Attachment-based therapy (children)
Attachment-based therapy is a phrase intended to apply to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder. Individual Therapeutic Approaches
Child-Parent Psychotherapy (CPP)
This intervention was developed from "infant-parent psychotherapy", a psychoanalytic approach to treating disturbed infant-parent relationships based on the theory that disturbances are manifestations of unresolved conflicts in the parent's past relationships. The "patient" is the infant-parent relationship. Infant-parent psychotherapy was expanded by Alicia Lieberman and colleagues into Child-Parent Psychotherapy, a manualized intervention for impoverished and traumatised families with children under the age of 5. In addition to the focus on the parents early relationships the intervention also addresses current life stresses and cultural values. CPP is supported by five randomized trials showing efficacy in increasing attachment security, maternal empathy and goal-corrected partnerships. The trials also showed a reduction in avoidance, resistance and anger. The therapy is delivered through unstructured weekly sessions involving both parent/s and child over the course of a year. The trials were conducted with low income groups, maltreating families, families with depressed mothers and families where children were exposed to domestic violence. 'Circle of Security'
This is a prevention program using parent education and psychotherapy intervention developed by Glen Cooper, Kent Hoffman, Robert Marvin, and Bert Powell designed to shift problematic or 'at risk' patterns of attachment – caregiving interactions to a more appropriate developmental pathway. It is stated that it is explicitly based on contemporary attachment and congruent developmental theories. Its core constructs are Ainsworth’s ideas of a Secure Base and a Haven of Safety (Ainsworth et al. 1978). The aim of the protocol is to present these ideas to the parents in a user-friendly, common-sense fashion that they can understand both cognitively and emotionally. This is done by a graphic representation of the child's needs and attachment system in circle form, summarising the child's needs and the safe haven provided by the caregiver. The protocol has so far been aimed at and tested on preschoolers up to the age of 4 years. The aim of the therapy is:
To increase the caregivers sensitivity and appropriate responsiveness to the child’s signals relevant to its moving away from to explore, and its moving back for comfort and soothing; 2.
To increase their ability to reflect on their own and the child’s behavior, thoughts and feelings regarding their attachment – caregiving interactions; and 3.
To reflect on experiences in their own histories that affect their current caregiving patterns. This latter point aims to address the miscuing defensive strategies of the...
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