Attachment Focused Family TherapyAn overview

Spencer Anderson, LCSW

Marianne Schram, LCSW

Attachment Theory

An attachment relationship is characterized by:Proximity seeking - The young child will attempt to remain within the protective range of parents. This protective range is reduced in a strange or threatening situation. Secure base effect - The presence of an attachment figure fosters security in the child. This results in reduced attention to attachment considerations and in confident exploration and play. Separation protest - Threat to the continued accessibility of the attachment figure gives rise to protest and active attempts to ward off the separation.

The attachment system is triggered: Within the child - feeling sick, tired, hungry, hurt.Within the environment - frightening, threatening, or confusing events. Within the caregiver - threats of separation, emotional unavailability, and feeling rejected.

Exploratory system

Comfort system

Dimensions of CaregivingSensitivity – Insensitivity: The extent to which the parent monitors the child’s needs and responds to these predictably and consistently.  Acceptance – Rejection: The extent to which the parents accepts the child and the emotional state being signaled. Cooperation – Interference: The cooperative parent responds to the infant as if it is a two-way relationship. The interfering parents will tell the child how he or she should be, for example: “You are not hurt.” Accessibility – Ignoring: The extent to which the parent is emotionally available to the child.

Secure AttachmentTrust in sensitive, responsive caregiving

Child Feels:positive towards self and others

“I can rely on me, I can rely on you.” This child is rewarding to care for.

Secure AttachmentTrust in sensitive, responsive caregiving

Child Feels:positive towards self and others

“I can rely on me, I can rely on you.” This child is rewarding to care for. Ambivalent Attachment

Expectation of inconsistent caregivingChild Feels:

negative towards self, needy towards others

“You will sometimes attend to me, I fear abandonment.”

This child is emotionally tiring to care for.

Ambivalent AttachmentExpectation of inconsistent caregiving

Child Feels: negative towards self, needy towards

others“You will sometimes attend to me, I fear

abandonment.” This child is emotionally tiring to care for.

Avoidant AttachmentExpectation of rejecting caregiving

Child Feels: reliance towards self, negative towards

others“I will do it myself, I fear the loss of

closeness if I need you.”This child feels distant and therefore

is not rewarding to care for.

Avoidant AttachmentExpectation of rejecting caregiving

Child Feels: reliance towards self, negative towards

others“I will do it myself, I fear the loss of

closeness if I need you.”This child feels distant and therefore

is not rewarding to care for.

Disorganized AttachmentExpectation of frightening caregiving

Child Feels: negative towards self, negative towards

others“I will control. I am powerful. I am scared

and fearful.”This child is overwhelming to care for.

Disorganized AttachmentExpectation of frightening caregiving

Child Feels: negative towards self, negative towards

others“I will control. I am powerful. I am scared

and fearful.”This child is overwhelming to care for.

Attachment Styles

Meeting Hidden Need•Support around being apart – child needs to learn to be apart and to feel secure that parent will be there when needed. •Support to trust knowledge of the world and not just rely on feelings.•Child needs to learn that s/he can trust that parents will do as they say.

Meeting Hidden Need•Support around being apart – child needs to learn to be apart and to feel secure that parent will be there when needed. •Support to trust knowledge of the world and not just rely on feelings.•Child needs to learn that s/he can trust that parents will do as they say.

Meeting Expressed Need•Reassurance of availability to the child •Predictability and consistency•Structure and routine•Co-regulation of expressed emotion

Meeting Expressed Need•Reassurance of availability to the child •Predictability and consistency•Structure and routine•Co-regulation of expressed emotion

Expressed Need•I can’t trust in your availability. •I need you to attend to me all the time.

Expressed Need•I can’t trust in your availability. •I need you to attend to me all the time.

Meeting Expressed Need•Offer comfort and reassurance when needed.•Help the child to explore and learn in the world.

Meeting Expressed Need•Offer comfort and reassurance when needed.•Help the child to explore and learn in the world.

Hidden Need•I will not show my need to separate and explore.•I will pull you in and push you away to keep you noticing me.

Hidden Need•I will not show my need to separate and explore.•I will pull you in and push you away to keep you noticing me.

Expressed Need•I will tell you when I need comfort and reassurance. •I will enjoy when you help me to explore.

Expressed Need•I will tell you when I need comfort and reassurance. •I will enjoy when you help me to explore.

