Attachment Centered Play Therapy

Clair Mellenthin

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351858809
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Attachment Centered Play Therapy offers clinicians a holistic, play-based approach to child and family therapy that is presented through the lens of attachment theory. Along the way, chapters explore the theoretical underpinnings of attachment theory to provide a foundational understanding of the theory while also supplying evidence-based interventions, practical strategies, and illuminative case studies. This informative new resource strives to combine theory and practice in a single intuitive model designed to maximize the child-parent relationship, repair attachment wounds, and address underlying symptoms of trauma.

1
ATTACHMENT THERAPY DEFINED

Introduction

Attachment is an idea core to human social and emotional development. It’s a phrase that is used quite often in the world of clinical psychology and has been described as “a lasting psychological connectedness between human beings.” This lasting psychological connectedness describes why and how we can still feel connected to people, even if there have been long periods of space and time since the last time we’ve been able to see them or spend time together. Consider loved ones from long ago who may have passed away. If you were particularly close to them, you can probably still feel the tender pull of your heartstrings and remember standing close to them or hearing their laugh. This is what it means to have a lasting psychological connectedness.

Throughout this book, you will learn how attachment patterns are created, why attachment is so necessary in human relationships, and how you can develop a healthy interdependence in your relationships with others. You will also walk away with a toolbox of useful play therapy interventions and an understanding of why and how to use each intervention with your client populations. For the purposes of clarity, throughout this book, the word “parent” will be used to describe whomever may be acting in the parental role of child-rearing – regardless of if it is a biological, adoptive, foster, step, or kinship placement; grandparent; etc. Also, the phrase “attachment figure” refers to someone who provides support, protection, and care (usually the parent).

The Origin of Attachment Theory

Attachment theory has been in existence for several decades. Many refer to British psychiatrist John Bowlby as the father of attachment theory; in the 1960s, he was one of the first to recognize and study the importance of the bond between parent and child. Around the same time, American psychologist Mary Ainsworth began studying infants and mothers, specifically how their interactions (or lack of interactions) impacted the child’s development and emotional regulation. Since these early days of theory, we have come leaps and bounds from just theorizing about the importance of attachment to understanding the innate biological need of attachment. We also know that this is not just a developmental milestone and need in childhood: early attachment is crucial to laying the foundation for a lifetime of strong attachment in relationships.

Bowlby described attachment theory as “an attempt to explain both attachment behavior, with its episodic appearance and disappearance, and also the enduring attachments that children and other individuals make to particular others” (Bowlby, 1988, p. 29). Attachment behaviors are the seeking out of others for the comfort of security and/or maintaining proximity to one who is “better able to cope with the world” (Bowlby, 1988). Both children and adults engage in these behaviors when faced with fear, a sense of threat, loss, or abandonment. They are most observable when a person is experiencing fatigue, fear, loneliness, illness, or is overwhelmed by caregiving. The attachment figure being sought after may be a parent, a teacher, a caretaker, a friend, or even a perceived better-abled peer if there are no adults available who are perceived to be emotionally and physically safe. Depending on the nature of the child’s patterns of engagement, these attachment behaviors may be highly adaptive or maladaptive, from seeking out reassurance and touch in a healthy, secure relationship to dramatically acting out with behavioral and emotional outbursts when the relationship is insecure. The wide range of attachment behaviors that children can exhibit all have the goal of seeking connection and proximity to someone who can protect and care for them.

Spectrum of Attachment

Traditionally, mental health clinicians were taught to view attachment as relational patterns fitting into four neat little boxes: Secure, Insecure, Avoidant, and Disorganized. In reality, however, attachment, like humans, tends to be messy and not so easily categorized. Instead, it flows along a spectrum and is unique to each individual relationship. This is why it is not atypical when working with a client family to find that a parent has a secure attachment with one child but a more ambivalent attachment with another child. Between parents, there may be an avoidant attachment, where they avoid uncomfortable feelings or situations and move away from one another emotionally instead of pulling closer.

As clinicians, we must be aware and mindful of the uniqueness of each relationship and their individual attachment patterns as well as the attachment pattern that the family system manifests. These patterns of attachment ebb and flow along the lines of the attachment spectrum depending upon the developmental stage of the child and family, the impact of trauma upon the system, as well as the nature and individual characteristics of each individual member of the family (Figure 1.1).

Figure 1.1 Spectrum of Attachment.

