In His Own Words

— Attachment Therapy for “Attunement” —

• [Allison:] “Because of ambiguity of the phrase as well as because of the fact that holding the child is only one aspect of the interventions, I do not use the term ‘holding therapy’ when referring to this work. I cannot think of a short phrase to describe this therapy.” Allison laughed. “The closest that I can come is Attunement-enhancing, Shame-reducing, Attachment Therapy.”

  — Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children
  (Northvale, NJ: Aronson, 1998), pp. 94-95

• The therapeutic stance of holding the child is often the most important intervention in the therapeutic process.

  — Facilitating Developmental Attachment (Northvale, NJ: Aronson, 1997), p. 103

• The standard therapeutic position is for the child to be lying across my lap with his head and sometimes his legs supported by pillows. One of his arms is behind my back; I hold his free hand.

  — Facilitating Developmental Attachment (1997), p. 105

• The therapist … gradually moves the child into the emotional spheres of terror, rage, and despair that the child wants to avoid. … She directs therapy in ways that the child would never choose to do. … the child reluctantly gives up control …

  — Facilitating Developmental Attachment (1997), p. 56

• Many children have screamed and screamed at me while being held … Other children quickly move into experiencing and expressing despair or terror. Later they may move into strong expressions of anger. My affect matches the child’s.

  — Facilitating Developmental Attachment (1997), p. 104

• Because of the intensity of her regressive behaviors, I decided to focus during the sessions on the neglect that she experienced as a baby. By now, I was often holding Melinda [approx. age 11] in my lap. … Melinda accepted being held, at times with an attitude of mild resignation and she did not dissociate in spite of the contact.

  — Facilitating Developmental Attachment (1997), pp. 156-157

• “You’re hurting me!” Katie exclaimed. “You might think I’m going to hurt you, Katie, and it must be scary that you can’t move your arms and get away from me but I’m not hurting you,” said Jackie. “Yes you are!” Katie screamed again. “Oh, Katie,” Jackie said quietly. “How much you’ve been hurt in your life. …” “Shut up! You are hurting me!” Katie screamed.

  — Building the Bonds of Attachment (1998), p. 103

• Often when poorly attached children are held, at home or in therapy, they complain that they are being hurt.

  — Building the Bonds of Attachment (1998), p. 132

• Recently I was holding 4-year-old Jack in therapy … gently tickling his ribs. I then paused and made a facial expression suggesting that I had just remembered something. I very quietly said: ‘Your Mom and Dad said that you are often very mad at them! You scream and kick and scratch them. I wonder why.’ Jack immediately became very tense, started to scream, and tried to get out of my arms. … I engaged him with a great deal of physical contact.

  — Facilitating Developmental Attachment (1997), p. 68

• This book is focused on the smaller group of foster and adopted children who have disorganized, insecure, and disrupted attachment histories and who lack the ability and readiness to form a secure attachment with their new parents. … It is in these situations that intensive therapeutic interventions are required. … To be effective, the child must be engaged by the therapist at the level of preverbal attunement rather than in a setting of rational discussions. The therapy must also involve a great deal of physical contact between the child and the therapist and parent. During much of the most intense therapeutic work, the child is being touched or held by the therapist or parent.

  — Facilitating Developmental Attachment (1997), pp. 6-7

• I might hold a child who is very resistant and wants to leave … One child insisted that I get his permission before touching him. While usually I would not give such control to a poorly attached child …

  — Facilitating Developmental Attachment (1997), p. 96

• In treatment, the child should have to really struggle to find ways to resist the therapeutic engagement and progress.

  — Facilitating Developmental Attachment (1997), p. 128

• When the therapist directs him to recall and reexperience significant memories from his abusive and neglectful past, he is likely to feel intense rage, terror, and despair that will often be focused on the therapist.

  — Facilitating Developmental Attachment (1997), p. 41

• … [T]he therapist is assuming a position of significant power over the child in the session. While it is my thesis that assuming such a position is crucial for success … it must be recognized that this position could easily become abusive.

