The therapist needs to take an active and directive stance in working with the child and family on core issues that the child and family may initially find difficult to address. Therapeutic interventions may be confrontational, intrusive, and challenging to the child. The parents and therapist are in control of the session and of the child, in a nurturing, safe and empathic manner. The adults take the lead in attachment therapy but are always observing and responding to the feelings and needs of all family members. Both the child and the family must have a developmentally appropriate understanding of the therapy process and goals.
Informed consent is an important element of treatment planning.
A child may be therapeutically held during the course of attachment therapy. In unique cases when family members choose not to attach, after careful work and evaluation, respect will be given to their choice and an alternative treatment plan will be established. As attachment is on a continuum so is treatment. Interventions should be flexible and specific to the needs and emotional state of each member of the family. These interactions may be exaggerated with the child to produce a therapeutic effect.