Parenting the Child with a Secure Attachment Pattern

Parenting the Child with an

Ambivalent Attachment Pattern

Meeting Expressed Need•Gently challenge the need.•Help child feel comfortable needing and being helped by parent.

Meeting Expressed Need•Gently challenge the need.•Help child feel comfortable needing and being helped by parent.

Expressed Need•I will act like I need to explore even when I need comfort.•I will not show my need for comfort and reassurance.

Expressed Need•I will act like I need to explore even when I need comfort.•I will not show my need for comfort and reassurance.

Meeting Hidden Need:•Help to feel comfort and safety with the parent.•Support to accept nurturing.•Co-regulation of emotion that is hidden.•Help to trust emotion and to know that it will be acceptable to others.

Meeting Hidden Need:•Help to feel comfort and safety with the parent.•Support to accept nurturing.•Co-regulation of emotion that is hidden.•Help to trust emotion and to know that it will be acceptable to others.

Hidden Need•I will do it by myself.•I fear my need of you. •I will push you away.

Hidden Need•I will do it by myself.•I fear my need of you. •I will push you away.

Meeting Expressed Need•Help child trust in your ability to meet his/her need. •Help child trust in your ability to keep him/her safe.

Meeting Expressed Need•Help child trust in your ability to meet his/her need. •Help child trust in your ability to keep him/her safe.

Meeting Hidden Need•Help child to feel safe.•Maintain a low stress environment.•Help child to trust his/her own thinking and feeling.•Help child develop emotion regulation.

Meeting Hidden Need•Help child to feel safe.•Maintain a low stress environment.•Help child to trust his/her own thinking and feeling.•Help child develop emotion regulation.

Expressed Need•I will not need you. •I will be in control.

Expressed Need•I will not need you. •I will be in control.

Hidden Need•I can’t explore the world.•I can’t seek comfort.•I am too busy keeping myself safe.

Hidden Need•I can’t explore the world.•I can’t seek comfort.•I am too busy keeping myself safe.

Parenting the Child with an Avoidant Attachment Pattern

Parenting the Child with a Disorganized Attachment Pattern

As children grow they make a mental video of what and how they do things with their parents. •The mental video is more about emotions and sensation than thoughts and memories•Influences how a child relates to other people•Influences how a child feels about themselves

Over time, what a parent and child do with each other becomes stored in their minds •Helps them develop mental “habits” as they repeat the same routine. They become “models” of what a parent does and what a child does.•Habits are connected to big emotions. •Models help children know what parents will do next.•Models help parents know what a child will do next.

Models help children figure out who they are•A child might hold a positive model that views themselves as lovable and good at things – they view others as available, loving, interested and responsive•A child might hold a negative model of themselves as unlovable, uninteresting, unvalued – they view others as unavailable, neglectful, rejecting, unresponsive, and hostile

Models are STABLE

The model a child creates of his/her parents will usually stay the same if little is done to change it•If a parent who is usually loving, gets angry then a child will still view the parent as loving after they’ve made up•If a parent is usually uninterested, then child will usually think that s/he is not interesting, even when a parent acts interested once in a while.

Models can CHANGE. A child’s model of parent can change when •A parent acts the same way over and over (consistent)•The change is bigger than what’s normal (dramatic)Examples:•Severe illnesses•Abuse/neglect•Divorce•TherapyEarly models are most difficult to change

Internal Working Model

“How we experience our children, is how they learn to experience themselves.”

Shared Intentions About Time Together•Both the parent and the child want the same thing from their time together. Both want to let the other:

Teach and learnShare and understandSpeak and listen

•The reverse is also true. If a child isn’t open to understanding, listening, or learning a parent will have a difficult time teaching, sharing, or speaking to him or her.

Shared Intentions About Time Together•Both the parent and the child want the same thing from their time together. Both want to let the other:

Teach and learnShare and understandSpeak and listen

•The reverse is also true. If a child isn’t open to understanding, listening, or learning a parent will have a difficult time teaching, sharing, or speaking to him or her.

Matching Affect •Being attuned with your child. Expressing similar:•Intensity•Rhythm•Matching nonverbal/body language•Parents are telling child that they “get it” or understand what child is going through. •Don’t match emotions. A parent can express the intensity of anger without being angry; a parent can express the rhythm of depression without being sad. •This helps the child regulate his/her emotions. A parent is “co-regulating” with the child because the parent is being emotionally stable and in control. •It’s more powerful to “show” or “experience” regulating emotions than just to say it. Child: “No one ever listens to me!”Parent: [matching rhythm and intensity] “No one! How hard that must be if it seems that no one listens to you!”

