What do children need from permanent placements? 

 
Observations from an attachment perspective Dr. Steve Farnfield University of Roehampton London UK 

## Over View

•  Attachment •  The parents •  The children •  Assessment •  Interventions 

## What Is Attachment?

A unique, enduring, and affectively charged relationship (e.g., with one's mother, with one's spouse) A strategy for protecting oneself (of which there are thre basic strategies, Types A, B, and C, as identified by Ainsworth, and many sub-strategies, as described by the DMM) The pattern of information processing that underlies the strategies. 

 
  
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## What Is Attachment?

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## A Strategy Is …

• What we believe will make us safer • It is a matter of perception • You can feel anxious or scared when there is no dange • You can feel safe when under threat 
! Type A: Very COGNITIVE; little affect ! Type C: Little cognition; intense AFFECT ! Type B: Balanced and integrated COGNITIO
and AFFECT 

## Of Patterns Of Attachment The Parents

Childhood attachment system 
1. 
The parents state of mind regarding their childhood 
attachments 

2. 
Parent's resolution of loss and trauma 

 The spousal system 
3. 
Pair bonding  and sexual partnership 
Affiliative / wider support system 
4. 
Kinship, friends and wider support system 
Care giving system - parenting 
5
Th
i
f th
hild t th
t

a).  Mental illness b).  Learning disability c).  Substance abuse d).  Child sexual abuse e).  Domestic violence. f).  Reconstituted families. g).  Adolescent motherhood. 

## Type 2. Socio-Political.

!  Inherent in cultural / sub cultural or class norms 
is information about what has enabled the group / culture to survive !  Includes poverty, economic oppression, racism !  Stories about the history of dangers faced by 
the tribe and myths about survival 

## Type 2 Modifiers.: Socio-Political.

! Cultural and sub cultural norms with 
regard to child rearing ! E.g. use of physical punishment; what 
is acceptable behaviour in girls compared with boys; whether adults play with small children 

## Type 2. Socio-Political.

! Because they are culturally normative 
they are rarely questioned inside the culture. 

## 

! But may be at odds with the norms hel
by outsiders 

## ! Shame

# Type 2. Socio-Political.

## Moving From One Culture To Another Poses

problems if behaviour functional to survival one culture exposes the family to new dang risks in the next. 

!  Mentalising refers to the process by whic
humans attend to 䇾mental states in onese and others䇿 
!  It develops throughout child and early 
adulthood and 䇾is the most fundamental common factor among psychotherapeutic treatments䇿.  

## Parenting Assessments - Do Be Do

  What parents do How parents think about what they do 

## Assessment - Families What They Do

  CARE-Index (Hautamaki, 2014) 
Marschak MIM (1960) 
  Lausanne Trilogue Play Paradigm (LTP) Fivaz-Depeursinge & Corboz-
Warnery 1999  
  Observation 

## Assessment - Parents Ow People Think About What They Do: Adult Attachment Interview - Dimensions 1&2

MM-AII Crittenden & Landini, 2011) 

## Attachment Style Interview - Dimension 3

ifulco, 2014) 

## Questionnaire Assessment - Dimension 4 G. Family Support Scale, Dunst Et Al 1993) Meaning Of The Child Interview - Dimension 5

rey & Farnfield, submitted) 

## Parent Development Interview - Mentalising/ Reflective Functioning (Slade Et

al 2005)

! Secure attachment directly correlates with 
high level mentalising - and insecure with low level mentalising 
! It holds important information about how 
the adult reacts to displays of anger and desire for comfort in their child. 
# Adult Attachment Predicts Maternal Brain An Oxytocin Response To Infant Cues

Lane Strathearn, Peter Fonagy, Janet Amico and P Rea Montague Neuropsychopharmacology (2009), 1–12 
Children benefit from being placed with alternative carers who are secure on the  AAI 

• 
Significant correlation between autonomous (secure) 
foster mothers and foster children assessed as secure the SSP. 
• 
Non autonomous foster parents had a disproportiona
number of children rated disorganised (Dozier et al. 2001).  
• 
All adopted children made progress in terms of 
increasing positive representations of attachment themes using the narrative story stem procedure, but those whose adoptive parents were secure on the AA also showed a decline in negative themes, suggesting resolution of trauma (Steele et al., 2003; see also 
Beijersbergen et al 2012)

## Placement Stability

•  Foster parent commitment to the child was a 
strong influence on placement stability.  
•  The number of children a foster carer had 
previously cared for was negatively correlated with commitment to the current child, and tha the younger the child at the start of fostering the more committed were the carers (Lindhie & Dozier 2007). 

