The Efficacy of Child Parent Relationship Therapy for Adopted Children With Attachment Disruptions

The interaction between parent and child is the child's primary introduction to the world of relationships (Purvis, Cross, & Sunshine, 2007; Ryan & Bratton, 2008; Siegel & Hartzell, 2004; Van Fleet & Sniscak, 2003). A secure attachment experience during the 1st year of life is integral to a child's emotional well-being and holistic development. For many children, however, their initial relationships are not conducive to facilitating a felt sense of security. Children who have experienced frequent changes in caregivers, recurring neglect, and abuse can experience difficulty feeling safe in relationships (Forbes & Post, 2006; Purvis et al., 2007; VanFleet & Sniscak, 2003). Adopted children, particularly those who have been in foster or institutional care, are more likely to have encountered these experiences, which can compromise their ability to form secure attachments in their adoptive family (Flughes, 2006; Perry & Szalavitz, 2006). Adoptive Families Adoption is a familiar occurrence in society. "[A]lmost two-thirds of Americans have personal experience with adoption through their own family or close friends" (University of Massachusetts, 2008, "Current Activities," para. 1). It is estimated that there are 1.5 million adopted children in the United States (Evan B. Donaldson Adoption Institute, 2007). Annually, approximately 127,000 adoptions occur in the United States: 15% intercountry, 39% through publicly funded agencies including foster care, and 46% through private adoptions (Child Welfare Information Gateway, 2004b). The combination of foster care-based adoptions and international adoptions comprises approximately one third of U.S. adoptions. These families are often in the greatest need for therapeutic services because of the greater likelihood of multiple losses of attachment figures in the adopted child's past. Adopted children with a history of attachment disturbances often present with myriad behavior problems that are disruptive and confusing to the adoptive family. Juffer and Van IJzendoorn (2005) conducted a meta-analytic review on behavioral problems reported with adopted and nonadopted children and concluded that adopted children demonstrated greater comorbidity of internalizing and externalizing behavior problems than nonadopted children. Untreated externalized behavior problems in early childhood are of particular concern because of the tendency for disruptive behaviors to remain stable over time (Barkley, 2007; Brinkmeyer & Eyberg, 2003). The relationship between children's externalized problems and ongoing social, emotional, and academic difficulties across their life span is well documented (Webster-Stratton & Reid, 2003). The number of losses of primary caregivers, disrupted placements, and repeated traumatic events contribute to the severity of behavioral problems, the overall mental health of the adoptee, and the risk of long-term adverse effects (Hughes, 1999,2006; Perry & Szalavitz, 2006, Purvis et al., 2007). Adoptive parents are typically ill-prepared to parent a child who has difficulty forming an attachment and who presents with intense emotional and behavioral struggles. Hughes (2006) discussed the potentially detrimental and reciprocal effects that a child with attachment difficulties can have on the adoptive parents. The adoptive parents may feel that they are failing as parents and are at risk for becoming discouraged, withdrawn, and unresponsive to their child's needs. Interventions that focus on the parent-child relationship and attachment dynamics are essential to helping adoptive families who are struggling to connect and create a new family. Attachment Dynamics Attachment theory is a well-established framework for understanding social emotional development and for conceptualizing the nature of a child's primary relationships. Since Bowlby's (1982) pioneering observations on human attachment behavior, researchers and clinicians have been interested in understanding and applying attachment principles in child counseling (e. …