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Attachment Therapy:
What it is and What it isn't
by Arthur Becker-Weidman, Ph.D.

There are many misconceptions and fictions about treatments for trauma-attachment disordered children. Is treatment dangerous and deadly? Is it a miracle cure? What, exactly, is attachment therapy? First, some truths. Attachment therapy is the only form of treatment that is effective with trauma-attachment disordered children. It is the only "evidence-based" treatment, meaning that there has been research published in peer-reviewed journals. Attachment therapy is primarily an experiential-based treatment, designed to facilitate experiences of safety and security so that a secure attachment may grow. Attachment therapy, as with any specialized treatment, must be provided by a competent, well-trained, licensed professional. Attachment therapy is a family-focused treatment.

Attachment therapy is the name for an approach and a set of principals that have proven to be effective in helping trauma-attachment disordered children heal; that is, develop healthy, trusting, and secure relationships with caregivers. Attachment therapy is based on five central principals. These principals are based on the causes and courses of disorders of attachment.

At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first two years to three years of life. These experiences disrupt the normal attachment process so that the child’s capacity to form a secure attachment with a caregiver is distorted or absent. The child lacks trust, safety, and security. The child develops a negative working model of the world in which:

FIRST PRINCIPAL. Therapy must be experiential. Since the roots of disorders of attachment occur pre-verbally, therapy must create experiences that are healing. Experiences, not words, are the "active ingredient" in the healing process. Traumatized children who are unable to trust do not respond to traditional forms of treatment such as play therapy, residential treatment, or talk therapies, since these therapies require and work through a relationship between the therapist and client.

For example, one eight year old boy who had Reactive Attachment Disorder, Bipolar Disorder, and a variety of sensory-integration disorders wrote about his past therapy and attachment therapy this way:

Effective therapy uses experiences to help a child experience safety, security, acceptance, empathy, and emotional attunement. A number of techniques and methods are used including psychodrama, interventions congruent with Theraplay, and other exercises.

SECOND PRINCIPAL. Therapy must be family-focused. Therapy opens up a child so that what the parents have to offer can get in and heal the child. It is the parents’ capacity to create a safe and nurturing home that provides a healing environment. Being able to have empathy for the child, accept the child, love the child, be curious about the child, and be playful are all part of the "attitude" that heals. Parents are actively involved in treatment. They are either in the session with the child on the parent’s lap or watching the therapy through a one-way mirror or by closed circuit TV. This is essential. It ensures that the parents are actively and fully involved in treatment.

THIRD PRINCIPAL. The trauma must be directly addressed. Therapy helps healing by providing the safety and security so that the child can re-experience the painful and shameful emotions that surround the child’s trauma. Revisiting the trauma is essential if the child is to begin to revise the child’s personal narrative and world-view. It is by revisiting the trauma and sharing the anger and shame with an accepting, empathetic person that the child can integrate the trauma into a coherent self.

FOURTH PRINCIPAL. A comprehensive milieu of safety and security must be created. Traumatized children are often hyper-vigilant, insecure, and deeply distrusting. A consistent environment that is safe and secure is essential to creating the experiences necessary for the child to heal. This milieu must be present at home and in therapy. Good communication and coordination among home, school, and therapy is another important element of effective treatment. "Compression-wraps," invasive and intrusive stimulation designed to evoke rage, "re-birthing," and other provocative techniques are not part of attachment therapy. These intrusive and invasive techniques are not therapy, not therapeutic, and have no place in a reputable treatment program.

FIFTH PRINCIPAL. Therapy is consensual and not coercive. At our center we are very clear that physical restraint is not treatment. A child may be restrained is the child is about to hurt him/her self, destroy property, or hurt the therapist. Holding is one of the experiential methods used, but it is not a restrictive, invasive, or constricting holding. The holding used is better described a cradling much as one would cradle an infant or toddler. Cradling helps promote a safe, secure, and comforting milieu. Parents review and sign a detailed informed consent document, as do teenagers. In the first session all children identify something that the child wants different about the child’s life; that is the basis for a consensual relationship.

The therapist must be well trained, licensed, and have significant experience in treating trauma-attachment disordered children. A good resource to locate such therapists is the Association for the Treatment and Training in the Attachment of Children, ATTACH. In selecting a therapist you should look for the following:

In summary, therapy for traumatized children who have disordered attachments must be experiential, consensual, and provide an environment of security, acceptance, safety, empathy, and playfulness. Only an experienced and trained therapist can provide attachment therapy.

Any information on the Attachment Disorder Site does not replace professional advice. This site is my attempt to pass on my knowledge from reading and learning everything I could find on this issue so that I could help our son and maybe help others who are walking this same path.

The resources on this entire site are provided for your personal perusal. I have no way to guarantee the accuracy or appropriateness of any information or advice for a particular situation. Nothing on the Attachment Disorder Site constitutes medical, legal or other professional advice and I assume no liability or responsibility for any diagnosis, treatment, decision made, or action taken in reliance upon information contained on these sites including any sites linked to it or your use of the Internet.

Permission must be granted by Nancy Geoghegan to use any part of this site. Feel free to email me to discuss this matter.