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Re: “When Love is Not Enough

I feel compelled to respond to this article on behalf of the Association for Treatment and Training in the Attachment of Children (ATTACh), an international organization of clinicians, parents, and child welfare professionals. Some of the information contained in this article is considered counter-therapeutic, and certainly out of date, in the treatment of children with histories of attachment-related traumas. I would recommend interested readers to go to the ATTACh website (www.attach.org) and read the White Paper addressing issues in coercive interventions with children for more information.

The article by Susan Kuchinskas confuses many critically important issues. First and foremost is that in the article children with attachment difficulties are characterized as both "little monsters" and as children with PTSD. Children with unresolved traumas are reacting in predictable ways evidencing the ways their brains are literally being "hijacked" into survival modes of defensive and/or dissociative responses. They are not "choosing" to be controlling or manipulative--although their reactions often appear that way. They are responding in what are known as "conditioned emotional reactions" (previously termed "flashbacks"). Children who have experienced significant maltreatment in their early years at the hands of their caregivers have faced a particularly devasting form of "relational trauma". This means that there is a combined effect of the hurt of the maltreatment itself (whether abuse, neglect, or both), the loss of a caregiver as a source of security and comfort, and the fact that the child is left alone to deal with the overwhelming distress that is engendered by the maltreatment. Some children literally die from this (as found by the pioneering work of Dr. Rene Spitz in the 1940's). Children who survive develop a survival response that Dr. John Bowlby called "compulsive self reliance". They did not choose this response--indeed life offered a profound lesson that it is them against the world.

If we do not understand this very fundamental, literally "hard-wired by experience" response, we can risk re-traumatizing children by seeing their resistance as a conscious, chosen behavior. Doing so can fuel parents' frustration and sense of rejection and can lead to escalating efforts to control these children to get them to comply with parental authority. These efforts too often tragically risk reinforcing the child's distorted beliefs that adults are hurtful and coercive--beliefs that are the antithesis of seeing adults as a source of comfort and safety (the foundation of secure attachment).

Research from neuroscience, trauma, and child development have made compelling arguments that internventions need to begin with more sensitive and supportive approaches that help regulate the child's fear reactions. As triggers are "tamed" in an environment that offers active supports and soothing from the caregiver, while simultaneously acknowledging and challenging the distorted negative perceptions and beliefs that derive from the earlier trauma, the child can begin to develop better regulation of emotions and behaviors along with more constructive perceptions and beliefs about self and others. As beliefs change, then the behaviors can change.

Yes these children often have sustained real damage to their brains--but neuroscience provides compelling evidence of the brain's capacity for growth and change. There has never been greater hope about the chance of resiliency for these affected children! Attachment therapy is following the many examples from medicine of developing techniques that are less invasive, yet ultimately more effective.

Vicky Kelly Psy.D., LCSW, MHA
President of ATTACh

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Posted by Vicky Kelly on 12/09/2007 at 8:32 AM

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