Matching Affect •Being attuned with your child. Expressing similar:•Intensity•Rhythm•Matching nonverbal/body language•Parents are telling child that they “get it” or understand what child is going through. •Don’t match emotions. A parent can express the intensity of anger without being angry; a parent can express the rhythm of depression without being sad. •This helps the child regulate his/her emotions. A parent is “co-regulating” with the child because the parent is being emotionally stable and in control. •It’s more powerful to “show” or “experience” regulating emotions than just to say it. Child: “No one ever listens to me!”Parent: [matching rhythm and intensity] “No one! How hard that must be if it seems that no one listens to you!”

Focusing on the Same Subject

•When parent and child are attending to separate things, they are not experienceing either as intersubjective. They are having separate experiences. •If a parent focuses on what a child experiences, a child is much more likely to be influenced by a parent’s point of view. •A parent is not trying to convince, judge or teach. A parent simply offers his or her own perspective.Child: [after being told she couldn’t do something] “I’m not going to talk about it with you, you’ll never be a good parent!”Parent: [matching rhythm and intensity] “I know you’re really angry about this.” [A little more calm] “I’ve just noticed that we’ve done really well talking things through lately and it seems to help us both.”

Focusing on the Same Subject

•When parent and child are attending to separate things, they are not experienceing either as intersubjective. They are having separate experiences. •If a parent focuses on what a child experiences, a child is much more likely to be influenced by a parent’s point of view. •A parent is not trying to convince, judge or teach. A parent simply offers his or her own perspective.Child: [after being told she couldn’t do something] “I’m not going to talk about it with you, you’ll never be a good parent!”Parent: [matching rhythm and intensity] “I know you’re really angry about this.” [A little more calm] “I’ve just noticed that we’ve done really well talking things through lately and it seems to help us both.”

The Three Parts of Intersubjectivity

“PACE represents the characteristics of a personal attitude that creates safety and emotional intimacy, openness and delight within the parent-child relationship. It provides a context in which any conflicts or behavioral problems can find an easier resolution. It provides a balance whereby affective and reflective abilities are primed to respond in enjoyable, as well as in stressful situations. Most important, it enables the parent to perceive her child beyond any challenging or worrisome behaviors, and to experience her child’s permanent place in her mind and heart. Because of the magic of intersubjectivity mixed with love, PACE enables the relationship to truly transform both parent and child.”

~ Dr. Daniel Hughes

Playfulness

Acceptance

Curiosity

Empathy

PLAYFULNESS

Facilitate the Capacity for Fun and Love • Create reciprocal intersubjective experiences• Stay physically close• Integrate and resolve own issues from own attachment history• Use eye contact, smiles, touch, hugs, rocking, movement, food• Be emotionally available in times of stress• Offer safe surprises• Be playful, nurturing, and hold your child• Make choices for your child and structure his or her activities• Promote reciprocal communication of thoughts and feelings, shared

activities• Use humor and gentle teasing• Be mindful of basic safety and security• Offer opportunities to imitate parents• Engage in spontaneous discussions of past and future• Develop routines and rituals to create a mutual history

When we encourage playfulness, we are referring to an attitude of levity and light-heartedness. Playfulness is the opposite of heaviness and intensity. When we adopt a playful attitude, we communicate to our children that the strength of the relationship is larger than minor (and sometimes more than minor) irritations. Family members with a playful attitude don’t take themselves too seriously and are able to laugh at their mistakes.

Thoughts•Help child to identify and verbalize thoughts and feelings.•Help child learn to use words to communicate thoughts and feelings.

Thoughts•Help child to identify and verbalize thoughts and feelings.•Help child learn to use words to communicate thoughts and feelings.

Feelings•Help child to express feelings.•Teach child to identify and express inner life.•Help child to know that parent understands and empathizes. •Guess and put into words reasons for strong emotions.

Feelings•Help child to express feelings.•Teach child to identify and express inner life.•Help child to know that parent understands and empathizes. •Guess and put into words reasons for strong emotions.

ThinkingHelps Child To:•Grow capacity to think about behavior of self and others.•Experience positive sense of self and trust in others. •Change belief and attributions about self and others.

