In order for a traumatized child to heal, that child must be able to form a lasting, loving relationship with an older caregiver. Though this concept sounds intuitively valid, attachment therapy, a developing field based on the idea that the most fundamental need of a deeply emotionally-damaged child is a caring and reciprocal relationship with a parent or other adult, is still in its infancy.
In The Attachment Therapy Companion: Key Practices for Treating Children & Families, attachment experts Arthur Becker-Weidman, Lois Ehrmann, and Denise H. LeBow seek to create a foundational text. Though they suggest that the book might be useful for caregivers as well, it is designed as a manual for clinicians, outlining the existing best practices in attachment therapy and organizing the field for the way forward. The text has an unfortunate tendency to repeat itself and some of the later chapters feel insubstantial; still, the authors have crafted a strong case for attachment therapy as an exciting theory deserving of further research.
Attachment therapy is new enough that it does not yet have a fixed terminology, so the authors wisely begin with a discussion of key definitions and concepts. The book is careful to distinguish what it terms “attachment-focused therapy” from more heavily “touch-reliant” techniques, explaining that, though touch may be involved in some successful attachment-focused strategies, the focus of the therapy is building an emotional understanding and trust between the child and caregiver. There is also an emphasis on the importance of reciprocity: The child must not only feel the effects of the caregiver’s love and support but also feel that the caregiver is affected by the child in turn. A major theme is that the caregiver’s place in the therapeutic process is equally significant to the child’s, whereas the clinician “takes more of a coaching or consultant role.”
The book argues that attachment is already the basis for many trauma-focused therapies, though it may not always be explicitly labeled. By making attachment the specific target of therapy for children who have experienced lasting trauma, the authors believe that clinicians will be able to avoid frequently used but insufficient diagnoses such as PTSD or bipolar disorder. The authors devote significant time to discussing the particular difficulties of diagnosing and treating children, and claim that attachment-focused therapy is especially suited to the developing minds of the young. They emphasize the necessity of a flexible, individualized treatment plan and rely more on case studies and examples to guide readers in working with their own clients than on step-by-step methodologies.
The Attachment Therapy Companion seems to do a fine job of consolidating current knowledge in the field and paving the way for future developments. The chosen examples are presented in a dialogue format that effectively demonstrates ways in which the clinician can strengthen the child-caregiver relationship. The emphasis on careful listening and avoiding blame for disruptive behavior, with the clinician playing the role of facilitator, provides a convincing image; it is easy to picture the children in the chosen examples making significant progress.
However, it is a bit difficult to imagine a clinician reading this book and successfully implementing its ideas without significant further research, as the text tends to be vague on the beginning stages of the therapy. The book states that a prerequisite for these techniques is a comprehensive assessment of the suitability of both child and caregiver, including “an assessment of the child and the caregiver’s capacity to be insightful, responsive, sensitive, reflective, and committed, and their state of mind with respect to attachment.” Yet it does not offer advice on how to locate and enlist such a qualified caregiver. The book addresses the fact that many traumatized children have difficult family situations when discussing behavior management and treatment logistics but does not address the seemingly larger question of how an attachment therapist would find a suitable caregiver in the lives of these children. As the book argues that attachment-focused therapy is the best way to treat these children and that the role of the caregiver is essential, the lack of strategies offered to find such a caregiver is glaring.
Ultimately, the book seems a useful resource for clinicians interested in working with child victims of lasting trauma—but it is not quite the foundational text it seeks to be. It is by no means comprehensive, and its weaknesses call out for further research and further writings. Considering the integral role of the caregiver and the significant emotional qualifications required of him or her, it seems like the logical next book would be a primer for the caregivers themselves. (Attachment-focused therapy puts an uncommon amount of responsibility on the parent figure, so he or she deserves to be provided with an uncommon amount of clinical information.) What The Attachment Therapy Companion does, however, is outline a new therapeutic model that requires more psychological knowledge from the client. Though it does not solve all of the problems of such a model, it proves the worth of its field.
The Attachment Therapy Companion: Key Practices for Treating Children & Families
W. W. Norton & Company, September, 2012
Paperback: 240 pages