It is important to note that no one is 100% securely attached or, on the other side of the spectrum, 100% chaotically attached or unattached. We all land somewhere in the middle or tend to fluctuate within the same scope of the spectrum in most of our relationships. For example, an individual who has a relatively secure attachment will likely weather life’s storms and the impact of trauma while maintaining their relative secure base. Their attachment patterns may waver and move toward the less secure area of the spectrum as they are healing from trauma, but they will be much more likely to be able to retain some secure level of attachment, even through the trauma process, and repair and rebound much easier than an individual without this foundation.

Individuals who typically fall under the more severe avoidant or chaotic side of the spectrum are more likely to remain within this scope of the spectrum and may even become more relationally disorganized, especially when experiencing grief, loss, and trauma. However, they still manifest attachment needs and attachment-seeking behaviors – these just may be more maladaptive than a child whose emotional needs have been consistently met.

Hermit Joe

Consider the following factitious example of an adult manifesting attachment-seeking behaviors: imagine a town long ago, where settlers had established homesteads. Everyone in the community worked together to provide for their families. Everyone except a hermit named Joe. Joe lived far away from the town in a small cabin and kept to himself. But every Tuesday at 1:00 pm, Joe made the journey to town. When the townspeople saw him approaching, they would avoid him and quickly shuffle their children away from such a strange and unkempt man. Joe went to the general store to buy a bottle of whiskey. He would grunt and glare at the shopkeeper as he helped him purchase him item. He would then leave without a word. However, Joe came to the store every single week at 1:00 pm on Tuesday without fail and repeated this ritual over and over. What the shopkeeper didn’t know (and Joe himself most likely didn’t understand) was that Joe was trying to get his attachment needs met through their interactions. Joe wasn’t polite or friendly, and he certainly did not have strong people skills, but even still, he wanted to connect with someone.

I sometimes wonder how many Hermit Joes in our world go unnoticed or unrecognized. Individuals who may not have strong communication skills but still ache to be connected to others (as we all do) and attempt to meet their attachment needs. Is there anyone in your life that you can think of who fits this description?

Key Concepts of Attachment

The four key concepts of attachment theory come from the work of Dr. Susan Johnson (2004), who developed Emotionally Focused Therapy™ (also known as EFT). In EFT, identifying the attachment patterns between partners and within families is crucial to the healing process. Dr. Johnson refers to these attachment behaviors as “the dance” between romantic partners as well as between parent-child relationships. Interestingly, these types of attachment behaviors look similar across ages and relationships. For example, a young child may have learned early that the only way to receive attention from an emotionally unavailable parent is to act out or throw tantrums. The parent gives the child his/her full attention, if only momentarily, and regardless of if this attention is negative, the child’s attachment need of being seen (more on this in Chapter 3) has been met. This same child may carry these attention-seeking behaviors into adulthood and use them in adult relationships, possibly acting out when feeling threatened or afraid of abandonment. This grown adult may tantrum just as a younger child would until the attachment is available to them.

The key concepts work together like building blocks in forming healthy attachments in our relationships. One of the ways I like to teach these key concepts is to visualize this as the framework for building a home.

Secure Base

The first key concept is a secure base. Let’s visualize this as the foundation to a home. A foundation is crucial for the house to be able to withstand the wind and rain, much less the pressures from the ground it is built upon. Our relationships are similar in that a secure base is the attachment figure’s ability to serve as a home base for a child to explore the world around them. There is an inherent message that “the world is safe, and I will be here for you, to help you and protect you.” This is a beautiful dance to witness between parent and child; the child has the permission to go out and explore the world, knowing that their attachment figure will be there when they need to return for comfort and acceptance. When a secure base is not present, the child is taught the opposite – “the world is not safe, and you are not safe without me.” If a parent believes the world to be scary or dangerous and believes the only way to protect their child is to refuse permission to explore on their own, the child comes to believe similarly. This has the potential to create significant insecurity within the child and leaves them feeling emotionally paralyzed and scared to go out and explore the world. The child learns that the world is scary and that others cannot be trusted to keep him/her safe.

Safe Haven

A safe haven is the second key concept. I like to think of the safe haven as the floor of the house, giving us something firm to stand on. To create a safe haven, the attachment figure can give comfort and soothing to the child in the face of anxiety or threat. Renowned child psychologist Daniel Siegel also refers to a safe haven as a “safe harbor,” which is a beautiful metaphor (2011). A harbor is a shelter that protects the ships coming into port, shielding them from the waves and rough water. A harbor also provides a safe place to refuel, rest, and repair before the ship sets sail again. Isn’t this what we want all of our homes to be? To shelter our children from life’s storms? When a safe haven is present, the child can seek out soothing and comfort, and the relationship becomes the shelter for the child.