  — Facilitating Developmental Attachment (1997), p. 41

• Between sessions 30 and 45, Jenny [age 8] struggled at home and in therapy with intense, sudden volatile emotional expression.

  — Facilitating Developmental Attachment (1997), p. 189

• … Hughes said he uses a type of therapy that some would label holding, but that he calls attachment therapy or trauma therapy. The goal is to get the child to talk about his trauma and to hold him so he feels “safe and relaxed, comforted and supported while he’s doing this tough work,” Hughes said.
     Setting the child free even when he asks may not always be in his best interests, according to Hughes.
     “This is much less intrusive or difficult than being put in a psychiatric hospital or having to move [from the foster parent] again,” he said. “Although having a child confront issues is stressful, it’s one-tenth as stressful as having a disruption in his life.” In cases where a child is resistant to being held, Hughes’ technique is to tell him, ‘I’m sorry it’s so hard, but we have to do this in order to help you.’
     “But I’d never do it in anger or to terrify the child — I’d do it with a lot of empathy,” he said.

  — reported by Ruth-Ellen Cohen, “DHS curbs use of holding therapies,"
  Bangor [Maine] Daily News (26 April 2001)

— “The Pain of Shame” —

• [Allison:] “… She will feel closer to us, in spite of her well-established defenses, and she will actually feel safer when she is being held. She will be more receptive to affective memories and current experiences that she habitually guards against. When I am holding her I am confident that she will be more receptive to experiencing both affective attunement as well as the pain of shame.”

  — Building the Bonds of Attachment (1998), p. 95

• “Will you hold her against her will?” Kathy [casework-supervisor] asked.
     “The answer is ‘yes’ but with qualifications,” Allison said. “She is likely to resist entering into both of the experiences of attunement and shame. … I will hold her in spite of her telling me that she wants me to let her go. … On some occasions being held against his or her will has triggered anxiety that is trauma based. …”

  — Building the Bonds of Attachment (1998), p. 95

• … [W]e also explore past shame experiences associated with the child’s history of abuse and/or neglect. The child is aroused as we explore these traumas and self-negating experiences. … In re-experiencing these original abusive events, we are helping the child to reframe the events without the overwhelming emotion of the time and without the pervasive self-contempt. … The child can return, again and again, to this experience in therapy and at home.

  — Facilitating Developmental Attachment (1997), pp. 113-114

• In therapy I will calmly focus on a shame-inducing experience in the child’s life and the act of exploring it does often precipitate a shame-rage response. … [T]he treatment interventions at The Attachment Center at Evergreen (Colorado) have become increasingly similar to the approach that I am recommending. …

  — Building the Bonds of Attachment (1998), p. 294-295

— Scripted Ritual During Holding Therapy —

• At times, the child will resist repeating what he is told to say. That resistance is simply utilized by the therapist without annoyance. The therapist might say: “You don’t want to do what I tell you. No problem. Say, ‘I don’t want to say what you want me to say.’” If this gets no response, the therapist could say, “No problem. I’ll talk for you.” The therapist, then, speaks for the child with much emotional intensity.

  — Facilitating Developmental Attachment (1997), p. 123

• [A]fter telling a child to say that he’s mad at me, I might say, ‘Say it again!’ ‘Louder!’ ‘Again!’ ‘Look in my eyes and say it like you mean it!’ This commonly leads to a level of emotional honesty and intensity that the child seldom shows. … After the child has repeated what I told him to say, it becomes obvious to him that I have not abused him.

  — Facilitating Developmental Attachment (1997), p. 120

• Allison initially spoke for Katie a great deal because it was most unlikely that Katie had the ability or motivation to speak for herself.

  — Building the Bonds of Attachment (1998), p. 133

• “Say to your mom, ‘Leave me alone!” Katie complied. “Louder, Katie!” She again complied. “Louder!” Katie screamed, “LEAVE ME ALONE! “Now look at your mom, Katie, and yell it as loud as you can …”

  — Building the Bonds of Attachment (1998), p. 126

• At times Katie might refuse to repeat a phrase. … Allison simply … spoke for her. … [T]he conversational strategies … are useful in maintaining affective attunement.