## Carers' Attachment On The Aai

 ! Dozier et al found attachment among foster carers d not differ from non-clinical populations (Dozier et al., 2001). ! Coram-Anna Freud study (Steele et al.,2008) found more interviews with adoptive mothers were rated secure than expected, but the opposite was true for adoptive fathers. ! Santona & Zavattini (2005) Adoptive parents 76% autonomous - secure 

# Carers Attachment On The Aai

! A study using the DMM-AAI of prospective adoptive parents found only 7% AAIs were rate balanced-secure and that mothers who already had a child of their own were significantly more likely to be in the range secure/normatively insecure (most often in Type A2) whereas for fathers who already had a child the opposite wa the case (Farnfield 2012).  

## Parents Compared With The Typical Safe Population

North American Safe 
•  23% dismissing (A), 
•  58% secure (B) 
•  19% preoccupied 
(C)  
•  18% for unresolved 
Prospective Adopters 
•  46% A or A+ 
•  13% secure B 
•  10% C or C+ •  31% A/C •  60% for unresolved 
loss or other trauma 
loss 
 or trauma 
(Bakermans-Kranenburg & van IJzendoorn, 2009)  
(Farnfield, in preparation) 

## Unresolved Loss & Trauma Attachment And Reproduction

he function of attachment is to: eep yourself alive ong enough to reproduce Have grand children And pass on your genes

## Adoption Challenges All This Disorientation A Dmm Modifier

The speaker has a problem locating the source of their 

## Memories/Information About Protection

Over attributes the self as the source of what they know A/C or AC strategy the DMM ratings of disorientation are rare and this samp adopters is remarkable in that:
21% (n10) of the interviews were rated disorientated A/C o
 
No difference in terms of sex (5M and 5F)
9 with Uloss or U trauma 

## Infertility & Disorientation

t seems possible that 21% of applicants were confused regar whether they wanted to pass on their own genes or those o another couple. The impact of this on the child is not known infertility?

Santona and Zavattini 2009

## The Children Of Patterns Of Attachment Attachment

A+ includes: ! Compulsive care giving (role reversal) ! Compulsive compliance (fear) C+ includes ! Aggressive/helpless 
! Punitive / seductive 
! Paranoid 

## Attachment And Fostered/Adopted Childre Face Severe Dangers:

1.  Maltreatment and/or neglect in their fami
of origin 
2.  Attachment trauma 3.  MOVES within state care 4.  Loss of friends/continuity of place 

## Type A/A+

 
Inhibit things th will displease car Do things that w please or placa predictably dangerous care Happy!

Afraid!

## Compulsive Children

! By 3 months infants can inhibit negative affect - the ͂good baby̓ ! Rigid, robotic (frightened) babies ! Frozen watchfulness ! By 24 months toddlers are able to falsify positive affect i.e. smile and/or say they are happy when they feel sad o worried ! By 4 years the strategy is perfected into the͂sunshine
ff t̓
Victoria Climbié
1991- 2000

## A Little Ray Of Sunshine

She liked to dress up and was given clothes to dress up in by the nursing staff. Nurse Taub would take her to see the babies in the neo-natal ward and bought her sweets and treats. According to Dr Rossiter, she was a ͆little ray of sunshine͇. 

(Laming 2003) 
"You could beat her and she wouldn't cry ... She could take the beatings and pain like anything" Karl Manning 

## Assessment And Children

  Strange situation 11 months - 4 years Modified strange situation for siblings Narrative story stems  3 - 11 years School Age Assessment Attachment 6-9 years Attachment interviews 6 years onwards Various trauma / PTSD scales/ Depression 

## Identity - A Memory Systems Approach

Everyone must be who he was in the fi years of his life, even if later these were buried under. No one can become what he cannot find in his memories. 

!  **Jean** Améry - Auschwitz survivor 

## Identity - What Usually Happens

! A core self : 0 - 3/6 months ! A self that knows it exists in the minds of othe 12/18 - 36 months ! Ability to tell a story about the self 36 months ! Autobiographical memory 6 years onwards ! Adolescence: a place for the self in the world 

## Children At Most Risk Of Identity Crise

1.  Multiple moves ( 2+) in the care system before th
age of 6 years 
2.  Serious and prolonged abuse in infancy / preschoo
years 

## Identity And Life Story Work

! How can we enable children to generate their own life story? 