What happens in the absence of a safe haven? If it’s not present or available, the child quickly learns that their attachment figure may not be able to consistently meet their needs (if at all). The child lives in an anxious state as there is no place to go to when he/she is in need of soothing or comfort in the face of threat. Children without a safe haven also learn to mistrust others as their world has been demonstrated to be unpredictable and inconsistent.

Proximity Maintenance

The third key concept of attachment is proximity maintenance. Continuing our metaphor from earlier, this would be the walls in the home we are building. We have established a strong foundation to stand on with the first two key concepts and now need to create shelter in our home. Proximity maintenance is the desire to be physically near the attachment figure, who can then provide security and soothing a child’s anxiety or distress. In today’s world, there are several factors that can disrupt or delay proximity maintenance, such as parental military deployment, ongoing multi-day business trips, divorce, or other types of separations. By utilizing technologies such as Skype, FaceTime, and Google Hangouts, families can create a virtual proximity maintenance that allows us to see one another in real time, even if we can’t be together physically. When we can educate our families (especially parents) on how important that time together is, it’s amazing what we can do to maintain a secure base and connection, even if physical distance keeps us apart.

When a chronic lack of proximity maintenance is present in a parent-child relationship, the child learns early on that their primary attachment figure or caregiver will not respond with empathy, soothing, or concern. Rather, they are often met with indifference, avoidance, or even violence. In Robert Karen’s book Becoming Attached, he describes an encounter at a park with his young children, playing and observing, as therapists tend to do (1994). He noticed a little boy had tumbled off the slide, ending up banged and bruised, with bloody knees and ripped pants. Instead of calling out for help or attention, the boy lay there quiet and frozen; not once did he look out and seek out his mom or call for her. When his mother finally recognized that he had been hurt, instead of showing signs of love and concern, she showed signs of annoyance and disdain. This is a sad example of how an attachment figure failed to provide the adequate proximity maintenance to her child in need.

Separation Distress

The last key concept is separation distress. This can be likened to the roof of the house we have been creating in this metaphor. In every relationship, it is normal and healthy to experience some level of distress when there is a separation from your attachment figure. This means that you are actually attached and bonded to one another, and that being apart brings up feelings of anxiety, trepidation, and concern. In this key concept, we are assessing not only the level of distress manifested but also the child’s chronological age and emotional age.

To illustrate the experience of separation anxiety from a parent perspective, consider the following hypothetical situation: imagine leaving your young children for the first time to go on a long-awaited vacation. You have scheduled a trusted sitter to watch the children; you have daycare arranged, meals planned, and flights booked. On the day of your departure, you are looking at your precious babies, feeling a mix of excitement, relief, and complete fear as you get ready to walk out of the door. There may be tears shed on all sides as you leave to drive to the airport. On the flight, you constantly check the nanny cam, and as soon as you land, you may feel the urge to call to check on things. Your partner calms you down and helps you to take a deep breath, look around at the beauty of the scenery, and feel confident that your kids are being well taken care of. This is an appropriate level of separation distress being manifested by a parent. Yes, parents and children both experience separation distress when they are away from one another.

In observing children when no apparent behaviors of separation distress are manifest, this could indicate a lack of attachment or significant injury to the relationship between parent and child when separation occurs. On the other hand, extreme distress may indicate that t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• Foreword
• Acknowledgments
• Introduction
• 1 Attachment Therapy Defined
• 2 Attachment Centered Play Therapy Defined
• 3 Developmental Attachment Needs along the Attachment Spectrum
• 4 Understanding Attachment Ruptures and Wounds
• 5 Upside Down and Inside Out: The Impact of Divorce on Attachment
• 6 Broken Pieces: The Impact of Death, Grief, and Loss on Attachment
• 7 Worlds Apart – The Impact of Separation on Children and Families
• 8 When the Bough Breaks: The Impact of Complex Trauma on Parent-Child Attachment
• 9 More than Sticks and Stones: The Impact of Emotional Abuse and Neglect on Attachment
• 10 Inviting Parents into the Playroom Experience: The Hows, Whys, and Ways
• Appendix
• Index