  — Building the Bonds of Attachment (1998), p. 291

• Generally, psychodrama focuses on the abusive and/or neglectful parents from the past.

  — Facilitating Developmental Attachment (1997), p. 123

• A common psychodrama sequence is for the past abusive/neglectful caregiver to deny responsibility for the maltreatment of the child and even to blame the child for what occurred.

  — Facilitating Developmental Attachment (1997), pp. 124-125

• The “abuser” then verbally attacks the new parent as lying and also as spoiling the child. The “abuser” tells the child that the new parent cannot be trusted. … A dramatic and therapeutic way to end such a sequence is for the “abuser” to take the child’s arm and say: “You’re coming back with me; I’ll teach you who’s right!” The child most certainly then pulls back and the new parent holds the child tightly and both the child and new parent order the “abuser” to leave. … Since the child usually has ambivalent feelings about the primary caregiver from the past, further psychodrama sessions are often indicated. …

  — Facilitating Developmental Attachment (1997), p. 125

• Katie can transfer the attachment because Jackie would have become a part of herself.

  — Building the Bonds of Attachment (1998), p. 225

— “Contracting” —

• [Sample Contract for therapy:] Child’s Commitment: … I will work to learn because I really do not have another option if I want to be happy.

  — Building the Bonds of Attachment (1998), p. 306

• … I added that [the boy and his mother] both need to agree to follow my directions in each session, and I promised not to tell them to do anything that was too hard, too funny or too boring.

  — Facilitating Developmental Attachment (1997), p. 129

• In the contract there was no mention of the past, although I fully intended to interpret for him at a later time how experiences from his past were making it difficult for him …

  — Facilitating Developmental Attachment (1997), p. 144

• In order for the child to understand what to expect, he is told that he will be held a lot by me and by his parent, and he is given a brief reason for this plan. His history of physical and/or sexual abuse will be mentioned so that he knows that the therapist is aware of his possible anxiety about physical contact. Such abuse truly makes appropriate physical contact more important.

  — Facilitating Developmental Attachment (1997), pp. 104-105

— Regression and Reparenting —

• The therapist needs to consider the parent as a co-therapist …

  — Facilitating Developmental Attachment (1997), p. 40

• Frequently with poorly attached children, the child must be allowed and encouraged to regress and relate to his new parent as if he were a much younger child … Numerous therapy and home activities support the child’s regression … [t]hey include the following: 1) Holding, rocking, feeding, giving him a bottle, combing his hair; …

  — Facilitating Developmental Attachment (1997), p. 89

• … [A]n outsider may see it as punitive when I direct parents to restrict their child’s activities and give him constant supervision for a period of time …

  — Facilitating Developmental Attachment (1997), p. 225

• Since the child is often directionless and easily becomes dysregulated, his parents provide him with a structured routine, and they reduce his choices when these choices lead to repetitive failure. Essentially, the parents allow the child to rely on their own organized inner states, until he is able to gradually develop a more fully defined and integrated inner state himself.

  — “Psychological interventions” (2003), p. 275

• The parent then gives examples of how the daily routine will be different …: “At dinner I’ll be selecting your food, cutting it, and feeding you. That’s a special way for us to be together. It might seem a little strange at first but you’ll enjoy it soon.

  — Facilitating Developmental Attachment (1997), p. 236

• For regression to have a significant effect on the child’s functioning, it needs to be both comprehensive and of long duration. Simply encouraging him to use a bottle occasionally will have no meaningful results. Rather, the parent literally raises him as if he were much younger. Thus, if the 6-year-old boy is to be raised as if he were 2 years old, the parent will have to be prepared to provide him with the extensive supervision and involvement that she would actually give her 2-year-old. … She schedules his day for him since he does not have that skill. He is not ready to choose his clothes or play with certain toys unsupervised nor can he select his food or play outdoors alone. He will have to be helped to dress or manage his hygiene. … She will have to make any baby sitters aware of his regression needs …

  — Facilitating Developmental Attachment (1997), p. 211

• I have worked with a number of children whose foster or adoptive parents were willing and able to give them this gift of regression. Others have questioned this intervention, thinking that the child could feel humiliated and that the interventions could be experienced as punitive.

