Sunday, January 5, 2014

A 10 Step Approach to Create an Attachment Toolkit for Parents Dealing with a Sub-Optimal Relationship With Their Child

Over the past few years I have worked with a number of families where the relationship between the parent(s) and their child had been sub-optimal. Often the underlying reason for this was due to attachment issues. Typically what I have done in these cases is worked with the clients to understand the issues and eventually develop what I have been calling an Attachment Toolkit.

Based on feedback from clients, I have now developed an easily understood 10 step approach aimed at creating and implementing this Toolkit.

The Attachment Toolkit outlines a number of approaches and ideas for how the parent(s) can better manage their relationship with their child. These are focussed on either reinforcing a secure attachment relationship, or repairing an insecure one.

The Toolkit is developed based on client specific examples of interactions between parent(s) and child that will have been identified in my intake form and discussed with the Parents. It will outline suggestions for how to handle these differently in the future.

The 10 step approach is outlined below.

Session
Interaction
Attending in Counselling Room
Activity
Note
1a
Face to Face 
Parent(s)
Initial meeting where I meet the parent or parents, understand the background and introduce my assessment form. This is where the parent answers a series of questions about the child and their relationship with him or her.
1b
Parent Fills out the form.
N/A
The parent(s) fills out the form. The form covers areas such as
·          The Child’s behaviour.
·          The Parent’s relationship with the child.
·          The Parent’s experience of being parented.

Filling out the form takes from one to one and a half hours.

It process of filling out the form helps the parent to think through their relationship and its history.

The parent(s) then post this assessment form to me.
This has to be done by both parents.
2
Analysis time by Sheila.
N/A
I read and assess the forms to understand   the parent child relationships, both conscious and unconscious. This is so that I can focus my subsequent questioning and discussion in order to highlight issues and areas to address early in the programme.
3
Face to Face
Parent(s)
I review the form with the parent(s) and ask further clarification questions.

I take the Parent(s) through some initial verbal suggestions on how to deal with the child based on the interaction to date
4
Face to Face
Child & Parent(s)
Initial session with the child and parent
5 to 8
Child (Potentially parent(s) also for some sessions)
The exact structure of sessions 5 through 8 are determined based on the previous sessions, the child’s age, the presenting issues and other factors. Typically the child will be in all of them. The parent(s) may also attend some or all or part of these also.
9
Analysis time by Sheila.
N/A
I prepare a toolkit of approaches and ideas for how the parent(s) can manage situations with the child on an ongoing basis. These are focussed on either reinforcing a secure attachment relationship, or repairing an insecure one.

The toolkit will be based on client specific examples of interactions between parent(s) and child that will have been identified in the assessment form and discussed in previous sessions. They will outline suggestions for how to handle these differently in the future.
10
Face to Face
Parent(s)
I take the parent(s) through the toolkit and answer any queries. I also discuss with the parents what form follow up support may take.

I recommend a minimum of two follow up sessions over the subsequent month with the parents.

Depending on other factors additional counselling for the child might be appropriate.

If you would like more information on this, please leave a comment or get in Contact.

All the best,

Sheila


Sunday, September 8, 2013

What to Do When You Have A Row With Your Child


Fostering a good parent-child relationship is as important, if not more important, than tending to the practicalities of parenting. Attachment Theory has taught us that this relationship is the cornerstone of the child’s personality. The originators of the theory hypothesised that a child would develop the following three core skills in a secure attachment relationship with its primary carer. The first of these is the ability for a child to be in control of their own feelings. They termed this emotional regulation. The second is self-reliance or a sense of independence. The third is social competence or an ability to manage relationships and in particular, peer relationships. (I will return to these in a future blog post).

It is therefore important that the relationship between a carer and a child fosters development of these skills. We also know from the theory that personality formed in infanthood, typically endures into adulthood. Another significant feature of this relationship is that patterns of parent-child communication developed in the early years of one generation tend to be passed down unchanged to the next generation. (This is another subject I will return to in another blog post). 