ThinkingHelps Child To:•Grow capacity to think about behavior of self and others.•Experience positive sense of self and trust in others. •Change belief and attributions about self and others.

BehavingChild Needs to Experience:•Clear and explicit behavioral rules.•Empathy with discipline.•Calm, clear response linked to behaviors.

BehavingChild Needs to Experience:•Clear and explicit behavioral rules.•Empathy with discipline.•Calm, clear response linked to behaviors.

FeelingParent:•Controls emotional rhythm.•Provides empathy and support for negative emotions. •Facilitates experience of positive emotion. •Helps child to understand and manage emotion.

FeelingParent:•Controls emotional rhythm.•Provides empathy and support for negative emotions. •Facilitates experience of positive emotion. •Helps child to understand and manage emotion.

ACCEPTANCE

Child

What are we accepting? We are accepting our child; his or her experience, thinking, feelings, and sensations. It is critical (if we want health in relationship with our children) that we can differentiate between who they are as people and the behaviors they display. “I see you and know you are good. I see your behavior and it is not okay.” We are not necessarily accepting the behavior of our child, but we are accepting that our child is responding the best s/he can and we are willing to take the time to understand what is going on in his or her world that drives his or her actions. From this place, behavior change happens as a collaborate effort, rather than a clash of wills.

CURIOSITY When parents use curiosity towards their child’s internal story:• They work together with their child to understand their

experience• They have a greater impact/influence on their child’s

internal storyParents• May struggle using curiosity• Child’s beliefs, perspective, experiences may make

parents feel:o They are not doing well enougho That their children don’t love themo Reactivity due to their own discomforto Painful reminders about how they were parentedo Secondary trauma: shame

Children• May become anxious with parents' curiosity• May have discomfort due to how they felt

parents reacted in the past

Steps to being Curious:•Start with not knowing (no assumption, no venting frustrations)

•You don’t know and don’t assume that your child knows•Make guesses

•How might your child see, feel, think about a given situation? •Evaluate your child’s response

•Does it help the story continue (even if your child is still upset)?•Does your child’s body language or facial expression change?•Does the discussion turn to how each person feels rather than who’s wrong and who’s right?

EMPATHY

How to Communicate Empathy 

Focus on how child is experiencing him/herself, rather than about what’s being said

Convey empathy rather than giving advice Focus on how your child responds rather than

what your child says

What Reduces Empathy 

Reassurance Talking out of (reasoning) Problem solving Nagging Minimizing

Understanding Shame and Guilt 

“You are so very good, even when your behavior is lousy.” 

• Shame focuses on self, guilt focuses on behavior.• Shame is a much more painful affect than guilt.• With shame one experiences feeling small, worthless and

powerless; with guilt, one experiences feeling tense, remorseful, and regretful.

• With shame one is concerned with the other’s evaluation of oneself; with guilt one is concerned with the effect of one’s behavior on the others.

• With shame one desires to hide, escape or attack; with guilt, one desires to confess, apologize, and repair the relationship.

• With shame, the self is split between the observed (devalued) and observing self. With guilt, the sense of self remains unified and is not devalued.

Behind the Shield Lives:

•Sadness•Fear•Judgment•Worthlessness

Blame

MinimizingAnger & Rage

Lying

Shame Shield

Shame (continued) Children express shame through behavior. Often parents assume misbehavior is an attempt to be hurtful to the parent, to manipulate, or otherwise control a situation. Most often, however, misbehavior is a child’s attempt to manage deep shame.

Sequence when working with Parents

1. Use PACE to listen for reasons for seeking treatment (history, better/worse, what’s been tried, successes, how it affects them)

2. Curious about other aspects of the family that might be contributing to the stressors (employment, moves, marriage, health, substance abuse, extended families)

3. Curious about their perceptions of their child’s strengths as well as their own (recent joy)4. Curious about hopes and dreams when they decided to become parents5. Curious about when they first started to doubt whether their hopes and dreams would come

true6. Curious is they have experienced grief over a sense that their hopes and dreams might never

come true7. Curious about any feelings of shame over a sense of failing as parents  

Therapist must be experienced by the parents as:1. Being good people 2. Who are doing the best that they can for their children and

family3. Who love their children and want to improve their relationships

with them

ParentingApproachPleasure

Child ReadingMeaning Making

ParentingApproachPleasure

Child ReadingMeaning Making

Blocked CareBlocked Care

ChildChild

ParentParent

Parenting is Abusive and/or

Neglectful

Parenting is Abusive and/or

Neglectful

No Give or Take (Due to Parent

or Child)

Chronic Blocked Care: Relates to long-standing difficulties. No bond, no desire to approach from the start of the relationship.Acute Blocked Care: Difficulty under acute stress linking to current crisis.Child Specific Blocked Care: Response to child’s attachment trauma difficulties. Unique temperament/quality in child can trigger memory of past unresolved relationship(s).

