Deborah Gray has been working with children, parents and families for a long time. As I read her new book, Promoting Healthy Attachments: Hands-On Techniques to Use with Your Clients, I thought how great it would be to be one of her practicum students, just to see her work in action.
Throughout her new book, she gives descriptions of how she works with children and families, and she gives credit to the families she works with as being great teachers for her. She also has a long list of pioneers and those who continue to expand on attachment theory as teachers.
Gray has put this book together to “arrange trauma, neglect, loss, and attachment theory into a working model for treatment.” I discovered at the end of the book that she wrote this to pass on her knowledge. She has done a really nice job. At times I felt as if I were in the therapy room with her and the family.
The book is divided into two parts. The first addresses the development of attachment, close connections, stress systems, sense of self, and theory of mind. Gray says she doesn’t give an overview of attachment theory and history, but she does talk about parenting, the forming of attachment patterns, and changing attachment patterns. She gives an overview of attachment patterns, how to recognize specific patterns, and how to move those patterns to secure ones.
The second part of the book is seven chapters about therapy processes, methods and techniques in treatment. Gray describes her book as “practical” and that she sees “therapists as more than mental health mechanics.” She stresses that her book “is not a set of instructions.” She feels that clinicians use skill sets similar to musicians. We make music with clients in therapy that “includes connecting, making sense of life events, and engaging empathetically as clients struggle toward integration and regulation. Our skills include graceful phrasing, timing, direction, knowledge application, and technique.” She also includes repairing work when our music gets out of key or we focus too much on left-brain cognitive skills.
Using music as a metaphor, she has written a very large work. It is so comprehensive and covers so much that it is a bit difficult to write about. She includes checklists to help determine client attachment style. She covers how to conduct the intake. She even covers how to set up the office and what distance your chair needs to be from the client — no closer than three feet, no further than six feet. Her chair has wheels so that the distance can vary as the therapy situation changes. She is a close observer of the process and all of the people in the process, including herself.
Gray also addresses the pacing of a session, how to help with emotional regulation, increasing or decreasing emotional intensity, and how to guide parents and children into attachment repair. She uses improvisation, narratives that can be written, verbal or drawings according to what works best with the person. She has some good guidance for working with people who have trouble with executive functioning.
She also uses imagination and visualization according to the developmental level of the child to help with reframing and changing self-talk. She keeps treats and bubble gum in the office. She also uses pictures she takes of clients as anchor moments for them. The client picks one of the pictures taken of a meaningful moment in therapy and gets a copy.
She gives guidance on the structure of therapy — when to meet alone with the child, when to meet alone with the parent, and when to meet together. The chapters in Part 2 are divided into groups — children, parents, adolescents and highly stressed families. There are also chapters on play and spirituality. I like the emphasis on play and physical activity and its part in healthy development and attachment. She also says that therapists should not be spiritual advisors and should be open to those who have a higher power as something like nature, but she is geared to the Abrahamic religions and makes no mention of other alternatives. I do think she is just asking therapists to include faith/spirituality in the therapy discussion in a respectful way to help with growth and change. You work with the person in front of you and do not proselytize.
Gray covers a wide range of feelings and issues — compassion, empathy, grief, trauma, abandonment, shame, loss, anger, safety, depression, resiliency and more. She has had a long career. She has worked with families over thirty years and as a therapist over twenty-five years. Just as a blueprint is not the house and sheet music is not the song, a book of techniques is not the actual therapy. She has many pages of dialogue that are helpful and thoughtful in helping others to come up with their own variation. I tried to picture how she maintained boundaries at times, how she wrote the progress notes, how insurance companies and regulatory agencies would react to a treatment plan co-written with a child using pictures. In the end she says, “I do not know a more precious gift to offer families than our help with loving connections.” Her passion for the work, and for those she works with, shines through.
Promoting Healthy Attachments: Hands-On Techniques to Use with Your Clients
W.W. Norton & Company, November 2018
Hardcover, 320 pages