So given the primacy of this relationship here are a few suggestions of what a parent can do when they have a disagreement with their child.

  • The first thing to do is to seek to repair the relationship quickly. Children need to learn that when relationships break down, they can be repaired. By resolving a difficult situation, you are modelling to them that relationships matter and that they need to be rectified when they go wrong.
 
  • Do not bring up past misdemeanours. Children are always learning how best to do things and this takes time. Reminding a child of his past failings does not increase his self-esteem or level of competency.

  • When you see the child trying to resolve a situation with a sibling/friend, comment positively on it afterwards. Remember to reward effort not excellence. The child is learning and a positive comment from you will increase his self-esteem, make him more self-reliant and competent in negotiating relationships for the future.

  • Remember your emotions are your own responsibility, not your child’s. Therefore, it is important when negotiating a disagreement that you are in control of your own. However, you are also responsible for helping your child to control/regulate his emotions. This is done by remaining calm and explaining to him what has gone wrong and how the situation needs to be rectified. Emotional regulation is a skill and a process that children learn that takes time.

  • The child does not always have to like the solution, but you are the adult and you make the decisions based on what you believe to be the right thing to do.

A final point to bear in mind is that creating a good relationship takes time and persistence which in the long run will make a difference.

If you have any thoughts on the above, please share them in the comments.


Sheila

Sunday, August 4, 2013

Ghosts In the Nursery 1: Primary Carer Behaviours And Subsequent Infant Responses

One of the questions that is often asked with regard to Attachment Theory is - what are the Behaviours in a Primary Carer that Contribute to fostering a Secure Attachment in a Child. The question is also often asked in reverse also, i.e. what are the behaviours that contribute to an Insecure Attachment. A related question is what are the corresponding behaviours in the child that are triggered by the various behaviours of the primary carer.


This article attempts to answer these questions.

As with much of Attachment Theory, The Strange Situation is one of the best tools there is to understand the dynamics of attachment and to answer the questions posed above. The Strange Situation experiment begins with a Primary Carer sitting near a child in an unfamiliar room filled with toys. It looks at a child's responses when a) a stranger joins the primary carer in a room and attempts to interact with the child b) when the primary carer leaves the room with the stranger staying and c) when the primary carer returns. This experiment has taught us that it is a child’s response to its primary carer at reunion, rather than separation, that reveals the most about attachment security and insecurity.  Let us begin by analysing the responses of the child in the Strange Situation.

In the experiment, secure children are immediately reassured by reconnecting with their primary carer no matter how distressed they had been by their original separation and are rapidly able to resume play.

Avoidant children do not seek the primary carer out when she returns. The avoidant child appears more interested in the toys and does not appear to miss her.

Ambivalent /resistant children are not comforted by the primary carer’s return at all and remain distressed. 

Disorganised/disorientated children appear afraid of the primary carer upon her return.

So with a basic understanding of the child’s responses, let us look at the carer’s behaviours that contribute to triggering these.

In essence, it is the quality of communication in the relationship between the primary carer and child, that determines the difference between a secure and an insecure attachment relationship. Below are some of the things that contribute to these relationships.

Children who are securely attached are picked up quickly by their primary carers when they cry and they are held with tenderness and care. They are only held for as long as they want to be held. Their primary carers tend to blend their rhythms’ with those of their child. According to Ainsworth(1978), “these mothers’ behaviours reflected sensitivity rather than misattunement, acceptance rather than rejection, cooperation rather than control and emotional availability rather than remoteness”.

These primary carers read the child’s nonverbal cues and respond. Secure infants communicate their feelings and needs directly, safe in the knowledge that their communication will evoke an attuned response.

The primary carers of avoidant children are generally uncomfortable with physical contact rand tend to be emotionally unavailable. These children, as a result react with anger to their mother’s rejection and their own attachment needs tend to be sidestepped. 

