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ANZJFT Volume 27 Number 2

June 2006

Contents

In Brief: Coming Events, Jottings and Announcements
Editorial: Attachment and Family Therapy	Stephen Allison
Parent and Child Therapy: An Attachment Based Intervention for Children with Challenging Problems	Heather Chambers, Jacqueline Amos, Steve Allison and Leigh Roeger
Attachment and Risk of Future Harm: A Case of Non-accidental Brain Injury	Kasia Kozlowska and Sue Foley
Sustaining People Right through their Lives: Interview with Graham Martin	Jackie Amos
Attachment and the Repetition of Trauma: A Case Study of Attachment-Based Crisis Intervention	Paul Cammell
Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations	Kasia Kozlowska, Sue Foley & Pat Crittenden
A Dynamic-Maturational Model of Attachment	Patricia M. Crittenden

Abstracts & Sample Articles

In Brief: Coming Events, Jottings and Announcements

View article. [PDF format - 53KB]

Editorial: Attachment and Family Therapy

by Stephen Allison
View article. [PDF format - 66KB]

Parent and Child Therapy: An Attachment Based Intervention for Children with Challenging Problems

by Heather Chambers, Jacqueline Amos, Steve Allison and Leigh Roeger

Parent and Child Therapy (PACT) is an attachment based intervention for children aged between four and 12 years old experiencing emotional and behavioural problems. It is appropriate for distressed parent-child relationships which have not responded to systemic family therapy. PACT seeks to reframe parent-child relationship distress using narrative techniques and experiential tasks based on the concept of supported looking. Therapy occurs in parallel for parent and child using a one-way screen. PACT improves parents' reflective capacity and sensitivity, and for the child's sense of security in her primary attachment relationship. An outline of the four stages of PACT is presented along with a case study to illustrate the course of PACT. Finally we discuss the dissemination of PACT within a busy child and adolescent mental health service and outline our plans for future outcome evaluation.

Attachment and Risk of Future Harm: A Case of Non-accidental Brain Injury

by Kasia Kozlowska and Sue Foley

Decision making in cases of non-accidental brain injury is complex. Courts often view 'alternate care' as a means of ensuring that children are protected from further physical abuse. It is important for treating and assessing clinicians to present the court with a broad systems perspective highlighting the multiple factors which combine to impact on the child's future safety, welfare and wellbeing. These include risk and protective factors in the family of origin, the family's openness to monitoring and treatment; the child's needs for long-term attachment relationships, and the risks associated with alternate care. This paper highlights the need to consider long-term attachment needs as part of any risk-of-harm assessment for young children who have been maltreated. Attachment issues are considered in the case of Nellie, a 17-month old toddler with a serious and unexplained non-accidental brain injury.

Sustaining People Right through their Lives: Interview with Graham Martin

by Jackie Amos

In this interview Graham martin reflects on his long career in child and adolescent mental health. He shares his formative experiences with some of the pioneers in the field of attachment theory and the many varied ways that this information has influenced his work in the provision of care to children in hospital, health promotion, understanding the distress of suicidal youth, and his ongoing therapeutic work with families.

Attachment and the Repetition of Trauma: A Case Study of Attachment-Based Crisis Intervention

by Paul Cammell

This article explores the difficult case of a 16 year-old who was causing a great deal of anxiety by presenting with dramatic behaviour, such as leaping off buildings, swallowing needles and poisons, and jumping in front of cars. The case study explores a six-month period of crisis intervention, which focused on the unique kind of attachment relationship that existed between the teenager and his mother. The mother had experienced recurrent traumatisation prior to his birth, and it was found that the after-effects of this traumatisation must have influenced the teenager's early attachment experiences and subsequent development. The attachment-based therapy treated the crises as primarily 'relational crises'. The therapy involved investigating and sharing formulations about their attachment history, cultivating an insight into the relational or dynamic determinants of the teenager's crises. Broader suggestions are made concerning the application of attachment theory to different approaches in family therapy, as well as to our understanding of phenomena such as transgenerational traumatisation.

Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations

by Kasia Kozlowska, Sue Foley & Pat Crittenden

Children are put at risk of emotional and physical harm when parents seek unnecessary medical care. Understanding why parents seek medical interventions that create risk for their children requires us to consider how past experience, and its manifestation in conscious and unconscious memory, influences behaviour in the present. Past experiences of danger affect how parents interpret dangerous situations in the present and how they organise their child's protection. This paper uses a detailed case example to demonstrate how the use of a specific interpretive tool in conjunction with the adult attachment interview can greatly assist the process of therapeutic intervention with parents who are seen to display factitious illness by proxy. When coded using the Dynamic-Maturational Method, the Adult Attachment Interview (AAI) allows assessment of Implicit, Explicit, and Integrative dispositional representations (memory traces) and the developmental process through which parents have learnt to attribute meaning to information and to organise their behaviour accordingly. In this case study, psychosocial assessment of the family included an AAI for each parent. The use of this assessment tool both aided the therapy team in the process of case formulation and intervention planning, and had a therapeutic value in and of itself. The approach taken represents a marriage of psychodynamic and systemic therapeutic principles, using an understanding of the legacy of past experience to effect change in present family relationship dynamics. We argue that treatment is more likely to be effective if the parents and professionals have a shared understanding of the parents' intentions and the developmental process that led to unsafe behaviour which requires change.

A Dynamic-Maturational Model of Attachment

by Patricia M. Crittenden

This paper provides an overview of an attachment-based approach to formulation of behavioural and psychiatric disorder. The dynamic-maturational model (DMM) of attachment places many such problems within a context of family attachment relationships. In the DMM, neurological maturation interacting with experience is central to the self-protective strategies that individuals develop to regulate familial attachments. When the relationships fail to protect child (or parent), more extreme strategies are organised to wrest some measure of safety and comfort from an otherwise threatening environment. A wide range of such strategies is described. It is argued that recognising attachment strategies in patients is crucial to providing helpful treatment (and to reducing the risk of inappropriate treatment).