  — Facilitating Developmental Attachment (1997), p. 211

• Invariably, his reduced choices and his need to be constantly at his mother’s side are not resented. He is neither embarrassed nor secretive about his being given a bottle, sung to, and rocked throughout the day. He often begins to talk “baby talk” with his mother and enjoy her attuned response …

  — Facilitating Developmental Attachment (1997), pp. 211-212

— Deflecting Criticism (2002-3)? —

• … [C]haracteristic of my treatment and parenting model and, I believe, congruent with attachment and trauma literature [is] … Eye contact, voice tone, touch (including nurturing-holding), movement, and gestures are actively employed to communicate safety, acceptance, curiosity, playfulness, and empathy, and never threat or coercion. These interactions are reciprocal, not coerced.

  — Treatment and Parenting Model (30 Nov 2002)

• In looking for treatment strategies that are congruent with how secure attachment are facilitated, it is immediately obvious that the “holding and coercive therapies” described by O’Connor and Zeanah have no place. Such interventions tend to be based on the premise that the child with attachment disorder needs to be forced to obey the adults in his life. … Clearly such interventions are not based on principles derived from attachment theory and research.

  — “Psychological interventions for the spectrum of attachment disorders and intrafamilial trauma,” (Sep 2003), 5(3):271-277 at 272-273

• The child’s resistance to parenting and treatment interventions is also accepted and contained and is not made to be shameful by the adults.

  — Treatment and Parenting Model (2002)

• [I had studied] the work of Milton Erickson. … A central feature involved accepting whatever “resistance” was being manifested. … Still, many children manifested more intense resistance than I had anticipated. … The child appeared to be relaxed, he or she had control over the pace of the exploration, the parents who were present conveyed understanding and support, and still many children remained reluctant participants in the therapeutic process.

  — Foreword to Creating Capacity for Attachment by Arthur Becker-Weidman & Deborah Shell (OK: Wood N Barnes, 2005), p. xi.

• I am confident that all interventions I use are consistent with principles of attachment and trauma theory and research.

  — Treatment and Parenting Model (2002)

• Interventions that involve nurturing touch and physical proximity can also be done more safely with the child when the parent is the adult providing them. However, if the parent is not resolved with respect to her own history, then an initial period of separate individual treatment for the parent and the child may be indicated.

  — “Psychological interventions” (2003), p. 274

• These children are also often not comfortable with touch and thus are deprived of the safety, comfort, and validation that being touched or held can bring.

  — “Psychological interventions” (2003), p. 274

• When the child is in distress, manifesting either fear, shame, or anger, he is brought closer to the parent in order to be able to co-regulated his dysregulated affective state.

  — “Psychological interventions” (2003), p. 275

• The distressing affects of shame and fear need to be co-regulated by the therapist and caregiver before continuing in the interactions.

  — “Psychological interventions” (2003), p. 275

— Attachment Therapy Research —

• … [T]here is little supporting research for these treatment interventions.

  — Facilitating Developmental Attachment (1997), p. 9

• When there is a lack of consensus regarding the definition of attachment disorder as well as the means of assessing it, there most certainly will be considerable difficulty in attempting to provide treatment for the “undefined” disorder, and extreme difficulty in determining if such treatment for “attachment disorder” is effective. It might be more accurate to say that research on attachment disorder treatment is now impossible given the current state of affairs.

  — “Psychological interventions” (2003), p. 272

— Additional Parenting Techniques —

• … [W]hen their child is screaming loudly in response to routine discipline … [a] more effective response might be … [r]eward the scream, with enthusiasm, and give the child a cookie.

  — Facilitating Developmental Attachment (1997), p. 230

• Katie’s doing a lot of sitting since she does not want to follow the most basic expectations.

  — Building the Bonds of Attachment (1998), p. 165

• The child who steals will be shown designated items to steal and rewarded if the items are not found by anyone in one week.

  — Facilitating Developmental Attachment (1997), p. 231

• An audio monitor and/or door alarm is considered for the bedroom.