The primary carers of ambivalent infants tend to be inconsistently responsive to their infants attachment signals. This is due to the primary carer’s own state of mind intruding on her ability to tune into her children. Consequently, these children learn to communicate their attachment needs in a persistent way in the hope that keeping up the pressure would keep up the care. 


The primary carers of disorganised infants tend to be frightened, disassociated or to frighten their children. These children as a result are fearful of the parent but have no coherent strategy on how to manage their attachment behaviours.

Wednesday, June 5, 2013

Attendance at a Course On Mentalisation at the Anna Freud Centre in London


I was fortunate enough to attend a course on Mentalisation Based Theory (MBT) at the Anna Freud center in London.

The course was given by Peter Fonagy and Anthony Bateman, the two originators of Mentalisation Theory. MBT is one of the more recent developments in the overall Attachment Theory area. Fonagy and Bateman are the authors of the seminal text on the subject. Handbook of Mentalizing in Mental Health Practice.

I will return to what I learned on the course at a later date.


However, this post is just to share some of the photos I took at centre. The center is a few doors away from where Anna, and indeed Sigmund himself, lived.

It was nice to be in a place with these kind of historical links

See the photos below.
.

The Home of Sigmund and Anna Freud

The photos below are from the walls inside



Sunday, February 17, 2013

How To Improve a Child's Self Esteem


Self esteem, Self worth, Self concept. These words mean the same thing. Essentially, they all mean, how a child feels about herself. A child develops her self esteem through early messages about herself from hr parents and latterly through the development of a particular talent or skill.

A child will then select messages from her environment (such as her school or sports club), which will further reinforce these messages.

If a child has poor self esteem, it will take a while to change her negative self concept This is a process that will take time.

It is not always easy to find the source of a child’s negative self esteem. Sometimes she may have got vague message about herself and her fantasy has filled in the rest.

Examples of low self esteem are: blaming others, unable to say ‘no’, whining, unable to lose a game, attention seeking behaviours such as playing the class joker, excessive shyness or withdrawn behaviours.

Practical Ways to Improve a Child’s self esteem

Below are some ideas about how to improve a child’s self esteem:-
1.       Listen and acknowledge a child’s feelings.
2.       Accept the child as she is, treat her with respect.
3.       Give specific and to the point praise, e.g. you played well in the match today.
4.       Be honest, if she did not play well then that is fine, she did her best given how she was feeling.
5.       Use ‘I’ statements rather that ‘you’ e.g. I get really annoyed when you throw your clothes on the floor and not, ‘you are always doing the same thing – throwing your clothes on the floor’.
6.       Give the child age appropriate responsibilities and levels of independence and decision making responsibilities. This helps the child to develop their sense of self, while all the time checking back with the parent.
7.       While the child need boundaries rules and consistency, don’t be too annoyed with her when she gets things wrong. She is learning.
8.       Also think well of yourself and your partner, make sure she hears you compliment each other.
9.       It is good for her when she hears you, as a parent, take pride in a job that you have well done.
10.   Avoid ‘shoulds’ or ‘could haves’.
11.   Accept her judgement. E.g.,  if she feels bad because someone is mean to her, that is how she feels. Better to explore this with her, such as by asking why she feels this way, than to dispute how she feels.
12.   Explore her negative sense of self with her. See below for an example of how to this :-

Child:
I am useless at swimming.
Parent:
What makes you say that?
Child:
I can’t breathe properly when I am doing the breast stroke.
Parent:
Ok not yet, but you can do the leg movement and the arm movement and given your body weight, you are doing very well
Child:
I suppose that is true, the other children in the class are bigger than me.

Generally in the process of teasing this out with the child, the child will realise where her potential is and as a result that she is not so bad after all. It may be that she realises that she is better at some other activity rather than swimming and that is okay.

Optimum emotional and cognitive development of a child occurs in a family environment. The family is best placed to create support  and love, promote hope, tolerate pain and generate positive thinking.

Remember change will happen when a child becomes what she is and not when she tries to become what she is not.