! Risk of children borrowing semantic statements from professionals ! Identity is clearly not something you get at adolescence 
The externally assembled self  
䇺There is no me, I do not exist.䇻 Peter Sellers  

## Life Story Work Should Be:

! Ongoing ! Developmentally appropriate ! Rooted in current experience ! Done in conjunction with the people who
were there 

## Identity

The greater part of identity is being know by others - our family or tribe. 

Memories We can give children information but we cannot give them memories they do not have 

## Intervention Attachment & Biobehavioral Catch-Up (Abc) (Dozier, Lindhiem & Ackerman, 2005)

! Brief home visiting programme for foster parents and foster children. ! Uses video feedback and attends to a foster carer's state of mind as assessed by the AAI and their This Is My Baby Interview (TIMB) which assesses commitment to the child
! Intervention children showed more typical levels of the 'stress hormone' cortisol than controls and were not significantly different to a third group who had never been in care (Dozier et al., 2008)  

## Home Based Video Feedback

Increase in parent sensitivity increases security of child attachment at any age (Beijersbergen et al, 2102 - longitudinal adoption study) Improving parents sensitivity is easier tha improving child attachment security (see Farnfield & Holmes, 2014) 

## Améry, J. (1999) *At The Mind'S Limits*, Granta. Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2009). The First 10,000 Adult Attachment Interviews: Distributions Of Adult Attachment

representation in non clinical and clinical groups. Attachment & Human Devel- opment, 11, 223–263. 

## Beijersbergen, M. D., Juffer, F. Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H., (2012). 'Remaining Or Becoming Secure: Parental Sensitive

Support Predicts Attachment Continuity From Infancy to Adolescence in a Longitudinal Adoption Study,' *Developmental Psychology*, 48, 5, Pages 1277–1282 Bifulco, A. (2014) The Attachment Style Interview (ASI),  in (eds) S. Farnfield. & P. Holmes, P (2014) The Routledge Handbook of Attachment: Assessment. London: Routledge. Pp 178-191. Crittenden, P.M. (2005) Keynote Address at the German Association of Infant Mental Health (GAIMH), Hamburg, Germany.  
www.patcrittenden.com Crittenden, P.M. (2008) *Raising Parents: Attachment, parenting and child safety,* Cullompton, Devon UK: Willan.

## Crittenden,P.M. And Landini, A. (2011) *The Adult Attachment Interview: Assessing Psychological And Interpersonal Strategies,* New York And London: W.W. Norton & Co.

Dozier, M., Stovall, K. C., Albus, K. E., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467–1477.

er et al (2008) ' Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care,' Development & Psycho Pages 845-859.

## T, C.J., Trivette C.M. And Hamby, D.W. (1994) 'Family Support Scale' In Dunst. C.J., Trivette, C.M., And Deal, A.G., (Eds) Supporting And Strengthening Familie Ma: Brookline Books. Eld, S. (2014) 'Assessing Attachment In The School Years: The Application Of The Dynamic Maturational Model Of Attachment To The Coding Of A Child Attachm

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## Eld, S. (2012). Bindung  Und Anpassung Bei Ersatzeltern. In: Stokowy, M., & Sahhar, N. (Ed.) Bindung Und Gefahr. Das Dynamische Reifungsmodell Von Bind

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## Eld, S. & Holmes, P. (2014) (Eds) *The Routledge Handbook Of Attachment: Assessment.* London: Routledge. Depeursinge, E. & Corboz-Warnery, A (1999) *The Primary Triangle: A Developmental Systems View Of Mothers, Fathers, And Infants*, New York: Basic Books. B. & Farnfield, S. (Submitted) 'The Meaning Of The Child Interview (Motc) - A New Procedure For Assessing The Parent-Child Relationships Of 'At Risk' Famil Validity.' Amaki, A. (2014) Mothers And Infants: Screening For Maternal Relationships At Risk With The Care-Index. ,  In (Eds) S. Farnfield. & P. Holmes, P (2014) The R

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M. (1960) 'A method for evaluating child-parent interactions under controlled conditions'. *Journal of Genetic Psychology*, 97, 3-22.

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## Of Patterns Of Attachment In Adulthood