  — Facilitating Developmental Attachment (1997), p. 238

• If he has hit another child and exclaims: “He took my ball and made me mad!” we might respond: [“]Good thinking. You now know that your anger needs to be integrated better if you’re going to avoid consequences like you’re now going to get for hitting that kid. Good luck learning how to do it.[”]

  — Facilitating Developmental Attachment (1997), p. 239

• A much more effective approach, which conveys a healthier message to the child, is to present the consequences without any reminders, explanations, second chances, or discussions.

  — Facilitating Developmental Attachment (1997), p. 241

• PARENTAL SELF-CARE … 1.) Recall often that you are not the source of your child’s problems …

  — Facilitating Developmental Attachment (1997), p. 212

• Maintain a support network with other parents of poorly attached children. Many parents and professionals will not be able to understand what you are experiencing.

  — Facilitating Developmental Attachment (1997), p. 213

— The Therapy, the System, and the Child —

• I was asked to provide treatment for Jenny. I consented when the Department of Human Services agreed not to try to place her for adoption for at least 1 year.

  — Facilitating Developmental Attachment (1997), p. 181

• … Katie [age 7] will be able to form an attachment with adoptive parents after first learning how to do it with Jackie.

  — Building the Bonds of Attachment (1998), p. 207

• [Allison testifying in court for termination of parental rights of birth mother who had been largely attempting to follow court recommendations for reunification:] “Katie demonstrates symptoms consistent with Reactive Attachment Disorder. … She is extremely oppositional … Treatment needs to be very intensive … it will take an exceptional parent to raise her …

  — Building the Bonds of Attachment (1998), pp. 231-233

— Name-Dropping —

• A good description of how to provide consequences to a child’s behaviors … can be found in Parenting with Love and Logic (1990) by Foster Cline and Jim Fay. Deborah Hage (1995) presents a good summary of the principles that she employs, as a parent and therapist, in her work with unattached children.

  — Building the Bonds of Attachment (1998), pp. 285-286

• I am indebted to Connell Watkins, Deborah Hage, Foster Cline … for many of these concepts.

  — Facilitating Developmental Attachment (1997), p. 215

• Martha Welch (1989) in Holding Time, presents a treatment model … While holding her child, the mother forcefully expresses the full range of her own affect to her child … Such intense reciprocal expression of affect leads to a “breakthrough” of intimacy …

  — Building the Bonds of Attachment (1998), p. 292

• Therapeutic affective attunement experiences … are also considered to be central to Ann Jernberg’s Theraplay (1979) … emphasiz[ing] physical contact, eye contact …

  — Building the Bonds of Attachment (1998), p. 291

— Endorsements, References and Acknowledgments —

• I discovered your book. It is so thorough, balanced and clear in describing these kids and your parental attitude that is so effective in getting through to them. Thanks for writing it.

  — Review of Nancy Thomas’s When Love is Not Enough: A Guide to Parenting Children with RAD — Reactive Attachment Disorder
  (Glenwood Springs, CO: Families by Design, 1997), [inside front cover]

• [There are approving references in Facilitating Developmental Attachment (1997) to the works of Foster Cline (Hope for High Risk and Rage Filled Children), Richard Delaney & Frank Kunstal (Troubled Transplants), Gregory Keck & Regina Kupecky (Adopting the Hurt Child), Martha Welch (Holding Time), and Milton Erickson.]
• [The references in the 1997 book, except Keck & Kupecky, are repeated in Building Bonds of Attachment (1998) to which are added approving references to Cline & Jim Fay’s Parenting with Love and Logic, Deborah Hage’s contemporaneous piece on “Therapeutic Parenting,” Ann Jernberg’s Theraplay, and Gerald Nelson’s Who’s the Boss?.]
• [Also in Facilitating Developmental Attachment (1997, p. vii), Hughes makes these acknowledgments: “[T]he Attachment Center in Evergreen, Colorado, served as the initial impetus for my exploring ways to touch and hold these children in therapy and to raise them at home. … Connell Watkins, Nancy Thomas, and Deborah Hage were especially willing to share their understanding and skills in working with children with attachment problems.”]