Saturday, August 11, 2012

How a Child’s Attachment Changes from Infanthood to Middle Childhood


Middle Childhood
Attachment in Middle Childhood refers to the emotional and social development of the child in the six to twelve age category. In early childhood, the aim of the child is to retain proximity to his parents. It uses attachment behaviours such as crying and smiling to achieve this goal, thus ensuring physical and psychological safety. As the child gets older and moves into middle childhood, availability of parents becomes more important than proximity. Availability refers to open communication between the parent and the child, the parent being responsive to the child’s needs and the parent being physically accessible to the child. There is also a change in his attachment behaviours as crying and smiling are replaced with an internalised expectation and belief system regarding attachment.

The change from proximity to availability is largely due to the fact that, the child is becoming more self-reliant. To take an example. If an older child is feeling distressed, then a phone call or a photograph of the attachment figure may be sufficient to alleviate the child’s anxiety.

While friends provide friendship during this period, parents continue to fulfill the child’s attachment needs (a feeling of felt security in the context of availability and protection in a relationship). The parent also acts as the main source of social support. Essentially, the child’s internalised view of relationships, based on his interactional history with his parents, continues to influence his perception of social events and expectations regarding relationships. This also influences the child’s ability to cope with the school environment and the changes that take place in it over time.

One of the key developments in Attachment Theory was the Strange Situation Experiment. The Strange Situation Experiment is used to assess the attachment of infants at 15 months. In the experiment, a child plays with toys in the presence of its mother. A stranger enters the room, engages with the mother and the child, the mother subsequently leaves. The stranger attempts to comfort the child. The stranger leaves and the mother re-enters. This is repeated a few times. The reactions of the child to the mother’s departure and re-entry are classified, according to a well-developed set of criteria to determine the child’s attachment categorisation. There is one secure category and three insecure ones.

The secure child will feel upset when the mother leaves the room and will seek her out. He will find comfort in her when she returns. He will then return to explore the environment comforted in the knowledge, that she is in close proximity if needed.


An Insecure – avoidant child will not be upset when the mother leaves the room and he will keep playing. When the mother returns, he will not seek her out - he ignores her. He will not seek proximity or contact from the parent on return and will appear unemotional.

The Insecure – ambivalent child, will do little exploration of toys and show signs of distress before the mother leave the room. When she leaves the room, the child is generally inconsolable and fails to take comfort in her when she returns. He will continue to focus on the parent and cry. He will not return to play when the parent returns.

The Insecure – disorganised child displays some avoidant and ambivalent patterns of behaviour. In general, he displays disorientated behaviours in the parent’s presence. He may run towards the parent and then freeze before he reaches her. He may cling to the parent and cry while at the same time, look away.

In middle childhood, these patterns of behaviour for secure and insecurely attached children will continue unless, there is an interruption in the continuity of care. E.g. where the parent experiences a trauma (such as divorce, ill health, or the death of another loved one) rendering her less available to the child, then a previously securely attached child can, over a period of time, develop an insecure attachment style. This can work the other way as well, where an Insecure attachment style can become secure due to positive changes occurring in the parent’s life, rendering her more available to the child.

A child who is securely attached in middle childhood, has more harmonious interactions with teachers and peers, is better liked, has more friends and has fewer behavioural problems. He is able to use his parents to assist him in stressful situations. His communication pattern with his parents tends to be a more emotionally open one, from which he can develop problem-solving skills. These skills can then be applied to other situations, which can in turn lead to the development of more complex coping ones. These skills are supported and underpinned by the parents.

Emotional regulation and independence are desired outcomes for adulthood and these skills are best mastered in a secure attachment relationship.
                                                                                                                                                             
An insecurely attached child has less positive social expectations and may assume that people will generally be unhelpful. In addition, he will tend to see himself as less competent and will have difficulty in calming himself when distressed. Unfortunately, this behaviour is self-reinforcing. An insecurely attached child will tend to carry this view of himself and others into other relationships, thereby encouraging less benign behaviour from others, leading to difficult social interactions and relationships.