Chronic Blocked Care: Relates to long-standing difficulties. No bond, no desire to approach from the start of the relationship.Acute Blocked Care: Difficulty under acute stress linking to current crisis.Child Specific Blocked Care: Response to child’s attachment trauma difficulties. Unique temperament/quality in child can trigger memory of past unresolved relationship(s).

ParentingApproachPleasure

Child ReadingMeaning Making

ParentingApproachPleasure

Child ReadingMeaning Making

ChildChild Give and Take

ParentParent

Parent-Child Relationship

Parent-Child Relationship with Blocked Care

Parenting is a Job

with No Pleasure

Parenting is a Job

with No Pleasure

oror

executive system

No executive system

The Parental Approach System: A motivational system that provides the experience of safety for the parent so that he or she can approach the child, staying open and engaged with the relationship. This system enables parents to be close to their children and not get defensive.

The Parental Reward/Pleasure System: Enables parents to get pleasure from parenting. It is part of our social engagement system. We are motivated to engage with each other. This is a reciprocal process as each enjoys being with the other. If we do not experience pleasure we may disengage from the relationship.The Parental Child Reading System: Enables parents to understand and empathize with the child’s inner experience. It makes sense of verbal and non-verbal communication from the child. This system provokes a deep interest in the child, the parent wants to make sense of the child, and to recognize the uniqueness of the child. Attuned relationships facilitate the child reading system.

The Parental Meaning Making System: Enables parents to understand themselves as parents. They construct a narrative or story about being a parent. This links with their past history of attachment and relationships. The parent makes meaning through the lens of past relationships. Under stress parents tend to make negative meanings.

The Parental Executive System: Enables us to emotionally regulate, to focus our attention, and to control our impulses. This system facilitates planning and problem solving. A parent uses the executive system to monitor the quality of the parent-child relationship and engage in timely, effective repair of the relationship. This requires cognitive flexibility, the ability to adapt to new information or changing circumstances. This system also allows us to change our beliefs when we have new information. When we parent, we rely on this system to monitor our feelings and actions and the degree to which we are attuned to our child. It helps us cope with any conflicts between parental and non-parental feelings and it allows us to reflect on our experience of being a parent.

USE PACE WHEN INTERACTING WITH YOUR CHILD AND YOUR PARTNER

DO MINDFULNESS PRACTICES SUCH AS COMPASSION MEDITATION

TRY YOGA: HOLDING DIFFICULT POSES WOULD ACTIVATE THE EFFORTUL CONTROL DORSAL ACC SYSTEM

REFLECT FOR AWHILE EVERY DAY AND DO A COMPASSIONATE REVIEW OF HOW YOU DID BEING PACEFUL WITH YOUR FAMILY

WORK ON RESOLVING OLD UNRESOLVED CONFLICTS FROM THE PAST BECAUSE THIS REQUIRES HOLDING THE CONFLICT IN YOUR MENTAL WORKSPACE AND CREATING A NEW SYNTHESIS , A PROCESS THAT REQUIRES THE INTERPLAY OF THE DORSAL ACC AND THE DORSOLATERAL PFC

Working with Parents to Resolve Blocked Care

Re-Thinking DisciplineRegulating

EmotionsHow can a child REALLY know they’ve done something wrong?

Connection before Correction

• shame• trauma & prefrontal cortex• trust & Plan B

Consequences:

o Safetyo Proximityo Relationalo Reparativeo Naturalo Clear o Postpone

AttunementAttunement

Limits & ConsequencesLimits & Consequences

Relationship Repair

Relationship Repair

Children need regulation before consequences; otherwise whether they are reparative, logical, natural or anything else they will not work. Therefore parents/schools need to develop processes that are regulatory based rather than consequence based. If the child is regulated (sensory and emotionally), then understood and their internal experience validated (ie PACE), then they will experience remorse and want to make amends, at this point they can be helped to think of a consequence that is reparative.