there are no conclusive clinical studies on the effectiveness of therapeutic interventions for attachment disturbances in children (van Ijzendoom & Bakermans-Kranenburg, 2003). The fundamental aim of this research was to compare the perspectives of therapists, parents or carers and children regarding efficacy and suitability of a range of treatments currently used with attachment-disordered children. Their perceptions, experiences and opinions of therapy were recorded using structured interviews. Fourteen therapists, twenty-six parents and five children and young people were interviewed. Using computer assisted qualitative data analysis software (CAQDAS) the interviews were analysed for trends and associations facilitating conceptual development. A number of significant points became clear as a result of this study. Psychotherapists who worked individually with children without parental involvement in the treatment were extremely reluctant to take part in the study and so their views could not be justly represented. Parents' perception of success correlated closely with their sense of being supported, valued and included in the therapeutic process. Their perception of failure of therapy was close! y linked with feeling excluded and criticised by therapists. Parents and children did not always agree with the therapist's opinion that therapy had been successful or even useful. Most parents included in this study whose child had been referred to Child and Adolescent Mental Heath Services (CAMHS) were not consulted regarding the treatment of their child or the therapy they were offered. The majority of families were offered individual child psychotherapy or family therapy when they were referred to CAMHS. Even so, some CAMHS now offer attachment based therapies, therapeutic parenting and therapies that encourage partnership with parents