So, what can you as a parent to foster a secure attachment in your child? This is a subject that I will return to in greater detail in a future article. However below are some ideas that may be useful.

As the child grows through middle childhood, effective parenting includes being a sensitive listener, granting autonomy for exploration as well as monitoring friends and the child’s activities. Also, making time for joint activities and maintaining respect for the child during conflict and disciplinary issues.

Sheila Hayes

Recommended Additional Reading

Introductory Reading


In Depth Reading




The Bowlby Attachment Trilogy
       1969:     Attachment, (Updated in 1982)
       1972:     Separation: Anxiety and Anger
       1980:     Loss: Sadness and Depression
                                 





Wednesday, July 18, 2012

Why It Is Important To Explain and Reflect A Child’s Emotion Back To Them

Marie Murray wrote an excellent piece recently in The Irish Times Health Supplement on the subject of explaining and reflecting a child’s emotion back to them.

Children are not born with control over their feelings. This is a skill they learn through interaction with their carers. Just as children learn to dress themselves, they also learn to control their feelings and to express their feelings in a constructive and clear way. Mastery of emotions is further enhanced when they are linked to corresponding behaviours.

This is best understood by way of example.

Sarah and Kate are friends and are 4 years of age. They are playing in the lawn and taking turns at kicking the ball into the goal where Sarah’s mother is the goalkeeper.  It is Sarah’s turn to get the ball but Kate takes it.

Sarah storms over to her mother and says

“I am not playing anymore with Kate, I hate her and this is a stupid game”.

Sarah’s mother then says to Sarah in a soothing voice:-

 “Sarah you are angry with Kate right now. She did not wait for her turn and now you do not want to play with her”. Sometimes these things happen and it is ok to be annoyed. I am sure Kate didn’t mean it”

Here Sarah’s feelings and subsequent behaviours are explained to her by her mother. The more this is done by Sarah’s mother in various circumstances, the more Sarah can then make sense of why she is feeling and behaving towards Kate in this particular way.

Explaining and reflecting reassures and calms Sarah as her mother expresses to her what she may be feeling. Sarah can also see in her mother’s eyes that her mother is being empathic towards her. Contrary to popular belief, acknowledging Sarah’s feelings does not encourage her to be angrier.

Sarah has learned from previous experience that when her feelings have been acknowledged by her mother, she has felt calmer and in control. This repeated explaining and reflecting process helps Sarah understand and regulate her emotions as she learns that her feelings will not overwhelm her. Regulation happens as Sarah learns that she is able to imitate her mother’s responses and attitude and previous difficult emotions suddenly become more manageable.   

·         In the above example, Sarah can tolerate her frustration with Kate because her mother is emotionally available to her.er  Her mother is able to accurately acknowledge and reflect how Sarah felt and behaved at that moment. Her mother’s empathy reveals to Sarah that she is understood. Her mother also offers a hypothesis to Sarah - that Kate didn’t mean it. Effectively, her mother is able to ‘take in’ or contain Sarah’s anger. This has the effect of detoxifying the intensity of Sarah’s anger for her, so she can understand and eventually come to terms with her experience. The ability of a carer to take in or contain a child’s emotions is a key element in ensuring a secure attachment in a child’s emotional landscape.

I would recommend you read Marie Murray’s article in full.

Psychology References

Below, I have also outlined some information on the Psychological concepts that are relevant to this area together with links for further reading.

Explaining and Reflecting: This is called Parental Affect Mirroring in the Psychological literature. One of the key thinkers in this area is Professor Peter Fonagy of University College London. Follow this link for an extract from his seminal book Affect Regulation, Mentalization and the Development of The Self.

The act of a mother being emotionally available to her child is called,  “maternal reverie” in the psychological literature.  This was a concept introduced by the British Psychologist Wilfred Bion in the nineteen sixties. Interestingly, Bion was also a key thinker in the area of Group Dynamics and his ideas have been incorporated into military training around the world.

The taking in of anger is known as containment. Again Bion was a key thinker in this area. See the links above for references.